Background & Purpose
Effective communication is essential to understand the needs of patients and to provide patient-centered care. However, in cases of perinatal loss, which tend to occur unexpectedly, clinicians often experience difficulty communicating effectively as they need to deal with both the patients' emotions and their own emotional reactions. The purpose of the present study was to develop and to evaluate the effectiveness of a communication skills training based on cognitive behavioral theory (CBT) designed for nurses who work with parents who lost their babies during the perinatal period.
Methods
This is a single-group experiment with a pre- and post-test research design. Licensed nurses and midwives who provided perinatal loss care were recruited for this study. The training goal was to precipitate changes in attitudes and behaviors of the clinicians. The effectiveness of the training was assessed by measuring self-efficacy (SE), sense of difficulty, compassion satisfaction (CS), compassion fatigue (CF), attitude about communication, and communication behaviors. These were measured at three points: pre- and post-intervention as well as at a one-month follow-up.
Results
Forty-seven nurses and midwives participated in the study and received a one-day communication skills training, of which 37 (78.7%) completed the questionnaires given at the pre- and post-intervention as well as at a one-month follow-up. The results included the following: (1) SE significantly increased after the training (p=.000), and SE remained higher at the one-month follow-up compared to pre-intervention (p=.000); (2) sense of difficulty significantly decreased after the training (p=.000) and at the follow-up (p=.000); (3) although no changes in CS and CF were found, the additional subgroup analysis revealed that participants who had low SE and high sense of difficulty prior to the intervention (n=13) reported significantly reduced secondary traumatic stress, which is one of the element of CF, after the training (p=.001); and (4) at one month following the training, 28 participants (75.7%) reported that they experienced changes in their attitudes and behaviors toward communication.
Conclusion
Nurses and midwives who received the CBT-based communication skills training reported increased self-efficacy and reduced sense of difficulty in providing perinatal loss care, and these changes were maintained one month after the intervention. The findings also suggested that the training program may contribute to changes in perinatal loss care providers' cognition, attitudes, and behaviors toward patient-clinician communication.

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Purpose
This study aims to clarify the reflections made by expert midwives during their care for childbirth.
Methods
14 expert midwives were observed during their practice and interviewed. Interpretative phenomenological analysis of the interview was made.
Results
The reflection made by midwives were classified into two categories, a reflection made during and after their care for childbirth.
Whether the midwife was aware of unpredictable or uncertain situations as a concern was the difference seen in the reflection made during the care for childbirth. When a midwife was aware of concerning situation, [State 1: reflection that creates trials] was made where midwives reflect on their past experiences and took various trials to prepare themselves for the event that they assumed to follow. On the other hand, when childbirth was progressing normally and as predicted, [State 2: reflection that fuse with the situation] was made where midwives were not aware of any concerns and instantaneously restored their empirical knowledge and their somatic sensation into their care. After their care, [State 3: reflection by mirroring and seeing themselves objectively] was being made.
The [reflection that creates trials] was sorted out into 2 themes, <making trials while uncertain of its success> and <drawing out means from ones' rich past experience>.
The [reflection that fused with the situation] was sorted out into 2 themes, <recognize the situation instantly through restoring their somatic sensation> and <leading natural action foreseeing the normality of the process>.
The [reflection by mirroring and seeing themselves objectively] was sorted into 5 themes, <reconsidering their action due to their awareness of concern>, <sharing the process parturient can find the significance of their own chirdbirth>, <patterning and rewriting the learning from their experience>, <reconsidering the attitude as a midwife> and <polishing the empirical knowledge thoroughly by involving with others>.
Conclusion
The reflection made by midwives were classified into three states, [reflection that creates trial] [reflection that fused with the situation][reflection by mirroring and seeing themselves objectively].

