Purpose

Body image such as desire for thinness has been considered as a factor related to gestational weight gain. However, the association has been unclear. This systematic review aimed to clarify whether body image before pregnancy or during pregnancy was associated with gestational weight gain.

Methods

We conducted a database search (Ichushi-Web, CiNii, PubMed, CINAHL, and PsycINFO) and hand search for relevant publications in English and Japanese using the following keywords: pregnancy, body image, and weight gain. The search included all studies from the inception of each database to March 2019. According to inclusion and exclusion criteria, researchers reviewed titles, abstracts, and full articles, and then evaluated the quality of each article and selected the articles included in this review.

Results

Seven articles were included in this review. Six articles examined the association between pre-pregnancy body image and gestational weight gain. Desire for thinness before pregnancy was related to excessive gestational weight gain in 3 out of 3 relevant articles. In addition, misperception of pre-pregnancy body size was associated with excessive gestational weight gain in 1 out of 3 relevant articles. In women with normal pre-pregnancy body mass index, overestimation of pre-pregnancy body size was associated with excessive gestational weight gain. In women with pre-pregnancy overweight or obesity, underestimation of pre-pregnancy body size was associated with excessive gestational weight gain. Feeling fat during pregnancy was significantly negatively associated with gestational weight gain in one article which examined the association.

Conclusion

This review suggests that desire for thinness and misperception of body size before pregnancy were associated with excessive gestational weight gain. For proper gestational weight control, an intervention considering body image before pregnancy may be beneficial. Further research regarding the association between body image during pregnancy and gestational weight gain is needed because of small number of studies reported to date.

Purpose

Tea consumption during pregnancy is assumed to increase the risks of preterm birth and small for gestational age (SGA). However, this association remains unclear. This review aimed to assess the effects of tea consumption during pregnancy on preterm birth and SGA.

Method

A search through 4 databases (PubMed, CINAHL, CiNii, and Ichushi-Web) and handsearches were conducted for identifying relevant publications in Japanese and English. We first screened the identified articles based on the inclusion and exclusion criteria and then evaluated the quality of articles using a risk-of-bias assessment tool. We used Mantel-Haenszel test to integrate the results of articles included in the review.

Results

Eleven articles were included in the review. Five articles examined the association between any tea consumption during pregnancy and preterm birth. Among the 5 articles, a meta-analysis of 3 articles that had the similar classification criteria for tea consumption indicated that the risk of preterm birth was significantly higher in women with high tea consumption (3 or more cups per week or 1 or more cups per day) than in women with low tea consumption (odds ratio=1.32, 95% confidence interval=1.06-1.63).

By tea type, the consumption of green, Japanese and Chinese, or black tea was associated with an increased risk of preterm birth in 3 out of 7 relevant articles. However, meta-analyses showed no significant associations between the consumption of green or black tea and preterm birth.

Black tea consumption during pregnancy was reported to be associated with an increased risk of SGA in 1 out of 7 relevant articles. In meta-analysis, no significant association between black tea consumption and SGA was found.

Conclusion

The meta-analysis showed an association between any tea consumption and preterm birth. On the other hand, there was no association between tea consumption and SGA. Further research regarding an association between tea consumption and SGA is required because of the small number of studies that could be used in the meta-analysis. Healthcare professionals would need to grasp individual daily tea consumption and inform pregnant women of the possible association between high tea consumption and an increased risk of preterm birth.

Objective

In this study, we aimed to describe women's experiences of labor pains during natural childbirth.

Study Participants and Method

This study involved qualitative and descriptive research based on Merleau-Ponty's phenomenological philosophy. The study participants were 9 women at six weeks after natural childbirth. Data were collected through non-structured interviews and analyzed with reference to the steps in Pollio's approach to phenomenology.

Results

We identified the following five elements as a framework for women's experiences of labor pains in natural childbirth: “realization”, “acceptance”, “battling”, “sharing”, and “comparison”.

“Realization” was experienced by mothers who realized that their labor pains had started from the duration of their perceived physical pain and the consistency of that pain with their pre-existing knowledge of labor pains.

“Acceptance” was experienced by mothers who accepted the phenomenon of labor pains in their own way, having recognized the significance and necessity of labor pains in the childbirth process.

“Battling” was experienced by mothers who questioned whether or not they could control themselves at a critical moment in a state of severe labor pains.

