Purpose

The purpose of this study was to determine: 1) the association between contraceptive decision-making and perceptions of fertility decline as well as associated factors, and 2) the relationship between contraceptive decision-making and contraceptive behavior, in perimenopausal women.

Methods

Women between the ages of 40 and 50 who agreed to participate were included in the study. A self-administered, non-rated questionnaire was administered between July and November 2021. Contraceptive decision-making and the perception of fertility decline were measured using Visual Analogue Scales. In addition, contraceptive behavior was assessed in terms of contraceptive types and usage frequency. Logistic regression analysis was used to examine the relationship between contraceptive decision-making and perceived fertility decline, to identify factors associated with perceived fertility decline, and to examine the relationship between contraceptive decision-making and contraceptive behavior.

Results

The questionnaire was sent to 354 women, of whom 123 were eligible for analysis (47.2% response rate, 73.7% valid response rate). Among women without the desire to become pregnant, those with a higher awareness of their declining fertility were less likely to use contraception than those with a lower awareness (odds ratio (OR): 0.30, 95% confidence interval (CI): 0.14-0.66), and a significant associated factor was knowledge of age-related fertility changes (OR: 2.85, 95%CI: 1.16-7.02). Among women without the desire to become pregnant who had sexual intercourse within 1 year, those more willing to use contraception used contraception every time they had sexual intercourse (OR: 21.57, 95%CI: 5.30-87.83) and used more effective methods (OR: 4.20, 95%CI: 1.49-11.82).

Conclusions

Perimenopausal women without the desire to become pregnant were more aware of their own fertility decline and less likely to use contraception when they were aware of age-related fertility changes. In addition, the clear intention to use contraception led to the choices of using contraception and using a highly effective contraceptive method each time. Therefore, in order to avoid unwanted pregnancies, it is necessary to provide fertility knowledge that captures the characteristics of the perimenopausal period, promotes an understanding of the need for contraception, and supports contraceptive decision-making.

Purpose

To identify midwifery practices during childbirth that help prevent perineal lacerations in hospitals, and how these differ according to the level of experience in newborn delivery assistance.

Methods

A self-administered, unmarked questionnaire was distributed to 202 midwives working in hospital obstetric wards in the Tokyo metropolitan area and having experience assisting in deliveries. The main questions asked were about the frequency of information collection and support offered during birth that help prevent perineal laceration. Descriptive statistics were calculated, and the midwives were divided into groups with less than 200 cases of delivery assistance and more than 200 cases of delivery assistance based on the median. Comparisons were made based on the number of experiences of delivery assistance using the Mann-Whitney's U test. This study was conducted with the approval of the Research Ethics Committee at Yokohama City University (Approval No.: F221000005).

Results

A total of 100 valid completed questionnaires were analyzed (50.5% response rate, 98.0% valid response rate). The types of information gathered most frequently (“always” or “sometimes” by more than 90% of midwives) were “whether the baby is a first birth or a multiparous birth” and “estimated weight of the baby.” In terms of support, the most frequent (“always”) practices were “perineal protection” (88.0%), while the less frequent ones were applying a “perineal warm pack” and “bathing in the first stage of labor.” Furthermore, midwives who had assisted in more than 200 deliveries were significantly more likely than midwives who had assisted in fewer than 200 deliveries to collect information on obstacles to perineal extension, such as previous episiotomy or perineal laceration, and to provide support that did not interfere with natural perineal extension, such as “a voice that does not require excessive effort” and “not touching the perineum too much.”

Conclusion

Midwives with more experience in assisting deliveries provided support based on what they learned experientially. The study suggested the need to facilitate the transfer of assessments and supports from experienced midwives to novices, to raise the standard of midwifery practices.

Purpose

To clarify the status of midwives' support to paternal role acquisition, their perception of the importance and future implementation of such support, as well as the difficulties faced in providing such support.

Methods

A survey of midwives at a perinatal maternal and childcare center in prefecture A was conducted using a self-administered, unmarked questionnaire, and descriptive statistics and content analysis were conducted.

