Objective

To clarify the latest evaluation indices and employed scales capable of systematically evaluating patient education material to utilize these in the evaluation of “Midwifery Guidelines for Pregnant Women Giving Birth and Their Families.”

Subjects and Methods

A search of the literature was conducted using the web version of Igaku Chuo Zasshi and PubMed. Papers describing the evaluation of patient education material were extracted based on titles, abstracts, and whole manuscripts. The extracted papers were sorted according to the type of patient education material, evaluators, evaluated domains, and evaluated items.

Results

Twelve papers were extracted, of which 3 were regarding the evaluation of audiovisual education material and 10 were regarding the evaluation of text-based education material. One paper evaluated both audiovisual and text-based education materials. The evaluations of patient education material differed in the evaluated domain and scale used according to the type of education material. In particular, the evaluations of the readability of text-based patient education material involved scores such as the Flesch Reading Ease, Flesch-Kincaid, and Simple Measure of Gobbledygook (SMOG), while other domains were evaluated using the DISCERN instrument, the LIDA instrument, the Patient Education Materials Assessment Tool (PEMAT-P), and the Visual Aesthetics of Websites Inventory (VisAWI). Evaluations were performed by two evaluators for all of the papers. In the evaluations of text-based education materials, evaluation from multiple domains using scales according to the purpose of the patient education material was found to be necessary, in addition to evaluating readability.

Conclusions

We will further examine the use of readability evaluation scales and the Japanese version of the PEMAT, which can evaluate comprehensibility and ease of actions, for the purpose of evaluating “midwifery guidelines for pregnant women giving birth and their families.”

Purpose

The aim of this study was two-fold: 1) to focus on qualitative studies in which data on adolescent women's psychosocial challenges related to their menstruation were collected and 2) to conduct a scoping review the literature in different countries to identify adolescent women's challenges through their experiences of menarche and menstruation.

Methods

We conducted a search for qualitative studies published after 2000 on challenges related to menstruation for adolescent women in November 2021 on PubMed and the NPO Japan Medical Abstracts Society database (Ichushi-Web). We extracted categories and raw data from each of the included studies. We then compared and re-categorized the interpretations and raw data or codes of each study (registered: UMIN000048385).

Results

The re-categorization resulted in four categories and 14 subcategories―four subcategories under Individual Challenges: (a) impact of physical changes, (b) impact of psychological changes, (c) access to information and education on menstruation, and (d) knowledge and perception of menstruation; six subcategories under Social Challenges: (a) social prejudice, (b) feeling of shame, (c) taboo of menstruation, (d) restrictions on social life, (e) religious challenges, and (f) interaction with others who have experienced menstruation; two subcategories under Family-level Challenges: (a) relationship with mother and (b) relationship with family and guardians, including mother; and two subcategories under Lack of Access to Resources: (a) fragility of infrastructure and (b) lack of privacy.

Conclusion

This study revealed that adolescent women undergo diverse experiences and face various challenges when it comes to menarche and menstruation. The results can help understand adolescent women's menstrual experiences and the factors that should be considered to improve reproductive health. The results also indicate the need to ensure that all women have access to accurate information, appropriate menstrual management, psychological support to view menstruation positively, and the necessary menstrual resources.

Purpose

The purpose of this study was to clarify the background structure of the practice of clinical midwives in caring for socially vulnerable pregnant women as well as to describe it phenomenologically.

Methods

The research design was a phenomenological study. The research collaborators were midwives with more than 10 years of clinical experience who had worked with socially vulnerable pregnant women on multiple occasions and were able to talk about their practice, using a network sampling method. Data collection was conducted using the unstructured interview method.

