Most mothers in Japan want to breastfeed their babies and to receive breastfeeding care from nurse-midwives. Although psychological stress influences breast milk secretion, previous studies of midwifery practice and breastfeeding in Japan focused on the skill of breast massage and seldom examined psychological aspects of breastfeeding care. Participant observations of breastfeeding care by 26 nurse-midwives for 41 mothers at a hospital and a midwifery center provided the data for this study. From 226 interactions 540 units were identified and grouped according to major theme. Content analysis yielded three main categories: initiating caregiving situation (n=107; 19.8%); relieving and encouraging the mother (n=181; 33.5%); and teaching breastfeeding technique to the mother (n=252; 46.7%). Although each main category has implications for psychological stress, the category relieving and encouraging the mother has this as its focus. Compared to the other two main categories, a higher proportion of care in this category was judged to describe inadequate care. 35.9% of the 181 units of interaction observed were judged to describe inadequate care, care which could discourage a mother's will to breastfeed and interfere with learning; the psychological aspect of breastfeeding care seems to be the key to improving care by nursemidwives.

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