Purpose
The aim of the present study was to clarify the meaning of children's experience of being present at the birth of a younger sibling.
Methods
The study participants were eight pairs of children and their mothers who gave birth to a second or third child in a maternity clinic or at home. The survey of mother-child interactions in the first through fourth stages of labor was conducted using a participant-observer method. The observations made in the delivery setting were confirmed in a semi-structured interview of the mother during the puerperal period. Categories were extracted after interpreting phenomena obtained from settings considered to be significant. While comparing the similarities and differences in each setting, the patterns of the phenomena were arranged and the significance of the childbirth experience of the sibling was derived.
Results
Seven categories were extracted for childbirth experience of the siblings: 1) experience causing swings of various emotions, 2) experience that nurtures a rich sensibility of life and sexuality, 3) experience that raises empathy from participation in childbirth, 4) stressful experience that threatens the self, 5) experience that makes one feel the closeness of others, 6) crisis experience that shakes the mother-child relationship, and 7) experience that builds a new sibling relationship. The categories were broadly divided into those related to internal aspects of the child, and those related to the child's relationships with people around him or her.
Conclusion
Childbirth for the elder siblings was an experience that aroused curiosity and led to an interest in life. However, the childbirth experience also includes critical elements that threaten a child's mental state. For the child to get through this experience and have it be a valuable growth experience, the role of family in supporting the child and the assistance of midwifes are important.

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Objective
The objective of this study was to investigate the effects of iyashi healing care provided on postpartum day 1 on mother's fatigue and breastfeeding.
Sample and Methodology
Using a quasi-experimental design, we explored the effects of healing care with respect to mother's fatigue in early puerperium and breastfeeding. The study sample comprised 153 mothers on postpartum day 1 after normal childbirth. We divided them into two groups: a group of 80 mothers who were provided with the healing care, and a control group of 73 mothers who were provided with standard care.
The indicators of postpartum fatigue were the level of Fatigue Accumulation Checklist, the level of Edinburgh Postnatal Depression Scale, and self-knowing sleeping time. The indicators of breastfeeding were the number of feedings during hospitalization, breast problems during hospitalization, and digestion rates at discharge and after one month.
Results
It was suggested as follows. Scores on the Fatigue Accumulation Checklist and Edinburgh Postnatal Depression Scale measures in the intervention group were lower than those in the control group. Additionally, mothers in the intervention group were less likely to experience difficulty of direct breastfeeding during hospitalization than their counterparts in the control group. However, it was inadequate for verifying the effect of iyashi healing care.
Conclusion
It did not result in verification of the hypothesis of "iyashi healing care provided in early puerperium must have been effective in preventing postpartum fatigue and in promoting breastfeeding".

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Purpose
The purpose of this study was to clarify the structure of learning expected of student-midwives at assisting their first three deliveries.
Methods
The participants in this qualitative descriptive study were eight midwives concurrently responsible for the midwifery care and the education of student-midwives, especially for guiding them as they learn delivery. Data collection occurred in two phases. First, the debriefing session between students and their mentors after the delivery was observed. Then, several days after the debriefing sessions, semi-structured interviews were conducted with the midwives. Interviews were transcribed verbatim to allow descriptive and inductive content analysis.
Results
From the analysis, the following five themes were identified; "increase clinical knowledge and skills and judgment as they experience deliveries", "build the attitudes and sensibilities as clinical practitioners", "develop ways of the learning in clinical situations and expand the realistic practice", "learn to clarify and expand their learning by exploiting every debriefing session", "strengthen aspirations to be a midwife".
Considering relationships among these themes, the structure of learning expected of student-midwives at assisting their first three deliveries was structuralized as follows.
Midwives expect the students basically to "learn to clarify and expand their learning by exploiting every debriefing session", and to "develop ways of the learning in clinical situation and expand the realistic practice". Especially, midwives expect the students to "increase clinical knowledge and skills and judgment as they experience deliveries", "build the attitudes and sensibilities as clinical practitioners". And finally, Midwives expect that the students' clinical learning with them would be oriented to "strengthen their aspirations to be a midwife".
Conclusion
From the analysis, a structure of the themes was developed. At the core of what midwives expect of the student-midwives throughout the practical training is increasing knowledge, skills and judgement, and midwives also expect the students to build the attitudes and sensibilities as clinical practitioners. And midwives consider that the debriefing session is an important process for this learning and helping students exploit it is an objective of mentors. Therefore, midwives also expect that the students will develop ways of the learning in clinical situation and expand the realistic practice and become stronger in their motivation to become midwives through learning to clarify and expanding their leraning by exploiting every deberiefing session with their mentors at the clinical sites.

