Purpose
The purpose of this study was to summarize the attributes, antecedents and consequences of the concept of child abuse and neglect, which could then serve as the bases for the development of a child abuse and neglect screening tool to guide the prevention of child abuse and neglect during the perinatal period.
Method
Literature was identified from nine databases: Ichushi-Web, CiNii, MEDLINE, CINAHL, PsycINFO, SocINDEX, Minds, National Guideline Clearinghouse, and TRIP database using the keywords child abuse, pregnant women, postnatal, and child care. Relevant findings of 26 articles in English, 32 articles in Japanese and the 2014 Japanese Guide for Medical Treatment of Child Abuse and Neglect were analyzed using Rodgers's 2000 concept analysis model.
Findings
Five attributes were identified: 1) one-sided controlling relation to the abused child, 2) caregivers either unaware or aware of own behavior, 3) child's experience, 4) harm to the child's well-being and 5) failure to protect child's well-being. Five antecedents were identified: 1) caregiver factors, 2) child factors, 3) socioeconomic factors, 4) the overlapping of multiple factors and 5) a lack of appropriate intervention. Five consequences were identified: 1) child's security, 2) caregiver denial and isolation, 3) effects on the prospective health of survivors, 4) distress of surviving mothers and 5) intergenerational diffusion of abuse. Lastly, one surrogate term, child maltreatment, and three related concepts, (discipline, shaken baby syndrome, Munchhausen syndrome by proxy) were found. Based on this analysis, the concept of child abuse and neglect was defined as: the child's experience of crisis with or without the caregiver's awareness, including harm to the child's well-being and a lack of action to guard the child's well-being based on the one-sided controlling relationship of the child's caregiver.
Conclusion
This analysis summarizes the current concept of child abuse and neglect, which could provide a basis upon which to develop a child abuse and neglect screening tool. The analysis clearly demonstrated the possibility of long-term harm to abused children, repeating child abuse and neglect and the importance of appropriate preventive interventions during the gestational period, especially, the importance of appropriate interventions for grown-up survivors to prevent their repetition of child abuse and neglect. Moreover, effective prevention entails recognizing interventions are required not only for pregnant women but also for their partners and children and must include improved instrumental support and other multiple factors.

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[in Japanese]

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Purpose
A purpose of this study was to determine the support to encourage the father role acquisition of duty midwives and to determine its relevant factors. And it is intended to obtain a suggestion to examine the construction of the family care system in the perinatal period.
Subjects and Methods
A self-administered questionnaire was used with midwives currently working in hospitals and clinics. The investigation was given factor analysis about an item of the support to promote the acquisition of the role as father. And the investigation was given a t test and the one-way layout analysis of variance of the difference of the scores by the attribute of the nurse midwife.
Results
Four hundred and twenty-two midwives completed the survey (a valid response rate of 93.6%). Eight factors were extracted from the results of the factor analysis: having a supportive attitude toward fathers, preparing fathers for their role during delivery, encouraging awareness of being a father, encouraging peer support, encouraging and reinforcing the father's support of the mother, promoting attachment, supporting the father's needs, and facilitating communication between both parents. Cronbach's alpha coefficients for each factor ranged from 0.72 to 0.95. Although the behaviors captured by the factors "encouraging and reinforcing the father's support of the mother", "promoting attachment", "preparing fathers for their role during delivery,! "having a supportive attitude toward fathers," and "facilitating communication between both parents," and were being performed comparatively well. The scores showed significant variances based on years of midwife experience, number of midwife, whether the couple attended parenting classes, whether the father was present at the delivery, and whether the father received childcare guidance.
Conclusions
Support to encourage the father role acquisition of duty midwives years of experience and the number of midwives was related. In order to encourage acceptance of fatherhood, midwife must first acknowledge that the father is also undergoing a transition into parenthood. Therefore, fathers should be provided with systematic networking opportunities with other fathers. In addition to benefits of the father's presence at the delivery, there are also potential benefits of conducting classes for men about becoming parents. Both of these should be taken into consideration when encouraging role acceptance.

