Purpose

To investigate the governance of the Japanese Midwives Association and the challenges it faced based on reviews of agendas proposed at its annual meetings.

Methods

Literature review of the Bulletin of Annual Meetings of the Japanese Midwives Association (between 1929 and 1943) and other midwifery journals.

Results

A nation-wide organization of midwives in Japan was founded in 1927 with a view to consolidate the scope of their work and to raise their status. An annual meeting of the Japanese Midwives Association was held in a different prefecture each year hosted by the head of that prefectural association who took over the Association's presidency for one year until the next meeting. In more than half of the prefectures a male medical doctor was the head of the prefectural Midwives Association. A review of bulletins of annual meetings of the Japanese Midwives Association revealed three major points. One is that midwives in the prewar period were eager to establish midwifery by demarcating boundaries between midwives and medical doctors on the one hand and those between midwives and lay birth attendants on the other. This fact is evident in the meeting agendas: requests to revise articles of the Midwife Regulations to allow midwives to give injections in emergency cases; requests for medical doctors not to assist in normal deliveries; and requests banning lay attendants at births. Secondly, emergent public welfare services in the early Showa Period began to have a major impact on midwives' living standards. The increase in institutional deliveries without charge or with limited charge for the urban poor coupled with the introduction of health insurance, negatively influenced the lives of midwives who had been practicing independently. Thirdly, the war with China and the beginning of World War II changed the agendas of the annual meetings of the Japanese Midwives Association. After 1938 requests for preferential allocations of cotton cloth used in deliveries increased due to the shortage and rationing of materials. The government's introduction of community nurses as a new profession to reduce infant mortality gave rise to a renewed question of how to differentiate the scope of midwives work from that of community nurses. Nevertheless, midwives gave unanimous support to the government's involvement in the war and believed they could contribute to the country's war efforts by delivering healthy babies.

Conclusion

Agendas proposed at the annual meetings of the Japanese Midwives Association illustrate that the government was reluctant to approve midwives of a legal status they endeavored to achieve, considering the sensitive relationships involving midwives, medical doctors, and nursing professions. Although the Japanese Midwives Association tried to pass a law which aimed to elevate their status by establishing the scope of midwifery work, the attempt was blocked by the beginning of World War II. A study on challenges facing the Japanese Midwives Association in prewar period gives us a new insight into present day midwives' position in the society.

Purpose

In postpartum mental health, postpartum depression is a serious disorder. In Japan, the Japanese version of Edinburgh Postnatal Depression Scale (EPDS) has been used to screen for postpartum depression, but it has not screened all mothers at risk. Therefore, we examined objective indicators that reflect the psychological state of the mother, which can be used in conjunction with the EPDS to accurately screen mothers at risk. This study examined the relationship between maternal psychological status and urinary catecholamines and serotonin at 1-month postpartum.

Methods

We used the EPDS and Profile of Mood States Second Edition (POMS-2) to measure mothers' postpartum psychological state. Analysis was conducted on 94 women at their 1-month postpartum checkup in Ibaraki Prefecture, Japan. Psychological state and biological state and background factors were analyzed using logistic regression analysis and multiple regression analysis. Urinary catecholamines and serotonin were measured as stress response and depression indicators. Background factors were age, parity, delivery method, support, and lactation status.

Results

Higher urinary noradrenaline levels were associated with an EPDS score. Lack of husband support was associated with higher POMS-2 Total Mood Disturbance, Confusion-Bewilderment, and Depression-Dejection scores. In addition, first-time mothers had higher Tension-Anxiety scores on POMS-2, and mothers using formula milk or mixed feeding scored higher on Confusion-Bewilderment.

Conclusion

These results suggest that urinary noradrenaline reflects postpartum maternal depression. In addition, the husband's support, being primipara, and breastfeeding were associated with better mental health for mothers.

Objective

We will clarify the factors that determine the intention of breastfeeding based on the theory of planned behavior including the Japanese version of IIFAS.

