Purpose

A scoping review on the use of peripheral intravenous catheters (PIVCs) in neonatal intensive care unit was performed to determine (1) the incidence of PIVC-related complications, (2) risk factors for these complications, and (3) measures to prevent them.

Methods

We searched the MEDLINE database through PubMed, CINAHL, and Ichushi-Web version 5 (from the Japan Medical Abstracts Society) for articles published from inception until January 2022. The inclusion criteria were as follows: (1) articles reporting the incidence of neonatal PIVC complications; (2) articles identifying the risk factors for neonatal PIVC complications or measures to prevent these complications; (3) article types including original observational studies, randomized controlled trials, reviews, case reports, symposia, conference proceedings, guidelines, and commentaries ; and (4) articles published in English or Japanese. We excluded articles that included non-neonatal patients and those that evaluated catheters other than PIVCs. We screened data on the incidence of PIVC-related complications, risk factors associated with these complications, and their preventive measures and extracted them.

Results

We analyzed 47 articles. The incidence of complications of PIVC was 45.6–94.6%. The incidence of infiltration, extravasation, and occlusion was 1.0–78.0%, 2.4–84.0%, and 1.4–77.3%, respectively. Risk factors for PIVC complications included gestational age, body weight, antibiotic use, intravenous nutrition, total number of insertion attempts, insertion site, and type of infusion to maintain the patency of PIVCs (intermittent or continuous). The most essential preventive measures identified were enhancing nurse education and implementing specific PIVC management interventions.

Conclusion

The incidence of PIVC complications was high, and the most common complications were infiltration, extravasation, and occlusion; thus, attention should be paid to these. Certain factors associated with PIVC complications are difficult to address, while others are amenable to intervention. Improving nurse education and implementing specific management interventions are essential measures for preventing PIVC complications.

Purpose

This study aimed to clarify the experiences that students found difficult during midwifery practice, as well as the components of the students' resilience.

Methods

Midwifery students who were currently enrolled in a university's graduate program and had already acquired credits for midwifery practice were chosen as participants. A semi-structured interview was conducted by using an interview guide, and a verbatim transcript was created from the data obtained and analyzed qualitatively. The study was conducted with the approval of the Research Ethics Committee of Ibaraki Prefectural University of Health Sciences (approval number: 810).

Results

The research participants totaled 12 students. Three core categories were extracted as experiences that students found difficult during their midwifery practice: anxiety and fear due to immaturity; negative responses from those who want to be supportive; and difficulty in adjusting to practical training with responsibilities that last day and night. In addition, six core categories were extracted as components of student resilience in midwifery practice: emotional regulation; recognition of the presence of supporters; building relationships; improving knowledge and skills; changing mood; and developing a vision of the midwife they wanted to become.

Conclusion

Although the students experienced various difficulties during their midwifery practice, they adapted to the practice by using multiple resilience factors and were able to overcome difficult situations. Instructors and teachers need to have a relationship with students and to implement educational considerations that allow the components of resilience to work effectively.

Purpose

To develop a “Fertility Literacy Scale” in male and female reproductive generations, and to examine its reliability and validity.

Methods

Based on data obtained from previous research and a literature review of existing measures of fertility knowledge and factors affecting fertility, a 60-item draft questionnaire was developed to measure fertility literacy. A web-based survey was administered to 648 men and women of reproductive age to test the scale's reliability and validity.

Results

In an exploratory factor analysis, 7 factors and 31 items were selected for the [knowledge of age and health conditions affecting female fertility], [knowledge of physical risks affecting male fertility], [knowledge of lifestyle affecting male fertility], and [knowledge of male sexual function and fertility], [ability to judge the risk of one's own situation based on obtained information], [ability to make decisions and take action for the future], and [ability to seek support and communicate]. Discriminative and convergent validity were ensured, and the scaling success rate was 100%. The known group validity of the “Fertility Literacy Scale” was significantly higher in the group with infertility treatment than in the group without infertility treatment (p<.001~.039). A moderately significant correlation was also found between general health literacy and the factors of Self-care Behaviors Ability and its total score (r=.420–.596, p<.01). The reliability coefficients was .911 for the overall scale and .794–.881 for the subscales.

