Purpose
This study describes the changes in the Women's Health Voluntary Group (WVG) members developed by participatory approach as a direct result of their participation in the WVG program in rural areas of Myanmar.
Method
A total of 74 people, including: 22 WVG members, eight people directly involved in the program, 20 WVG's family members, and 25 villagers, were interviewed in using a semi-structured interview format at intervention villages of the WVG program. Data was translated in Japanese and analyzed qualitatively and inductively.
Result
The analysis of WVG changes yielded 10 categories and 28 subcategories. WVG members developed from a stage of 'ignorance' to a stage of 'extension of consciousness derived from acquiring knowledge'. There was a core of 'behavior changes triggered by acquiring knowledge that could be used in their daily life' participation in the WVG program. The process of change was instigated by functions that could be applied within the village community: 'family support', 'handling of money', and 'the presence of things'. These functions had direct effects on the process of change. The changes were attained due to: 'the women's motivation to participate' and 'thought based on their religion and culture'. Furthermore, 'the sense of gratitude projected by the local community' and 'the collaboration with the basic health staff', in the form of greater cooperation, appeared as secondary benefits of the program.
Conclusion
The program resulted in changes in the WVG members themselves. This occurred in terms of an extension of consciousness derived from acquiring knowledge together with behavioral changes caused by the acquiring of knowledge applicable to daily life. These results occurred, as a direct result of participation in the WVG program.

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Purpose
To elucidate the structure of ethical dilemmas on the basis of the experiences of midwives involved in the care of women who were diagnosed with fetal abnormality during prenatal tests.
Methods
After ethical considerations were made, unstructured interviews were conducted on 8 midwives who had the aforementioned experiences; their "feelings," "perception," "thoughts," and "way of thinking" were extracted and analyzed qualitatively and inductively.
Results
Twenty-three concepts and 6 categories were extracted. In their relation with pregnant women, the midwives experienced actual dilemmas faced by healthcare providers, realized the difficulty of interventions in reproductive health, and "reaffirmed the position of midwives in organizations." In addition, inexperienced midwives lacked self-confidence and were confronted with their own sense of values and sense of ethics, and because of "the hardship and difficulty of involvement as primary care providers," they occasionally felt the limitations of nursing care. However, despite the burden caused by a shortage of human resources and problems within the system, the midwives found support in "the sense of satisfaction and sense of fulfillment that they get from being closely involved with mothers," and found a meaning in their involvement from the time of pregnancy. In addition, in some instances, they empathized with the pregnant women as if it were from the perspective of a family member, and built up, at an emotional level, the hopes regarding the vitality of the child. By starting to share time during pregnancy, the midwives were faced with "the difficulty of confronting a handicapped child because of their potentially biased sense of values," and therefore, doing so was an opportunity for them to confront their own sense of values. It also gave the midwives "an opportunity to reconsider the meaning of prenatal tests." Sharing time with pregnant women while experiencing dilemmas was an opportunity for them to explore the best ways to be helpful as midwives, and "continuing the relationship while sharing the death of a child" gave them an opportunity to mature themselves as midwives.
Conclusion
While deepening their relationship with pregnant women, the midwives experienced the difficulty to confront their own sense of values with issues such as the diagnosis of prenatal tests and handicapped children and experienced dilemmas associated with gender role expectations in consequence of the fact of belonging to the same sex as the pregnant women. Despite the feeling of satisfaction from being a reliable presence, the resulting hard and busy work created an environment prone to dilemmas and burnout. In addition, in their reproductive healthcare work environment, where life and death coexist side by side, they acted with self-defense by controlling their emotions and by lowering their sensibility to ethics. However, the dilemmas that the midwives experienced have been addressed as individual problems, and since there was no occasion to examine the ethical issues, which could only be experienced in clinical settings, this resulted in a vicious cycle.

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Purpose
The purpose of the current study is to focus on the first-time mothers in their late gestation to reveal the social norms that influence their intention to feed their infants.
Methods
In order to make clear of the variations of social norms that influence the intention of first-time mothers in regard to feeding their infants, the study is conducted with a qualitative and descriptive analysis in mind, where 17 first-time mothers in their late gestation whose pregnancies were normal and who were visiting one particular maternal perinatal medical center in Tokyo were each given a semi-structured interview, with qualitative analysis conducted using the data obtained.
Results
The study subjects all revealed their intention to breastfeed, though with different feelings by indicating either "I absolutely want to breastfeed my child," "Between 'I absolutely want to breastfeed my child' and 'I want to breastfeed my child if possible'" and "I want to breastfeed my child if possible." In terms of the social norms that influence first-time mothers in their willingness to breastfeed, there were 6 options for the subjects to chose from: "Inclination toward 'natural ways,'" "Be the socially expected 'mother,'" "Be a responsible 'mother,'" "Be a wise, self-protective 'mother,'" 'Advocate the adequacy of milk-giving and being a 'mother,'" "Have the socially expected environment and knowledge required of a 'mother.'"
Conclusion
The social norms that influence the intention of first-time mothers to feed their infants shown in this study indicated that, while social norms stipulate the motherhood ideology and the image of a socially expected "mother" who should be responsible for protecting her children's "health," many first-time mothers had their own social norms or set of values to respond to their anxiety of failing to breastfeed and childrearing stress, as well as to justify their actions in avoiding to be recognized as deviating from their "mother" role.

