Purpose
The aim of this study was to explore the ways miscarriage can alter a couple's marital relationship and its related factors.
Method
A qualitative, contextual analysis was conducted of 166 subjects-women who had miscarried from three months to two years earlier and their spouses. They were recruited by notices on bulletin board at women's centers, through an Internet Web Site, and through acquaintances. An open-ended question, "How did the miscarriage alter/ affect your relationship?" was asked on questionnaires. 14 males and 152 females responded, describing changes in their relationship after miscarriage. The descriptions were coded into 177 data, which were grouped and analyzed using inductive and contextual methods.
Results
The contents were compiled into five categories: two negative changes-a worsening of a shallow relation and the aggravation and breakdown of the relation; and three positive changes-better cycle of the development and maturing of each person as an individual and as a couple; a deepening and evolving of each couple's relation; and a improvement of intimate relations.
Eight factors were involved in the negative changes: a) mutual misunderstanding of the difficulties encountered; b) a negative judgment of one's spouse; c) an inability to share the mourning process; d) a continued shallow marital relationship; e) a decrease in communication; f) a lack of agreement on the desirability of having a child; g) sexual difficulties; and h) a general doubting of the value of remaining as a couple.
Seven factors were involved in the positive changes: a) strengthening of the couple's bond by sharing the difficulty; b) a recognition of the miscarriage and his/her spouse's reaction; c) a positive evaluation of his/her spouse; d) an open-mindedness to the partner and reconfirmation of his/her own feelings toward the partner; e) a sharing of the mourning process; f) an affirmation of and commitment to improve the marital relationship; and g) a self-awareness and striving for being a parent.
Conclusion
These results reconfirmed that a miscarriage is a major stress factor which can cause a crisis in a marital relationship. They also suggest that the ways that women and men face the miscarriage and faced themselves and whether they share the mourning process relates to the development of the relationship. The data also suggests that a miscarriage lets the couple confirm whether they want to have a child or not. Finally, the data suggests that a miscarriage, if encountered positively, can help the couple grow from growth into an existential humanistic relationship.

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Purpose
The objective of this research is to apply economic evaluation to clarify the importance of childbirth education from the perspective of the consumer and to reveal reasons for its perceived importance and related factors.
Method
In applying the Contingent Value Method (hereafter, CVM) to survey 383 pregnant women (71.4%) attending a childbirth facility, a questionnaire was used to investigate the perceived importance of childbirth education based on willingness to pay (WTP), along with associated reasons and related factors.
Results
1. For the importance of childbirth education questionnaire, 34 women (8.9%) did not respond to the question regarding WTP for childbirth education, 32 women (8.3%) responded that it should be free and 315 women (82.8%) answered that it should cost the consumer. For those WTP, the mean price was 900.8 ± 675.5 yen.
2. The following nine factors were found to contribute toward the importance of childbirth education: interaction with others, expectations concerning expertise, embodiment of childbirth and childrearing, alleviation of anxiety and stress, regard for individuality, adaptation to changes in family relations, atmosphere creation, material satisfaction, and the specification of conditions/environments.
3. WTP was found to be linked to: pregnancy term, and whether the pregnant woman had previously participated in childbirth education.
Conclusion
The importance of childbirth education for pregnant women is revealed by the WTP, which was mean 900.8 yen. The WTP was lower the longer the term of pregnancy and the more they had participated in childbirth education previously. Furthermore, nine factors were revealed that contribute to the importance of childbirth education.

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Purpose
The purpose of this study was to implement and evaluate health training guidance using the self-monitoring method in order to improve self-care behavior among Primiparae.
Method
Intervention consisted of establishing two groups consisting of an interview group who self-monitored daily self-care behavior and were interviewed by midwife nurses (17 subjects) and a recording group who only performed self-monitoring (20 subjects), and intervening for 20 weeks from week 15 to week 34 of pregnancy. A control group was also established consisting of pregnant women who did not undergo intervention (18 subjects). Evaluation indices consisted of apprehension, intention to implement self-care behavior, and practical application status of self-care behavior, and these indices were measured in weeks 15, 26 and 36 of pregnancy.
Results and Discussion
In the recording group, 25% of the subjects withdrew from the program by the second evaluation. When analyzed using a repetitive two-factor analysis of variance, apprehension was observed for the main effect of the group (p<.01), a significant interaction (p<.05) was observed between the group and time in diet and daily activities with respect to the intention to implement self-care behavior, and with respect to practical application of self-care behavior, the main effect of the group was observed for prevention and early detection of abnormalities (p<.05). Self-monitoring serves to alleviate apprehension and bring about the effect of enhancing the intention to implement self-care behavior, and the combined use of interviews by midwife nurses was suggested to enhance the practical application of self-care behavior.

