Purpose

The purpose of this study was to identify the following two research questions for paternal depression through a meta-analysis of relevant qualitative studies: 1. How has paternal depression been screened for by professionals? 2. What are the coping strategies/support available for paternal depression and the challenges in providing strategies/support for paternal depression?

Methods

Relevant articles were identified using the following databases: CINAHL, MEDLINE, and Google Scholar. The search keywords used were ‘support’ AND ‘postpartum depression of father’ OR ‘paternal depression’ OR ‘mental health of fathers’ AND ‘qualitative study’ in the database. There were 32 qualitative articles retrieved from the database and through hand searching, of which 5 articles were included in the analysis. Meta-ethnography were utilised in this study. All analysed papers were scored and guaranteed by the Critical Appraisal Skills Program (CASP; 0-10 points) as valuable qualitative studies. The analysis was performed using NVivo 12 for Windows.

Results

In the present meta-synthesis, the Patient Health Questionnaire -9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire -15 (PHQ-15), and the List of Threatening Events were used to identify depression in fathers. Additionally, one study used the six criteria of the definition of postnatal depression to identify paternal depressive symptoms. As a result of the meta-synthesis, the following eight metaphors were extracted from all analyses articles: ‘Triggers of paternal depression’; ‘Awareness of paternal depression’; ‘The Impact of paternal depression’; ‘Coping’; ‘Lack/unhelpful of information resources’; ‘Barriers to seeking help’; ‘Reasons for needing supports’; and ‘Helps for paternal depression’. Paternal depression due to a sequence of triggering events and the perceived symptoms varied. Once fathers realized they had depression, they attempted to cope with it. However, there were inadequate therapies and information to cope with depression. Moreover, embarrassment of seeking help due to being male was also a barrier to coping with depression. In contrast, the responsibility to protect the family motivated them to acknowledge their depression and seek social support and professional help.

Conclusion

Anxiety and general depression scales were used to screen for paternal depression, and no measures for paternal depression were not used. Men who were aware of paternal depression tried to cope with it; however, it is possible that support for paternal depression was not sufficiently available and that masculinity may also be a barrier to seeking help for depression. On the other hand, the responsibility of protecting their families motivated fathers to be proactive in seeking help to overcome depression.

Purpose

Premenstrual syndrome (PMS) is characterized by mental and physical symptoms during the luteal phase of the menstrual cycle. In Japan, 70–90% of women experience some symptoms related to PMS. This review aimed to assess the effects of aromatherapy on PMS symptoms and autonomic nerve system among women with PMS.

Methods

A search was performed through six databases (Ichushi-Web, CiNii, MEDLINE, CINAHL, Cochrane Library, and PsycINFO) using keywords such as “aromatherapy” and “premenstrual syndrome” for identifying relevant articles that were published in Japanese and English until March 2021. The study design consisted of only randomized controlled trials. These articles were screened based on the inclusion and exclusion criteria. We used inverse variance methods to integrate the results of articles included in the review.

Results

Five articles were included in this review. Essential oils used in these articles were lavender, clary sage, rosa damascene, citrus aurantium, and geranium. Two articles assessed the immediate effects of aromatherapy while three articles assessed its longitudinal effects. Aromatherapy significantly reduced the mental symptoms related to PMS, such as irritability, anxiety, and depression in four out of four articles, and significantly reduced the physical symptoms such as edema, fatigue, and hypersomnia in three out of three articles. Two articles examined the effects of aromatherapy on the autonomous nervous system and found that it increased the high frequency power, an indicator of the parasympathetic nervous system activity. Meta-analyses showed that aromatherapy significantly reduced mental and physical symptoms of PMS, and significantly increased the high frequency power. However, heterogeneity was found in these analyses.

Conclusion

The findings of this review suggest that aromatherapy reduces the mental and physical symptoms and positively affects the autonomic nervous system among the PMS patients. Further studies are required to identify the most effective essential oils and implementation methods for reducing PMS symptoms.

Purpose

The purpose of this study is to clarify the relationship between factors contributing toward feelings of child-rearing difficulty experienced by older primiparas at one month postpartum.

