2018 Volume 32 Issue 2 Pages 147-158
Aim
The aim of the study was to describe the actual organizational structure, policy, management and administration, and evaluation concerning the establishment of midwife-led birth units alongside hospitals or clinics where midwives conducted pregnancy checkups and deliveries.
Methods
The study design was a quantitative-qualitative descriptive study. The research facilities were hospitals and clinics, which had midwife-led birth units. The survey participants were one midwife from each facility. To collect data the researchers first sent midwives a questionnaire to respond and then they conducted structured interviews based on participants' responses. The collection period was from September to December 2017. The survey queried the: (1) number of midwives and advanced midwives, (2) requirements for midwives who could work in midwife-led birth units, and (3) criteria for pregnant women eligible for admittance to midwife-led birth units and other minor details. Descriptive statistics were used to analyze quantitative data and the qualitative data was sorted into categories regarding their similarities. St. Luke's International University Research Ethics Review Committee (17-A 054) approved this research.
Results
Midwives from 28 medical facilities throughout Japan consented to participate. The annual average number of deliveries for midwives within the hospital 45.5 (SD 65.2), and ranged from 0 to 255 cases; the median number was 13 cases. The average number of midwives in the hospital was 40.6 (SD 28.9) and the average number of advanced midwives was 13.5 (SD 9.7). The number of midwives involved in midwifery outpatients averaged 12.8 (SD 9.4), with the most frequent period of midwifery experience being 10 to 15 years. The number of midwives involved in in-hospital midwifery was 10.1 (SD 3.9); with commonly more than 20 years of experience. The Japanese Guidelines for Obstetrics and Gynecology criteria for pregnancy admissions for midwife-led units and for referrals to obstetricians were adopted in 27 facilities (96.4%). Midwives and obstetricians collaborated with each other to support women who have threatened preterm birth or women with psychosocial risk factors at two hospitals (7.1%).
Conclusion
In midwife-led birth units alongside the hospitals or clinics, criteria for low risk pregnancies and for referral to obstetricians were based on the Japanese Guidelines for Obstetrics and Gynecology. Midwives implemented their practice safely by using timely consultations with near by obstetricians.
