Purpose
This study clarifies the structure of fathers' child-rearing behavior and awareness for late school-age children and examines the factors influencing it.
Method
With the consent of the collaborating elementary school, we distributed a questionnaire survey among the students. We obtained valid responses from 251 students and analyzed the data. We performed a factor analysis of fathers' child-rearing techniques from their responses on behavior and awareness. Then we determined the correlation coefficients of the "family factors," "work factors," and "personal factors" and examined the factors that influence fathers' child-rearing behavior and awareness. To determine the degree of this influence, we analyzed the variables in which the correlation was confirmed by a multiple regression analysis.
Results
The factor analysis of the fathers' child-rearing behavior and awareness for late school-age children determined that the first behavior factor is "management: request behavior for maturity" and the second "conversation: behavior of expression." The first awareness factor is "conversation: awareness of expression" and the second "management: awareness on request for maturity." We confirmed that both behavior and awareness have a high internal consistency. The factors that influence fathers' child-rearing behavior and awareness were the sense of the gender role, which is one of the "personal factors" that correlated with both the behavior and awareness factors, acceptance of the parent role, and the satisfaction with the marital relationship, which is one of the "family factors." To determine the level of influence of fathers' child-rearing behavior and awareness, we performed a multiple regression analysis of three variables in which correlations were observed, as independent variables. Results revealed that the factor that the most influential in fathers' child-rearing behavior and awareness was satisfaction with the marital relationship.
Conclusion
The fathers' child-rearing behavior with their late school-age children is the controlling behavior, such as enforcing social norms and basic life style. They are also aware of the responsiveness of communication involving cooperation with children. The factor that influences the fathers' child-rearing behavior and awareness the most was satisfaction with the marital relationship. Thus, the father's satisfaction with the relationship with his wife encouraged his involvement with the late school-age children's upbringing. Thus, the results suggest the need for support, including that of family members.

View full abstract

Aim
To assess the program by outcome evaluation and process evaluation of providing developed the partnership support program to increased partnership, decreased psychological distress, and maintain Quality of Life (QOL) for couples in the process of fertility treatment including the possibility of using assisted reproductive technology.
Methods
A quasi-experimental one-group pretest-posttest design was used to evaluate before and after scores in psychological distress and QOL. The partnership support program was implemented with 36 consenting patients (18 couples) in various phases of fertility treatment from one fertility clinic in Kanto region of Japan. The main outcome measures were partnership, QOL, relationship satisfaction with partners and psychological distress. Participants completed self-administered valid and reliable questionnaires, developed by the authors. A content analysis thematic approach was applied to the qualitative evaluation comments.
Results
Valid responses were obtained from 25 program participants (12 men, 13women). In comparison of before and after of program intervention, female group participants increased their QOL score and Partnership score. Their psychological Distress scores were significantly reduced by program participation (p=0.021). In the male group, there was no significant change in scale scores.
Those male and female participants who scored lower on the Partnership scale and QOL were analyzed as subgroups. The males' group Partnership and QOL scale score averages improved from pre to post test, but not significantly. However, the females' Partnership scale score averages significantly increased after intervention (p=0.028) but their QOL scores, while improved, did not reach significance.
The content analysis of the evaluation yielded four categories: (1) deepening of understanding, (2) relief, (3) useful for communicating and (4) information gain. In the evaluation process, 72% of the participants were aware of their information gain; 90% felt the deepening of communication with their partners. The majority (90%) of participants indicated high satisfaction with the program and 77% evaluated amount of content and length of time was appropriate.
Conclusion
The partnership support program had great utilization and satisfaction for couples. This program was useful in order to maintain QOL, improve the partnership, and reduce psychological distress for women, however it had less impact for the men. Implementation of a program for the prevention of increasing psychological distress in patients undergoing fertility treatment, in clinics is highly recommended. Even so there are many aspects to understanding what could provide more individual support to men, to women, and to both as a couple. Researchers and clinicians are encouraged to explore these possibilities.

