Purpose

This study aimed to determine the factors associated with excessive crying (EC) and its effects on mothers and infants, based on the results of recent studies on EC, and to obtain suggestions for future research.

Methods

A literature review was conducted for studies written in Japanese or English from 2013 to 2023. A search was conducted in PubMed using the following: “(excessive crying OR infant colic) AND related factor.” No keywords corresponded to EC in Japanese; thus, a search was attempted in Ichushi-Web using keywords related to infant crying. Consequently, a total of 17 papers were analyzed. Factors for EC and its effects on mothers and infants were extracted from these references.

Results

Some differences in the definition and measurement of EC were observed in the studies. Factors that increased the risk of EC were maternal anxiety disorders before and during pregnancy, gender-based household maltreatment during the perinatal period, preterm delivery, fussy/difficult infant temperament, and antibiotic use during the neonatal period. Conversely, factors that reduced the risk included higher social support and relationship well-being during pregnancy and postpartum, and higher partner involvement in the newborn's care. When EC was evident, the risk of maternal anxiety, postpartum depression, and parenting stress increased. Children who cried excessively in infancy were also at a higher risk of behavior and mood problems in early childhood.

Conclusions

Risk factors for EC and its effects on mothers and infants were identified. Future research is needed to investigate the causal relationship between the factors that significantly differed in the presence or absence of EC, and clarify the cause of the relationship between depression and anxiety and EC. Investigating the lived experience of EC in Japan and considering appropriate interventions is also necessary.

Purpose

This study aimed to clarify and establish a midwife's judgment index of fetal head movement during the third rotational movement and contribute to the education of novice midwives and midwifery research.

Methods

The subjects were 14 advanced midwives or midwives with equivalent years of work experience and number of deliveries. They were asked to cooperate in the study using the kinship method. The subjects were asked to assist in delivery using two delivery simulators and select the simulator with a higher reproducibility of the third rotational movement. The subjects were then interviewed using semi-structured interviews regarding their reasons for selecting the simulators and how they judged the third rotational movement in the delivery. After obtaining their consent, we recorded the interview data using an IC recorder and made a verbatim transcript of the recorded data, from which we extracted data related to their judgment of the third rotational movement. The extracted data were categorized according to their similarity in semantic content. This study was conducted with the approval of the Okayama University Department of Medical Sciences Clinical Research Review Expert Committee.

Results

All of the study subjects indicated that the simulator with better reproducibility was the Sophie and Sophie's Mum Birth Simulator 4.0. (MODEL-med^®). The verbatim record of the indicators of occipital node slippage was analyzed, paying attention to the time of delivery. Consequently, 11 indicators were extracted and categorized as “before,” “during,” and “after” occipital tubercle slippage. They were as follows: before occipital tubercle slippage, the midwife “feel the roundness of the infant's head”, “palpate the strong infant's counter flexion pressure”, and “the perineum has room to extend to the occipital tuberosity glides off”; during occipital tuberosity slippage, “the infant's head can be grasped with the entire palm of the caregiver's hand”, “the caregiver can feel changes in the shape of the infant's head and delivery pressure in the caregiver's finger joints”, “the infant's forehead can be seen”, “the balance between caregiver pressure and infant anteflexion pressure changes”, and “the perineum changes as the limits are approached”; and after occipital tuberosity slippage “roundness of the infant's head becomes unfeasible to palpate”, “direction of delivery of the infant's head changes from horizontal to vertical”, and “perineum is restored” were applicable.

Conclusion

Eleven categories were extracted as judgment indicators of the third rotational movement. The three categories of indicators along the progression of the third rotational movement made it possible to specify which indicators were present before and after the infant's occipital-temporal node slipped.

Objective

This study was to identify which situations fathers who are raising children experience difficulties from pregnancy to the childcare period.

Subjects and Methods

Group interviews were conducted with fathers of children aged 6 years or younger. The transcripts were qualitatively analyzed to identify codes, subcategories, and overarching categories of experiences.

