Purpose
The objective of this study was to elucidate the process of acquiring a feeding method by mothers of 0-3 month-old twins.
Subjects and Methods
Research was conducted based on the Grounded Theory Approach using the Symbolic Interaction Theory proposed by Blumer as theoretical bases. Data were collected by observation of participants and semi-structured interview methods from 5 mothers of twins who had no congenital anomaly or disease at birth and who started breastfeeding immediately after birth. Interviews took place during postpartum hospitalization, and at 1 month and 3 month check-ups of infants. The methods of Strauss & Corbin (1990/1999) and Saiki (2005) were used for analysis.
Results
The process of acquiring a feeding method by mothers of 0-3 month-old twins was "acquisition of due proportion feeding". "Due proportion feeding" is a feeding attitude that applies the concept of "due proportion" clarified by Jean Simon Pictet (Inoue, 1975). It is a unique feeding attitude toward twin created by their mothers who make judgments "taking priorities into consideration", while having "contradictory feelings" about "comparing the twins" in order to "respect their individuality" and "respect equality". During hospitalization, mothers conducted "accompanied feeding" in which midwives accompany their feeding. After discharge, "pressure from crying infants" was increased and "unusual physical condition" occurred, but mothers handled the crying twins by "supplementing with formula after wavering" or using "a strategy to overcome frequent feeding". Until 1 month postpartum, mothers selected feeding methods caring mainly about the weight difference of the twins, but concern about the weight difference disappeared with "growth of the babies" and they came to feed the infant with higher priority by comparing the twins, in order to understand their individual characteristics. Then "pressure from crying infants" decreased and mothers shifted to "mother-led breastfeeding" where the twins were fed based on their needs and conducted "continued breastfeeding".
Conclusion
The process of acquiring a feeding method that fits the mothers of 0-3 month-old twins was "acquisition of due proportion feeding". Healthcare professionals should understand this process and provide support so that the mothers of twins understand the characteristics of each individual infant.

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Objective
The purpose of this qualitative study was to identify those attitudes and actions by healthcare professionals that detracted from the breastfeeding mother's confidence in nursing her infant.
Methods
The subjects of this research were a convenience sample of 40 mothers: 35 were recruited at a breastfeeding counseling room at a nursing college in Tokyo and five from a sibling preparation class at the same location. Data were collected from August through November 2007 following established ethical procedures. Researchers used semi-structured interviews about problems and coping with breastfeeding and providing nutrition for their infant. All interviews were taped and transcribed. The data were systematically analyzed. Codes were extracted and then aggregated into sub-categories from which categories were created. A research team provided conformability.
Results
Regarding breastfeeding support, the interviews revealed that some interactions with health care professionals were described as: "unhelpful", "causing anxiety", and "results in confusion". Identified were five categories of behavior of healthcare professionals that failed to support the breastfeeding mother thus, contributing her sense of confusion and anxiety about nursing her infant: (i) intrusive behavior of healthcare professionals dismissing the mother's wishes and intentions to breastfeed, (ii) insufficient help to become independent with breastfeeding, (iii) dismissing the mothers' feelings, (iv) discordant advice from the mothers' expectation, and (v) provision of inconsistent information. Mothers desired to institute frequent breastfeeding including the addition of human milk substitute provided by healthcare professionals. Unfortunately those health care providers did not listen?to their requests nor did they?respond?empathically to?the?mother's sense?of?suffering?and anxiety of breastfeeding and the child?rearing. Mothers choose to breastfeed; they felt a sense of commitment to providing the best nutrition that could to protect their infants. The lack of support and concern by health care providers left mothers with a burden of regret and a sense of failure about their ability to breastfeed. The sense of failure continued after discharge and they continued to experience challenges?and?difficulties about their breastfeeding or expression?of?their milk at home. Mothers were left alone to manage their breastfeeding problems.
Conclusions
Women were motivated to breastfeed but their interactions with health care providers resulted in feelings of failure, confusion and anxiety. Health care providers need education to promote: (i) mother-driven support considering mother's intentions, (ii) support for mothers to be independent breast-feeders, (iii) empathy for the mother's feelings, (iv) adequate observation and assessment ability, and (v) provision of consistent information based on an evidence.