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Purpose
In this study, we focused on biopyrrin in urine as an oxidative stress maker due to ease of measurement, less invasive risk, and its comprehensiveness as a marker of stress. The aim of this study was to explore the possible use of biopyrrin as an objective indicator of stress during pregnancy.
Method
A cross-sectional study was conducted from July to August in 2005 on 594 pregnant women and 35 non-pregnant women attending N clinic. The methods included self-reporting questionnaire, reviewing maternal records, and morning blood and urine sample collection. We measured biopyrrin in the urine and serum lipid metabolism makers such as acetoacetate, 3-hydroxybutyrate acid, triglyceride, total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol, and free fatty acid and glucose metabolism markers such as glucose and glycated albumin.
Results
Urinary biopyrrin levels in the first, second and third trimesters were significantly higher than in non-pregnant women (p<0.001). The urinary biopyrrin level in the third trimester was significantly higher than that in the first and second trimesters (p<0.001). Elevated urinary biopyrrin levels were related to disease and increased symptoms of pregnancy-induced hypertension such as hypertension, urinary protein, increasing 3-hydroxy butyric acid, glucose and GHQ score, as well as decreasing HDL and fatty acid.
Conclusions
We determined that urinary biopyrrin levels were higher during pregnancy than in non-pregnant women and that third trimester levels were significantly higher than those in first and second trimesters. Other markers of general health linked to increasing urinary biopyrrin levels included increasing 3-hydroxy butyric acid, glucose and GHQ scores, and decreasing HDL and fatty acid.

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Purpose
In this research, it was intended to analyze the domestic bibliographies from 1990 to 2005 regarding pregnant teenagers and to point out future challenge.
Methodology
"Japana Centra Revuo Madicina (Ichushi Web)" and "Current Index to Japanese Nursing Literature (Saishin-Kango Sakuin)" were used. The key words used for this search were "underage pregnancy, young primipara, teenage pregnancy and adolescence pregnancy". As the result, 106 bibliographies were found and were analyzed, and were reviewed by categorizing the data.
Results
Based on the analysis of the bibliographies, the content was categorized into 4 items regarding the background of pregnant teenagers, pregnancy and child rearing, and future challenge was added as 5th categories. In the existing bibliographies, there were relatively many proposals about the status of pregnant teenagers and the effect of care and support, but not much research were available demonstrating and discussing about the care and the characteristic difference by various age categories. Furthermore, it did not clarify psychological and sociological impacts about getting acceptance of teenage pregnancies and about its experience of raising children. And about what this meant and how this would influence to their health of those pregnant teenagers.
Conclusion
It is important to pursue high quality research in future teenage pregnancy. And also it is important to study subjects' experience while paying attention to subjects' characters.

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Purpose
The purpose of this study was to determine the changes in the emotional responses of first time fathers whose primipara wives had been hospitalized for threatened premature delivery. The change in the subject's awareness of becoming a father, and their feelings concerning the pregnancy and delivery, from immediately following hospitalization to delivery, were examined.
Method
Data were collected using semi-structured interviews of three first-time fathers whose primipara wives had been hospitalized for threatened premature delivery. The interviews, which were subjected to content analysis, were conducted weekly immediately after hospitalization and through delivery.
Results
1. This study shows that awareness of becoming a father, and feelings of helplessness and alienation towards pregnancy and delivery, coexisted.
2. Until delivery, fathers experienced a sense of insecurity concerning their awareness of coming fatherhood. However, no relationship was seen between the degree of insecurity felt and the severity of symptoms of threatened premature delivery.
3. Even fathers who were making efforts to support wives had identical feelings of helplessness and alienation towards pregnancy and delivery.
Conclusion
This study shows that there are changes in father's emotional responses toward pregnancy and birth when expectant wives are hospitalized for threatened premature delivery. The hospitalization of wives has two discernable effects on husbands. First, wives hospitalization is a motivating factor which helps facilitate the father's positive feelings towards coming parenthood. Second, fathers experience a sense of insecurity concerning their awareness of coming fatherhood. This study suggests that it is significant for nursing staff to be aware of the emotions of first time fathers whose primipara wives have been hospitalized for threatened premature delivery, and to take necessary steps to support the father's role: to avoid preconceived ideas of the father's emotional state, to understand the feelings of fathers, institute schemes of communication to support the developing awareness of coming fatherhood, and facilitate the fathers participation in the pregnancy and delivery.

