Objective

The aim of the present study was to examine the significance of the relationship between biomarkers and self-reported psychological distress as physiological and sociopsychological assessment indexes, respectively.

Methods

The Ichushi-Web, PubMed, CiNii, and Cochrane Library databases were searched, with “pregnancy,” “pregnant women,” “stress,” and “hormones” as keywords. Articles that discussed the use of indexes for physiological and sociopsychological assessments of mental stress experienced by pregnant women were extracted. As a result, 10 Japanese and 32 overseas articles were selected for review.

Results

Cortisol level was frequently used as a stress biomarker in all the articles. The number of biomarkers was greater in the overseas articles than in the Japanese articles. The results clarified that the physiological and sociopsychological assessment indexes were not always associated and correlated.

Conclusion

1) Physiological assessments should be chosen depending on the study purpose and biomarkers used in the study.
2) Indexes for physiological and sociopsychological assessments are not always associated and correlated.
3) Demographic factors and the survey period may affect the assessments of mental stress indexes among pregnant women.
4) Mental stress in pregnant women should be evaluated from various aspects such as a combination of plural physiological and sociopsychological assessment indexes, an interview method, and a prospective study.

Purpose

To identify the traumatic experiences of midwives and explore the relationships among post-traumatic stress disorder (PTSD), resilience, and post-traumatic growth (PTG) after the traumatic experience.

Methods

This study was performed using a survey questionnaire with a target sample of 1,198 midwives from 308 hospitals, clinics, birth centers, universities, and vocational schools in Japan. The total sample evaluated was 681 midwives (56.8%). Using a mixed methods study, quantitative data were analyzed statistically and qualitative data were analyzed using content analysis. The association between categories and each variable was analyzed.

Results

There were 575 midwives (84.4%) who described their traumatic experience. The contents were classified into four categories: “Unexpected state of the mother and child in delivery”, “absurd situations that lead to struggle”, “sadness and witnessing trauma”, and “hostile remarks from supervisors, physicians, patients and families and harsh environment”. Among the four categories of experiences, the average Impact of Event Scale-Revised (IES-R) score of “hostile remarks and harsh environment” was the highest and the PTG level was the lowest. Moreover, of the 575 midwives, 86 (15.0%) responded that they had considered moving to another facility or opting for attrition. In addition, PTSD and job retention (r=−.229), support and job retention (r=−.181), PTSD and support (r=−.143), PTG and support (r=.148), and PTG and resilience (r=.314) showed a significant correlation (p<.001).

Conclusion

Midwives who have experienced direct trauma were at a higher risk of PTSD. These findings suggest that when a midwife who has experienced traumatic stress is able to find adequate support in the workplace, this can serve to lower her risk of PTSD and prevent attrition, as well as contribute to her professional development.

Purpose

To identify pregnant women's loneliness and its correlated factors such as demographic data and social relationships, and to explore those impacts on maternal role identification and common physical complaints during pregnancy. The definition of loneliness in this study was: the subjective and negative feeling of the experience that social needs are unmet or unsatisfied, in quantity, quality, or both.

Methods

A self-administered questionnaire survey including the revised UCLA loneliness scale (scores range from 20-80 points with higher points indicating higher loneliness), quantity of social support and its satisfaction, the Violence Against Women's Screen (DV score), maternal role identification and common physical complaints during pregnancy was distributed to 1,675 pregnant women after the 34th week of gestation in 5 perinatal care facility between July and October 2015. A total of 1,310 questionnaires (78.2% effective response rate) were statistically analyzed.

Results

The revised UCLA loneliness scale mean score of all pregnant women was 33.1. The highest mean score in pregnant women was 42.3 in those who were suspected of having fetal abnormality. Loneliness was more prevalent in those who were single (mean score=38.8), and having only a junior high-school education (mean score=37.0).

Multiple regression analysis indicated the loneliness score was higher in pregnant women with lower satisfaction with their social support (β=−.331), lower quantities of social support (β=−.161), lower annual household income with 6 million yen as a reference category (3 million yen to 6 million yen: β=.104, less than 3 million yen: β=.141), past history of mental disorder (β=.111), and higher score on DV (β=.069) (adjusted R²=.21). A higher loneliness score was associated with the lower score of identification with the maternal role (β=−.428, p=.000). The loneliness score was not associated with frequency of common complaints during pregnancy.

