Purpose
We examined the relationship between the success-rate, as shown by the LATCH score, of breastfeeding mothers who were in the early stages of postpartum and the basic data collected regarding the hardness and length of their nipples.
Methods
The exam was carried out targeting 394 breastfeeding, Japanese female who had given birth 1-2 days prior. The survey included assessments of nipple hardness, nipple length, and the LATCH score. The nipple hardness was subjectively measured and classified into 3 stages. Nipple length was measured using the same manufactured plastic syringe that was used in previous Thai studies. The cooperating facilities' nursing staffs were provided training in advance of the study. Statistical analysis was performed using Welch's t-test and the χ² test. The cut-off for nipple length that leads to successful breastfeeding was calculated using the ROC curve. This study was approved by the Saga University Ethics Committee.
Results
For this study, 311 (87%) people from 11 facilities cooperated. Compared to the primipara group for the first 1-2 days postpartum, the multipara group's nipples were more flexible. Over all, the average nipple length was 12 (SD 3.4) mm. The average primipara nipple length was 11 (SD 3.2) mm while the nipple length of multipara women was 13 (SD 3.2) mm; thus the multipara group was longer (p<0.001). The overall average LATCH score was 7.4 (SD 1.9) points. The average primipara LATCH score was 6.5 (SD 1.7) points. The average multipara LATCH score was 8.0 (SD 1.7) points. The multipara groups' LATCH score was higher (p<0.001). There is a relationship between the LATCH score and the nipple hardness. Hard is 6.0 (SD 1.8) points. Medium is 7.5 (SD 1.8) points. Soft is 8.2 (SD 1.7) points. As the flexibility increases, so does the LATCH score. In order for the latch score to achieve 8 points or higher, the nipple length cut-off must be 11mm. When compared with the previous studies' decubitus female nipple length cut-off value of 7mm, that is 4mm more than before.
Conclusion
The flexibility of early postpartum nipples in the multipara group was more flexible and nipple length was longer. When breastfeeding was successful, nipple length was greater than 11 mm, and was longer compared to the Thai women.
When nipples were flexible the LATCH Score was higher. Challenges concerning the thorough education on the measuring method of nipple length and LATCH Scores and securing the trust between the determination on measurement of nipple length and LATCH scores remain.

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Objective
To explore women's decision-making and their experiences in the process during the antenatal period from the time women decided to continue with the pregnancy after the diagnosis of their baby's lethal condition.
Methods
A descriptive, qualitative study was used. Semi-structured interviews were conducted 1-4 times for each participant. Data analysis was performed qualitatively and inductively using the stories of women who continued their pregnancy while knowing their baby would die after delivery with the baby's lethal condition.
Result
Five women, who had lost the baby after the diagnosis of their baby's life-limited and life-threatening conditions, participated in the research. After the decision of continuing their pregnancy, they were forced into making multiple decisions based on their baby's medical issues. Those decisions include undergoing amniocentesis to get the confirmation of the diagnosis, resuscitation for the baby, delivery mode, timing of the birth and birth plan for the delivery. Four themes were found throughout those women's experiences in decision making: continuing pregnancy, however, my baby is what it is, concluding the hard and conflictive decision-making with compromise understanding the baby will never be cured, suffering from the pressure of their decision-making, and redirecting their value to processing the baby's death. Here was the belief existed behind these themes for the women to become a mother for the baby, even though they were going to die.
Conclusion
Women explored the parent role for their baby during the antenatal period, and they were getting ready to be a mother even though their baby was going to die. Other family members, friends, and medical staff did not pay enough attention to their feelings and the women's process to be a mother. The care for the women was lacking. Nurses and midwives need to show more interest in woman's feelings and to acknowledge their parenting role, and they need to support continual care after the diagnosis even though their baby is going to die.

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Purpose
To determine the factors that influenced the difficulties faced by midwives and nurses when caring for fathers of stillborn infants.
Methods
This was a descriptive cross-sectional survey using an 18-item Difficulties questionnaire with a Cronbach's alpha .932 (range .77-.92) and established face validity. The score ranged from 18-72 and the higher score indicated greater difficulty. The survey was provided to a purposive sample of 730 midwives and nurses from 39 hospitals (perinatal medical centers and maternity wards of general hospitals) in the Kanto region. The 451 (85.3%) valid responses were analyzed statistically.
Results
1. The average Difficulties score when caring for fathers of stillborn infants was 54.0±9.2 points (range 18-72). Difficulties were characterized by four factors: (a) difficulty facing fathers showing their grief reactions (which scored the highest; (b) bringing out fathers' hopes; (c) dealing with fathers who showed denial and (d) managing midwives' and nurses' own emotions when dealing with fathers. Especially difficult for midwives and nurses to manage were fathers: distrusting health care providers, showing anger, not expressing their feelings, and keeping up appearances.
2. The relevant factors that affected the difficulties in caring for fathers of stillborns, particularly for the primary nurses were: knowledge of parents' grief, seeing and hearing the parents experience of loss, and experiencing the care of many cases of stillbirth.
3. Difficulties in caring for fathers of stillborn infants, weakly and negatively correlated with the knowledge of the parents' grief (r=-.38, p=.001), on the other hand, less difficulties in care was weakly and positively correlation with improvement of care for fathers (r=.27, p=.001).
Conclusion
Although the most difficult aspect in caring for fathers was facing fathers who were showing their grief reaction, increased knowledge about grief and how to care for them reduced midwives' and nurses' difficulties. Therefore there is a need to develop continuing education programs for midwives and nurses that focus on fathers regarding caring for pregnancy related losses such as stillbirth and infant.