Results

Seven facilities consented to the survey (35.0% consent rate), and the number of valid responses was 78 (35.6% valid response rate) for quantitative data and 68 (31.1% valid response rate) for qualitative data. In terms of the implementation status of the 37 items, the three items with the lowest percentage of “always/mostly implemented” were those related to peer support and breastfeeding. In terms of perceived importance, the item with the lowest percentage of “very important/somewhat important” responses was “having fathers with breastfeeding experience talk about the psychology of breastfeeding fathers”. In the scores for implementation of father support, there was a significant difference in the experience of learning about father support. In terms of recognition of the future implementation of support, 74 respondents (94.9%) answered that more active support for fathers is needed, and 14 codes were identified as support needed in the future, including “support using ICT (Information and Communication Technology)”. Sixty-eight respondents (87.2%) felt difficulties in providing support to fathers, and 13 codes were extracted, including “Insufficient time and opportunity to provide support to fathers”.

Conclusion

The items with the lowest percentages of implementation and recognition of importance were those related to peer support and breastfeeding, suggesting that particular consideration is needed to raise awareness of the importance and increase the implementation rate. There was a significant association between the implementation and learning experience of support for fathers, suggesting the need to examine midwifery education to provide quality support. Although awareness of the need for support for fathers was considered high, 87.2% of midwives felt difficulties in providing support, suggesting the need to expand support using ICT to increase opportunities to provide support.

Purpose

This study aimed to clarify the components related to midwifery care for pregnant women's continued self-care for relieving “hiesho” (sensitivity to cold) at birth centers.

Methods

In total, 129 midwives working at birth centers for at least five years, handling deliveries across the country, and who provided support for pregnant women's self-care for relieving hiesho at prenatal checkups were selected for this study. An anonymous self-administered questionnaire survey was conducted. The main method of analysis was an exploratory factor analysis of midwifery care for pregnant women's continued self-care to relieve hiesho. This study was approved by the Ethical Review Committee of Yokohama City University and followed all relevant ethical considerations (approval number: F221000004).

Results

In total, 95 valid questionnaire survey responses were received (valid response rate 92.2%). The two items that were “always implemented” (response rate of >95%) for midwifery care of pregnant women's continued self-care for relieving hiesho were “Interacting with pregnant women to be aware of the presence of the fetus” and “Interacting with pregnant women so that they can have the desire to give birth on their own.” The four components of midwifery care were as follows: (1) Promoting awareness while understanding pregnant women's thoughts of continuing self-care for hiesho, (2) Motivating pregnant women to start with self-care for hiesho that they can do, (3) Creating opportunities for pregnant women to access information about self-care for hiesho themselves, and (4) Sharing information among midwives that leads to promote self-care for hiesho with respect for the individuality of pregnant women.

Conclusion

It was deemed important, in the context of midwifery care for pregnant women's continued self-care for relieving hiesho, to increase the intrinsic motivation of pregnant women for self-care, and related efforts were implemented at a high frequency. The four components of midwifery care extracted in this study encouraged pregnant women to continue self-care for relieving hiesho by motivating them to change their behavior, increasing their self-efficacy for self-care, creating opportunities for them to actively access information about self-care for hiesho, and implementing care that respects their individuality.

Purpose

This study aimed to determine the psychology of pregnant women in a crisis that resulted in emergency admission to the maternal fetal intensive care unit (MFICU) under restricted family visitation owing to the spread of the coronavirus disease-2019 (COVID-19) pandemic.

Methods

This qualitative descriptive study included four pregnant women who were hospitalized within one month of being transferred to a general obstetric ward from the MFICU under restricted family visitation. Data were collected through semi-constructive interviews.

Results

The psychology of pregnant women was analyzed per Aguilera's problem-solving crisis model and can be summarized into eight categories. Pregnant women felt happy to be pregnant despite the COVID-19 pandemic. However, they were in a state of imbalance and feeling seriously ill due to emergency MFICU admission, which they associated with ICU. Furthermore, they felt an urgent need to restore their equilibrium by meeting their families and share their child's growth. However, they gradually came to a realistic perception that hospitalization was necessary to protect children. Further, they maintained the same family relationships they had before their hospitalization even under visitation restrictions. In addition, these women reported that nonfamily interactions were encouraging during their hospitalization. Moreover, they had an appropriate coping mechanism to reconcile their desire to visit their families. Hence, they reached a state of equilibrium recovery in which they flexibly adapted to the special care environment.

