Objective
The present study aimed to integrate the existing assessment tools focused on breastfeeding by mothers for their infants during the lactation period, and to make a review from the viewpoint of different constructs in the features and from the itemized contents and their usefulness.
Methods
We made a keyword search in the domestic and foreign literature on the assessment tools for breast-feeding, and prepared a code table with reference to the integrative research review by Harris (1998). We also qualitatively examined the itemized contents of each tool. Further we made an analysis by using a content analysis for the question contents as factors, and examined the constructs measured by each tool. In addition, we searched the study papers, in which these retrieved assessment tools were used, to compile a code table with reference to the classification of Victoria M, Kate D, Ros B, & Fiona D (2000).
Results
There were a total of 11 tools from the domestic and foreign sources of literature, including the itemized contents which were developed with the aim of supporting breast-feeding for mothers and infants during the lactation period. The breakdowns were primarily related to overall observation of breast-feeding and to evaluation of skills of the helpers. The questions in the tools consisted of "Condition of mind and body in a mother and her infant", "Environment", "Readiness toward lactation", "Breast-feeding behavior" and "Changes after lactation". Among these questions, "breast-feeding behavior" has been the most common focus, but the direct observation on the condition of the breasts, especially on milk production and the secretory condition of milk, was rarely made. There were 16 papers in which these tools were employed. Therefore, the high efficacy was demonstrated in these kinds of tools, such as IBFAT, LATCH that have smaller number of questions, and tools, such as PIBBS that support the premature babies because they not only were easy to use but also provided unique features which other tools did not have. It was suggested that the features of such useful tools were: (1) fewer items, (2) having no misleading or ambiguous expressions, (3) setting up one question for each sentence, and (4) providing evident objective conditions.
Conclusion
Most of the current tools that have been developed for the purpose of supporting breast-feeding focus on breast-feeding behavior, while there have been no tools directly examining the production of milk and the secretory conditions.

View full abstract

Purpose
The purpose of this study was to examine the current state of knowledge regarding the relationships between maternal hydration and pregnancy outcomes as a basis of the management of maternal hydration status during pregnancy.
Methods
A search of literature was conducted using four key electronic databases (Central Medical Journal web version , PubMed, CINAHL, and the Cochrane Library) and reference lists from: three widely used medical obstetric textbooks and selected articles. In order to integrate available knowledge, all published literature before the 5th of August 2009, written in the Japanese or English language that focused on the effects of maternal hemodynamic patterns and maternal hydration on pregnancy outcomes was sought yielding 83 articles for review. The articles were grouped by: language, type of article, and specialty, and categorized according to the research focus. Findings were systematically synthesized and discussed according to three foci of this review: 1) the relationship between maternal hydration and pregnancy outcomes; 2) recommended hydration methods for pregnant women; 3) measurement methods evaluating maternal hemodynamic patterns and hydration status in pregnancy.
Results
A number of studies reported the positive relationship between maternal hydration and increased amniotic fluid volume. However, limited research findings were noted regarding preventive or treatment effects of maternal hydration on complications in pregnancy. Although no study was found with regard to the trends of maternal fluid intake, the relationship between maternal caffeine consumption and pregnancy outcomes and the validity of a self-report survey in determining the quantity of maternal caffeine consumption were found. There were a variety of methods and measurement tools evaluating maternal hemodynamic patterns and hydration status in pregnancy. However, as a management strategy for prenatal care, optimal methods that enabled only non-invasive measurement of maternal hemodynamic patterns were not found. Also, clinical evidence for methods in maintaining maternal hydration status during pregnancy was not found.
Conclusions
The association of maternal hydration with increased amniotic fluid volume, the needs of careful examination for a type of fluids recommended for pregnant women, and bioelectrical impedance analysis as a potential non-invasive tool measuring maternal hydration status in pregnancy were found in this review. Future studies might include conducting descriptive or exploratory studies in the trends of fluid intake in relation to the pregnancy outcomes, identifying recommended hydration methods for pregnant women, and developing non-invasive and feasible measurement tools in determining physiological effects of maternal fluid intake.

