Purpose

This study aimed to elucidate the current state of the quality of life (QOL) of Japanese women undergoing infertility treatment and to identify the factors affecting it.

Methods

A comprehensive literature search using keywords such as “infertility (treatment),” “infertility-female (treatment),” and “quality of life” was conducted on Ichushi web version 6, PubMed, CINAHL, and Psycinfo. Original articles meeting eligibility criteria were considered for the review, and content that described the current state of the QOL of Japanese women undergoing infertility treatment and identified factors affecting it, were extracted.

Results

Following the literature search, 13 papers were extracted, and seven types of QOL scales were used to identify factors affecting QOL of Japanese women undergoing infertility treatment. Among six sub-items selected from the FertiQOL scale, “Emotional items” and “Treatment environment items” revealed lower scores, whereas “Relational items” revealed a higher score. Discrepancies in scores for “Social functioning” were noted between SF-12 and SF-36. In one study using WHO/QOL-26, “Physical” domain indicated the lowest QOL scores, whereas another study indicated no significant differences in scores between the “Physical,” “Psychological,” “Social relationships,” and “Environment” domains. Among “Quality of life during infertility treatment scale,” “QOL related to family relationships items” recorded the highest score. Factors affecting QOL were categorized into personal factors, treatment-related factors, psychological factors, and social factors. The love and involvement of the partner and trust in infertility treatment had an impact on improving QOL.

Conclusion

To measure the QOL of Japanese women undergoing infertility treatment, several types of health-related QOL scales were used. The sub-items or domains with low and high QOL scores varied across the QOL scales. Given the finding that the love and involvement from those women's partners, and their confidence in infertility treatment improved their QOL, medical professionals should support the relationships between the women undergoing treatment and their partners, and provide respectful explanations and care to patients.

Purpose

The development and utilization of in-hospital midwifery and outpatient midwifery care have been promoted since around 2008 to address the diverse needs of pregnant women and postpartum mothers, improve the quality of care, and redistribute tasks due to the shortage and uneven distribution of obstetricians. Therefore, we conducted a literature review on the current status of in-hospital midwifery and outpatient midwifery care in Japan, assessing their safety and user satisfaction; this endeavor was aimed at further promoting in-hospital midwifery and outpatient midwifery care.

Methods

We conducted a literature review on the safety and user satisfaction of in-hospital midwifery and outpatient midwifery care in Japan over the past 10 years. We extracted 20 articles from the Japan Medical Abstracts Society Web using keywords such as “in-hospital midwifery system.” These articles were analyzed for the descriptions of the safety of in-hospital midwifery, including specific data on delivery outcomes; we also analyzed 15 articles that provided qualitative insights and satisfaction surveys from expectant mothers who had used in-hospital midwifery and outpatient midwifery care.

Results

Regarding the safety of in-hospital midwifery, the rate of medical intervention tended to be higher in the physician-controlled group than in the in-hospital midwifery group (e.g., 52.8% vs. 75.8%); however, there were no significant differences between the two groups in clinically significant delivery outcomes such as neonatal asphyxia and atonic bleeding. Satisfaction with in-hospital midwifery and outpatient midwifery care was high, exceeding 80% in both groups. Advantages highlighted by participants included feeling more relaxed and having extra time during visits, alongside increased peace of mind due to the trust established with the midwife.

Conclusion

The safety of in-hospital midwifery was not significantly different from that of non-in-hospital midwifery, and satisfaction with both in-hospital and outpatient midwifery care was consistently high. In the future, it will be necessary to collect information on the quality of midwives who are in charge of in-hospital midwifery and outpatient midwifery care, as well as on how to inform users of such services, and to study the detailed requirements for the diffusion of safe and highly satisfactory in-hospital midwifery and outpatient midwifery care.

Purpose

This study aimed to investigate the prevalence of reproductive health and rights (RHR) in Japanese people and the state of their medical experiences surrounding unplanned pregnancy.

Methods

An online questionnaire was conducted from December 2021 to January 2022, targeting Japanese men and women subjects aged 20 or above. The questionnaire content included the participant's background, knowledge of RHR and sexuality, coping behavior regarding RHR, unplanned pregnancy consultation, and medical experience of abortion. Quantitative and qualitative data were assessed via descriptive statistics and content analysis.