Conclusion

Pregnant women who were urgently admitted to the MFICU under restricted family visitation due to the COVID-19 pandemic always desired to share their child's growth with their families. However, they gradually responded positively to the fact that hospitalization was necessary to protect their children. Moreover, the pregnant women used information and communication technology to promptly share the progress of their pregnancies and growth of their children with their families. Finally, they came to terms with their feelings and flexibly adapted to the special medical care environment during their hospitalization.

Objective

This study aimed to examine the developmental process by which fathers of twin infants settle into the parental role between the time they learn of the pregnancy and the age of three months to approximately one year and to find ways to help fathers assume the parental role from the early stages of pregnancy.

Methods

Web-based semi-structured interviews using the interview guide were conducted with 10 fathers of twins. The interview content was transcribed verbatim and labeled. Data were classified and analyzed using the Trajectory Equifinality Model.

Results

Seven participants were observed to be first-time fathers, and three were experienced in child-rearing. The analysis indicated nine essential paths and junctures. Fathers experienced surprise more than joy when they learned of the pregnancy, and experienced emotional suppression. The fathers were [concerned about the physical risk to the mother and fetus] after their wives became pregnant with multiple children, and they [supported their wives who were in physically unstable condition], but they were [unable to imagine fathering twins during the pregnancy]. When [the twins were born and he became the father], [he confirmed that they were twins through photos and videos during the post-delivery hospitalization]. After [the children were discharged from the hospital], [he and his wife began to raise their children together], and [as they faced the harsh reality of child-rearing], [he felt the burden of child-rearing], they demonstrates ingenuity [explored his role as a father]. As time progressed, they gathered inner strength and grew into their roles as fathers of the twins.

Discussion and Conclusion

Existing studies have revealed the child-rearing experiences and mental health status of fathers of multiple births. However, this study also clarified the developmental process observed among fathers from when they learned of the pregnancy to the present when they assumed their parental role, in addition to their child-rearing experience and mental health. The study results indicate that fathers must learn about the implications of “multiple births” from the gestational period and prepare themselves for child-rearing to assume the parental role confidently. Fathers need to cultivate emotional skills to deal with various conflicts that arise in child-rearing. Additionally, practicing parenting as a couple is essential for family bonding. Understanding and supporting the developmental process of fatherhood is crucial to strengthen the parental partnership between couples.

Purpose

This study aimed to investigate how women without recurrent gestational diabetes mellitus (GDM) lived their daily lives after being diagnosed with GDM in the past.

Methods

A qualitative descriptive study was conducted, consisting of semi-structured interviews with five women who did not have a recurrence of GDM. A verbatim transcript was prepared from the data obtained, and the parts of the transcript that were related to the daily life after the diagnosis of GDM were extracted, coded, and subcategories and categories were formed.

Results

Women without GDM recurrence were surprised at their diagnosis and reflected on their lives, while at the same time worrying about the effects of hyperglycemia on their fetus. They also talked about the reality of the mental and physical burden caused by the restrictions on daily life, requested by the medical staff, that they found troublesome and painful, which started along with the diagnosis. However, some women gained positive experience by managing their blood glucose through dietary changes with the support of their family members. By continuing their lifestyle at the time of GDM out of concern for recurrence and the effects on their fetus it prevented the recurrence of GDM. In addition, the cooperation of family members was necessary to maintain this lifestyle, and the participants expressed their continued concern that they would develop diabetes in the future.

Conclusion

Women without GDM recurrence continued with the lifestyle behaviors they had acquired during GDM with the support of their families both during and after GDM treatment. In addition, after pregnancy, these women remained mindful of preventing a recurrence of GDM in order to protect their children, from the harmful effects of hyperglycemia on the fetus. By maintaining their daily lifestyle changes they were able to prevent a recurrence of GDM.

Purpose

The purpose of this study was to examine the association between depression/bonding and parenting environment and perinatal high-risk factors among postpartum women in a comprehensive perinatal and maternal health center.

