Purpose

This study aimed to analyze the concept of self-confidence in order to discuss the structure of mid-career midwives' self-confidence and the possible direction of future research.

Methods

Walker and Avant's (2008) approach to concept analysis was used to review the literature on self-confidence, self-efficacy and self-esteem. The analysis focused on midwifery, nursing, education and psychology. In addition, the following areas were explored 1) the application of the concept of self-confidence; 2) related concepts; 3) attributes; 4) operational definition; 5) model cases, borderline cases, and contrary cases; and 6) antecedents, consequences, and related factors. In addition, the structure of mid-career midwives' self-confidence as defined by this concept analysis was used to discuss the direction of future research.

Results

The operational definition of the comprehensive concept of self-confidence is confidence about one's specific behavior, competence, and value. The concept of self-confidence includes uncertainty due to change in conditions and context. The attributes of the concept are confidence about one's behavior, confidence in one's own value, and uncertainty. The antecedent of the concept is the feeling of anxiety in a situation in which one has perceived the expectations of others regarding one's ability to achieve a goal. The consequences of the concept are perceiving positive change in thoughts and development and being able to test one's ability to solve problems and improve. The factors affecting the concept are interpretation of experience, mastery due to experience, knowledge and skill, ability to self-evaluate, appropriateness of one's own expectations and the expectations of others, evaluation by others, support from others, and environment around the individual (including the workplace).

Conclusion

The concept of self-confidence suggests the structure of mid-career midwives' self-confidence. In addition, it can contribute to the development of a scale for evaluating mid-career midwives' self-confidence, and help clarify the problems faced by mid-career midwives by revealing the factors affecting mid-career midwives' self-confidence. However, it remains necessary to identify the appropriate level of self-confidence that mid-career midwives who say ‘I don't have self-confidence’ must have.

Objective

The objective of this study was to analyze the gap between expectations and experiences of pain and fatigue in childbirth, by comparing women's experiences with epidural anesthesia and those with no anesthesia, and to explore how the gap related to satisfaction with delivery.

Methods

This study was a longitudinal quantitative descriptive study using a questionnaire survey. Expectation of pain, actual pain, fatigue and satisfaction were measured quantitatively. It compared participants' responses at two-time points: during pregnancy after 36 weeks gestation and during postpartum (within 2 days). The survey was conducted with a purposive sample of 700 pregnant women from a Japanese urban hospital. The 609 (87.0%) valid responses were analyzed statistically.

Results

1. There was in gap between expectations and experiences of labor pain. Those who responded, “more painful than expected” were more frequently in the ‘no epidural anesthesia’ group. Conversely, those who responded that perineal pain was “more painful than expected” were more frequently in epidural anesthesia.

2. The fatigue after delivery was a mean of 60.1 (SD=27.2) with epidural anesthesia and a mean of 52.2 (SD=28.0) for no epidural anesthesia, which was significantly higher in the epidural anesthesia group (P<0.001). In both groups, those whose pain was higher than expected also had significantly higher fatigue levels.

3. Satisfaction with delivery was a mean of 7.61 (SD=1.85) with epidural anesthesia, a mean of 8.65 (SD=1.43) compared to no epidural, which was significantly higher (P<0.001). With epidural anesthesia, there was a significant inverse relation between ‘expectation and experience gaps’ of labor pain and satisfaction with delivery, but not with no epidural anesthesia.

Conclusion

This study confirmed there was a gap in women's (1) expectations of pain and actual experiences of pain and was related to (2) fatigue. In both groups, it is desired to reduce the gap between pain and fatigue.

This study highly recommends providing information to women during their antenatal care regarding pain management during labor and fatigue including the possibility of a gap in their expectations and experiences. In particular, for those women having epidural anesthesia, that gap between expectations of pain and actual labor pain had a greater influence on reducing satisfaction with delivery.

Purpose

Cesarean section birth rates in Japan increased to 19.7% by 2014. In Japan, there is no suitable scale for comparing the satisfaction of childbirth experience between vaginal deliveries and cesarean sections. This study aimed to develop a Japanese version of Salmon's Item List to compare different delivery modes.

