Purpose
The aim of this study is to determine the competencies required of midwives who work as instructors at neonatal cardio-pulmonary resuscitation seminars.
Subjects and Methods
The study was conducted between October 2010 and July 2011, using the two-round Delphi technique. Twenty-two panelists were selected out of those midwives, nurses, neonatologists and obstetricians with ample experience in the subject matter instruction who were nominated as experts by the Japan Society of Perinatal and Neonatal Medicine and the Japan Academy of Midwifery. The questionnaire was composed of general competency items (ibstp, 2003). Two surveys were conducted to reach a consensus on the competency items. The items consisted of 98 sub-items included in 18 competency items: four competencies in professional foundations, two in planning and preparation, eight in instructional methods and strategies, two in assessment and evaluation, and two competencies in management. The first survey was summed up, the proportion calculated and the whole comments listed anonymously, which was attached to the second survey sheet. The consistency rate of the responses among the panelists to the second survey was calculated, which led to the judgment that their ideas became basically in convergence.
Results
Twenty panelists participated in the study (out of 22 to whom the study sheets were distributed: 90.9% collection rate), who had conducted instructions 12.9 ± 13.8 (mean ± SD) times. The items that showed a high level of shared agreement among the panelists were "to communicate effectively", "to establish and maintain professional credibility", "Stimulate and sustain learner motivation and engagement", and "Evaluate instructional effectiveness". The items of a low level of common agreement among them were "to promote the retention of knowledge and skills", "Promote transfer knowledge and skills", "Plan instructional methods and materials", "Provide darification and feedback", "Assess learning and performance", and "Manage the instructional process thragh the appropriate use of technology". The comments provided in the free comment area by the panelists included: "Midwives are not necessarily familiar with the pathological conditions and physiology of neonates". and "No feedback on instruction has been given to the instructors".
Discussion
It was considered that the competencies required of seminar instructors include interactive communication with participants as well as to sustain their motivation. Many of the panelists agreed that evaluating the instruction was necessary despite few opportunities to do so. This suggests that some form of feedback should be provided to improve the quality of instruction. It was also revealed that enhancing the midwives' knowledge in pathological conditions and physiology of neonates remained as an issue.
Conclusion
The competencies required of midwifery instructors for neonatal cardio-pulmonary resuscitation commonly picked out by many of the panelists were "Communicate effectively", "Establish and maintain professional credibility", "Stimulate and sustain learner motivation and engagement", and "Evaluate instructional effectiveness".

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Objectives
To ascertain the state of delivery care needs of women in rural Bangladesh in order to gain insight into approaches involving skilled birth attendants (SBA).
Subjects and methods
Subjects were 9 women who resided in the rural areas of the Bogra District and who had delivered within the last year. The study design was a descriptive study involving qualitative inductive analysis. Field notes from field work, data from semi-structured interviews with subjects, and data from unstructured interviews with key informants were collected. Data from semi-structured interviews were analyzed using qualitative induction. Interviews were conducted by researchers directly in Bengali (the official language) without the use of an interpreter.
Results
Three core categories of delivery care needs of women in rural Bangladesh were identified: "support to give birth at home," "support to safely deliver a healthy child," and "support to give birth with relatives present." In addition, care needs were found to be heavily affected by religion and customs. Based on the women's descriptions, SBA were accepted favorably as a provider of information during pregnancy and a provider of aid in the event of problems but were not considered necessary during a normal delivery. During a normal delivery, women preferred a traditional birth attendant, primarily in the form of a relative.
Conclusion
For SBA in rural Bangladesh to be chosen as birth attendants, 3 criteria must be met. First, SBA must be better able to make assessments, make decisions, and respond to obstetric emergencies. In addition to being skilled, SBA must consider the social and cultural backgrounds of villagers they will be attending. Finally, SBA must respect the needs of women and their families and support their decision-making.