View full abstract

Purpose
The presence of husbands at childbirth has been widely accepted in Japan. However, the negative effects of attending childbirth on husbands can include mental health disorders such as symptoms of PTSD, anxiety, and depression. The purpose of this study was to explore husbands' experiences and feelings with attending their partners' childbirths and to describe the transformation process of their feelings before, during, and after childbirth.
Methods
Semi-structured interviews were conducted by a male interviewer. Fourteen Japanese men who had attended their wives' childbirths at two maternal hospitals within the past three months were recruited. Ten agreed to be interviewed and participated in the study from October 2011 to January 2012. Data were collected using an ethnographic approach called the Rapid Assessment Process. Interviews were approximately 90–120 minutes long and were conducted in person at a time and location convenient for participants. Two researchers independently analyzed the qualitative data using content analysis to identify categories and sub-categories of husbands' experiences and feelings before, during, and after attending childbirth.
Results
Seven of ten participants were attending childbirth for the first time. All participants attended the vaginal delivery from the first stage until the end of labor. Five categories consisting of 12 sub-categories emerged as descriptions of the husbands' experiences and feelings: "Wanted to support my wife," "Concerns about unknown world," "Overcame a problem with my wife," "Noticed the differences between men and women," and "Grew up." Two factors—"Responses of the medical staff" and "Appreciation from my wife"—affected the experiences and feelings of the husbands regarding attending childbirth. Furthermore, their feelings shifted as time passed. Specifically, "Wanted to support my wife" was apparent in husbands' feelings and actions during their wives' pregnancy. Categories that were salient during labor were "Concerns about unknown world," "Overcame the problem faced with my wife," and "Noticed the differences between men and women." Finally, "Grew up" was a common theme during the postpartum period. It was demonstrated that experiences and feelings were different between men who had and those who had not attended childbirth previously. Data from four subcategories, including "A feeling of powerlessness" and "Discover a new world," were not extracted from participants who had already attended childbirth.
Conclusion
Husbands' feelings regarding attending childbirth were transformed before, during, and after childbirth. The present findings might help caregivers to better understand husbands' feelings and anxieties, which could facilitate husband involvement in childbirth. Health care providers should incorporate this process in working with husbands involved in childbirth to help husbands as well as childbearing women have a satisfactory childbirth experience.

View full abstract

Purpose
To determine women's perception of antenatal perineal massage and to identify factors impeding their massage practice.
Methods
A questionnaire survey was conducted with a purposive sample of 390 women from eight Japanese urban hospitals, clinics and birth centers and who had a vaginal and full-term delivery. The 334 (85.6%) valid responses were analyzed statistically.
Results
1. There were 114 women (52.1%) who practiced antenatal perineal massage and 105 women (47.9%) who did not. Among the 114 women who practiced perineal massage, 59.6% continued the massage until childbirth. Of the 105 women who did not practiced the massage, 45.7% felt a resistance to touching their perineum.
2. The rate of women taught how to practice antenatal perineal massage by a midwife, and who practiced perineal massage was significantly larger than who had not practiced (p=.000). Conversely, the rate of women who were taught how the massage during their maternity class, and did not practice was significantly larger than who practiced (p=.000).
3. Over half of women who knew how to perform antenatal perineal massage felt it was difficult for example: 'how to move fingers','how much pressure to apply', 'how deeply should a finger be inserted into the vagina' and 'how long does massage practice last'. Women who stopped practicing antenatal perineal massage had felt significantly more difficulty in practicing the massage than those who continued until childbirth (p=.012)
4. Women who continued to practice perineal massage felt significantly more positive 'effects on preparation for childbirth' and 'effects on childbirth' than who stopped practicing the massage (p=.000).
5. Self-efficacy, 'childbirth in my own way', of primiparous who practiced perineal massage was significantly larger than who did not practice (p=.014).
Conclusion
Factors impeding antenatal perineal massage practice were: (1) resistance to touching their perineum, (2) lack of knowledge and (3) some difficulty practicing the massage. Moreover, it was important to not only practice perineal massage but also continue in order to redeem the effects. Therefore, midwives and maternity educators need to support pregnant woman in their efforts to continue antenatal perineal massage until childbirth.