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Purpose
The purpose of this study is fact-finding survey of the infant cleaning care and elucidate midwives thought and practice of early infant cleaning care by mixed methods research. The quantitative data are to elucidate on trends in the selection of early infant cleaning care by obstetrics facilities across Japan, as well as to elucidate on the selection of cleaning care by qualitatively extracting the opinions of midwives on cleaning care, such as their ideology, difficulties, as well as the background of these social factors.
Methods
An explanatory mixed-methods design was used. Quantitative data was sent to obstetrics facilities across Japan for self-administered questionnaires to be sampled with probability proportionate to size. Correlated factor analysis of cleaning care was implemented using logistic regression analysis and a chi-square test for items such as attributes, cleaning care based on number of days, care implementation time, and so on. In the qualitative survey, semi-structured interviews were conducted for five midwives practicing infant cleaning care and the verbatim records were used to conduct qualitative and inductive analyses.
Results
Responses were collected from 256 institutions in the nation-wide cross-sectional survey. Most respondents opted for a dry technique (65.3%) for cleaning on the day of delivery, and for bathing (67.9∼92.2%) from one day after delivery. A bathing needed more time than a dry technique. In logistic regression analysis, Kanto area (p<0.05; OR= 2.1) and each number of nurse and midwives (p<0.05, p<0.01; OR=1.1, 1.1) increased significantly associated with a dry technique choice. As for infant cleaning care of the qualitative survey were showed four categories. Four categories were extracted, namely, "infant-centered cleaning care," "parents-centered cleaning care," "cleaning care in consideration of medical personnel's burden," and "switching between the two infant cleaning techniques."
Conclusion
The infant cleaning care selection had contributed to the number of nurses, midwives, and area with facilities. The midwife was performing the infant cleaning care for the infant's assessment to top priority. The bathing or the dry technique are defined by the facility cleaning care of current, time load, and the culture of Japan. So midwife was wavering in care selection.

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Purpose
The purpose of this study was to identify pregnant women's efforts to induce labor during the seven days before parturition, and to clarify the relationship to medically induced labor.
Methods
A self-administered questionnaire survey was distributed to 694 puerperants in 20 hospitals, clinics, and maternity homes. Included were puerperants who had given birth to a full-term infant and met other inclusion criteria between July and October 2013.
Results
1. A total of 530 questionnaires (76.3% effective response rate) were analyzed.
2. Of the 530 puerperants, 491 (92.6%) made some kind of effort to induce labor. Multiple responses were allowed. Practices included the following: walking 66%, nipple stimulation 55%, squatting 44%, stair stepping 42%, acupuncture, moxa cautery, acupressure or the like 20%, laxatives 13% and sexual intercourse 9%.
3. Low-risk primiparas were analyzed using logistic regression analysis after adjusting for maternal age，gestation period and walking. The group that walked at moderate intensity at least 50 minutes or more per day or a total of 300 minutes or more during the seven days showed a significant decrease in the rate of medically induced labor compared to the other methods (OR 0.425 ; 95%CI:0.208-0.866).
4. Nipple stimulation was not performed as directed by previous research.
Conclusion
Exercise ranked the highest for pregnant women's efforts to induce labor. For low-risk primiparas, walking was associated with a significant decrease in medically induced labor.

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Purpose
This study aimed to establish a revised version of the Japanese BPEBI (J-BPEBI) and examined its reliability and validity.
Methods
The Breastfeeding Personal Efficacy Beliefs Inventory (BPEBI) was developed as a measure of breastfeeding confidence to support breastfeeding promotion research. It consists of 22 items with a visual analog scale (VAS). The original Japanese version of the BPEBI was developed in 2008. The original BPEBI was revised to use a 5-point Likert scale instead of VAS. The subjects were mothers whose children were 2-3 years of age. Questionnaires were distributed to 578 mothers; 286 were collected and 241 were eligible for analysis. All statistical analysis were conducted using SPSS ver. 20.
Results
The mean breastfeeding duration was 1 year 5 months (standard deviation=9 months). To clarify the structure of the J-BPEBI, factor analysis was performed. The results showed that the J-BPEBI contained three factors: 1) "confidence in capability to manage breastfeeding for a longer duration", 2) "confidence in capability to manage social support and information for breastfeeding", and 3) "confidence in capability to manage breastfeeding in different environments and situations".
The J-BPEBI had no correlation with the General Self-Efficacy Scale. However, there was a positive correlation coefficient of 0.314 (Spearman's ρ, p=0.000) with the duration of breastfeeding. The J-BPEBI also had a positive correlation coefficient with the two sources of self-efficacy information ("performance accomplishments" and "emotional arousal") as specified by Bandura.
Cronbach's alpha coefficient reliability score for all 22 items was 0.902, and the reliability score for each factor was 0.640-0.916.
Conclusion
A 22-item J-BPEBI with a three-factor structure was developed, and its construct and concurrent validity were confirmed. The internal consistency of the J-BPEBI was verified using Cronbach's alpha coefficients. The J-BPEBI is thought to be useful for assessing breastfeeding duration and breastfeeding self-efficacy.

