Objectives

This study aimed to examine ideas that mothers accompanying hospitalized infants have about breastfeeding and their underlying thoughts, as well as the psychology that accompanies such ideas, and to discuss support for mothers who continue to breastfeed while accompanying their infants in the hospital.

Patients and Methods

We conducted semi-structured interviews with 11 mothers, who had continued breastfeeding while accompanying their infants aged <1 year who were hospitalized in three medical facilities with pediatric inpatient wards. The mothers were asked to recall their experience of breastfeeding while accompanying their hospitalized infants at 3-5 months after their infants were discharged. The mothers' ideas about breastfeeding, underlying thoughts, and the psychology accompanying breastfeeding. Data obtained from these interviews were analyzed qualitatively and inductively.

Results

Among mothers' ideas about breastfeeding were “continue breastfeeding in the same way as before,” “breast milk is best for babies' growth and development,” and “it is what I can do as a mother of a struggling child.” Underlying these ideas were “unshakable values regarding breastfeeding,” “responsibility as a parent,” and “connection to the child through breast milk.” As for the psychology associated with breastfeeding, “the mother's role that is not smoothly fulfilled,” “conflict with one's ideas about and actual state of breastfeeding,” “opportunity to engage in childcare,” and “appreciation for support” were extracted.

Conclusions

As a form of support to increase the positive feelings among mothers as they live their lives accompanying their nursing infant in the hospital, nurses must continue to support the mothers' thoughts on breastfeeding. As nurses gain knowledge regarding support for breastfeeding, address the concerns of mothers, request support from an early stage from midwives when necessary, have an ongoing understanding of the concerns of mothers, and provide an environment where they are easily approachable, these become an awareness for opportunities to be thankful toward the support and an opportunity to focus on childcare. Through this process, we surmise that mothers will be able to develop positive thinking and confidence about breastfeeding.

Purpose

The purpose of this study was to evaluate the feasibility of midwives implementing postpartum pelvic floor muscle training using vaginal palpation. This occurred through developing a manual and a process of midwifery training by which midwives learned teaching techniques of vaginal palpation using the manual.

Methods

The first step was to develop a vaginal palpation pelvic floor training manual. Eight medical professionals (midwives, nurses & physicians) specializing in the treatment of the urogenital area considered the suitability of content. Next, using the resulting modified manual, researchers gave a 30-minute lecture for seven midwives. Then the midwives practiced their pelvic floor muscle training by vaginal palpation with consenting women on their fourth postpartum day. Following the pelvic floor muscle training by vaginal palpation, midwives did a guided reflection on their experience. The qualitative contents were thematically analyzed.

Results

During the first step, the contents of the procedure manual were modified according the condition of women with weakened pelvic floor muscles after vaginal delivery. Modification concerned the place and timing of implementation, the time required, and lubricants. In the second step, there were questions about the method of vaginal palpation and the use of the Oxford scale to evaluate pelvic floor muscle strength: the Oxford scale was easy to implement. Three categories were extracted from the results of reflection: (1) Learning of techniques, (2) Actual experience of vaginal palpation, and (3) Awareness of the practice. Based on interviews and a questionnaire survey the postpartum women had no negative reactions and comments and experiences were positive. There were no problems occurring in the implementation.

Conclusion

Midwives who participated in this study were able to master the teaching techniques of pelvic floor muscle training by vaginal palpation without difficulty using the prepared manual and found that there were no problems in implementation. It was suggested that postpartum pelvic floor muscle training by vaginal palpation could be practiced clinically as part of midwifery care.

Purpose

The purpose of this study is to determine the lessons learned from experiences by midwives who are Level I of Clinical Ladder of Competencies for Midwifery Practice in the care of women with high-risk pregnancy in the delivery stage.

Participants and Methods

The study design was set as a qualitative description study. A semi-structured interview was carried out on twenty Level I midwives working at general perinatal medical centers, regional perinatal medical centers, or secondary medical agencies in X prefecture, with experience in caring for women with high-risk pregnancy in the delivery stage. The data were transcribed, interpreted, summarized, and classified into categories and subcategories depending on the similarities and differences between the emotions, thoughts and behavior, and knowledge acquired from experience of the midwives.

