Purpose

To elucidate the current state of care for hiesho and analyze factors that affect the relevant implementation of care.

Method

The study design was a quantitative descriptive research. The investigation was carried out over approximately 2 months, during October and November of 2017. The research field included facilities all over Japan that were handling childbirth (hospitals, clinics, maternity homes), and the research participants were nursing staff members who had been handling health check-ups of pregnant women for three years or more. As a tool for measurement, we used an anonymous self-administered questionnaire. Furthermore, this study was conducted with the approval of the ethics committee of the institutions with which the researchers are affiliated, and by sufficiently ensuring ethical considerations (Approval No.: A170900006).

Results

The study recruited a total of 2,694 participants, of which 733 were ultimately part of the analysis (recovery rate of 27.5%, effective response rate of 98.8%). Out of the entire sample, those who were actively caring for hiesho made up 44.1%, while 55.0% of participants had experience learning about hiesho. As factors affecting the implementation of care for hiesho, we adopted five items, namely the experience of learning about hiesho (odds ratio [OR]: 3.4), awareness of the importance of care for hiesho (OR: 3.0), presence or absence of an outpatient midwife (OR: 1.7), time taken for health check-ups for pregnant women (OR: 1.2), and awareness of how a cold state affects childbirth/delivery (OR: 1.1) (p<0.001).

Conclusion

The percentage of subjects carrying out care for hiesho during health check-ups for pregnant women in the perinatal period was low, at less than 44.1%, and compared to midwife homes, fewer nursing staff members work in hospitals and clinics. Furthermore, as “experience of learning about hiesho” was a factor that significantly affected the implementation of care for hiesho, in the future, it will be necessary to provide opportunities for nursing staff involved in the health check-ups of pregnant women, in particular those nursing staff members working in hospitals and clinics, to learn about hiesho.

Purpose

This study aimed to develop a self-confidence scale for senior midwives and to verify its reliability and validity.

Methods

A self-confidence scale for senior midwives was developed based a literature review, a concept analysis of self-confidence, and data from interviews with senior midwives in the hospital setting. A questionnaire survey was conducted on senior midwives working in hospitals who had between 6 and 15 years of experience. Questionnaires were sent to 1,216 senior midwives, among whom, 547 responded, and 477 were eligible for analysis. Exploratory factor analyses and covariance structure analysis were conducted to verify the reliability and validity of the scale. All statistical analyses were conducted using SPSS Amos ver. 25.

Results

After the exploratory factor analysis, the scale was composed of the following four subscales: 1) ‘self-confidence in ability to provide maternity care’, 2) ‘self-confidence in leadership’, 3) ‘self-confidence in behavior as a professional’, and 4) ‘self-confidence in pursuing self-improvement’. Overall 22 items were extracted. The correlation coefficients among each subscales were .568∼.771, and correlation coefficients between the overall scale and each subscales were .765∼.945. Correlation coefficient between the self-confidence scale for senior midwives and the self-esteem scale was .443, and that between the self-confidence scale for senior midwives and the generalized self-efficacy scale was .491. Cronbach's alpha for the overall scale and each subscale were .705∼.827. The results of the confirmatory factor analysis revealed the following: GFI=.834, AGFI=.787, CFI=.916, RMSEA=.087.

Conclusion

The self-confidence scale for senior midwives developed in the present study was composed of four subscales and 22 items. Furthermore, its content validity, internal consistency, concurrent validity, and reliability were verified. The scale contents reflected necessary abilities for senior midwives. Therefore, this scale appears to be a useful tool for senior midwives for evaluating their own practical abilities as a midwife.

Purpose

The purpose of this study was to explore the practical wisdom of expert midwives caring for women who demonstrated a strong fear of pain during delivery.

Subjects and Methods

Semi-structured interviews were conducted with 13 expert midwives recruited using snowball sampling. Subject matter that met the research criteria were extracted as small themes from the cases narrated by the research participants. These concerns were then grouped according to their similarities, and were subsequently abstracted for classification into main and large themes.

