2013 Volume 27 Issue 2 Pages 267-278
Objectives
The Japan Academy of Midwifery developed and disseminated the "2012 Evidence-based Guidelines for Midwifery Care" in order to achieve a more uniform standard of care during childbirth. The aim of this study was to describe the implementation of the Guideline among hospitals, clinics and midwifery birth centers. The focus was on care during the first stage of labor. Data was collected through October 2010 to July 2011.
Methods
Participants were managers who were in charge of hospitals, clinics and midwifery birth centers handling childbirth in Tokyo, Kanagawa, Chiba, and Saitama. Questions about the Guideline's implementation during the first stage of labor comprised 18 items. The Ethics Committee of St. Luke's College of Nursing, Tokyo, Japan (No. 10-1002) provided ethical approval.
Results
Agreeing to participate were 255 institutions (total response rate, 37.2%): 18 hospitals (response rate, 50.2%), 66 clinics (20.8%), and 71 midwifery birth centers (54.2%). Responses to continuity of caregivers for care during pregnancy and childbirth indicated Guideline adoption in midwifery birth centers (92.9%) and clinics (54.7%), but not in hospitals (15.3%). Two interventions for inducing labor were minimally adopted: (1) membrane sweeping for induction of labor was not common (hospitals .8%, clinics 3.1%, midwifery birth centers 1.4%), and (2) nipple and breast stimulation (hospitals 0%, clinics 1.5%, midwifery birth centers 5.6%). It was a policy for 38% of midwifery birth centers to provide continuous electronic monitoring on admission. Epidural analgesia was used if necessary as a policy in 31.6% of hospitals and 31.3% of clinics. Possibility for immersion in water around 40 centigrade for labor pain management as a practice in midwifery birth centers was higher (92.7%) than in hospitals (48.3%) and clinics (26.7%). Examples of adoption of methods for labor pain management with higher rates were: position change (95%), back massage (88%), warm pack (74%), and walking (61%). A routine enema to accelerate contractions was not common (hospitals 1.7%, clinics 9.1%, midwifery birth centers 1.4%). No institution had a policy for amniotomy as routine care.
Conclusion
There were considerable gaps between the Guideline and practice in hospitals, clinics, and midwifery birth centers. Based on the results of this study, evaluation of the Guideline should be conducted in a few years. Limitation of this study was the low reply rate of respondents. It is necessary to elucidate the actual conditions throughout Japan.