View full abstract

Purpose
The purpose of this study is to shed light on the period from infertility treatments to six months after delivery during which the women who became pregnant with twins after receiving Assisted Reproductive Technology (ART) went through the process of becoming a mother.
Methods
The study design is the life story method. The participants were four women who (1) became pregnant with twins after receiving ART, (2) do not have any inherent abnormalities and did not have complications with the fetus after eight months of pregnancy, (3) were anticipated at the eighth month of pregnancy to have a smooth pregnancy and delivery process. The data was collected through semi-constructive interviews and the participant-observer method. Interviews and observations were carried out in a longitudinal way at the following five points: (1) during regular outpatient visits to a maternity clinic, (2) during hospitalization after delivery, (3) around the time of the one-month health checkup of the babies, (4) around the time of the three-month health checkup of the babies, and (5) around the time of the six-month health checkup of the babies.
Results
The research describes life stories of: participant A whose dream of making a family with her husband has come true by having the babies, participant B who tries to be a strong mother for her babies, participant C who tries to recover from her previous pain of losing her child, and participant D who still has not really been able to feel that she has become a mother.
Discussion
All of the research participants during their pregnancy denied the thought that they might become a mother. But after delivery, they recovered the time they spent with their fetus by rewriting their stories as if they had prepared for becoming a mother from the time of their pregnancy. They also gave meaning to the current situation as 'satisfied' by recalling their harsh experience where their self-esteem was hurt during the infertility treatment. The women told their stories of going forward as a mother by giving an affirmative meaning to their unresolved past and accepting it.
At the same time, however, there was a possibility that their stories of being hurt by the stigma of infertility, which they cannot get rid of even after delivery, casts a shadow on their stories of becoming a mother. The stories of women becoming a mother after being pregnant with twins following ART were to be re-written along with the narrative that continues from the period of the infertility treatment to that of child rearing, at the base of which, it was believed, exists the continued stories of being hurt. It was suggested that it is necessary to understand the experience of women from the time of infertility treatment through to child rearing and provide continuous support that is appropriate for each woman's experience.

View full abstract

Objective
To reveal the component factors and related factors for the abilities that midwifery faculty members expect midwifery instructors to possess.
Subjects and methods
We conducted a survey on the level of importance (from 1 to 5) of 88 actions related to the basic attributes and general job competency of midwifery instructors. Between June and September 2011, we distributed a letter requesting cooperation and a survey form to midwifery faculty members with more than 3 years of experience at 139 midwife training institutions across Japan (except for those in the 9 prefectures affected by the Great East Japan Earthquake). We analyzed 185 valid responses using factor analysis to extract component factors and related factors, and we used the Mann-Whitney U test and Kruskal-Wallis test to investigate associations between the factors.
Results
The mean (standard deviation) number of years of experience as a midwifery faculty member was 8.97 (5.88), and that as a clinical midwife was 9.50 (5.63). Statistical analysis extracted the following 5 factors: "leadership ability in midwifery care as a practitioner", "goal-oriented teaching focusing on student understanding", "creative teaching depending on the status of students", "application and adjustment of human resources to meet the conditions", and "self-control and motivation to improve leadership ability". We collectively called these factors "abilities of midwifery instructors expected by midwifery faculty members". Cronbach's alpha coefficient was .974 for all factors and ranged from .894 to .933 for individual factors. In all midwifery faculty members, the mean value on "leadership ability in midwifery care as a practitioner" was highest among all factors. In addition, a significant difference was noted between the years of experience in clinical midwifery and "self-control and motivation to improve leadership ability" (p<.01), suggesting that this ability was considered important by midwifery faculty members with many years of clinical experience compared with those with only a few years of clinical experience.
Conclusion
Of the 5 factors on abilities expected of midwifery instructors by the midwifery faculty members, "leadership ability in midwifery care as a practitioner" was considered by all faculty members to be the most fundamental. Furthermore, those with comparatively longer clinical experience placed importance on the need for high-level leadership ability based on their own experiences as practitioners.

