Purpose
We investigate the three points of view concerning the practice of clinical care delivery and continuing midwifery care from the perspective of newly graduated midwives. The first point of view concerns cases in which the clinical practice is successfully applied in the clinical setting. The second concerns cases in which the newly graduated midwives face difficulties in the clinical setting. The third concerns newly graduated midwives' suggestions regarding the practice of clinical care delivery and continuing midwifery care. This study evaluates the efficiency of the practice of clinical care delivery and continuing midwifery care.
Subjects and Method
Semi-structured interviews were conducted on seven midwives who had graduated from a midwifery educational program three or four months prior. Interviews were transcribed and a qualitative inductive analysis was performed using the methods of Berelson.
Results
Clinical practices that were successfully applied in the clinical setting were "midwifery diagnoses and skills based on practice experiences" , "midwives' responsibilities and attitudes affected by communication with senior midwives and pregnant women" and other two factors. Concerning about a difficulty in the clinical setting, the midwives reported "confusion regarding diagnoses due to a lack of experience" and other three factors. During interviews, the newly graduated midwives reported that they hoped to learn about "breast diagnoses and health guidance for breastfeeding care through senior midwives' advice", "midwifery diagnoses and skills for understanding pregnant woman and newborn babies" and other two factors.
Conclusion
The present findings suggest the following four points for improving clinical practice:
1. Reconfirm what the subjects learned by reflecting on the care delivery after each practice.
2. Emphasize the importance of experience in caring for pregnant woman, and establish an environment that encourages advice from senior midwives
3. Use practice time effectively for midwifery care other than care delivery, and motivate students.
4. Experience the practice of breastfeeding care with a model midwife.

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Purpose
The purpose of this study was to clarify what information concerning intrapartal care midwives focus on, and to analyze the relationship between the data, years of experience and the number of assisted deliveries.
Methods
The subjects of this study were 768 midwives (553 who worked at hospitals or clinics, and 215 who worked at maternity homes) in Japan. Data were collected using a self-reported questionnaire. The questionnaire consisted of demographic information and 177 items regarding provision of care for normal delivery. We asked the midwives to rate the importance levels of the 177 items using the five-point Likert scale. Factor analysis was used to clarify the importance of the factors and two-way analysis of variance (ANOVA) was used to analyze the effects of the number of years of experience and number of assisted deliveries. The midwives were divided into groups based on whether they had more or less than ten years of experience following the "ten-year rule", and into those with less than 300 assisted deliveries and more than 300 assisted deliveries based on the mean of the group with less than 10 years of experience.
Results
The response rate was 56.9% (n=437). To conduct statistical analysis, appropriate data from 433 respondents were used. As a result of factor analysis, 17 factors composed of 82 items were extracted from the 177 items (cumulative percentage contribution: 67.9%). The 17 factors included data about various physiological and psychological aspects of women, requests for care, the family situation and birth environment. ANOVA revealed a statistically significant main effect for the number of years of experience. Comparing the mean importance-level scores of the 17 factors for those with more than ten years of experience and those with fewer, the more experienced group had significantly higher scores for 9 factors (p<0.01). These 9 factors included psychological condition, family situation, requests for care, timing of cutting the cord, protection of the perineum or not, and the lunar cycle in nature. The 8 factors for which there was no significant difference with years of experience included the physiological condition of women, data obtained using medical equipment and the environment in the labor room. No significant main effect was observed between any of the 17 factors and the number of assisted deliveries.
Conclusion
Seventeen selected factors provided an overall picture of the concrete information that midwives considered to be important to provide intrapartal care. Of these, 8 factors for which there was no significant difference related to the number of years of experience consisted of visual and objective information. The 9 factors for which there were significant differences reflected midwives' competency related to more than ten years of experience such as insight, communication and responding to diverse needs. It is suggested that these 9 factors indicate midwives' competency acquired through accumulation of more than ten years of experience.

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Purpose
The aim of this study was to clarify the process of how women perceived the experience of giving birth after maternal transport.
Methods
The study participants were 5 women, approximately one month after childbirth, who had experienced maternal transport in 2 perinatal care facilities. Semi-constitutive interviews were conducted with the participants and data was collected. The data obtained was qualitatively described and analyzed.
Results
From the stories of the 5 women, the results of analysis of the perception process in the experience of childbirth after maternal transport extracted 6 categories and 15 corresponding sub-categories.
Women who gave birth after maternal transport could do nothing but "leave it to the medical staff" when she was feeling anxiety for herself and her child due to unexpected circumstances and treatment from stressed medical staff. The desire to escape from a situation where independent decisions could not be made was "an interpretation of the present situation based on the medical staff's explanations and a past experience". However, by grasping the state of affairs, they understood that it was impossible to return to the situation that they were hoping for and therefore there was only the option of "accepting an unescapable situation". The women used "decision-making that puts the child first" discerning that it was their mission to prolong the pregnancy for as long as possible to ensure that appropriate medical care was available immediately following the birth. After birth, they were "wavering in the unifying experience of childbirth" and interpreting the result of having chosen alternative methods of pregnancy and childbirth that differed from what they had themselves imagined as something worthwhile, and modifying the discrepancies between ideal and reality. The women were "depending on the people around them" such as family, patients in the same ward and medical staff to unify the sense and acceptance of the state of affairs, decisions and the experience of childbirth.
Conclusion
Women who have given birth through maternal transport need support from those around them so that they can understand the circumstances in order to make a reconstruction of the sequence of events surrounding the birth as their own experience. Further, the necessity of a connection in order for the women themselves to give meaning to the situation where they had no other option but to choose an alternative method was suggested.