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Purpose
To describe feelings and behaviors of mothers before and after participating in sexuality education class in order to identify family's changes due to the classes.
Method
This was a qualitative descriptive study. Volunteer mothers attended one two-three hour class with the sibling (s), and occasionally other family members. Ten pregnant mothers participated in individual semi-structured interviews before beginning classes and one month after they ended. Recorded interviews were corded and categorized to identify changes in family.
Results
Mothers concerns were categorized into three themes: sexuality education as a first step, sibling preparation for the older child and family, and family-centered childbirth. Mothers had [hoped to provide scientific knowledge on sexuality for their child], however they [worried about what topic to discuss with their child] and [searched for the age-appropriate approach for teaching sexuality]. After the classes, they [felt confident to talk about sexuality with their child], and [could see evidence of the child's good understanding of the classes]. At the same time they looked back on the past and [criticized their own sexuality education in childhood]. During pregnancy and before the classes, mothers [felt difficulty in dealing with their older child]and [hoped the older child would accept the newborn smoothly]. After the classes they [felt reassured that regression by the older child was healthy]and [realized how the class helped their child to grow up]. Mothers [expected childbirth with family] and [wanted to prepare the child to join the childbirth]; these were motives to participate in the classes. After the classes mothers[felt confident because of having same knowledge base]in the family. In addition, the classes [created the opportunity to face the coming childbirth].
Conclusion
The classes, one two-hour session, were effective in promoting positive changes for pregnant mothers with regard to their concerns for the older child and family centered childbirth. To confirm and clarify the effects of the classes we have to increase the number of participants and also assess long term effects.

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Objective
It is known that the concentration of salivary secretory IgA (sIgA), which is a local immunity, changes according to different levels of stress. In previous research, it has been reported that there are changes in the concentration of salivary sIgA due to exercise load and psychological stress, but there is not much data about pregnant and puerperal women. The objective of this research is to collect longitudinal and basic data about the salivary sIgA concentration from the time of pregnancy to the puerperal period, and to compare stress levels of Cesarean section delivery with those of vaginal delivery.
Method
The salivary sIgA concentration was measured using the enzyme immunoassay (EIA) against 61 healthy pregnant women (of whom 19 had decided on scheduled Caesarean deliveries, and 42 on vaginal deliveries. Saliva samples were taken three times: during pregnancy, directly after delivery, and during the puerperal period. The subjects were also asked to complete a "Profile of Moods States" (POMS). The ages of the subjects, parous experience, duration of labor, blood loss, and gestational age were also noted, as physical factors.
Results
1) There was a large individual difference in the salivary sIgA, between subjects but a rather strong positive correlation (P<.01) was seen in the longitudinal changes in the sIgA concentration (during pregnancy, directly after delivery, and in the puerperal period). 2) In the vaginal delivery group, there was no change in the sIgA concentration between the pregnancy period and directly after the delivery, but there was an increase in the puerperal period (P<.01). 3) However, the salivary sIgA, directly after delivery were significant higher than that in during pregnancy and puerperal period in subjects who received Cesarean section (P<.0001). 4) There were no significant differences in the sIgA concentration due to physical factors such as parous experience, duration of labor, blood-loss during delivery, age and gestational age. 5) The POMS scores changed during pregnancy, directly after delivery and in the puerperal period, but did not have any relationship with the sIgA concentration.
Conclusions
Depending on the method of delivery, it can be understood that the changes in the sIgA concentration during pregnancy and the puerperal period have different dynamics. These findings suggest that directly after delivery Cesarean section group mothers were under a lot of stress by comparison with the vaginal birth group. However, in view of the marked increase in the sIgA concentration in the Cesarean section group, it is also possible that other variables apart from stress (such as the influence of anesthetics) may affect the sIgA values. There is a need to consider particular factors linked to method of delivery when evaluating levels of stress during pregnancy and the puerperal period.