View full abstract

Purpose
To analyze the body temperature of pregnant Brazilian women living in Brazil who are aware of hiesho (sensitivity to cold) and to analyze the characteristics of their accessory symptoms during pregnancy and daily activities.
Method
Subjects were 200 Brazilian women living in Brazil who were in the 20th or later week of pregnancy. Data was collected by measuring body temperature and through a paper questionnaire. The study took place between October 2007 and February 2008.
Results
1. The average difference between forehead core temperature and core temperature of the sole of the foot among pregnant women aware of hiesho was 2.8°C and 2.0°C among pregnant women with no awareness of hiesho, a significant difference between the two groups (p=0.018). 2. In a comparison of awareness of hiesho and the scale for determining hiesho, among pregnant women aware of hiesho, 70.2% also met the scale for determining hiesho. Among pregnant women with no awareness of hiesho, 89.5% were determined not to have hiesho, also based on the scale for determining hiesho (Terasawa). 3. With regard to the relationship between hiesho among pregnant women and accessory symptoms/daily activities, no cause-and-effect relationship was observed between awareness of hiesho and hiesho-related pregnancy-associated troubles. There was a positive correlation between irregular living habits and hiesho-related pregnancy-associated troubles (β=0.41, p=0.049). Additionally, there was a positive correlation between irregular living habits and consumption of "unhealthy" foods through hiesho-related pregnancy-associated troubles (β=0.38, p=0.021).
Conclusions
1. The difference between forehead core temperature and core temperature of the sole of the foot among pregnant women aware of hiesho and pregnant women with no awareness of hiesho was significantly large. Awareness of hiesho reflects temperature differences, which is an objective indicator. 2. Among pregnant women with no awareness of hiesho, the coincidence ratio with the scale for determining hiesho (Terasawa) was approximately 80%. 3. Among pregnant Brazilian women, there was no cause-and-effect relationship between differences in core temperature and awareness of hiesho on the one hand and hiesho-related pregnancy-associated troubles, irregular living habits and consumption of "unhealthy" foods on the other; daily activities have no impact on hiesho.

View full abstract

Objectives
To implement and evaluate the application of the Kemp Assessment, designed to screen for parental child abuse and neglect.
Method
The Kemp Assessment, translated from the Family Stress Checklist into Japanese for women at postnatal settings in Japan, was implemented by interview to access the risk for child abuse and neglect. The Kemp Assessment is comprises of ten items each weighted from 0 (no risk) to 10 points (highest risk) discriminating low-risk of child abuse and neglect from high-risk with a maximum score of 100. The cutoff point was a score of 25 (higher risk). Cronbach's α of the Kemp Assessment was 0.57.
Utility of the Kemp Assessment Process was evaluated through screening method, scoring, and follow-up for high-risk women using an evaluation questionnaire. The Ethics Committee of St.Luke's College of Nursing approved the protocol.
Results
Participants were 88 (95.6%) of the 92 eligible women in the postnatal period at an urban hospital. The average total score was 9.8 (SD=9.8). Scoring 0 were 26.1% and eight women (10.0%) scored at high-risk for child abuse.
According to the evaluation questionnaires the screening interviews were appropriate for timing and place. While interviews lasted 25-77 minutes; about half the participants required over 40 minutes, only 20.5% responded that the interview was slightly long. More than 60.0% responded that the interview was helpful in easing anxiety and for obtaining community resource information. For follow up of identified high-risk women, the researchers used participants' background information and details of the women's situation and of their families. Researchers and the midwives referred high-risk women to community health centers to continue support.
Conclusion
Participants' evaluation indicated positive reactions for the screening and follow-up methods. Researchers referred high-risk women to community health centers to continue support. The Kemp Assessment could be safely utilized in prenatal settings in Japan, when the psychometric properties of the instrument and study design are strengthened.