Method

First, we pre-tested 22 women receiving a one-month postpartum check-up using a Japanese version of Salmon's Item List that had been translated per the process recommended by World Health Organization. Next, 401 women undergoing one-month postpartum check-ups at 5 different secondary emergency hospitals completed the translated questionnaire. SPSS Statistics ver. 23 was used for statistical analysis, and the significance level was set at 5%.

Results

There were 344 (68.8%) valid responses. Cronbach's alpha for the total scale was 0.849 and 0.654–0.90 for the three subscales, which were similar to the original version. Higher scores indicate more positive experiences. The highest total score was for planned cesarean, followed by normal delivery, emergency cesarean section, and vacuum extraction.

Conclusion

This scale can objectively evaluate childbirth experience via any mode. There is, nevertheless, still room for improvement of the Japanese version of Salmon's Item List by re-examining its subscale components.

Purpose

The principle aim of the present study was to clarify differences in support behaviors by the husband toward the pregnant wife and interest in the fetus during pregnancy between maternity hospital and general hospital prenatal checkups and related factors.

Methods

Of 328 husbands of a puerperants (full-term/vaginal childbirth [excluding twins], within one week after childbirth), the subjects comprised 137 husbands who responded (response rate: 42.4%). The subjects comprised 70 persons in five maternity hospitals and 67 persons in one maternity ward of a general hospital in the Kanto region. An anonymous self-administered questionnaire was distributed from July to October 2014; the contents of the questionnaire concerned the support behaviors by the husband toward the wife and interest in the fetus during pregnancy, loving relationship between the husband and wife, and desire of wife for husband to accompany her to prenatal checkups/childbirth education classes. For examination of differences, Mann-Whitney's U test, two-way analysis of variance, etc. was used, and Spearman's rank correlation coefficient was used for correlation analysis (significance level was set at 5% for all tests).

Results

The age of the subjects was 26–52 years old, (mean age: 36.2±5.3 years). Comparison of maternity hospital/general hospital prenatal checkups revealed that the birth of the second or younger child was the most common in the maternity hospital prenatal checkups and the first child was the most common in the general hospital prenatal checkups (p<.01). Therefore, we conducted a two-way analysis of variance using two factors, (i.e., maternity hospital/general hospital prenatal checkup and first child/ second or younger child), and it was shown that being the first child affected interest in the fetus (main effect: p<.001). By contrast, regarding support behaviors toward the wife, in the case of a general hospital prenatal checkup, subjects had a high possibility of carrying shopping bags and accompanying walking and massaging the wife and tended to be affected by being the first child. Thus, the results were divided by question item.

Among factors related to support behaviors by the husband toward the wife and interest in the fetus, as the score for loving relationship between husband and wife increased, support behaviors toward the wife (ρ=.197–291, p<.05) and interest in the fetus (ρ=.276–.313, p<.01) also increased.

Conclusion

Interest in the fetus was influenced by being the father of a first child without a difference between maternity hospital and the hospital prenatal checkups. However, the results regarding support behaviors toward the wife were divided according to the question item. Furthermore, factors related to support behaviors toward the wife and interest in the fetus included a loving relationship between husband and wife.

Purpose

Newborns delivered normally at full term are not covered by the current medical insurance system. There is no criterion for the proper assignment of nursing staff in newborns. Fundamental materials are being desired to ensure infant safety and increase the quality of nursing care. The purpose of this study was to clarify the nursing care and time in maternity wards. Target subjects were newborns from immediately after birth to day four.

Method

We applied a one-on-one time study method to investigate nursing care provided to newborns delivered normally for the first eight hours immediately after birth, and for eight hours between 8:30 am and 4:30 pm on day one to day four at three hospitals with maternity wards.

Results

Subjects of this study were 64 newborns delivered normally and 122 nurses. Nursing care provided to the newborns changed according to the day after birth. Mean nursing time was approximately two hours per newborn during the eight hours measured. No significant difference was observed in the time used to provide nursing care among the days.

Conclusion

This study clarified the nursing care and time for newborns. Furthermore, it is desirable to accumulate data to consider the proper assignment of nursing staff in newborns.

Aim

The aim of the study was to describe the actual organizational structure, policy, management and administration, and evaluation concerning the establishment of midwife-led birth units alongside hospitals or clinics where midwives conducted pregnancy checkups and deliveries.