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Purpose
Because sleep is essential for normal pregnancy-associated physiological changes and healthy fetal development it is important to provide advice to first trimester expectant mothers in order to enhance self-care. Therefore, the aims of the present study are to clarify first trimester sleep quality and sleepiness characteristics, and to elucidate the affects of stress on sleep and sleepiness characteristics.
Methods
Self-administered questionnaires were distributed to 46 first trimester expectant mothers who were recruited from outpatient departments of two hospitals in Hiroshima, Japan between April 2007 and January 2008. The questionnaire was composed of the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), a sleep log, and the Perceived Stress Scale (PSS).
Results
The average global score of the PSQI (PSQIG) was 6.67 (±3.20), and 65.2% of participants exceeded the cutoff score. Participants with higher perceived stress had significantly higher PSQIG scores (r=0.38, n=46, p<0.01). There was a positive correlation with PSQIG (r=0.40, n=46, p<0.01) and regularity of bedtime, indicating that participants with well-regulated daily habits have lower PSQIG scores. The average ESS score was 10.1 (±4.3), with 50.0% of participants scoring 11 points or higher. Moreover, primipara had higher scores than multipara (un-paired t (44)=2.52, p <0.05), and those participants with more children had lower scores (r=-0.32, n=46, p<0.05). Sleepiness duration and nap duration were not significantly different for parity. For employment (employed or not-employed), nap duration was significantly different (un-paired t (27)=2.27, p<0.05), however, there was no significant difference in sleepiness duration.
Conclusion
This study has shown that first trimester expectant mothers have markedly poor sleep quality and higher levels of sleepiness when compared to women of the same age in the general population. In addition, this study suggests that sleep quality is improved by controlling stress and by having well regulated sleep habits.

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Purpose
This study was to clarify the characteristics and changes of the sleep-wake rhythm in mothers from late pregnancy to four months postpartum.
Methods
Participants were 57 women in late pregnancy to four months postpartum. The subjects were 57 mothers after 35 weeks of pregnancy who gave informed consent to participate. Of these, forty-seven mothers 1 month postpartum and thirty-four at 4 months postpartum, were surveyed longitudinally at.
Participant recorded 24 hours sleep-and-wakefulness using a day-by-day plot method on Sleep Log at intervals of 30 minutes for one week.
We calculated sleep parameters: total sleep time (TST), nocturnal sleep time (NST), diurnal sleep time (DST), longest sustained sleep period (LSP), LSP onset and offset times, numbers of total sleep hours and diurnal sleep hours, time of waking after sleep onset (WASO), number of WASO and sleep-wake cycle.
Results
TST were 7.79 hours in late pregnancy, 6.73 hours 1 month postpartum and 6.91 hours in 4 month after delivery (F=18.21, p<0.001). NST were 6.75 hours, 5.85 hours and 6.36 hours (F=12.27, p<0.001) respectively. LSP were 6.39 hours, 3.46 hours and 4.13 hours (F=87.61, p<0.001). TST, NST and LSP in postpartum were shorter than those late pregnancy. WASO were 0.42 hours, 1.70 hours and 1.14 hours (F=45.42, p<0.001). Number of WASO were 0.3 times, 1.7 times and 1.5 times (F=78.60, p<0.001). WASO in postpartum was longer than those late pregnancy, and number of WASO in postpartum was larger than those late pregnancy.
It was found that LSP showed significant negative correlation with LSP onset in late pregnancy (r=-0.481, p<0.001), and 4 months postpartum (r=-0.396, p<0.05).
In addition, LSP were predominantly between 0:22 and 6:50, while cycle of sleep-and-wakefulness rhythm was approximately 24 hours, which showed a range of 24.04 hours to 24.08 in the mothers in this study.
Conclusion
The sleep-wakefulness rhythm in mothers is disturbed from late pregnancy to postpartum, although TSP, NSP, LSP decrease and WASO increases. The mothers who go to bed early are able to sleep longer during nighttime hours and sleep-and-wakefulness was approximately 24 hours cycle in all mothers.