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Purpose
The purpose of this study is to examine the roles and function of the Japanese custom of the parturients' perinatal visit and stay with their parents 'Satogaeri', which is still practiced by many women. To learn about their impressions of 'Satogaeri', and the assistance received from their own mothers during 'Satogaeri', we analyzed the subjective experience of women yielded from interviews conducted, either before or after delivery. Our findings were discussed in light of improving childrearing support and development of the mother-infant relationship and maternal identity.
Subjects and method
Using a semi-structured protocol, ten primiparae and five multiparae were extensively interviewed individually to generate detailed, subjective narratives concerning their home stay experiences and the assistance they received from their mothers. These data were analyzed using qualitative methods.
Results
In addition to the traditional form of Satogaeri in which a woman visits her parents' home and stays with them for a period of time, either before delivery or after, the study found new forms of Satogaeri in which some women had their mothers come to their homes, stay with and help the daughters, or either one commutes between their respective homes daily. Ten out of 15 subjects reported that 'they thought it was a matter of course for them to practice Satogaeri.' The subjects gave the following three as the most useful functions of this experience: (1) It enabled them to relax themselves physically, (2) It resolved their anxiety about childrearing demands, (3) It provided an opportunity for them to learn how to care for their babies under the guidance of their own mothers. Some subjects also reported experiencing some discontent during Satogaeri, due to lack of privacy, mothers' over-interference and anxiety over re-adaptation to a life without their mothers' assistance when Satogaeri ends. Two subjects were even reminded of past conflicts with their parents. However, through intimate interactions and conversations, they managed to overcome the hurt feelings and resolve their conflicts. All subjects reported obtaining better mutual understanding with their parents through Satogaeri. As having only a satisfactory mother - daughter relationship is the minimum prerequisite for either party approaching the other regarding Satogaeri, specialized, professional assistance is considered necessary and possible for some would-be yet hesitant participants of a Satogaeri experience.
Conclusion
As a custom, Satogaeri has provided a place, or locus, to assist birth-giving women to regain their usual bodies, and to ease their anxiety about up-coming childrearing tasks. It serves as a haven for infant development as well as the development of motherhood, with the benefit of learning under the guidance of one's own mother. This is especially important because modern Japan is rapidly becoming a society where the transmission of childrearing traditions and knowhow is in danger of being disrupted due to the disappearance of extended families and local communities; the main childrearing niches that have existed for thousands of years. In order to benefit from this practice, professional assistance for some prospective individuals, with attachment conflicts, could be helpful. Assistance for post-Satogaeri should also be considered and provided for special individuals.

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Purpose
As a basic study to identify nursing actions that will help mothers to grow into the maternal role, this study examined, from the viewpoint of the maternal role , the subjective experience of mother-infant interactions among mothers breastfeeding their babies in the postnatal period.
Methods
The subjects were mothers who wanted to breastfeed their baby, who had their children in the same room with them for 24 hours a day, and who had a healthy postpartum course together with their baby. Consent to participate in the study was voluntary, and level of care and confidentiality were guaranteed. Data were collected through participant observation and semi-structured interviews, and the observed mother-infant interactions and mothers' perceptions reported in the semi-structured interviews were taken as single episodes. A qualitative inductive analysis was then performed.
Results
Five healthy primiparae and seven healthy multiparae agreed to participate in the study. Eighty-five episodes, identified from semi-structured interviews and observed mother-child interactions during breastfeeding from directly after childbirth until one month, were qualitatively analyzed based on role awareness reported by the mothers themselves. From this analysis 10 categories and 25 subcategories expressing mothers' role awareness were derived. The 10 categories were "Inhibition of behavior seeking child's needs," "Arrangements for effective suckling," "Positive approach to child," "Conflict between responding to child's needs and mother's own physical needs," "Trial and error in finding methods of care suited to the child's characteristics," "Confirming the needs of the child," "Deepening the bond with the child," "Assessment of breastfeeding," "Rebuilding of maternal role," and "Limited response to child."
Conclusion
Categories to evaluate acquisition of the maternal role among mothers who breastfed their children were identified.
As mothers are acquiring the skill to breastfeed their children they also grow into the maternal role and develop their abilities. Breastfeeding was shown to be an important act of nurturing that helps mothers to acquire a maternal role attainment.
It was found that even when observed interactions were the same, actions may be done with different role awareness among mothers, and that maternal role awareness cannot be evaluated using the quantity of observed interactions alone.