View full abstract

Purpose
The purpose of this study was to clarify the difficulties experienced by midwives in caregiving for women who had undergone medical termination of pregnancy.
Methods
The study population comprised 9 midwives who had 2-10 years of work experience and had acted as caregiver for women who had undergone medical termination of pregnancy. Data were obtained using tape-recorded semi-structured interviews. The data were transcribed and interpreted: furthermore they were summarized and segregated into categories and subcategories depending on the similarities and differences between the difficulties experienced by the midwives.
Results
We segregated the difficulties experienced by these midwives while caregiving for the mothers into 4 categories: (1) the distress the midwives experienced on taking a fetal life, which was caused by their sense of value for life; (2) the guilt that they experienced due to incomplete caregiving for the mothers; (3) the strained relationship between the midwives and mothers due to incomplete caregiving; (4) the inability to completely fulfill the role of a caregiver. Medical termination of pregnancy involves artificial termination of a fetal life for the midwives. The midwives cannot endure the death of the babies and are at a loss regarding caregiving for the mothers. The sense of incongruity that they experience and the behavior of the distant relatives of the mothers make them hesitate about caregiving for the mothers, and they cannot fulfill their role completely.
Conclusion
The difficulties experienced by midwives while caregiving for mothers who undergo termination of pregnancy include distress due to the fact that they had terminated a fetal life; this distress was due to the midwives' value system that did not support their role in the termination of pregnancy. Because of this, the midwives did not take proper care of the mothers. These 2 issues led to a strained relationship between the midwives and mothers and hampered the ability of the midwives to completely fulfill their role of caregiving.

View full abstract

Purpose
The aim of the present study was to clarify midwife recognition of the types of negative support (NS) they provide for pregnant and parturient women, the factors related to NS and the consequences generated by NS.
Objects and Methods
Semi-structured interviews were conducted on 9 midwives who worked in a hospital. The semantic content of discussions relating to NS were parsed, coded, and categorized, and subcategories and categories were established.
Results
Attribute of NS was comprised of 2 categories: "speech and behavior of the midwife providing NS", and "reactions of the women who received NS". Moreover, the following 3 categories related to NS were recognized: human factors, environmental factors, and system factors. Human factors were grouped into 3 subcategories: "women characteristics," "midwife characteristics," and "communication." Environmental factors were grouped into 2 subcategories: "human environment" and "work environment." System factors included one subcategory: "hospital and ward system." In addition, the following 2 consequences of NS were recognized: "perception and subsequent response after NS" and "what midwives gained through the NS experience." Perception and subsequent response after NS was classified into 4 subcategories: "midwife's feelings after recognizing NS," "midwife's response after recognizing NS," hospital and ward response to NS," and "women's response after NS was dealt with." What midwives gained from the NS experience was also classified into 4 subcategories: "increased awareness of midwife care," "heightened identity as a midwife," "definition of NS," and "remaining unresolved issues for midwives."
Conclusion
When supporting pregnant and parturient women, who are physically and emotionally unstable, the present findings suggest the importance of first developing an interest in, respecting and having compassion for the women and considering things from their perspective. During the process of confirming the women's intentions, investigating and explaining "why" something is necessary, being grateful for their various signals, having time to review how communication should be conducted, and applying experiences of failure are also believed to be important.

View full abstract

Purpose
The frequency of skipping breakfast among reproductive-age women has been increasing in Japan. Skipping breakfast was reported to result in low intake of several nutrients including folate and vitamins required for fetal development and the prevention of pregnancy complications. A high total homocysteine (tHcy) level, which occurs in association with a folate and vitamin B₁₂ deficiency, can lead to adverse perinatal outcomes. The aim of this study was to examine whether skipping breakfast during pregnancy is associated with the folate and vitamin B₁₂ intake, circulating tHcy, folate and vitamin B₁₂ levels.
Methods
Two hundred and fifty-four healthy women with a singleton pregnancy (age: 30.4±4.7, gestational age: 27.5±9.6 weeks) were recruited from a prenatal clinic in metropolitan Tokyo, Japan. The plasma tHcy, serum folate and vitamin B₁₂ levels were measured. The nutrient intake was assessed using a self-administered diet history questionnaire. Information on lifestyle factors relevant to tHcy levels and skipping breakfast was obtained from the questionnaire. We defined skipping breakfast as forgoing breakfast including a staple food, such as rice or bread, more than twice a week during the preceding 1-month period. A multiple regression analysis was performed to determine whether skipping breakfast was associated with plasma tHcy levels, after adjusting for confounding variables.
Results
Thirty percent of the participants skipped breakfast more than twice a week. The rate of primipara was higher than multipara among breakfast skippers (p=0.005). Skipping breakfast was associated with high plasma tHcy levels among the pregnant women after adjusting for confounding factors, including serum folate and vitamin B₁₂ levels (p=0.024). Meanwhile, there were no significant differences in the energy-adjusted intake of folate and vitamin B₁₂ or in serum folate and vitamin B₁₂ levels between the breakfast skippers and the non-skippers.
Conclusion
The relationship between the plasma tHcy levels and skipping breakfast could not be explained by the low levels of serum folate and vitamin B₁₂ among the breakfast skippers, in contrast to our hypothesis. However, our results indicated that any factors relevant to skipping breakfast may affect the tHcy levels during pregnancy. Therefore, health care providers may need to pay closer attention to whether pregnant women have breakfast or not, in order to prevent increased tHcy levels.

