Purpose

This study assessed research trends in postnatal debriefing to identify implications for future practice and research.

Method

A literature search of the Japan Medical Abstracts Society, CINAHL, and PubMed databases was conducted using the following keywords: Childbirth, After-birth, Postnatal, Postpartum, Debriefing, and Midwife-led counseling, including all studies published between 1980 and 2016. We only selected original articles and identified studies on postnatal debriefing offered to postpartum women. We used Garrard's matrix method to describe the results.

Results

Eighteen articles were selected for the analysis. Differences were observed in the trends in postnatal debriefing studies in Japan and foreign countries. Japanese studies began by using a qualitative approach for postnatal debriefing, describing the effects of intervention. Subsequently, further studies also delved into hypothesis testing assessing the effects of postnatal debriefing. In contrast, foreign studies on postnatal debriefing initially included qualitative research to describe the effects of intervention and hypothesis testing to evaluate the effects of intervention. In cases where the researchers indicated a lack of robust evidence on postnatal debriefing as a problem, an increase in the hypothesis testing approach using a Critical Incident Stress Debriefing to evaluate the intervention was observed. However, a Cochrane systematic review revealed no evidence of benefits from a single debriefing session and indicated some potential for harm, as researchers focused on surveys to research current practice and qualitative studies to explore women's experience of postnatal debriefing. It was revealed that intervention was not appropriate for all women and that the timing of the intervention needed to be examined while considering individual situations. Possibly, the past practices did not reflect women's needs. Subsequently, a study utilizing hypothesis testing was conducted based on past studies and was aimed at development of the practice of considering women's needs.

Conclusion

In Japan, the routine of performing postnatal debriefing needs to be reevaluated. To provide appropriate intervention required by women, it is necessary to identify women's postpartum needs for postnatal debriefing and investigate the practice that needs to be performed.

Purpose

This study explores the care related to milk expression that promotes breast milk production, as the first step in developing an educational program for obstetric nurses to promote early postpartum breast milk production in mothers of preterm infants.

Methods

Five reviewers conducted a search of published manuscripts using the following databases: PubMed, CINAHL Plus with Full Text, and Ichushi Web Ver. 5 of the Japan Medical Abstracts Society. They also included manuscripts used in a literature review of breast milk expression published by Cochrane Library. The titles, abstracts and main texts of these manuscripts were used as references to extract manuscripts that included the amount of breast milk produced by mothers of preterm infants as their outcome. Two reviewers evaluated and reached agreement on the quality of each manuscript using the Cochrane Handbook for Systematic Reviews of Interventions (5.1.0), Risk of Bias Assessment Tool for Nonrandomized Studies and the GRADE Handbook. They organized the research objectives, methods and results of each manuscript to identify care related to milk expression to promote breast milk production in mothers of preterm infants.

Results

Meeting the inclusion criteria were 35 articles: 24 interventional and 11 observational studies. There was low-quality evidence from the randomized controlled trials for example, insufficient information about random sequence generation, allocation concealment and blinding. Also, sample size had not been calculated in most of manuscripts. There was low-quality evidence from the nonrandomized controlled trials for example, insufficient consideration of confounding variable. Evidence considered applicable in nursing practice was obtained from the observational studies. Useful methods of care related to milk expression that promoted breast milk production were: starting breast milk expression within one hour of delivery if possible, guaranteeing at least seven breast milk expression sessions and at least 100 minutes of breast milk expression per day, fully explaining both hand and electric breast pumping and adding at least six sessions of hand breast pumping to electric breast pumping per day until mothers entered stage II of milk production, and were performing kangaroo care.

Conclusion

Building on the findings from this review the next phase is to document mothers' actual breast expression experience and interview obstetric nurses to build an accurate data-base of about breast milk expression among mothers of preterm infants in Japan. The aim is to deepen understanding of the actual situation of support for breastfeeding among mothers of preterm infants and to develop an educational program that enables nurses working on obstetric wards to provide care related to milk expression that promotes adequate breast milk production.

Research Objective

The objective of this study is to identify the perspectives that midwives who make newborn visits focus on to assess the mental health of primipara mothers within a month of childbirth.

Methods and Subjects of the Study

The study was conducted among midwives (n=13) who make newborn visits to examine the mental health of primipara mothers mainly at the time of their visits to provide mothers with postpartum guidance. Data was collected through semi-structured interviews, and a qualitative analysis was performed.