Results

Valid responses from 367 women and 368 men were analyzed. We found that 11.4% of women and 3.0% of men responded that they were “familiar with RHR.” Information regarding sexuality was obtained from the internet; however, 65.9% of women and 79.3% of men responded that they were unconfident or did not know whether their information about sexuality was correct. The role of midwives regarding sexual reproduction was known by 32.4% of women and 14.1% of men. A total of 30.0% of women and 24.5% of men responded that the contraception method must be determined by the women and that their desire must be respected. The decision for the woman “to give birth” was the same by the woman herself in 45.2% of cases and by the woman and her partner as a couple in 43.6% of cases. In contrast, the decision “not to give birth” was made as a couple in 48.8% of cases, while the woman herself in 24.0% of cases was low. Furthermore, 6.8% of both women and men had an abortion in the past, and 14.7% of women and 12.8% of men had received unplanned pregnancy counseling. Both men and women felt hurt by the treatment from the medical staff. They wanted the medical staff to listen to what they had to say without rejection, to have a kind attitude, and to provide accurate information.

Conclusion

RHR was not prevalent among Japanese men and women. Information regarding treatment from medical staff regarding unplanned pregnancy was unavailable in medical systems that took RHR into account. Therefore, RHR needs to be popularized, and the awareness of medical staff who protect RHR needs to be increased.

Purpose

To determine whether the “Midwifery Guidelines for Pregnant Women and Their Family” is understandable and actionable for average women and their families to clarify issues for the next revision.

Methods

From the 54 items, including question, answer, and the explanation, in the Guidelines, 19 were evaluated. Two midwives evaluated 19 of 54 items of the Guidelines using the Patient Education Materials Assessment Tool-P (PEMAT-P) on the bases of understandability and actionability. The transcription of the discussion between the midwives to reach a consensus on the PEMAT-P assessments and the data from the semi-structured interviews, conducted after the assessments, regarding the reasons for the rating were subjected to qualitative descriptive analyses. Readability was assessed using the text readability measurement system.

Results

The mean score for understandability was 77.7 (standard deviation: SD = 13.8), with 16 (84.2%) of the 19 evaluated items being above the cutoff of 70. The mean score for actionability was 39.8 (SD = 25.9), with 2 (10.5%) items above the cutoff of 70. Based on the qualitative data collected, it was found that the Guidelines should be revised as per the readiness of the readers, considering the order in which the contents appear, and adding and revising visual materials and direct actionable expressions to help readers with smooth understanding and facilitating the understanding about the actions that the readers can take. The mean score for readability was 2.3 (SD = 0.6), labeling Japanese writing of the Guidelines as difficult.

Conclusion

The Guidelines was found to be understandable; however, it was difficult level in Japanese and unactionable. When revising, it is required to use easy-to-understand Japanese following the readiness of the readers and to include direct actionable expressions to allow the readers to take action.

Purpose

The purpose of this study was to clarify the advantages and challenges of utilizing the 2012 revised version of the Maternal and Child Health Handbook (MCH Handbook), and to identify requests for the 2023 format revision from the perspectives of public health nurses, midwives, and nurses involved in maternal and child healthcare services.

Methods

The study participants were public health nurses, midwives, and nurses who utilize the MCH Handbook in maternal and child healthcare services. They were recruited via the snowball sampling method. Focus group interviews were conducted with two to five participants from each occupational field representing a “hospital,” “community,” and “municipality.” The results were qualitatively analyzed.

Results

Eleven participants―five public health nurses, five midwives, and one outpatient pediatric nurse, took part in the study. They averaged 11 ± 6.8 years of experience in maternal and child healthcare services. The hospital group consisted of four midwives; the community group comprised one midwife and one nurse; and the municipal group consisted of five public health nurses. As a result of the performed qualitative descriptive analysis of the contents of the focus group interviews, two major categories become apparent: ‘Advantages in utilizing the MCH Handbook’ and ‘Requests for the revision of the format of the MCH Handbook’. The structure of the MCH Handbook and issues related to the use of each page were classified by page number, and a table was created. Regarding the first two aforementioned categories, 7 categories and 21 subcategories were extracted. They included ‘Ease of information collection’; ‘Continuity of records after childbirth’; ‘Effective tool for guidance’; ‘Hybridization with electronic records’; ‘Effective delivery of information’; ‘Collaboration for continued use’; and ‘Handbook applicable to everyone’.