“Sharing” was experienced by mothers who felt labor pains were eased, mitigated, or otherwise made tolerable as a result of contact with others.

“Comparison” was experienced by mothers with recollections linked to feeling that their recent labor pains were better or worse than previous labor pains or some other previous pain, or were better or worse than their previous knowledge had indicated.

Conclusion

Midwives supporting women in labor should understand the individual context in which a mother experiences labor pains, respect the intuition that mothers have about their labor pains, and build relationships of trust with the mothers while fostering such relationships between the mother and other people around her.

Purpose

This study aimed to compare differences in mens' development as a father based on whether their partners had returned home, and to examine the relationship between development as a father and factors related to returning home.

Method

An anonymous self-administered questionnaire survey was conducted at seven obstetric medical facilities among 345 men approximately one month after their first child was born. The question items included the Developmental Scale of Becoming a Father, the Subjective Well-Being Scale, basic attributes, the form of returning home, and the actual condition of the father's life during the returning period. Mann-Whitney U tests or Kruskal-Wallis tests examined the relationship between factors related to returning home and two scales' scores. Additionally, the scores were compared by the partner's presence or absence at home.

Result

There was no difference in the development as a father one month after the child's birth regardless of whether their partners had returned to their parents' home.

In the group whose partners returned home, there were four items significantly related to scores on the Developmental Scale of Becoming a Father: daily contact with partner via telephone; stressed about childcare and domestic household chores; and feeling psychologically distant from the child. There were significant negative associations with the last item.

Conclusion

Those who contacted their partners daily during returning period had expanded perspectives by having a child, and those who felt psychologically distant from the child showed less affection to their families, suggesting the importance of active communication.

Furthermore, it was suggested that those who were stressed about childcare and domestic household chores were developing as fathers by seeking to combine and fulfill their roles. These men may have been in the early stages of the process of developing as a father. Therefore, it is important for men whose partners are returning or planning to return home to obtain parenting knowledge and have opportunities to think about parenting behavior.

Purpose

The aim of this study was to compare attitudes toward childrearing among female college students in Japan, the United States, and Indonesia.

Methods

Survey questionnaires were distributed to samples of students in these three countries between December 2015, and April 2016. The questionnaires included the following: eleven questions on childrearing (a four-point Likert scale), their desirable educational policy, and their demographic characteristics. A Mann-Whitney U test, chi-squared test and Spearman correlation analysis were used to analyze the data.

Results

A total of 474 female students (185 Japanese, 101 Americans, and 188 Indonesians) completed the questionnaires. Most of the participants responded that they wanted to have children in the future. In addition, respondents from all countries expressed their belief in gender equality in education. Some differences were also found. While more than 99.0% of both American students and Indonesian students believed that children should receive the highest level of education possible, 66.1% of Japanese students respond in the same way (p<0.01). Oppositely, 30.6% of Japanese students answered, “Somewhat Disagree”, and 3.3% of them answered “Disagree”. In addition, a larger percentage of Japanese students viewed that “the childbearing was a woman's job” at 31.4% in contrast to 28.0% of American students and 20.7% among Indonesian students. The difference between Japanese students and Indonesian students was especially large and statistically significant (p<0.05). Large portions of the Japanese students (67.6%) and Indonesian students (75.0%) believed that the roles of the father and mother in childrearing were different while significantly smaller portion (25.0%) of American students held the same view (p<0.01). Regarding child custody, 54.1% of Japanese students and 72.2% of Indonesian students agreed to the statement “child custody should be given to mothers if children are young in the event of a divorce” where a significant difference was observed in a much smaller portion (19.0%) of American students agreeing to this statement (p<0.01).

Conclusion

While Japanese students believed in gender equality regarding children's education and career paths, they believed in appropriateness of gender specific tasks in parenting which was reflected in their agreement to the statement, “young children should be raised by the mothers.” In addition, for the Japanese college students, high cost of education appears to be a potential significant barrier to parenting.

Purpose

The aim of this study was to clarify the change process of nipple tissue after initiating breastfeeding.