Research Subjects and Method

The research subjects were older Japanese primiparas who visited a hospital for health examinations one month after giving birth at one of seven hospitals and six maternity clinics located in A prefecture. A self-administered questionnaires were used that required the subjects to enter their personal attributes as well as their responses to the following rating scales: Parenting Resilience Scale, Child Care Stress Scale short form, Postpartum Maternal Confidence Scale, Postpartum Maternal Satisfaction Scale, “feelings about child-rearing” in the Japan Child and Family Research Institute (JCFRI) Child-Rearing Support Questionnaire, self-diagnosis checklist of accumulated exhaustion level, and sense of having a sufficient night's sleep. Fundamental statistics of the attributes and scales were calculated, and feelings of child-rearing difficulty were compared by occupation and support. An analysis of covariance structure regarding the relationship between variables was also conducted.

Results

The 252 valid responses (response rate 85.7%) received from 294 older primiparas were analyzed. The mean age of the surveyed mothers was 37.8 (±2.4) with the maximum age being 46. The average score of feelings of child-rearing difficulty was 18.1 (±4.6) of which the higher points were scored by those with occupations (p=.009). No differences were identified due to presence of support. The factors directly contributing toward feelings of child-rearing difficulty of older primiparas were maternal confidence (−0.54), and child-rearing stress (0.36). Increase in parenting resilience reduced feelings of child-rearing difficulty as a result of reduced accumulated exhaustion (−0.33) and child-rearing stress (−0.41), and improved postpartum maternal satisfaction (0.31) and maternal confidence (0.30). Furthermore, an increase in parenting resilience also had an influence on the sense of having a sufficient night's sleep (0.31) and accumulated exhaustion level.

Conclusion

Postpartum maternal confidence and child-rearing stress had a direct influence on feelings of child-rearing difficulty experienced by older primiparas. Parenting resilience did not have a direct influence on feelings of child-rearing difficulty, however, it did reduce feelings of child-rearing difficulty via positive feelings about physical state, including accumulated exhaustion level, and psychosocial states including a sense of having a sufficient night's sleep, child-rearing stress, postpartum maternal satisfaction, and maternal confidence.

In conclusion, Parenting resilience is an important factor that influences feelings of child-rearing difficulty via all factors.

Purpose

The purpose of this study is to clarify the psychological processes that occur in women who decide to stop breastfeeding when they return to work, and choose to explore the breastfeeding support options that are preferable for working women.

Participants and Methods

The WHO recommends that infants are exclusively breastfed up to six months of age and that breastfeeding is continued up to two years of age. In the present study, semi-structured interviews were conducted with 12 mothers who had carried to their full term and had given birth to a baby weighing a minimum of 2500g. The interview participants were women who had breastfed their babies after giving birth, but had decided to stop breastfeeding when they returned to work after a period of less than two years of continuous breastfeeding. The results were analyzed using the modified grounded theory approach (M-GTA).

Results

Eight categories and 18 concepts were generated, relating to the psychological processes of women who decided to stop breastfeeding upon returning to work. While the participants wanted to continue breastfeeding after returning to work, however, before they had returned to work, they gradually came to feel anxious about balancing work with night-time breastfeeding because of the difficulty of night-time breastfeeding after returning to work. Participants also developed a perception from others' opinions that they should stop breastfeeding, and therefore, began to reconsider the necessity of breastfeeding and experienced resistance to breastfeeding as the child grew. However, when participants attempted to start the process of weaning, they had an indistinct sense of anxiety about stopping breastfeeding and felt pain caused by stopping breastfeeding. In addition, because some participants desired to continue breastfeeding, they felt sadness about stopping breastfeeding, and sometimes had feelings of conflict about the same. Because of this, some participants would involuntarily respond to what the child wanted because of their feelings of guilt toward the child, while others experienced feelings of guilt about their decision to stop breastfeeding. Despite these repeated conflicts, participants who had made a firm decision and commitment to stop breastfeeding approached the weaning process with a strong resolution to not compromise. Finally, when they had completely weaned their child, participants accepted their decision to stop breastfeeding.