Methods

Health guidance was provided to 625 postpartum women who gave birth between April 2019 and March 2020 at the center at three time points (when discharged from hospital, at the 2-week checkup, and at the 1-month checkup). Responses to the “Childcare Support Checklist”, the “Edinburgh Postpartum Depression Scale (EPDS) Questionnaire”, and the “Your Feelings toward the Baby (Bonding) Questionnaire” obtained at that time were included in the analysis. The EPDS and bonding questionnaires were taken chronologically and analyzed for their association with 11 child care environment risk items and 12 perinatal high-risk items. To examine factors associated with changes from the baseline to one month later, multiple regression analysis was performed, adjusting for baseline values and number of births experienced as covariates.

Results

The EPDS and bonding questionnaire results improved significantly over time (p for trend<0.0001). However, multifactor analysis showed that the EPDS worsened significantly for the “having a history of psychological counseling or psychiatric treatment” (β=0.77, p=0.006), “unable to consult husband” (β=1.68, p<0.0001) and “unable to consult mother” (β=1.25, p=0.0007) factors. On the other hand, EPDS results significantly improved for “young childbirth” (β=−1.66, p=0.019). Bonding results significantly worsened for the “emergency cesarean section” (β=0.38, p=0.002) and “unable to consult husband” (β=0.47, p=0.017) factors.

Conclusion

The EPDS and bonding questionnaire results for women who gave birth at a comprehensive perinatal center improved naturally up to one month after discharge from the hospital. However, these improvements were inhibited among those with underlying poor mental health and those who had no one in their immediate family to consult. On the other hand, one possible reason for the improvement in depression among young mothers may be the effect of support programs unique to comprehensive perinatal centers.

Purpose

The purpose of this study was to clarify the characteristics of midwifery care for foreign Muslim women living in Japan.

Methods

A qualitative descriptive study was conducted with five midwives who had experience providing midwifery care to Muslim women in obstetric outpatient clinics and hospital wards in Japan. Data were collected through semi-structured interviews using an interview guide and analyzed qualitatively and inductively.

Results

Upon analysis we identified 34 subcategories, 14 categories and three core categories as characteristics of midwifery care for Muslim women. Midwives who provided care to Muslim women focused more on the religious background of the patient than on the background of the patient, such as country of origin or linguistic communication level, which is usually the focus when caring for foreigners, and they were “aware that the patient was a Muslim”. From the early stage, the midwives were “practicing religious considerations based on one's nursing perspective” as professionals, while giving “informed consent and sharing information on religious considerations” with the patient, family members, and medical staff.

Conclusion

Religious considerations were found to be a significant characteristic of midwifery care for Muslim women. Midwives gave informed consent for religious considerations to Muslim women and their families from the early stages of midwifery care, and they practiced religious considerations through trial and error based on one's own nursing perspectives. However, as religion is a sensitive issue, midwives tended to hesitate in addressing the individual needs of Muslim women, even though they were aware of the diversity and uniqueness of each woman's needs. As a result, midwives tended to give Muslim women only uniform consideration. Our study showed that in order to improve midwifery care for Muslim women, it is necessary to factor in the diverse needs of each individual woman and connect them to more culturally appropriate care.

Purpose

The aim of this study was to examine the characteristics of users of postpartum care services and compare the factors associated with utilization of these services for users and non-users. The focus was on postpartum physical and mental discomfort, childcare anxiety, qualities of partners regarded as the closest supporters, and the use of instruction in childcare techniques.

Methods

A longitudinal study using a web-based self-administered questionnaire was conducted from May 2019 to February 2020 with study participants at 35 weeks gestation and one month postpartum. Of the 2,402 women given the research information leaflet at the time of their antenatal checkup, 667 (27.8%) responded to the first self-administered web-based survey, and 448 (18.7%) responded to the second one. The 448 respondents who answered at both time points and indicated whether they used the postpartum care services were included in the analysis. The respondents were divided into two groups: those who answered that they had used the postpartum care services and those who responded that they had not. Chi-square tests, Mann-Whitney U tests, and student t-tests were performed on the investigation variables.

Results

Characteristics significantly associated with users of postpartum care services included the following: annual household income of at least 9 million yen, status as an employed woman, desiring to be pregnant, receiving a negative reaction from one's partner when becoming pregnant, first breastfeeding was the day following the birth, a strained relationship with one's partner at one month postpartum, and low scores on the Short Form-8 (SF-8) Japanese version of the Physical Component Summary (PCS) at one month postpartum.