View full abstract

Purpose
The aims of this study were to (1) develop a short-form of the multidimensional CHS (Child-care Happiness Scale), which was developed by Shimizu, Sekimizu, Endo et al. (2007), and (2) examine its reliability in order to increase general applicability.
Methods
Mothers with infants younger than 6 years of age were asked to evaluate 41 items in the CHS that involved various situations which give rise to a feeling of happiness during child-care using a 5-point scale. We also used the Subjective Happiness Scale (SHS) and Beck's Depression Inventory (BDI), which measure psychological health, in order to confirm the validity of the short-form CHS (SF-CHS).
Results
There were a total of 672 valid respondents. A factor analysis was performed on 41 items of the CHS, and then 16 items were selected for the SF-CHS, which consists of 3 factors: "joys of child-care," "connection with the child," and "husband's support." Items for the 3 factors had sufficiently high Cronbach's α coefficients (0.81-0.86), which represent their internal consistency. There was a significant positive correlation between the SF-CHS and SHS. In contrast, there was a significant negative correlation with BDI. There was a decreasing trend for "joys of child-care" and "connection with child" with increasing mother's age. Furthermore, "husband's support" was higher for mothers whose youngest child was less than 1 year old than for those whose youngest child was 4 years or older, and lowest for mothers with only one child.
Conclusions
Differences between the SF-CHS and original CHS, their practicality, and future issues were discussed. Our findings suggest an association between SF-CHS and psychological health. The conciseness of the SF-CHS allows immediate feedback to each mother of her child-care happiness profile. In the future, SF-CHS can be expected to become a useful resource for mothers to reflect on their feelings on child-care.

View full abstract

Purpose
To examine traditional birth attendants (TBAs) and their care in the Republic of Madagascar through an analysis of care and perceptions from TBAs and women who receive their care.
Method
The researcher spent two months in the village of A on the outskirts of the city of Antsirabe in the Republic of Madagascar. Four TBAs and 11 women who received TBA care currently and in the past participated in semi-structured interviews. Interviews covered care and perceptions of TBAs and the evaluations of women receiving their care. In addition, a TBA accompanied the researcher while observations at a TBA care site were conducted. Data were qualitatively analyzed, sorted, and discussed.
Results
TBA activities included physical examinations during pregnancy, care during delivery, and home visits following birth. Fundamental objectives at the core of TBA care were to check the position of the child, promote labor progression, and regulate body temperature of the mother. Women who received care reported that TBAs relieved fatigue, served as a source of childbirth knowledge, and provided strength during delivery. In contrast, the women felt that TBAs did very little following the birth. Perspectives on TBA care from the women who received care agreed with that of TBAs themselves close to 50% of the time. Differences in perspectives may have arisen from the fact that the women did not remember the care they received during delivery, and because the guidance was provided based on experience and traditions and thus lacked detailed substance.
Conclusion
Results showed that TBAs need to supplement their knowledge in addition to fulfilling their valued role as doulas in order to meet women's needs. To this end, effective training practices are needed in conjunction with initiative to overcome barriers such as tribal status and pride as medical workers. Performance of practical actions to enhance their understanding of TBA care will enable them to fulfill their valuable support role more effectively.

