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Pregnancy check-ups(Separated from the hospital)

Kawasaki city tama hospital(Managed by St. Marianna university school of medicine)

Obstetrics and gynecology department%FMJWFSZEVFEBUF()
Please fill in when your due date is advised.
(Today’ s date:)

3FWJTFEJO4FQUFNCFS Contents

Introduction

Page 2

I. Check-ups between pregnancy confirmation and delivery

Page 3

II. Check-up procedure

Page 4

III. Booking into hospital for delivery

Page 6

IV. Doctor’ s examinations and testing

Page 7

V. Suggestions for check-ups

Page 8

VI. Suggestions during pregnancy

Page 10

VII. Guidance during pregnancy

Page 14-Mother’ s class guidance (More details on the other paper.)Page 15

VIII. Admission into hospital

Page 16

IX. Contacts

Page 18-Visitors for 3 west Himawari ward

1

Last pageIntroduction

I. Check-ups between pregnancy
confirmation and delivery

Thank you for choosing Kawasaki city tama hospital (managed by St. Marianna*First check up and pregnancy confirmed – You will have a uterus cancer screening test.

university school of medicine).

We will pre-book the date of admission for your delivery. (page 6)

This guidance shows all the details for prenatal check-ups,

Please follow your doctor’ s direction on how often you need to have check-ups.

please read through carefully beforehand and bring it to each check-up.
*Around 10 weeks – Your due date will be advised.

We provide various services to mothers and babies.

After a check-up, we will confirm your booking of admission for delivery. (page 6)

You can receive specific care for your need as well as basic healthcare.
We have obstetricians, pediatricians, midwives, nurses, nutritionists, pharmacists, andthey will fully support you with their specialization through your pregnancy and after
birth.
We will support you to be confident and ready to welcome your baby, and help you in
preparation to go home.
This obstetrics and gynecology department provide continuous care for inpatientsand outpatients.
Our doctors, midwives and nurses are committed to cooperating with each other andtaking care of mothers and babies, and will do our best to make you feel comfortable
during your hospital visits and stays.
Additionally, our midwives will give you all the necessary and important information
through mother’ s class, personal lectures during your pregnancy, support for breast
concerns after birth and mothering.
Furthermore, as we are also a medical educational institution, our medical students
and midwife/nursing students may be involved in your care.
They will always be under their trainers’ supervision, and we guarantee that they willassist in providing you and your family with the highest quality of service.
We prioritise our service for you and are continuously focused on improvement.
Please communicate with us any thoughts or requests from your pregnancy, delivery
and after birth. We will take note and use it for our continual development.

Blood testing for the first trimester. (page 7)
You will start having check-ups every 4 weeks. (Please follow your doctor’ s direction.)*Around 16 weeks – You will have transvaginal and transabdominal ultrasound tests.
Additionally, you will have a vaginal cultivation test. (page 7)*After 20 weeks
You will have a pre-mother’ s orientation. (a lecture from midwife) (page 14)*Around 24-26 weeks
You will start having check-ups every 2weeks. (Please follow your doctor’ s direction.)*Around 28 weeks – Blood testing for the second trimester.
Transabdominal ultrasound test. (page 7)*Around 32 weeks – You will have an outpatient check up by a midwife if there are nocomplications. (page 7)*Around 36 weeks – You will have a NST before check-up. (page 7)
You will have a vaginal cultivation test. (same as at 16 weeks)
Blood testing for the last trimester.

Sincerely,
Staff of gynecology and obstetrics department

If you plan on having a caesarean section, you will have a preparation test and yourdoctor will explain the operation.
You will have an outpatient check-up by a midwife if there are no complications.
You will start having weekly check-ups. (Please follow your doctor’ s direction.)23

II. Check-up procedure

3. Blood pressure andweight check(Floor plan is on the next page.)
1. Reception – Please insert your patient card into the reception machine for returning
patients and take the receipt with your number.
2. Laboratory testing (number 13) – Please insert your patient card into this (different)

4. Hand in yourmaternal handbook
and a receipt withblood pressure andweight results at East
outpatient reception(number 12).

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check-in machine.
You will have a urine test (every time) and blood test (only with the direction of your doctor).
3. Blood pressure and weight check – Please measure at the waiting room on aisle E and takethe receipt with your results.

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5. Wait time

East outpatient reception

4. East outpatient reception (number 12) – Please place the measurement results and yourmaternal handbook in a blue clear file, hand in at East outpatient reception (number 12).