Conclusion

The information aggregation and continuity of the MCH Handbook were evaluated positively by maternal and child healthcare services. Public health nurses working for municipalities hoped for cooperation with schools to achieve continued care and use of the handbook. Expectations were that the handbook would respond to societal changes, such as the diversity of caregivers and individuality of children, and facilitate joint parenting by mothers and fathers.

Purpose

The purpose of this study was to clarify the actual situation of consultation activities for women with an unplanned or unwanted pregnancy conflict, and issues of counselors' collaboration with midwives at the Pregnancy (Ninshin) SOS consultation service.

Subjects and Methods

Surveyed were a majority (N=53) facilities nationwide with consultation services by Pregnancy SOS. A total of 318 people, including one administrator from each facility and up to five counselors, were surveyed using an anonymous web-based or questionnaire survey. The survey included 14 items for the administrators, such as business type, number of counselors, and issues of the facility, and 29 items for the counselors, such as conflicts and difficulties, and what they expected from midwives. Descriptive statistics were calculated for the quantitative data, and qualitative data were coded by semantic content and summarized into categories at a higher level of abstraction.

Results

Responses were obtained from 33 (62.0%) administrators and 84 (32.0%) counselors. The largest number of administrators was 12 (36.4%) in their 50s, and 13 (39.4%) were midwives. Issues faced by the administrators in their activities were: financial issues that included difficult to secure stable funding; human resource issues included difficult to ensure counseling quality and lack of human resources, and other issues included loss of support and difficulty in well-known activities. The average age of the counselors was 52, and the average experience of working with Pregnancy SOS was 3.9 years. The counselors' conflicts and difficulties included challenges in establishing a system of cooperation with other facilities and barriers to continuing effective support activities. Requests for cooperation from other midwives and obstetric medical institutions included establishment and expansion of a close and flexible cooperation system and involvement and flexible response by understanding the people concerned.

Conclusion

There were various challenges noted by administrators and counselors in continuing the activities of the hot-line service “Pregnancy SOS” such as financial issues, secure human resource, and the way to collaborate with other facilities. Counselors had difficulties with: support and collaboration, because they faced a wide variety of support for consulters with diverse backgrounds, establishing a system of collaboration to solve the problems of consulters, barriers to providing effective support, evaluating consultation responses and the psychological burden of responding to consultations. They also asked midwives and obstetric medical institutions to: review their collaboration and response to consulters, participate in consultation activities, and promote sex education.

Purpose

Multiparas characteristically spend their entire pregnancies caring for their older child(ren) and have past pregnancy experiences. This study aimed to clarify how caring for older child(ren) and past pregnancy experiences affect prenatal lifestyle behaviors in multiparous women. Lifestyle behaviors were defined as those related to physical activity and dietary habits.

Methods

Online semi-structured interviews were conducted between 2021 and 2022 with 17 multiparas who were 2–3 months postpartum. Participants were recruited from a prospective cohort study of perinatal life in three districts of Japan. The interview participants were asked about their lifestyle behaviors during pregnancy and their underlying thoughts related to lifestyle. The interview data were analyzed inductively using a qualitative descriptive approach. This study was approved by the Ethics Committee of the University of Tokyo.

Results

Nineteen codes, ten subcategories, and five categories were extracted. Participants tried to [continue the pre-pregnancy life activities during pregnancy, considering the care of the older child(ren) to be the center of their lives] in terms of their dietary habits and outgoing behaviors. In addition, they attempted to [perform minimal household chores and physical activities related to the care of the older child(ren) despite having symptoms of nausea and vomiting in pregnancy and threatened premature labor]. They also experienced [passively decreased physical activity and dietary intake due to the care of the older child(ren) itself and the support of the husband and older child(ren)]. Those who had experienced falls and excessive weight gain during past pregnancies tried to [live carefully to ensure a healthy pregnancy process this time based on their experiences and risks in past pregnancies]. They also tried to [consciously implement what they had done to prevent health problems in their past pregnancies for better outcomes of this pregnancy] based on the knowledge gained and guidance received from their healthcare providers during past pregnancies.