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Purpose
The objective of this study was to describe the detailed experience of healthcare professionals who assisted out-of-hospital delivery immediately after the Great East Japan Earthquake in order to increase awareness and preparedness of nursing professionals for out-of-hospital deliveries in future large scale disasters.
Methods
Semi-structured interviews were conducted between October 2013 to March 2014 for three healthcare professionals (a midwife, a public health nurse, and an emergency paramedic), who assisted out-of-hospital delivery immediately after the Great East Japan Earthquake. Based on descriptions of those subjects about their experience, common terms were analyzed using inductive methods.
Results
There are nine common terms among these healthcare professionals who have managed safely and exactly out-of-hospital delivery immediately after the Great East Japan Earthquake. Those were "hesitation and emotional conflicts" at first due to sudden encounter of assisting delivery, "determined to assist a delivery", "involvement of people around them", "their personal experience of handling delivery", "proper judgment of the labor progress", "appropriate procedures against the risks of infection, bleeding, and hypothermia", "rapid adaptation of using household utensils as alternative tools", "talking to a woman in labor to comfort her" and "normal delivery which they only catch the babies".
Conclusion
These healthcare professionals had managed safely and exactly out?of-hospital delivery immediately after the Great East Japan Earthquake, even if the jobs were different. Results indicated we have to prepare to accept the out-of-hospital delivery in future large scale disasters. Through this study, we were able to make sure that the risk assessment, communication, resourcefulness etc. were basic cares for the women in labor.

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Purpose
The aim of this paper is to identify targets for midwifery care over the next 30 yearsby reviewing research from the last 30 years into mothers' satisfaction with midwifery care.
Methods
PubMed and the website of the Japan Medical Abstracts Society were used for searching. The key words used were in three groups: [midwifery/ care/ practice/ service], [mothers/ pregnant women/ women in labor/ postpartum women/ clients], and [satisfaction/ evaluation]. The conditions for selection were that papers should be original, and that they should have been published between 1985 and 2015.
Results
Using the keywords, 317 Japanese studies and 114 overseas studies were found. Most of these were quantitative and few were concerned with mothers' satisfaction with midwifery care. Twelve Japanese studies and 28 overseas studies were deemed to be relevant to the current study and were selected for analysis.
In Japan in the 1990s about eighty per cent of mothers reported that they were satisfied with midwifery care, and by 2012 this figure had increased to about ninety per cent. A New Zealand study from 2001 reported that seventy-seven per cent of mothers were satisfied with midwifery care. However, few studies indicated satisfaction rates, and there has been insufficient research to suggest reliable estimates.
Conclusion
This study suggests the following targets for next 30 years. Further research is needed into mothers' satisfaction with midwifery care. The scale used to measure satisfaction, made in 1997, needs further development. The standard of midwifery care needs to be raised to a similar level throughout Japan before any reliable satisfaction figures can be given for the nation as a whole. New approaches are needed to support mothers who wish for a natural childbirth.

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Purpose
Current data regarding the effects of alternative freestyle delivery positions are insufficient to determine optimal delivery methods used by pregnant women, nurse midwives, and physicians. This study aims to confirm the safety of freestyle delivery positions in comparison with that of dorsal lithotomy in terms of maternal and neonatal physical risks.
Methods
We analyzed 219 healthy mothers with normal singleton pregnancies and cephalic spontaneous vaginal deliveries at term and included 50 mothers who delivered in the dorsal lithotomy position (lithotomy group) and 50 who delivered in a freestyle position (freestyle group) in our matched case-control study.
Results
The Apgar score at 1 min was lower in both primiparous and multiparous women in the freestyle group compared with those in the lithotomy group (p<0.001), whereas the umbilical artery pH level was higher in multiparous women (p<0.001). In primiparous women, the duration of the second stage of labor was longer (p<0.001) and postpartum blood loss at 2 h was greater (p=0.01) in the freestyle group compared with the lithotomy group. Neonatal birth weight at 1 month after birth was not significantly different between the groups. In addition, the extent of midwive's practical experience significantly affected the duration of the third stage of labor in primiparaous women in the freestyle group (R2=0.23, p=0.01).
Conclusions
Our results verified the positive effects of delivery in a freestyle position on respiration and circulation of the neonates and the necessity to safety manage postpartum blood loss at 2 h in primiparous women who deliver in this position.

