Journal of Japan Academy of Midwifery
Online ISSN : 1882-4307
Print ISSN : 0917-6357
ISSN-L : 0917-6357
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Foreword
Review articles
  • Manami NAKANISHI, Megumi HARUNA, Kaori YONEZAWA, Emi SASAGAWA, Naoko H ...
    2021 Volume 35 Issue 1 Pages 3-10
    Published: 2021
    Released: June 30, 2021
    [Advance publication] Released: March 25, 2021
    JOURNAL FREE ACCESS

    Purpose

    The aim of this study was to review previous studies on infant skin problems and to summarize 1) the types of skin problems, 2) body area observed depends on the skin problem, and 3) the method of scoring for severity of skin problems.

    Method

    A search was conducted on PubMed for literature related to infant skin problems in August 2017. Among the 429 papers identified, 13 were included in this review.

    Result

    There were nine papers on diaper dermatitis, one on infant eczema, and three on seborrheic dermatitis.

    Four papers about diaper dermatitis used scales that were developed or used in previous studies, including the diaper rash and erythema scoring scale, Neonatal Skin Condition Score (NSCS), and Diaper Rash Severity Scale. Only the NSCS was validated. Although, erythema was assessed in all papers about diaper dermatitis, most of the types of skin problems were different among papers.

    Dryness, scaling, papules, and erythema were assessed in the literature on infant eczema, whereas erythema, scaling, and crusting were assessed in the literature about seborrheic dermatitis.

    Conclusion

    There was not the validated scale which was specialized the one skin problem. Also, the skin conditions related to each skin problem were different. Therefore, along with the scales for assessing the skin conditions of the entire body, the scales specialized for each skin problem or body area that have been examined for reliability and validity are preferable.

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Original articles
  • Mihoko FUJII
    2021 Volume 35 Issue 1 Pages 11-21
    Published: 2021
    Released: June 30, 2021
    [Advance publication] Released: April 07, 2021
    JOURNAL FREE ACCESS

    Purpose

    This study aimed to elucidate the experience and expected midwifery care of women who deliver twins after assisted reproductive technology (ART).

    Methods

    A descriptive qualitative study was conducted with five primiparas who delivered twins after receiving ART treatment. In 2018, semi-structured interviews were conducted with individual participants, followed by thematic analysis.

    Results

    The analysis revealed that women who became pregnant with twins after undergoing ART treatment demonstrated four characteristics: (a) Persistent anxiety both during and after pregnancy related to the possible sudden loss of one or both of the children, (b) Sense of alienation from losing continuing midwifery support postpartum, (c) Bouts of unexpected, intense pain after parturition, and (d) Panic associated with parenting of twins. The studied women identified four themes of support that they expected to receive from midwifery care: (a) To be provided with information to dispel their anxieties related to having a high-risk pregnancy, (b) To be introduced during pregnancy to other women who had been pregnant with twins, (c) To be empathized with about how hard it is, both mentally and physically, to carry and deliver twins, and (d). To be appreciated for the effort involved in carrying and then raising twins.

    Conclusion

    After repeated experiences of being disappointed following anticipation of motherhood during their fertility treatments, women who become pregnant with twins through ART face anxiety when they learn the high-risk status of their pregnancies from medical personnel's behavior. Anticipatory worry about the possibilities of fetal deaths and abnormalities throughout their pregnancies and continuing post-partum fear related to sudden death of the child were common characteristics seen in the subjects.

    Women who become mothers of twins after ART may have a difficult motherhood experience due to the fear of their child's death.

    Midwifery care should continue post-partum, confirming the healthy growth and survival of children and giving patients a sense of comfort and relief after they have become mothers.

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  • Yasue OTA
    2021 Volume 35 Issue 1 Pages 22-35
    Published: 2021
    Released: June 30, 2021
    [Advance publication] Released: June 11, 2021
    JOURNAL FREE ACCESS

    Objectives

    This study aimed to introduce an e-learning programme for nurses engaged in mother and infant care in the early postpartum period to facilitate mother–infant bonding in this period, and to qualitatively evaluate the effectiveness of the programme through how nurses utilize acquired knowledge and skills during care sessions and looking at verbal, behavioural, and cognitive changes of nursing professionals.

    Methods

    The three-hour e-learning programme has three steps based on the learning goals. Participant observations were conducted during care sessions to collect data about verbal and behavioral changes before and after the programme intervention. Data were analysed based on case analysis. Cognitive changes were assessed using reflective interviews.

