Objective
This study examines relationships between Somatic Sensations of Pregnancy and Fetal Attachment.
Subjects and method
A Somatosensory Scale of Pregnancy (SSOP) was devised on the basis of a preliminary survey of 26 items, organized under Factor 1, "unlocalized somatic sensations" (14 items), Factor 2, "localized somatic sensations" (8 items), and Factor 3, "fetal-centered somatic sensations" (4 items). SSOP was used together with the Muller Maternal-Fetal Attachment Scale in a survey of 390 primiparas in three classes of maternity facilities that differed in numbers of ultrasound examinations performed and numbers of hours spent on antenatal examinations or health care counseling. The two types of facilities that conducted ultrasound scans at every examination were classified as a "hospital" or "maternity home conducting frequent scans", while the third class of facility was treated as "maternity home conducting infrequent scans."
Results
Subjects in the middle stage of pregnancy who received examinations at maternity homes conducting frequent scans showed significantly higher fetal-centered somatic sensation scores than those examined in hospitals; similarly, a significantly higher level of fetal-centered somatic sensation was shown by late-term subjects examined at both classes of maternity home, as compared to subjects examined in hospitals. Subjects in both the middle and late stages of pregnancy examined in maternity homes conducting ultrasound infrequently showed significantly higher degrees of fetal attachment, but there was no significant difference on this measure between subjects examined by either of the two classes of maternity homes. No significant differences were shown in unlocalized or localized somatic sensation scores of subjects in middle or later pregnancy subjects, regardless of the type of facility where their antenatal examinations were held. Fetal-centered somatic sensation scores and fetal attachment scores were shown to be significantly correlated (p<0.000), with a correlation coefficient of 0.427 (0.372 for midterm and 0.323 for later term pregnancy).
Conclusions
The somatic sensations of women during pregnancy may be classified as unlocalized, localized and fetal-centered. Of these three factors, it was found that fetal-centered somatic sensations are associated with fetal attachment.

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Purpose
We described the experience of pregnant teenagers who decided to continue pregnancies and classified their decision making factors.
Subjects and Method
We conducted 3 to 4 semi-structured interviews (30 weeks after pregnancy, during admission, 1 month after deliver) to 8 pregnant teenagers who gave their informed consents. By using phenomenological research method, we analyzed verbally obtained data in a qualitative manner.
Result
The experiences of continued pregnancy among the teenagers are summarized as follows: {Case A} "Even though I cannot get married, I wish to end the agony in life by becoming a mother." {Case B} "I regret my last abortion and with this pregnancy I am able to receive approval from my parents." {Case C} "The unexpected pregnancy with my counterpart brought great agony but with his permission to continue pregnancy, I am able to positively tackle my studies." {Case D} "From my past bitter experience of abortion, I decided to continue this pregnancy even under the extreme opposition of his mother and my financial difficulties." {Case E} "I decided to continue the pregnancy because of the joy I can anticipate with a new family and because of my opposition towards the idea of abortion within healthcare." {Case F} "I intend to cope with this unexpected pregnancy along with my university studies and my psychological troubles." {Case G} "I could get enough support and hope for a new future family even though I am isolated by friends." {Case H} "I could find my own values and prepare myself to become a new parent after defending myself against the severe oppositions from both sides of the parents."
The above comments characterized the teenagers' experiences into "regret from previous abortion," "anxious to build a new family," "acceptance from others," "demonstration of own strong will," and "opposition towards the denial by healthcare givers."
Conclusion
Most of the teenage pregnancies are unexpected. The teenagers experienced problems such as attempting a balance between studies and pregnancies or juggling for family adjustments. Each case described presented individual meaning and we derived 5 factors that influenced the decision making of continued pregnancies among teenagers.