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Purpose
The purpose of this study was to make clear the images women in their twenties have of childbirth through interviews of said women.
Methods
Unstructured interviews were conducted with 33 unmarried women residing within the Kanto region between the ages of 20 to 29 who had not experienced childbirth and data was collected. The resulting data was inductively analyzed, the core category of each participant was pattern coded, and characteristics of the images of childbirth were found.
Results
Ten characteristics that indicated the images of childbirth held by women in their twenties were extracted: 1) Most of the study participants held both "positive images" and "negative images" toward childbirth; 2) Almost all of the study participants have a wide range of images of childbirth; 3) A very select few participants held either only "positive images" or "negative images."; 4) Approximately half did not have concrete images of what it would be like for them to experience childbirth; 5) Although over four out of ten participants held images of childbirth as something "painful," this view was not tied to feelings of avoidance of childbirth; 6) The "gendered image" of childbirth was divided into two groups ? one which believed childbirth is desirable for women and one which did not; 7) The "temporal image" of childbirth was divided into two groups ? one which was conscious of childbearing age and one which was aware of the timing of childbirth; 8) One in three study participants held images that the reconciliation of childbirth and work is difficult; 9) One in five study participants held images that childbirth makes one feel guilty; 10) In the "societal ideal image," discontent and expectation toward society was reflected.
Conclusion
Nearly all of the study participants combined positive and negative images of childbirth and attributed various significances to them, some of which were linked and others of which were diverse. Present behind the fact that approximately half of the participants did not have concrete images of what it would be like for the women themselves to experience childbirth were the following images: harsh employment conditions for women, inadequate family-centered measures in the workplace and community, the absence of role models reconciling work and childbirth, and inadequate education of both men and women regarding autonomously selecting the timing and method of birth. Addressing these problems was considered a pressing task in order to create an environment conducive to childbirth in Japanese society where the birth rate is low.

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Purpose
The purpose of this study to mothers who welcome a second child, in order to facilitate the adaptation to two simultaneous child care to evaluate and develop a preparatory education during pregnancy.
Subjects and Methods
We developed a preparatory education program based on the ADDIE model and compared between two groups: an intervention group and a control group The outcome variables were "mothers' awareness of the first child's condition," "awareness of caring for both children simultaneously," and "child's outlook scale". These variables were measured before the program, one week after birth, and one month after birth.
Results
Two-way analysis of variance of the results of the intervention group (n=31) and control group (n=28) on "mother's awareness of the first child's condition" showed that "the first child hugged the second child" (p <.05) in the intervention group, suggesting an enhanced interest of the first child towards the second child. As for "awareness of caring for both children simultaneously," the intervention group showed "positive feelings about caring for both children" (p <.05) and "being able to imagine caring for both children simultaneously" (p <.05), suggesting a positive attitude towards raising two children.
Conclusion
The education program specifically developed for multiparous women is useful for promoting the adaptation to caring for two children simultaneously.