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Objective
To clarify the development process of mothers as caregivers up to 6–7 months postpartum and acquire basic data for the purpose of devising support measures appropriate to development states by looking at chronological changes in the Attachment-Caregiving Balance Scale, which was developed as a scale to measure the development of the maternal caregiving system.
Methods
Mothers who received a 1-month postpartum health check were asked to participate in follow-up research. Valid responses from 116 participants gained from research conducted up to 6–7 months after birth were analyzed. All surveys were collected through mail. The research included the Attachment-Caregiving Balance Scale, childbirth history, and the existence of a parenting adviser. Shifts in the 6 factors that comprise the Attachment-Caregiving Balance Scale were compared using one-way analysis of variance, and covariance structure analysis was utilized to confirm impacts on the 6 factors, such as the child's age and whether a mother had previously given birth.
Results
Out of the 6 factors, significant differences were seen in primipara and multipara at 1 month postpartum for "adaptation: attachment," "sensitivity: attachment," and "sensitivity: caregiving," while a difference was seen in "sensitivity: attachment" at 3–4 months postpartum and 6–7 months postpartum. Significant differences were seen during the 3 postpartum phases in "adaptation: attachment" and "sensitivity: caregiving" for primiparas, and "sensitivity: caregiving" for multiparas. Although childbirth history and the child's age significantly impacted some of the 6 factors, an estimated value of over 0.2 was seen only in childbirth history and "sensitivity: attachment," and the child's age and "sensitivity: caregiving." The coefficient of determination for both was around 10%.
Conclusion
From 1 month to 6–7 months postpartum "adaptation: attachment" declined and "sensitivity: caregiving" rose. No significant chronological difference was seen in "sensitivity: attachment," but multiparas showed a tendency toward increase. Though a child's age and childbirth history were factors impacting the caregiving system, the impact was not substantial. Based on the above, it can be inferred that a caregiver's development is not simply determined by a child's age or whether a mother has previously given birth. Rather, it is thought to be tied to effective support measures that utilize the developmental state of each of the 6 factors and elements that impact them as one type of assessment material.

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Objective
The purpose of this study is to clarify the elements of midwifery care to encourage the recovery of domestic violence victims during their perinatal and child rearing period from the perspectives of both victims and nurses.
Method
The study used both qualitative and descriptive research designs. Those who participated in the study were: (1) 21 victims of domestic violence who had been suffering from their partners' violence even before pregnancy and had seen obstetricians during pregnancy, and (2) 10 nurses who victims in the first group credited with recognizing the abuse and helping them with their emotions and outlook. We asked those victims of domestic violence about the moment they were able to realize that their recognition toward suffering from DV had changed through their communication and involvement with the nurses while they were visiting medical institutions. We asked the nurses how they tried to assist domestic violence victims based on interview results of those victims. Interviews were conducted in a semi-structured manner with the reference of an interview guide. After conducting the interviews, the researchers conducted a qualitative analysis of the data.
Result
Nursing interaction that led to positive changes in IPC recognition were classified into three categories; Interaction that created a sense of reassurance and safety for these women and children, Interaction that helped women regain a sense of themselves, Interaction that stimulated maternal self awareness. The core category emerged as "building relationships" with other people. In the first category, nurses "conducted IPV assessment and provided information while creating a relationship in which the women felt safe". They felt the nurses understood them and were safe to talk to. In the second category, nurses "encouraged women to be more aware of their own existence" and accept themselves as they are. The women then felt accepted and not alone. In category three, nurses "made women recognize their own identity as bearers of life'. The women then recognized their role as a protector and nurturer of their child, which led them to leave the home for the child's sake. The nurses also gave them the strength to follow through with their decision.
Conclusion
It can be considered that those victims of domestic violence, who were suffering from violence by their trusted partners and isolated, perceived their existence that is valued by others on the way of "forming ties in relationship", experienced an opportunity to believe others and recovered trust in others and headed for their own recovery. With those findings, it was indicated that the above described care is an important element of midwifery care encouraging victims of domestic violence to recover.

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Purpose
This study records and clarifies the reasons for which women choose during pregnancy to undergo painless childbirth through epidural anesthesia, as well as their experiences through childbirth.
Subjects and methods

Semi-structured interviews and qualitative descriptive analyses were carried out during the hospitalization and one-month checkups of fourteen women who gave birth through elective painless childbirth, and whose progress, like their children's, was satisfactory from pregnancy through postparturition.
Results
Women who chose painless childbirth during pregnancy had distinctive backgrounds including a natural tendency to be frightened, a desire to preserve their strength for after the birth, a desire to give birth safely, a desire to redress the unsatisfactory experience of a previous childbirth, and so on. They felt that "painless childbirth was their only possible option." Further, they "justified giving birth through painless childbirth" from information that it was the mainstream method overseas and/or from hearing from others who had experienced it, and "gained a sense of security during pregnancy" from giving birth through painless childbirth. On the other hand, they felt "anxiety regarding giving birth through painless childbirth" and "confusion at prejudices regarding painless childbirth," and coped with these in their own ways during pregnancy.
Conclusion
From the results of this study, it is desirable for women choosing painless childbirth to feel when making their choice that it is the only option possible for them, and to receive nursing support which fully understands and takes into account anxieties and prejudices regarding giving birth through painless childbirth.