View full abstract

Purpose
Mothers soon after childbirth are recovering physically and also taking on multiple roles. However, their physical health has been relatively neglected both in research and practice. This article describes the general health status of mothers in early parenthood, degree of their perceived achievement of desired childrearing, and related factors.
Method
Participants were 500 women 6 to 11 months postpartum, selected by a random sampling of mothers from the Basic Resident Register, and resident in a ward in an ordinance-designated city. A questionnaire conducted by postal mail was composed of 26 items on topics such as physical symptoms, degree of accumulated fatigue, Short Form 8 Health Survey (SF-8) within the previous month, and sleep quality. The questionnaire culminated in the question "Do you think you have achieved your desired childrearing so far?"
Results
Respondents to the questionnaire were 274 mothers (response rate, 54.8%). Almost all mothers had experienced one or more physical symptoms, with a mean 4.5 (SD 2.8) symptoms per mother. All SF-8 scores fell below 50. Mothers reported a mean 6.4 (SD 1.3) hours of sleep and 2.7 (SD 1.4) interruptions per night. Perception of better recovery from exhaustion by sleeping was correlated with achievement of desired childrearing (p<0.01). Almost half of the mothers (n = 156, 56.9%) responded that they had achieved their desired childrearing. Three factors associated with such achievement were: "reasonably enough" (odds ratio 4.7, 95% confidence interval 1.88-11.58) or "enough" (6.9, 1.65-28.97) perceived recovery from exhaustion by sleeping; being over 40 years of age (6.1, 1.14-32.60); and living with the child's grandparent(s) (3.4, 1.06-11.09).
Conclusions
Mothers self-rated their health as poor. The factors associated with achieving their desired childrearing in early parenthood were having enough sleep to recover from exhaustion, being over 40 years of age, and living with the child's grandparent (s).

View full abstract

Purpose
The purpose of this study was to clarify the experiences, from pregnancy with a first child to puerperium and childcare, of women who became pregnant through fertility treatment.
Methods
The subjects were 9 women who were receiving fertility treatment for a second pregnancy after giving birth to a first child through fertility treatment. Data were obtained from semi-structured interviews on the subjects' experiences from pregnancy with a first child through fertility treatment to puerperium and childcare, and a qualitative descriptive study was performed.
Results
Nine categories were identified as experiences of pregnancy: Growing desire for a second child; contrary to expectations, lack of actual sense of pregnancy and delivery; joy and pride in pregnancy; anxiety and reassurance in selecting a birthing facility; feeling of relief at having come this far on a long journey; acceptance that one cannot have a natural delivery; fluctuation between anxiety about abnormalities or disorders in the fetus and feeling that it will be all right; thankfulness and stress with respect to family; and uncertainty about continuation of pregnancy. Three categories were identified as experiences of the intrapartum period: Longing for the birth of a healthy child; delivery with little sense of fulfillment; and joy at becoming a mother and motivation for child rearing. Five categories were identified as experiences of puerperium and childcare: Joy felt from existence of baby; easing of worries regarding baby; anxiety about raising one's first child despite joyful birth after much difficulty; weakness of one's feelings and emotion towards childbirth; and connection between unsettling events and medical treatment.
Conclusion
Women who became pregnant through fertility treatment had various experiences, including anxiety about abnormalities or disorders in the fetus during pregnancy, intrapartum period, puerperium, and child raising, and weak sense of fulfillment from pregnancy and childbirth. The findings suggest that nurses need to understand these unique experiences of women who have difficulty becoming pregnant and provide appropriate care.

