Purpose
The purpose of this study was to analyze the concept of perinatal loss and examine the possible applicability of that concept to perinatal, postnatal, and maternal 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 contents were qualitatively analyzed for attributes, antecedents, and consequences.
Results
The attributes of perinatal loss were found to be: 1) could not deliver a healthy baby, 2) recognition of being a parent, 3) acknowledgement of the couple and family members' feelings.
The antecedent was death of a baby by miscarriage, stillbirth, or neonatal death.
The consequences of normal grief were: 1) recover a sense of being ordinary, 2) living at heart with their lost child, 3) deepen the bond of the couple and family members again. On the other hand, the consequence of prolonged grief was a turning for the worse of the marital relationship.
The definition of perinatal loss was as follows: the couple who lost a child in the perinatal period had the feeling that they could not deliver a healthy baby, recognition of being a parent and acknowledgement of the couple and family members' feelings.
Conclusion
It is recommended that women and families who experience perinatal loss and normal grief be aware of the emotional response, and consider each other, progress toward recovering a sense of feeling ordinary, live at heart with their lost child and deepen the bond of the couple and family members again. On the other hand, for those who experience prolonged grief a need exists to recognize a possibility of a turning for the worse of the marital relationship. The concept of perinatal loss is widely understood in the field of childbearing. The possibility of it being further developed is anticipated as the body of experiences with patients grows. Nurse midwives need to understand the meaning of what is lost for parents following the death of their child. As a result, it is the underlying basis of perinatal loss care for Japanese culture.

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Purpose
The purpose of this study was to devise a safe and effective foot care method and to determine the psychological and physiological impact of this method on pregnant women.
Method
Eleven healthy pregnant women at 32-37 weeks of gestation participated in this study. Each participant received foot care for 25 minutes involving fomentation of the sub-knee region followed by a gentle foot massage from the peripheral to central direction. Pulse rate, blood pressure, circumference of their calves, skin temperature, skin blood flow, and brain waves were measured before and after performing foot care. Subjective symptoms associated with their feet were assessed by a questionnaire survey performed immediately before and after, as well as the day after foot care was performed. Uterine contraction and fetal health were monitored during the intervention. Physiological and psychological measurements taken before and after foot care were compared using statistical analyses.
Results
1) Many women reported improvements in the condition of their feet, which continued through the following day. Circumference of their calves also decreased after receiving foot care. 2) Women felt refreshed after receiving foot care, which continued through the following day. Foot care also had a relaxation effect, as evidenced by decreased pulse rates. 3) Blood circulation improved during fomentation, as evidenced by an increase in skin temperature and skin blood flow. However, we were unable to detect whether this effect persisted. 4) Consistent with the predominance of α3 waves in the brain wave patterns, women became sleepy during and after foot care. 5) Foot care had no adverse effects on uterine contractions or the fetus.
Conclusion
The foot care method used in this study was designed to be safe for healthy pregnant women. Foot care helped pregnant women relax and feel refreshed, and improved the conditions of their feet. Our findings suggest that foot care is both physiologically and psychologically beneficial for pregnant women.

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Purpose
The present study aims to make a sampling of the factors constituting the observation viewpoints by midwives in the community who are well versed in breastfeeding during lactation period, and thus to clarify the characteristics of their viewpoints.
Methods
The study was carried out at a midwife clinic specializing in breastfeeding support, a hospital and a maternity center in Japan. The subjects for this study were 6 midwives, and 25 postnatal women who received the breastfeeding care by the midwives for the first time were employed as the study collaborators. We conducted the semi-structured interviews with the subjects after making observations at breastfeeding care for the study collaborators, and made a sampling from the data collected that were deemed to be the "observations by midwives". Then we compared our categorized data with those in the literature.
Results
The observation factors for assessing breastfeeding care by midwives for the postnatal women and the children were composed of the 3 categories, i.e. "Mother", "Child" and "Mother and Child". In comparison with the previous studies, the category of "Mother" was found to additionally contain the sub-categories of "Behavior Characteristics", "Reflection" and "Image" as the indicators of psychological state, and the sub-categories of "Clothes", "Lifestyle" and "Medical support" as the indicators of social state. The sub-category of "Behavior characteristics" indicated the women's behavior based on their cultural values. The "Child category" was newly sub-divided into "Power" and "Follow-up". Also in the category of "Mother and Child", the sub-category of "Event" was newly added in the present study. As the observation characteristics by midwives, the observation factors attaching great importance to specific and individualized aspects of the environment or life surrounding a mother and child were taken as a sample. Among such observation factors, especially the observation factor of midwives evaluating the conditions of breasts by touching them using their own hands was taken as a sample. Furthermore, as the characteristics of the observation viewpoints by midwives, these were constructed on not only the respective viewpoints of "Mother" and "Child", but also the viewpoint of the dyad of "Mother and Child".
Conclusion
It was found that, in breastfeeding care, midwives observed multi-facedly the detailed information closely related to the life of a mother and child during the lactation period, examining directly the breast conditions by their own hands. Moreover, their observations characteristically consisted of not only the respective viewpoints of "Mother" and "Child", but also the viewpoint of the dyad of "Mother and Child".