Results

The study involved nine fathers actively involved in caring for their infants and young children. During the pregnancy stage, they [struggled to understand the physical changes and associated coping mechanisms affecting their pregnant partners]. They felt that the [lifestyle adjustments necessitated by their wives' pregnancies were burdensome] and often found themselves [suppressing their own feelings to accommodate their wives' emotional fluctuations]. They also expressed [frustration with societal expectations that did not allow them to prioritize family life]. Throughout the childbirth period, they experienced [anxiety about the safe delivery of their child] and searched for ways to [fulfill the roles expected of them as husbands] while also [juggling household responsibilities and work in anticipation of the childbirth]. During the child-rearing period, they [strove to engage with childcare task], [perform housework and childcare, but it backfires], and managed [the burden of balancing work with family life]. They also had to [navigate the changes in family relationships and the increased need for attentiveness as their lifestyles evolved].

Conclusion

The nine fathers actively engaged in child-rearing struggle to understand the physical changes their partners experience during pregnancy as well as how to cope with them. They find the lifestyle adjustments necessitated by their wives' pregnancies to be burdensome, and they suppress their own feelings in order to accommodate their wives' emotional fluctuations. Regarding the childbirth and child-rearing periods, the findings align with previous research. During childbirth, they experience anxiety until the child is born and search for ways to fulfill the roles expected of them by their wives, attending the birth while feeling perplexed and helpless. During the child-rearing phase, they must adapt to changes in their lifestyle and family relationships, tackle childcare tasks they find difficult, and remain attuned to their wives' emotional states.

Objective

This study aimed to clarify concepts based on elements that constitute parental readiness during pregnancy in primigravid women requiring long-term hospitalization due to medically high-risk pregnancy and their husbands, and to determine the direction of support.

Participants and Methods

Semi-structured interviews were conducted with primigravid women aged 20–40 years at ≥22 to <34 weeks of pregnancy, who were diagnosed with medically high-risk pregnancy due to maternal factors requiring hospitalization and treatment, as well as their husbands. Using the Steps for Coding and Theorization (SCAT) method, we extracted from the data themes and constructs relating to parental readiness in primigravid women and their husbands. Following qualitative descriptive analysis by further stratification of these, conceptualization of parental readiness was performed.

Results

A total of 17 participants, including 6 pairs of primigravid women who were all diagnosed with threatened premature labor as the chief complaint and their husbands (12 participants) and 5 primigravid women who alone provided consent, were enrolled in this study. Stratification of the themes and constructs for the 11 primigravid women and 6 husbands led to the extraction of 34 and 29 elements, respectively. Furthermore, as a result of stratification of each element, 8 concepts were extracted from primigravid women (e.g., [acceptance of pregnancy as the foundation for becoming a parent]) and 7 concepts were extracted from husbands (e.g., [mutual marital relationship with shared significance]). By focusing on the characteristics, commonalities, similarities, and differences of the concepts from primigravid women and their husbands, 7 directions of support were derived, including “acceptance of pregnancy can be shared,” “mutual marital relationship can be constructed,” “realization of the presence of the fetus can be shared between husband and wife,” “image of becoming parents can be enriched and shared between husband and wife,” “side effects of hospitalization for becoming parents can be alleviated,” “gap between husband and wife about becoming parents can be eliminated,” and “the burden of becoming parents can be eliminated.”

Conclusions

The concepts of parental readiness during pregnancy in primigravid women whose pregnancy became medically high-risk and their husbands could be determined from elements extracted by stratifying each of the themes and constructs of parental readiness. Moreover, by focusing on concepts that were similar, common, and different between primigravid women and their husbands, seven directions of support to accompany the transition to parenthood aligning with the background of participants were derived. In the future, determining whether or not primigravid women and their husbands are transitioning to parenthood along these directions will help facilitate a review of whether the support is unsatisfactory or situational.

Objectives

This study aimed to test the reliability and validity of a 50-item version of the Quality of Life (QOL) Scale for Pregnant Japanese Women.

Subjects and methods

An anonymous, self-administered questionnaire survey was conducted on Japanese pregnant women visiting for their pregnancy checkup in October 2021–March 2022. The main items were the original QOL Scale for Pregnant Japanese Women developed by the authors (50-item version), the WHOQOL-26, and the effects of COVID-19 on their pregnancy life. SPSS and AMOS were used for the statistical analysis, including item and exploratory factor analyses, calculation of reliability coefficients, verification of the suitability of factor structure models, a correlation analysis between existing scales and the new scale, and comparison of scores to known populations.