Conclusion

High loneliness was identified in pregnant women who were suspected of having a fetal abnormality or who were social vulnerable. To find highly lonely pregnant women early, it is important to assess their social support, economic situation and DV along with mental health. Continuous and individual midwifery care for them is required to support their process of becoming a mother.

Purpose

The aim of this study was to consider items and develop a scale that measures mothers’ perceptions of the childbirth experience in regard to cesarean delivery.

Subjects and Methods

An anonymous, self-administered questionnaire survey was conducted on puerperal patients in four hospitals who had undergone either emergency or planned cesarean delivery between March 13 and August 31, 2015. The survey was conducted using the placement method.

A draft scale composed of 26 items was designed for use in the questionnaire based on previous literature. After item analysis of the draft scale, the data were analyzed using principal factor analysis with promax rotation. The reliability of the scale was confirmed by Cronbach's α coefficient and item-total correlation, and the validity was confirmed by known-groups and content validity.

This study was approved by the Ethics Committee on Epidemiological Studies at the Kagoshima University Faculty of Medicine (Approval No. 327).

Results

Valid responses were collected from 134 mothers.

Three items were rejected based on item analysis of the draft scale. Factor analysis on the remaining 23 items identified 15 items and the following three factors: “feelings of fulfillment toward birth” (seven items), “adaptation to cesarean delivery” (five items), and “acceptance of my delivery method” (three items).

Regarding the reliability of the scale, Cronbach's α coefficient was 0.823 (0.636–0.840 for subordinate factors). Item-total correlation indicated a significant correlation between all items and total score (p<0.01). Therefore, the reliability of this scale was confirmed for each factor.

Regarding the validity of the scale, the mean scores for emergency cesarean delivery were significantly lower than those for planned cesarean delivery (p<0.01), which confirmed the known-groups validity of the scale; this result was similar to those reported in previous studies. Content validity was established because the extracted factors were generally consistent with the opinions expressed by a midwifery expert in the free descriptions in the questionnaire.

Conclusion

The newly developed scale used in this study, which was composed of three factors, showed good reliability and validity, which suggested that it was appropriate for measuring mothers’ perceptions of the childbirth experience in regard to cesarean delivery. This scale can be used during birth reviews to improve care for puerperal patients who had a cesarean delivery.

Objective

This study is to clarify the relation between weight gain and the onset period of low back pain (LBP) during pregnancy. In addition, the article investigates the presence or absence of effective ways to manage LBP.

Patients and Methods

A sample of 117 post-partum women was recruited from a certain maternity clinic within Mie prefecture. All participants answered a questionnaire. By using 2006 MHLW (Ministry of Health, Labour and Welfare)'s recommended amount of weight during pregnancy as a reference, the samples were classified in 3 groups: insufficient when the amount of weight gain is below the MHLW recommendation, appropriate when the amount of weight gain is within the limit of recommendation, and excessive when the amount of weight gain is above the recommendation. Through the items in the questionnaire, we were able to obtain fundamental information regarding LBP. Data obtained was analyzed with relevancy among the three groups and LBP using chi-square tests by SPSS (version 21). Also, we performed one-way analysis of variance among three classified groups as for amount of weight, Breslow score.etc.

Results

1. Eighty two (70.7%) of the 116 included subjects had LBP in pregnancy. Among them, about 70% women suffered from LBP by third trimester pregnancy. Extra weight gain tends to cause early LBP.
2. More than 70% of all subjects experienced severe LBP period during third trimester pregnancy.
3. Within the three groups, the primary types of interference to basic actions and postures in daily life include “holding a crouching or standing position”, “holding or lifting up a heavy load”, “turning over in bed”, and “sitting for a long time”.
4. Techniques for reducing LBP include “using cushion or pillow”, “wearing a waist corset or pelvis belt”, “getting a massage”, “maternity swimming”, “applying a compress to the waist”, or “taking pain medication”. However, few women utilized the techniques, even though these techniques can be effective for all women suffering from LBP.

Conclusion/Discussion

The findings from this study show that when a woman gains a lot of weight, she is more likely to experience LBP early. In addition, those women tend to experience difficulties in simple movements of daily life during early stages of pregnancy. It is therefore necessary to provide proper health guidance in early stages to manage weight gain during pregnancy, to prevent LBP. Even though some treatments are effective, it is a fact that few women utilized them. Extensive information should be shared with everyone, especially health professionals and pregnant women. Given the significant impact on the quality of maternity life, health professionals need to be proactive in helping pregnant women to prevent LBP.