View full abstract

Purpose
The purpose of this study was to develop a "Women-Centered Care (WCC)" pregnancy questionnaire (WCC-preg questionnaire) that measured women's perceptions of care they received during pregnancy and to test its validity and reliability.
Methods
Participants were women who had a single-child birth and were hospitalized at the participating settings.
The WCC-preg questionnaire is a self-administered questionnaire, which was developed based on interviews and substantive studies. This instrument originally contained 60 questions focused on their perceptions of women-centered care they received during pregnancy. Women were asked if they agreed or disagreed using a 5-point Likert-type scale. The higher the points, the more women felt that they received WCC. To examine criterion-related validity, the following scales were used; the Maternal Attachment Questionnaire (MAQ), the Labour Agentry Scale (LAS), and the 10-point Likert-type Care Satisfaction Scale.
To test validity and internal consistency, 591 women from 13 settings were recruited. Among these women, 500 responded and 482 were included in the analysis. To test stability using test-retest, questionnaires were distributed to 100 women at one setting. Among these women, 60 responded and all were included in the analysis.
Results
In testing face validity, the WCC-preg questionnaire ended up to be a 50-item questionnaire. To test the construct validity, factor analysis was conducted. Eventually six factors emerged: "feelings of encouragement", "being respected", "trusting the caregiver", "effective interaction", "help in decision-making", and "non-threatening manner". These were found to be suitable components of WCC. The correlation with WCC-preg questionnaire and MAQ showed low correlation (r=0.22, p=0.00) while LAS showed moderate correlation (r=0.48, p=0.00) and the Care Satisfaction Scale showed high correlation (r=0.79, p=0.00) thus confirming the WCC-preg questionnaire's criterion-related validity.
Cronbach's alpha was 0.98 indicating high internal consistency. However, the correlation of the test-retest was 0.55 and therefore stability remains an issue.
Conclusion
This study developed a questionnaire to measure women's perception of WCC during pregnancy and tested its validity and reliability. As a result, the validity of the WCC-preg questionnaire was confirmed. Although there remained an issue concerning stability, the internal consistency was high.

View full abstract

Objective
The aim of the present study was to clarify how midwives recognize and implement care for women leaving an island to give birth on the mainland.
Subjects and Methods
Using an ethnographic approach, participant observation and interviews were conducted on 6 primary informants, who were midwives working at an obstetrics department on an isolated island, and 38 secondary informants, who comprised women leaving the island to give birth and their family members, an obstetrician working at a hospital on the island, an occupational health nurse, women engaged in child-raising with experience of leaving the island to give birth, midwives working at a mainland birthing hospital and staff at a mainland accommodation facility used by the majority of women leaving the island to give birth.
Results
It was found that antenatal care was performed with consideration given to the period that would be spent on the mainland, while postnatal care was conducted divorced from the circumstances surrounding mainland delivery. During antenatal care, midwives recognized that women leaving the island to give birth would be forced to lead solitary lifestyles on the mainland and thus were susceptible to increased anxiety and fears regarding childbirth. They also recognized the difficulties of nutrition management due to the change in environment. Against this background, it was found that midwives aimed to provide care that would engender the physical and mental state required for women giving other women the strength for childbirth. In addition, with the inevitable break in the continuity of care between pregnancy and the postpartum period, midwives recognized that the postpartum care provided to women returning home after leaving the island to give birth was not as complete as that provided to women who delivered on the island. However, despite this incompleteness of care, midwives were still able to establish connections with postpartum women.
Conclusion
In order for mothers and infants transferring between mainland and island environments to transition from pregnancy to child-raising safely and without worry, the following three points were found to be necessary for care coordination.
1) Care that recognizes the susceptibility for increased anxiety and fears regarding childbirth.
2) Care that responds to the difference in environment provided by mainland lifestyles.
3) Care that recognizes that child-raising begins in a place far from the help of experts in the case of puerperal women who have returned to the local area.

