Abstract
Purpose
Using five locations in Japan that are taking the lead in establishing in-hospital birth centers as model cases, we are developing factors for the establishment of in-hospital birth centers.
Subjects and Methods
We surveyed midwives at five general hospitals that have established in-hospital birth centers (one midwife at each facility). We collected data using a structured interview survey, focusing on the preparations that were made to establish the in-hospital birth center. To conduct our analysis, we recorded the interviews, transcribed the inter-views, and then integrated the transcribed data using the KJ method.
We examined and diagrammed the relationships between the categories chronologically.
Results
The data sampled from the transcriptions was ultimately combined into groups: "Background behind the es-tablishment of an in-hospital birth center," "Infrastructural system creation," "Skills development of midwives," and "Staff placements and cooperation". When these four elements were expressed in a structural drawing, the path toward the establishment of an in-hospital birth center promoted by midwives was shown to be comprised of two phases: (1) an uphill portion reflecting the "Background behind the establishment of an in-hospital birth center," and (2) a flat portion, reflecting the "Infrastructural system creation," "Skills development of midwives," and "Staff placements and cooperation." Moving toward the establishment of an in-hospital birth center required the presence of midwives dedicated to the development of such a facility. When these midwives moved forward in their efforts, the uphill slope expressed in the "Background behind the establishment of an in-hospital birth center" was impor-tant. Some of the factors that facilitated the progress made by these midwives as they struggled uphill toward their goal included "positive reasons for establishing the facility" and "the involvement and support of key persons." The factors impeding their progress included "negative reasons for establishing the facility." When the supporting fac-tors won out over the impeding factors, forward progress could be made. Progress along the flat road that followed the uphill slope could then proceed smoothly.
Conclusions
Making progress toward the establishment of in-hospital birth centers requires the strong dedication of mid-wives to this cause, as well as an environment that is supportive of their efforts.