Methods

Fifty Japanese breastfeeding women were enrolled at an obstetrics and gynecology clinic in Sapporo, Japan, from October 2016 to January 2017. Collected photographs were processed for color correction using CASMATCH^® (KENIS Ltd., Osaka, Japan) and size correction using image-editing software (Photoshop 6, Adobe System Inc., Tokyo, Japan) and were displayed in chronological order. Visual analysis was conducted by three researchers based on the following seven nipple skin changes defined in a previous study: “erythema”, “swelling”, “blistering”, “scabbing”, “fissure”, “purpura”, and “peeling”. In addition, these data were analyzed together with nipple pain and characteristics of participants. Observed results are organized based on three factors: the order of signs, chronological changes in one sign, and the relationship among the sings. A model was developed to describe the change process of nipple tissue.

Results

A total of 776 images were collected, and the following 15 patterns pertaining to the change process of nipple tissue were revealed. There were seven patterns pertaining to the order of signs: 1) development of “erythema” and/or “swelling” → improvement or healing; 2) “erythema” and/or “swelling” → “fissure” → epithelialization → healing; 3) “fissure” → healing; 4) “erythema” and/or “swelling” → “blistering” → rupture → “scabbing”; 5) “blistering” → rupture → “scabbing”; 6) “erythema” → “scabbing”; and 7) “erythema” and/or “swelling” → “scabbing” → “erythema” of the peeled area. There were four patterns of chronological changes in one sign: 1) course of “fissure”, 2) course of “blistering”, 3) developing patterns of bloody “scabbing”, and 4) signs that predicted peeling of “scabbing”. There were four patterns of relationships among the sings: 1) relationship between “erythema” and/or “swelling” and development of “blistering” or “scabbing”, 2) relationship between “swelling” and “blistering”, 3) relationship between “swelling” and “peeling” or worsening of “scabbing”, and 4) relationship between “purpura” and/or “peeling” and the others.

Conclusion

The change process of nipple tissue after initiating breastfeeding was presented based on daily nipple images. The findings of this study suggest that observations focusing on minor changes in the nipple tissue, such as “erythema” and/or “swelling” prevents more severe nipple trauma that can lead to the discontinuation of breastfeeding.

Purpose

The purpose of this study was to evaluate the utility of pelvic floor muscle training using vaginal palpation in postpartum period from the change of pelvic floor muscle contraction before and after teaching and the postpartum women's reactions.

Methods

14 postpartum women who had vaginal deliveries in a maternity home and had a good postpartum progress participated in the study. Midwives implemented pelvic floor muscle training using vaginal palpation on women's fourth postpartum day. In order to evaluate the utility of teaching muscle contractions using vaginal palpation, the change of pelvic floor muscle contraction before and after teaching and the postpartum women's reactions were used as indices. Pelvic floor muscle contraction force was measured using the Oxford scale to quantify changes before and after teaching of pelvic floor muscle contraction. In addition, three observation indices evaluated: (1) movement of the vaginal and anal muscles; (2) presence or absence of substitute muscle contraction and (3) sensation of muscle contraction. Interview data from participants' reactions were analyzed qualitatively after practice as well as an anonymous questionnaire one month later.

Results

After the training, the majority of participants' weak pelvic floor muscle contractility disappeared, their use of substitute muscle contractions decreased and participants increased their understanding of the muscle contraction sensation. Five participants who did not understand how to contract the pelvic floor muscles before the training showed improvement on the Oxford scale after training. This change seemed to be due to increased awareness of contraction site and contraction sensation particularly through the midwives' use of vaginal palpation with pelvic floor muscle training.

Pearson's correlation analysis indicated a strong significant correlation between Oxford scale score and the “movement of the vaginal and anal muscles”, “substitute contraction”, and “sensation of contraction”; these three variables proved to be a valid evaluation index of pelvic floor muscle contraction.

Based on the interviews and an anonymous questionnaire, participants had no negative opinions on the pelvic floor muscle training using vaginal palpation. Two categories were extracted as evaluation from the postpartum women: Comprehension of pelvic floor muscle contraction, and Requirements for vaginal palpation. Comprehension of pelvic floor muscle contraction were supported by three subcategories: (1) understanding of the contraction site, (2) direct sensation of contraction, and (3) confirmation of correct muscle group contraction. Requirements for vaginal palpation were supported by three subcategories: (1) trust in providers of practice, (2) painless implementation and (3) consideration for shame.

Conclusion

Vaginal palpation was used as a teaching method for pelvic floor muscle training in the early postpartum period because it helped to confirm the contraction site, the direct sensation and the correct contraction. We suggest that vaginal palpation may have good utility for teaching postpartum women pelvic floor muscle training who have difficulty in understanding and feeling proper pelvic floor muscle contraction.