Conclusion

The validity and reliability of the Fertility Literacy Scale for men and women of reproductive age were confirmed. The scale is expected to be applied to interventions that promote reproductive life planning in the future.

Purpose

This study aimed to examine midwives' perceptions and practice situation of midwifery care during labor with epidural analgesia, along with the factors associated with these practices among midwives.

Methods

An anonymous, self-administered questionnaire survey was conducted among 927 midwives working in facilities offering labor with epidural analgesia. Exploratory factor analysis was used to assess perceptions of midwifery care during labor with epidural analgesia, and basic statistics were calculated to evaluate the status of care practices. Additionally, multiple logistic regression analysis was performed to identify factors associated with midwifery care practices in labor with epidural analgesia. Ethical approval for this study was obtained from the Ethical Review Committee of Yokohama City University (Approval No. General 2023-030).

Results

In total, 447 valid questionnaire survey responses were received (valid response rate: 98.8%). The following factors were identified as contributing to the perception of midwifery care during labor with epidural analgesia: “I have my own issues with midwifery care in labor with epidural analgesia,” “I want to learn more about and experience labor with epidural analgesia,” “I want to bring out the autonomy of pregnant women who choose labor with epidural analgesia,” “I feel the need for midwifery care from the pregnancy period during labor with epidural analgesia,” and “There are specific needs and support for labor with epidural analgesia.” Midwifery care for labor with epidural analgesia was implemented in over 80% of cases across 26 out of 31 identified care items, with particular emphasis on essential care during the delivery period. The factor most related to the practice of midwifery care for labor with epidural analgesia was the factor score of the fifth factor (OR: 1.84, 95% CI: 1.33-2.55).

Conclusion

The factor that most influences the practice of care labor with epidural analgesia is midwives' perception that “there are needs and support that are unique to labor with epidural analgesia,” In order to increase this awareness, it is necessary to deepen understanding of the unique needs of labor with epidural analgesia and to clarify the care related to these needs.

Purpose

To understand how young pregnant women living on remote islands made decisions about surrounding pregnancy continuation and to identify the self-determination process and support needed.

Methods

We interviewed women up to their early twenties living on the remote islands in Prefecture A who had previously become pregnant and given birth as teenagers. We conducted analysis using a combination of structural and thematic narrative analyses.

Results

The nine participants were between 15 and 19 years old at the time of pregnancy, when some were students, some had graduated and were employed, some had interrupted their studies due to pregnancy, and some had given up on their planned career at the time of pregnancy. A structural narrative analysis of the self-determination process revealed five types of structural element: “situation,” “action,” “evaluation,” “consequence,” and “conclusion.” In the “situation” phase, the pregnancy was first noticed. This occurred through noticing physical changes, such as hyperemesis gravidarum or an enlarged abdomen, the absence of menstruation, or irregular menstruation. In the self-determination process of the nine pregnant participants, six of the participants made their own decision to continue their pregnancies upon realizing that they were pregnant; three of the participants finally decided to have the baby while feeling upset or confused. In terms of “action,” five of the women's parents and partners were in favor of having the baby, while four were against it, but these four were eventually influenced by the strength of the participants' will and allowed the participants to have their baby. In terms of “evaluation,” all participants took actions, such as reporting to their partners and families, based on their strong will to have the baby. The thematic analysis revealed three patterns, after a participant had discovered that she was pregnant and decided to have the baby: 1) Their partners and family members agreed with and supported this decision; 2) Their partners agreed, but their parents opposed the decision; however, the parents were persuaded and eventually supported the decision; 3) Their partners and family members opposed the decision but were persuaded and eventually supported the decision.

