The purpose of this study was to 1) examine changes in low back pain, gait index (visualization index of gait and step according to kinematic data), and physical activity in the second and third trimesters of pregnancy: and 2) determine the relationship between these three variables.
The study participants were 35 Japanese pregnant women. Clinical data on low back pain, gait index, and physical activity were collected twice, once during the second and once during the third trimester. The visual analog scale (VAS) was used to measure low back pain. Gait measurements were recorded using a wireless motion recording sensor unit containing a piezoresistive triaxial accelerometer and a triaxial gyroscope. For gait analyses, we calculated the coefficient of variation (CV), root mean square (RMS), harmonic ratio (HR), and autocorrelation coefficient (AC). RMS, HR, and AC were measured across three physical planes: vertical (VT), mediolateral (ML), and anteroposterior (AP). Physical activity was measured by wearing a life coder GS® for three or more days.
Eighteen pregnant women (51.4%) with no back pain before pregnancy had higher VAS during the third trimester than in the second trimester (p=0.01). Steps (p=0.01) and medium/high intensity activity time (p=0.01) decreased significantly more in the third trimester than in the second trimester. CV was significantly larger during the third trimester than during the second trimester (p=0.03). The third trimester showed a significantly smaller RMS in the mediolateral planes than did the second trimester (p=0.03), which showed trunk stiffness. A moderate negative correlation was observed between HR in the second trimester and VAS in the third trimester (r value: −0.411 to −0.517, p<0.05). Moderate positive correlations were observed between number of steps/day in the second trimester and RMS (r value: 0.436，p<0.05) and AC in the third trimester (r value: 0.379 to 0.460, p<0.05).
This study found that gait indices were more unstable in the third trimester than in the second trimester. Pregnant women were able to maintain their gait ability by reducing their body sway due to muscle depression. Unstable gait indices may lead to increased falls, so supported exercise regimes are required to ensure and maintain gait stability from the second trimester until the third trimester.
The HUG (Help-Understanding-Guidance) Your Baby program is designed to support parents with a newborn baby. This study aimed to evaluate the usability of the program through 1) questionnaires on class contents and use of learning materials, and 2) interviews on parenting experiences of those who participated in the HUG Your Baby program during pregnancy.
Participants and methods
This study is a program evaluation study that integrates findings from questionnaire data and qualitative interviews. Descriptive statistics of the questionnaire data after the program during pregnancy, 1 month postpartum, and 3 months postpartum were calculated, and differences between 1 month postpartum and 3 months postpartum were analyzed. Semi-structured interviews based on the evaluation method of the intervention study by Bowen et al. were conducted 2 to 7 months after the birth of the baby.
The questionnaire survey included 82 participants who responded both at 1-month postpartum and at 3-month postpartum. In terms of the frequency of use of learning materials, use of the following materials was significantly higher in the 3 months after delivery: newborn behavior DVD (p<0.001), newborn behavior leaflet (p<0.001), breastfeeding leaflet (p<0.001), and swaddles (p=0.001). In comparisons of the comprehensibility of the learning materials, significant differences were found between the newborn behavior DVD (p=0.032) and breastfeeding leaflet (p=0.009). More than 90% of mothers answered “I would recommend” or “I would highly recommend” HUG Your Baby to other people.
With regard to demand, in the interviews, many mothers reported that they had expected parenting to be difficult; however, they considered the title “HUG Your Baby” to be positive and reassuring. They wanted to love their children without stress and to make parenting easier. With regard to practicality, in the interviews, participants described the following benefits of the program: being able to respond to the child's crying, breastfeeding and cuddling according to the sleep pattern of the newborn; being helped by parenting experiences; and being able to share learning materials with other family members.
The program HUG Your Baby is highly usable in terms of meeting parents' needs regarding understanding and responding to the newborns behaviors. The learning materials were useful for obtaining support from other family members, and their comprehensibility increased as they were repeatedly used.
Psychological stress during pregnancy can be considered as a predictor of premature birth, small for gestational age (SGA), and low birth weight (LBW). Owing to a rise in the number of working pregnant women in recent years, there has been increased focus on the possible effects of occupational stress on pregnancy outcomes. The aim of this review and meta-analysis was to investigate the associations of occupational stress during pregnancy with premature birth, SGA, and LBW.
A search through 6 databases (Ichushi-Web, CiNii, MEDLINE, CINAHL, Scopus, and PsycINFO) was conducted with “premature birth,” “birth weight,” and “occupational stress” as keywords for identifying relevant publications in Japanese and in English. The search covered the period between the beginning of each database and December 2019. The identified articles were screened based on the inclusion and exclusion criteria. We used DerSimonian-Laird method to integrate the results of articles included in the review.