Centraltreatmentroom

5. Please wait for your doctor’ s examination. – Please wait at the waiting space in front of
East outpatient reception.
When your number is displayed on the electronic board, please proceed to the waiting room

Elevators

on aisle E.

West outpatient reception(Please advise our receptionist if you wish to leave and wait outside the hospital. They may

Stairsadvise you when to return. Please make sure you let them know when you come back.)
We will call you in when all your testing results are ready, so patients who have checked in

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6. Doctor’ s examination – Interview, internal examination and transvaginal ultrasound

1. Reception for
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2. Laboratory
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Please confirm your next appointment.
*Please give your patient card to the doctor when you come into the examination room.

Cafe*You will be given a guidance paper, booking receipt and prescription (only under doctor’ sGeneralinformation

direction). (There may be a wait.)
7. Checkout – Checkout counter (number 4)
Please hand in the clear file with the guidance paper at the checkout counter.
If you live in Kawasaki-shi or Yokohama-shi, please also hand in your public expense benefit
ticket (Kouhi hojoken) at every visit.

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st floor5III. Booking into hospital for delivery
Firstly, you will pre-book the date of admission for delivery. No registration involved.
Your doctor will advise you of your expected due date around 10 weeks into your pregnancy.
Once advised, please come to the admission and discharge counter number 5 where you will
be registered.
*If you wish to cancel the booking, please advise our nursing staff immediately*Please note that your booking (including pre-booking) will be cancelled without notice if we
do not hear from you for a month.
*If you decide to have your delivery at another hospital, we may ask that you go there or
another hospital for your check-ups.
<Room request> We will process your room request following your booking.
1. Obstetrics suite (LDR) extra 24,000yen/day (tax excluded)
2. Private room (A) extra 17,000yen/day (tax excluded)
3. Shared room (4 beds) No extra charge
1. Obstetrics suite (LDR)(For patients whose husband are present during labour. This room can be used throughout
your stay at the hospital).
Please advise our nursing staff if your husband wishes to be by your side during labour.
Your husband needs to hear the explanation of your delivery plan and rules for LDR beforeuse.
*If this is your first pregnancy, please join our mother’ s class. For the 5th lesson, we ask yourpartner to join too and a midwife will explain the rules for LDR after the class.
*If this is not your first pregnancy, please book a guidance run by a midwife from 30 weeks
into your pregnancy. You need to come with your husband and a midwife will explain yourdelivery plan and rules for LDR. (Extra charge for the guidance after the first 30 minutes)
2. Private rooms & 3. Shared rooms(Private rooms in 3 west Himawari ward are only ‘Private room (A)’ .)You can change your request for the rooms anytime, but please note that you can have theroom only if it’ s available at the time of your admission.
*Please see the last page for visitor’ s rules.
Average length of hospital stays:
In case of natural birth –––––––6 days (from the day of your delivery until 5th day after your delivery)
In case of caesarean section – 9 days (from the day before the operation until the 7th day after the operation.)6

IV. Doctor’ s examinations and testing
1. Doctor’ s examinations
Internal examination – Your vaginal discharge will be examined. (each time)
Cervical condition and width will be examined. (after 37 weeks)
Ultrasound –<Transvaginal ultrasound> Size of fetus will be checked. (until approx.16 weeks)
Length of uterine cervical canal will be examined to confirm if there are any signs of miscarriage.
<Transabdominal ultrasound> Size and position of the fetus will be checked. (after 16 weeks)
Palpation – Abdominal size and uterus will be measured, and it will be examined if there is no edema.
(after 20 weeks
2. Testing
Urine test, weight and blood pressure tests (each time)
Blood test (once at all trimesters, and only when there is a doctor’ s direction)
Others*At first trimester – Below will be checked from blood test only at first trimester.
Blood type, rubella antibody, blood-borne infections (lues, hepatitis B, hepatitis C, HIV, Human T-cellleukemia virus)‘Consent form for HIV test’ will need to be filled.
*At 15-19 weeks – during doctor’ s examination
Vaginal cultivation test (Candida, Gram-negative bacteria B (B streptococcal) etc.), chlamydia test
*Around 28-32 weeks – Transabdominal ultrasound (at diagnostic imaging room number 14)
Only one extra adult will be permitted in the room.
The test will be run by a laboratory technician, but our obstetric doctor will give you an explanation for
the image afterward the test.
*At 33-35 weeks --- Vaginal cultivation test
*After 36 weeks – NST (Non-stress test)
What is NST? It’ s a test to check the fetus’ health condition and mother’ s abdominal tightness
without stress (contraction).
Two sensors (one to hear the fetus’ heartbeat, another to check abdominal tightness) will be attached
to your stomach and will be monitored continuously for 30-40 minutes. You will be lying on a reclining
chair during the test.
We understand that you might feel uncomfortable when you lay on your back during the third
trimester. If you feel uncomfortable, please lay on your side as this may feel better for you.
Attention: As you won’ t be able to move for 30-40 minutes, please avoid taking your child to this test.
Please note that children cannot come into the lab.
3.Outpatient check-up by midwives
Around 32, 37 and 39 weeks into your pregnancy, you will see our midwife for an examination andguidance.
Only if there is no complication, the doctor will advise about the guidance.
Please come to the hospital a little earlier than the booking time as each patient needs to have a
booking and has only 30 minutes for the check-up.
Please collect your urine, measure your weight and blood pressure, hand in your patient card andmaternal booklet to the reception when you arrive at the hospital.