Subjects and Methods

The subjects were women in the third trimester of pregnancy who were visiting maternity hospitals or clinics in Akita Prefecture. A self-administered, anonymous survey conducted by mail included 16 IIFAS items, measuring the intention to breastfeed along with the knowledge and attitudes toward nursing and lactation: 3 items on subjective norms; 4 items on behavioral control; and 12 items on the subjects' attributes.

Results

Effective responses were obtained from 285 women (52.9% response rate) whose mean age was 31.3 (±4.6) years. There were 157 primiparous women (55.1%) and 128 multiparous women (44.9%).

The mean IIFAS score was 58.4 (±5.9). Measuring the level of intention, the 15 women (5.3%) who said they “definitely want to breastfeed” scored 63.7. Furthermore, 181 women (63.7%) who said they “want to breastfeed if possible” scored 59.1, 15 women (5.3%) who said “either is acceptable” scored 54.7, 68 women (23.9%) who said they “want to use mixed feeding” scored 56.1, and 5 women (1.8%) who said “want to use milk substitutes” scored 57.2. In intergroup comparisons, the women who chose breastfeeding had significantly higher scores.

When the women were divided based on those who wanted to breastfeed and those who preferred other options, the former group scored higher on the IIFAS, subjective regulation, and behavioral control. Choosing to breastfeed also significantly correlated with higher education, being a health care professional, not being self-employed, having a family business, or working for wages, receiving maternal counseling, having breastfed in the past, and the satisfaction with past nursing methods. A logistic regression analysis proved that the IIFAS correlated with the intention to breastfeed (p<.001).

Conclusion

The intention to breastfeed could be explained by the theory of planned behavior. In order to support the willingness to breastfeed, midwives should not only use IIFAS to understand their own perceptions and values of breastfeeding, but also understand the employment situation and past breastfeeding experience for multiparous women. Needs individual support.

Purpose

The purpose of this study was to reveal the characteristics of mothers who used stay-type postnatal care facilities, usage situation, reasons for use. In addition, to reveal the difficult situations that postpartum mothers experienced when they used stay-type postpartum care facilities.

Methods

This study surveyed users of stay-type postpartum care facilities in Tokyo who consented to the research. Data included mother's socio-demographics and responses to open-ended questions about situations that were difficult during their postpartum period. Data were analyzed using simple aggregation; open-ended responses were categorized using content analysis.

Results

From the 9 facilities queried, 111 questionnaires were returned during the one-month of data collection. Mother's ages ranged from 35 to 39 and the mode was 39 (35.1%), indicating that most were older mothers. The most common length of stay was less than one week after delivery by 39 (35.1%) of mothers. Mother's stay difficulties were sorted into 9 categories: (1) Situation of sleep deprivation due to frequent breastfeeding and baby crying; (2) Situation of caring for infant with physiological pain and distress after childbirth; (3) Breastfeeding situation that are not ideal; (4) Situation of dissonance with family due to changes in family roles; (5) Situation with vague anxiety and loneliness; (6) Situation of unclear judgment on the growth, development and physical condition of infant; (7) Situation that require self-judgment and response to childcare that goes against the image; (8) Situation of self-loathing by comparing self with others; (9) Situation of worries about returning to work and financial matters.

Conclusions

In recent years, the number of older women giving births, high-risk births, and painless births (epidural anesthesia) has increased, and it takes time to recover after delivery. Therefore, a postnatal care facility is necessary as a place for infant-care education according to the physical condition of the mother and the individuality of the baby. Postnatal care facilities that provide care mainly by midwives are expected. Because of necessary to adjust the childcare style according to the physical and mental conditions of the mother, breastfeeding conditions, and the individuality of the child. It is also expected to enhance self-efficacy to prevent mental health problems.

Objective

We studied 14 people comprising 7 couples with the aim of clarifying spouses' consciousness of their marital relationship in the child-rearing stage and their thoughts on parenting together, which involves the interplay between their cooperative relationships and adjustments to these.

Methods

We conducted semi-structured interviews with husbands and wives separately during home visits, qualitatively analyzed their narratives, and extracted subcategories and categories from codes.