Results

The data of 541 women (valid response rate 69.0%) aged 31.5 ± 4.9 years and 24.6 ± 9.0 weeks of gestation was included in the analysis. Four items were deleted through the item analysis, and nine items with factor loadings <0.4 were deleted through the exploratory factor analysis. The questionnaire consisted of 9 factors and 37 items, with the number of questions per factor ranging from 2 to 8. The Cronbach's α coefficient for the scale overall was α=0.918, and each factor, α=0.708–0.902, confirmed good internal consistency. An analysis of the suitability of the factor structure model showed generally good results, with GFI=0.824, AGFI=0.791, CFI=0.859, and RMSEA=0.067. The scale had a correlation r of 0.817 compared to the WHOQOL-26, confirming concurrent validity. Based on previous studies, we compared scores in terms of the impact of COVID-19 on pregnancy and found that those who felt the impact had lower QOL scores than those who did not, confirming known group validity.

Conclusions

The 9-factor, 37-item QOL Scale for Pregnant Japanese Women was shown to have good reliability and validity, warranting future studies to continue investigating its clinical usefulness to make the scale easier to use in practice.

Objective

This study aimed to explore midwives' attitudes and perceptions regarding induced abortion as well as the pain they experienced when providing care.

Subjects and Methods

A self-administered, anonymous questionnaire survey of midwives in 11 prefectures in Japan was conducted between March and September 2022. The questionnaire included questions about their backgrounds, experience of abortion care, attitudes toward hypothetical clinical scenarios, perceptions regarding induced abortion, and pain experienced during care. The chi-square test was used for the analysis, and intergroup comparisons were made when significant differences were found.

Results

A total of 571 responses to the questionnaire were collected, and 563 sets were included in the analysis. In terms of age, 28.1% of the respondents were in their 40s. The largest proportion (41.7%) of the respondents was accounted for by midwives certified 21 or more years ago. More than half of the respondents (55.4%) had provided birth assistance in 201 or more deliveries. At the time of the survey, 67.5% and 14.6% of the respondents worked in hospitals and clinics, respectively. Of the respondents, 63.1% had studied reproductive health/rights, and 74.1% had studied abortion care. From the first year of employment, 53.6% had provided first-trimester abortion care, and 36.6% provided second-trimester abortion care. As for midwives' attitudes toward hypothetical clinical scenarios, the respondents were less accepting and empathetic in cases of high school students repeating abortion due to unrestrained sexual activity and in cases of choosing abortion because correctable congenital malformations were found. Furthermore, 32.5% of the respondents answered that abortion is “a right of women/both women and men,” while 55.1% answered that “I can be neither affirmative nor negative because it depends on the situation.” During abortion care, 96.0% of the respondents felt that it was “painful,” with the most common reason being painfulness for caring about the woman, followed by painfulness for caring about the fetus and painfulness for caring about the midwife herself.

Conclusion

Midwives' attitudes and awareness toward induced abortion as well as the pain they experienced when providing care, suggest that the quality enhancement of induced abortion care in Japan requires improvements in basic midwifery education, training and the support environment to ensure that midwives' personal beliefs are respected.

Purpose

To determine the effects of milking stimulation early in the postpartum period for mothers who have delivered late preterm or slightly underweight newborns who are expected to be weak feeders, and managed in the obstetric unit.

Methods

A historical-controlled study was conducted to examine the effects of the intervention. Participants were 36-week preterm or full-term infants whose birth weight was less than the 30th percentile of their period-of-birth weight, and their mothers. The intervention group underwent milking stimulation with an electronic pump once on the day of delivery and four times a day following the postpartum day, before or after direct breastfeeding. Comparisons between the intervention and control groups were analyzed using propensity scores, and feeding methods used were categorized as main breastfeeding and formula milk to allow for comparative analysis.

Results

There were 40 participants in the intervention group and 64 in the control group. Artificial milk supplementation on the third postpartum day was significantly lower in the intervention group (−38 mL; 95% confidence interval [−67, −10], p=.008). The intervention group was 2.88-fold more likely than the control group to use main breastfeeding as the primary source of nutrition for their infants at the time of hospital discharge (95%CI [1.18, 7.03], p=.02).