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Purpose
The purpose of this study was to clarify the factors related to the intention of nurses to continue working at maternity centers.
Methods
In this cross-sectional study, questionnaires were mailed to maternity centers. The prospective sample consisted of 1,632 nursing staff & midwives, nurses, and practical nurses — who handle childbirth at 136 maternity centers. The collected data concerned intention to continue, job satisfaction, and employment, and was examined for its relation to intention to stay. Dates were statistically analyzed.
Results
Completed questionnaires were returned by 1,037 (63.5%) nursing staff (334 midwives, 282 nurses, and 421 practical nurses) at 122 maternity centers. Among the nursing staff, a high percentage of nurses, 83.0%, intend to continue. Job satisfaction scores for nurses who intend to stay were significantly higher than those for nurses without intention to stay. Intention to stay and satisfaction with "balancing work with life" were statistically significant for each type of nursing staff, with odds ratios of 2.2 to 2.7. Intention to stay and satisfaction with "respect for the nursing job" were statistically significant with odds ratios of 4.5 for midwives and 3.8 for practical nurses. Three elements comprised this factor: the nurse-physician relationship, respect for nurses' opinions, and support from nursing administrators. The intention to continue, "multiple midwives in employ," and satisfaction with "work significance" also were statistically significant for all nursing staff.
Conclusion
The factors related to the intention of nurses to continue working at maternity centers were workplace satisfaction, "balancing work with life," "respect for the nursing job," "work significance," and employment of "multiple midwives." For midwives, "respect for the nursing job" was particularly important.

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Purpose
The purpose of this study was to explore the factors related to breastfeeding continuation and to examine the relationship between self-efficacy and breastfeeding continuation.
Methods
The subjects were mothers whose children were 2-3 years of age. Data were derived from three questionnaires: an original Breastfeeding Continuation Questionnaire, Japanese Breastfeeding Personal Efficacy Beliefs Inventory and the General Self-Efficacy Scale. The questionnaires were distributed to 1103 mothers; 424 were collected and 404 eligible questionnaires were analyzed. Statistical analysis employed the use of SPSS 15.0J for Windows. Two-sided p values equal to or less than 0.05 were considered to be statistically significant.
Results
The mean breastfeeding duration was 1 year 4 months, the mode was 1 year and the maximum was 4 years 3 months. The breastfeeding continuance related to 6 hospital practices in the first week after delivery: (1) practice rooming-in within 24 hours (p=.000), (2) give newborn infants exclusively breast milk (p=.000), (3) provide midwifery assurance for the mother that her milk will flow (p=.000), (4) practice breastfeeding during the nighttime on the day of birth (p=.002), (5) practice skin-to-skin contact for at least 20 minutes (p=.006) and (6) help mothers initiate breastfeeding within one half-hour after birth (p=.009). Of the factors after discharge, two were associated with the continuation of breastfeeding: the mothers felt they had sufficient breast milk (p=.000) and the midwives had helped her with breastfeeding (p=.000). In addition, the midwifery care for mothers who perceived milk insufficiency and were assured that their breast milk would flow adequately resulted in promotion of breastfeeding continuation. Breastfeeding duration was positively correlated with high self-efficacy on breastfeeding (r=.392, p<.01). Related factors were: mastery experience, verbal encouragement and physiological states.
Conclusion
Important factors determining the continuation of breastfeeding were the six hospital practices employed on behalf of the mother and newborn immediately after birth and during the first week of hospitalization. Of particular concern is that midwives need to identify and assist those mothers who feel they lack sufficient breast milk and then provide extra assurance that their breast milk will flow. There was a positive relationship between breastfeeding continuation and self-efficacy.