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Purpose
To examine the reality of menstruation-related symptoms among women raising infants in various stages of menstruation, and identify changes in their handling of their children through a menstruation cycle, broken down by the types of menstruation-related symptoms: To study whether the types of menstruation-related symptoms could cause variations in the mothers' sleeping status, health status, perception of parenting support, sense of satisfaction in life and feelings toward parenting.
Methods
The study distributed questionnaires to 192 women currently raising infants concerning their menstruation-related symptoms and handling of the children during different stages of a menstruation cycle (follicular phase, luteal phase and menstruation period). At the time of the initial survey, the samples were also asked about their sleeping status, health status, perception of parenting support, sense of satisfaction in life and feelings toward parenting. Statistical analysis was conducted on 172 valid responses (89.6%).
Results
1. According to the types of menstruation-related symptoms, the samples (with the average age of 35.6) were divided into those with minor symptoms (60 samples, 34.9%), those with the tendency of period pain (29 samples, 16.9%), those with a PEMS tendency (53 samples, 30.8%) and those with a PMS tendency (30 samples, 17.4%).
2. As for their handling of children, broken down by the types of menstruation-related symptoms, the group with a PEMS tendency returned significantly lower scores in emotional and nurturing attitudes during the menstruation period.
3. Compared to other groups, the group with the PEMS tendency had a greater proportion of samples who reported proneness to tiredness and health conditions. This group, compared to the group with lighter menstruation-related symptoms, returned a significantly lower score in "husband's participation/cooperation in parenting" in the question concerning their perception of parenting support. The score indicating their level of satisfaction in the past and present life was also significantly low.
Conclusion
The breakdown of menstruation-related symptoms among matured women raising infants has indicated the possibility that many of them have a PEMS tendency, which is considered to be more typical among women in their teens to early 20s. Those with a PEMS tendency are likely, during the menstruation period, to suffer a compromised capacity in handling children, feel that their husband do not provide sufficient support, and indicate a low level of satisfaction in life. These findings point to the need to, when formulating parenting support, identify menstruation-related symptoms of applicable women, and consider extending assistance in reducing the symptoms.

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Objective
This research sought to clarify the variety, manifestation period, incidence rate, and frequency of minor symptoms (hereafter, MS) currently experienced by expectant mothers.
Method
Questionnaires were distributed to 623 expectant mothers (56 first trimester, 201 second trimester, 366 third trimester; 28.1±8.0 mean gestational weeks) who were present for medical examinations in Obstetrics and Gynecology Outpatient Departments of 11 hospitals throughout Japan. The questionnaire inquired about 95 symptoms gathered from previous research, studies related to MS, and interviews with expectant mothers and puerperal women asking about symptoms during pregnancy.
Results
Of participants who exhibited symptoms more than 50% experienced 45 of the 95 symptoms. Forty-seven symptoms with high incident rates (more than 50%) or high frequency rates (from "often present" to "always present") were designated as MS for this study. Fatigue, increased urinary frequency, and general malaise were experienced at a high frequency by more than 90% of participants. Each participant experienced from 2 to 46 MS. The average number of MS per participant was 27.0 (±10.4). There was no significant difference in the number of MS by parity. Not-employed participants experienced more MS than employed participants, and in particular, not-employed primipara experienced a higher number of MS. When comparing first, second, and third trimester participants, no significant difference was found in the number of MS, however, high incidence MS did differ. After factor analysis of the 47 MS the following five groups of symptoms were extracted: "muscle and joint pain related to fetal development", "upper gastrointestinal", "sleep related", "constipation related", and "negative psychological".
Conclusion
The results of this study identified MS not found in previous research and changes in the incidence rate of MS, which may be attributed to alterations in the expectant mother's lifestyle, environment, and employment status. Because the appearance of MS with high incidence rates differ according to trimester or individual attributes this study suggests the importance of providing expectant mothers with timely health care advice and education that is appropriate to their condition.