Methods

The study design was a quantitative-qualitative descriptive study. The research facilities were hospitals and clinics, which had midwife-led birth units. The survey participants were one midwife from each facility. To collect data the researchers first sent midwives a questionnaire to respond and then they conducted structured interviews based on participants' responses. The collection period was from September to December 2017. The survey queried the: (1) number of midwives and advanced midwives, (2) requirements for midwives who could work in midwife-led birth units, and (3) criteria for pregnant women eligible for admittance to midwife-led birth units and other minor details. Descriptive statistics were used to analyze quantitative data and the qualitative data was sorted into categories regarding their similarities. St. Luke's International University Research Ethics Review Committee (17-A 054) approved this research.

Results

Midwives from 28 medical facilities throughout Japan consented to participate. The annual average number of deliveries for midwives within the hospital 45.5 (SD 65.2), and ranged from 0 to 255 cases; the median number was 13 cases. The average number of midwives in the hospital was 40.6 (SD 28.9) and the average number of advanced midwives was 13.5 (SD 9.7). The number of midwives involved in midwifery outpatients averaged 12.8 (SD 9.4), with the most frequent period of midwifery experience being 10 to 15 years. The number of midwives involved in in-hospital midwifery was 10.1 (SD 3.9); with commonly more than 20 years of experience. The Japanese Guidelines for Obstetrics and Gynecology criteria for pregnancy admissions for midwife-led units and for referrals to obstetricians were adopted in 27 facilities (96.4%). Midwives and obstetricians collaborated with each other to support women who have threatened preterm birth or women with psychosocial risk factors at two hospitals (7.1%).

Conclusion

In midwife-led birth units alongside the hospitals or clinics, criteria for low risk pregnancies and for referral to obstetricians were based on the Japanese Guidelines for Obstetrics and Gynecology. Midwives implemented their practice safely by using timely consultations with near by obstetricians.

Purpose

The aim of this study was to assess how midwives perceive their work for a Childrearing Support Home Visitation program in Japan.

Methods

We conducted a qualitative descriptive study. The participants were 12 midwives who belonged to the Japan Midwives Association and engaged in the Childrearing Support Home Visitation program in Japan. Data regarding how midwives perceive their work for the program were collected through semi-constructive interviews. Their responses were then analyzed using a qualitative inductive approach.

Results

Twenty-six sub-categories and nine categories were extracted regarding how the midwives perceived their work for the program. The nine categories were further summarized into 3 groups. First, “Establishing relationships with clients to develop a good rapport for a continuous visit,” “Utilizing knowledge and skills as a midwife, and the strength of continuing support;” and “Accepting the client personalities and improving midwife capabilities to enhance confidence” were classified as “Importance and difficulty in creating relationships with clients.”

Second, “Managing their own work-related stress,” “Recognizing work-related stress when their client support is insufficient,” “Rewarding the accomplishments brought on by midwife support,” and “Feeling that their perspective on various issues increased their activity as a midwife,” were classified as “Work-related stress and job satisfaction as a supporter”.

Third, “Determining the scope of responsibility and the limit of their support,” and “Recognizing the necessity of communication with other midwives in the same program” were classified as “Difficulties and problems with providing support”.

Conclusion

Midwives recognized their contribution to the Childrearing Support Home Visitation program as providing continuous support related to their own specialty. They considered that engaging in this program broadened their view and increased their activities in midwifery, suggesting that such activity in the community leads to professional growth. On the other hand, they recognized psychological challenges which required peer support when they faced clients. They also determined the limit of their own support.

Purpose

The authors' birth center is an in-hospital midwifery facility annexed to the Perinatal Medical Center. Even if the course of pregnancy and delivery is uneventful, unexpected massive bleeding can occur after childbirth. Pregnancies conceived via assisted reproductive technology (ART) are said to be a risk factor for placenta accreta; and placenta accreta can cause critical obstetrical hemorrhage. In our facility, if a parturient conceived via ART wishes to give birth in an in-hospital midwifery unit, childbirth is carried out in a birth center with the permission of the obstetrician. We conducted a case-control study about postpartum hemorrhage (PPH) to examine the safety of giving birth of pregnant women conceived via ART (fresh embryo transfer and cryopreserved embryo transfer) in an in-hospital midwifery care.