Results

The participating couples lived in A Prefecture. Mean ages of the wives and husbands were 38.9 and 41.1 years, respectively, and they had been married for a mean of 8.7 years. Wives held that [there is something supporting my child-rearing] from responses such as “I can appreciate the feelings I have during child-rearing” and “I feel my husband growing.” They also had [thoughts on my involvement with my child] from responses such as “my involvement with my child is not wrong” and “I am conscious of the environment in which I am.” While some conducted an [objective analysis of my husband] from responses such as “I am conscious of my communication with my husband,” and “I have some minor complaints about my husband,” some had [a sense of satisfaction toward the partnership with my husband] according to responses such as “I feel as if things are going well with my husband,” “I have a sense of gratitude toward my husband,” and “I have trust and understanding toward my husband.” In contrast, husbands held that [I have my own ideas regarding my wife and child] according to responses such as “I have a stance on cooperation between spouses” and “I face my child.” While some made [efforts to help my wife in child-rearing] according to responses such as “I make compromises with my wife,” and “It's natural for my wife and I to help each other,” some had [a sense of satisfaction toward the partnership with my wife] according to responses such as “I have trust and gratitude toward my wife” and “I am satisfied with the relationship with my wife.”

Conclusion

Married couples who supported one another and had feelings of gratitude and a mutually trusting relationship also had a sense of satisfaction toward their relationship with one another. Relationships between husband and wife were maintained and adjusted through thoughts of husbands who indicated they wanted to support their wives and who in reality were also supported by their wives for the purposes of child-rearing. These marital relationships maintained favorable thoughts on parenting together.

Aims

The purpose of this study was to identify midwifery practices offered to single mothers during pregnancy by midwives.

Subjects and Methods

The study design followed a qualitative descriptive style. The subjects were five midwives who had been practicing midwifery for over four years at an obstetrics medical institution in Prefecture A. Semi-structured interviews were conducted with each participant separately. Interviews focused on their perspective, the form of support for single mothers, and their collaboration with public health nurses. A continuous comparative analysis was conducted and abstracted into subcategories and categories to generate a core category to identify midwives' practice during pregnancy for single mothers.

Results

The following four categories were extracted as the primary objectives of midwifery practice regarding single mothers: “determine whether the mother can raise the child as a single parent,” “to stay close to the woman who has decided to give birth as a single mother and make assessments focused on child rearing,” “to assess changes in trying to become a mother based on the ongoing involvement,” and “to collaborate with public health nurses in anticipation of the transition to single motherhood and child rearing.” The core category extracted was “to protect the safety of mothers and infants for future child-rearing from the pregnancy period.”

The results indicate that midwives start “determine whether the mother can raise the child as a single parent,” and once determine that they can, “they simultaneously practice staying close to the woman who has decided to give birth as a single mother and make assessments focused on child rearing,” and “assessing changes in trying to become a mother based on the ongoing involvement.” In their service to single mothers, they also aim “to collaborate with public health nurses in anticipation of the transition to single motherhood and child rearing.”

Conclusion

Midwives attempt to understand the background of single mothers and their readiness for pregnancy. They monitor the changes of pregnant woman as they adapt to becoming mothers while providing compassionate and continuous support for them. Furthermore, midwives play a central role in connecting public health nurses and single mothers in the post-natal period.

Purpose

This study aimed to clarify the mental and physical health of older primiparas as well as couples' awareness of wives' satisfaction with husbands' support in one and three months after childbirth.

Methods

This study had a qualitative research design. The participants were eight older primiparous couples. Self-administered questionnaires and semi-structured interviews were conducted to clarify the mental and physical health of older primiparas as well as couples' awareness of wives' satisfaction with the support in one and three months after childbirth. The data were analyzed qualitatively and inductively.

Results

The following categories were identified similarities and differences of couples' awareness regarding the mental and physical health of the older primiparas in one month after childbirth: “Delayed physical and mental recovery due to pregnancy and childbirth” and “Feelings of physical and mental burden for having to adapt to the unfamiliar lifestyle of childrearing and the schedule of raising children”. The following categories were identified in three months: “Chronic sleep deprivation and fatigue due to older age”, “Breastfeeding suitable for mothers and children and stable life rhythm” and “Higher mental capacity due to older age.”