Results

Midwives who are Level I according to the Clinical Ladder of Competencies for Midwifery Practice experienced positive feelings and negative feelings of “fear of abnormal situations”, “anxiety corresponding to high risk”, “relief by support from other midwifes/doctors”, and “courage of self-awareness as a midwife” when caring for women with high-risk pregnancy in the delivery stage.

During care, the midwives engaged in “making progressive use of knowledge” while “ensuring adequacy of knowledge” and acting.

On the other hand, “difficulty in responding” due to inexperience and the effects of emotional bias was also observed.

Knowledge acquired through experiences in caring for women with high-risk pregnancy included “learning method about high-risk”, “physical assessment for the maternal body and the need for education based on it”, “response to the high-risk cases”, and “coordination by the medical team”.

Conclusion

Midwives who were Level I according to the Clinical Ladder of Competencies for Midwifery Practice accumulated knowledge on physical assessment for the maternal body and response to high-risk cases, coordination by the medical team by balancing negative and positive feelings, ensuring the adequacy of knowledge by senior midwives and physicians, and practicing care of women with high-risk pregnancy by making progressive use of knowledge. Moreover, they learned study methods for high-risk situations by reviewing previous cases.

Purpose

The purpose of this study was to explore practicum instructors' actions for and perceptions of how they promoted noticing and interpreting data for novice midwives in relationship to clinical judgment during women's deliveries.

Methods

This was a qualitative, descriptive study using participant observation and semi-structured interview with eight pairs of practicum instructors and novice midwives in three hospitals from the Kanto region. Participant observation focused on the scene where the practicum instructors educated novice midwives. After participant observation, practicum instructors were individually interviewed using the semi-structured interview. Data source triangulation from the participant observation educational scenes and the interviews were content analyzed and integrated.

Results

We extracted four educational scenes to promote noticing and interpreting data. The theme of educational scenes promoting noticing were to: (1) utilize without missing opportunities; (2) teach how to notice using the five senses, and (3) encourage their independent noticing. The theme of educational scenes promoting interpreting data was to use questions to promote reasoning skills.

Conclusion

The practicum instructors used every opportunity to encourage the novice midwives to notice the pregnant women's status using their five senses and to independently notice the pregnant women's changing status with delivery. Then, they promoted novice midwives thinking using skillful questioning. In order to promote noticing and interpreting data of novice midwives, it was suggested that the practicum instructors should be able to consider the timing suitable for teaching, educate novice midwives to use their five senses to feel the status of pregnant women and to encourage them to expand their thinking and interpreting data through skillful questioning.

Purpose

The World Health Organization (WHO) released “WHO recommendations: Intrapartum care for a positive childbirth experience” in 2018. The guideline is considered the revised edition of the ‟Care in Normal Birth: a practical guide” issued in 1996 dedicated to childbirth in healthy pregnant women. This study aimed to compare the old and new WHO guidelines, and to describe the changes that have been made.

Methods

First, the basic characteristics of both the guidelines were compared. Second, subheadings were created in Japanese to describe the contents of both the old and new guidelines. A comparable list of subheadings of the old and new guidelines was made, and the categories of recommendation were shown in the same table. Finally, we analyzed the following details: “newly added items in the new guideline”, “items that were present in the old guideline but were not included in the new guideline”, and “items in the new guideline for which the recommended levels have shifted”. Then, the overall changes in the WHO recommendations for normal childbirth were described.

Results

The old and new WHO guidelines were similar with regard to promoting the respectful maternity care. The major points that were revised included the respect for diversity of the progress of labor and modification of the definitions and standard duration of the first and second stages of labor. Additionally, the new guideline included recommendations on the care for women who have undergone epidural anesthesia, and for newborns. Recommendations considered to have been widely accepted in several birth settings, such as the use of clean instruments was not included in the new guideline. The category levels that elevated from the old guideline were the items related to oxytocin administration at the third stage of labor, umbilical cord traction, and care for women who underwent epidural anesthesia. The new guideline emphasized the midwifery cares which promote women's positive childbirth experience. However, the contents of midwifery cares were consistently unchanged in the new and old guidelines, although there were differences in expressions.