A total of eleven articles were included in this review. High occupational stress during pregnancy significantly correlated with a higher rate of premature birth in 2 out of 9 articles, with a higher rate of SGA in 2 out of 6 articles, and with a higher rate of LBW in 1 out of 2 articles. Meta-analyses showed that the rates of premature birth (odds ratio [OR]=1.2, 95% confidence interval [CI]=1.0-1.3) and SGA (OR=1.2, 95%CI=1.0-1.4) were significantly higher in women with the highest level of occupational stress, than in those with lower stress levels. Subgroup analyses indicated that moderate heterogeneity in the relationship between occupational stress and premature birth was partly explained by research regions.
The findings suggest that high occupational stress during pregnancy is associated with higher rates of premature birth and SGA. Improving the work environment and controlling workload may be required to prevent premature birth and SGA.
This study aimed to explore the meaning of the lived experiences of child-rearing women after first childbirth, with describing their experiences of child-rearing as they are.
The study employed a descriptive phenomenological approach with in-depth interviews. Participants included 10 primiparas, eight months after having given birth. Employed Colaizzi's model and NVivo11 for analysis.
The major findings of this study consisted of 3 thematic categories: “The attention of surrounding people since having the child;” “The determination to live together with child through the tense days long-term;” “Looking for satisfaction with my own life.” Participants became able to face themselves through the difficulties of childrearing, and through relations with the people around them. Consequently they acquired new values in life, being not able to notice so far.
These findings suggest it is important to support child-rearing women how they catch the meaning of their child care experiences. It's necessary to be considering care to a woman during the child-rearing period as support of the family and the surrounding person of the woman, not to be turned to only herself, when a midwife care for a woman during the child-rearing period.
In this study, we investigated the effects of standing tests on autonomic nervous activity during the early, middle, and final stages of pregnancy, to evaluate the mechanism of autonomic nervous system regulation by standing tests during pregnancy.
For 73 pregnant women, heart rate variability during a standing test was measured longitudinally during each pregnancy stage. Additionally, indicators of autonomic nervous activity, namely the total autonomic nervous system (CVRR), sympathetic nervous system (LF/HF), parasympathetic nervous system (CCVHF), and sympathetic/parasympathetic nervous systems (CCVLF) were assessed. Data obtained from four minutes in the sitting position, one minute immediately after standing (standing up), one minute from one to two minutes after standing (standing position), and one minute immediately after sitting (sitting down) were analyzed. A two-way analysis of variance and subtests were conducted using repeated measurements based on pregnancy stage and position.
A main effect for pregnancy stage was found in LF/HF and CCVLF. A main effect for the standing test was observed in all indicators. Interaction was observed for indicators other than CCVHF. Multiple comparisons revealed that CVRR and CCVLF increased significantly (all, p<.001) when standing up compared with the sitting position during early, middle, and final stages; these values decreased in the standing position (only significant during the middle stage; in order, p=.004, .033) and increased significantly when sitting down (all, p<.001). Among the pregnancy stages, CCVLF in the sitting, standing up, and sitting down positions was significantly lower (p=.015, .032, .008) in the final stage than in the early stage. Furthermore, LF/HF increased significantly (early, middle stages, p<.001; final stage, p=.001) when standing up compared with when in the sitting position at each pregnancy stage. The value was significantly high in the standing position for the early and final stages (early, p<.001; final, p=.004), but it decreased in the middle stage to a value not significantly different from that in the sitting position. The value when standing up during the final stage was significantly lower (p=.015) compared with that in the middle stage. The CCVHF decreased when standing up compared with the sitting position in early, middle, and final stages (early, p=.001; middle, p<.001). It decreased significantly in the standing position (all, p<.001) and increased when sitting down (middle stage, p=.011; final stage, p<.001).
Effects of the standing test on autonomic nervous activity are not uniform in different pregnancy stages, and it is suggested that in the standing position during the middle stage, activity of the CVRR, LF/HF, CCVLF is suppressed. When standing up in the final stage of pregnancy, activity of the LF/HF, CCVLF is suppressed.
This study aimed to develop and assessment of a training program for improving midwives' knowledge and perceptions of family role acquisition in the perinatal period.
Subjects and Methods
We executed a blended training program with online e-learning course and intensive training on methods of support for a group of midwives working at a department of obstetrics. We adopted ADDIE model for the program and designed it over previous studies and needs analysis. The survey is quasi-experimental study based on convenience sampling. We conducted a before-and-after evaluation study for the training program with measuring knowledge and perceptions of family role acquisition in the perinatal period.
For the recruited 25 midwives, the number of years of experience as a midwife was less than 10 years for seven midwives (28.0%) and 10 years or longer for 18 midwives (72.0%). In terms of knowledge and perceptions of support for families, understanding necessity of support for families (p=.02) increased significantly after the training program and incapable to support families in pregnancy while knowing the necessity (p<.001) not understanding families' needs (p=.02) and unclear about specific types of care for families (p=.04) decreased significantly after the training program.