The following categories were identified for couples' awareness of wives' satisfaction with husbands' support in one month after childbirth: “Support of wife's physical and mental health due to unfamiliar and irregular parenting”, “Collaboration in housework and parenting through trial and error” and “Husband's attitude as a father developed through childcare”. The following categories were identified in three months after childbirth: “Support of the wife's physical and mental health based on a stable life rhythm and the wife's mental capacity”, “Stable housework and childcare cooperation” and “Husband's attitude as a father developed through childcare”.

Conclusions

Older primiparas felt a delay of physical and mental recovery and childcare burden in one month after childbirth. In three months after childbirth, they recognized chronic sleep deprivation and fatigue due to older age, stability of childcare and life rhythm and higher mental capacity due to older age. Similarities and differences of couples' awareness about husbands' support for their wives' satisfaction were clarified: support for the wife's physical and mental health, the couple's cooperation in housework and childcare, and the husband's attitude as a father. In particular, the support for the wife's physical and mental health was recognized as different awareness of the couple. Therefore, it was difficult for the husband's support to reach a consensus between the couple. In order to maintain the physical and mental health of the older primipara, it was important to increase the husbands' support with wives' satisfaction by sufficient couple communications and share consciousness.

Purpose

This study explored and clarified the conditions of clinical judgments regarding the onset of labor.

Methods

A cross-sectional study with 467 midwives was conducted. The backgrounds of the midwife subjects (years of experience as a midwife, number of deliveries assisted) for different starting times of labor (as determined using a revised version of Question 25 of the afternoon session of the 101st national midwife license examination) answer groups were analyzed using the Kruskal-Wallis test, and the reasons given for judging the starting time of labor (free response) were coding and classified into 4 elements of labor.

Results

Responses were collected from 251 subjects, and 203 were used for analysis. Background factors were as follows: 192 (94.6%) worked at medical institutions, they had 12.1 ± 9.2 years of experience (mean ± SD), and had assisted 394.1 ± 679.0 deliveries. As for the breakdown of the starting time of delivery, 3 respondents (1.5%) answered “4 a.m.,” 42 (20.7%) answered “8 a.m.,” 123 (60.6%) answered “9 a.m.,” 4 (2.0%) answered “11 a.m.,” and 31 (15.3%) answered “cannot be judged from the presented information.” Midwives' backgrounds did not vary according to answer groups. In addition to the definition of the starting time of labor, descriptions such as the mother's facial expression and degree of pain also varied for differing time answer groups.

Conclusion

Clinical judgments of the start of labor varied among the midwives, suggesting that the differences depending on practice wisdom, such as the information to be focused on and its interpretation.

Purpose

This study clarified what pregnant women who took a COVID-19 PCR screening test thought and feeling about the test.

Methods

Participants were 120 pregnant women who took a PCR screening test and received a negative result. The data were collected from web forms or questionnaires that the participants completed. The survey asked the following questions: their feelings when they learned that the PCR screening test was scheduled for them, their thoughts when they were given the explanation of the PCR screening test, changes in their feelings about the test before and after the explanation was given, their feelings until the test started, their feelings until receiving the result, their feelings after the result became available, their feelings about changing the delivery method if the result came back as positive, and their thoughts on whether the availability of the PCR screening test constitutes a factor in selecting a delivery facility. Answers for scales were analyzed by simple tabulation, and answers for open-ended questions were analyzed by extracting similar words from sentences the participants wrote and counting the number of participants who wrote each word.

Results

The number of questionnaires distributed was 120, and the valid responses was 92. A total of 92 subjects, including 1 teenagers, 21 in their twenties, 63 in their thirties, and 7 in their forties and over. 49 were primipara and 43 were multipara.

Pregnant women had negative emotions such as “anxiety” “nervous” before undergoing the PCR screening test. While waiting for their test results, pregnant women were hoping it wasn't positive.

After they got results, their heart felt at ease such as “secure” “great”. In addition, they felt that more attention to preventing infection.