Subjects and Methods

During the survey period between April 2013 and March 2016, the total number of birth center deliveries was 604, including 567 not conceived through ART and 37 conceived through ART: fresh embryo transfer in 9 cases and cryopreserved embryo transfer (CET) in 28 cases. We carried out a statistical analysis of the amount of postpartum bleeding, the amount of bleeding during the 24 hours following delivery, and the frequency of PPH (postpartum bleeding of 500mL or more, or bleeding of 800mL or more during the 24 hours following delivery) among pregnancies not conceived through ART, pregnancies conceived through fresh embryo transfer, and pregnancies conceived through CET. Multiple linear regression analysis of the amount of postpartum bleeding and the amount of bleeding during the 24 hours following delivery was performed, and the frequency of PPH was determined using multivariate logistic analysis.

Results

The amount of postpartum bleeding and the amount during the 24 hours following delivery were significantly greater among pregnancies conceived through CET than among those not conceived through ART; the frequency of PPH was also significantly higher among pregnancies conceived through CET than among those not conceived through ART. In addition, PPH consisted of critical obstetrical hemorrhage in 4 cases, 3 of which occurred in mothers pregnant with fetuses conceived through ART using CET.

Conclusions

Our study suggested that pregnancy conceived through CET was a risk factor for PPH. Regarding care system and eligibility for giving birth of pregnant women conceived through CET in an in-hospital midwifery unit, further investigations are needed.

Purpose

This study aimed to describe the characteristics and their perceoptions of women who utilized public postpartum heath care service of Sapporo City in the first Fisical Year. In this study, the perceptions deal with women's awareness related to their postpartum experiences and care.

Methods

Participants include women who had received the postpartum care service funded by Sapporo City in Fiscal Year 2016. The postpartum care service program was offered at six midwifery clinics. We used the methodological triangulation design with a quantitative and qualitative survey. The quantitative survey was conducted via a self-administered questionnaire on women's characteristics and the contents of or satisfaction with the care that they received. Additionally, we conducted semi-structured interviews with the women to collect data on their perceptions regarding the postpartum care service. We analyzed the quantitative data using IBM SPSS 22, and the qualitative data were analyzed using the Rapid Anthropological Assessment Procedure (RAP).

Results

Data were collected from September, 2016 to March, 2017. In total, 57 women responded to the questionnaire, and 21 women participated in the interview. Findings revealed that 49 (86.0%) women were satisfied with the postpartum care service program funded by Sapporo City, but a few were dissatisfied. The analysis of the qualitative data yielded following seven categories pertaining to the perceptions of the women: spending the postpartum period at the delivery facilities, the suffering experienced after childbirth, reason for using the postpartum care service, experience of the postpartum care service, advantage of midwifery clinics for the postpartum care service program, expenses toward the postpartum care service, and women's demands for the postpartum care service.

Conclusion

Most of the women who utilized the postpartum care service program of Sapporo City were satisfied with the care. They recognized some difficulties related to childrearing and their own postpartum condition, and acknowledged the usefulness of the postpartum care. All women hoped that the public financial support for postpartum care would continue and expand.

Purpose

This study aimed to investigate breastfeeding difficulties and concerns that first-time mothers experienced during the first 4 months after hospital discharge.

Subjects and Methods

The subjects were 11 first-time mothers at 3 months postpartum who had experienced breastfeeding difficulties or concerns. A semi-structured interview was conducted with each individual, and the obtained data were analyzed using a qualitative and inductive approach.

Results

With regard to the experience of breastfeeding difficulties and concerns among first-time mothers, the following 8 categories were extracted: [Responses of an infant who does not adapt to breastfeeding], [breastfeeding problems], [unsettled sucking patterns], [evaluating whether or not an infant has breastfed sufficiently], [no steady increase in breast milk volume], [breast and nipple soreness], [changes in daily life due to breastfeeding], and [involvement of people close to the mother against her wishes].

The period when the mothers with breastfeeding concerns and difficulties became less anxious and started to establish their own way of breastfeeding their infants varied between 1 month (at the earliest) and 3 months (at the latest) postpartum.

Conclusions

The results indicate that midwives must continue supports for mothers who have difficulty breastfeeding, such as sucking-related problems, during and after their hospitalization, and also must help mothers understand that their infant is getting sufficient milk by showing data on the infant's body weight and the amount of milk their infant consumed, in order to reduce mothers' anxiety over insufficient intake. It is also important that midwives provide emotional support for mothers who cannot breastfeed their infant.