Purpose

To clarify the clinical experiences of newly qualified midwives who participated in clinical practice as midwives for one year after they had completed basic training.

Methods

Focus group interviews were conducted with five midwives who participated in clinical practice for one year after they had completed their basic training. A qualitative and inductive approach was used to explore the clinical experiences through their oral responses.

Results

As for results with the research, it was clarified that the newly qualified midwives have seven categories of impressions as given below; “They are satisfied with environment to acquire the experience as midwives.” “They feel that the work of midwives is worthwhile and fulfilling.” “They cannot be involved in the care for pregnant and parturient woman in satisfied way with more care.” “They are frustrated about the gap between their knowledge which they learned with basic midwifery training and clinical practice.” “They are frustrated because there is any friend sharing their experience.” “They are anxious about the gap between their ability and required ability in practice” “They want to keep working as midwives.”

Discussion

To form a career of midwives, consideration for the amount of conduct of labor which they experienced and its review, mental and educational support of senior for the newly qualified midwives with considering their individuality and continuous education to make up for the gap between the basic education and the clinical practice are highly needed.

Purpose

The aim of this study was to examine the prevalence of hand and wrist pain, the onset of symptoms, affected areas, and related factors in postpartum women.

Methods

Eight hundred and seventy-six postpartum women, within a year after giving birth, agreed to complete anonymous questionnaires. We analyzed 514 valid questionnaires (response rate, 58.7%) returned from mothers in the 1st to 8th month postpartum.

Results

Of the 514 participants, 181 (35.2%) reported having experienced hand and wrist pain. The onset of symptoms varied widely from pregnancy to the 7th month postpartum. There was an increase in the onset of symptoms at the 1st month postpartum. Participants reported bilateral pain. There was a slight difference in pain incidence between the left and right sides. Affected areas were the radial styloid process, radiocarpal joint, ulnar styloid process, thumb metacarpophalangeal joint, and carpometacarpal joint, in ascending order. Older age at delivery, primiparity, and previous history of hand and wrist pain were significantly related to postpartum hand and wrist pain. Hand and wrist pain was not significantly correlated with breastfeeding, resumption of menstruation after delivery, and the use of mobile devices.

Conclusions

One-third of postpartum women had hand and wrist pain for 8 months after delivery, which commenced in the 1st and 2nd month postpartum. Regarding postpartum hand and wrist pain, we need to pay attention to women with older age, primiparity, and previous history of hand and wrist pain.

Purpose

Ultrasonographic diagnostic imaging has recently been applied to breast care. The present study used ultrasonography to define postpartum changes in the thickness of mammary gland tissue between before and after breastfeeding. We also aimed to determine the relationship between the thickness of mammary gland tissue and the volume of suckled milk.

Method

Fifty-one puerperal women were assessed by ultrasonography before and after breastfeeding at four to seven days after birth in a rooming-in system between January and September 2013. The thickness of mammary gland tissue in the left and right breasts and the volume suckled during each feed were measured.

Results

We analyzed 91 breasts in 15 primiparous and 33 multiparous women who continued breastfeeding after birth. The thickness of mammary gland tissue significantly decreased after breastfeeding (p<0.01). The mean thickness of the tissue before and after breastfeeding was 33.6±8.86 and 32.0±8.47 mm, respectively. The difference in thickness of the tissue weakly correlated with the amount of suckling (r=0.27, p<0.01). The correlation was significant in primiparous, but not in multiparous women (r=0.40 and r=0.17, respectively).

Conclusion

The ultrasonographic findings showed that the thickness of mammary gland tissue was significantly decreased after, compared with before breastfeeding during the early postpartum period. Furthermore, the relationship between the thickness of mammary gland tissue before and after breastfeeding and the amount of suckling suggested that either primiparous women were significantly correlated during the early postpartum period, but were not significantly correlated for multiparous women. This study most importantly revealed that ultrasound images show changes in the thickness of mammary gland tissue before and after breastfeeding during the early postpartum period.

Purpose

The purpose of this study is to clarify the prevalence of lower urinary tract symptoms (urinary incontinence and overactive bladder) in four to nine months postpartum women and to determine the relationship between lower urinary tract symptoms and QOL.