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Objective
To describe the mothers' stories following the stillbirth, especially the meaning of the existence of the deceased children for them in their grieving process.
Methods
A descriptive, exploratory qualitative study was used. Unstructured interviews were conducted 2 or 3 times for each participant. Tape-recorded interviews were transcribed and analyzed qualitatively and inductively. Data analysis started from description of each mother's experience. Then, common themes were found relating to the mother's feelings about the deceased child. Finally, structured descriptions of the mothers' stories were derived from the data.
Participants
Five mothers who have experienced stillbirth and have participated in self-help groups for bereaved parents.
Results
In the early grieving stage, the theme of "existence of anguish" emerged. The theme of anguish had 5 components 'my lovable child', 'my child is dead', 'child whose life could have been saved', 'child disregarded by society', and 'invisible child'. In the later grieving stage, the theme emerged where mothers incorporated the children into their life and that they would "exist together" and remain connected over time. The emerged components to this theme are as follows: 'existence of the deceased child in the storytelling which cultivates identity as a mother', 'giving the deceased child a comfortable place', and 'existence of the deceased child who encourages the mother's personal growth'.
Conclusion
In the beginning of the grieving process, mothers suffered strong anguish from the deceased children such as regret, self-blame, getting hurt, and emptiness. However, it was found that the bereaved mothers described positive change by incorporating the deceased children into their life through storytelling and mementos as time goes on. The positive change means personal growth. In this process, mothers always faced the existence of the deceased children, even though they didn't have any time with their visible living children due to stillbirth.

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Purpose
The purpose of this study is to clarify the experiences of midwives in caring for mothers of high-risk infants in post-partum wards.
Methods
There were a total of ten participants in this study who were all midwives employed at postpartum wards of hospitals that champion NICUs (Neonatal Intensive Care Units). All participants have had experience concerned with the care of mothers of high-risk infants within the past three years.
A qualitative research design by means of a phenomenological approach was adopted. Data collection was carried out by way of unstructured interviews. Data analysis involved the following six processes: 1) turning the contents of interview into a transcription 2) imaging the world of the participants gathered from rereading the data 3) presenting the experiences of the target midwives as tentative themes 4) explicating the tentative themes from the other participants' data 5) integrating the themes showing the experiences of midwives for all ten target participants and describing both the data that supports the themes as well as the interpretation of it 6) continuing the search for the essence at the root of the midwives' personal experiences and integrating the personal experiences of the midwives. Researchers reflected on their own personal experiences in clinical pathology and investigated ways that would be useful to get closer to the participants' own personal experiences.
Results
The essences of the midwives' experiences in caring for mothers of high-risk infants in post-partum wards were image, desire, and a sense of mission/role consciousness. Mothers of high-risk infants have an image of tracking out a mental process related to feelings of guilt; there is a desire for the mother to accept the baby; and there is a sense of mission/role consciousness for the midwives to listen to mother's feelings. With these types of essences supported, the following five themes with characteristics of the personal experiences of the midwives shown clearly will emerge. Theme 1: I hope the mother will accept the baby. Theme 2: I want to accommodate for the mother's feelings while the care is given. Theme 3: I do not want the mothers to experience any extra stress. Theme 4: Difficulty in listening. Theme 5: I want to deepen my relationship with the mothers.
Conclusion
This time, the relationship between the experiences of both mothers of high-risk infants in post-partum wards and the midwives that care for them became obvious. Together with the understanding of these kinds of experiences, from now midwives can care with self-confidence. It is necessary for midwives that are specialists in the subject of caring for mothers of high-risk infants to take training that emphasizes listening skills.

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Purpose
The purpose of this qualitative study was to clarify key emotional processes experienced by women who achieved pregnancy via assisted reproductive technology.
Subjects and methods
The participants in this study were eight primiparas who achieved pregnancy via assisted reproductive technology. One to six months after delivery, data was obtained using semi-structured interviews and, after obtaining participant consent, was qualitatively analyzed via a phenomenological approach.
Results
Over the course of the pregnancies, the following nine major themes were identified: Feelings of Mission and Pressure by Becoming Pregnant, Attention to the Avoidance of Jealousy, Wisdom in Overcoming Anxiety, Maternal Self-consciousness, Release from Feelings of Loneliness, Recovery of Self Confidence, Positive Acceptance of Infertility and the Treatment Experience, Confirming One's Awareness of Growth, and Feeling Authentic Joy from Pregnancy.
Following knowledge of conception, the informants reported feeling pleasure from the experience, accompanied by thoughts of a sense of mission and of pressure. At the same time, they also experienced feelings of oppression from the blessing of pregnancy. They paid special attention to avoiding jealousy of others when having pregnancy check-ups, and underwent a stage of maternal self-consciousness from the early stages of the pregnancy that was accompanied by a consciousness of their fetus. They managed their feelings of anxiety by using wisdom to overcome, and through the process, underwent a passage of release from feelings of loneliness. Informants by their fifth month of pregnancy spoke of a recovery of their self confidence, a positive acceptance of their earlier infertility and the treatment experience, as well as a confirmation of own personal growth. They all underwent days of considerable joy from the beginning to the conclusion of the pregnancy.
Conclusion
It was concluded that the emotional process among women who achieved pregnancy via assisted reproductive technology could be understood qualitatively along these nine major themes. They experienced peculiar feelings until the fourth month of pregnancy. Their fifth month of pregnancy became a turning point, and their feelings did not differ significantly from those of women during a typical pregnancy.

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