Conclusion

Multiparas had different attitudes and experiences regarding their physical activity and dietary habits during pregnancy than first-time mothers due to the presence of older child(ren) and past pregnancy experiences, which varied depending on the age of the older child(ren), childcare situation, and risks of previous pregnancies. When providing health guidance regarding lifestyle adjustments during pregnancy, it is necessary to consider the childcare situation for older child(ren) and past pregnancy experiences.

Purpose

This study aimed to describe the relationships of dietary behaviors, nutrient intake, and perinatal outcomes with the degree of maternal-fetal attachment in the third trimester of pregnancy.

Methods

This was a secondary analysis of 163 patients who underwent regular health checkups from the first trimester of pregnancy to 1 month postpartum. Participants answered the Prenatal Attachment Inventory (PAI), the Brief-Type Self-Administered Diet History Questionnaires, and a self-administered questionnaire about their dietary behaviors and health status in the third-trimester health check-up. The PAI scores in the third trimester were classified into three groups: low, medium, and high to ensure equal number of participants in each group, and Fisher's exact test and one-way ANOVA were used. Subsequently, an analysis of covariance was performed by adjusting for age, parity, and pre-pregnancy Body Mass Index (BMI) as covariates. The polynomial contrast subcommand estimated the linear trends across the PAI categories.

Results

The analysis included 123 pregnant women (43 primipara (35.0%) and 80 multipara (65.0%)) with a mean age of 31.3±4.4 and a mean PAI score of 60.6±11.9 in the third trimester (valid response rate=77.4%). There were 37 (86.0%) in the low group, 39 (92.9%) in the medium group, and 38 (100.0%) in the high group who recognized their physical condition as “better.” The group with higher attachment awareness tended to consider themselves to be healthier (P=0.06). The estimated marginal mean energy intake in the lower, medium, and higher attachment groups were 1472.9±51.3 kcal, 1505.3±51.7, and 1443.1±54.2 kcal, respectively, after adjusting for age, parity, and pre-pregnant BMI. None of the groups met Japanese dietary standards for energy intake. Moreover, the estimated marginal mean birth weights in the lower, medium, and higher groups were 3013.0±48.8 g, 3105.7±49.2 g, and 2940.3±51.5 g, respectively, indicating a significant inverse U-shaped association between the three attachment groups (P=0.04).

Conclusion

The stronger the maternal-fetal attachment, the more aware mothers are of their own health, however, the participants did not meet the recommended nutritional intake standards, indicating a discrepancy between awareness of practicing desirable health behaviors and the nutritional intake status of pregnant women. Midwives need to be aware of this discrepancy and provide health guidance to pregnant women who express stronger attachment.

Purpose

This study aimed to determine the effective swaddling methods for stabilizing premature infants during transition.

Methods

The study included 12 premature infants during the transition period following admission to the NICU/GCU, with parental consent. The following data were collected: physiological indicators (heart rate, breathing rate, oxygen saturation), and a behavioral indicator (frowning behavior). Data was collected at rest and up to 20 minutes after nursing care. Evaluations were made at rest and at “0 to less than 5 minutes”, “5 to less than 10 minutes”, “10 to less than 15 minutes”, and “15 to less than 20 minutes”. Repeated measures analysis of variance were performed to reveal the effect of swaddling on the stability of premature infants. Furthermore, the Mann-Whitney U test was conducted to compare our findings to swaddling methods as defined in the literature to identify the differences.

Results

After nursing care, swaddling was carried out in 48 situations, and the effect of swaddling on stability was shown by heart rates that were significantly closer to the resting heart rate (p<0.001). Stability did not differ significantly between those who were compliant or noncompliant with swaddling. However, when comparing the swaddling method, the “upper limb restriction group” showed more “frowning behavior” than the “no upper limb restriction group” at 0 to less than 5 minutes after care (p=0.040) and 10 to less than 15 minutes after care (p=0.024).