The results demonstrated that this program was useful in enabling midwives to acquire knowledge on support of families and improves their perceptions of the necessity of the support regarding family role acquisition in the perinatal period.
To determine whether menstruation education in high school students leads to changes in self-care to manage menstrual pain and to determine factors that influence such changes in self-care.
Subjects and Methods
The use of 23 self-care items was compared between immediately after and three months after intervention via menstruation education in 124 female students at High School A using a self-administered questionnaire.
There were significant differences in the number of students performing seven of the 23 self-care activities between immediately after and three months after education: [Keep a menstrual cycle record] (p=0.004), [Lie down] (p<0.001), [Massage the abdominal and lower back area] (p=0.004), [Get enough sleep] (p=0.029), [Visit the hospital] (p=0.021), [Soak in a bath] (p=0.031), and [Eat three meals a day] (p=0.041).
In analyzing associations between the status of performing self-care activities after education and physical, psychological, and social factors, students with the physical factor “menstrual pain” carried out significantly more self-care activities three months after education than immediately after education, compared to those without menstrual pain (p=0.025). Significant associations were not detected for other factors.
Three items showed significant associations between changes in the number of students performing each of the 23 self-care items from immediately after to three months after education and physical, psychological, and social factors. Significantly more students with “someone who takes care of me or cares about me when I am unwell” vs. those without performed the activity [Keep a menstrual cycle record] three months after intervention (p=0.022). Similarly, significantly more students with “menstrual pain” vs. those without performed the activity [Massage the abdominal and lower back area] three months after intervention (p=0.045). On the other hand, significantly fewer students without “someone who provides me with information” vs. those with performed the activity [Eat three meals a day] three months after intervention (p=0.005).
Menstruation education in students with menstrual pain leads to changes in self-care to manage menstrual pain.
The significance of “menstrual pain” and “status of menstruation support” as factors that aid in carrying out and continuing self-care.
The purpose of this study was to examine the self-care activities of mothers who live in remote locations without childbearing facilities during gestation and childbirth so as to provide healthcare guidance in accordance with their established self-care activities.
We conducted a focus group interview and qualitative descriptive analysis with nine mothers, who live on remote islands without childbearing facilities, within one year of delivery. In the study, multigravidas (women who have been pregnant before) provided responses based on their experience of raising children.
Mothers living on remote islands without childbearing facilities reported that they gathered information from the Internet or consulted experienced individuals during their pregnancies and practiced self-care for their bodies and fetuses with their families' assistance. They visited the hospital in response to changes in their physical condition, carefully observed bleeding, and ate meals in accordance with their cultural traditions. During the postpartum recovery period, they undertook traditional self-care, with a focus on responding to abnormal symptoms, taking home remedies at an early stage in response to changes in their physical condition, hospital visits, and investigating breast abnormalities. The cultural traditions reported include not doing needlework or working with water after childbirth, and drinking fish juice to increase breast milk output.
Mothers living on remote islands without childbearing facilities did not handle their own labor; however, as a result of a strong desire to avoid unnecessary travel and living in locations without resident obstetricians, they skillfully detected abnormal symptoms and responded on their own. In order for women to undergo pregnancy and postpartum periods safely on remote islands without childbearing facilities, they must be able to sense changes themselves, and should be provided with accurate information from doctors, public health nurses, and other healthcare professionals. In the future, the healthcare industry must be aware of these trends and should have an increased responsibility in providing relevant information to mothers in remote locations.
Midwifery students have increasing opportunities to care for women at risk for developing perinatal abnormalities during pregnancy and labor due to their increased age at the time of pregnancy. The purpose of this study was to develop and evaluate the new educational program targeting midwifery students to increase knowledge and enhance clinical judgement to respond high-risk pregnancies.
We developed an educational program based on the blended learning approach that combined web-learning in advance with clinical conference style and role play or simulation in class. The themes of program were premature abruption of placenta/eclampsia and hypertensive disorders of pregnancy/HELLP syndrome. Participants were 11 midwifery students in the master's course. The knowledge and self-efficacy to assess and respond to situations were measured before and just after program and four months after program. The knowledge test for premature abruption of placenta/eclampsia (9 items; 0-36 points) and the knowledge test for hypertension/HELLP syndrome (16 items; 0-64 points) were used with multiple-choice questions. In addition, the self-efficacy test for premature abruption of placenta/eclampsia (12 items; 0-93 points; α=.93) and the self-efficacy test for hypertension/HELLP syndrome (10 items; 0-40 points; α=.91) were on a 4-point Likert scale. These data were collected from November 2016 through March 2017.
Bonferroni's test was used to detect difference across multiple times. This study protocol was approved by the St. Luke's International University Research Ethics Committee.