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Purpose
This study sought to identify factors related to "anger/hostility" of mothers of eighteen-month-old children, and to investigate influences of these on feelings toward their children, and then, to obtain basic materials for parenting support that may result in helping prevent child abuse.
Methods
Self-administered survey questionnaires were mailed to 69 mothers who were followed continuously since late pregnancy and whose children turned eighteen months old. Valid responses were obtained from 33 mothers who provided complete information at all time periods: late pregnancy, postpartum hospitalization, and one month and eighteen months after birth. Question items included personal attributes, types of stress and ways of coping, feelings based on the Japanese version of the POMS (Profile of Mood States), feelings toward their children, and feelings toward their husbands.
Results
Levels of "anger/hostility" at eighteen months after birth were the highest among all study periods, and they were highly correlated with levels at other periods, and with negative mood. This period also showed high scores of positive feelings toward children, and yet scores on negative or ambivalent indices were also high at that time. There were significant differences in positive feeling scores across time periods. Variables associated with "anger/hostility" at eighteen months after birth were: age, stress consciousness, "fatigue" in types of stress, "abandonment/resignation" and "affirmative interpretation" in stress coping, and "negative feeling" toward husbands. While there was no direct correlation between "anger/hostility" and feelings toward children, there were causal relations between scores of positive feelings toward children and "affirmative interpretation" in stress coping, and between scores of negative or ambivalent feelings toward children and negative feelings toward husbands.
Conclusion
Factors related to "anger/hostility" at eighteen months after birth are not directly attributable to the children, but appear to be associated with husbands or fatigue. Yet, unresolved "anger/hostility" and its potential to induce child abuse is a concern. It is thought that the following are useful as a preventive plan: providing solutions by encouraging mothers to cope with stress positively rather than by abandonment or with resignation; promoting a common understanding of the sex roles between married couples; and at check ups one-month postpartum, providing the mother with a physical check up, coaching about breast feeding, psychological assessment and advice, and reconsidering the need for childcare that prioritizes family relationships, including relations with husbands.

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Objective
In perinatal care provided by midwives, infections can spread via the hands because they often come in contact with blood, body fluids, and excrement. The present study clarified the relationship between the use of gloves and individual attributes of midwives.
Methods
Subjects were 189 midwives working at hospitals with obstetric facilities in Tokyo who completed a self-administered questionnaire survey. The questionnaire was designed to ascertain individual attributes, such as age, experience, and level of interest in preventing hospital-acquired infection, and the use of gloves in ten perinatal-care procedures with various levels of exposure to blood, body fluids, and excrement. The use of gloves was assessed in four grades, from "always" to "never". With respect to individual attributes and glove usage, the subjects were divided into two groups, and a χ² test was used to assess association.
Results
Responses were obtained from 177 midwives (response rate: 93.6%). With regard to the use of gloves, the proportion of midwives stating "always" was 100% for direct assistance during the second and third trimesters and ≥98% for vaginal examinations of pregnant women and placental measurement and procedures. The proportion stating "never" was 74.1% for breast care and 64.1% for neonatal diaper changing. As to the relationship between individual attributes and glove usage, the factors varied among the perinatal-care procedures. With some perinatal care procedures, glove usage associated to nursing education, midwife education, infection-related education, and recognition of the standard precautions. Age and clinical experience besides obstetrics did not correlate to use of gloves during any of the perinatal care procedures.
Conclusions
The results showed that the majority of midwives wore gloves when they could not avoid coming into contact with blood or body fluids, but that most midwives did not wear gloves when they could have come into contact with milk or neonatal feces. In addition, midwives did not necessarily wear gloves if they did not think they would come into direct contact with blood or bodily fluid.
As glove usage in some perinatal care procedures was related to relevant education, it is necessary to improve education about infection before and after graduation.