Conclusion

The findings suggested that, in order to provide breastfeeding support that is preferable for working women, it is important to respect the agency of working women, whether they choose to continue breastfeeding or stop breastfeeding, and to support women in choosing and accepting their own breastfeeding method.

Purpose

The purpose of this study was to reveal facts about lower urinary tract symptoms and urinary bladder volume in the third trimester and early puerperium and to explore characteristics of lower urinary tract functions in the early puerperium.

Methods

A prospective observational study was conducted in women with singleton pregnancy going through vaginal delivery during their third trimester and early puerperium (Days 1–5 of puerperium). In the third trimester, self-administered questionnaire survey using CLSS and ICIQ-SF was conducted along with measurement of residual urine volume. In the early puerperium, subjective bladder sensation and urinary bladder volume were investigated once daily before urination and residual urine volume as well as presence or absence of difficulty in urination, feeling of incomplete emptying and urinary incontinence after urination. Urinary bladder volume and residual urine volume were measured using a portable ultrasound device and presence or absence of reduction in bladder sensation was classified by comparing urinary bladder volume and subjective bladder sensation. This study was conducted with an approval from the ethics committee for “human subject researches” of Toyama Prefectural University.

Results

A total of 23 subjects were included in the analysis. In the third trimester, prevalence of lower urinary tract symptoms was the highest for daytime frequency and nocturia at 87.0%, followed by urinary incontinence and urinary urgency. The mean ICIQ-SF score was 5.0±3.9.

The mean urinary bladder volume in the early puerperium was 375.8–447.7 ml. The urinary bladder volume tended to be high at 447.7±193.5 ml in Day 4, and 47.6% of the subjects had more than 500 ml. The prevalence of lower urinary tract symptoms was the highest for reduction in bladder sensation; It was reduced from 52.9% in Day 1 to 36.4% in Day 3 but increased to 42.9% in Day 4. There was no association observed between the number of days of puerperium and lower urinary tract symptoms. A logistic regression analysis revealed that the higher the ICIQ-SF score in the third trimester, the more prominent the reduction in bladder sensation in Day 4 (p=0.046, odds ratio 1.35).

Conclusion

In the early puerperium, the women may have increased amount of urine volume while experiencing reduction in bladder sensation regardless of the number of days in puerperium; the bladders are likely to become full. The ICIQ-SF score in the third trimester was associated with the presence of bladder sensation in Day 4 of puerperium.

Objectives

The objectives of this study were to ascertain the status of fertility knowledge among working men of reproductive age and to identify their information needs.

Methods

The study participants comprised 500 men aged 20–39 years (as of April 1, 2019) whose wives or partners had never given birth, who answered an online questionnaire in March 2020. The questions asked about their attributes, knowledge of fertility and information needs, concerns about their own health, and sources of information about pregnancy and childbirth. The questions about fertility consisted of 20 items, which comprised Saito's 2014 “13-item infertility knowledge scale”, partly modified with permission and an additional seven questions written by the authors. Descriptive statistics were calculated, a stratified analysis based on background factors was performed, and the resulting 20-item scale was examined for reliability and validity. This study was approved by the Research Ethics Committee of the Faculty of Nursing, Toho University (Approval No. 2019010).

Results

The study population consisted of 500 men (mean age 29.8 ± 5.5 years), of whom 60.6% were university graduates, 45.6% wanted to have children, and 21.0% had a partner. After excluding 98 participants (19.6%) who answered “don't know” to all 20 items on fertility knowledge from the analysis, the mean correct score for fertility knowledge was 42.1% ± 23.9% (range 19.4%–67.7%). The correct score rate was significantly different for those who wanted to have children (p = 0.03) and who had experienced infertility consultation (p = 0.01), but was not associated with age, level of education, or the presence/absence of a partner. Questions about fertility consisted of 20 items, and their reliability and validity were confirmed. A total of 54.4% of the participants had information needs, and these needs were greatest concerning age, diet, and lifestyle. The proportion of participants with health concerns was 42.4%. Their sources of information about pregnancy and birth were their partners, the Internet, and social media.