Conclusion

In the self-determination process of young pregnant women giving birth on remote islands, the time spent on self-determination was short, as many of them had no doubts before deciding to keep the baby, and those involved in the decision making only included the participant, partner, and family members, as there were limits to interventions. It is important to create an environment where privacy is protected because of the small and tightly knit community. In addition, sex education based on life planning is essential, and support is required to enable self-determination in terms of the knowledge and information needed for teenage pregnancy and the options available for the future of the mother and child.

Objective

This study aim was to elucidate the experiences of midwives who assisted mothers diagnosed with amniotic fluid embolisms and explore the challenges faced by midwives in responding to such cases.

Participants and Methods

Semi-structured interviews were conducted with five midwives who had experience assisting mothers diagnosed with amniotic fluid embolisms. The interviews explored these experiences, such as the ways in which they responded and their psychological states, in relation to the progression of amniotic fluid embolism cases. Subsequently, the data were analyzed qualitatively and descriptively.

Results

All patients assisted by the midwives had been diagnosed with uterine-type amniotic fluid embolisms. Sixty-six codes were extracted from the experiences of midwives who assisted these women, and codes were further organized into 23 subcategories and seven main categories. Immediately after the onset of the initial symptoms, midwives assisting the mothers with amniotic fluid embolisms experienced “being at the mercy and feeling fear of bleeding that would not stop no matter what was done” and “a sense of impending crisis after detecting signs of sudden deterioration in the patient's symptoms and the actions of those around her.” Following the commencement of emergency responses, they were “shocked by the patient's rapid progression to a critical state” and “confronted with their own inadequacies in emergency responses as midwives.” Further, they experienced “an intense and growing desire to save the woman's life, no matter what it took.” After assisting their respective patients, they were left with “a deep sense of guilt toward the woman and her family” and “a heartfelt determination to ensure that this experience would not be in vain.”

Conclusion

Midwives who assisted mothers with amniotic fluid embolism faced profound emotional and professional challenges, including fear of uncontrollable bleeding, emotional shock, guilt, and a drive for future preparedness. It is important for midwives to always have a sense of responsibility as the person in charge of dealing with amniotic fluid embolisms; it is crucial that midwives have knowledge regarding the unique progression of amniotic fluid embolisms, while continuing to undergo training and collaborating with other departments on a regular basis. In addition, it was suggested that mental health care for midwives who responded to amniotic fluid embolisms in mothers is necessary; a better understanding of the psychological state of midwives who have responded to amniotic fluid embolisms in mothers is crucial.

Purpose

Midwives' proactive and active involvement benefits expectant and postpartum mothers and promotes task shifting and sharing, which was initiated due to the physician work style reform. However, despite the expectation that hospitals would be settings where midwives can work proactively, no demonstrated increase in the number of in-hospital midwives has been observed. One of the suggested reasons for this is anxiety regarding responsibilities, such as midwifery diagnosis and midwifery. This study conducted a review of previous research and examined the factors influencing midwives' mission in terms of their professional duties. This study aimed to determine midwives' needs to be able to work independently against the background of continuing task shifting and sharing. Two hypotheses were proposed: high generalized self-efficacy positively influences an expanding sense of mission and influences the expanding sense of mission through the quality of experience.

Methods

A mediation analysis was conducted with the expanding sense of mission scale as the dependent variable, the generalized self-efficacy scale as the independent variable, and the quality of nurses' occupational experience scale as the mediating variable. Of the 100 facilities randomly selected from 2082 delivery facilities across Japan, 35 facilities and 605 midwives who provided consent were included in the study. A total of 184 responses (30.4% response rate) were obtained, and 176 valid responses (95.7% valid response rate) were included in the analysis. The research for this study was conducted from April to July 2024.

Results

The mean age of the participants was 38.1 (SD 10.6) years, the mean years of clinical experience was 14.3 (SD 9.8) years, and the mean years of midwifery experience was 12.9 (SD 9.5) years. The mediation analysis results indicated that generalized self-efficacy had a direct effect on the expanding sense of mission and an indirect effect on the quality of nurses' occupational experiences. These results supported both of the study's hypotheses.

