Purpose
The purpose of this study was to analyze the concept of shared decision making being used in Europe and America, and examine the possible applicability that concept to women's reproductive health in the practice of midwifery.
Methods
Rodgers' (2000) approach to concept analysis was used to review literature focused on the areas of nursing and psychosociology, and the contents were qualitatively analyzed for attributes, antecedents, and consequences.
Results
The attributes of shared decision making were found to be 1) that the patient is involved and 2) that it is a dynamic decision process where persons involved mutually influence one another.
This process acts as an agency of communication and interaction. Through numerous two-way communications, persons involved share information gathered concerning choices available, the current situation, outlook, goals, values, preferences, and ideas. Working together they move toward a desirable decision and come to agreement.
The antecedents were 1) a change in health concept-variation in disease structure and response system characteristics, 2) medical uncertainties and advances in scientific technologies, 3) the certainty of a paradigm shift in the medical model, 4) characteristics of those involved, including the patient, and perception of authority.
The consequences were 1) maximizing people's health and QOL, 2) psychological changes and growth in the patient, 3) patient satisfaction with decisions, and 4) the practice of ethical clinical care, including the use of appropriate scientific technology.
Conclusion
The concept of shared decision making is being widely introduced in the field as a care methodology, and the possibility of it being further developed is anticipated as the body of experiences grows. This concept provides concrete support to women-centered care and research by placing women at the center of the decision-making while at the same time sharing the process. This concept can be applied when providing continual support.

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Purpose
This study investigates how mothers work to enhance their well-being in the child-caring years, the effects of a positive state of mind during this time brings, and what hinders mothers from boosting their levels of happiness.
Method
A loosely structured interview was conducted with 23 mothers with infants living in City A. All interviews were taped and transcribed verbatim. The data was then analysed qualitatively and inductively.
Results
The methods that mothers used to heighten happiness during childcare included (a) adding some creativity to their daily life to a moderate extent; (b) listening to others' childcare experiences and thereby feeling relieved; (c) maintaining peace of mind through good time management; (d) praising themselves after overcoming tough situation/difficulties; (e) feeling rewarded for the stress of childcare; (f) relying on and appreciating people with whom they live with; and (g) feeling united with their children in terms of time, space and emotions. The factors that hindered mothers from enhancing their well-being while raising children were (a) fatigue and frustration derived from compounded stress; (b) their nature to try to do more than they can handle; and (c) inability to trust others with self-imposed determination to do everything by themselves. Mothers' good well-being during the child-caring years was found to boost levels of thoughtfulness, a driving force in childcare, and comfort.
Conclusion
Factors such as the addition of some creativity into their daily life to a moderate extent, positive thinking, having contact with others and, especially, listening to them, and feeling united with their children in terms of time, space and emotions are considered to more effectively boost mothers' happiness. It was found that feeling happy more frequently contributed to even greater overall happiness, which in turn resulted in increased consideration for other family members, including their children. It is also assumed that reliance on and gratitude to people whom they live with, feeling rewarded for their stress, confidence gained through managing tough situation, and maintaining peace of mind through good time management are among factors that could change mothers' mentality, thereby boosting their happiness.

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Purpose
The purpose of this study was to determine the relationship between back pain and the length of time in postpartum, and to identify the factors associated with those pain symptoms.
Methods
The data were collected three times for postpartum women; one day; five days and one month after delivery. A questionnaire was carried out and the investigation was based on the results of this.
Results
There were a total of 67 postpartum women who were able to provide follow-up data until one month after delivery. The prevalence of back pain of those who completed a full term pregnancy were 58 (86.6%), one day after delivery there were 31 (46.3%), five days after delivery there were 35 (52.2%); one month after childbirth there were 32 (47.8%). Significantly, back pain decreased to around 50% for early postpartum (p<0.001). However, during the following month postpartum there was no significant decrease, and low back pain tended to be persistent.
The back pain intensity five days after delivery was strong so there was much pregnant body weight gain (r=0.392, p<0.01). The degree of difficulty in daily living due to back pain five days after delivery was great, and the physical difficulty of being in labor was great (r=0.381, p<0.01), and therefore the degree of distress in daily living by episiotomy and perineal laceration were also great (r=0.513, p<0.01). In addition, those who suffered with back pain five days after delivery, tended to have only engaged in light labor during pregnancy (p<0.05). If the back pain intensity one month after delivery is strong, the loss of weight rate is small (r=-0.336, p<0.01).
Conclusion
In many cases back pain decreased in early postpartum. However, one month after delivery, back pain persisted in more than 40% of postpartum women. The persistence of back pain in postpartum was associated to the above-mentioned weight gain during pregnancy, physical stress during delivery (supine persistence and perineal breakdown), and the slow rate of weight loss postpartum.