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V. Suggestions for check-ups
To ensure a smooth check-up, please choose clothing that is easy to undress (to show your

Please note that your appointment can be delayed because of emergency operations or

stomach) and take off your underwear and socks. Please avoid boots as it could beother situations.

dangerous when changing.

Thank you for your understanding and cooperation.

As we can check your health condition from your face, please put on minimum make up andPlease note that you might need to wait longer if you are late for your appointment.

light-colored nail polish. We recommend you cut nails short and stop using nail polishespecially from the third trimester.

If you wish to change your outpatient appointment, please call the phone number below.
Please note that you can change it within one week from your existing appointment.

To prevent infection, we suggest you wash your hands and rinse your mouth when you

Reservation center 044-933-8140(Weekdays 14:30 – 16:00)

come home. We recommend you wear a mask inside the hospital as we have the internal
medicine and pediatric departments in the same building.
We recommend you get the flu immunisation. You can get it anytime throughout yourpregnancy and after you give birth.

The frequency between pregnancy check-ups are based on law, please follow yourdoctor’ s direction.

You will have an internal examination each time. As we do not have a facility to look after
your child, please bring a babysitter for the child if he/she cannot wait by him/herself.
If you come with your child independently, please ensure your child is secure with a belt intheir stroller.
As we have the internal medicine and paediatric departments in the same building, we do notrecommend bringing your child to prevent infection.
To ensure a smooth check-up, please note that we ask your family to wait outside thedoctor’ s examination room while the doctor operates an ultrasound test.
Only one extra adult is allowed when the ultrasound test is operated at the lab.
Please let our staff know if there’ s anyone who can’ t be in the lab.
We ask your family to listen to the doctor’ s explanation with you.

Please note that we may reject your delivery at the hospital if you are unable to follow it.
We do not have pregnancy check-ups on Thursday and Saturday.
Guidance for maternal booklet (Boshi techou)Once your pregnancy is confirmed (around 7-10weeks),please receive the maternal booklet at the city office in yourresidential area. This booklet is a small but important clinicalrecord. Please take it with you always. Please remember tofill out sections such as your name and residential address.
Please hand it in at each check-up. Our obstetrics andgynecology will fill out the ‘History of pregnancy’ section.
Please take out anything between pages as there’ s a chance for you to lose it while wehandle it.
If you live in Kawasaki-shi or Yokohama-shi, please hand in your public expense benefit
ticket (Kouhi hojoken) each time at the checkout counter.
The expenses you have spent before you received the tickets will be returned.
If you have a mother’ s class on the same day of your check-up, please let the east
outpatient reception know when you hand in your maternal booklet.

89

VI. Suggestions during pregnancy
Bleeding‘Threatened abortion and threatened preterm labor’

You may experience a slight amount of bleeding or/and mild stomachache

The uterus contracts (your lower abdomen feels tense) before the normal period for

during your first trimester.

delivery (earlier than 37 weeks into pregnancy). If you feel heavy in your stomach, yourIt happens in a healthy pregnancy but this could be a sign of a miscarriage or

stomach feels tense, or experience pain in your lower abdomen, we suggest lying down

threatened abortion.

and resting. If your condition does not improve or it happens often, we suggest visiting the

However, even if you visit the hospital right after you start experiencing minor

hospital no matter when your next appointment is.

bleeding, currently there’ s no effective treatment for it.

Please make sure to call the hospital first. (available 24 hours)

Therefore, if you experience minor bleeding or a mild stomachache at night oron the weekend, visiting emergency is not always necessary and you can‘Membrane rupture’simply wait until the following weekday or your next appointment.