Conclusion

The results suggest that to enhance midwives' expanding sense of mission, they must follow a reflective process in which they self-evaluate their experiences or evaluate them with facilitators, and recognize and verbalize their challenges. Although using an expanding sense of mission as a variable, as it was in this study, is a new theory, the reliability of the scale indicated by Cronbach's α coefficient and the support for the study's two hypotheses has suggested that the theory contributed to the demonstration of the reproducibility of the value of an expanding sense of mission.

Purpose

The purpose of this study was to clarify the experiences regarding collaborations between midwives and public health nurses in providing postnatal care.

Methods

The participants were midwives and public health nurses with at least three years of field experience who had been engaged in or implementing standard of care for at least one year as part of postnatal care programs. Semi-structured interviews were conducted to explore their individual experiences in collaborating with the other party (i.e., the midwife or public health nurse) throughout the process of postnatal care, from initiation to completion, and a qualitative descriptive analysis of the responses was carried out.

Results

Five midwives and three public health nurses were included as participants. In terms of their experiences in collaborating with the other party involved in postnatal care, both groups agreed that “establishing face-to-face relationships between midwives and public health nurses” before the postnatal care process began enabled good collaboration, and they considered “building trust with mothers” as the goal of fostering maternal autonomy. It was found that during postnatal care, both the midwives “offering individualized breastfeeding care and personalized guidance through their specialized skills” and the public health nurses “drawing on their expert knowledge and judgment to connect mothers to relevant social resources after the postnatal care period” provided support by leveraging their respective expertise and worked together to protect the lives of mothers and children. However, differences in opinion emerged regarding ongoing support after completion of the postnatal care period, with midwives expressing “a desire for feedback from public health nurses for them to continue providing support for mothers after the postnatal care period” but public health nurses viewing “support for mothers after completing postnatal care programs as being the responsibility of public health nurses within the community.”

Conclusions

The two groups shared common experiences regarding collaborations from before initiating postnatal care to after its completion and worked well together. However, their opinions regarding support after the completion of postnatal care differed owing to their different areas of expertise. It was suggested that, for ongoing support aimed at promoting the health of mothers, children, and families in the community, both parties need to further respect the expertise and role of the other while developing a continuous cooperative relationship.

Objective

This study aimed to clarify the childbirth experiences that make women who gave birth in hospitals or clinics feel that they would want to give birth again.

Methods

This qualitative descriptive study targeted nine women registered in nationwide monitors with Cross Marketing Inc., including six who had vaginal deliveries and three who had epidural deliveries. The analysis involved repeated reading of the verbatim interview transcripts, coding, categorising subcategories based on semantic similarities, and abstracting them into categories and themes.

Results

From the 241 codes, 82 subcategories, 17 categories, and eight themes were extracted. Childbirth experiences that makes women feel they would want to give birth again were characterised as follows; [the envisioned childbirth], which includes〈positive thoughts and actions toward childbirth〉 and 〈fears and anxieties about childbirth〉 and 〈hopes for a painless and safe birth〉. Additionally, it was described as [a physically and mentally burden-free birth], encompassing experiences of 〈a physically easy〉 and 〈an enjoyable〉 birth. Furthermore, during labour, women experienced [the sensation of the baby emerging]. Immediately after childbirth, they felt a sense of [release] and [accomplishment in managing physical changes]. Moreover, they [experienced a sense of happiness], strongly felt [the mystery of life] and [gratitude toward their child], and deepened [bonds with family and healthcare providers]. These factors contribute to [the desire to challenge childbirth again], seeking a fulfilling and ideal birth experience.

Conclusion

Even in hospitals and clinicsin which childbirth satisfaction is lower than that in birth centres, women who autonomously decide perceived childbirth as a positive life event. Consequently, they develop a proactive desire to experience a more fulfilling birth during their following delivery.

Purpose

The purpose of this study was to develop a linguistically valid Japanese version of the London Measure of Unplanned Pregnancy (LMUP), a screening tool for assessing unplanned pregnancy.