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Purpose
To explore how maternal hydration status relates to negative pregnancy outcomes that includes preterm labor, pregnancy induced hypertension, and low birth weight using bioelectrical impedance analysis based on path analysis.
Methods
Participants were healthy women with a singleton pregnancy between 26 and 29 weeks of gestation. During two prenatal visits at 26-29 weeks and 34-36 weeks, clinical data were collected by self-reported questionnaire and medical chart review. In addition, bioelectrical impedance measurements were performed using a tetrapolar multifrequency impedance analyzer. Data on pregnancy outcomes were collected by self-report questionnaire and medical chart review. The relations among the variables are discussed, using path analysis.
Results
Data from 332 of 340 participants were analyzed. Negative pregnancy outcomes that correlated with significant differences in mean bioimpedance values were "preterm labor and suspected preterm labor" (SPTL) (p<0.01), "elevated blood pressure after measurement at 34-36 weeks of gestation until delivery" (EBP) (P<0.05), and "low birth weight" (LBW) (p<0.01). Higher resistance (R) values, suggestive of lower hydration status, were found in the SPTL and LBW groups, and lower R values, suggestive of higher hydration status, were found in the EBP group. In the path analysis, statistically significant paths were drawn from R or hemoglobin level to each of the three negative pregnancy outcomes. The results suggest that lower body water and/or plasma volume were related to SPTL or LBW, and that higher body water and lower plasma volume were related to EBP.
Conclusions
Possible correlations were found between bioimpedance values and negative pregnancy outcomes, mediated by maternal hydration status. However, combinations of indices for assessing the risks of negative pregnancy outcomes were not identified. Further studies are needed to identify indices for evaluating maternal hydration status leading to healthy pregnancy outcomes taking into consideration women's lifestyles and possible future clinical implications.

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Purpose
The aim of this prospective study is to assess factors related to post void residual (PVR) and lower urinary tract symptoms in the second trimester of pregnancy, and the postpartum of women who presented normal bladder function before and until the second trimester of their pregnancies and delivered vaginally.
Methods
Pregnant women planning vaginal delivery who presented no bladder function problems before the present pregnancy and until the second trimester of their pregnancies (PVR of less than 50 ml) were selected for this study. PVR was measured using an ultrasonography device. PVR was measured once during pregnancy (24th to 27th week); once every day from day 1 to 5 and once at one month postpartum. In addition, participants completed a questionnaire about lower urinary tract symptoms. Statistical analysis conducted were the t-test for independent sample, Pearson's Chi-squared test,
Results
Covert urinary retention (CUR) occurred in 18.5% of participants in their first day postpartum and in 30.8%, 24.6% and 15.4% of women in their third, fourth and fifth day postpartum respectively. After 1 month postpartum all participants presented a less than 50 ml PVR. Lower tract urinary symptoms (LUTS) reported by the participants were: reduced bladder sensation (72.3%), straining to void (55.4%), feeling of incomplete emptying (29.2%) and urinary incontinence (7.7%). Reduced bladder sensation, feeling of incomplete emptying and straining to void decreased to about 10% in the first month postpartum (p<0.01). However, urinary incontinence increased from 7.7% in the first day postpartum to 15.4% in the fourth postpartum day (p<0.05) and remained unchanged after one month. None of the studied factors were found to be related to CUR, however, baby weight at birth was related to straining to void (p<0.01). There was significant relation between LUTS and the 4th and one month postpartum (p<0.05). The group experiencing CUR at 4th day postpartum presented a highly significant (p<0.01) incidence of urinary incontinence.
Conclusion
While CUR was present at 4th day postpartum in up to 24.6% of participants, it disappeared completely at one month postpartum. LUTS such as reduced bladder sensation, straining to void, feeling of incomplete voiding and urinary incontinence persisted. Although the present study could not clarify factors related to CUR, the analysis showed that baby weight at birth was significantly related to straining to void. In addition, LUTS reported during the 4th days were significantly related to LUTS at one month postpartum. CUR at 4th day postpartum was significantly related to urinary incontinence at one month postpartum.