    Results

    Study participants were 17 nurses. 52 interactions before intervention and 51 interactions after intervention were analysed. For verbal changes, 13 of the 17 participants appeared to improve their responsiveness toward infants by becoming more attentive to infant behaviours and responding to them in an appropriate manner. Results also showed enhancements in participant role model behaviours around building relationships with infants. These nursing professionals' enhanced behaviours appeared to inspire mothers to imitate nursing professionals' interactions with infants. With respect to their relationships with mothers, the nurses appeared to respond to the mothers' feelings and needs and treated them with affection and supportive attitudes. In terms of cognitive changes, nursing professionals appeared to recognise the importance of observing infant behaviours, and engaging in self-reflection about their previous methods of mother–infant care that tended to overemphasise breast management and nurse-centred activities.

    Conclusion

    Post-programme results demonstrated that a verbal and behavioral change in which nurses encouraged role behaviors that promoted mother-infant bonding, indicating a cognitive transformation of new recognition and reflection on their own mother-infant care that they had been performing.

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  • Haruko SHINKAWA
    2021 Volume 35 Issue 1 Pages 36-47
    Published: 2021
    Released: June 30, 2021
    JOURNAL FREE ACCESS

    Purpose

    The present study aimed to clarify the changes in the incidence and frequency of pregnancy-related discomforts in the period from the third-trimester pregnancy to 1 year postpartum, and factors associated with the symptoms.

    Methods

    The participants were pregnant women who visited the obstetrics and gynecology outpatient departments of four hospitals for medical examinations or maternity classes in Hiroshima, Japan. A questionnaire survey was administered five times longitudinally: during the pregnancy period, at discharge, and at 1 month, 4 months, and 1 year after childbirth. The contents of the survey consisted of the existence and the frequency of 29 frequently experienced discomforts of pregnancy, type of delivery, feeding condition, childcare burden scale, Japanese version of maternal attachment inventory (MAI-J), and Japanese version of Edinburgh postnatal depression scale (EPDS). We performed one-way analysis of variance for analyzing the changes in the number of symptoms from pregnancy to postpartum and chi-square tests for analyzing the prevalence of each symptom. The Pearson product factor correlation coefficient and unpaired t-tests were used for analyzing the relation between the number of symptoms and the factors affecting postpartum health.

    Results

    Questionnaires were distributed to 1566 women in the pregnancy period, and we collected third-trimester data of 681 women and used data of 422 women. Questionnaires were also distributed to the women during the following postpartum periods: time of discharge, 126; 1 month after childbirth, 88; 4 months after childbirth, 79; and 1 year after childbirth, 70. The number of pregnancy-related symptoms were decreased as time passed by (F=130.93, p<0.01). The prevalence of 22 symptoms significantly decreased after childbirth, while the prevalence of three symptoms increased and that of four symptoms remained unaltered. The number of symptoms at the time of discharge and 1 month after childbirth were significant correlated with the EPDS score (r=0.39–0.58, p<0.01) and the childcare burden scale (r=0.30–0.44, p<0.05) from 1 month to 1 year after childbirth.

    Conclusion

    The findings of this study confirm that some pregnancy-related discomforts continue to postpartum and that the number of symptoms in postpartum is associated with postpartum depression and the stress of postnatal care. We thus showed the importance of maternal care during pregnancy as it affects childcare later on. Childcare starts from pregnancy. Thus, a smooth transition to childcare is possible only if pregnancy-related discomforts such as “minor troubles” are not taken lightly, as women require all the physical, mental, and emotional care right from the beginning of pregnancy to be strong and healthy in all aspects of the postnatal phase.

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Data
  • International Committee of the Japan Society of Midwifery Education (2 ...
    2021 Volume 35 Issue 1 Pages 48-56
    Published: 2021
    Released: June 30, 2021
    [Advance publication] Released: February 15, 2021
    JOURNAL FREE ACCESS

    Purpose

    This study aimed to acquire knowledge regarding the differences of training courses and educational institutions providing midwifery education through visualization by analyzing the related data from the International Confederation of Midwives (ICM).

    Methods

    Secondary analysis was performed using data from 109 countries out of 113 countries included in the ICM data available on their website. The following midwifery education-related items were plotted on the world map: (1) academic degree at the time of graduation, (2) midwifery education program, and (3) number of midwifery graduates per educational institution. For regional comparison, data were divided into six regions according to the World Health Organization (WHO) classification.