Methods

The Japanese version of the LMUP was prepared through the following stages: (1) Forward translation into Japanese by two researchers; (2) Researcher consultation and integration of forward translation; (3) Back translation into English by two researchers; (4) Researcher consultation (creation of a tentative Japanese version); and (5) Reexamination.

Results

In the process of creating the Japanese version of the LMUP, the version was finalized after linguistic validity was examined in the fifth stage, which consisted of researcher consultation and review with the author who developed the original LMUP questionnaire. The main points that required consideration in the translation process included the minimization of differences in meaning and nuances between the two languages as perceived by respondents due to varying temporal perspectives, such as “In the month that I became pregnant” and “Just before I became pregnant.”

Conclusion

Through a formalized translation process, a linguistically valid Japanese version of the LMUP was developed. The next steps will be to pilot test the translated version and perform an assessment of reliability and validity.

Purpose

This study clarifies the role of midwifery care in achieving childbirth autonomy in pregnant women scheduled to deliver elective epidural labor. By comparing epidural labor with natural birth, it offers suggestions for midwifery care that are necessary to elicit the autonomy of childbirth for pregnant women who wish to have the same.

Methods

A total of 146 midwives who work at facilities in the Tokyo metropolitan area that handle natural birth and epidural labor, are currently involved in antenatal checkups, and have at least three years of experience as a midwife were selected for this study. An anonymous self-administered questionnaire survey was administered. The primary analysis calculated the basic statistics for midwifery care leading to maternal autonomy in childbirth, followed by Mann-Whitney U tests of differences between variables. The study was approved by the Ethical Review Committee of Yokohama City University, which took into account all relevant ethical considerations (approval number: F230800034).

Results

A total of 97 valid responses were obtained from the questionnaire (collection rate: 69.1%; valid response rate: 96.0%). Midwifery care that encourages pregnant women to take the autonomy in childbirth achieves high implementation rates of care elements in both natural birth and epidural labor and includes “giving encouraging words to recognize the pregnant woman's efforts (natural birth 99.0%, epidural labor 96.9%)”, “during the preventive examination, in addition to the essential examination points, listen to the pregnant woman's concerns and questions (natural birth 97.9%, epidural labor 98.9%),” and “acknowledge and respect what the pregnant woman has to say (natural birth 97.9%, epidural labor 96.9%).” In contrast, “encouraging interaction with other pregnant women received low implementation rates (natural birth 28.9%, epidural labor 32.0%)”. Concerning the awareness of midwifery care to take autonomy in childbirth for pregnant women planning to give birth through epidural labor, the highest percentage of respondents chose “the same as natural birth” for most of the items. The implementation rates of midwifery care in epidural labor showed differences in the availability of midwifery care education/training for autonomy in childbirth.

Conclusion

Midwifery care during the gestational period to promote autonomy in childbirth is the same for both natural birth and epidural labor and is based on the same awareness. However, there were differences in the availability of midwifery care education/training in epidural labor, suggesting that improved education/training for midwives could support the autonomy of pregnant women who wanted to have epidural labor.

Purpose

The purpose of this study is to determine what kind of parenting support fathers with children between the ages of one month and three years want from professionals during pregnancy and the child-rearing period.

Methods

A self-administered, unscored questionnaire was administered to fathers with children between the ages of one month and three years at three facilities in Y city, X prefecture.

Results

There were 113 research collaborators (valid response rate: 32.1%). The top three most common support needs of fathers were “30. support for wife/children,” “29. support for wife's emotional needs,” and “23. explanation of risks/procedures of childbirth”. The bottom three items with the least support needs were “13. providing a place to make papa-friends,” “12. opportunities for fathers to talk with other fathers,” and “9. presenting role models for fathers”. In terms of basic attributes and the parenting support needs that fathers expect from professionals, “19. prenatal education for fathers” was significantly sought by three basic attributes (number of children, age of children, and participation in fatherhood classes or parenting classes). “7. Providing information on the Child Care Leave Law, local child-rearing support for fathers, etc.” was significantly requested by two basic attributes (whether or not they have taken child care leave and whether or not they have given birth at home). Four categories of free comments were extracted (provision of information, expansion of public support, etc.).