Conclusion

The early milking stimulation intervention was found to significantly reduce the amount of formula milk supplementation required on the third postpartum day. Although the newborns in this study had less ability to suckle milk during breastfeeding, it was inferred that milking stimulation led to a greater natural milk production mechanism.

Objective

The objective of this study is to clarify the practice contents considered by skilled nurses (nurses and midwives) as “comfortable” care in the field of maternal nursing.

Subjects and Methods

Semi-structured interviews were conducted with seven skilled nurses (2 nurses and 5 midwives) with more than 6-7 years of clinical experience in perinatal nursing within the field of maternal nursing, and the data were analyzed qualitatively and descriptively.

Results

The characteristics of the practice contents considered by skilled nurses as “comfortable” care consisted of three core categories: [“Reducing physical and mental suffering” by being ‘on hand’ as a professional during the perinatal period], [“Supporting decision-making” regarding self-care throughout the perinatal period], and [“Adjusting the environment” with respect for human naturalness and ordinariness].

Conclusion

The results suggest that skilled nurses, equipped with specialized knowledge, skills, and attitudes, are able to create “comfortable” care continuously during the perinatal period by being by the side of women and their families throughout the perinatal period and by aiming to provide physical and mental comfort while looking ahead. It was also suggested that by respecting the “naturalness” and “individuality” of the daily lives of women, children, and families, it is possible to support them in realizing their innate abilities, such as their ability to care for themselves and make decisions, and ultimately provide excellent care that only skilled nursing can provide, with the intention of achieving physical and mental comfort.

Purpose

The purpose of this study was to clarify the educational practices employed by clinical instructors in order to increase the self-efficacy of midwifery students during childbirth care training.

Methods

Semi-structured interviews were conducted with 8 clinical instructors who were certified as Clinical Ladder level III and had training experience in childbirth care, and the results were analyzed using the KJ method.

Results

The educational practices employed by clinical instructors in order to increase the self-efficacy of midwifery students in the delivery of care consisted of 8 elements. Clinical instructors first perform “To determine the care that a student can provide to an obstetric patient, obtain information about the student” and, at the same time they also perform “Need to continually make decisions necessary to care for maternity patients from pre- to post-care”. Based on these results, they afterward perform “Guide the student to set achievable behavioral goals”, “Before the student provides care to an obstetric patient, the clinical instructor first demonstrates the care”, “Allowing students take care of pregnant women as much as possible”, and “Undertake a ‘review’ to clarify and make students aware of what they could accomplish during the care”. These educational practices convert into a circular structure and provide feedback for “Need to continually make decisions necessary to care for maternity patients from pre- to post-care”. On the other hand, in order to allow midwifery students gain real-world experience with patients in labor, clinical instructors also perform “Building relationships with women in labor”. Furthermore, the clinical instructors' belief regarding “Recognize the student as an individual and engage with them in a way that allows them to feel that the pursuit of a career as a midwife was a worthwhile decision during their practical training” influences the entire educational practice to increase the self-efficacy of midwifery students.

Conclusion

In order to increase student self-efficacy, clinical instructors demonstrated a strong commitment to fostering self-efficacy in students and nurturing junior midwives. Amid the ever-changing dynamics of labor, they consistently made the necessary decisions in a timely manner while determining the maternal care that students could provide. They encouraged students to carry out the appropriate care as far as possible and practiced an educational approach that helped students recognize and acknowledge what they were able to accomplish.

Purpose

Research on perinatal practices of midwives is limited, particularly in cases where female victims of intimate partner violence (IPV) cohabiting with their partners do not voluntarily seek help. Through interviews with midwives experienced in handling IPV cases in medical settings, this study explored strategies that midwives use to support these women.

Methods

The study included midwives working in medical facilities involved in perinatal IPV victim support or those with structured IPV-focused practices. A qualitative descriptive research design was used, conducting semi-structured online interviews. Verbatim transcripts were coded and abstracted to focus on the characteristics of women experiencing IPV without seeking help and their families, and the corresponding midwifery practices. Codes were analyzed for similarities and differences to generate subcategories and categories. The study received approval from the research ethics committees of Kobe Women’s University and Kobe Tokiwa University.