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Purpose
It is recognized that mental disorders in women in the puerperal period have an influence on subsequent childcare. In order to establish effective support measures, the present study aimed to investigate the following: the level of anxiety experienced by women at various stages of pregnancy and the puerperal period, the possibility of predicting the incidence of postpartum depression in the end-stage of pregnancy, and the factors associated with anxiety in each stage of pregnancy and the puerperal period.
Subjects and Methods
Subjects were 189 women who gave birth at one of 3 hospitals in A City. The survey periods were from August 2000 to August 2001, and June 2004 to January 2005. The survey methods adopted were the State-Trait Anxiety Inventory (STAI) for subjects in the end-stage of pregnancy, and on the 5^th day, and the 1^st and 3^rd month of puerperium; the Stein Maternity Blues Score for those on the 5^th day of puerperium; and the Edinburgh Postnatal Depression Scale (EPDS) for those on the 5^th day, and the 1^st and 3^rd month of puerperium. A questionnaire survey was conducted in order to investigate the factors that affect various forms of anxiety, such as social anxiety, financial anxiety, and anxiety regarding obstetric issues. The analysis used the multiple-regression analysis.
Results
The level of state anxiety measured by the STAI was found to be higher of trait anxiety, and the levels were higher in the end-stage of pregnancy than in the puerperal period. The maternity blues score was 23% among subjects on the 5^th day of puerperium, and those who were at risk for postpartum depression, as indicated by a score of 9 or higher on the EPDS, scored 14.2% in the 3^rd month of puerperium. Regarding anxiety-related factors in the end-stage of pregnancy, "childbirth experience," and "support from female siblings (availability)" were extracted from the STAI. Factors that were extracted from more than one of the three scales (STAI, Stain, and EPDS), in the puerperal period were "cooperation from husband (availability)" "financial difficulty" and "opportunity to become pregnant" for the 5^th day of puerperium, "opportunity to become pregnant" for the 1^st month of puerperium, and "cooperation from husband (availability)" and "opportunity to become pregnant" for the 3^rd month of puerperium.
Regarding a prediction system for the prevention of postpartum depression, the STAI, which can be adopted for the pregnancy period, was considered to be preferable because it showed positive correlations with other scales. However, following fact was proven from the multiple regression analysis. In STAI (Trait-anxiety) in the term pregnancy, there puerperal period all trait-anxiety relation. And, there was the relation with EPDS of the 3^rd month of puerperium in STAI (Trait-anxiety) in the term pregnancy.
Conclusion
The present study revealed that it is possible to predict the incidence of postpartum depression by identifying mothers at high risk in the end-stage of pregnancy using the STAI (Trait-anxiety). Furthermore, it was found that the related factors extracted according to the mothers' puerperal stages were associated with the living environment, such as cooperation from the husband, and planning for pregnancy. Therefore, it is necessary to develop a support system for both the end-stage of pregnancy and the puerperal period.

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The Research Center for Development of Nursing Practice in St. Luke's College of Nursing planned, implemented and evaluated a program with the objective to prepare siblings for the birth of another sibling in the family.
A total of 89 families enrolled in the program. Classes averaged 8.1 families representing the 25.9 participants. The average age of the attending children was 3.8 years old. Eleven classes were held from July 2005 to November 2005. A questionnaire evaluation was conducted before and after the class and again after the birth of the sibling.
Evaluation before classes began revealed that the main reasons for attending the class were to: (1) prepare older siblings for a new role, (2) understand the mechanism of pregnancy and childbirth and (3) join in the childbirth. In addition, parents reported they wanted to know how to explain sex and pregnancy/childbirth to children and how to care for older siblings after the baby was born.
Evaluation after the class ended indicated that the most impressive experiences were: (1) holding the life-sized baby doll, (2) a puppet show of childbirth and (3) a picture story showing the mechanisms of pregnancy/childbirth.
Evaluation after childbirth indicated that the children had changed after the class: (1) they talked about the baby more, (2) they were gentler toward their mothers' abdomen, and (3) they wanted to help their mothers a lot. Half of the parents answered that now children could naturally understand the process of childbirth and smoothly participate in the childbirth process.
Overall we received positive responses from participants. However it is important for the next phase that we examine approaches for more effective advertisement, adequacy of manpower and effectiveness of the evaluation method of the program.

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