Results

The research collaborator was Ms. A., a midwife in her late thirties who had been working at a hospital for more than 10 years. The first practice studied was the practice of “looking at the mother and the child and their surroundings,” which she described as the landing point of the question of “looking at the person,” and the second was the practice of “stepping in” and “passing” the relationship to the community, which came to light through looking at the mother and the child as well as their surroundings. The practice of “looking at the mother, the child, and their surroundings” consisted of the following four components. “Seeing the mother and child and their surroundings from various angles,” “Seeing the mother's past and future from the point of pregnancy,” “Listening to the mother so that she feels taken care of,” and “Recognizing changes in mothers with difficulties as their strengths.” Community collaboration consisted of two components: “stepping in” and “passing” to the community.

Conclusion

The clinical midwives' practice of caring for socially vulnerable pregnant women revealed the structure of the practice of “looking at the mother and child and their surroundings” as well as the practice of community collaboration, based on the question of “looking at the person.” The practice suggested that the midwife's sense of value is not directly related to care, but that care is determined by “looking at the mother and child as well as their surroundings”. The study also showed the involvement of clinical midwives in building relationships with socially vulnerable pregnant women and the practice of connecting socially vulnerable pregnant women with their local communities.

Purpose

This study aimed to clarify the perspectives of experienced midwives working in the community regarding the detection of situations where child abuse and abuse risks are high in situations of postpartum mothers and child support, such as childcare consultation.

Methods

The participants were midwives with 10 or more years of experience in their professions, and who had experience in providing support to parents and children in cases of child abuse or high risk of child abuse. Semi-structured interviews were conducted using an interview guide. The data obtained were transcribed verbatim, and the content was qualitatively analyzed with reference to Krippendorff's content analysis method.

Results

The data collected in the interviews were summarized into 90 codes, 37 subcategories, and 8 categories. The eight categories are as follows: “what is reflected in the home environment,” “suffering manifested in the mother's mental and physical condition,” “lack of ability to seek help,” “difficulty in developing attachment to the child,” “mismatch between the child's condition and parenting method,” “behavior toward the child,” “condition of the child in crisis,” and “dissonance in family relationships.”

Conclusion

Experienced midwives working in the community had multifaceted perspectives of the home environment, state of the mother and child, and attitude of the family. These perspectives could only be formed by building a supportive relationship from a holistic perspective as viewed by the mother. For preventing child abuse and providing care, skilled midwives working in the community believed in offering continuing support that is based on the support relationship from the standpoint of maternal protection.

Purpose

Multiparous women face difficulties in child caring that are different from those of primiparous women. However, there is still no adequate support environment for these multiparous women. This study aims to identify the difficulties in child caring experienced by multiparous women raising two children of different ages as perceived by midwives in order to examine the nature of support midwives must be prepared to provide.

Methods

Semi-structured interviews were conducted with nine midwives with at least five years of experience in providing services for multiparous women. Data collection focused to on the difficulties in child caring for multiparous women raising two children of different ages, as perceived by the midwives through their involvement with these women. The interview data were qualitatively descriptively analyzed.

Results

The difficulties of this population, revealed six categories and thirteen subcategories. Multiparous women experienced situations where they “could not apply all of their child caring experience of the first child” in raising the second child. These women who experienced raising two children for the first time “lacked knowledge and skills to raise two children in parallel”. Further, they faced “difficulties in reconfiguring their perspective on child caring”, which they had developed through the experience of raising the first child. These new difficulties brought the mothers an “increase in the burden of child caring”, leading to an “accumulation of fatigue from raising the two children”. The analysis also showed that it was difficult for the mothers to use coping behaviors for prenatal and postnatal issues due to the “difficulty in obtaining support because they were multiparous”.

Conclusion

The findings show the difficulties in child caring unique to multiparous women. Here it is necessary for healthcare professionals to understand these difficulties and determine the need for support for multiparous women.

Objective

The objective was to compare the pressure and shear force values applied to the perineum in the course of the perineal protection provided by skilled midwives and novice midwives, their changes over time, and the differences and characteristics of the techniques involved.