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Objective
The objective of this study is to investigate the characteristics of judgments made by expert midwives when assisting labor by describing their clues to judgment.
Subjects and methods
This study is designed as a qualitative and descriptive study. The definition of "expert midwives" in this study refers to those who have more than 20 years of experience and who have assisted in more than 1,000 labor cases. The participants in this study were four midwives with between 27 to 53 years of experience, some of whom assisted in over 1,000 labor cases and others in over 3,000 cases. Explanations about the study protocol were provided to the midwives and pregnant women, and then their consent to participate was obtained. A total of nine cases of assisted labor were observed and described in field notes, from which midwifery care episodes were distilled. Then, semi-structured interviews focusing on the care episodes were conducted with the midwives, and analyzed qualitatively.
Results
Analysis led to 5 categories and 15 subcategories of expert midwives' judgment clues in assisting labor. The five categories were as follows: "palpation," "reading body language," "having insight into progress," "following natural flow," and "trusting the pregnant woman's strength." From these categories, two themes of characteristics of expert midwives' judgment clues emerged: "making good use of knowledge based on experience," and "having faith in themselves."
Conclusion
Expert midwives made their judgments by using knowledge obtained through physical experience, and based on their own faith in natural childbirth.

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Purpose
To understand what kind of student involvement (care, advice, talking, orientation, address) serves to support women in continuous care cases, and to reconfirm the significance of continuing case practical training in midwifery education.
Subjects and methods
Semi-structured interviews were conducted with 13 women who were under the continuous care of students from one university.
Results
A total of 87 different methods of student involvement that the subjects considered to be supportive were identified, and were classified into 4 categories of (1) sympathetic acceptance, (2) always being there, (3) diligent care, and (4) touching at times of anxiety or sadness. There was further classification into 2 subcategories of "sympathetic acceptance" and "thinking together about things" for (1) sympathetic acceptance; 3 subcategories of "being together," "attentiveness," and "talk and encouragement" for (2) always being there; 3 subcategories of "sincere and gentle care," "makes efforts for me," and "responds quickly" for (3) diligent care; and 2 subcategories of "holding my hand" and "patting or squeezing my shoulder" for (4) touching at times of anxiety or sadness.
Conclusion
Through practical training involving the continuous care of individual women, students conduct the kind of close individual care that is necessary as a midwife, and fulfill their role as a companion to pregnant women. In addition, the students make efforts to respond to the needs of the pregnant women in their care, and they learned the orientation and address. Therefore, practical training in which students provide continuous care for individual pregnant women during their midwifery education is thought to be meaningful.

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Purpose
No quantitative information exists concerning the language of midwifery and perinatal care. To characterize the language learning burden placed on someone entering this area of health care, especially someone whose first language is not English, a study was undertaken of the lexical and syntactical features of a corpus of the literature of midwifery and perinatal care.
Methods
A corpus was created consisting of articles from 5 leading journals dealing with midwifery and perinatal care published from January to December in 2005. Keywords were identified by comparison with a corpus of general English and a corpus of the public health literature. Additionally, commonly recurring phrases were identified, and measures of readability were calculated.
Results
It was possible to identify 3,590 key words, including 242 highly prevalent core terms, and several phrases which have particular importance within the domain of midwifery and perinatal care. The vocabulary and phraseology suggest that the literature focuses on the interaction of mother, child and care-giver, processes related to birth and the importance of holistic care. Anatomical and pathological terms are uncommon. On average, the readability of the literature was appropriate for English speaking college graduates, with an average Flesch Reading Ease of 30.7.
Conclusions
Using statistical methods, it was possible to identify a core vocabulary which had particular importance to and was highly prevalent in the literature of midwifery and perinatal care. The language of midwifery and perinatal care is distinct from general English, and more closely related to the language of public health. It is important to note that the language of midwifery and perinatal is relatively accessible if approached in a targeted fashion. It would appear that a high level of fluency in the literature of midwifery and perinatal care is achievable independent of high fluency in general English. However, this hypothesis remains to be tested with language learners.

