Purpose

The purpose of this study was to first develop a scale to measure the sense of difficulty continuing work felt by individual midwives to provide career building support for midwives working at hospitals and then test the reliability and validity of the scale.

Methods

Questions for the scale were selected based on the literature and past studies on the sense of difficulty continuing work that focused on midwives, and a draft scale to measure the sense of difficulty continuing work among midwives working at hospitals was developed. Experts assessed the appropriateness of the questions, and a revised draft of the scale was developed with 47 questions. Questionnaires were subsequently administered to 694 midwives working at hospitals and clinics to test the reliability and validity of the scale.

Results

Valid responses were received from 509 midwives (response rate: 87.8%). Nine items were removed based on the results of item analysis. Factor analysis was conducted (major factor method, promax rotation) and the number of items was adjusted according to the criteria. The final scale had a five-factor structure comprising 23 items: five items in factor I [Factors related to building relationships]; five items in factor II [Factors related to duties as a midwife]; five items in factor III [Factors related to utilizing expertise]; five items in factor IV [Factors related to flexible adjustment of work methods]; and three items in factor V [Factors related to work roles]. The temporary model was examined using confirmatory factor analysis, which showed an acceptable fit. Known-groups validity comparisons revealed significantly higher total scores for midwives who wanted to quit than for midwives who wanted to continue working and midwives who wanted to continue working for a fixed term (p<0.001). Strong correlations were observed between total scale score and the subscales of the Brief Job Stress Questionnaire (r=−0.55 to −0.78). Cronbach's alpha coefficient for the scale was 0.91. Stability was confirmed with the re-test method (r=0.77).

Conclusions

The scale to measure the sense of difficulty continuing work among midwives working at hospitals comprised 23 questions in five factors and was confirmed to be both reliable and valid. This scale may be an effective tool for assessing the sense of difficulty continuing work in midwives working at hospitals.

Purpose

To clarify the cognitive gaps between the expectations and real-life experiences of foreign women from Asian countries who gave birth in Japan.

Methods

Semi-structured interviews were conducted between March 20 and July 22, 2018, with foreign women of Asian origin who have given birth in Japan in the past five years. Six interviews about their experiences before and after childbirth were analyzed qualitatively.

Results

The childbirth experiences of foreign women from Asian countries in Japan resulted in three cognitive gaps. These women experienced before giving birth “loneliness of giving birth in a cross-cultural environment.” However, as pregnancy proceeds, these changed to experiencing “alleviated anxiety through gathering information,” “confidence to mutual understanding with medical staff.” After childbirth, this further changed to “satisfaction with the perinatal service in comparison with their home country,” resulted in 《the positive gap due to unclear expectations for the medical environment in Japan.》“Concern about medical staff attitudes towards foreigners,” altered to “trust built with the medical staff,” and caused 《the positive gap due to low expectations for medical professionals.》“Confusion over the cultural differences between their home country and Japan” arose after childbirth from “a belief that their own culture (postpartum/childcare customs) is obvious,” led to 《the negative gap due to implicit expectations for their own culture (postpartum/childcare customs).》

Conclusion

The expectations and later experienced realities of childbearing among foreign women from Asian countries in Japan were compared. The analysis revealed a positive gap regarding the Japanese medical environment and medical personnel and a negative gap regarding childbirth culture. There are negative and tacit expectations when foreign women give birth in Japan, and care should be based on the assumption that a discrepancy may arise between their expectations and reality. Health professionals should actively intervene from the initial stages of pregnancy to bridge the gap, for example, by providing information about Japanese medical care, encouraging foreign women to rethink the image they have of medical personnel, and explaining the local culture of childbirth.

Objectives

The study investigated the ability of mothers to overcome their grief following a stillbirth or neonatal death, and elucidated their experience of the next pregnancy.

Subjects and Methods

The participants in the study were mothers who experienced a stillbirth or neonatal death, and subsequently gave birth to a live baby at full term. Unstructured interviews were held, followed by analysis using Giorgi's descriptive phenomenological approach.