Method

Participants consisted of 10 faculty members and advanced midwives (skilled midwives) and 10 midwifery students and new midwives (novice midwives). A force sensor was attached to the center of their right palms, over a sterile glove, to measure the pressure and shear force values applied to the perineum of the phantom during perineum protection in a simulated delivery in which the baby was delivered in three labor cycles from a chicken-egg sized expulsion. The data obtained were graphed, their patterns classified, and comparisons between skilled and novice midwives computed. A one-way analysis of variance was used to determine differences in the maximum pressure values for each labor cycle, and Student's t-test was used to compare the maximum pressure values between the two groups. To visually capture the direction of pressure, the relative coordinates of the shear force values at each timing were displayed and analyzed as a vector.

Results

When the data on the pressure values obtained were plotted on a graph, all skilled midwives showed a pattern of differential pressure values between the intermittent and contraction phases, whereas 4 out of 10 novice midwives showed a pattern of constant pressure values. A one-way analysis of variance was performed to compare the maximum pressure values for each labor cycle of the skilled midwives. The results showed that the maximum pressure values for the skilled midwives were similar for labor cycles 1 and 2 and significantly higher for labor cycle 3 compared to labor cycles 1 and 2. A similar analysis for novice midwives indicated that the pressure values were higher in labor cycle 3 than in labor cycle 2, but were similar in labor cycles 1, 2, and 3. Student's t-test was performed to compare the maximum pressure values for each labor cycle between the skilled midwives and novice midwives. The results showed that skilled midwives had lower maximum pressure values than those of novice midwives in labor cycles 1 and 2, but the same amount of pressure in labor cycle 3. Analysis of shear force during labor cycle 3 at the time of occipital tubercle slippage, when the infant's nose started to emerge and when the pressure value reached its maximum, visually indicated that skilled midwives tended to apply more shear force forward (toward the pubic bone) to the birth mother than that applied by novice midwives in all situations.

Conclusion

It became clear that there was a difference in the pressure and shear force applied to the perineum during perineal protection provided by the skilled midwives and novice midwives, at different times in the progression of childbirth. We recommend that novices be instructed about the timing, strength, and direction of pressure, through a series of sessions during which they act as assistants to skilled midwives.

Purpose

This study aimed to investigate the effects of back heat therapy on the stress and the mammary blood flow in nonpregnant, nonlactating women.

Participants and Methods

The participants were 21 women aged 20–41 years (23.6 ± 5.3 years) who were in non-pregnant/non-lactating periods and whose menstrual cycle was in the follicular phase. The same study participants back heat therapy (heat therapy group) and underwent supine resting (rest group) at the same time of the day on different days, and the results of the two groups were compared. The experimental procedure included the following stages: pre-intervention rest, intervention (back heat therapy or supine rest), and post-intervention rest, with each stage lasting for 15 minutes. Stress levels of the participants were evaluated by measuring the levels of cortisol and human herpesvirus 6 and 7 (HHV6 and HHV7) in saliva samples and using a 9-level Likert scale, with scores ranging from 1 (uncomfortable) to 9 (comfortable). Notably, the samples were collected before and after intervention and the end of the experiment. During the experiment, mammary blood flow was continuously measured using a laser Doppler flowmeter, and the average values were calculated every 5 minutes.

Results and Discussion

There were no significant differences in cortisol and HHV6 and HHV7 levels between the heat and rest groups; however, the heat therapy group reported a significantly higher level of comfort than the rest group (p < .01) on the Likert scale. Although back heat therapy induced a state of comfort in the participants, it did not significantly affect stress levels. A significant relationship was observed between the intervention method and time during the measurement of the mammary blood flow. Further, owing to the significant main effect of time, multiple comparisons were performed. The heat group exhibited significant differences at all time points after intervention compared with the baseline values obtained before intervention (p < .05, p < .01, and p < .05), whereas the rest group exhibited significant differences during the first 5–10 min of intervention and at all time points after intervention (all p < .01). Notably, both groups exhibited significant changes in mammary blood flow after intervention, but there were no significant differences between the two groups in terms of in mammary blood flow. Back heat therapy did not have a significant effect on mammary blood flow during intervention, but it was suggested to promote mammary blood flow after intervention. However, it is also possible that supine rest itself promoted mammary blood flow after intervention.