Results

The investigation by midwives resulted in the following categories and subcategories of perspectives concerning primipara mothers’ mental health and primipara mothers who are not in good environments for parenting. ‘Conditions of mothers’ were classified into seven subcategories: expressing difficulty, feeling overly compelled to take care of the newborn and a tendency for self-blaming, disorderly life activities, inappropriate coping behaviors, poor postpartum physical recovery, uncomfortable living environment, and financial situation impacting the mother. ‘Newborns and child rearing situations’ were classified into three subcategories: a difficult baby, confusion about parenting, and anxiety about breastfeeding. ‘Mothers’ experiences impacting parenting were classified into six subcategories: lack of parenting experience, parenting history impacting child rearing, a career impacting child rearing, mental health history, painful childbirth experience, and death of someone close to the mother. Finally, ‘support given to mothers was classified into five subcategories: inappropriate support from a partner and/or a family member, inappropriate support from a medical professional, isolation and/or an inappropriate relationship, asking numerous questions due to anxiety, and inability to communicate and collect information easily.

Conclusion

Midwives deduced the mental health conditions of primipara mothers within one month of childbirth along with the conditions the mothers and their newborns were in, their living environment, and so forth, and observed that the mothers’ experience, support given to them, and nature of their relationships with others impacted the mothers’ mental health conditions. The study confirmed the importance of providing specific support responding to individual needs of respective primipara mothers who gave birth within one month. Midwives are expected to assess both primipara mothers’ living conditions and the conditions of the mothers and their newborns, and offer primipara mothers assistance by utilizing and collaborating with various social resources in local communities.

Purpose

According to a refugees support association in Japan, the fact is known that an increasing number of refugee women seeking advice about reproductive health. Based on this, a trial program to improve reproductive health for refugee women living in Japan was held in 2013. The aim of this study was to modify and evaluate the program.

Methods

This is a before-after study. The modified program was held for refugee women between the ages of 15 to 49 living in Japan. The program content included: menstruation and pregnancy, contraception, sexually transmitted diseases, and genital hygiene. Self-administered-questionnaires before and after the program asked about: knowledge, awareness, self-efficacy, and self-esteem. Furthermore, they completed questions about their response to the program content and the setting.

Results

There were 17 program participants and this study focused on seven of the participants ranging in ages from 31 to 48 years and from Southeast Asian countries.

The mean individual knowledge scores increased significantly from 8.43 before the program to 13.00 (p=0.001) after the program. Items responses that increased significantly were: “identification of the ovulation day (p=0.031)”, “the effect of emergency contraception (p=0.031)” and “not washing inside of the vagina (p=0.016)”.

These two items of awareness increased significantly after the program: “I will use a condom (p=0.038)” and “I can use a condom correctly (p=0.041)”. There were no significant differences in the self-efficacy scale, but the self-esteem scale rose significantly (p=0.004).

Half of the women answered “few” about the program number of time and the number of participants. Most respondents were interested in all aspects of using condoms and knowledge of diseases. More than half of the women responded positively about workshops focused on menstrual cycle beads, basal body temperature and how to use a condom.

Conclusion

Refugee women's knowledge and their awareness about reproductive health were improved. Their self-esteem was improved, but self-efficacy was not changed. Challenges for the future are to set the program number of times according to participants and to do a long-term evaluation several months after program implementation.

Purpose

The principal aim of the present study was to describe the experiences of mothers regarding continuation of breastfeeding after returning to work following childbirth.

Methods

Cooperation of two maternity homes in an urban area was sought for the study. Data were collected using focus group interviews with 10 women who were breastfeeding after childbirth and desired to continue breastfeeding before returning to work or school. Data were qualitatively analyzed using the content analysis method.

Results

The subjects were eight women who returned to work and two who returned to academia after childbirth (age range: 20-40 years). The time taken to return to work was between two and 10 months postpartum. Regarding the method of breastfeeding before return to work, nine subjects selected breastfeeding and one selected mixed feeding; following return to work, four selected breastfeeding and six selected mixed feeding.

A total of 200 codes, 61 subcategories, and 17 categories were extracted from the data. The following seven categories were extracted from data of women who returned to work following childbirth and continued breastfeeding while working: “selection of continuing to breastfeed after returning to work as a mother,” “preparation and adjustment in anticipation of breastfeeding after return,” “presence of supporters for continuation of breastfeeding,” “continuation of breastfeeding as part of life,” “various barriers to maintain balance,” “values and stance regarding breastfeeding,” and “happiness of child becoming happiness for self.”