Conclusion

The effect of swaddling of premature infants during transition was shown by heart rates that were significantly closer to the resting heart rate. The swaddling method without restriction of the upper limbs was also suggested to be effective in stabilizing infants.

Objective

In 2012, the Mother and Child Health Handbook was revised, which resulted in the expansion of the Relevant Personal Data field. This study aims to identify the context and reasons why pregnant women left this field blank during pregnancy, and explore the factors that contributed to its incompleteness.

Subjects and Methods

This study interviewed three mothers who visited Maternity Clinic A, which is not involved in childbirth services, and who left at least half of the sections in the Relevant Personal Data field of the Mother and Child Health Handbook incomplete within three to four months postpartum. The study was explained to the participants using a research request document, and written consent was obtained. In compliance with ethical principles, the participants were invited to talk about the factors that contributed to the incomplete Relevant Personal Data field using an interview guide. Each participant interview lasted approximately 30 minutes, was recorded using an IC recorder, and was analyzed qualitatively and descriptively. Furthermore, this study was conducted in accordance with approval obtained from the Research Ethics Committee of Fukuoka Prefectural University, in line with ethical considerations.

Results

The analysis revealed that the following factors contributed to the incompleteness of the Relevant Personal Data field: insufficient intervention from maternal and child health practitioners, mothers’ lack of understanding of the content of the handbook, busyness due to work, uneventful pregnancy progress, selective recording of information for transmission, and utilization of tools other than the handbook.

Conclusion

Semi-structured interviews were conducted with mothers to investigate the factors that contributed to the incomplete Relevant Personal Data field of the Mother and Child Health Handbook. The analysis revealed six factors that led to incompleteness. These findings underscore the importance of intervention by healthcare professionals when the handbook is issued and during prenatal check-ups, and consideration of the confidentiality of personal information when referring to the Relevant Personal Data field. If this field is utilized more, the information recorded can be used for the early detection of and intervention for high-risk pregnant women. Nevertheless, even if the information is recorded in the field, it may still be insufficient, thereby highlighting the need to create an environment in which pregnant women can readily consult with midwives. Furthermore, in Japan, there is a demand for a handbook that can cater to diverse needs. This suggests the necessity for interdisciplinary collaboration among midwives, public health nurses, and other healthcare professionals to assess the content of and approach to the handbook.

Purpose

This study aimed to elucidate the operational characteristics of maternity homes in Prefecture A, where the number of such facilities is increasing, with the goal of contributing to the sustainability and development of maternity homes in Japan.

Methods

This study targeted six midwives, who are either founders or representatives of maternity homes in Prefecture A. We conducted semi-structured interviews to gather information on the current situation and challenges in the operation of maternity homes. Through participant narratives, distinctive features of maternity homes in Prefecture A were identified. Based on this, solutions to ensure the continued sustainability and development of maternity homes in Japan are proposed.

Results

The characteristics of maternity homes in A Prefecture include “Various operating structures” depending on the areas. First, there is a publicly operated maternity home in Prefecture A. Additionally, among privately owned maternity homes, there are two patterns: those managed by multiple midwives handling several deliveries, and those run by individual midwives collaborating to manage deliveries in the community. The background for the establishment of diverse operational structures was influenced by the centralization of birthing facilities in certain areas. Furthermore, in areas affected by centralization, there were instances of women raising their voices to secure birthing places. The contractual relationships between maternity homes and back-up obstetricians/medical institutions were generally satisfactory，with only few regions facing challenges in securing contracts. There is one region where the prefectural midwives' association had contracts with appointed medical institution, in the vicinity. It has become clear that challenges for the survive and development of maternity homes include the training of practicing midwives and financial issues.

Conclusion

For maternity homes to survive and thrive in the future, it is essential to understand the needs of mothers, promote collaboration among midwives, and collaborate with healthcare institutions and authorities to establish maternity homes tailored to the perinatal healthcare system of the respective the areas.