    Results

    Regarding academic degree at the time of graduation, from among 87 countries, diplomas and bachelor's and master's degrees were confirmed for 47 (54.0%), 65 (74.7%), and 35 (40.2%) countries, respectively (multiple answers). Regarding the midwifery education program, from among 94 countries, 76 (80.9%) had a direct-entry education program and 57 countries (60.6%) had a post-nursing midwifery education program. For the number of midwifery graduates per educational institution, the data for 80 countries were divided into quartiles. The median of midwifery graduate per institution was 22.5.

    Conclusion

    An international comparison was made through visualization using ICM data, and this study identified a wide range of training course and educational institutions of midwifery education. Direct-entry programs were more adopted than post-nursing midwifery programs. In the countries in Africa, where maternal mortality ratio and total fertility rete were high, a diploma course was more likely to be provided, and the number of graduates per institution tended to be higher.

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  • Emi TAHARA-SASAGAWA, Megumi HARUNA, Chizuru MISAGO
    2021 Volume 35 Issue 1 Pages 57-65
    Published: 2021
    Released: June 30, 2021
    [Advance publication] Released: April 23, 2021
    JOURNAL FREE ACCESS

    Purpose

    Humanization of childbirth refers to the concept of care that values the physiological processes of the mother and child. This concept has been introduced into the laws of Latin American countries. The present study aimed to analyze the care for maternal and child considered as humanization of childbirth in the relevant laws and regulations of Latin American countries.

    Methods

    Recent laws and regulations related to humanization of childbirth were researched from the government and ministry websites of 20 countries in Latin America with Spanish and Portuguese as the native language. The guaranteed laws in the care for women during pregnancy, childbirth, and postpartum and their newborns were extracted and compared with the itemized recommendations from the World Health Organization (WHO) guidelines about intrapartum care for a positive childbirth experience.

    Results

    Through online research, seven countries were found to mention laws and regulations about the care for women and newborns to promote humanization of childbirth. Specifically in Argentine law, 16 items in the care for women and newborns were guaranteed to promote humanization of childbirth. Additionally from other countries, 12 items in Chile, 18 items in Colombia, 16 items in Ecuador, 17 items in Nicaragua, 23 items in Panama, and 26 items in Peru were the respective number of guaranteed laws about the care for women and newborns. There were 22 items of care guaranteed by the laws from two or more countries from which 13 items overlapped with the itemized recommendations from the WHO guidelines. Although the care to achieve the humanization of childbirth differed from country to country, there was a common emphasis on respect for pregnant women, postpartum mothers, and newborns, as well as attitudes and postures as caregivers. However, there were fewer descriptions about clinical procedures and practices at each stage of labor.

    Conclusion

    The care in achieving the humanization of childbirth varies from country to country. The emphasis on the care and attitudes of health care providers in respecting women and newborns was common in the laws and regulations of the seven countries. As continuity is considered an important issue in humanization of childbirth, it is likely guaranteed that Latin American countries intend to ensure continuity of humanization of childbirth by enacting legislation. In prospect, Japan may have much to learn from this movement.

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  • Yuko Masuzawa, Hiromi Eto, Eri SHISHIDO, Kaori BABA, Mariko IIDA, Yaek ...
    2021 Volume 35 Issue 1 Pages 66-71
    Published: 2021
    Released: June 30, 2021
    [Advance publication] Released: March 25, 2021
    JOURNAL FREE ACCESS

    The Japan Academy of Midwifery provides an update to guidelines for midwifery care during pregnancy, childbirth and postpartum in 2020 to guide the practice of evidence-based, comfortable care. With the goal of “midwifery care for all pregnant women”, the guideline was first published in 2012 and first updated in 2017. The expected roles for these midwifery guidelines include: in clinical practice, as an information tool for midwives to use when making decisions with women; in education, as a tool to understand the evidence base for care and the level of quality of that evidence; and in research, as a tool to recognize the evidence gap.

    The second update for the evidence-based midwifery guidelines – pregnancy, childbirth and postpartum 2020 has just been published. In this guideline, clinical questions (CQs) were collected from the public and the guideline committee members judged them for importance. A search for evidence about CQs was conducted by worldwide guidelines and using the three databases (MEDLINE, the Cochrane Library, Ichushi-Web) in January 2018.

    Ten new CQs (five pregnancy CQs and five postpartum CQs) were added to the 2020 edition of the midwifery guidelines, and existing CQs were reviewed for additional evidence and reexamined for their importance in relation to the 2016 edition. As a result of this review, 14 CQs (one pregnancy CQ and 13 intrapartum CQs) had their wording changed and 11 CQs (five pregnancy CQs and six intrapartum CQs) had their recommendations added to or changed. “What is involved in medical treatments” is limited to “evidence and commentary” instead of recommendations.