Conclusion

On returning to work or academia, the women selected to continue breastfeeding as a mother and had various experiences while continuing breastfeeding. Our results suggest that midwives need to understand that women returning to work after childbirth have such experiences and provide support for these women.

Purpose

The purpose of this study was to evaluate the feasibility of the “Mama's Touch Program” on primiparas’ secretion of oxytocin and cortisol as evaluation indexes.

Methods

This study compared the oxytocin and cortisol levels of the intervention group, consisting of primiparas who participated in the “Mama's Touch Program” once at 38 weeks and once at 39 weeks of gestation, with the primipara control group. During the 60-minute program the intervention group observed the relationship between the infant and the mother, and then practiced touching the infant such as giving a hug or a touching gesture. For both groups, saliva samples were collected at three time points: before the intervention, 30 minutes after, and 60 minutes after the intervention. Salivary oxytocin level was analyzed using an oxytocin ELISA kit (Enzo Life Sciences, Inc.) Cortisol level was analyzed using the Cortisol Salivary Immunoassay kit (Salimetrics, LLC). We analyzed the: (1) collection of saliva; (2) saliva for oxytocin and cortisol and (3) interactions with infants.

Results

At 38 weeks gestation, seven primiparas participated in the intervention group and six primiparas participated in control group; by the 39 weeks of gestation, five remained in the intervention group and five in the control group. Oxytocin concentrations at 38 weeks and 39 weeks gestation were small and varied widely among participants. Cortisol concentration was reduced from pre to post 30 minute and from post 60 minutes in both groups at 38 and 39 weeks gestation. Among the intervention group at 39 weeks gestation, the pre to post 30 minutes cortisol concentrations were significantly reduced (p=.044). Of the 69 saliva samples (0.5mL-6.0mL), the oxytocin level was measured in 45 (65.2%) in duplicate assay, and the cortisol level could be measured in all the samples in duplicate assay. The interactions with infants were too varied for measurement because of infants’ age and response.

Conclusion

The study was found to be feasible in terms of collection of saliva, analysis of saliva and interaction with infants. A larger full-scale RCT can be conducted, after developing a: (1) protocol for specific interaction with infants, (2) guideline for instructions from mother and (3) mechanism to increase saliva amount.

In order to provide safe and comfortable care throughout the perinatal period, there must be a practical guideline, which midwives can follow. The Japan Academy of Midwifery published the “Evidence-based guidelines for midwifery care in pregnancy and childbirth – 2016 edition”, containing care policies for healthy low-risk women and newborns. In this 2016 edition, we added the new pregnancy section including 13 Clinical Question (CQ)s and the latest evidence was added to the existing 30 CQs in the intrapartum section of the “Evidence-based guidelines for midwifery care during childbirth – 2012 edition”.

This guideline describes and answers those clinical questions midwives face when caring for women. Recommendations we describe here are based on the latest evidence. Therefore, we believe this updated guideline reflects the best practice at this point in time. We hope this guideline will: 1) enable midwives to provide evidence-based practice and support women's decision making, 2) assist midwifery students to recognize the importance of knowing the constantly advancing field, and 3) promote further research activities where evidence is needed. The aim of introducing this guideline in English is to: 1) introduce and distribute the guidelines, compiled by Japanese midwives, to other countries and 2) enable Japanese researchers to use the English version as a common understanding by referring to this guideline when submitting to international journals.

In this 2016 edition, a total of 43 CQs and the recommendations for care are introduced. Although the following six CQs are commonly utilized medical treatments in the field of obstetrics, these practices require obstetrician's supervision. Therefore, we only described the evidence statements and not the recommendations: The following six CQs are: Intra-CQ1. Induction of labor; Intra-CQ2. Membrane sweeping; Intra-CQ7. Epidural anesthesia; Intra-CQ21. Episiotomy; Intra-CQ26. Perineal repair; and Intra-CQ28. Prophylactic uterotonic. Revisions in the recommendations from the 2012 edition are as follows: “Intra-CQ 3. Is nipple or breast stimulation effective to induce labor?”; “Intra-CQ9. Is acupressure or acupuncture effective to relieve labor pain?” and “Intra-CQ14. Is acupressure or acupuncture effective to augment labor?”

This paper is composed of an excerpt from the “Evidence-based guidelines for midwifery care in pregnancy and childbirth – 2016 edition” and the recommendations described here are fully translated.