This study aimed to develop a self-confidence scale for senior midwives and to verify its reliability and validity.
A self-confidence scale for senior midwives was developed based a literature review, a concept analysis of self-confidence, and data from interviews with senior midwives in the hospital setting. A questionnaire survey was conducted on senior midwives working in hospitals who had between 6 and 15 years of experience. Questionnaires were sent to 1,216 senior midwives, among whom, 547 responded, and 477 were eligible for analysis. Exploratory factor analyses and covariance structure analysis were conducted to verify the reliability and validity of the scale. All statistical analyses were conducted using SPSS Amos ver. 25.
After the exploratory factor analysis, the scale was composed of the following four subscales: 1) ‘self-confidence in ability to provide maternity care’, 2) ‘self-confidence in leadership’, 3) ‘self-confidence in behavior as a professional’, and 4) ‘self-confidence in pursuing self-improvement’. Overall 22 items were extracted. The correlation coefficients among each subscales were .568∼.771, and correlation coefficients between the overall scale and each subscales were .765∼.945. Correlation coefficient between the self-confidence scale for senior midwives and the self-esteem scale was .443, and that between the self-confidence scale for senior midwives and the generalized self-efficacy scale was .491. Cronbach's alpha for the overall scale and each subscale were .705∼.827. The results of the confirmatory factor analysis revealed the following: GFI=.834, AGFI=.787, CFI=.916, RMSEA=.087.
The self-confidence scale for senior midwives developed in the present study was composed of four subscales and 22 items. Furthermore, its content validity, internal consistency, concurrent validity, and reliability were verified. The scale contents reflected necessary abilities for senior midwives. Therefore, this scale appears to be a useful tool for senior midwives for evaluating their own practical abilities as a midwife.
To elucidate the current state of care for hiesho and analyze factors that affect the relevant implementation of care.
The study design was a quantitative descriptive research. The investigation was carried out over approximately 2 months, during October and November of 2017. The research field included facilities all over Japan that were handling childbirth (hospitals, clinics, maternity homes), and the research participants were nursing staff members who had been handling health check-ups of pregnant women for three years or more. As a tool for measurement, we used an anonymous self-administered questionnaire. Furthermore, this study was conducted with the approval of the ethics committee of the institutions with which the researchers are affiliated, and by sufficiently ensuring ethical considerations (Approval No.: A170900006).
The study recruited a total of 2,694 participants, of which 733 were ultimately part of the analysis (recovery rate of 27.5%, effective response rate of 98.8%). Out of the entire sample, those who were actively caring for hiesho made up 44.1%, while 55.0% of participants had experience learning about hiesho. As factors affecting the implementation of care for hiesho, we adopted five items, namely the experience of learning about hiesho (odds ratio [OR]: 3.4), awareness of the importance of care for hiesho (OR: 3.0), presence or absence of an outpatient midwife (OR: 1.7), time taken for health check-ups for pregnant women (OR: 1.2), and awareness of how a cold state affects childbirth/delivery (OR: 1.1) (p<0.001).
The percentage of subjects carrying out care for hiesho during health check-ups for pregnant women in the perinatal period was low, at less than 44.1%, and compared to midwife homes, fewer nursing staff members work in hospitals and clinics. Furthermore, as “experience of learning about hiesho” was a factor that significantly affected the implementation of care for hiesho, in the future, it will be necessary to provide opportunities for nursing staff involved in the health check-ups of pregnant women, in particular those nursing staff members working in hospitals and clinics, to learn about hiesho.
The purpose of this study was to explore the practical wisdom of expert midwives caring for women who demonstrated a strong fear of pain during delivery.
Subjects and Methods
Semi-structured interviews were conducted with 13 expert midwives recruited using snowball sampling. Subject matter that met the research criteria were extracted as small themes from the cases narrated by the research participants. These concerns were then grouped according to their similarities, and were subsequently abstracted for classification into main and large themes.
According to the research participants, regardless of the delivery period, women showed various expressions of pain during delivery, including crying out, violent behavior, rigidity even in intermission, not reacting, speaking in an aggressive manner, otherwise dangerous behavior. In terms of the practical wisdom of the expert midwives attending to such women, the following were extracted as the large themes: receptive attitude; Promote their own presence to women; preventing her from becoming too caught up in the moment; not encouraging her agitation; making her husband's feelings stay close to her; and inferring her needs from mother-daughter relationships and responding to those needs. Additionally, it was apparent that the expert midwives competently cared for women who expressed high levels of fear during delivery on the basis of the following basic attitudes stemming from practical wisdom: understanding that a woman expresses her feelings like a child in the process of becoming a mother, and that often women who seem to be in a state of panic are actually listening to them calmly.
Expert midwives accept any expression of distress or anger without encouraging agitation as long as they are not jeopardizing the mother or the child. Additionally, they take into account the feelings of the husband seeing his wife acting out of the ordinary, as well as the mental distance between the woman and husband. These midwives are often well-versed in ascertaining what underlies these strong feelings of fear. Mother-daughter relationships sometimes play a significant part in this. Key characteristics of expert midwives are that they do not erase their own presence and take the initiative in interacting with the mother.