Purpose
The purpose of this study was to analyze various maternal positions in the second stage of labor and the associated occurrence of perineal lacerations and episiotomy.
Methods
The literature search focused on the areas of nursing, midwifery and physiology. Analyzed quantitatively was the association between various maternal positions and outcomes of perineal laceration and episiotomy were then analyzed quantitatively.
Results
The findings related to maternal positions in the second stage of labor associated with perineal lacerations and episiotomies were the sitting position with mixed results of intact perineums and perineal lacerations. This was a major characteristic of using the birthing chair. Maternal positions, which were more likely to be associated with intact perineums and less with perineal lacerations, were: lateral, hands and knees and squatting. The maternal position, which was most likely to be associated with episiotomies, was the recumbent position, which included lithotomy and, semi-recumbent.
Conclusion
The numerically highest incidence of episiotomies was in the recumbent position, which may reflect the ease of performing an incision in that position.

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Purpose
The purpose of this study was to examine and summarize the current state of knowledge regarding the scales used to assess labor pain, the manner in which they are used, their validity and reliability.
Method
A literature search was conducted using three key electronic databases (Igaku Cyuou Zasshi, Pubmed and CINAHL) and the reference lists from the selected articles. To integrate the available knowledge, all literature published until May 2010, written in Japanese or in English, and that used a scale for measuring labor pain for women during and after childbirth was sought, yielding 50 articles for review.
Results
The following scales were those most often used in the literature for measuring the intensity of labor pain: Visual analogue scale (VAS), Numerical rating scale (NRS), Face rating scale (FRS) and Verbal rating scale (VRS). In addition, the Mcgill pain questionnaire (MPQ) was used to measure both the intensity and quality of labor pain. Each of these scales is used during and after delivery.
VAS is a measurement scale that tries to measure the individual amount of pain that a patient feels ranges across a continuum from none to an extreme. In most of the studies reviewed, the VAS was used, as it ensures concurrent validity with PPI of MPQ, discriminant validity, convergent validity, as a measurement of labor pain.
NRS, FRS, VRS and PPI of MPQ are scales that try to measure the pain as a categorization of none, mild, moderate and severe would suggest. PPI has a concurrent validity with VAS but the other scales do not ensure any validity.
However, MPQ ensures factor validity, discriminant validity as a measurement of labor pain, MPQ (Japanese version) needs to be reconsidered for translation and categorization.
All of these scales do not ensure their reliability as measurements of labor pain.
Conclusion
The most common scale for measuring labor pain was the VAS.
However VAS is a validated scale that can measure the individual amount of labor pain, the VAS scores vary by the individual; thus, it is difficult to compare VAS scores between subjects.
VAS, NRS, FRS, VRS and PPI of MPQ do not ensure their reliability as a measurement of labor pain.
MPQ, which is a validated scale to measure both quality and quantity of labor pain, have more difficulty to answer during labor compared with VAS, NRS, FRS, VRS. In Japan, not only improving MPQ Japanese version but also developing Short formed MPQ Japanese version is needed.
Therefore, some caution is required in choosing scales, measuring, and handling to increase the precision of the measurement of labor pain.

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Purpose
The present study aimed to develop a scale to measure occupational identity in midwives and examine associated factors. The study further intended to explore the intention to continue working as a midwife and to elucidate the measures that would encourage occupational growth in the field.
Participants and methods
A mailed self-administered questionnaire survey targeted 414 midwives with less than two years of experience and working at 87 hospitals across Japan. Factor analysis, stepwise multivariate regression analysis, and the t-test were subsequently performed to assess occupational identity in midwives.
Results
Valid responses were obtained from 204 participants (valid response rate: 49.3%) with a mean age of 25.5 years (SD=3.9). A Midwife Occupational Identity Scale consisting of 26 items in the following five categories was created: "pride in being needed as a midwife" (F1); "establishing one's perspective as a midwife" (F2); "confidence in one's decision to become a midwife" (F3); "pride in expertise as a midwife" (F4); and "intent to make a societal contribution as a midwife" (F5). Variables associated with subcategories of the midwife Occupational Identity Scale comprised "experiences accompanied by positive feelings during midwife schooling", "psychological support from instructors", "experiences accompanied by positive or negative feelings after being employed", "gap in occupational knowledge between graduating and the start of employment", "future development, number of assisted cesarean cases", "psychological support from veteran midwives", "attitude on gender roles", and "presence of a role model".
Variables associated with the intention to continue work were "confidence in one's decision to become a midwife" (F3), "experiences accompanied by positive or negative feelings after becoming employed", "future development", and "attitude on gender roles".
Conclusion
The present study confirmed the reliability and construct validity of the midwife Occupational Identity Scale. The results suggest that occupational identity in midwives is enhanced by awareness and experiences during schooling and employment as a midwife, psychological support, and an egalitarian attitude. In addition, occupational identity was shown to be associated with the intention to continue work as a midwife.

