Recognition and implementation of care by midwives for women leaving the island to give birth

Abstract

Objective
The aim of the present study was to clarify how midwives recognize and implement care for women leaving an island to give birth on the mainland.
Subjects and Methods
Using an ethnographic approach, participant observation and interviews were conducted on 6 primary informants, who were midwives working at an obstetrics department on an isolated island, and 38 secondary informants, who comprised women leaving the island to give birth and their family members, an obstetrician working at a hospital on the island, an occupational health nurse, women engaged in child-raising with experience of leaving the island to give birth, midwives working at a mainland birthing hospital and staff at a mainland accommodation facility used by the majority of women leaving the island to give birth.
Results
It was found that antenatal care was performed with consideration given to the period that would be spent on the mainland, while postnatal care was conducted divorced from the circumstances surrounding mainland delivery. During antenatal care, midwives recognized that women leaving the island to give birth would be forced to lead solitary lifestyles on the mainland and thus were susceptible to increased anxiety and fears regarding childbirth. They also recognized the difficulties of nutrition management due to the change in environment. Against this background, it was found that midwives aimed to provide care that would engender the physical and mental state required for women giving other women the strength for childbirth. In addition, with the inevitable break in the continuity of care between pregnancy and the postpartum period, midwives recognized that the postpartum care provided to women returning home after leaving the island to give birth was not as complete as that provided to women who delivered on the island. However, despite this incompleteness of care, midwives were still able to establish connections with postpartum women.
Conclusion
In order for mothers and infants transferring between mainland and island environments to transition from pregnancy to child-raising safely and without worry, the following three points were found to be necessary for care coordination.
1) Care that recognizes the susceptibility for increased anxiety and fears regarding childbirth.
2) Care that responds to the difference in environment provided by mainland lifestyles.
3) Care that recognizes that child-raising begins in a place far from the help of experts in the case of puerperal women who have returned to the local area.