Conclusions

Among men of reproductive age, wanting to have children and experiencing infertility consultation had a significant impact on their fertility knowledge. In light of the status of fertility knowledge among men of reproductive age and their needs, providing information, disseminating knowledge, and raising awareness is a task for the future.

Purpose

To clarify the relationship of mother–daughter intergenerational succession of generativity, which involves concerns toward nurturing the next generation, with health literacy and health of female college students.

Methods

A descriptive, cross-sectional study based on a questionnaire survey. Setting: Seven Japanese colleges chosen through non-random convenience sampling. Participants: Female nursing students (n = 561), female non-medical students (n = 586), and their mothers. Outcome Measures: For mothers, the Generativity Scale was used. For the students, the Generativity Scale for Student were used, Health Literacy Scale for Women of Reproductive Age and the Short Form-8.

Results

Valid responses were received from 153 pairs (13%) of female students and their mothers, consisting of 52% (80/153) non-medical students and 48% (73/153) nursing students. The students' age ranged from 18–29 years, and mothers' from 39–62 years. A multiple group covariance structure analysis showed significant paths in both non-medical and nursing students, indicating that mothers' “Generative concerns” enhanced students' “Intergenerational succession of wisdom,” “Self-care of menstruation,” “Knowledge of female body,” and “Choice of female health information and practice.” Among non-medical students, a path lowering “Mental component summary” (β = −.35, p < .05, R² = .21) was demonstrated from “Self-care of menstruation.”

Conclusions

It was confirmed that when mothers had a high level of “Generative concerns,” students' “Intergenerational succession of wisdom” and health literacy of women of reproductive age increased.

Purpose

Recently, an increasing numbers of women are requesting epidural anesthesia during vaginal delivery (hereinafter referred to as epidural delivery) in Japan. While this number is expected to increase, there appears to be a negative view regarding epidural delivery among the midwives, and some midwives find it difficult to accept. The purpose of this study was to ascertain the feelings and perceptions of the midwives involved in epidural delivery and to determine the kind of care they provide.

Methods

This was a qualitative descriptive study. Sixteen midwives with an experience in epidural delivery underwent semi-structured interviews. The obtained data was transcribed; and the sections, where the midwives expressed their feelings on involvement in epidural delivery, were extracted, coded, and categorized.

Results

The midwives' perceptions regarding epidural delivery were collated into six categories. Perceptions such as “feeling that epidural delivery also has merit” and “willingness to accept epidural delivery” included positive opinions held by the midwives due to their involvement in epidural delivery, where they were trying to respond to the increase in epidural deliveries. Contrastingly, the midwives also held the opinion that, “I find it difficult to support women, who receive epidural anesthesia, to ensure that the delivery progresses safely and smoothly,” and “I find it difficult and I feel anxious about my lack of knowledge about epidural delivery.” These perceptions show that the midwives find providing support in epidural delivery difficult. Feelings such as “involvement in epidural delivery has reiterated my feelings on the merits of natural delivery” described how the midwives truly believed the merits of natural delivery when they were involved in epidural delivery. In the background of the aforementioned categories was “conflict with my own feelings as a midwife that arises while providing support for an epidural delivery as per the pregnant woman's wishes.”

Conclusion

Midwives involved in epidural delivery have variable point of views, perceiving the benefit of epidural delivery, but finding the provision of support difficult. It was clarified that even under these circumstances, midwives are involved in safe epidural deliveries per the pregnant women's wishes. Midwives need to acquire accurate knowledge to be able to provide highly safe and satisfactory care during epidural deliveries, and to align themselves with the pregnant woman's wishes and expectations.

Purpose

The purpose of this study is to investigate and analyze the techniques and ways of thinking that skilled midwives at independent birth centers in Japan use to ensure safe delivery, and thereupon to appraise the perineal management techniques introduced in two commonly used midwifery textbooks.

Methods

Participation in this study was requested from 25 managers of independent birthing centers in the Tokyo metropolitan and Kansai areas, eight of whom gave consent. Eight skilled midwives became the subjects of this study. With reference to the techniques used in the second stage of labor that was clarified by author's previous study, skillful midwives' techniques using a phantom and their ways of thinking were documented by a movie camera and IC recorders, and semi-structured interviews were conducted. The data collection period lasted from July to August 2017, and the data were analyzed qualitatively using the descriptive method.