Results

The study participants were six mothers who had experienced a stillbirth or neonatal death between 16 and 37 weeks of gestation, and subsequently had their first live birth. During the next pregnancy, the mothers who had experienced a stillbirth or neonatal death were unable to avoid “doubts and negativity about their own physical conditions as mothers” as a result of their stillbirth or neonatal death experience. The mothers frequently experienced anxiety or fear because of the “trauma of reliving the death in the next pregnancy.” Several of the mothers had regrets about their previous pregnancies and felt that they will “accept the life as it actually is,” they also felt “connections with the life of the lost child.” When the gestational week when they experienced a stillbirth or neonatal death in their previous pregnancy passed, the mothers felt that “as the weeks progressed, I gradually became reassured that I was actually going to have the baby.” As the pregnancy progressed, their past and present experiences interacted and the mothers developed a strong desire to “accept the life as it actually is,” despite their anxiety or fear. Although the mothers had the painful experience of feeling unable to share their grief and distress about losing a child, they also had the positive experience of being emotionally rescued by the existence of people who they can be close to, physically and emotionally and “share the existence of the lost child.”

Conclusions

Six themes were representative of the mothers who experienced a stillbirth or neonatal death and subsequently became pregnant again. These mothers appreciated the miraculous nature and dignity of life from their experience of having lost a precious child. They discovered a way of living as mothers who “accept the life as it actually is.” The mothers felt that they wanted to continue walking the path of life together with the lost child through the next pregnancy. Nurses need to support the women as being mothers of the lost child and the new child through their process of growth, while acknowledging and embracing their experience of trauma.

Purpose

The purpose of the study was to determine the current status of contraceptive education and counseling provided by midwives.

Methods

The anonymous web-based questionnaire survey was administered to midwives working in medical institutions and in the community. The survey included: the implementation (within 3 years) of individual counseling and group education on contraception, the target population, the place of implementation, the content of implementation, and the facilitating and inhibiting factors in the implementation of individual counseling and group education. Descriptive statistics were calculated for quantitative data, and content analysis was conducted for qualitative data.

Results

Responding were 708 midwives. Individual counseling on contraception was provided by 278 (39.3%) and group education by 274 (38.7%). Respondents (55.8%) provided individual consultations with 155 women who were hospitalized after childbirth and 21.9% provided for 61 women who were hospitalized before or after abortion. A majority of consultations (n=206, 74.1%), took place at hospitals, clinics, and midwifery centers. There were 107 (39.1%) midwives providing group education for women hospitalized after childbirth, 104 (37.8%) junior high school students, and 95 (34.7%) high school students. The most common place of implementation for group education was school or university 164 (59.9%). The most common content of implementation was “general information on contraceptive methods” for both individual counseling and group education, by 246 (88.5%) and 263 (96.0%) respondents, respectively. The most common factor promoting individual counseling and group education was the improvement of midwives' knowledge and skills. The inhibiting factors included difficulties in accessing women's partners and limited educational content in schools.

Conclusion

The implementation rate of both contraceptive counseling and education by midwives was about 40%. The issues for promoting the implementation of contraceptive education and counseling were identified. Midwives as a profession need to acquire not only general knowledge about contraception, but also in-depth knowledge and support skills regarding contraception to assist women.

Purpose

Mental health problems such as postpartum depression have been recognized as a public health problem not only in Japan but also in other countries. Cognitive-behavioral therapy (CBT) is one of the methods to support expectant and nursing mothers with mental health problems. In this study, we conducted a web-based training course for midwives to acquire basic knowledge of CBT and aimed to clarify the changes in knowledge of CBT and confidence in CBT practice before and after the training.

Methods

We conducted a web-based survey of midwives who participated in the training before and after the training. The survey consisted of participant characteristics, a knowledge test with 13 items about basic knowledge of CBT and 18 items about knowledge of perinatal mental health, totaling 31 items, with a score range of 0 to 31 points; the confidence in CBT practice consisted of 8 items regarding CBT skills, with a 4-point Likert scale and a score range of 8 to 32 points. A correspondence t-test was used for analysis.

Results

Twenty-two midwives responded to the survey (response rate 55%), and 19 who responded before and after the training were included in the analysis (valid response rate 86.3%). The mean score of the knowledge test was 25.8 (SD=0.7) before training and 27.1 (SD=0.4) after training, with no significant difference (p=0.08). The overall percentage of correct answers was 83.4% before the training which increased to 87.4% after the training. The mean score of basic knowledge of CBT was 9.7 (SD=2.3) before the training and 12.0 (SD=0.8) after the training, with a significant difference (p=0.001). The mean scores for the 18 perinatal mental health questions were 16.1 (SD=1.4) before training and 15.1 (SD=1.7) after training, with no difference (p=0.60). The mean score for confidence in CBT practice increased from 19.3 (SD=5.2) before training to 23.8 (SD=4.0) after training, with a significant difference (p=0.001). In the item of confidence in CBT practice, the item that increased the most was the Socratic question and answer method.