Objectives

We investigated an OSCE for evaluating delivery practices during the completion of a midwifery course (below, “pre-graduation”) and implemented trials for pre-graduation students to analyze the validity of this OSCE.

Methods

We implemented a two-stage development process during the period from March 2017 to March 2018. In Stage 1, we planned an OSCE that evaluated the clinical reasoning tasks. For scenarios, we set four scenes and eight tasks as excerpts from the stretch of time between when a pregnant woman enters the hospital and the completion of childbirth. The evaluation chart was based on the Japan Society of Midwifery Education's (2016) “Factual Survey of Midwifery Student Degree of Learning of Delivery Care Abilities” and was completed after running a pilot test. In Stage 2, we ran trials for pre-graduation midwifery students, with two lanes of two student test subjects and six evaluating instructors in teams of three, and we aggregated the trial data and extracted items that were consistent or different among the evaluations of the evaluators. We also conducted focus-group interviews of the evaluators, analyzed the content, and integrated it with quantitative data to analyze the results. This study obtained the approval of the affiliated institution's ethics review committee.

Results

The items of the evaluators' evaluations that were in agreement were “prediction of progress status,” “delivery preparation timing,” “torso delivery,” and “judgment of hemorrhage.” Conversely, the evaluations varied for the following items: “psychological support,” “support for accelerating delivery progress,” “assistance of child's first respiration,” “identification of external deformities,” and “precautions against abnormalities.” The evaluators opinions were that the diagnostic skills appeared well, that it was difficult to standardize the evaluation of behavioral aspects, and that detailed standards were needed regarding technical aspects.

Conclusion

This OSCE aims to evaluate students' abilities to gather information, to conduct all kinds of medical examinations for pregnant women visiting hospitals and to make decisions about care plans and put them into practice. In the trial, students' clinical reasoning was made apparent, and the results suggested that the trial had high validity as an evaluation method for the comprehensive practical abilities of pre-graduation students. In the future, it will be necessary to accumulate and study data, while further increasing validity by improving on topics such as evaluator consistency, standardization of evaluation standards, number of cases, number of tasks, time required, and number of evaluators.

Purpose

The purpose of the present study was to clarify the actual status of the lives of grandmothers who provide childcare support for twins.

Subjects and Methods

We requested research cooperation from multiple pregnancy groups among others as well as medical institutions that handle multiple pregnancies in Prefecture A. A semi-structured interview survey was conducted with six grandmothers of twins who provided childcare support, and the results were qualitatively and descriptively analyzed.

Results

The category [Busyness of providing support for raising two grandchildren] consisted of the subcategories <Crying from two children that cannot be responded to even by two adults>, <Breastfeeding that requires time and effort, unlike my own childcare experience>, <Continuous bathing>, <Providing childcare to the degree that I feel like I am the mother>, and <Physical burden due to aging>; the category [The burden of overlapping responsibilities toward the twins and daughter in addition to family life] consisted of the subcategories <Difficulty of giving the same degree of consideration to family life as before>, <Giving consideration to my daughter>, and <Lack of cooperation of family members living together>; the category [I come second] consisted of the subcategories <Restrictions on time for hobbies>, <Adjustment of the amount of work>, and <Inconvenience of being unable to use my time freely>; the category [Feelings of guilt and family discord arising from the developmental status of the twins and the bias toward one child] consisted of the subcategories <Feelings of guilt from comparing the growth of the twins>, <Feeling sorry that I have a bias>, <The entire family cares more for one of the twins>, and <Family discord resulting from bias>; the category [I want to provide support as my daughter's mother] consisted of the subcategories <As a mother, I want to reduce the burden on my daughter> and <I want to do for my daughter what my parents did for me>; the category [Being a positive experience for me] consisted of the subcategories <Grandchildren follow me>, <By providing childcare support, the psychological distance between my daughter and myself has decreased>, <Enjoyable experiences gained while spending time with my daughter and her twins>, <Experiences have led to health promotion>; and the category [I feel that it cannot be helped for the time being] consisted of the subcategories <Having the outlook that things will become easier with the growth of the twins> and <Prediction that current life situation is for a limited period of time>.

Conclusion

The grandmothers focused their lives on providing childcare support.