Results

Seven midwives from three medical facilities participated in the study. Three categories were identified describing the characteristics of women experiencing IPV without seeking help and their families: “inability to recognize IPV as an issue”, “resistance to interventions disrupting family balance”, and “children at risk in closed domestic environments”. Six categories describing practices to support such women emerged. Midwives need: “to be certain to accumulate evidence based on signs of concern”, even if the woman does not ask for help voluntarily; to be able to understand a couple's relationship by “engaging in repeated in-depth questioning again and again throughout the course of maternity care”; “to help women recognize IPV and how to signal for help”, and “to assess a couple's ability to care safely for children”. Furthermore, midwives should not only “ensure that support relationships and care are handed down to the community” but also try to “Creating an in-hospital system to maintain connections with families even after they are discharged”.

Conclusion

Although continued cohabitation with the husband poses a high risk of child abuse, women often do not recognize IPV as a problem and resist home interventions. In this situation, midwives applied the following practices. They used IPV screening as a communication tool to discuss marital relationships, and identified IPV by focusing on the marital relationship in various maternity care settings. They fostered trusting relationships with women and created a safe environment in which to talk, using a trauma-informed approach to encourage women to confide their experiences of IPV while also taking into consideration the effects of trauma and creating a sensitive and tactful context. They instructed women in how to signal for help and informed them about how hospitals and public health nurses can serve as a source of support and how hospitals will provide different forms of care. They provided information to public health nurses to assist their assessment of parents' readiness and specific challenges as part of their provision of targeted care. Midwives also assisted public health nurses in nurturing the couple's motivation to receive community support, and promoted the development of a relationship between the couple and public health nurses. In other words, it is important for midwives to assess the couple's relationship, encourage women to acknowledge IPV and seek help, and ensure collaboration with to connect support systems, enabling couples to safely raise their children.

Purpose

This study aimed to verify the reliability and validity of the Japanese version of Paternal Involvement with Infant Scale (PIWIS-J) based on the PIWIS, a 35-item, 5-factor developed in the United States.

Methods

This study was conducted on fathers caring for their infants, using an online questionnaire. Participants were recruited from fathers who came to a hospital in Kansai region for a one-month postpartum checkup for their partner/wife and from a website providing childcare information between July and December 2023. A portion of the participants was retested on the PIWIS-J two weeks later. An exploratory factor analysis was conducted to test construct validity. To verify the reliability, the intraclass correlation coefficient (ICC) and Cronbach's alpha were calculated. Criterion-related validity was tested using the Multidimensional Scale of Perceived Social Support (MSPSS) and the Japanese version of the Coparenting Relationship Scale (CRS-J).

Results

Data from 72 and 177 participants were analyzed for reliability and validity testing, respectively. Exploratory factor analysis confirmed that the PIWIS-J has a 29-item, 4-factor structure. ICC was 0.80 and Cronbach's alpha was 0.90. The criterion-related validity results showed that the correlation coefficients between the PIWIS-J and the MSPSS and CRS-J were 0.28 and 0.28, respectively.

Conclusion

The reliability and validity of the PIWIS-J have been confirmed in fathers caring for infants. The PIWIS-J would be useful in studying paternal involvement in infant care and its effects on mothers, infants, and fathers.

Aim

This study aimed to develop a Japanese version of the Neonatal Infant Pain Scale (NIPS) and evaluate its reliability and validity.

Methods

After the Japanese version of NIPS was created through translation and back-translation, the researchers assessed neonates' behavior during adhesive removal. Additionally, two observers watched a video from before to after the adhesive removal and evaluated the neonates' behavior at three-time points, such as “before,” “during,” and “after” adhesive removal. For construct validity assessment, total NIPS scores at the three time points were compared using the Friedman test. Internal reliability was confirmed by calculating Cronbach's alpha and item-to-item correlations and adjusted item-total correlations for the NIPS at the three time points.

Results

The total NIPS scores at three-time points (χ²=48.04, df=2, p<.001) had a significant difference, and total scores were high when pain procedures were implemented, confirming construct validity. Intraclass correlation coefficients of the total NIPS scores between researchers and observers were r=0.72 (p<.001), which confirmed inter-rater reliability. Cronbach's alphas for the NIPS “before,” “during,” and “after” adhesive removal were 0.95, 0.86, and 0.94, respectively. Correlation coefficients for the inter-item correlations ranged from 0.60–1.00 for “before,” 0.39–0.79 for “during,” and 0.65–0.94 for “after.” Adjusted item-total correlations ranged from 0.71–0.92 “before,” 0.61–0.80 for “during,” and 0.72–0.88 for “after.” These results confirm the internal reliability of NIPS.