View full abstract

Objective
This study sought to describe the experiences of women terminating infertility treatment and to ascertain the significance the women attributed to those experiences.
Subjects and methods
This study was a study of the life stories of women who decided to terminate infertility treatment; these women were asked to narrate their experiences, which were then interpreted from their perspective. Study participants were four women who underwent assisted reproductive technology in the past and who have now terminated their infertility treatment. When gathering data, researchers encouraged the women to talk openly about their personal experiences from the time they began to consider infertility treatment up until the time they decided to terminate the treatment and to talk about their thoughts and feelings at various stages during this period. Consideration was given to making a connection between particular events and thoughts and feelings at that time in order to analyze the experiences of the four women and discern their individual stories.
Results
Participant A became pregnant for the first time in her 10th year of treatment but suffered a miscarriage. Although the miscarriage did not require curettage, the experience eroded her self-confidence. Participant A felt conflicted, not wanting to give up on having a baby but also plagued by doubts as to whether she would ever be able to conceive. Having tried so hard, Participant A felt as if she had reached the end of treatment, and she declared that this round of treatment would be her last. Suffering menstrual irregularities and uterine pain, Participant B sensed that she was too old to have a child. Since she was undergoing infertility treatment more for her mother and husband than for herself, she was unable to verbally express her desire to terminate that treatment. At her husband's encouraging, she finally decided to ease her burden and terminate treatment. Like Participant B, Participant C was encouraged by her husband to terminate treatment. After terminating treatment, however, Participant C felt a substantial sense of loss and had regrets about giving up on treatment. She had an abrupt change of heart and decided to become a foster parent. Having suffered repeated miscarriages of indeterminate cause and repeatedly undergoing curettage, Participant D felt physically overwhelmed and decided to terminate treatment.
Conclusion
Study participants became aware of the limits of their own ability to conceive and realized that some problems were not amenable even to advanced technology. Participants also wished to be accepted as they were despite their fault or flaw of not being able to have a baby. With such approval of others, participants were able to accept themselves for who they were and seek to terminate treatment.

View full abstract

Objective
The present study was conducted to shed light on the changes in perception toward student practical training by women continuously attended by student midwives.
Subjects and Method
Semi-structured interviews were conducted on ten women who were continuously attended by student midwives. Data was analyzed using the Grounded Theory Approach.
Results
The perception toward student practical training by women continuously attended by student midwives were markedly different at the time they received the request to participate in the student midwife practicum, at gestation, at intrapartum, and at puerperium. Participants stated at the time they received the request for participation, "I gave my consent because I wanted to cooperate with student midwifes," and "I gave my consent because I thought there might be some benefit to being attended to by a student midwife." At gestation, participants commented on benefits such as "I learned much from their health advice," and "The attitudes of those around me changed as I was being attended to by the student midwife." However, there were some who stated that "The student midwife behaved awkwardly at times." At the intrapartum period, participants who experienced natural birth made comments such as "I was surprised that the midwife conducted a pelvic examination and provided birthing assistance, but I accepted her assistance." Participants who experienced a Caesarean operation expressed comments such as "I feel sorry that the student midwife could not learn from the delivery." Impressions at the puerperium period included, "I felt that I could depend on the student midwife," with all participants indicating a certain level of trust in the student midwives. As for overall impressions of the practicum, all participants evaluated it positively, stating "I was happy that a lot of people could be involved, not just the student midwife." Regarding changes in impressions of the student midwives as they proceeded through their practicum, comments of participants fell into two distinct patterns: "We gradually opened up in the natural course of things;" and "My feelings of trust were proportionate to my uneasiness."
Conclusions
The results of the present study suggest needs to provide prior explanation of the birthing assistance provided by student midwives, as well as skill acquisition for caring for women during the gestation and puerperium periods.

View full abstract

Objective
This study aimed to clarify the role of parents in sex education at home from the perspectives of both parents and children.
Materials and Methods
From among junior high school students and their parents in M City, A Prefecture, we recruited 21 people, comprised of 11 students and 10 of their parents, as our test subjects. We notified them by letter, and later explained the survey to them by telephone to obtain their informed consent. In non-structured interviews conducted separately with the parents and students, we asked their opinions about the role of parents in sex education at home. Then, we conducted a qualitative description and analysis of the data.
Results
Eleven categories were extracted regarding the role of parents in sex education. Among them, the role of parents in sex education as defined by the parents fell into the following 8 categories: "know what is taught as sex education at school", "work in liaison with sex education at school", "advise their children if asked about sex", "accept their children's growth", "provide accurate sexual knowledge", "adjust parent-child relationships", and "keep the relationship between the mother and father on good terms". On the other hand, the role of parents in sex education as defined by the children fell into the following 3 categories: "support their children to receive the desired sex education", "intervene in their children's problematic sex-related issues", "adjust the home environment".
Conclusion
Our study suggests that the role of parents in sex education is, in addition to providing knowledge, to advise their children based on their own experiences and cope with their children's practical issues. With regard to the parent-child relationship, it is important for parents to communicate with their children and be approachable.