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Objectives
The Japan Academy of Midwifery developed and disseminated the "2012 Evidence-based Guidelines for Midwifery Care" in order to achieve a more uniform standard of care during childbirth. The aim of this study was to describe the implementation of the Guideline among hospitals, clinics and midwifery birth centers. The focus was on care during the first stage of labor. Data was collected through October 2010 to July 2011.
Methods
Participants were managers who were in charge of hospitals, clinics and midwifery birth centers handling childbirth in Tokyo, Kanagawa, Chiba, and Saitama. Questions about the Guideline's implementation during the first stage of labor comprised 18 items. The Ethics Committee of St. Luke's College of Nursing, Tokyo, Japan (No. 10-1002) provided ethical approval.
Results
Agreeing to participate were 255 institutions (total response rate, 37.2%): 18 hospitals (response rate, 50.2%), 66 clinics (20.8%), and 71 midwifery birth centers (54.2%). Responses to continuity of caregivers for care during pregnancy and childbirth indicated Guideline adoption in midwifery birth centers (92.9%) and clinics (54.7%), but not in hospitals (15.3%). Two interventions for inducing labor were minimally adopted: (1) membrane sweeping for induction of labor was not common (hospitals .8%, clinics 3.1%, midwifery birth centers 1.4%), and (2) nipple and breast stimulation (hospitals 0%, clinics 1.5%, midwifery birth centers 5.6%). It was a policy for 38% of midwifery birth centers to provide continuous electronic monitoring on admission. Epidural analgesia was used if necessary as a policy in 31.6% of hospitals and 31.3% of clinics. Possibility for immersion in water around 40 centigrade for labor pain management as a practice in midwifery birth centers was higher (92.7%) than in hospitals (48.3%) and clinics (26.7%). Examples of adoption of methods for labor pain management with higher rates were: position change (95%), back massage (88%), warm pack (74%), and walking (61%). A routine enema to accelerate contractions was not common (hospitals 1.7%, clinics 9.1%, midwifery birth centers 1.4%). No institution had a policy for amniotomy as routine care.
Conclusion
There were considerable gaps between the Guideline and practice in hospitals, clinics, and midwifery birth centers. Based on the results of this study, evaluation of the Guideline should be conducted in a few years. Limitation of this study was the low reply rate of respondents. It is necessary to elucidate the actual conditions throughout Japan.

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Purpose
The purpose of this study is to describe how Japanese women who are married to Balinese men and reside in Bali perceive their child-raising within the context of Bali-Hindu philosophy and their experience in child-raising.
Method
The researcher spent three months in Bali, Indonesia. The data were collected using semi-structured interviews with 11 Japanese women, then qualitatively analyzed and sorted into categories. Interviews included how Bali-Hindu philosophy affects the Japanese women's child-raising practices.
Results
Twelve categories and 39 subcategories were extracted from the data in this study. The Japanese women who settled into Balinese life gradually accepted Bali-Hinduism and they openly used folk therapy for their children. On the other hand, folk therapy was not used by the women who were less easily influenced by Hinduism. To accept Hinduism was difficult for Japanese women, even though they thought that Bali was a more appropriate environment for raising children when compared to Japan because everybody participated in child-raising. In addition, they thought that Hinduism influenced child health. Most Japanese women appreciated the Balinese family's assistance with raising their children. At the same time they felt discomfort living with Balinese extended families.A cause of the difficulty in accepting Hinduism is the idea of domination of the women by the men. Furthermore, there is a link between perceptions about how to provide a better life options to their children and challenge of having to accept Hinduism. Although the depth of acceptance was variable, they prepared themselves for bringing up their children in Bali.
Conclusion
For Japanese women who married Balinese men residing in Bali, the Bali-Hindu philosophy had a significant impact on their attitudes and on their child rearing practices.

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