Conclusion

The reliability and validity of the Japanese version of NIPS were confirmed. Japanese medical staff may assess a neonate's pain during medical procedures using the NIPS. Future use of NIPS will be widely expected in many situations with neonates, including in the neonatal unit of the obstetrics department beyond use in the NICU.

Purpose

Knowing the dietary behavior for obese women and those with excessive weight gain during pregnancy may facilitate better gestational weight management. We aimed to determine the dietary behavior characteristics of pregnant women with pre-pregnancy obesity and excessive weight gain.

Methods

Following term singleton deliveries, 238 mothers completed a 24-item dietary behavior questionnaire (DBQ) to identify causes of excessive weight gain during pregnancy concerning misperceptions and regrets concerning weight gain, eating quickly without chewing well, uneven taste preferences when eating out or at restaurants, worries about running out of food, worries about running out of fruit and vegetables, eating fruit and sweets when available, and reluctance to leaving food on their plate. Pre-pregnancy body mass index (BMI) was divided into thin, normal, moderately overweight, and severely overweight categories. Using Japanese Society of Obstetrics and Gynecology Weight Gain Guidelines, weight gain during pregnancy was classified as exceeding recommended or within recommended limits. Student's t-, one-way analysis of variance, and multiple comparison tests were used to determine associations between each group and the DBQ scores.

Results

Of 218 (99.0%) valid responses, women with class 1 and 2 obesity scored significantly higher than women in thin and normal weight groups regarding misperceptions and regrets concerning weight gain and reluctance to leave food on their plate (class 1 obese vs. thin group, p < 0.01; class 2 obese vs. thin group, p < 0.01). Women with class 2 obesity scored significantly higher than the other groups in eating quickly without chewing well and uneven taste preferences when eating out or at restaurants, respectively (p < 0.01). In the exceeding recommended weight gain group, scores were significantly higher for misperceptions and regrets concerning weight gain and reluctance to leave food on their plate (p < 0.0001 and p < 0.001, respectively).

Conclusion

The eating behavior characteristics of pregnant women with obesity or excessive weight gain have been clarified. Pregnant women with class 2 obesity tend to eat quickly without chewing thoroughly and show a preference for certain tastes. These findings suggest that assessing eating behavior during pregnancy could lead to better guidance on appropriate weight gain.

Objective

The public postpartum care services (sango kea jigyou), was designed for use by mothers and their babies and excluded the use by only mothers. However, over time the Japanese government began to encourage municipalities to allow mothers exclusive use of the services. Unfortunately, this service has not been widely implemented. Therefor the purpose of this study was to identify facilitators and barriers to implementing the public postpartum care services exclusively for mothers.

Methods

This was a qualitative descriptive study. Participants were recruited from directors of midwifery birth centers and nurse managers of obstetrics and gynecology at postpartum care service facilities commissioned by the Tokyo Metropolitan Government. They all had experience accepting users of the postpartum care services exclusively for mothers. Semi-structured interviews provided data and were analyzed based on the Consolidated Framework for Implementation Research (CFIR).

Results

Participants (N=6) were from midwifery birth centers. Nine facilitators and seven barriers were identified across the four domains and ten constructs of CFIR. Facilitators related to the characteristics of the ‘innovation’ included the fact that “financial aid reduces the economic burden on users compared to other support methods.” Barriers included “the use of postpartum care services exclusively for mothers does not meet the usage criteria of municipalities.” Facilitators related to the ‘outer setting’ included “close coordination with municipalities on a daily basis,” while barriers included “the lack of a system to support mothers who cannot care for their infants with diverse needs through multidisciplinary teams”. Facilitators related to the ‘inner setting’ included “providing care that respects the diverse needs of mothers.” ‘Individual-level’ facilitators included “midwives at postpartum care service facilities understand the purpose of related laws and policies and have the ability to negotiate with municipalities,” while barriers included “feelings such as not knowing what to do during support arise.”