Conclusion

In this study, the use of postpartum care services was associated with decreased physical quality of life (QoL) after childbirth. In addition to the need for rest, the relationship with one's partner might be related, suggesting the need to consider the relationship with the partner as a factor in deciding whether to use postpartum care services. In addition, financial difficulties associated with using the current postpartum care services also existed. Therefore, physical QoL, the relationship with one's partner, and financial support should be considered so that those needing postpartum care services can access them.

Purpose

This study aimed to assess the impact on marital satisfaction of marital communication attitudes during the child-rearing period.

Methods

We conducted a cross-sectional study using a questionnaire with parents whose children had undergone the nationally required health examinations at 18 months or 3 years. The question items came from the Scale on Marital Communication Attitude and the Scale on Marital Satisfaction, and asked about basic attributes. To assess the impact of marital communication attitudes on marital satisfaction, a multiple linear regression analysis with forced entry was performed using scores of marital satisfaction as dependent variables and scores of three factors (‘close/sympathetic,’ ‘overbearing,’ and ‘avoidant’) in marital communication attitudes as independent variables. We also typified communication attitude patterns by two-step cluster analysis based on the scores of marital communication attitudes and examined whether there were differences in marital satisfaction between husbands and wives using an unpaired t-test.

Results

Questionnaire forms were distributed to 936 married couples. The 116 collected (response rate: 12.4%) were included in the study. A multiple linear regression analysis showed the adjusted R² value to be 0.46 for husbands and 0.5 for wives (p < 0.01). The communication attitude that most strongly impacted on marital satisfaction in husbands was close/sympathetic (β = 0.522), followed by overbearing (β = −0.172) and avoidant (β = −0.149). In wives, close/sympathetic most strongly impacted on marital satisfaction (β = 0.557), followed by avoidant (β = −0.223); however, overbearing was not significant. The cluster analysis classified married couples into two groups: a close/sympathetic couple group with higher scores in close/sympathetic attitude and an overbearing and avoidant couple group with higher scores in overbearing and avoidant attitudes. The t-test indicated that both husbands and wives in the close/sympathetic couple group showed significantly higher marital satisfaction.

Conclusion

During the child-rearing period, marital communication attitudes greatly impact marital satisfaction. A close/sympathetic communication attitude and other attitudes toward their partner play a particularly important role in increasing marital satisfaction.

Purpose

Body shape satisfaction has drawn attention as a factor related to dietary behavior. However, the association between body shape satisfaction and nutrient intake during pregnancy has not been fully elucidated. Therefore, this study aimed to examine the association between body shape satisfaction and nutrient intake among Japanese pregnant women.

Methods

This cross-sectional study was conducted at a general hospital in Osaka, Japan, between March and November 2020. We recruited women with singleton pregnancies in their second or third trimesters. Information on demographic characteristics, body shape satisfaction, fetal attachment, and depression was assessed using a self-administered questionnaire. Based on the responses regarding body shape satisfaction, participants were classified into three groups: “satisfied,” “neither satisfied nor dissatisfied,” and “dissatisfied.” Nutrient intake was assessed using a validated diet history questionnaire. Covariance analysis was performed with energy-adjusted intake based on the density method as the dependent variable. Second- and third-trimester analyses were conducted separately to account for gestational age-related differences in nutritional recommendations.

Results

A total of 99 and 101 women in their second and third trimesters, respectively, were included in the analysis. Among those in the second trimester, 18 (18.2%), 42 (42.5%), and 39 (39.4%) constituted the “satisfied,” “neither satisfied nor dissatisfied,” and “dissatisfied” groups, respectively. Of those in the third trimester, 26 (25.7%), 32 (31.7%), and 43 (42.6%) occupied the “satisfied,” “neither satisfied nor dissatisfied,” and “dissatisfied” groups, respectively. In the second trimester, no association was observed between body shape satisfaction and nutrient intake. However, among women in the third trimester, the “dissatisfied” group had significantly lower intakes of the following nutrients: fat, dietary fiber, potassium, calcium, iron, magnesium, α-tocopherol, vitamin B₁, vitamin B₆, and folate.

Conclusion

Body shape dissatisfaction was associated with a lower energy-adjusted intake of several key nutrients in the third trimester. Healthcare professionals may need to consider body shape dissatisfaction when providing nutritional guidance to pregnant women.