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Purpose
We examined historic processes related to nurse midwife education in Japan to elucidate current nurse midwife education. As background of the government establishment midwife training school establishment, we examined the contemporary state of educational facilities, teachers, and education contents.
Method
To elucidate aspects of midwife education that started at the Tokyo Municipal Hospital Midwife Training School, a midwife training school in Tokyo, the authors examined Tokyo Archive Building documents, medical journals, official daily gazettes, and newspapers.
Results
Results show that, by 1890, nine training organizations were operating in Tokyo. For a Bachelor of Medicine, physicians were required to graduate from another section. The Department of the Interior licensed midwives after they received education.
Training schools commonly enrolled students for 1.5-year courses, but examination of the total course hours showed vast differences of 400-1,200 hr. Fields emphasized in the actual curriculum varied, variously emphasizing experimental medicine, abnormality of midwife studies, and midwife studies. Various midwives were so educated, provoking the criticisms voiced by Hamada.
The total number of hours was equivalent when we compared the government establishment midwife training school with the Tokyo midwife school. The time distribution differed. Practical education is respected in the government establishment midwife school, and that assigned half of the total education time to practical education. Whereas a lecture is made much of in the Tokyo midwife school, that awarded 10% of the degree to the total time for practical education and 80% for lectures. Regarding the lectures themselves, the medicine and midwife study components were about evenly divided.
Conclusions
It is different in a curriculum what you make much of. Curricula differ in terms of their characterization of the role of the midwife. Future studies will examine midwife education contents based on descriptions by physicians and midwives who underwent education. . We want to make use of this results of research for nurse midwife education.

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Purpose
This study aims to investigate the effect of health advice given healthcare professionals to pregnant women in hospital about avoiding the wearing of tight clothing around the trunk in order to reduce the risk of premature birth.
Methods
This was a retrospective study of medical records from an inpatient ward at a national medical center in Tokyo, Japan. Participants were women who had been admitted for threatened miscarriage or premature birth from the 1 April 2011 to 31 March 2013. Of the 230 women admitted during this period, only 208 women met the criteria of this study were included in the study. The intervention group was defined as those women who received advice from healthcare providers to avoid wearing constrictive clothing around the trunk, and the control group was defined as those women who received no such advice. All data for analysis was transcribed from medical records.
Results
The mean age of all participants was 34.7 years (SD: 5.0). Of the 208 participants, 103 (49.8%) were multiparas and 150 (72.1%) were allocated to the intervention group. The results of bivariate analysis showed that both premature birth at <34 weeks (p=0.077) and premature birth at <37 weeks (p=0.875) had no significant difference between the two groups. After adjusting for basic characteristics and potential confounders such as socioeconomic status and past medical history, the adjusted odds ratio for premature birth at 34 weeks gestation was significantly lower in the intervention group (adjusted odds ratio (AOR): 0.15, 95% CI: 0.04-0.57) compared with the control group, however there was no association with premature birth at 37 weeks (AOR: 0.67, 95% CI: 0.28-1.60).
Conclusion
The findings of this study showed that advice from healthcare providers to avoid wearing constrictive clothing around the trunk might have the potential to reduce the risk of premature birth at <34 weeks. This study has several limitations, including no randomization, and a small sample size due to the preliminary nature of the survey. A well-designed randomized controlled trial is needed to verify the effectiveness of this intervention.