Conclusion

After the training, the participants' basic knowledge of CBT and confidence in CBT practice increased. In the future, based on the knowledge acquisition status of the participants, it is necessary to re-examine the knowledge required for CBT practice and to explore the contents and methods of training, including the acquisition of CBT skills, with the aim of promoting the use of CBT in clinical practice.

Purpose

To clarify foreign Muslim women's experiences of pregnancy and childbirth in Japan and offer suggestions to improve midwifery care.

Methods

A qualitative descriptive study was conducted with three foreign Muslim women who had experienced pregnancy and childbirth in Japan. Data were collected through semi-structured interviews using an interview guide and analyzed qualitatively and inductively.

Results

Foreign Muslim women who chose to give birth in Japan relied on the reputation of Japanese and fellow Muslims “choosing a safe and secure birth facility”. They “were puzzled by the differences from their home countries” in various aspects such as childbirth and nursing practices, language, and medical personnel's response, and “followed religious norms through trial and error”. The women, at this critical stage of their lives, repeatedly struggled with accepting the fact that they could not follow their faith in the best possible manner. Finally, they compromised came to terms with it, and followed the process of “flexible interpretation of norms to fit their current situation”. They were also “grateful that their needs were met”, including a safe delivery for both mother and child and adherence to religious norms.

Conclusion

This study identified five core categories of foreign Muslim women's experiences of pregnancy and childbirth in Japan: choosing a safe and secure birth facility, being puzzled by the differences from their home countries, following religious norms through trial and error, flexible interpretation of norms to fit their current situation, and feeling grateful that their needs were met. Based on the evidence, to improve midwifery care for Muslim women, it is necessary to provide safe and secure care while demonstrating expertise and understanding of Muslim women's religious conflicts and the anxiety and confusion common to expectant foreign mothers. It is also essential to respect their culture and values, which includes their religious beliefs. In sum, it is necessary to provide care that considers the individuality and diversity of Muslim women, thereby ensuring them a positive childbirth experience.

Purpose

This study aimed to evaluate the current state of intrapartum care practices in El Salvador and examine whether the presence or absence of care makes a difference in women's satisfaction with care, based on the recommendations listed in the “WHO recommendations: Intrapartum care for a positive childbirth experience” (hereafter, WHO guidelines).

Methods

Secondary analysis was performed on data from a baseline survey conducted to assess the effectiveness of the interventions of the Japan International Cooperation Agency (JICA) Technical Cooperation Project for “Humanization of Childbirth based on Scientific Evidence in the National Women's Hospital” (hereafter, project). In the project, pregnant women who were admitted to the National Women's Hospital of El Salvador for vaginal delivery were recruited to (1) a direct observation survey on care during labor, and to (2) an interview regarding satisfaction with obstetric care on postpartum women, from May to June 2021. Those who participated in both the survey and the interview were included in the secondary analysis. Of the 56 items of care specified in the WHO guidelines, 22 were examined and the relationships between the care items and the scores of the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale were analyzed by conducting a Mann-Whitney U test.

Results

Forty-four women were included in the study. The median COMFORTS scale score was 154 out of 200. Women with heavy postpartum hemorrhage were significantly less satisfied with the COMFORTS subscale of “Care during labor” (p=0.046). Further, women who were not administered prophylactic uterotonics for postpartum hemorrhage prevention as part of the active third stage of labor were also significantly less satisfied with obstetric care (p=0.042). Among the recommended care items, those routinized in El Salvador (including the use of prophylactic uterotonics for the prevention of postpartum hemorrhage and early skin-to-skin contact) were followed. However, vaginal examination at intervals of four hours and intermittent fetal heart rate auscultation were not followed. Non-recommended care including fundal pressure (Kristeller maneuver) and nasal or oral suctioning of the newborn was also observed.

Conclusion

Satisfaction was lower when women experienced postpartum hemorrhage or were not administered prophylactic uterotonics during the third stage of labor; these women may have felt that they did not receive adequate care. The results indicate that women who received the adequate care recommended in WHO guidelines and experienced better birth outcomes reported higher levels of satisfaction. The study suggests the need to ensure proper intrapartum care practices and provide adequate obstetric care to women in El Salvador to ensure proper satisfaction.