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Purpose
To clarify the actual status of the "preferable care" following perinatal death (stillbirth and early neonatal death), care-givers' evaluation of such care, and factors associated with their evaluation.
Method
Among care-givers' working for maternity units in the Hokuriku area and engaged in perinatal death care, a questionnaire survey was conducted on "preferable care" (care desired by many mothers who had experienced perinatal death, extracted from the literature) among them, their evaluation of perinatal death care, and factors associated with their evaluation (their personal factors, care-related factors, environmental factors, and target-related factors). Analyses covered 276 care-givers who had evaluated cases of less than 5 years.
Results
Their mean age was 35.5±9.3 years and the mean period of working for maternity units was 9.2±7.0 years. As for the occupation, 71% were midwives. Out of 20 items of "preferable care", 13 were practiced in 70%. Among these items, care for the child and family to live together was practiced in more than 80%, but continuous involvement after discharge, including referral to a mental specialist or support group, was only practiced in some 10%. Their evaluation of perinatal death care resulted in scores ranging from 0 to 96.8 points (mean: 47.4±22.1 points), correlated with the prevalence of "preferable care", the time spent on care, the amount of knowledge (represented by the levels of learning experience and knowledge, and self-evaluation of knowledge), and the level of experience (based on age, the number of years of working for maternity units, and the number of care cases experienced) (r=0.26-0.58, p<0.01). The evaluation score was higher in midwives (occupation), and in care-givers engaged as the person in charge or the administrator (role in care). The evaluation of perinatal death care was affected by the prevalence of "preferable care", the time spent on care, and the number of years of working for maternity units; 46.4% of the evaluation was explained by 4 factors.
Conclusion
Out of 20 items of "preferable care", 13 were practiced in 70%. Among these items, care for the child and family to live together was practiced in more than 80%, but post-discharge care was only practiced in some 10%. The evaluation of perinatal death care resulted in 47.4±22.1 points on average, affected by the prevalence of "preferable care", the time spent on care, and the number of years of working for maternity units.

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Purpose
The purpose of this study was to explore and describe the experiences of women who breastfed their children in Japan's postwar period when breast milk substitutes were not readily available.
Methods
The subjects of the study were 13 healthy elderly women who gave birth to their first child in 1955 or earlier, and who raised their infants on breast milk. Information on women's experiences breastfeeding their children were gathered mainly from semi-structured interviews. The interview data were recorded after obtaining the consent of the women. Afterwards, transcripts were prepared and a qualitative inductive analysis was performed with reference to the methods of ethnography.
Results
Four categories such as: "good lactation and physicality", "positive thought and behavior toward the continuation of breastfeeding"; "psychosocial involvement toward breastfeeding by others"; and "affirmative self-concept of themselves as mothers", along with the following sixteen subcategories including as: [the continuation of good lactation]; [a lifestyle promoting natural lactation]; [nursing continuation and contraception effect]; [acquisition of knowledge and information about breastfeeding]; [nursing custom assuming autonomous feeding]; [experience of the pleasant feeling that nursing brings]; [extension of weaning time]; [firm convictions as to the value of breastfeeding]; [pain and distress from restricted free nursing]; [another person's decision as to breast milk deprivation]; [strong support and trust of mother]; [nursing support that a midwife makes a difference]; [cooperation among community through back up of mother's milk]; [guarding and passing on breastfeeding tradition and experience]; [smooth acquisition of breastfeeding skills and confidence in child care]; and [formation development of high maternal role awareness]. These were extracted from the descriptive data on the breastfeeding of these 13 women.
Conclusion
In Japan's postwar reconstruction years breast milk substitutes were not readily available, and women who experienced breastfeeding at that time were self-aware with regard to good lactation; they inherited the psychosocial involvement toward breastfeeding by others; they had a positive attitude and behavior with regard to the continuation of breastfeeding; and may be assumed to have had an affirmative self-concept of themselves as mothers through the act of raising their children on breast milk. These women and their families were motivated by the belief that "there is only mother's milk to bring up my child".