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This study was conducted to clarify the first one to one-and-a-half year experiences of fathers whose first child was a preterm baby.
The research subjects were fathers whose first child was born preterm 1-1½ yr. prior to this study.
For this inductive qualitative study, the data were collected through semi-structured interviews.
In asking for the fathers' cooperation in this study, the research objective was explained to them verbally and by written document. Additionally, it was explained to the research subjects that they would not be disadvantaged if they decided nor to cooperate in this study, that they would be able to withdraw from the research at any time, and that their privacies would be protected.
Six fathers agreed to participate in this study. The average age of the subjects was 38 (ranged in age from 35 to 44). The gestational age of the subjects' babies ranged from 28 to 33 weeks, and their birth weights ranged from 980 to 1,740 grams.
Fathers' first 1-1½ yr. experiences were classified into six categories: 1) concern about and wish for the life of their child and wife; 2) concern about their wife; 3) relief and excitement about childbirth and having a child without any physical defect; 4) concern about having a child who is different from a "normal" child; 5) beginning of bonding with their child; and 6) realization of their child growing up to be a "normal" child.
This research illustrated that fathers devoted their energies to protecting their preterm child when they felt strong anxiety about the child. Yet, fathers became more conscious of the need for child upbringing and discipline after they felt that the child was catching up with "normal" full term children.

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Purpose
To confirm the effects of relaxing back massages on early healthy postpartum mothers by using autonomic nervous system activity and subjective self-ratings derived using a questionnaire on relaxation.
Method
We randomly assigned 45 healthy mothers who had delivered 3 days previously to 2 groups: intervention group (22 mothers who received 20-min back massages with odorless oil) and control group (23 mothers who did not receive back massages but were instructed to rest in bed in the supine position). A quiet climate-controlled room was used. Autonomic nervous system activity was assessed using the heart rate, RR-interval variability, LF/HF (low frequency/high frequency) ratio, and HF, all of which were measured using LRR-03 (GMS). The data of RR-interval variability and subjective relaxation scores were used to determine the effects of back massages.
Result
The heart rate and LF/HF ratio decreased, while the HF value and relaxation score increased in both the groups. Although the results derived using the RR-interval variability data and relaxation scores indicate that back massages had a relaxing effect, no significant differences were detected between the groups. In some mothers of the intervention group, unique and varying patterns of heart rate, HF, and LF/HF ratio were observed because of changes in their autonomic nervous system activity.
Conclusion
Back massages seemed to predominantly activate parasympathetic rather than sympathetic nerves. They also apparently produced a feeling of relaxation. However, the results did not validate any substantial effect of the relaxing back massages on postpartum mothers because of the absence of a statistically significant difference between the 2 groups. We estimate that this result is attributable to the following factors: frequent resting in bed in the supine position, sleeping during the intervention, inter-individual differences in autonomic nervous system activity, and time since delivery.

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Purpose

As a preliminary investigation prior to a study involving pregnant women, we conducted a cold-water lord test in adult females to objectively evaluate chilliness (hiesho). In addition, we examined its association with symptoms and physical findings.
Subjects and Methods
The subjects were 45 healthy females. They were instructed to immerse their left hands in cold water (15ºC) for 1 minute (cold-water loading). We measured the finger skin temperature and peripheral blood flow for 10 minutes after loading, and calculated the level of recovery of the dermal temperature as a percentage of the pre-immersion value (recovery rate).
Results
In 9 females (20%), the recovery rate after 10 minutes of the finger skin temperature was less than 90% (unfavorable recovery group). In this group, the finger skin temperature before loading, pre-lording peripheral blood flow, basal metabolic rate, body mass index, and percent body fat were significantly lower than in the favorable recovery group. There was no significant difference in the Hiesyo Sensation Scale. The finger skin temperature before lording (r=0.501), peripheral blood flow before loading (r=0.392), and basal metabolic rate (r=0.368) were correlated with the recovery rate after 10 minutes. However, the accuracy was estimated to be low using regression analysis.
Conclusion
The recovery rate of the dermal temperature after cold-water loading was lower in females showing a lower dermal temperature, peripheral blood flow, and basal metabolic rate. However, there was no association with hiesho-related symptoms.