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Purpose
The present study aimed to clarify practice efforts of child care consultants using the "Mothers' Psychological Health Checksheet" in continuous consultations.
Subjects and Methods
Seven consultants in charge of 2-3 mothers who had conducted 3 home visits, and 20 mothers (80% were full-time homemakers, and 90% had 1 child) participated in the study. Children were between the ages of 1 and 2. The "Mothers' Psychological Health Checksheet" (hereafter, the checksheet) was used at the consultations. The checksheet, which was designed to understand the emotional health of mothers who are raising children, comprises 13 items from the short form of the Child Care Happiness Scale and 16 items from the short form Child Care Stress Scale. We performed content analysis of consultant practice efforts at the consultation, focusing on any changes in practice efforts that occurred at the time of each of the three consultations.
Results
Across all three consultations, several common practice efforts within [acknowledge feelings as a mother] were identified, and included "acknowledge feelings experienced in child care," "acknowledge feelings toward the child (ren)," and "acknowledge feelings about child care support." Within [affirmation of the mother] was "affirm that child care is fine the way it is currently," and within [reassure the mother] were "provide reassurance by conveying that the children are in a developmental stage" and "provide reassurance by conveying feedback offered by others." In addition, within [affirm the mother's way of thinking] was "affirm the way of thinking about child care." At the second child care consultation, we extracted the practice effort of "acknowledge the difficulty of pregnancy," and at the third consultation, we extracted "acknowledge the desire to value the family," "acknowledge the feeling when receiving praise from someone else," and "acknowledge that thinking of one's own future is a good thing."
Conclusions
Of all practice efforts required of a child care consultant, roughly 60% involved the affirmation of a mother's feelings in some way, and thus is thought to be very important. As children grow up, and as mothers gain experience, the consultant must make efforts to become more involved in acknowledgement and affirmation of maternal feelings and thoughts. In addition, efforts to console the mother were made at all consultations. The present study clarified the various efforts of child care consultants to increase the awareness of mothers through the use of checksheets.

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Objective
The purposes of this study was to explore the meaning of undergraduate midwifery students' experience through the clinical practice.
Methods
The research design was a descriptive phenomenological approach with semi-structured interview. The Colaizzi's method was used for data analysis. The sample consisted of six elected midwifery program students in their senior year of a 4 year baccalaureate.
Results
The major findings of this study consisted of four thematic categories. In the first category; "Worry about unexperienced delivery care", subjects were worried about the clinical practice because they didn't have a clear image of delivery. Following the procedural manual was best for them to prepare for clinical practice. In category II; "Challenge to the first midwifery practice", they reacted to the tension of early stage of clinical practice with anxiety and strain. They gradually adjusted to their surroundings on the third and fifth cases of delivery care and could feel hands and reflect on their clinical practices. Although students were distracted by different types of delivery process in each instance, they were rewarded by appreciative words from their clients. In category III; "Professional prospects", encountering an ideal midwife brought them hope, seeing young midwives who work vigorously also brought them encouragement and raised concerns about their own lack of skills. They recognized the importance of trusting relationship in the continuous care and developed observation skills toward women who faced delivery. They found their professional growth by taking care women carefully, safely, and persistently. In the last category; "Challenge to curriculum of midwifery clinical practice", they had to take the clinical practice within a very tight schedule in their senior year of a 4 year baccalaureate. It took some time to adjust to a new institution, as they had to have clinical practice in several institutions. It was hard for them to achieve the objectives of clinical practice during the specified period because of the decrease in the number of deliveries. They expressed their anxieties about becoming midwives with unsatisfied feeling after clinical practice.
Conclusions
The undergraduate midwifery students' perception and personal growth regarding clinical practice clearly varied a great deal from the first delivery care experience to the last one. The implication arising from this study for undergraduate midwifery program is that it is necessary to become professionally fulfilled by developing observation and coping skills to detect abnormal conditions at the earliest stage, and improve achievement objectives and teaching methods to meet each example of delivery care at each practical stage.