It takes 2-3 months for first-time mothers to get used to breastfeeding and life with a child. Thus, midwives must not only teach breastfeeding techniques and methods, but must also take into account the daily life of a mother and her child when providing breastfeeding support.

Purpose

This research explores how husbands view the changes of their marital relationship after the birth of the first child.

Methods

We conducted focus group interviews with nine research participants. Research participants were divided into two groups of five and four, were called for the focus group interview on separate days. We conducted the focus group interview one time for each group. Research participants are males who have become a father to their first child between one to three months prior to the focus group interview. We obtained permission from local Health Centers to gather and interview research participants. Interview data were coded and categorized, using the word-for-word list extracted from the data, and analyzed qualitatively. This research was approved by the Ethics Committee at the Ibaraki Prefectural University of Health Sciences.

Results

Married couples change a family upon the partner relationship they have established. Interview data indicated that the couples have been going through major changes after their first child being born. Addition of a new family member has brought married couples new challenges to their relationships; research participants explained they have [created mutual goals with their wives] in order to overcome the challenges. Research participants stated that sharing the same goals enabled them [to share the responsibilities and to adjust their relationships], resulting in showing [appreciation to their partners for making efforts]. Research participants have been trying to understand the role of being a mother, and [added obligations as a husband to support their wife]. Couples [developed the sense of family] by having the mutual goals and coming up with strategies on how to achieve the goals, as well as, showing appreciation to each other.

Conclusion

The birth of the first child brings married couples a major change to their relationship. Participants shared their experiences during the interviews that they redefined their marital relationship, and had created a new mutual goal centering their child. In order to accomplish the goals, research participants have imposed the obligation as a husband in addition to responsibilities of being a father. Participants explained that they have made an effort to maintain the balance between being a partner and a parent, recognizing the transformations of their partners into parents. Being aware of additional role as a parent and recognizing changes in their relationship, the sense of family evolves from the sense of partnership.

Purpose

This study reveals obstetric nurses' current situation and challenges to promote breast milk production for mothers of preterm infants, as well as the actual outcome of mothers' status of breast milk expression during the same period of time.

Methods

We surveyed two mothers who gave birth to preterm infants: at 28 and at 30 weeks' gestation. To describe the current situation of mother's breast milk expression we collected the following data: time of starting and ending breast milk expression, frequency of breast milk expression per day, amount of breast milk per day, method of breast milk expression, place of breast milk expression, event before and after breast milk expression, and daily mood during the first month after giving birth. In addition, we conducted a focus group interview with four midwives, each with four years of clinical experience and who worked on the obstetric ward. They were prompted to discuss aspects of their nursing care to promote breast milk production for mothers of preterm infants. The interview content was analyzed using thematic analysis.

Results

With regard to two mothers' status of breast milk expression during the first month after giving birth, we found the times at which the mothers begin breast milk expression to be delayed more than one hour after birth. Except for the birth day, the average frequency of breast milk expression per day of mother A was 6.83 times, and that of mother B was 6.67 times. Moreover, during the first month after giving birth, both mothers had difficulty stabilizing their milk volume to at least 500mL per day. The midwifery focus group results revealed six categories impinging on their care to promote breast milk production for mothers of preterm infants on maternity wards: “implicit care policies”, “difficulty initiating early breast milk expression after a cesarean delivery”, “difficulty establishing mothers' rhythm of breast milk expression”, “lack of opportunities to provide care after discharge”, “difficulty providing care in cooperation with the neonatal intensive care unit”, and “difficulty maintaining mothers' motivation for breast milk expression”.

Conclusion

Mothers of preterm infants had delayed breast milk expression more than one hour after birth. The frequency of breast milk expression was low. Obstetric nurses encountered some barriers in their attempts to provide care to promote breast milk production for mothers. There was a gap in the recognition of nurses and practice especially, for the first time starting breast milk expression. We found the time at which not only the mother of cesarean section but also of vaginal delivery begins breast milk expression to be delayed. Building on the findings from this research, the next phase is to develop an educational program that enables nurses working on obstetric wards to set the standard of and provide care to promote breast milk production such as early and frequent breast milk expression for mothers of preterm infants.