Subjects and Methods

Subjects were postpartum women who gave birth four to nine months previously and could complete Japanese questionnaire. At the time of visitation to the hospital for infant checkup or child care consultation, the subjects were provided a questionnaire and asked that it be placed in the collection box or returned by postal mail within 2 weeks. To measure QOL, SF-12 ver.2 standard edition was used, and data regarding symptoms were estimated by overactive bladder symptom score (OABSS). Information regarding the presence and degree of stress urinary incontinence was also obtained.

Results

989 questionnaires were distributed and 544 valid responses were received. Regarding the respondents, an average of 211 days had passed since birth, 83.6% of the subjects experienced vaginal delivery. The total women who experienced urinary incontinence was 188 (34.6%). 141 had stress urinary incontinence, and of these, 72.3% had symptoms less than once a week, but 82.0% noticed the development or worsening of symptoms after pregnancy or delivery. Women who were suspected of overactive bladder by OABSS were 8.5%. Women who experienced urinary incontinence or overactive bladder showed a lower “Role Physical” score and “Role Emotional” score than non-symptomatic women, and the summary score “Role-social component score”, to which both the Physical and Emotional Role Functions are contributory, was also significantly lower. Especially in symptomatic women with overactive bladder, reduction in the “Role-social component score” was significant, as the “Social Functioning” score also decreased. Regarding women with urinary incontinence, the “mental component score” was significantly lower than that for non-symptomatic women.

Conclusions

Urinary incontinence occurred at a high rate in four to nine months postpartum women, and most were aware of the chance of symptoms occurring during pregnancy and delivery. Although both symptoms of urinary incontinence and overactive bladder were mild, influence on QOL could be seen from various aspects. “Role-social component score” was low in symptomatic women, and increased difficulty in concentration at work and everyday activities could be clarified. In women with urinary incontinence, “mental component score” decreased, and feelings of depression or experiencing a decrease in energy were predicted.

Objectives

This study aims to elucidate midwives' awareness of the psychology and needs of women during childbirth after losing a previous child (hereinafter, “women who lost a previous child”) due to childbirth related malpractice, to elucidate the current situations and issues of support at facilities, and to examine the relevant factors for awareness of midwives in supporting the desirable care of women who lost a previous child.

Materials and Methods

A total of 145 facilities among the hospitals in Japan that handle childbirth were contacted at random, and were asked to participate in this survey. Self-administered questionnaires were distributed to 251 midwives working at 18 facilities who consented to participate in our study concerning the following points: knowledge, experience, understanding, and awareness about subsequent childbirth in women who had lost a previous child. This is a quantitative descriptive, and a relationship exploratory cross-sectional study. Analysis was performed using Spearman's rank-correlation coefficient and analysis of covariance structure.

Results

We obtained 139 responses (55.4% collection rate), of which there were a few midwives who had knowledge and experience about women who lost a previous child, and 7 midwives (5.0%) who had the experience of caring for women during subsequent childbirth. With regard to the understanding of necessary support for the subsequent childbirth in women who lost a previous child, although there were categories for which all the respondents shared affirmative awareness, 68 midwives (51.5%) indicated negative awareness for the following category: “physicians or midwives who are well-acquainted with malpractice or the cases where children were lost due to malpractice attend the subsequent childbirth”. Concerning the relevant factors of midwives' awareness in the desirable care of women who lost a previous child, “more than negative feeling,” the standardized coefficient from “understanding of necessary support” to “awareness of the desirable care” of women who lost a previous child was as high as −0.12 and 0.67, respectively.

Conclusion

With regard to midwives' awareness of the psychology and needs of women who lost a previous child, more than half indicated negative awareness for the following category: “physicians or midwives who are well-acquainted with malpractice or the children who were lost because of malpractice attend to the subsequent childbirth.” It is necessary to perform an investigation including factors related to the psychology of midwives that led to such an awareness. As for the current situations and issues of support at facilities for subsequent childbirth in women who lost a previous child, midwives' knowledge and experience about women who lost a previous child and experience in subsequent childbirth care are limited. Thus, midwives must make efforts to understand the issues by utilizing their knowledge and experience. Regarding the relevant factors related to midwives' awareness in the desirable care of women who lost a previous child, the results suggest that improving the “understanding of necessary support” for women who lost a previous child would lead to “awareness in the desirable care.”