    The purpose of this English-language publication is to introduce and disseminate Japan's midwifery care guidelines to the rest of the world, and to help researchers and others cite the content of the midwifery guidelines in English. This paper was translated from the originally published Japanese version of the 2020 evidence-based guidelines for midwifery care by the Guidelines Committee of The Japan Academy of Midwifery (Tokyo, 2020, 194p, https://www.jyosan.jp/uploads/files/journal/JAM_guigeline_2020_revised20200401.pdf)

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  • Maki MOROHASHI, Kayoko SEKIJIMA
    2021 Volume 35 Issue 1 Pages 72-87
    Published: 2021
    Released: June 30, 2021
    [Advance publication] Released: June 11, 2021
    JOURNAL FREE ACCESS

    Purpose

    Over the past few years, community midwives have increasingly been expected to remedy the problems of the declining birthrate, midwives’ preference to work in medical facilities, and the underutilization of midwives in those facilities. The aim of this study was to ascertain the actual activities and identity of community midwives by surveying all members of the Niigata Midwives Association.

    Methods

    With the approval of the President of the Niigata Midwives Association, a questionnaire was sent to all 223 members and returned by mail. Descriptive statistics were calculated, and responses were subjected to a χ2 test by 5 groups of years of experience in the community. Open-ended responses were qualitatively and descriptively analyzed.

    Results

    Of the 127 responses received (response rate: 56.9%), 94 from midwives who worked in the community were analyzed. The distribution was thirty percent of respondents in each of the 40s, 50s, and 60s age groups. Eighty respondents (85.1%) provided “home visits” and 64 (68.1%) provided “breastfeeding and breast massage care.” Respondents found “home visits” rewarding mainly. Of the 68 respondents who were “not birth attendance,” 48 (70.6%) did “not plan to attend births in the future.” Despite years of experience, respondents had honed their skills by attending workshops and seminars. There were 126 responses to open-ended questions from 40 respondents which were grouped into 8 categories: “lifelong care and support for women from close relationships”, “rewarding satisfaction and aspiration through own activities”, “continuous honing of skills to provide professional care”, “collaboration with community and other midwives”, “wonderful role of midwives”, “living as a community midwife for a lifetime”, “limited income”, and “need to raise awareness, social status and recognition of midwives”.

    Conclusion

    Community midwives were most rewarded by home visits and spending time, but they were also involved in various other activities, such as “breastfeeding and breast massage care.” They had continued to hone their skills, did not adhere to “birth attendance,” and planned to continue being community midwives for women from close relationships. However, low income, low public awareness and low social status were pointed out as problems.

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  • Chieko YANASE, Akiko YAMADA, Yuki TAKAHASHI
    2021 Volume 35 Issue 1 Pages 88-98
    Published: 2021
    Released: June 30, 2021
    [Advance publication] Released: June 11, 2021
    JOURNAL FREE ACCESS

    Purpose

    To describe midwives' perceptions of the continued existence of postpartum care services in midwifery homes, and to discuss the importance of midwifery homes in the community.

    Methods

    We conducted a qualitative study of 8 midwives who provided postpartum care services in midwifery homes in A prefecture. A semi-structured interview was administered where they described their perceptions of practicing at midwifery home. Data were descriptively analyzed.

    Results

    Regarding midwives' perceptions, the 1 core category [Practicing to support healthy life for mother-child dyads and their family] consisted of the 5 categories <To support postpartum mothers is an unchanging concern for midwives><Continued individual holistic supports><Supporting healthy feeding methods for both mothers and children based on mothers' feelings>< Leading breastfeeding to pleasant of child-rearing > and <Supporting bonding and/or family relationship>. Midwives realized the existence of midwifery homes in the community as [Places of seamless child-rearing support in the community] and consisted 6 categories <Mothers who gave a birth at midwifery home are healthy and independent><Places anyone can comfortably access at any time><Bases of child-rearing in the community>< Individual supports to mothers according to their background><Utilizing interdisciplinary approach in the community> and <Performing professional roles>.

    Conclusion

    Midwives recognized that postpartum care services were essential practices in their profession that was different from ongoing project of postpartum care services. Moreover, the midwives continuously supported healthy lives for mother-child dyads and their families based on capturing mothers who are a series from pregnancy. Furthermore, the midwives considered the midwifery homes as places where they could perform professional roles in the community.

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