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Purpose
The purpose of this study was to follow the treatment of acupuncture combined with moxibustion with the fetus in breech presentation and to explore the correlation between acupuncture, moxibustion and fetal movement.
Methods
Participants were pregnant women between 28-37 weeks gestational age, having a normal pregnancy until the diagnosis of fetal breech position, and wanting to receive acupuncture in combination with moxibustion. Mental and physical reactions, common pregnancy complaints, and fetal movements before and after the treatment were analyzed. The number of fetal movements was measured using Fetal Movement Acceleration Measurement (FMAM) as an objective index.
Results
A total of 12 women were eligible for inclusion (11 primiparas and one multipara) and the average age was 32.7 years. There were 24 treatments given to each participant. On each occasion all participants reported an increased warmth in their hands and feet. On 22 out of 24 treatments (91.7%), the participants stated they felt relaxed and sleepy post treatment. Participants felt no adverse effects post-treatment. Frequency of "cramping of feet" and "irritations" before treatments, significantly decreased post-treatment ("cramping of feet" z=-2.53, p=.011, "irritations" z=-2.00, p=.046; Wilcoxon signed-rank test). The cephalic version group comprised eight participants (66.7%); the breech presentation group whose fetus remained in the breech position even after treatment contained four participants (33.3%). The time from a breech presentation diagnosis to the start of treatment was as follows: the cephalic version group was an average of 8.6 days and the breech presentation group was an average of 27.3 days. Therefore, the cephalic version presentation group had a significantly shorter period than the breech presentation group (t =-3.7, p=.02) in seeking treatment. The cephalic version group was at an average of 31.5 weeks gestational age, whereas the breech presentation group was an average of 34.1 weeks gestational age for commencement of treatment. The cephalic version group began treatment substantially earlier, than the breech presentation group (t=-2.4, p=.04). The FMAM monitored fetal movements 20 minutes before treatment, again during the treatment and finally 20 minutes after the treatment. During treatment, the cephalic version group moved 173.71 times/hr, compared with the breech presentation group at 105.63 times/hr which was a significant difference (t=2.78, p=.02). Overall, fetal movements increased more "during treatment", or "20 minutes after treatment" in the cephalic version group.
Conclusion
Post-treatment, participants with the fetus in breech presentation felt a warmth of their hands and feet, were more relaxed and reported feeling sleepy. "Cramping of feet" and "irritations" felt by participants significantly decreased after treatment. A fetus position conversion rate was 66.7%. The cephalic version group started treatment an average of 8.6 days from diagnosis of breech presentation, and by an average of 31.5 weeks gestational age. In the cephalic version group, the fetal movement increased "during treatment" and "20 minutes after treatment". There were no adverse effects reported during these treatments.

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Purpose
The purpose of this study is to reveal changes in perception of menstruation in menopausal women.
Methods
The participants were seven women who had experienced pregnancy and childbirth but not a hysterectomy. They were interviewed in a semi-structured format about their perception of menstruation from menarche to the present. The data were analyzed by the hermeneutic phenomenology method.
Results
Results of the perception of menstruation obtained in this study were classified into five categories: "mixed feelings at the time of the acceptance of first menstruation and becoming used to it through experience", "functions and health of females perceived because they undergo menstruation", "menopause and aging", "influence of interaction with others upon the perception of menstruation", and "association between the perception of menstruation and menstrual pain".
Conclusion
To positively accept menstruation throughout life and deal effectively with menstruation, it is necessary to receive menstruation education in order to accept menarche positively, menstrual/sex education in late adolescence, menstrual education for mothers, and guidance on appropriate coping methods of menstrual pain. In addition, nurses need to develop a health education system in cooperation with school education and to create an environment where gynecological consultation is accessible to women.

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Object
The purpose of this study is to examine the safe perinatal care and delivery for low risk women by a midwife-managed delivery unit.
Methods
A total of 214 low risk multipara women who wished care in a midwife managed delivery unit were enrolled in this study. The care for pregnant women, assessed to be in low risk by obstetricians, was started after 28 weeks of gestation. In cases where complications or increased risk factors become event during pregnancy, labor, or in the postpartum period, the woman is referred to an obstetrician in the perinatal care center. Thirty-five women were excluded due to complications occurring before delivery. The perinatal outcomes of pregnancy were compared between 179 women in a midwife managed delivery unit and 258 low risk multipara women in a consultant led labor ward.
Results
Significant differences between the midwives unit and labor ward were found in Apgar Score at 1 minute (midwife managed vs. consultant led; 8.6±0.5 vs. 8.2±0.7, p<0.0001) and 5 minutes (midwife managed vs. consultant led; 9.3±0.5 vs. 9.0±0.4, p<0.0001), and in gestational age (midwife managed vs. consultant led; 39.8±0.9 weeks vs. 39.4±0.9 weeks, p<0.01). There were no significant differences in birth weight, blood loss, and umbilical artery blood gas pH (UA-pH). There was no severe asphyxia with UA-pH less than 7.00. Overall, there was little difference between the two groups.
Conclusions
Midwife managed perinatal care for low risk women results in safety equal to consultant led treatment.

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