Results

According to the research participants, regardless of the delivery period, women showed various expressions of pain during delivery, including crying out, violent behavior, rigidity even in intermission, not reacting, speaking in an aggressive manner, otherwise dangerous behavior. In terms of the practical wisdom of the expert midwives attending to such women, the following were extracted as the large themes: receptive attitude; Promote their own presence to women; preventing her from becoming too caught up in the moment; not encouraging her agitation; making her husband's feelings stay close to her; and inferring her needs from mother-daughter relationships and responding to those needs. Additionally, it was apparent that the expert midwives competently cared for women who expressed high levels of fear during delivery on the basis of the following basic attitudes stemming from practical wisdom: understanding that a woman expresses her feelings like a child in the process of becoming a mother, and that often women who seem to be in a state of panic are actually listening to them calmly.

Conclusion

Expert midwives accept any expression of distress or anger without encouraging agitation as long as they are not jeopardizing the mother or the child. Additionally, they take into account the feelings of the husband seeing his wife acting out of the ordinary, as well as the mental distance between the woman and husband. These midwives are often well-versed in ascertaining what underlies these strong feelings of fear. Mother-daughter relationships sometimes play a significant part in this. Key characteristics of expert midwives are that they do not erase their own presence and take the initiative in interacting with the mother.

Objective

The present study aimed to clarify the experiences of midwives caring for mothers considering relinquishing their baby for adoption and to obtain suggestions for improving the quality of midwifery care for these birth mothers.

Subjects and Methods

Semi-structured interviews were conducted with nine midwives working at medical facilities that have experience with providing care for pregnant women considering relinquishing their baby for adoption. Responses regarding the kind of care provided to birth mothers and midwives' thoughts and feelings during care provision were qualitatively and descriptively analyzed from the perspective of understanding midwives' experiences during care provision for birth mothers.

Results

Working in coordination with support groups and ward staff, midwives experienced providing care for birth mothers as part of a unified team. They accepted the birth mothers, who presented at the hospital under complicated circumstances, and experienced making a committed effort to provide unbiased midwifery care while also supporting birth mothers toward an emotionally and physically healthy pregnancy and delivery. Furthermore, they experienced sensing the growing maternal feelings and protecting birth mothers' right to provide a support for watching and touching a baby. Also, they experienced swirling ethical conflicts during the process of supporting birth mothers choosing adoption, while calmly watching over the extremes of the decision-making process and feeling the pain of the birth mothers choosing adoption.

At the same time, in order to uphold their responsibility as a healthcare provider, they experienced attempting to avoid involving emotions and conflict in their care. While feelings of dissatisfaction remained after the end of care provision, the midwives had also embarked on the process of recognizing care provision as a skill and deriving new perspectives and awareness of issues in midwifery care through involvement in these cases, such as learning how to respond to birth mothers.

Conclusion

The present findings indicate the importance of midwives recognizing that conflict and a need for emotional regulation may arise during care for birth mothers and of creating opportunities for sharing their feelings with their team.

Purpose

Glucose intolerance in pregnancy is likely to occur, as there is an increase in human placenta lactogen by the second trimester. We presumed that changing dietary habits and approximately 10-kg weight gain during pregnancy most likely influenced this condition. Thus, a pregnant woman should be encouraged to reconsider her dietary habits. In this study we examined the factors influencing glucose intolerance with a focus on weight gain and change in dietary habits through the second trimester.

Methods

This longitudinal study examined pregnant women from the first trimester through the second trimester. We recruited 180 pregnant women who were in their first trimester and who attended a single hospital prenatal clinic between March 2018 and June 2019. Patient characteristics included age, pre-pregnancy body mass index (BMI), maternal weight gain until the second trimester, blood glucose levels in the second trimester, dietary habits, and a brief dietary history questionnaire (BDHQ). A blood glucose level of 140 mg/dl or more during the second trimester placed the patient in the glucose intolerance group and a glucose level less than 140 mg/dl placed the patient in the normal group. Data analysis was performed using the chi-square test and the t-test for the comparison of dietary habits between the first trimester and the second trimester. Binominal logistic regression analysis was used to investigate the factors influencing glucose intolerance. We analyzed the data using the following covariates: pre-pregnancy BMI, weight gain until the second trimester, age, and energy intake.