Results

Eight midwives were considered for analysis. The midwives did not control or promote the third rotation, and during the delivery of the shoulders, they waited for the mother's contractions and delivered the fetus slowly by holding with both hands so as to optimize the fetus's rotation and the compact tucked-in position. Based on the belief that fetuses are to be delivered slowly through natural contraction and rotation, skilled midwives did not perform perineal management or actively intervene throughout the birthing process.

Conclusion

Fetal delivery techniques implemented by skilled midwives at birthing centers differ from the delivery assistance technique (perineal protection method) found in the two main textbooks of midwifery basics. Skillful midwives at independent birth centers used techniques to keep the fetuses in tucked-in position by optimizing their rotation. The midwives thought that slow delivery with natural contraction was not only important for preventing injury but also for the child's continued well-being.

Purpose

This study aimed to elucidate the infection control measures implemented for the care of perinatal women in obstetric facilities in Iwate Prefecture during the coronavirus disease (COVID-19) pandemic during June–September, 2020.

Methods

A questionnaire survey was conducted for nurse administrators in charge of perinatal care at medical institutions dealing with childbirth in Iwate Prefecture. This survey collected information regarding the measures implemented to prevent COVID-19 infections and the maternity care provided during June–September, 2020.

Results

This analysis included 17 facilities, comprising 11 maternal and perinatal care centers and general hospitals and 6 clinics. Of these, 16 either had established or were in the process of developing a basic policy for the perinatal women suspected of COVID-19. This policy included recommendations, such as treating COVID-19-suspected perinatal women in an outpatient fever clinic, installing consultation booths, and using staggered appointments. For perinatal women, the facilities had adopted restrictive measures, such as changing group parenting classes to individual ones and prohibiting visitors to the labor, delivery, and postpartum units. However, they also implemented active measures to enhance patient comfort and emotional security, such as providing thorough explanations and psychological support and using information and communication technology (ICT) to allow family members to share the joys of childbirth remotely. Nevertheless, the staff was anxious about the shortage of personal protective equipment and whether they could provide appropriate care when they encountered an actual COVID-19-positive patient. Nurses took further self-care measures such as recording their body temperature daily and refraining from out-of-prefecture travel.

Conclusions

During this survey, Iwate Prefecture had only confirmed some of its earliest cases of COVID-19. However, the majority of the perinatal facilities surveyed had already established anti-COVID-19 policies. As for maternal care, group parenting classes were switched to individual classes. Furthermore, attempts were made to reduce the stress of the perinatal women due to isolation from their family and friends by providing more extensive mental support through ICT and increasing their conversation time with them.

Although the nurses felt burdened working under conditions of shortage of staff and personal protective equipment, they not only continued to provide care to the perinatal women, but also presented ingenuity in the face of limited resources. Nonetheless, the anxiousness and nervousness of providing appropriate care to actual COVID-19-positive patients remained.

Objective

Periodontal disease increases the risk of an adverse outcome of pregnancy including preterm birth and low birth weight, and it is very important to maintain the oral health of pregnant women. This study aimed to clarify the current state of oral hygiene behavior and subjective periodontal disease symptoms among pregnant women in the second trimester during the COVID-19 pandemic.

Methods

This was a cross-sectional quantitative descriptive study. We recruited pregnant women in their second trimester who are literate in Japanese and visited a prenatal clinic in a hospital between June 2020 and May 2021. Data were collected based on the online survey and medical record information. The survey included questions about the patient characteristics (age, a pre-pregnancy body mass index (BMI), parity, history of smoking, educational level, an employment and a work from home in their second trimester, an annual income, and a family type), the number of meals per day, changes in oral care during the pandemic, the number of times they brushed their teeth per day, dental consultation, and subjective periodontal disease symptoms.