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Purpose
The purpose of this study was to explore the process of achieving confidence as mother four months after giving birth.
Methods
The subjects of this study were ten first-time mothers with four-month-old children who joined an event at a health care facility in a city in Japan. The data were collected using semi-structured interviews and recorded with the mothers' consent. They talked mainly about their perceptions as mothers and how they perceived their infants. We did a continuation comparative analysis. The data were summarized and categories were extracted. Finally the relationships among the categories were reviewed.
Results
The analysis resulted in the emergence of five categories: (1) establish how to take care of herself and her infant through trial and error, (2) realizing the growth of her infant and herself, (3) feeling that her real identity is a mother, (4) making childrearing a priority while also attending to housework and make a new start in life and (5) finding support to validate herself. After giving birth, mothers establish childrearing methods through trial and error. Also they experience the growth of their infant and acquire an actual feeling as mothers. Furthermore, mothers balance taking care of the infant with housework and can make a fresh start in their life after three months. Mothers recognized the evolution of their childrearing ability through the above process.
Conclusion
Only educating mothers about childrearing methods is insufficient. Through mothers' contact with their infants, they notice infants' growth and change. This leads to an actual feeling that she herself is growing as well. Furthermore, for mothers of infants four months old, mothers can balance housework and childrearing as they grow in confidence.

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Purpose
Oronasopharyngeal suction is routine neonatal care in many institutions in Japan. However, few studies have proved its efficacy in normal-term newborns. The purpose of this study was to evaluate the effects of oronasopharyngeal suction on oxygen saturation (SpO₂) and heart rate (HR) among healthy, term and vaginally newborn infants.
Methods
The subjects were 26 healthy, term and vaginally newborn infants whose mothers had no complication during pregnancy. They were randomized to suction and no suction groups for each week. The oxygen saturation and heart rate were documented 30 second-by-second starting from the fifth minute of life until two hours later. Two outcomes were defined, time to reach SaO₂ of ≥ 96% and time to do HR of ≤ 160 bpm, indicating stable status of respiratory and circulating functions, respectively.
Results
It took 623 ± 266 (mean ± SD) seconds to reach SpO₂ of ≥ 96% in no suction groups (n=13), 687 ± 205 seconds in suction groups (n=13). It took 593 ± 332 seconds to reach HR of ≤ 160 bpm in no suction groups, and 755 ± 442 seconds in suction groups. There were no statistically significant differences in either stable SpO₂ or HR between the two groups. SpO₂ and HR were likely to stabilize earlier in no suction groups than suction groups during the first 10 minutes, though no significant difference was observed.
Conclusion
The results of this study showed no physiological basis for oronasopharyngeal suction in healthy, term, and vaginally newborn infants. The clinicians including midwife should reconsider oronasopharyngeal suction as a routine procedure.

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Objective
The aim of this study was to qualitatively determine male partner behaviors perceived as supportive or collaborative by infertile Japanese women.
Methods
Semi-structured interviews were conducted with 24 Japanese women living in the Kanto area currently undergoing fertility treatment. Subjects were asked about supportive or collaborative behaviors and attitudes of their partners relating to fertility issues and treatments. Interview data were analyzed qualitatively.
Results
The following five categories of supportive/collaborative partner behaviors were clarified. 1) Participation in treatment process, such as providing semen for examination of sperm and for treatments such as artificial insemination by husband (AIH) or in-vitro fertilization and embryo transfer (IVF-ET), undergoing semen analysis, having intercourse at specified times, taking medicine to increase sperm production. 2) Expressing concern or interest in fertility issues and treatments, including the results of treatment and examinations, or freely discussing these issues with their partner. 3) Displaying concern for their own health, such as eating foods that enhance sperm production. 4) Providing emotional support, such as being considerate of their partner's emotional distress resulting from treatments or concerns over being unable to have children, expressing concern for their partner's mental and physical health, expressing approval of living as a childless couple, and respecting their partner's choices regarding treatment type and continuation of treatment. 5) Performing supportive tasks or care, such as doing housework or taking care of their partner following treatments.
Conclusion
The present findings qualitatively determined male partner's supportive or collaborative behaviors and attitudes as perceived by infertile Japanese women. Five categories of partner support during the treatment process were suggested. Results indicated that the first three categories were considered to be performed only by partners, while the others could also be performed by family members and friends.

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