View full abstract

Purpose
The aim of the present study was to clarify important factors affecting hospital midwives' decision to continue working while pregnant, after giving birth, and while providing childcare.
Methods
Subjects comprised 1469 midwives working at 336 hospitals with an Obstetrics and Gynecology Department. Subjects were either pregnant or providing childcare for children between the age of 0 and graduation from elementary school. A quantitative cross-sectional descriptive study was conducted using anonymous self-administered questionnaires distributed by mail. Survey content included subject attributes and health status, family and home environment, child and child-care environment, working environment, and motivation to work. Analysis was conducted to investigate the relationship between each survey item and "status of work continuation to date (continued work group and temporarily left job group)", and "intentions regarding future work continuation (hoping to continue group and considering leaving group)".
Results
A total of 986 questionnaires were collected (response rate, 67.1%), of which 951 were valid (valid response rate, 96.5%). The mean age of subjects was 36.8 ± 5.26 years and the mean number of children was 1.96 with most subjects having 2 children. The mean score on the Work Motivation Scale was 58.7 ± 8.68. A highly significant difference was observed between "status of work continuation to date" and the understanding and cooperation of parents and parents-in-law. No significant difference was seen between "intentions regarding future work continuation" and family understanding and cooperation; however, a significant difference was observed regarding workplace environmental factors of good working conditions, the ease of balancing working and childcare, the understanding of superiors, and the presence of other working-mother midwives as role models.
Conclusion
These findings suggest that a working environment in which it is easy to balance working and childcare, and the understanding of superiors are important factors affecting the decision of hospital midwives who are pregnant or are providing childcare to continue working. Strong personal motivation of the midwife and the understanding and cooperation of the family constitute prerequisites for continuing to work.

View full abstract

Purpose
This paper first focuses on outlining currently available knowledge throughout the world regarding women who decide to continue with their pregnancy knowing that there will be something abnormal about their child. Secondly, it discusses making information applicable to the existing issues available to midwives who deal with those women. Finally, the paper looks at coming up with a future agenda for improving the care environment for those women, to be worked on in clinical practice.
Methods
Published literature concerning those women who choose to carry on a pregnancy after having been informed of a fetal abnormality was searched for using the following sources: PubMed, PsycINFO, CINAHL, and Ichu-shi WEB. A search was made for English language articles published in any country between 1998 and 2009, using the keywords "prenatal diagnosis" and "fetal abnormality". We considered each article's targets, research method and results in order to analyze how fetal diagnoses and mothers' experiences influence the framing of psychological experiences.
Result
In reviewing twelve domestic and international journal articles, five themes were highlighted that constitute pregnant women's experiences carrying a child with a congenital abnormality, namely: grief, attachment, dilemma, uncertainty and isolation. These themes became clear that the experiences of those women carrying a child with a known congenital abnormality cannot be described in any one way, as there are so many constituent factors to take into account.
Conclusion
These themes can be helpful in understanding mothers' experiences. However, more studies need to be done in order to explore how they influence mothers' relationship with, and involvement in society. Understanding mothers' experiences from both psychological and social perspectives can help nurses improve their clinical practice, both in delivering the child and in caring for the mother. Future studies will yield further useful information, to help healthcare professionals assist mothers, children, and families cope with any challenge they may face.

View full abstract

Purpose
This study was conducted to examine the current status, awareness and education of ultrasonic diagnosis performed by midwives.
Subjects and Methods
We conducted a questionnaire survey involving midwives (n=794) working in 67 hospitals and clinics providing obstetric outpatient services and 81 maternity centers equipped with beds, identified through an Internet search.
Results
1 ) The numbers of midwives and obstetrician were significantly lower in facilities where ultrasonic diagnosis was performed by midwives.
2 ) The average age of midwives performing ultrasonic diagnosis (Group A) was markedly higher with increasing work experience, compared to those who do not perform it (Group B).
3 ) In Group A, 76.4% were of the opinion that "Pregnant and postpartum patients and their families will agree to ultrasonic diagnosis performed by midwives.", and 64.9% viewed "ultrasonic diagnosis as part of their tasks", giving a positive assessment.
4 ) Regarding the benefits of ultrasonic diagnosis performed by midwives, common answers in Group A included: "It will promote communication.", "Pregnant and postpartum patients and their families will become more interested in their babies.", "It is an effective means to determine the growth and abnormality of babies.", and "Compared to physicians, midwives can take more time for diagnosis". On the other hand, the majority of Group B cited "Possibility of the difference between the diagnosis of doctor", "an increase in workload" as a drawback.
5 ) On the ultrasonic diagnosis of the abnormality, about 80% of midwives answered "Though it is told to be abnormal, the concrete diagnosis name is not spoken".
6 ) Nearly 100% of midwives recognized the importance of education on ultrasonic diagnosis, and 80% thought that education, including lectures and practical training on "operative procedures" and "diagnostic imaging", should be provided by their facilities.
Conclusion
Since ultrasonic diagnosis is being performed by an increasing number of midwives, it is important to develop an education system and consultation system in an abnormal case.