Conclusion

The bottom three items with the lowest support needs were for peer support. However, providing a place for fathers to talk with other fathers as peer support prevents fathers from becoming isolated and encourages them to take on the role of father, and thus is considered necessary support even if the needs of fathers are low. In terms of support for fathers, it was considered necessary to expand prenatal classes for fathers and devise ways to provide information on childcare-related issues directly to fathers.

Purpose

This study aimed to implementation and potential use a training program for midwives on the Marital Relationship Support Program, during the transition to parenthood.

Methods

A mixed-methods design was employed, incorporating quantitative and qualitative descriptive approaches. Participants were midwives from midwifery and maternity hospitals in Japan. The training program comprised e-learning videos and online group training. A survey was conducted, including a confirmatory test after viewing the e-learning video and pre- and post-course responses assessing the participants' understanding and perception of support for couples' relationships. Additionally, open-ended responses were collected regarding participants' opinions about the training session, reasons for using the support content for couples, and expectations and concerns about using assessment tools for marital relationships. Mann-Whitney U test was used for pre- and post-course comparisons, and qualitative inductive analysis was used for the free response content.

Results

Of 51 participants, 32 responded after attending the final training program. Post-training scores were 3.0 or higher for seven of the nine items, indicating a high level of understanding and awareness of marital support. Participants' opinions on the training sessions were overwhelmingly positive, highlighting aspects such as reaffirmation of the importance of midwifery support for couples and understanding of specific methods of midwifery support for couples. However, some participants noted difficulties in supporting couples due to COVID-19 limitations. Notably, more than 80% of the respondents expressed interest in using the support content for couples, stating reasons such as opportunity to prepare for life with children. The opinion was expressed that the Couple Relationship Assessment Tool has the potential to provide midwifery support to enhance the strengths of couples in both individual and group settings.

Conclusion

This study demonstrates the potential use of a training program for midwives on marital relationship support during the transition to parenthood. The combination of e-learning video content and group training using assessment tools shows promise for enhancing midwives' understanding and practice of marital support. Future research should explore the impact of this training program on midwives' practice and couples' relationships.

Purpose

This study aimed to assess the quality of care provided in birth centers during childbirth from the perspective of the mothers, obtaining both quantitative and qualitative evaluations using a web questionnaire.

Methods

This was a cross-sectional study conducted using data collected anonymously by means of an online questionnaire. On their third or fourth postnatal day, women who gave birth at 96 birth centers answered questions regarding their satisfaction with the childbirth and midwifery care provided and the quality of childbirth care they received, including a) evidence-based care, b) safety, and c) women-centered care. Descriptive statistics were analyzed. Additionally, the mothers' descriptions of the provided midwifery care and their feelings about it were analyzed qualitatively and inductively.

Results

Almost 90% of the 113 mothers reported that they had receiving evidence-based and women-centered care. Approximately 90% of the mothers experienced a sense of safety regarding the system and facilities of the centers, and were fully informed about maternal transport facilities. The mean scores for satisfaction with childbirth and midwifery care were 98.2/100 and 99.3/100, respectively. Six categories were derived regarding provided midwifery care and mother's feelings about it, continuous accompaniment to mothers and their family, respectful, individual and diverse care, a feeling of security from careful handling, nurtured connections with midwives, a place where I will continue to belong, and a proactive and positive childbirth experience.

Conclusion

The mothers' perspectives revealed that evidence-based, safety and women-centered care was provided at birth centers. Consequently, most of the women were satisfied with their birth experiences at the birth centers. Receiving midwife-led continuity and respectful care from the antenatal period is important for a positive birth experience and a long-term childcare support. Regarding safety, it was considered necessary to provide explanations about possible complications and transportation options before complications occur, in order to alleviate the mother's anxiety and ensure a sense of security.