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Purpose
This study was aimed to determine the factors which have an influence on childcare adaptation in one-month-old babies' mothers.
Subjects and Methods
Subjects were two hundred and seventy five mothers who came to hospital to have their one-month-old babies undergo a regular medical check-up. They were first asked to participate in this research and then those who consented to cooperate were handed out a questionnaire. They were not asked to write their names on the questionnaire sheets.
Results
Two hundred seventy five subjects produced a total of two hundred and twenty six valid responses (82.2%), of which one hundred and twenty (53.1%) were from primiparae and one hundred and six (46.9%) were from multiparae. Including thirty two independent variables, two of which were found related to each other in an attribute, a multiple linear regression analysis was conducted on the collected data using a compulsory input method. It was found that as for primiparae, five independent variables were associated with childcare adaptation (R=0.84, R²=0.59, and p<0.001). They were "baby nursing is tough," "childcare is enjoyable," "bathing a baby is tough," "you have adjusted to life as a parent," and "you have a person who understands you." As for multiparae, four independent variables were found to be associated with childcare adaptation (R=0.78, R²=0.43, and p<0.001). They were "You have a very helpful person," "You can perceive your baby being hungry quickly," "You have adjusted to life as a parent," and "You have a person who helps you with childcare during the night."
Conclusion
To help mothers better adjust to life as a parent, providing them the following points is emphasized as all key in importance: practical childcare skills which enable them to feel in the early stage of child rearing that they have adjusted to life as a parent, assistance with childcare in the nighttime, emotional support, and coping skills for dealing with crying babies.

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Purpose
To give an account of the child care experience of mothers with twins during the one month period after discharge.
Objective and Method
The research objective is four mothers that gave birth to twins at hospital A from late June 2005 to early July, that were released together with their children that didn't have congenital malformations or other disorders, and that could participate in research for a one month period after discharge.
The research method looked back on the child care of twins during a one month period after discharge, and consisted of a half structured interview regarding events that were impressionable and feelings and experiences that occurred at that time. Acquired data was recorded word by word, and information in line with the disposition of context was analyzed.
Results
Two of the research participant mothers suffered from unexpected occurrences such as mastitis (breast inflammation), and were experiencing the characteristics of twins such as crying at the same time and they vomiting at different times. The multipara were feeling the difference in breast feeding methods and their body conditions felt bad in comparison to the prior births and childcare.
Also, the four research participant mothers spoke of their child care experience during the one month period after discharge, and the words and actions that reflected their positive and negative feelings towards child care were monitored.
As for the mothers with twins, spoke about the experience of being able to breastfeed directly in accordance with the realization of the growth of two people, and the words and actions that reflected their positive and negative feelings were monitored. They spoke from their experiences of unexpected occurrences, etc. that they couldn't predict while hospitalized, and their feelings such as "worry" and "anxiety." Of the participants in this research, they thought it was "a pity" because they couldn't make time for themselves or pay enough attention to the babies due to two people crying at the same time. During the homecoming, the mothers thought about their lives after returning home one month after discharge, and words and actions that reflected their positive and negative feelings of things that they couldn't imagine were monitored.
Conclusion
During the one month period after the discharge of the mothers with twins, the feelings were made clear concerning child care experiences that could correspond to seeing the growth of two people, anxiety towards occurrences that couldn't be predicted, and childcare that couldn't be imagined. Including the families, information provisions so that the twins specific lifestyle can be imagined and necessity of continuous assistance from the maternity nurses during hospitalization were both suggested.

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