Conclusion

I found that back heat therapy induced a higher level of comfort than supine rest. Additionally, the results of my study suggested that back heat therapy promotes mammary blood flow after intervention but does not affect the flow during intervention.

Purpose

The study aims were, firstly, to develop an online-based yoga program for pregnant women with low back pain and pelvic pain and to evaluate the feasibility of the prototype. Secondly, it was to determine changes in the outcomes of the yoga program in terms of location and degree of low back and pelvic pain, degree of daily life disability, and depressive symptoms.

Methods

This was a feasibility study to examine practicality, acceptability, and continuity of the program, and to clarify changes in outcomes using a before/after descriptive design. Pregnant women with low back or pelvic pain and no pregnancy problems or complications were included in the study. The yoga program was 8 weeks in duration and consisted of daily yoga practice, pain log entries, and yoga sessions. The feasibility of the program was evaluated using data from survey forms and opinions at yoga sessions regarding practicality (safety and burden), acceptability, and continuity. In addition, changes in the location and degree of back and pelvic pain, degree of daily life disability, and depression were measured before, during, and at the end of the yoga program, and changes at the three time points were compared. St. Luke's International University research ethics review approval was obtained (21-AC094).

Results

There were five participants enrolled then, one participant dropped-out. Safety: There were no unusual abdominal tensions, mood discomfort, or falls during the program. Burden was generally described as “light,” but individual records varied. Acceptability was generally high for the materials, and continuity was high for the daily yoga practice while using the materials, with four participants able to complete the program. All five participants were aware of back pain before starting the program and two at the end of the program at time 3. Pelvic pain was perceived by three of the four participants before the start and by one at the end of the study. Pain severity decreased from a mean of 40 (SD 16.7) before starting, 32 (SD 29.5) during participation, and 32 (SD 29.5) at end; Oswestry Disability Index-mean decreased from 22% before start, 20% during participation, and 14% at end; Edinburgh Postnatal Depression Scale-mean decreased from 6 points before starting, 3 points during participation, and 4 points at end.

Conclusion

This yoga program is feasible and may reduce low back and pelvic pain. Future improvements are needed to expand the number of participants to reconsider the timing of program initiation, and to increase the number of target facilities and participants.

Purpose

To clarify the components of breastfeeding clothing worn by puerperal women during postpartum hospitalization that make it easier for midwives to perform breast care.

Participants and Methods

A self-administered questionnaire was distributed to 130 midwives at five facilities in Fukuoka Prefecture, and 78 responded (60% response rate). Respondents were asked to choose among 10 different types of breastfeeding clothes―including those that help or hinder breast care worn by puerperal women who receive breast care, and breastfeeding clothes used at work. Respondents were asked to rate the 10 types of breastfeeding clothes in terms of “ease of access to the breast during breast care” on a four-point scale, and to rate 10 elements valued in breastfeeding clothes worn by hospitalized puerperal women.

Results

The breastfeeding clothes that facilitated breast care included the negligee (full front opening), pajamas (full front opening), and pajamas (yukata type). Conversely, clothes that impeded breast care by midwives consisted of four types: negligee (no front opening), pajamas (no front opening), negligee (upper front opening), and negligee (with opening for breastfeeding). Approximately 87% of midwives had experienced breast care for puerperal women wearing these types of clothes. Midwives emphasized “ease of access to the breast” and “comfort” as important elements of breastfeeding clothes worn by hospitalized puerperal women. Approximately 65% of midwives required an opening in clothes during breast care, with 92% requiring a size of 20 sq. cm or larger.

Conclusion

Three types of breastfeeding clothes aided midwives in breast care: negligees (full front opening), pajamas (full front opening), and pajamas (yukata type). Approximately 87% of midwives have provided breast care to puerperal women who wore breastfeeding clothes that impeded breast care. This shows that the design of breastfeeding clothes affects the ease of performing breast care. Approximately 65% of midwives required an opening in clothes during breast care, with 92% requiring a size of 20 sq. cm or larger. Since midwives emphasized ease of access to the breast, it became clear that they preferred a wide opening in breastfeeding clothing worn by puerperal women.