Results

A total of 147 pregnant women participated in the study. In the two groups (35 in the glucose group and 112 in the normal group), change in the women's dietary habits included having breakfast, carefully monitoring the speed at which they ate, and checking nutritional facts when they purchased food. Factors influencing glucose intolerance were found to be pre-pregnancy BMI and weight gain until the second trimester. The analysis showed the following results: odds ratio [OR], 1.18; 95% confidence interval [CI], 1.05-1.32, and OR 0.78; 95% CI 0.61-0.99.

Conclusion

Pregnant women experience nausea, vomiting, and/or changes in their taste for food in the first trimester. However, we considered that nutrition education and an appropriate weight gain until the second trimester would prevent glucose intolerance. In addition, optimal gestational weight gain must be examined in each trimester of gestation.

Purpose

This study aims to understand the prevalence and factors associated with diaper dermatitis in infants to contribute to disseminating to nurses the characteristics of infants predisposed to developing diaper dermatitis through a research review.

Methods

A search was conducted using the Ichushi Web, version 5, of the Japan Medical Abstracts Society and MEDLINE databases from search engine PubMed using the following combinations of key words: infant and diaper rash. Two authors reviewed the articles based on the inclusion and exclusion criteria. Results were limited to original articles in Japanese and English within the past 30 years up to May 27, 2019. Statistically significant factors associated with the development and prevention of diaper dermatitis were extracted from the selected articles.

Results

Thirteen articles were selected. The point prevalence of diaper dermatitis ranged between 11.5 and 70.6%, while its period prevalence was between 15.2 and 90.6%, both showing a wide range. The definition of diaper dermatitis included whether diaper dermatitis was present and the evaluation of its degree of severity was performed. Diaper dermatitis was identified by the evaluator when certain symptoms were present or a case of dermatitis was clear, regardless of the type of symptoms and their severity (as well as without defining symptoms). Factors associated with the development and prevention of diaper dermatitis were attributed to infants, skin condition, digestive condition, health condition, nutrition method, skin care method, and childcare environment. Many risk factors were associated with infants' digestive or skin conditions, and a few studies focused on skin care, such as apply products as preventives.

Conclusion

Further studies are needed to standardize the methods for evaluating diaper dermatitis because of the wide range of prevalence caused by disagreements in methods of symptom evaluation. Few studies have indicated the relationship between diaper dermatitis and skin care methods used at home, and further research is required in this regard.

Purpose

To investigate how independent midwives assess “prolonged labor”, and identify the actual state of midwifery care to promote the progress of labor.

Subjects and Methods

This study involved 3 independent midwives who have >15 years of working experience as a midwife and >3 years of experience as an independent midwife. Data were collected through semi-structured interviews, and the interviews were recorded using an IC recorder with the consent of the subjects. During the interview, the subjects freely talked about how they assess “prolonged labor” during the stages of pregnancy and labor, and the type of midwifery care they provide based on the prediction and assessment they made. The interview data were transcribed verbatim and analyzed using approach of the KJ method.

Results

Midwifery care provided by independent midwives for “prolonged labor” was described as follows: Independent midwives in this study valued [positive attitudes toward labor] and had [a philosophy to care for every pregnant and parturient woman in this world] in the practice of midwifery care. During the pregnancy stage, they provided [advice for successful progress of labor from the pregnancy stage]. During the labor stage, the midwives assessed the labor progress based on [assessment criteria developed based on their basic knowledge and experience]. Based on their assessment, they provided [care according to women's health status during the labor stage], in order for labor to progress smoothly.

Conclusions

In the care of pregnant and parturient women, the independent midwives placed value on developing a mutual trusting relationship with women, sharing the same belief that mothers and babies have potentials and possibilities, and helping the women accept their labor. They also maintained a holistic view to predict the probability of “prolonged labor”, and to prepare for women to have a smooth delivery. During the labor stage, the midwives assessed and practiced the care necessary for “prolonged labor” based on the information they obtained in the relationship from the pregnancy stage and according to the women's situation. In the future, midwifery care provided by such independent midwives must be shared among and passed on to midwives who are involved in the care of pregnant and parturient women.