Purpose

This study aimed to investigate the expectations of mothers regarding postpartum home visits less than 1 year after childbirth and to clarify the needs of mothers during postpartum home visits.

Method

This study was based on a survey conducted among 594 postpartum women in Tokyo, Chiba, and Saitama prefectures in Japan. All participants were surveyed within one year of delivery. A major part of the questionnaire concerned the requirements for postpartum home visits and included items on (1) basic attributes, (2) situation and method of delivery, (3) condition of the newborn baby, (4) postpartum support, (5) mothers' expectations regarding postpartum home visits (scheduling, number of visits, time, occupation of visitor, type of care), and (6) a free space for any additional comments.

Results

A total of 271 (45.6%) postpartum women returned the questionnaire. Their average age at delivery was 32.8 (±5.0) years. Of the respondents, 176 (64.9%) were primipara, and 95 (35.1%) were multipara. The average pregnancy duration was 39.0 (±1.6) weeks, with 86.0% having a vaginal delivery and 14.0% opting for a Caesarean section. A total of 185 respondents (68.5%) had either “no reservations” or “few reservations” about home visits. Additionally, 174 respondents (64.4%) wanted home visits one to two months after delivery, and 114 (42.2%) wanted home visits immediately after leaving the hospital to one month after delivery; 180 respondents (67.7%) said they would like multiple home visits within one month of delivery, while 237 respondents (87.8%) wanted to be visited by a midwife, making this the most desired occupation, and 174 (72.2%) wanted to be visited by someone from a hospital or clinic. The most desired types of care included weighing the infant (228 respondents, 84.1%), breastfeeding-related concerns (198 respondents, 73.1%), and pelvic care (163 respondents, 60.1%).

Conclusion

Although the postpartum period includes mental stress, the most desired types of care involved breastfeeding, weighing the infant, and other direct physical approaches. Few mothers within the first year of delivery had strong reservations about home visits, and many wanted multiple visits within two months of delivery. Many respondents expressed a desire for both a midwife and someone affiliated with a hospital or clinic. Thus, in the future, it would be desirable for midwives from hospitals and clinics to provide outreach-style home visits for seamless care.

Purpose

The aim of this study was to describe evaluation of the Early Essential Newborn Care (EENC) seminar with regard to: 1) hand washing technique, 2) knowledge test, and 3) practical skills in childbirth and neonatal care before and after teaching facilitators to coach midwives and nurses in developing countries.

Methods

The four-day EENC seminar was held in October 2016. We invited 2 instructors from the World Health Organization/Western Pacific Regional Office (WHO WPRO) to coach healthcare workers became a leader in the future, and practiced EENC at own facilities in developing countries and Japanese healthcare workers who would be working in developing countries. The main program contents were the evaluation of care techniques: hand washing technique, pre-post test of knowledge on EENC, practical skills of childbirth, neonatal care, and resuscitation.

Result

There were 18 participants (5 in developing countries, 13 in Japan) and 15 participated in both pre-test and post-test. Pre-/post-evaluation of hand washing technique indicated decreased contamination at post-test. The mean knowledge test scores increased from about 60% at the pre-test to over 90% at the post-test. During the skill practice, participants were separated into 3 groups, 6 participants each, and repeatedly carried out the skills in role plays. As for performance, all participants scored more than 90% at the post-test.

Conclusion

After the seminar, hand washing techniques improved, and the knowledge and performance scores became over 90%. Because the knowledge and skills gained in short-term education may diminish over time, it is important to devise a plan that ensures the continuation of training facilitators in each targeted developing country and longitudinal follow-up.

We need to consider practicing EENC seminar and developing adequate number of facilitators so that they can provide coaching in their own countries and longitudinal follow-up.

Purpose

The rate of mixed wards in facilities dealing with childbirth is approximately 80%. This research aimed to clarify nursing time and activities during the intrapartum period in cooperation with midwives and nurses in mixed wards for improving the safety of maternity service.

Subjects and Methods

We defined the delivery period as the time from admission to check up two hours postpartum. During the delivery period, we measured nursing time and activities of all nursing staff providing care to the newborn and mother following vaginal delivery according to the time study method.