Conclusion

Nine facilitators and seven barriers were identified across the four domains and ten constructs of CFIR. In order to comprehensively identify facilitators and barriers, it is necessary to also survey users and stakeholders.

Objective

To elucidate the meaning of the midwifery practice of “being present” (soba ni iru) during perinatal grief care.

Subjects and Methods

Midwives with at least 5 years of experience in maternity wards were asked to recall a scene of “being present” in their practice and were interviewed using a non-structured format. Data were analyzed using Benner's interpretive phenomenological approach.

Results

The research participants consisted of eight midwives with 6 to 24 years of experience. Four themes emerged as the meaning of the midwifery practice of “being present” in perinatal grief care: 1. Preserving Authenticity: “Being present” meant accepting the bereaved mother without judgment. Rather than trying to elicit her thoughts, the midwives prioritized accompanying the mother on her emotional journey. They sought to blend into the environment, essentially erasing their own presence. 2. Protecting Overflowing Emotions: By “being present” with the mother, midwives built a relationship of mutual understanding. This presence created a space where the mother could express her deepest emotions, with midwives providing constant support by accepting every feeling that welled forth. 3. Honoring Life and Its Beginnings: The midwives believed that both the mother and her child were precious, regardless of whether the child survived. By compassionately “being present,” they sought to convey that the child's life remained significant and connected to the future, even in death. 4. Affirming the Deceased Infants' Existence: The midwives recognized that society often struggles to comprehend the depth of a mother's grief after perinatal loss. By “being present” with the mother, the midwives etched her experiences and emotions in their memory, affirming the existence of the deceased infant. This played an important role in the mother's grieving process.

Conclusion

The practice of presence in perinatal grief care was seen as a means to honor the mother's true self and affirm the value of the life that existed, supporting her path forward.

Purpose

This study aims to summarize the effects of foot baths in pregnant women and women in labor and to summarize existing studies published in Japan and abroad.

Methods

In December 2023, we searched the web version of the Japan Medical Abstracts Society (Ichushi-Web), PubMed, and CINAHL, using the keywords “foot bath,” “pregnant woman,” and “pregnancy woman,” and 11 articles (8 in Japanese and 3 in English) were included in the analysis. Information on study design, subjects, intervention methods, evaluation methods of the intervention, and effectiveness were extracted.

Results

Six studies targeted pregnant women, while five targeted women in labor. In the majority of the studies, 40°C for 15 minutes, a depth of 15 cm, and a degree of immersion to soak the Three Yin intercourse were used as the foot bath method. Foot bath use in pregnant women led to a reduction in minor problems such as stiff shoulders, insomnia, and lower back pain, as well as a relaxation effect (subjective and psychological effects such as comfort and anxiety reduction). The effects of foot baths on women in labor were an “increase in the number of labor pains,” “shortening of the interval between labor,” “extension of the duration of labor,” “relaxation,” and “relief from childbirth pain.”

Conclusion

Relaxation effect and the possibility of reducing minor problems during pregnancy were the major effects of foot baths on pregnant women. Further, foot bath use may have a relaxation effect, a labor promotion effect, and a labor pain relief effect for women in labor. However, the results cannot be generalized because the assessment methods relied on subjective measures, and the study design was not a randomized controlled trial. Thus, further evidence is needed.

Objectives

The purpose of this study was to qualitatively evaluate the feasibility of a group supervision (GSV) program by a psychologist for midwives providing perinatal mental health care.

Method

In the GSV program of this study, the supervisees were midwives who belonged to a home nursing station and provided continuous support to women with mental health problems before and after childbirth. The GSV program consisted of one 30-minute meeting and three 90-minute GSV sessions. To assess feasibility, semi-structured interviews were conducted with the midwives and a psychologist. The interview guide focused on the achievement of the goals, acceptability, necessity, practicality, and feasibility of GSV. The researcher's observational data on GSV participation was also utilized as an adjunct. All data were analyzed qualitatively. St. Luke's International University research ethics review provided approval (23-A029).