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Purpose
As a preliminary step in considering how to support pregnant women at high risk who have no choice but to undergo long-term hospitalization during pregnancy and their husbands in elevating each other as parents, we aimed to clarify the differences between, and characteristics of, readiness for parenthood in first-time pregnant women and their husbands in normally progressing and high risk pregnancies.
Subjects and Methods
Subjects were pregnant woman-husband couples (20-40 years of age, 22 to <28 weeks into pregnancy with first child, who had accepted pregnancy, and who had not yet enrolled in a maternal or parenting course). We targeted 50 couples each for the normal progression group and the high-risk group (diagnosed with imminent abortion, premature rupture of the membrane, cervical incompetence, placenta previa, pregnancy induced hypertension (PIH), fetal growth restriction (FGR), multiple pregnancy, or previous problematic pregnancy; at least one week having elapsed after hospitalization). For the survey, we assessed characteristics, the marital relationship scale (6 items), the prenatal attachment inventory (21 items), realization of parenthood (19 items), and self-awareness and image of becoming a parent (visual analog scale) as well as contents of an anonymous self-completed questionnaire consisting of free responses related to this topic. SPSS Ver. 22 was used for statistical analysis, and as support for our interpretations, we adopted the results of free responses.
Results
Subjects included in the analyses were 16 couples in the normal progression group (response rate, 32%) and 9 couples in the high-risk group (response rate, 18%). Characteristics with significant differences between groups were the number of weeks into pregnancy at the time of questionnaire completion and family structure. Marital relationship and prenatal attachment were not significantly different between husbands and wives in either group, but they were strongly correlated with the item "realization and mental preparation of becoming a parent" in awareness of becoming a parent among wives, regardless of risk. Awareness of becoming a parent was significantly higher for the high-risk group in a comparison between the wives in each group with respect to the item "concern and anxiety about the to-be-born child" (p=.02). Self-awareness of becoming a parent was significantly higher in the high-risk group in a comparison between wives from marriage until pregnancy (p=.017); over the course of the time from marriage until pregnancy to the present, it significantly increased only for the wives of the normal progression group (p=0.18). The image of becoming a parent did not significantly differ between groups during the time from marriage until pregnancy or in the present, nor did it significantly differ within groups over time. However, it tended not to increase in the high-risk group for both wife and husband.
Conclusion
The results suggest that being in a high-risk state during pregnancy impacts the awareness and image of becoming a parent. Given that obstruction of this image during an important period in which practical preparations are made to become a parent can potentially cause confusion regarding parental roles after delivery as well as gaps in the marital relationship, there is a need to consider interventions that expand the images of becoming a parent for both husband and wife.

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Purpose
This study aims to clarify the characteristics and sequence of processes that expert hospital-based midwives perform during the progress of the first stage of labor.
Method
In this study, the author defined midwives who had a prominent degree of skill and knowledge in the delivery of midwifery care to expectant and delivering mothers as expert midwives. The subjects were four expert midwives who worked in this study in the maternity ward of the general hospital. The author used participatory observation and semi-structured interviews to gather data from the four expert midwives. The 4 midwives were observed during labor care and followed with interviews upon completion of their duties.
Data were analyzed by qualitative inductive analysis for the purpose of categorization of characteristics of clinical judgment performed by hospital-based expert midwives
Result
Using their past experience, expert midwives were able to recognize important labor progress features from the time of the first meeting with parturient women. Expert midwives had "total perspective" to link three elements of labor with parturient women's psychological background and risk factors; they controlled the general condition of parturient women while "identifying individual labor progress". In addition expert midwives "ascertained negative factors" that would negatively affect the progress of labor and "chose care measures" to control or minimize them. Furthermore, while delivering midwifery care, expert midwives "sensed a predictive turning point in the labor progress" or "created one intentionally" as needed. Expert midwives repeatedly "rebuilt the perspective of labor progress", "ascertained negative factors again", "chose new care measures" and made clinical judgments to adjust their care plans. Midwifery convictions and well-matured techniques skilled interventions were the base of the expert midwives judgment. In addition, building relations with parturient women was also one important step to obtain useful information and apply it when making clinical judgment.
Conclusion
Predicting the "turning point" during labor progress or creating one intentionally contributes to securing safety of the mother and child by preventing deviation of normal labor progress. This process is characteristic of the clinical judgment performed by hospital-based midwives whose main duty is to care for high-risk delivering mothers.