View full abstract

Objective
The purpose of this study was to clarify the feature of involvement of their mothers for primiparous women of less than two weeks of confinement about the breast-feeding by the participating observation and interview of primiparous women and their mothers in outpatient breastfeeding.
Study selection and Methods
The sample for this research consisted of 10 sets of primiparous women and their mothers who attended breast feeding visitor consultation together. The data were collected from February through July. The methods of research used were observation and interviews. The Interview Questions were 'daily child-rearing after leaving the hospital related to breast-feeding', 'the state of the daughter fromher mothers' viewpoint, etc. Observation of the study participants and all interviews were taped and transcribed and used as data. The transcribed data was adjusted into short sentences for analysis. After all this work compiling data, sub-patterns and the patterns were looked for and found which explained the nature and features of the relationship of primiparous women with their mothers.
Results
Two relationship patterns were found that were characteristic of the relationship. One is [individual relationship pattern] which consisted of sub-patterns such as [receptivity], [supportive], [educational]. The other one was [intergenerational tradition relationship pattern] which consisted of sub-patterns such as [handed down experience from old times about food] ,[traditional approaches to child caring]. The individual relationship pattern of could be said as personal, because those are the mother's feeling, such as perspective, a sense of values, etc. The other Intergenerational tradition relationship pattern was beyond the personal one, because it contained traditional customs which are transferred to the next generation as part of the propagation of these customs in the family. Moreover, there were two types within these interactions; one being a supportive affirmative of the relationship such as watching, receptivity, and the other one is an authoritarian attitude which already has been reported in a previous study.
In the background, it was considered that there was mothers' wish to want to let my daughter do the breast-feeding that was not possible to oneself.
Conclusion
The Features of the nature of the relationships between primiparous women and their mothers related to breastfeeding suggests that there is an [individual relationship pattern] and an [intergenerational traditional relationship pattern].

View full abstract

Purpose
The purpose of this study was to find out the significance of a grandmother's life in experiencing her daughter's return home for postpartum assistance.
Subjects and Methods
Semi-structured interviews were conducted with five grandmothers who had provided postpartum assistance to their daughters, all of whom had returned home for 4 to 6 weeks in the 2 months prior to the study. All daughters were first-time mothers who had given birth naturally, and all data were analyzed by qualitative inductive analysis.
Results
The following four core categories emerged when the significance to a grandmother's life in experiencing her daughter's return home for postpartum assistance was investigated: a) demonstrated latent abilities as a mother; b) gained happiness from daughter and grandchild; c) discovered personal growth; and d) discovered a new direction in life. The core category "demonstrated latent abilities as a mother" included the following categories: i) tracking the growth of the daughter as a mother, wife, and person; and ii) helping to bring happiness to her daughter and son-in-law. The core category "gained happiness from daughter and grandchild" included the following categories: i) happiness towards her daughter's growth and deepened affection; and ii) comfort and awe from the grandchild. The core category "discovered personal growth" included the following categories: i) pride in having raised her daughter; ii) acceptance of fatigue and self-sacrifice; and iii) discovered a tolerant and generous side of one's self. The core category "discovered a new direction in life" included the following categories: i) built a new relationship with the daughter; ii) happy to have been helpful to her daughter; and iii) a new direction to live the life one wants to live in the future.
Conclusions
The significance to grandmothers in accepting and providing postpartum assistance to daughters when they return home was not merely about providing childcare support; moreover, the following points were identified. Concerning a mother's happiness, it brings joy to watch one's daughter's growth as a mother, as a wife, as a person and deepens the affection and intimacy. It also enables her to watch over the amicable marital relationship between the daughter and the son-in-law, helps to bring happiness to the couple, and helps to foster relationships with the son-in-laws. Concerning a grandmother's happiness to their daughter's child, it deepens the sense of intimacy and affection and helps them gain a peace of mind. Watching the grandchildren grow provides them with inspiration and vitality. The experience helps them discover their self-growth and fosters new relationships with the daughters. It also aids in discovering a new direction in life that values individual life while treasuring one's family and noticing one's continuous self-growth.