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Objective
The purpose of this study was to clarify whether perineal warm pack application in the second stage of labor reduces first degree and second degree perineal laceration.
Methods
A historical controlled trial design was used. Participants were nulliparous women without medical complications, with delivery being at term, vaginal delivery, singleton pregnancy and cephalic presentation. The intervention method involved the midwife applying a warm moist towel to the perineum from close to full cervical dilation until vulvar cleaning is conducted. The towel was exchanged every 30 minutes to maintain its temperature. The extent of perineal laceration was evaluated immediately after delivery by the obstetrician attending the delivery. At the same time, the woman's basic information was collected from the medical record. Data analysis included t test and chi-square test. This study was approved by the institutional review board.
Results
Participants comprised 49 women in the intervention group and 50 women in the control group. There was no significant difference between participant characteristics of the 2 groups. In the intervention group, first degree perineal laceration occurred for 28 women (57.1%), and second degree perineal laceration occurred for 16 women(32.7%). In the control group, first degree perineal laceration occurred for 31 women (62.0%), and second degree perineal laceration occurred for 13 women (26.0%), with no significant difference between the 2 groups (p=0.517). Third degree perineal laceration occurred for 3 women in the intervention group (6.1%), and for 3 women in the control group (6.0%), while fourth degree perineal laceration did not occur in either group. Warm pack application time was a mean of 2.77±2.43 hours for the intervention group. Concerning warm pack application time and perineal laceration, warm pack application time for first degree perineal laceration was a mean of 2.27±2.59 hours, for second degree perineal laceration it was a mean of 3.98±1.99 hours, and for third degree perineal laceration it was a mean of 1.85±1.51 hours, with significant difference (p=0.002). No significant correlation was found between haemorrhage volume and warm pack application time, and between haemorrhage volume and the duration from warm pack application start until delivery of the baby. An increase in bleeding volume due to warming of the perineum was not found.
Conclusions
The effect of reduction of first degree and second degree perineal laceration due to warm pack application during labor was not found. However, warm pack application has the merits of physiologically improving skin elasticity, increasing circulatory blood flow, and producing heat shock proteins which are said to promote recovery, so a positive effect can be expected. Further research into the timing and application method is needed.

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Purpose
This study aimed to clarify what midwifery students learn from lectures on pregnancy by querying the students' perceived learning after the lectures.
Methods
The subjects comprised 18 midwifery students in a non-degree graduate course in midwifery specialty studies at University A Junior College. This study was implemented after receiving approval from the ethics committee at the university to which the authors belong. The investigation reached in July 2013. We analyzed data from verbatim records of student accounts of perceived learning from lectures and seminars on pregnancy.
Results
The contents of midwifery students' perceived learning from lectures on pregnancy were broadly divided into two categories. The first category was based on basic knowledge and comprised "the acquisition of basic knowledge in order to diagnose the progression of pregnancy" and "providing health guidance and care tailored to the patient" in terms of the ability to perform midwifery diagnoses. The second category comprised learning to "build better relationships by treating pregnant women and their families with compassion" and "use knowledge to independently acquire information essential to practice" in terms of deepening and supporting relationships by focusing on the people and environments surrounding pregnant women.
Conclusion
Midwifery students not only acquired knowledge, but also learned to support patients, show consideration toward pregnant women and their families, and adopt an attitude of self-learning.

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Purpose:
To find out the experiences of women with diabetes in the process from pregnancy through to childbirth.
Subject and Method:
The participants were women who had diabetes as an underlying disease and who had also experienced pregnancy and childbirth. The study design had a qualitative descriptive research methodology. Data were collected using semi-structured interviews. The data were analyzed using a grounded theory approach. The analysis of this study was made up to the axial coding step, and a storyline generation was conducted, which consisted of extracted phenomena and diagram of category relationships by each phenomenon.
Results:
The study involved eight participants with varied backgrounds such as primipara/multipara, vaginal delivery/caesarean section, and type I diabetes mellitus/type II diabetes mellitus. The paradigm was constructed from eight data of the participants, based on our diagram of category relationships. As a result, four phenomena were identified: "making a choice of pregnancy by their own will"; "proactively challenging to control their blood-sugar levels by trial and error"; "fighting to manage there diet during pregnancy"; and "accepting the children in their bodies as they are". Additionally, stories as a process of each phenomenon were drawn out.
Conclusion:
The experiences of women with diabetes from pregnancy through to childbirth were: growing sense of controlling their blood-sugar levels by choosing to be pregnant by their own will; dithering but challenging to find out proactively what way is best for themselves in terms of controlling blood-sugar levels during pregnancy; fighting to revise or adjust their diet when facing advancing pregnancy; and accepting the children from their bodies with or without deformity, and with or without disease, into their lives. These experiences involved conducting adaptive adjustments of pregnancy and diabetes all done by their own efforts, and were associated with conflict and pain. Therefore, it is expected that midwives should respect the independence of diabetic women and offer support physically, psychologically, and socially while staying by their sides, so that those experiences associated with pregnancy and childbirth can lead to well-being.

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