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Purpose
To clarify the factors related to premature rupture of membranes at full term delivery.
Methods
This retrospective study at a maternity hospital and midwifery home used antepartum and intrapartum records and chose women who had full term delivery.
Firstly we clarified relations each variable number and premature rupture of membranes, and finally we analyzed using binomial logistic regression analysis (step-up procedure) with the level of statistical significance set at two-sided 5%.
The Research Ethics Committee at St.Luke's International University approved this study.
Results
A total of 610 parturients (310 at maternity hospital and 300 at midwifery home) who gave birth from August 2010 through October 2012 cases were reviewed. The average age was 31.46 years, and there were 30% primipara and 70% multipara. Of those 20% experienced premature rupture of membranes.
There were Eight Factors (primipara, body mass index, parity, birthweight, sexual transmitted infection, doing a pelvic exam at preterm, doing a pelvic exam at full term and research settings) associated with premature rupture, and 474 parturient’s data were drawn by excluding each missing value. Significant factors associated with premature rupture were: primipara (OR=2.145, 95%CI: 1.308-3.519, p=.003), and sexual transmitted infection limited to multipara (OR=3.129, 95%CI: 1.378-7.015, p=.006). Doing a pelvic exam at full term (OR=1.837, 95%CI: 0.998-3.383, p=.050) have a relatively strong association with premature rupture.
Conclusion
Factors that relate to premature rupture of membrane at full term delivery were: primipara, doing a pelvic exam at full term it was slightly below a level of significance and sexual transmitted infection limited to multipara. It is necessary for women to learn primary prophylaxis for sexual transmitted infections and the risk factors for premature rupture of membranes, before getting pregnant. Midwives should discuss about the risks and benefits of conducting a pelvic exam at full term and gain clarity about indications to proceed.

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Purpose
The purpose of this study was to elucidate the chronological changes that take place during involution of the uterus after Caesarian section (CS) to obtain basic data for use in the assessment of an involution state.
Methods
The participants were 70 women who underwent CS of a single, full-term fetus and experienced a normal postoperative course thereafter. Fundal length and height of the uterus were measured from puerperium day 0 to puerperium day 7. Forty-eight of the 70 women were included in color analysis of the lochia using a self-administered questionnaire to record daily changes in lochia color. Statistical analysis was performed using SPSS ver. 22.0 software, and P < 0.05 was considered statistically significant.
Results
Mean fundal length gradually decreased from 18.1±0.32 (mean±SE) cm on puerperium day 0 to 15.6±0.21cm on puerperium day 3 and 13.4±0.20cm on puerperium day 7. Mean length decreased approximately 1 cm per day on puerperium days 1 and 2 (p < 0.01) and an additional 1 cm on puerperium day 4 and puerperium day 6 (p < 0.01). Median fundal height was one finger-width below the navel on puerperium day 0, two finger-widths on puerperium day 3, and three finger-widths on puerperium day 6, although there was wide variation in the measurements.
Lochia color, as checked by the puerperal women, showed significant change starting on puerperium day 6 (p < 0.05); however, 30% of the puerperal women still had red-colored lochia.
Conclusion
Post-CS fundal length was longer and showed more marked changes in comparison to vaginal births. Our investigation of changes in fundal height, as determined via palpation, indicated that three days were required for the height to decrease by one finger-width below the navel and that there was wide variation in the data. Notably, assessments dependent upon palpation are particularly susceptible to individual interpretation. In comparison to vaginal births, in CS births, lochia color change and involution of the uterus take longer to occur and the uterus is softer.
The results of this study, wherein satisfactory postpartum progress was observed after normal, standard CS of single full-term fetuses, represented basic data related to early puerperium involution of the uterus following CS; these data can be utilized as assessment criteria in the future.

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Purpose
The aim of this review was to assess the impact of an earthquake on pregnancy outcomes.
Methods
A search through 4 databases (PubMed, CINAHL, CiNii, and ICHUSHI) was conducted for identifying relevant publications in English and Japanese. Two individual reviewers screened the identified articles first based on the inclusion and exclusion criteria, and then selected according to the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS), a bias risk assessment tool.
Results
Six articles were included. The commonly reported outcomes were preterm birth, intrauterine growth restriction (IUGR), and low birth weight. After the earthquake, the preterm birth rate, IUGR rate and low birth weight rate significantly increased in 4 articles, 1 articles and 2 articles, respectively. We observed particular deterioration of pregnancy outcomes in women who were in the first trimester of pregnancy on the day of the earthquake and those who were pregnant with female fetus.
Conclusion
This review provides evidence that earthquake increases the preterm birth and low-birth-weight rate and that neonatal sex and the stage of pregnancy at the time of the earthquake are important factors for pregnancy outcome. Pregnant women are the most vulnerable for earthquakes during the first trimester of pregnancy.

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