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Purpose
The aim of the present study was to clarify the perceptions regarding infertility and the tolerance for infertility treatment of midwives caring for women who had become pregnant following treatment for infertility.
Methods
Subjects were nurse midwives with at least one year's clinical experience who were engaged in the care of pregnant women following infertility treatment at medical facilities throughout Japan that provide care from infertility treatment through to delivery. Subjects were asked to complete a self-administered questionnaire survey. The measurement instruments were the "perceptions regarding infertility," "tolerance for infertility treatment," and "background" sections of the questionnaire. Factor analysis was conducted and the following two factors were extracted from the section on "perceptions regarding infertility" (18 items): "acceptance of a life without childbirth" and "encouragement to have children and undergo treatment." Cronbach's alpha coefficient was 0.665 for both factors. The following four factors were extracted from the section on "tolerance for infertility treatment" (20 items): "approval in general of treatment involving a donor," "personal acceptance of treatment involving a donor," "personal acceptance of treatment between spouses," and "approval in general of treatment between spouses." Cronbach's alpha coefficient for these factors ranged from 0.858 to 0.947. A total of 449 valid responses were included in the analysis.
Results
With regard to midwives' "perceptions regarding infertility", of the two factors, "acceptance of a life without childbirth" received a significantly higher score than "encouragement to have children and undergo treatment" (p<0.01). This perception was more strongly observed in nurse midwives with no experience of infertility nursing or of their own infertility. There were significant differences among the four factors that were extracted from the section on "tolerance for infertility treatment" (p<0.05). Midwives were more tolerant of treatment between spouses than of treatment involving a donor and a tendency was seen towards tolerance for infertility treatment between spouses that more closely resembled natural reproduction. In addition, nurse midwives who offered "encouragement to have children and undergo treatment" were tolerant of treatment between spouses.
Conclusion
Midwives differed from members of the public and infertile couples in that they had low tolerance of infertility treatment involving a donor, not only with regard to whether or not they would personally use such treatment, but also as a general opinion. Their perception of acceptance of a life without childbirth also differed depending on whether or not their background included experience of infertility nursing or their own infertility.

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Objective
This research aimed to identify the changes in quality of life (QOL) and related factors during each stage of normal pregnancy.
Method
Pregnant Japanese women (in the early gestational period) who started maternity care with health examinations at obstetrics-and-gynecology hospitals and clinics were invited to participate in the study. After the initial questionnaire, which included parity, the subjects were asked to answer the Medical Outcomes Study Short Form (SF-36) in the first trimester (at 12-15 weeks of gestation), in the second trimester (28-29 weeks of gestation), and in the third trimester (38-39 weeks of gestation). In addition to parity, sociodemographic variables were also collected, including occupational status, family composition, support, number of deliveries, whether the current pregnancy was planned, and whether perinatal life was affected.
A total of 159 pregnant women who did not experience any complications during pregnancy were analyzed. The questionnaire consisted of 36 items generating 8 subscales of health-related functioning. Each subscale of the QOL score at 12-15, 28-29, and 38-39 weeks during pregnancy was compared with repeated-measures ANOVA. Also, QOL scores were compared by sociodemographic variables.
Results
The subscale that reflects "Physical functioning" showed a significant decrease throughout the entire pregnancy. On the other hand, subscales that reflect "Role-physical", "Bodily pain", "Vitality", and "Social functioning" decreased in the third trimester (p<0.05).
Furthermore, various factors contributed to lower QOL in each trimester of pregnancy. The subscale that reflects "Vitality" was lower in employed participants in the first trimester than in the second or third trimester. Subscales that reflect "Physical functioning", "Role-physical", and "Social functioning" decreased in the third trimester in participants whose mothers did not help with housework and talk about pregnancy and childbirth. Subscales that reflect "Bodily pain", "Vitality", and "Social functioning" decreased in the first trimester or the third trimester in multiparous subjects and in those whose current pregnancy was planned.
In addition, with respect to the effect on perinatal life, subscales that reflect "Physical functioning", "Role-physical", "Bodily pain", "Vitality", "Role emotional", and "Mental health" decreased in the first, second or third trimester in participants with physical ailments or who were emotionally unstable and who worried about body changes such as a figure or the weight, or child health, during pregnancy.
Conclusion
The present results show that QOL decreases during pregnancy, mainly in terms of physical health, and various factors including number of deliveries, support, and whether perinatal life was affected contribute to lower QOL in each trimester. Therefore, these findings indicate the importance of taking into account the various contributing factors and providing support to improve the various facets of QOL in pregnant women throughout pregnancy.

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