Purpose
Using the dependent care model proposed by Orem, a theoretician on nursing, this study aims at elucidating the breastfeeding continuation agency said to be necessary for mothers, through analysis of factors limiting breastfeeding continuation.
Method
In this study, designed as a descriptive study, data were collected using the semi-structural interview method. We conducted a questionnaire survey of 103 mothers who visited the hospital for examination one month after childbirth and could not continue breastfeeding, relying instead on mixed feeding comprising mother's milk and cow's milk, or bottlefeeding only.
Results
The survey revealed the following three characteristic factors that limited breastfeeding continuation: 1) abandonment based on experience, 2) maladjustment caused by difference between imaginary child and real child and 3) inappropriateness of advice, owing to affection toward the child. Relations were observed among these limitation factors; maladjustment caused by the difference between the imaginary child and the real child was accompanied by lack of experience in living with a child or lack of breastfeeding experience, a living environment in which the mother was pressed for time or had no mental “elbowroom”, erroneous judgment by the mother and family members that her breast-milk was insufficient, and their lack of learning to cope with problems.
Conclusion
Judging from the above results, the dependent care agency said to be necessary for a mother comprises the following: 1) ability to make the most of her experience; 2) recognition of the reality that the child cries, with adaptability to the child's cry; and 3) ability to stick to breastfeeding and to selectively accept support and take advice.

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Purpose
The purpose of this study is to show and determine what care and guidance midwives provide to mothers who are in the last stage of breastfeeding.
Method
In a counseling room of a municipal polyclinic hospital in Tokyo, 9 observations were made of 2 midwives who offered care and guidance on how to stop breastfeeding and 3 mothers who visited the room.
Results
The result of the observations was analyzed and classified into 239 topics according to their contents. These topics were roughly arranged in these 3 categories: 1) encouraging mothers (42.3%), 2) relieving mothers' anxiety (52.9%) and 3) observing mothers with due care and attention (4.8%).
Conclusion
Through the care and guidance of midwives, mothers came to think of them as a doula, which finally promoted the mothers to solve their problems by themselves. It follows that this suggests the care is indispensable not only in the stage of stopping breastfeeding, but also through breastfeeding. So it suggests it is in need of breastfeeding guidance clinic

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Purpose
The purpose of this study was to study the dynamics of secretory IgA (s-IgA) in the saliva during parturition, then use this information to investigate the stressors during parturition in terms of the immediate human environment, that is, the family.
Methodology
The subjects of the study were 18 parturients who had given their consent to be in the study. Ten of them were primiparas, while the remaining eight subjects were multiparas. None of these subjects showed any complications during their pregnancies, and all had normal vaginal deliveries at term.
Samples of saliva were taken during the final term of pregnancy and again during delivery, and the s-IgA contained therein was quantified using an enzyme immunoassay (EIA) kit (MBL Co. Nagoya. Japan). The time course for taking the saliva samples during delivery was as follows: Samples were first taken after the pains of the delivery had appeared and the subject had just entered the hospital, and then were taken every two hours after that until the subject entered the delivery room.
Nurses who were present during the delivery were also given a questionnaire, which included questions about whether or not family members were present.
Results
The concentration of s-IgA in the saliva during delivery differed considerably from one individual to another. However, in all cases these values were significantly higherat 6 hours before delivery than at 16 hours before. The values at 6 hours before delivery were also higher than the saliva s-IgA concentrations during the final term of pregnancy.
In addition, a positive correlation was found between the time family members were present and the s-IgA concentration in the saliva two hours before delivery.
Conclusion
Before the study, we had expected that the intensive labor and birth pains during delivery and the high stress of parturition would result in a low s-IgA concentration. However, we found that s-IgA concentration in the saliva actually rose during the course of delivery. In addition, because there was a positive correlation between the time family members were present and the s-IgA concentration in the saliva, it is possible that the presence of family members may be an important factor related to stress during parturition.

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Purpose
The purpose of this study is to clarify the following questions:
Are emergency caesarean sections perceived as a traumatic experience by women who had a live birth?
What reactions do the women have to the acute stress after emergency caesarean sections that were perceived as traumatic experience?
Methods
Eleven women who delivered live babies by emergency caesarean section at a private maternity hospital were interviewed using semi-structured guides on the second and seventh day after surgery and again at one-month post surgery. They were also observed in the post delivery ward. The data for birth and postnatal experiences from transcriptions and field notes were analyzed based on the diagnostic criteria for acute stress disorder in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association, 1994/1996). Further, the birth and postnatal (the first week post surgery) experiences of women who had acute stress reactions included re-experience their traumas were descriptively analyzed.
Results
Eight of the 11 women experienced their emergency caesarean delivery as a traumatic event, and three of the eight women re-experienced their traumas through flashbacks, nightmares, and intrusive memories. These 3 women perceived their violent birth experiences as traumas that overwhelmed their and their babies' lives or their identities, rather than simply as a surgical procedure. However, three factors contributed to changing their negative perceptions of childbirth, and then alleviating their acute stress reactions: 1) feeling comforted or healed by their babies, 2) good physical condition of mother and baby due to good hospital care, and 3) talking about their birth experiences with a third person.
Conclusion
These results suggest that early contact of mother and baby, support for breastfeeding, parenting and birth review are important to alleviate women's acute stress reactions after emergency caesarean section.

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[in Japanese]

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