View full abstract

Purpose
The purpose of this study was to explore reproductive health issues of female refugees and asylum seekers who resettled in Japan.
Method
Data were generated from a purposive sample of seven female refugees and asylum seekers, who were in the reproductive ages of 15-49 years and affiliated with an organization assisting displaced persons. Semi-structured interviews were conducted through interpreters. Qualitative data analysis was guided by content analysis. Strict confidentiality and anonymity was maintained.
Results
Female refugees and asylum seekers experienced complex difficult conditions in Japan. They either felt they had nowhere to go or this was the one and only place to live. Their life was characterized as terrible loneliness, and only religion gave them a sense of well-being. In their own country they had lost reproductive health and rights because of the social and economic situation. After they came to Japan, they used sexual activity as a means of relating with men to assuage their deep loneliness. As the result of casual unprotected sexual activities, five female refugees and asylum seekers in this study became single mothers. Even though they had little income, their religion drove their decision to have babies. After having babies, their emotional involvement relied most heavily on their children, and they found joy and happiness in their life.
On behalf of improving their reproductive health and rights in Japan, healthcare professionals need to personally attend to the refugee women. It is also necessary for healthcare professionals to learn and understand refugee women's background and why returning to their country of origin could be very dangerous; health care professionals should not necessarily recommend returning to their previous country even if the women's health condition is critical. Providing information relating to healthcare services in Japan is a significant point as well as caring for refugee women.
Conclusion
Female refugees and asylum seekers using the Japanese health care system were disadvantaged due to their status and gender. They felt loneliness and isolated because of their difficulty relating with the Japanese culture. Their problems were interwoven and complex and included economical, educational and psychological issues; likewise reproductive healthcare was limited leaving them vulnerable. Japan as a host country should consider developing reception systems for accepting refugees and asylum seekers for improving their life.

View full abstract

Objective
The aim of the study was to characterize the depressive tendency and stress-coping ability of pregnant and postpartum women who conceived through assisted reproductive technology (ART) and conventional infertility treatment, in terms of their serial changes, association, and influencing factors, to explore an effective approach to support these women.
Subjects and Methods
The survey was conducted from March to October 2011 at a hospital in Kyoto Prefecture, Japan. A total of 95 pregnant women (36 conceived spontaneously, 13 with conventional infertility treatment, and 46 with ART; valid response rate, 95%) who provided consent for participation were assessed longitudinally at 3 time-points (late pregnancy, early postpartum period [2-7 days postpartum], and 1 month postpartum) regarding their past history, depressive tendency (Edinburgh Postnatal Depression Scale, EPDS), and stress-coping ability (Sense of Coherence Scale, SOC). Data were compared among the three conception groups.
Results
The conventional infertility treatment group tended to have higher EPDS and lower SOC scores at the 3 time-points, with no significant differences among the groups. With respect to the relationship between EPDS and SOC scores, a significant negative correlation was observed in the ART group at all 3 time-points (r=-0.500 to 0.592, p<0.01) and in the conventional infertility treatment group at 2 time-points other than late pregnancy (r=-0.563, -0.640, p <0.05), and a relatively strong negative correlation was noted in the participants at late pregnancy (r=-0.466, p<0.01), early postpartum (r=-0.592, p<0.01), and 1 month postpartum (r=-0.623, p<0.01), demonstrating that the higher the EPDS total score, the lower the SOC total score. Regarding the influencing factors, the EPDS score at 1 month postpartum tended to be higher in older primipara (p=0.056), and SOC scores at late pregnancy and 1 month postpartum tended to be lower in older pregnant/postpartum women (p=0.057 and 0.052, respectively).
Conclusion
Depression in pregnant and postpartum women who conceive after ART is currently attracting increasing attention. However, the present finding that pregnant and postpartum women who conceived through conventional infertility treatment had the highest score on the scale for a depressive tendency suggests the need to support pregnant and postpartum women who conceive after infertility treatment, regardless of the type of treatment, from the early stages of pregnancy. Furthermore, the results showed that the depressive tendency and stress-coping ability changed over the peripartum period, and that the EPDS and SOC scores were closely correlated, highlighting the need to provide support for pregnant/postpartum women with high EPDS scores, namely "those who conceive after conventional infertility treatment" and "older primipara", so that they can improve their stress-coping skills.

View full abstract