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Purpose
The purpose of this research is to investigate the Marital Adjustment Test and factors related to marital adjustment in couples during pregnancy in Japan.
Methods
A Questionnaire was conducted on 206 pregnant women undergoing health checkups for pregnant women on an outpatient basis at the department of obstetrics and gynecology and their husbands with the objective of elucidating marital relationships during pregnancy as well as related factors.
Results
The results of the Marital Adjustment Test showed that 73.3% had a favorable marital relationship during pregnancy. Based on the results of the marital relationship awareness scale and the Marital Adjustment Test, the following five factors were identified as being related to marital adjustment during pregnancy: "acceptance of spouse", "wealth of life", "husband's trust and support", "favorable interpersonal relationship", and "expectations toward childbirth and child-rearing".
Conclusion
These findings suggest that establishment of a smooth relationship of trust between husband and wife is important for enabling marital adjustment that is favorable during pregnancy to remain favorable during child-rearing.

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Objective
In the present study, narratives of fathers who lost children to stillbirth or neonatal death are described with regard to their experiences from during their wive's pregnancies to the present in order to gain a deeper understanding of fathers who lost children and thereby obtain suggestions for necessary care.
Subjects and Method
A semi-structured interview was conducted with 6 fathers who had lost children to stillbirth or neonatal death. A qualitative descriptive approach based on phenomenological research methodology was used to analyze the obtained data.
Results
The experiences of the fathers who lost children to stillbirth or neonatal death were grouped into the following 7 categories.
1. Shock due to the child's unexpected death. The sudden loss of the child resulted in surprise and confusion, which in turn caused psychological shock followed by feelings of helplessness and emptiness. 2. Fathers' concern for their wives and suppression of their own sorrow. Fathers were more worried about their wives, who were going through both physical and mental hardships, than their own sorrow. 3. Maintaining father and husband roles while hiding their pain. Fathers played roles as both father and husband by working on various procedures for sending off their children, while at the same time hiding their pain. 4. Social stigma and pain in daily life. Fathers were not able to express their grief due to the expectations placed on men by society, and they experienced emotional pain at society's unwillingness to recognize their grief over the children's death. 5. Wishing to know the cause of death. Fathers attempted to find meaning in their children's deaths, and tried to accept the death. 6: Continuing to be a father. Fathers had already come to love their children before the birth, and did not give up this parental role even after the death. 7. Maturing as a person. The grieving fathers "overcame the hardship on their own," acquired a new view of life and death and a new view of existence, and wished to share their experiences to help other people.
Conclusion
Fathers who lost children to stillbirth or neonatal death were terribly shocked by the unexpected death of their children, but continued to play roles as both father and husband after the death, while at the same time suppressing their own grief. Their unexpressed pain was overlooked by society, and sometimes went unnoticed even by the fathers themselves; however, they never forgot the children they lost. This allowed the fathers to continue being fathers and to mature as human beings.

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Purpose
ThisThis study aimed to develop an assessment tool to evaluate the state of the breast and milk secretion of lactating mothers. In this study, items were carefully selected for an assessment tool to increase its usefulness in a clinical setting.
Methods
The original study designed an assessment tool that was based on the results of previous study (Osada,2007). Since then the content and surface validity were discussed by researchers in the maternity and midwifery fields, as well as midwives specializing in breastfeeding support in the clinical field, resulting in new content being added to modify the original assessment tool to modified it. Five midwives, having different lengths of experience in breastfeeding support and 45 pairs of mother and child participated in the survey study. A total of 90 breasts from 45 lactating mothers, who had no history of breast disease were used as the subjects.
Results
Exploratory factor analysis was performed on the validity of construction concept using both the principal factor analysis with the Promax rotation method. From these methods, three factors and 16 items were extracted: specifically the factors were, 1) viewpoint for observation of milk production, 2) viewpoint for observation of galactostasis, and 3) viewpoint for observation of the way of children's sucking the breast in order. Among these factors, the second was closely correlated with that of the previous assessment tool. Since the results of diagnosis using the current tool were similar to those obtained using ultrasonography, its criteria-related validity was confirmed. Since Cronbach's α coefficient of reliability was 0.844 (0.872, 0.786, 0.852 for subordinate concepts), the reliability of this assessment tool was confirmed. The interclass correlation coefficient and Cohen's kappa (k) coefficient were less than 0.4 for some items in midwives with six or less years of breastfeeding support experience; but was coincident among midwives with eight or more years of similar experience. But, it was coincident among the midwives whose experience was 8 years or more.
Conclusion
This assessment tool for diagnosing the state of the breast during lactation was constructed with 3 factors and 16 items. The reliability and validity of the assessment tool were satisfactory. Items were chosen for the tool so as to lighten the load for its users and decrease the inter-item deviation. Therefore, it is expected that this assessment tool will be available in the clinical field.

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Purpose
To determine the impact of amniotomy on spontaneous labour in uncomplicated pregnancies.
Methods
A retrospective study comparing outcomes for low-risk primiparous and multiparous women with spontaneous labour at term having amniotomy or no- amniotomy.
Results
A total of 326 primiparous (164 amniotomy group and 162 no-amniotomy group; and 435 multiparous (273 amniotomy group and 162 no-amniotomy group) yielded a total sample of 761 subjects. There was a statistically significant reduction in the length of the second stage of labour in the multiparous amniotomy group compared to the multiparous no-amniotomy group. The time from rupture to delivery was shorter in the primiparous amniotomy group and the multiparous amniotomy group compared with the no-amniotomy groups. Compared to the primiparous no-amniotomy group to the primiparous amniotomy group, there was a statistically significant difference for: oxytocin requirement (χ²=11.227, p=.001); Kristeller's expression (χ²=5.420, p=.020) and both Kristeller's expression and vaginal birth instrumentation (χ²=7.071, p=.001).
Conclusions
It is necessary to keep in mind that amniotomy had occurred with oxytocin, Kristeller's expression and both Kristeller's expression and vaginal birth instrumentation. A critical area to explore is the necessity of medical interventions post-amniotomy.

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