View full abstract

Purpose
This paper describes the process of developing a Breast Awareness program, implementation and process evaluation, as a part of midwifery practice.
Method
Evaluation study. We developed a Breast Awareness program to introduce the concept of Breast Awareness particularly breast cancer awareness to lactating women. The program was guided by the concept of health promotion program development that has a circular process including: needs assessment, program planning, program implementation and process evaluation. This program implementation was conducted twice with five lactating women whose babies were nearly weaned participating in each program.
Results
Elements of the program were extracted by analyzing a breast cancer health issue in the needs assessment. In this segment, the contributing risk factors (predisposing, enabling and reinforcing) were clarified.
Program purpose, sub-objects and strategic objects were indicated during program planning segment. Three program objects of participants were educed: (1) consider own breast as an important part of own body, (2) derive correct information about breast cancer, (3) knows and understands the aim of Breast Awareness, and a definite plan was selected to achieve those objectives. Five Breast Awareness codes formed the focal points of the program: 1) know what is normal for you, 2) look and feel, 3) know what changes to look for, 4) report any changes without delay, 5) attend breast screening if aged 50 (In case of Japan, if aged 40) or over (Department of Health, United Kingdom). The program was executed with a participatory approach, a lecture, demonstration and then mainly discussion. The program was revised after the second implementation and process evaluation.
Considerations
Three points were discussed: strategic significance of health promotion program development, consequential elements and tasks of the Breast Awareness program as a midwifery practice, and a recommendation to introduce Breast Awareness to women as an important component of women's health care.

View full abstract

Purpose
The purpose of this study was to make clear problems on women's labour positions from the perspective of midwives in hospital in order to promote alternative labour positions in midwifery in Japan.
Method
Self-administered survey questionnaires from 367 midwives from 16 hospitals encouraging women to use alternative labour positions, and 20 other hospitals were eligible for analysis. Question items included age, years of experience at a hospital and as a midwife, wishes to use alternative labour positions, opinions of maternal and foetal conditions, labour progress, birth environment and obstetric interventions (12 items) in non-supine positions, and anxiety in midwifery in assisting births in non-supine positions. Correlation analysis, Mann-Whitney U test and Kruskal-Wallis test were used to compare views mainly between two groups of midwives, one group where non-supine positions were used and the other where non supine positions were not used.
Results
65.6% of midwives in hospitals using non-spine positions had used non-supine positions during the second stage of labour. 93.0% of midwives whose hospitals do not use non-supine positions were considered desirable for using alternative labour positions. Nevertheless only 74.5% wished to use them, and 85.5% wished to promote those who work at hospitals using non-supine positions routinely. The biggest obstruction in using non-supine labour positions is midwifery (34.9%). Noncooperation of obstetricians and routine supine position use were problems for midwives whose hospitals used only supine position. Subsequently, problems of facilities, environment of labour, and shortage of midwives were indicated. Significant relations were found between wishes for using non-supine positions and their experience or anxiety in midwifery.
Conclusions
The decline of implementation of alternative positions showed factors of stagnation in the desire for its promotion. Midwives in hospitals using non-supine positions need to be able to gain more experience in studying for assisting births in non-supine positions, and improve their midwifery practices. Midwives and obstetricians need to have a course of action for providing consistent care of midwifery of labour positions for women. It is important for midwives in hospitals to realize the physiological effectiveness of non-supine positions and discuss the procedure of obstetric interventions for an emergency in order to be possible to provide organized treatment of midwifery.

View full abstract