Conclusion

It was found that most of pregnant women requested the PCR test, were satisfied with the explanation, and accepted the PCR test positively. On the other hand, they were psychologically uncomfortable until the test results became clear and were relieved that the result was known.

Purpose

The objective of this study is to clarify the contents of learning of school children from lessons of life given by midwives

Methods

Essays written by school children after receiving lessons of life given by anonymous midwives owned by the educational administration body and health administration body that manage lessons on life were used as data. Data from the educational administration body consisted of data from elementary and middle school students while data from the health administration body consisted of data from middle school students. Analysis was carried out using the text mining method. Due to differing contents in the lessons of life managed by the two bodies, data analysis was carried out according to the body. Text-type data was processed and component groups were extracted. Of the components, cluster analysis was carried out for those with occurrence frequency of 5 times or more. By making a sample search from the components of the clusters, the researchers considered the meaning of the clusters. Characteristics of learning were analyzed by setting the contents of learning as the qualitative variable and forming clusters and arranging them at the same time.

Results

7 clusters were extracted from elementary school students were:【Experiencing of various emotions after touching a baby】【Recognition of having been raised with much affection】【Feeling of having been in my mother's womb】, etc. The 6 clusters extracted from the learning of middle school students according to the A educational administration body were: 【Thoughts about one's future】【Feeling the ambivalence of babies】【Realization of affection shown by people around oneself】, etc. while the 6 clusters extracted from the B health administration body were: 【Thoughts about one's future】【Recognition of the value of life】【Recognition of having been raised with much affection】, etc. By examining the contents of learning and the cluster arrangement diagram, the experience of coming in contact with babies was most closely associated with learning for elementary school children.

Conclusion

The main lesson acquired by elementary school students from lessons of life given by midwives was the realization of the value of one's life. The main lesson acquired by middle school students was the value of other people's lives as well as one's own, in addition to thoughts about one's future.

Purpose

A breastfeeding program was developed by the author with the aim of supporting mothers returning to work after childbirth in continuing breastfeeding. The purpose of this study was to describe the development and evaluation of the pamphlets used in the breastfeeding program.

Methods

The primary objective of the pamphlet was to provide knowledge and information to help mothers who return to work within 1 year after giving birth continue breastfeeding. The secondary objective was to promote breastfeeding after returning to work. The main contents of the pamphlet included the effects of breastfeeding, the practice of balancing breastfeeding and work, how to express breastmilk, how to take medications while breastfeeding, weaning, and other information related to the continuation of breastfeeding. The main features of the pamphlet include its incorporation of the experiences and ingenuity of women who had continued breastfeeding after returning to work, and the depiction of their daily cycle after returning to work and how to continue breastfeeding. Participants were women in a program group (n=48) and a pamphlet group (n=46) among three groups of women included in a previous study who planned to return to work within 4-12 months after giving birth. In the pamphlet group, only the pamphlet was provided by mail. In the program group, the same text as in the pamphlet was used in the breastfeeding class. Comprehension, expectation agreement, utilization, and satisfaction were evaluated on a five-point scale. The two highest scores on the five-point scale were considered to indicate a “high” score, while the three lowest scores were considered to indicate a “low” score, and a chi-square analysis was performed to compare the rates of high and low scores between both groups. In the pamphlet group, the rates of high and low scores and the breastfeeding continuation rate at 3 months after returning to work were compared using the χ² test. The study took place from February 2017 to August 2018 and was conducted with the approval of the research ethics committee of the university to which the author belongs.

Results

The degree of comprehension of the pamphlets exceeded 90% in both groups. The degree of expectation agreement, utilization, and satisfaction were significantly lower in the pamphlet group than in the program group. Those who had high expectation agreement, utilization, and satisfaction in the pamphlet group had a high breastfeeding continuation rate at 3 months after returning to work.

Conclusion

The degree of comprehension of the pamphlet was high, demonstrating that it is a tool that can be used to provide knowledge and information. These results suggest that improving the pamphlet for mothers returning to work could contribute to the continuation of breastfeeding.