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Purpose
This study explored the characteristics of women with conceptions that preceded marriage and described their feelings toward babies, maternal behavior and marital relations.
Methods
A quantitative cross-sectional study was conducted by self-reported questionnaire among 198 (response rate 67.1%) primigravid women at the end of pregnancy and 173 (response rate 58.6%) husbands of those women. We distributed the questionnaire to pregnant women who were consulting an obstetrics clinic of a general hospital and collected census forms by mail or personal return. Census forms for these subjects consisted of background, attitude toward babies, maternal behavior, and marital relations, and the questionnaire for the husbands consisted of attitude toward babies, maternal behavior, marital relations and so on.
Results
There were 41 women with premarital pregnancy (20.7%). Twenty-one of these women were under 25 years old. The mean ages in the premarital pregnancy group for both the pregnant women (p<0.001) and their husbands (p<0.01) were significantly younger than control group, junior high school graduates or high school dropouts comprised significantly higher percentage than that in the control group (p<0.01). A key factor behind their decision to marry in the premarital pregnancy group were 'married because of pregnancy' was reported by about 70%, 'Planned marriage' was reported by about 50%. The score for feelings toward babies in the premarital pregnancy group was 28.3±8.1, and there was no significant difference between the two groups for feelings toward babies 'attachment'. However, scores for women in the premarital pregnancy group who are under 25 years old were lower than those of the control group. Negative feelings toward babies in the premarital pregnancy group were lower than those of the control group (p<0.05). Overall maternal behavior score did not significantly differ between the two groups. But in the subclassification 'I lead a well-regulated life ' (p<0.05), 'I aggressively participate in, mothers' classes and parents' classes and so on' (p<0.05), scores were significantly lower than those in the control group. In women who were under 25 years old 'I am happy when I image my baby' (p<0.05), 'I often talk to my baby' (p<0.01) were lower than those in the control group. There was no significant difference between the two groups regarding marital relations. Particularlly among women under 25 years old, wives in the premarital pregnancy group showed on lower marital relations score than that in the control group.
Conclusion
There was no significant difference between the two groups for feelings toward babies 'attachment', maternal behavior and marital relations. Negative feelings toward babies in the premarital pregnancy group were lower than those in the control group. Among women under 25 years old feelings toward babies 'attachment' and marital relation scores of their husbands were lower than those in the control group.

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The present study attempts to reveal the effects on children of being with their mothers during the birth of a sibling. The literature shows overall positive effects for fathers attending birth, however very little research has been done about how children are affected by witnessing birth. With the growing trend for entire families to take part in the birth experience, the authors believe it necessary to assess possible impacts on children from such practice before arbitrarily encouraging families to include children in the labor and birth experience.
Because young children often express themselves more freely through imagery than through language, drawings were used to assess the effects that witnessing birth had on children. Drawings were collected before, during, and after a sibling's birth from 24 children between the ages of two and twelve. The artwork was then examined from two different perspectives: an overview and a case study.
I An overall look at the artwork indicated no signs of trauma or shock. There seemed to be three patterns or tendencies for children as they drew in their sketchbooks during a two- month period; rendering drawings with more detail, about the same, or less organized. Half the children in this study drew pictures that became more detailed following the birth of their sibling. Eight others produced drawings with no significant changes. Drawings which tended to change towards regression-that is becoming more chaotic or less developed-after the birth were evident in four of the children.
II An in-depth look was given to the artwork of one boy who seemed to be negatively impacted by witnessing his mother's very difficult labor. In this case study, one can see how initial anxiety, surprise and fear gradually transform into his search for a new path, or way, to co-exist with the new baby in his home.
The results of this research show that family support seems to be a larger factor impacting siblings than actually witnessing birth itself. In addition, a tendency for very young children and boys in particular to be distressed by hearing and seeing their mother in pain was noted. In response to this, certain precautions are recommended in order to prepare children for the reality of childbirth and ensure a positive experience for everyone involved.

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Purpose
Recently, although most babies are delivered at hospitals, there is a shortage of obstetric doctors, especially in rural areas in Japan. Our purpose was to find themes and problems of present midwives by reviewing the history of midwifery education in Shimane Prefecture. We were inspired by the fact that Shimane Prefecture has 5 monuments commemorating 5 midwives dating back to 1918, an indication of the contribution of midwives in the past.
Methods
The initiation and transition of midwifery education in Shimane were investigated using reference literature, as well as interviewing related institutions and individuals between June 2003 and January 2006. Informed consent was obtained from each person and the findings were listed sequentially.
Results
We found that midwifery education in Shimane started in 1891, as the Matsue Nongovernmental Training School for Midwives. Though the name of the school was changed several times, it remained open until 1953. The school was discontinued until 1982, then restarted and continues as of today. However, the number of midwives remains insufficient.
Conclusion
Although situations of pregnant women and the role of midwives have been changing in accordance with the generations, midwives should be aware of the importance of their specialty to assist each pregnant woman for secured delivery, as well as collaborations with obstetricians and other midwives, while advocating a sufficient number of midwives to meet the present-day needs.

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