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Purpose
The purpose of this study is to examine the correlation between Life Habits, Mental Health and Parenting Self-efficacy of mothers with infants.
Methods
The subjects of the study were mothers with infants, who resided in urban districts of the Kansai area. The items surveyed under the ethical considerations were as follows: personal background, status of healthy life habits, GHQ-12 and Parenting Self-Efficacy Scale. The questionnaires were mailed in advance to the guardians, who had been scheduled for health checkups for infants. After the health checkups for infants, the questionnaires were collected from 648 subjects, of which 579 effective responses (effective response rate: 67.6%) were analysed.
Results
1. In the assessment of healthy life habits, an average of 4 out of 7 listed items were practised by mothers. The number or age of the infants did not affect this data.
2. The item 'quitting/non-smoking' (90.0%) ranked the highest, followed by the other 3, namely, 'reasonable drinking' (84.5%), 'having breakfast' (81.2%) and '6-8 h of sleep' (80.8%). Conversely, 'regular exercise' (6.0%) and 'not eating between meals' (7.4%) ranked the lowest, showing that these habits were difficult to develop.
3. Mothers with poor sleep habits showed significantly poorer mental health. This was particularly observed in the group that fell into the sleep category of '6 h or less'. This group showed an odds ratio 2.75 times higher than that of the group within the sleep category of '6-9 h or less'. Thus, the 6-h sleep group demonstrated significantly poorer mental health.
4. The group within the category of 'regular exercise' showed an odds ratio 2.96 times higher than that of the group that did not exercise, demonstrating significantly higher parenting self-efficacy.
Conclusion
The results of the study suggest that in mothers with infants, mental health deteriorates under conditions of sleep deprivation. Furthermore, parenting self-efficacy, which is a predictor of stress reaction, is believed to be closely correlated with the habit of 'regular exercise'. Therefore, The results suggest the importance of providing a mother with support that help her adopt health practices based mental health.

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Purpose
This study aimed to examine the changes in the autonomic nerve activity by RR-interval variability and the feeling of a relaxation by using a relaxation scale during early postpartum days, and investigated the related factors.
Method
Scores of autonomic nervous system activity and subjective relaxation of 127 postpartum women were collected 1-3days after delivery. Autonomic nervous system activity was assessed using the heart rate, RR-interval variability, low frequency/high frequency (LF/HF) ratio, and HF, all of which were measured using LRR-03 (GMS). The HF and LF/HF ratio was used as an index of parasympathetic and sympathetic nervous activity respectively. The data collected were analyzed using a growth curve model.
Result
The HF value and the LF/HF ratio was the highest on the first postpartum day and decreased on the second and third postpartum day. The differences in HF, LF/HF ratio and relaxation scores between the first and third postpartum days were insignificant. The relaxation scores on the second and third postpartum days were found to be influenced by the relaxation score on the first postpartum day. The HF and relaxation scores were related to the experience of childbirth and the age of the mother. The relaxation score increased with increase in the frequency of delivery, and the HF value was influenced by the age of the mother. Moreover, the HF was high when the relaxation score on the first postpartum day was high, and the HF value progressively decreased on daily basis.
Conclusion
The HF and LF/HF ratio were higher on the first postpartum day than on the second and third postpartum days. The autonomic nerve activity was thought to be unstable on the first postpartum day. This study suggests the importance of realizing the psychological state of the first postpartum day to provide timely postpartum care depending on the condition of the mother.

