Purpose
The purpose of this study is to clarify if there is a difference in aftereffects (perineumpain, pain, difficulties in urination or daily life) between puerperal women who received an episiotomy and those who experienced a second degree spontaneous perineum laceration, which is equal to an episiotomy.
Method
A questionnaire survey was conducted in three hospitals within Tokyo metropolitan area in Japan on the fourth or fifth day after childbirth and 165 primiparous women who had a aginal and full-term delivery participated.
They met the requirements of the study and were classified into three categories: women who received episiotomies, those with a first degree laceration, and those with a second degree laceration. 147 responses (89.1%) were valid and analyzed statistically.
Results
1. The result of visual analogue scale showed no difference in the degree of pain (discomfort) among those three categories on the day of the delivery, the first and the third day postpartum. The pain was significantly alleviated from the day of childbirth to the following day for those with natural tears but no such relief was found for those receiving episiotomies.
2. At the early stage of puerperal period, more than half of the participants in each category recognized the urination difficulty and decline of micturition desire. There was no significant difference between them.
3. In comparison of difficulties in daily life, those with episiotomies found it more difficult to shift their standing position to a sitting posture and to fall asleep than those with a first degree laceration. No difference was shown between those with a second degree laceration and those in the other two categories.
Conclusion
There was no significant difference in aftereffects between women who had episiotomies and those with a second degree laceration. It cannot be asserted that the aftereffects of a second degree laceration are more serious than those of an episiotomy.

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Purpose
The present study aimed to investigate the experience of women during the period beginning in pregnancy to one month after delivery, who had been diagnosed with fetal abnormalities after the second trimester.
Subjects and methods
Five women were included in the present study. Fetal abnormalities were diagnosed by ultrasound after the 22nd week of pregnancy. The women were received at a university hospital during their perinatal periods. The participant-observation method and interviews were utilized to collect data, and interviewed four times with the women during the period of pregnancy to one month after delivery. Data was analyzed using the inductive method to clarify the experiences and thoughts of each participant.
Results
Women diagnosed with fetal abnormality went through a process as time passed, expressed by the following eight statements;“I was surprised to be informed that the fetus had an abnormality, and I was shocked”;“I hoped that diagnosis was incorrect”;“I set up temporary goals”;“Confirmation of the diagnosis gave me a further shock”;“I had many pent-up feeling by the time of delivery”;“I felt anxiety about deliver”;“My thoughts as mother were to remain next to my child”; and “I am learning from my child and I myself have grown up”. Although women who were diagnosed with fetal abnormalities after the second trimester repeatedly experienced psychological shock and physical pain, positive expectations and warm thoughts about their children were still apparent.
Conclusions
These results suggest that nurses need not only to pay close attention to fetal abnormalities but also to keep a very close watch over women before and after delivery.

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Purpose
Postpartum depression should be treated during the early postpartum. The objective of this study, therefore, is to identify the relationship between self-evaluation of child birth experience and early postpartum depression so that information needed to study postpartum psychological support is obtained.
Methods
The study was conducted between April and September 2000 on 1, 500 mothers 1 to 7 days postpartum. The method of the study was anonymous self-reporting questionnaire with response rate of 62.1%. The question items included self-evaluation of delivery experience, postpartum depression, gynecological, psychological and social factors affecting the self- evaluation.
Result
It was found that the subjects with lower self-evaluation tended to experience postpartum depression. The factors affecting the depression identified were “dissatisfaction with health care staffs”, “younger age at delivery” and “anxiety at delivery”. These factors were commonly observed among mothers irrespective of their history of delivery.
Conclusion
It was indicated that mothers tended to have postpartum depression when they were not satisfied with their experience of delivery. The tendency is identical irrespective of their history of delivery. Presence of trustful health care staffs and their support of anxiety during delivery increased satisfaction of mothers at delivery, contributing to prevention of postpartum depression.

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