Results

A total of 113 responses were received. The percentage of pregnant women who were working was 77 (68.1%), of which 73 (94.8%) worked at an office. Moreover, 75 (66.3%) of pregnant women had four or more meals a day, and 38 (33.6%) had improved oral care practice than before the pandemic, of which 33 (86.8%) were noted to gargle with water or mouthwash after getting home, at work, or after brushing their teeth. The average number of teeth brushing per day was 2.9±0.8, but only 11 (9.7%) brushed their teeth after eating a snack. Furthermore, 64 (56.6%) had a dental examination by in their second trimester, of which 34 (53.1%) had subjective periodontal disease symptoms even after dental examination.

Conclusions

Given the prevalence and transmissibility of COVID-19, pregnant women who were in their second trimester performed oral care to prevent infection. On the other hand, it was also found that some of them did not brush their teeth after eating a snack. The fact that dental consultation rate remained high amid the COVID-19 pandemic leaves hope for the improvement of the consultation rate even after the resolution of the pandemic. Additionally, we suggested that regular dental examinations were important during pregnancy, since there were pregnant women who had subjective symptoms of periodontal disease even if they had undergone dental examination.

Purpose

Focusing on the views of midwives in court, examining the care and accountability of midwives will lead to the identification of important issues that would help prevent medical malpractice.

The objective of this study was to identify issues related to the prevention of medical accidents based on legal cases on medical malpractice in which the negligence of midwives was recognized.

Methods

This study used a legal database to search medical malpractice cases from 1999 to 2020. We selected and analyzed the cases in which most midwives' arguments were not recognized among the main issues based on the search results. For analysis, we used a method to organize the contention of the parties and prepare the background of the problem based on the medical history chart in chronological order.

Results

The keywords “medical malpractice” and/or “childbirth” were searched between April and December 2020. Ultimately, two cases were included for analysis. The court's factual findings were determined “Why the midwife's argument wasn't accepted”? “Inadequate records and retention methods,” “estimation of midwife's technique based on submitted materials,” “evaluation of consistency,” “impression based on evidence of inconsistency from other healthcare professionals,” and “impact of initial response in trials” were identified as issues in the documentary evidence and testimony.

Conclusion

According to an examination of the documentary evidence, inadequacies in records and retention methods raise doubts about the evidence's value. Furthermore, the submitted data suggested that the midwife's technique was flawed. The consistency assessments of witnesses revealed that the consistency and differences in testimony between healthcare providers affect court conviction. Finally, it is important to take responsibility for one's actions in this process given that the actions taken while engaging as midwives can be verified based on the evidence submitted and the testimony of midwives.

Purpose

The purpose of this study was to clarify the movement transformation process of menopausal women after Kinesthetic-Classic-Neo experiential learning and to examine the significance of Kinesthetic-Classic-Neo experiential learning and related issues in supporting the health of menopausal women.

Participants and Methods

A Kinesthetic-Classic-Neo experiential learning session was held for 14 menopausal women who had no prior kinesthetics experience. Interviews were conducted immediately after the session as well as one week and one month after the session in order to investigate what they felt and noticed during the session, the practicality of the experiential learning content and so on. The Steps for Coding and Theorization (SCAT) method was used to analyze the data of 12 participants who talked about the changes in their movement within one month after the session.

Results

Through Kinesthetic-Classic-Neo experiential learning, the participants gained “awareness of the comfortable sensation from the experience of movement,” “awareness of the physical burden of habitual movements,” “awareness of avoiding physical risks by practicing self-care of movement,” and so on. They showed “a willingness to practice self-care through movement in accordance with their physical and mental condition” by “eliminating anxiety about changes due to aging” and “anticipating the effects of practicing comfortable movements.” At one week after the experiential learning session, all the participants were practicing something they had learned in the session. At one month after the session, half of the participants were continuing to practice movements “to improve their good posture” and that “placed less burden on their body.” However, the frequency at which the other half practiced movements decreased for reasons such as “the feeling of forgetting more of what they had learned as time passed” and “the difficulty in changing habitual movements.”

Conclusion

After the Kinesthetic-Classic-Neo experiential learning session, the participants were more aware of the sensation of “movement” and practiced self-care of movement temporarily or continuously. The results suggest that learning self-care of movement may improve quality of life after menopause. To support the health of menopausal women, it is necessary to create opportunities for them to continue experiential learning.