Results

Participants included two midwives as supervisees and one supervising psychologist from one facility. These midwives evaluated the GSV as appropriate because: (1) They understood and were able to apply their knowledge and skills in perinatal mental health care in their clinical practice; (2) They gained a sense of psychological safety and experienced less difficulty, and (3) Group cohesiveness increased. Acceptability was also generally good, and although the participants felt nervous about the unfamiliar structure of GSV before starting, their resistance decreased as the sessions were repeated. Practicality was evident as both midwives and the psychologist were able to participate in the face-to-face meetings and all three GSVs. The same trend was observed for the psychologist.

Conclusion

The GSV program is highly feasible and has potential as a support method for midwives in charge of perinatal mental health care. In the future, it is necessary to reexamine how to expand the number of participants and how to increase the supervising psychologists' understanding of perinatal mental health.

Purpose

To examine midwives' child-rearing support for immigrant women in early postpartum period.

Methods

A self-administered questionnaire was distributed to 151 hospital midwives. The main questions asked regarded “supports for immigrant women in early postpartum period” and “difficulties in providing support for immigrant women in early postpartum period.” Statistics were calculated and analyzed based on midwives' clinical experience. The Mann–Whitney U test was used to compare clinical experiences. Participants were divided into two groups according to clinical experience: 10 years or less and 11 years or more. This study was approved by the Research Ethics Committee of Yokohama City University (Approval No.: F230800033).

Results

A total of 126 valid complete questionnaires were analyzed (89.4% response rate and 93.3% valid response rate). More than 80% of midwives provided the following supports to immigrant women in early postpartum period: “gathering information about life after discharge,” “using interpretation devices,” and “breastfeeding-related education that respects culture and religion.” However, more than 80% of midwives experienced difficulties in “linguistic communication” and “support in involving their families and key individuals.” Comparison results showed that midwives with 11 years' (or more) clinical experience practiced four supports significantly more than those with 10 years' (or less) clinical experience, including “cleaning care that respects culture and religion,” “dietary teaching that respects culture and religion,” “confirm and share knowledge regarding maternal and child health systems,” and so on.

Conclusion

The most frequently practiced supports were related to communication ingenuity, gathering information about life after discharge, and understanding different cultures and religions. However, midwives also experienced difficulties regarding these supports. This suggests the necessity of utilizing multilingual brochures and providing opportunities for midwives to share their experiences in supporting immigrant women in early postpartum period. Furthermore, this study suggests the need for sharing support experiences, particularly by experienced midwives, to raise the standards of midwifery practice.

Objective

To determine the effects of hot fomentation application to the back on women's stress levels and their breasts during the early postpartum period.

Subjects and Methods

Participants included 22 primiparous mothers who had delivered vaginally without any major complications during pregnancy that could obviously affect the newborn, experienced the delivery or postpartum period with their newborn, and wished to breastfeed their newborns from postpartum day 0 or day 1. A hot fomentation was applied to the back for 15 minutes every day from postpartum day 1 to 4 at the same time in the morning whenever possible. Stress was assessed through cortisol and human herpesvirus types 6 and 7 (HHV6 and HHV7) levels from saliva samples collected before and after the hot fomentation application and in the afternoon (approximately from 3 to 6 p.m.). Moreover, subjective evaluation was also performed using a 9-point Likert scale from “1: unpleasant” to “9: pleasant.” Breast engorgement and breast pain were also assessed using the Visual Analog Scale (VAS).

Results and Discussion

Stress was significantly higher after the hot fomentation than before (p<0.01) for all postpartum days (1–4 days). For HHV6, significant differences were noted after the hot fomentation application on postpartum day 1 only (p=0.016), suggesting that stress was relieved after the hot fomentation. However, no other significant differences were noted in cortisol and herpes virus levels between the days or time of the day (morning vs. afternoon) after the hot fomentation or by the number of postpartum days, with the sole exception of HHV6 after the hot fomentation on postpartum day 1, suggesting that the stress-relieving effect of the back hot fomentation was not yet clear. For breast engorgement and breast pain, median VAS in the afternoon increased with the number of days postpartum as the engorgement and pain became more intense. However, it was believed that there was no significant difference in the median VAS before and after the hot fomentation for breast engorgement and breast pain on all postpartum days, suggesting that the increase in breast engorgement and breast pain with postpartum days is a natural physiological change and that the back hot fomentation has no significant effect on either.

Conclusion

The application of hot fomentation to the back for early postpartum mothers was shown to bring comfort without notably affecting breast engorgement or breast pain.