The coat around the fetus (vitelline coat) breaks and amniotic fluid will gush out. It usually

Currently, there is no effective medication for threatened abortion during yoursmells different from urine and you cannot control the leaking. You will feel a gushing offirst 12 weeks of pregnancy, and we will just need to monitor the condition.

fluid from your vagina.

There’ s a study giving evidence for rest to be effective when a hematoma(Medication for vagina could make the vaginal discharge watery.)(clot of blood) inside the uterus results in a threatened abortion.

If this happens, please call and check yourself into hospital immediately. (available24

However, please visit the hospital immediately after contacting them by phone

hours)

if you experience a large clot of blood or severe pain in your lower abdomen,
or were told by the doctor that you have a chance of having an ectopic‘How to deal with fetal activities (What to do when fetal activity goes weak suddenly?)’

gestation (It has been called an ectopic pregnancy until recently. It means to

The fetus sleeps and wakes up every 20-30 minutes. A recent study shows after 28 weeks

be pregnant outside the uterus or around the ovary.) (The hospital is available

into the pregnancy it counts 10 fetal activities in 10-12 minutes when the fetus is awake and24 hours for this case.)

when counted properly. It’ s considered quite constant until the third trimester.
If you notice that ‘you feel less activity’ or ‘it suddenly goes weak’ , please call the hospital.
In some circumstances, we might ask you to visit the hospital and have a test to check the

When you have nausea during your pregnancy, we suggest you try and eat whatever you

fetus’ heart rate and if it’ s healthy.

can whenever you feel able. Once you stop having nausea, please maintain a balanced
diet. (rough standard is 2,000 calories a day.)
Hyperemesis is a condition causing severe nausea and you cannot drink much water anddo not pass urine at all. If you experience this condition for a few days, we recommend
you visit the hospital. (Please visit by 11:30am on weekday.)

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NotesWe suggest you visit your dentist after the nausea goes away (and after your due date isadvised.)You can have x-rays on your teeth only if your abdomen is blocked from the radiation
properly. Please tell your dentist that you are pregnant. If required, you can have cavity
treatment done as well as tooth extraction. Oral medication, cephem antibiotics andacetaminophen are permitted.
You can dye and perm your hair, but you may experience a rash as your skin is moresensitive.
After your second trimester, rings on your fingers may be more difficult to take off
because of your weight increase or swelling. We recommend you take it off earlier as soon
as you feel any difficulty.
We recommend you avoid going out as much and coming into contact with anyone unwellespecially when any epidemic infections such as flu, norovirus or slap cheek disease goaround.
If you have any symptoms of an epidemic infection, please call the hospital before making
an appointment to see a doctor. (to prevent further infection to the other pregnant
women)

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VII. Guidance during pregnancy

Mother’ s class guidance*There is one midwife in charge

1. Mother’ s class

The 1st session

12-16 weeks
The 2nd Monday

1. Introducing yourselves
2. Suggestions for your pregnancy
3. Weight control
4. Nourishment during your pregnancy by nutritionist

The 2nd session

23-27 weeks
The 4th Monday

1. Care for your breasts
2. Baby goods
3. Troubles during your pregnancy
4. What you need to bring at admission

The 3rd session

30-35 weeks
The 1st Saturday

1. Delivery plan and suggestions post delivery
2. Timing of admission and suggestions for your stay in hospital
3. Hospital tour

The 4rd session

3-4 months
after birth

1. Exchange of ideas about childcare
2. About baby food*Free participation

Our mother’ s class is for women who have their first pregnancy. If you are having your firstpregnancy and requesting the use of LDR, please make sure to take the class.
You are going to take three sessions with the same members.
Please book in advance and we can have a maximum of 17 people per class. We will ask if you
have taken the class when we confirm your booking into the hospital. Please advise ournursing staff if you wish to take the class. (We do not accept bookings by phone.)
Please see more details on page 15.
Detailed schedule will be in another paper.
All paid classes. (including textbooks)
Please pay in advance at the checkout counter (number 4) when you make a booking.
Please keep your receipt and hand in to the midwife on your first class.
2. Pre-mothers orientation (guidance by midwife)*For the first session, please meet in front of the east outpatient reception by 13:00.
(The midwife will tell you which room you need to go to for the second and third sessions.)*Time: 13:00 – 15:00*What to bring: Textbook (given at the first session), patient card (only at the first session),a pen, maternal booklet*If Monday is a public holiday, it will be postponed to Tuesday.