Purpose

This study aimed to determine the effectiveness of informational nursing support for nausea and vomiting of pregnancy (NVP).

Methods

An exhaustive search was performed using five databases, and experimental or quasi-experimental studies with abstracts satisfying PICO were selected. We examined the texts of the selected articles and finally selected those that met our inclusion criteria. Using Cochrane's Risk of Bias ver.2, we independently assessed risk of bias in five domains and pooled the results to assess quality. Items with differing results were discussed and final ratings were combined.

Results

A total of six papers were adopted. Subjective symptoms of NVP were measured using the Index of Nausea, Vomiting, and Retching, The Motherisk Pregnancy-Unique Quantification of Emesis and Nausea, and the Visual Analogue Scale. Quality of Life (QOL) of pregnant women was measured using Health-Related Quality of Life for Nausea and Vomiting during Pregnancy. Additionally, a paper tracked the duration of NVP. Intervention methods included telephone visits, a combination of interviews and telephone visits, lectures in small groups, and a combination of lectures and discussions. All studies included a baseline survey, followed by surveys at two and four weeks post-intervention. One paper had weekly follow-ups until NVP converged. It was suggested that nursing support, which mainly included information provision for NVP, can be expected to have a certain effect in alleviating the pain experienced by pregnant women. However, as a result of quality evaluation using Risk of Bias ver.2, all papers were rated as “high risk of bias” or “some concern.”

Conclusion

In the existing studies examining the effects of nursing support for NVP, the risk of bias was inevitable because of the nature of the intervention. Therefore, it is imperative to increase the reliability of the results by conducting randomized controlled trials, publishing the protocol prior to the start of the study, unifying scales for measuring subjective symptoms of NVP, and limiting outcome indicators to one. Furthermore, the timing of the intervention and follow-up intervals that consider the physiological changes of NVP should be considered.

Purpose

Nurses must stay close to couples if a baby is stillborn, share their thoughts, provide nursing care for stillbirths, and provide continuous nursing care to grieving parents. The purpose of this study was to develop a prototype grief care tool through which nurses can record their experiences related to the events. It will help them clarify their feelings when dealing with couples experiencing a stillbirth and providing nursing care from pregnancy to the postpartum period.

Methods

This is a qualitative descriptive study. The participants were 13 nurses (midwives/nurses) who dealt with natural or induced stillbirths after 12 weeks of pregnancy. A prototype grief care tool provided the most unusual cases of stillbirth nursing, and data were obtained through semi-structured interviews about nurses' feelings when dealing with stillbirths. The obtained data were analyzed qualitatively and inductively.

Results

Nurses' feelings about stillbirth were collated into four categories. “Sense of mission toward stillbirth nursing” was about sincerity and the sense of responsibility as a caregiver toward couples who had experienced stillbirth. In contrast, “difficulties caring for a couple with a stillborn child” dealt with difficulties in understanding and talking about the couple's feelings and anxieties about the stillbirth. Further, “inquiring minds about stillbirth nursing” was about looking back at the nursing provided, searching for better stillbirth nursing for couples, and wanting to learn more about stillbirth nursing. “Expectations for team medical care” was about being involved with couples as a team and supporting each other.

Conclusion

Midwives and nurses involved in stillbirths felt both a sense of mission in stillbirth nursing and a sense of difficulty in dealing with the parents. In addition, they looked back on their experiences in stillbirth nursing and searched for better stillbirth nursing methods. The findings suggested that using the grief care tool prototyped in this study to record the nursing experience of stillbirth will help nurses to recollect their thoughts on the couple and the stillborn at each stage of nursing. It would provide an opportunity to reflect on the nursing provided and feelings experienced, leading to an inquiry into stillbirth nursing.