Result

There were 10 deliveries (primipara=4, multipara=6) during this 14-day investigation.

The median delivery period was 467.0 minutes, the median total staff was 6 midwives and 2 nurses per each newborn and mother. The median nursing time used by midwives was 436.5 minutes and 41.0 minutes for nurses.

Of 26 observed categories, midwives spent significant time on diagnosis, record keeping and direct assistance in delivery. Nurses spent significant time on neonatal care, indirect assistance in delivery, and preparation and cleanup related to medical examination and treatment.

The amount of nursing time and activities was dependent on case differences and the stage of labor. Nursing staff communicated effectively with one another during the time from admission to full dilation of the cervix, exchanged information and adjusted their duties.

Conclusion

Observed categories revealed that midwives and nurses shared one another's professional roles. Frequent communication to the second stage, adjusting duties for other patients and preparing for delivery is important in mixed wards.

Results suggested that safe delivery is ensured when midwives and nurses are able to devote themselves to support for the second and third stages of labor.

Purpose

The purpose of this study is to have early-stage postpartum period mothers who are engaged in direct breast-feeding undergo Ashiyu for consecutive days, and to examine and qualitatively assess the effects of this exercise on their nipple shape and the condition of the nipples and areolae.

Subjects and Method

The subjects of the study were 25 mothers engaged in direct breast-feeding during early-stage postpartum period. The subjects were randomly assigned to two groups for comparison: an Ashiyu group with 14 subjects, and a control group with 11 subjects. The assessment metrics used were discernment of nipple shape through a pinch test and the condition of the nipples and areolae through palpation. The study was conducted after receiving confirmation from the Aichi Medical University College of Nursing Ethics Committee.

Results

The median of number of days in which temporarily-inverted nipples changed to ordinary nipples was 2.0 (range: 2-3; n=5) for the Ashiyu group and 4.5 (4-5; n=4) for the control group (p<.05); the median number of days in which flat nipples changed to ordinary nipples was 2.0 (2-3; n=6) for the Ashiyu group and 4.0 (3-4; n=5) for the control group (p<.05). The median number of days in which nipples changed from “hard” to “soft” was 2.0 (2-3; n=8) for the Ashiyu group and 4.5 (3-5; n=6) for the control group (p<.01); the median number of days in which areolae changed from “hard” to “soft” was 3.0 (2-4; n=3) for the Ashiyu group and 4.0 (4-4; n=1) for the control group. The median number of days in which any areolar edema disappeared was 3.0 (3-3; n=2) for the Ashiyu group and 4.5 (4-5; n=2) for the control group.

In each case where subjects had “no problems” in nipple shape nor in nipple or areola condition, or where subjects had “soft” nipples and/or areolae, there were no changes in nipple shape nor in nipple or areola condition during the five days of postpartum, in either of the groups.

Conclusion

Administration of Ashiyu to early-stage postpartum period mothers led to the following outcomes: temporarily-inverted nipples, flat nipples changed to ordinary nipples, nipples and areolae softened more earlier than a control group, and areolar edema earlier disappeared. This suggests that Ashiyu during early-stage postpartum period has a good effect on mothers’ nipple shape and the condition of their nipples and areolae.

Purpose

This study aimed to clarify mothers' experiences and feelings about childbirth through emergency cesarean sections until 4 months postpartum.

Methods

Participants were 3 primiparas who underwent emergency cesarean sections. A qualitative method was used to obtain their life stories. The data were collected through semi-controlled interviews about birth experience at 2 weeks, 6–8 weeks, and 4 months postpartum.

Results

Three women's stories were described: Case A removed the regret to delivery by success of the breastfeeding. Case B changed her thinking and accepted her birth experience due to gaining self-confidence and bonding with her child. Case C becoming a mother and discussed her experiences, she was accepting of her childbirth experience. The mothers' feelings toward emergency cesarean sections changed as a result of childcare.

Conclusion

Women who underwent emergency cesarean sections lost confidence in childbirth and as mothers. However, they provided childcare with their negative feelings and relieved feelings of their children were safe. Thoughts toward childbirth changed at 4 months postpartum when mothers realized value of their own birth. Further, they accepted their childbirth experiences by talking repeatedly them.