This orientation is for all women who do not take our mother’ s classes.

Yearly schedule(If you have had a caesarean section in our hospital before, you do not need to attend.)
You will attend one around 20 weeks into your pregnancy and need to make a booking.

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4FQUFNCFS/PWFNCFS(Please note that we do not take bookings by phone.)
Details: breast care, kangaroo care in our hospital, breast feeding, sharing a room with

Location: Number 1 guidance room at outpatient obstetrics and gynecology department
Please arrive before your booking time and be at the waiting room (on aisle E).
*Other guidance our midwives can offer
All by advanced booking and private guidance.
Other than pre-mothers orientation, we offer pregnancy guidance (weight control, nutritional

All guidance requires payment.

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5IFTU4BUVSEBZVIII. Admission into hospital
1. Timing of admission (More details will be advised at pre-mother’ s orientation or mother’ sclass)
Please call the hospital when your contraction starts or water breaks, the doctor will examine
you and decide if you are going to be admitted or not.
(Our nursing staff will advise if you should come to the hospital after they check your condition
over the phone.)
Our hospital staff are available on the phone for 24 hours. Please call 044-933-8111 (main) andadvise your pregnancy period and current situation.
It will be transferred to our nursing staff in the below wards, please explain your situation again.
Weekdays 8:30-16:30 & The 2nd and 4th Saturday 8:30 – 12:00 – To the outpatient obstetrics
and gynecology department
Other times – To 3 west himawari ward
If you are earlier than 37 weeks, they will transfer you to obstetrics and gynecology department.
Indication of contractions*Women in their first pregnancy: When you feel lower abdominal pain lead by your abdominal
tightening every 10 minutes or 6 times per hour.
(Please note that they might advise you to wait for another few hours at home.)*Women who have given birth before:
When you feel lower abdominal pain lead by your abdominal tightening every 10-15 minutes andit lasts for an hour.
Or When the pain gradually increases after every time you feel your abdominal tightening.
Or When you notice that the abdominal pain lead by tightening every 5 minutes.

4. What to bring to the hospital(More details will be advised at pre-mother’ s orientation and mother’ s class)*What you need for registration - your patient card, mother’ s booklet, healthcare card, deposit,
seal (hanko) and a pen*What you need for delivery - a long one-piece type of pyjamas with front slip
(Except when you are planning to have a caesarean section, we will ask you to wear thehospital gown until delivery.)
Obstetric binder (available for 1,000yen + tax at the hospital) or waist nipper(You can purchase the obstetric binder at the kiosk underground the hospital building.)*Sanitary pads will be given at admission.
*Others: drinks and straws*What you need for your hospital stay: pyjamas, underwear, towels, a box of tissues, thin baby
washcloths, baby milky lotion, earphones (if you wish to watch TV in a shared room)*What you need at discharge: Baby’ s clothes
Others – Please make sure to bring ongoing medicine (if you need any), left over pre-scripted
medicine and your medicine record booklet.
Rental pyjamas and towels
Pyjamas for after birth, bath towels, face towels (no limit with fee)

Indication of membrane rupture*When you feel gushing of fluid from your vagina, the liquid smells different to urine, or you findliquid in your vaginal discharge.
Your child who is younger than primary school age cannot enter the ward until you finish yourdelivery. Please make sure you leave your child to someone else or bring a babysitter to thehospital.
2. Visitors (Please see more details on the last page.)
More details are shown on the last page of this guidance.
We will explain it at mother’ s class and pre-mother’ s orientation.

5. Reminder for pregnant women who are going to be admitted for delivery
If one of the conditions below applies to you, antibiotics by drip will be administered.
1. GBS (Group B streptococcus) was positive from the vaginal cultivation test.
2. You had an early rupture of membranes before you came to hospital. water broke before
contractions started.)

3. Admission in hospital – Weekdays 9:00 – 17:00, The 2nd and 4th Saturday 9:00-12:30
Please register at number 5 Admission and discharge counter.
If you arrive out of the hours, please register after you are admitted.
You will need 50,000yen as a deposit, your healthcare card and stamp (hanko) at theregistration.

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IX. Contacts
Phone: 044-933-8111 (Main)*Weekdays 8:30 – 16:30
The 2nd, 4th and 5th Saturday 8:30 – 12:00(East outpatient reception or Obstetrics and gynecology outpatient department will answer.)*Out of hours
Earlier than 37 weeks of your pregnancy – Obstetrics and gynecology will answer.
Later than 37 weeks of your pregnancy – 3 west himawari ward will answer.

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