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Purpose
The purpose of this study was to analyze the actual conditions of burnout in Japanese midwives working in hospitals.
Methods
We conducted a quantitative cross-sectional survey by self-reported questionnaire in 839 midwives working in the obstetric departments of 72 hospitals in Japan. Burnout was assessed by Maslach Burnout Inventory (MBI). In order to determine the relationship between condition and background, the following factors were investigated: socio-demographics, characteristics of midwife work experience, workload, workplace features, job satisfaction, intention to pursue their career, and personal assessment of working environment. ANOVA, t-test and correlation analyses were conducted to identify relationships between MBI subscales and the above-mentioned factors.
Results
The response rate was 87.2%. In order to conduct statistical analysis, appropriate data from 708 respondents were used. Average age was 35.2 years. The results of emotional exhaustion, depersonalization, and sense of reduced personal accomplishment, which were MBI subscales, were 15.67±4.50, 11.89±4.32 and 20.61±4.30, respectively. Marriage status, maternity care experience, working hours per day, overtime work per month and paid holiday status, etc., had significant relationships to both exhaustion and depersonalization. Job status and shift system were significantly related to sense of reduced personal accomplishment. Significant negative correlations were found between job satisfaction and sense of reduced personal accomplishment. Another negative correlation was found between intention to pursue and both emotional exhaustion and sense of reduced personal accomplishment.
Conclusion
In comparison with the results of previous studies examining nurse burnout, emotional exhaustion and depersonalization were at the same level or lower. With regard to sense of reduced personal accomplishment, it was lower in this study when compared to previous results. Although causality cannot be confirmed, it was shown that there are relationships between burnout and both job satisfaction and intention to pursue. The implications for medical practice in hospitals include the placing of health care professionals on-site to treat midwives, the hiring of more midwives on staff and the on-going post-graduate education of midwives with limited experience.

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Purpose
The purpose of this study was to reconsider the role and responsibility of present midwives, through knowing the field of traditional midwives' activities.
Methods
The author interviewed an 82-year-old midwife whose career spanned two generations covering about 50 years while in private practice, from the 1910s to the 1960s. Seven interviews were conducted, with a total of 14 hours and 25 minutes from February 2004 to March 2005, and the comments were summarized into a life-history document.
Results
It was found that the practicing midwives in old times had a continuing close relationship with the mothers' families and the community, having knowledge of the circumstances and family environment of each pregnant woman. In addition to the ordinary maternal care, traditional midwives served as supporters and friends to the pregnant women, during both perinatal and postnatal periods, and pursued their role with a firm sense of mission.
Conclusion
From our interviews, we could postulate that midwives need to make their best effort in providing a sense of security and comfort to people, through an understanding of a person's feelings, along with the need of developing greater midwifery professional responsibility and improved clinical techniques.

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Purpose
This study explores attitudes among professional care providers in North America towards teen mothers where various support is provided.
Methods
Two focus group meetings were held with professionally trained care providers who are currently providing support to teen mothers. In a semistructured interview, the researchers asked them what they, as a care providers, thought was the most important attitude towards teen mothers. Qualitative methods were then used to identify themes and analyze the responses.
Results
The attitude of the care provider toward teen mothers is discussed. Three themes emerged from the research: The Philosophy of Care Providers (respect, no prejudgment, trust, and belief in their ability), Provider Perception of Teen Mothers (they are a teenager before being a mother, non-negative perception of teenage pregnancy and motherhood), Attitude of Support (understanding various cultures and their sense of values, and being informed of factual information). The background of this study helped us understand that poverty, improper upbringing, complex family backgrounds, social discrimination towards teenage pregnancy and features of an adolescent youth are characteristics of teenage pregnancy.
Conclusion
A care provider should be able to understand the present conditions, circumstances, and characteristics of a teen mother and adolescent youth, as well as respectively, but affirmatively counsel, guide, and suggest.

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Objectives
The purpose of this study was to clarify the morphological characteristics by cine MRI of the pelvic floor in patients with stress urinary incontinence before the start of exercise of the pelvic floor muscles.
Subjects and Methods
The subjects were 34 females who were recruited from the general public, and gave consent to this study. Differential diagnosis of stress urinary incontinence was performed by the pad test of the International Continence Society and the simplified diagnostic method of Nippon Medical School, and the subjects were classified into the control group (n=18) and incontinence group (n=16). As the mobility of the bladder neck region on cine MR images, the difference in the distance of the bladder neck region between during relaxation as the standard and each movement, such as abdominal compression and contraction of the pelvic floor muscles, was measured. The rates of changes in the distance of the bladder neck region caused by each movement in the control and incontinence groups were compared.
Results
All the subjects had stress urinary incontinence, and its severity was very mild to intermediate. The mobility of the bladder neck region observed by cine MRI was significantly higher during abdominal compression in the incontinence group than in the control group, and it was also significantly higher during abdominal compression under contraction of the pelvic floor muscles in the former than in the latter. Among the background factors, there was a significant difference in the birth weight of their children between the incontinence and control groups, but no significant differences in the remaining factors, such as the mean age, job, BMI, and the number of deliveries, were detected between the 2 groups.
Conclusions
In mild stress urinary incontinence in females, the mobility of the bladder neck region was high during abdominal compression. Furthermore, it was found that support of the bladder neck region by the pelvic floor muscles was low during abdominal compression under their contraction. Among the background factors, there was a significant difference in the birth weight of their children between the incontinence and control groups, but no significant differences in the remaining factors were detected between the 2 groups.

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[in Japanese]

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