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Purpose
The purpose of this study is to examine this relation between maternal-fetal attachment and behavior in daily life of primigravid women.
Methods
The participants of this study were 1,024 primigravid women in their third trimester that had already undergone an antenatal examination. Anonymous questionnaire were distributed to 40 hospitals and maternity centers in Hokkaido and returned by mail. Contents of the questionnaire consisted of information concerning fundamental attributes, pregnancy-related variables, Japanese translations of the Prenatal Attachment Inventory (PAI), Edinburgh Postnatal Depression Scale (EPDS), Rosenberg Self-Esteem Scale, and questions about participants' behavior in daily life during pregnancy (such as meal habits, sleeping and exercise). Data were analyzed using descriptive statistical analysis and nonparametric test.
Results
Of the 575 questionnaires collected, 440 were relevant to the analysis (valid response rate=43.0%). The average age of the subjects was 29, they were between 28 and 39 weeks gestation at the time. Issues that showed significant differences during the height fluctuations of maternal-fetal attachment concerned hopes and plans for the pregnancy, feelings of the pregnancy, images of the feelings and experiences subjects would have concerning the infant's care (ages 0-6 years), high self-esteem, meal habits during pregnancy, consciousness of consuming foods with higher iron content, sleeping during the day and exercise habits.
Conclusion
It is clinically useful to consider the behavior in daily life such as meal regularity, consciousness of consuming foods with higher iron content, allotting time to sleep during the day, and exercise as an objective index. These are issues that improve the maternal-fetal attachment. Research findings to date indicate that the consciousness of the primigravid women which values fetal well-being and growth serves as intrinsic motivation of the behavior in daily life of health.

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Purpose
We developed and evaluated a six-session program over three months, each session lasting two hours, for mothers of infants in order to increase the level of happiness in raising their children.
Method
We conducted this program twice with nine to ten mothers per group. A total of 19 mothers participated in the program (experimental group). We evaluated psychological indicators (i.e., psychological scales) such as feelings of stress and happiness in raising children and self-esteem, as well as physiological indicators (i.e., autonomic nervous activity, brain waves, salivary chromogranin) such as levels of relaxation and stress. These indicators were assessed before participating in the first session of the program, after participating in the last session, and one month after participating in the last session.
Similar evaluations were made on a control group of 16 mothers who did not participate in the program. Contents of the program for enhancing feelings of happiness in raising children consisted of developing relationships by talking with others about oneself, reflecting on one's feelings towards one's children, valuing happy moments in raising children, recognizing each other's hard work, affirming oneself and gaining self-confidence, making a life plan, and having others listen to one's issues. In addition, each session incorporated deep abdominal breathing and stretching exercises for smiling. Two-way analysis of variance was performed on each of the psychological and physiological indicators to analyze the group and time effects.
Results
Analysis of psychological indicators revealed no significant differences, except for the main effect of group on psychological fatigue due to stress in raising children. However, the effects were confirmed on some physiological indicators: significant differences were found in the main effect of group on heart rate, main effect of time on high frequency (HF) components of autonomic nervous activity, and two-way interaction effect on alpha-1 and alpha-3 brain waves. Alpha-3 brain waves were higher in the experimental group, indicating that the classroom allowed for concentration in a state of relaxed wakefulness.
Conclusion
Our future task is to develop a course program that is even more effective than the one described here. In particular, future programs should provide time for chatting with children present and time for individual counseling after each session, as well as continued support after program completion.

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Purpose
The purpose of this study is to elucidate how the respective infant feeding methods, exclusive breast-feeding and mixed/bottle-feeding, relate to anxiety over child-rearing and feelings toward the child.
Subjects and method
Data was collected through a questionnaire survey of 148 postpartum women who visited clinics for a checkup one month after delivery. The survey covered the subjects' backgrounds, their anxiety over child-rearing, Scale of Anxiety over Child-rearing (Makino, 1987) and Scale of Feelings toward the Child (Hanazawa, 2008). PASW Ver17.0 was used for analysis with a significant level of 5%.
Results
Regarding anxiety about child-rearing, women in the exclusive breast-feeding group felt less anxiety than those in the mixed/bottle-feeding group (p<0.001). Where feelings toward the child were concerned, a significant difference was found in the conflict index between the two groups, showing that women in the exclusive breast-feeding group had more positive and receptive feelings toward the child (p=0.039).
Conclusion
Breast-feeding is highly effective for alleviating anxiety over child-rearing and promotes positive and receptive feelings toward the child. Therefore, encouraging breast-feeding is considered desirable.

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