Medians of the total score of knowledge test for premature abruption of placenta/eclampsia were 12.0 points before the program, 24.0 points just after program and 20.0 points at four months after the program (p=0.007). In addition, medians of the total score of the knowledge test for pregnancy induced hypertension/HELLP syndrome increased from 24.0 points before the program to 48.0 points, and 44.0 points at four months after the program (p<0.001). The median scores of self-efficacy for premature abruption of placenta/eclampsia were 20.0 points before the program, 36.0 points just after the program and 35.0 points at four months after the program. The medians self-efficacy score before the program (15.0 points) increased just after the program (28.0 points) and remained higher four months after the program (25.0 points).
The educational program which we developed might be effective to increase knowledge and enhance clinical judgement after the program and keep them until 4 months after the program high.
When working to offer support in child-rearing, it is important to be aware of the fact that overcoming postpartum crises can be dangerous to a married couple, while ensuring that the married couple is parenting well during the stage of family reconstruction. As a first step in offering this support, the present study aimed to clarify the level of discussion among the couple regarding child-rearing, the feelings of each parent when criticized by the other about their child-rearing, and how each spouse perceived the underlying basis of the criticism.
Taking the appropriate ethical considerations, we distributed survey forms to 1062 individuals comprising married couples raising children. Of the 515 from whom surveys were recovered, data from 325 (185 wives and 140 husbands) who participated in the free description survey were analyzed. All written content of this descriptive qualitative study was analyzed by content analysis.
Subcategories and categories were identified.
Eighty percent reportedly discussed child-rearing with their spouse; these discussions were reportedly most frequent immediately after childbirth. The two categories describing the wife's reception of her husband's criticisms were as follows: “I receive my husband's criticism in a negative way” and “I receive my husband's criticism in a positive way.” Categories defining the underlying factors that wives felt were driving the criticisms from their husbands were as follows: “it is dependent on our personality tendencies,” “it is due to differences in our perception of the role of parents and our upbringing history,” and “restrictions in our marital relationship.” Meanwhile, the husband's response to his wife's criticism about their child-rearing was divided into three categories, as follows: “I receive my wife's criticism in a negative way,” “I receive my wife's criticism in a positive way,” and “it doesn't matter if my wife criticizes me.” Categories defining the underlying factors that husbands felt were driving the criticisms from their wives were as follows: “it is dependent on our personality tendencies,” “it is due to differences in our perception of the role of parents and our upbringing history,” and “the roles within the family and the associations therein.”
Examination of these couples and their criticisms of one another regarding child-rearing revealed some differences and characteristics. As we look toward being able to offer interventions that would enable favorable parenting among a married couple, we must keep in mind these differences in reception of criticism between wives and husbands, as well as the different underlying factors. Before the disparity in awareness or receptivity becomes too large within the married couple, it will be important to encourage them to communicate with each other about their feelings and review perception of his role as a parent, while respecting perspectives on child-rearing and any feelings of dissatisfaction.
The Japan Academy of Midwifery published “2016 Evidence-based Guidelines for Midwifery Care” (hereinafter, this is called “2016 Guidelines”). The objective of this study was to search and clarify about maternity care policies based on 2016 Guidelines among Obstetric Institutions in Japan.
The participants of this survey were 3164 institutions; hospitals, clinics, and midwifery birth centers in Japan. This study was self-administered anonymously questionnaire survey and was conducted with mail or web surveys. The questionnaire included 11 maternity care policies that based on “2016 Guidelines”. Data was collected through November to December 2016. The ethics committee of St. Luke's International University, Tokyo, Japan (No.16-A062) provided ethical approval.
362 institutions participated in the study (the response rate, 80.4%). Few institutions recommended or provided “Folic acid supplementation” (8.3%), “Screening for domestic violence” (6.9%) and “Antenatal perineal massage” (10.6%). Supplementation in pregnancy; Many institutions did not recommend “Vitamin supplementation” (60.1%) for pregnant women. Conversely, “Iron supplementation” was common (66.1%). The health guidance for discomforts in pregnancy; “Foot bath for leg edema” (74.9%), “Massage for leg edema” (78.4%), “Exercise for low back and pelvic pain” (92.5%) and “Taking dietary fibers for constipation” (96.1%) ware very common at each institutions. The health guidance of taking luxury grocery items; About half of the institutions provided “Health guidance for taking alcohols” (52.6%), but “Health guidance for taking caffeins” were provided still 29.0%.
There was significant difference about “Antenatal perineal massage” (χ2: 8.870, OR: 1.385, 95%CI: 1.129-1.699, p=0.003) whether institutions provided midwifery care in ambulatory or not.
Our results demonstrated that there were some gaps between evidence and clinical practice about maternity care in Japan. This study suggested that necessity of diffusion about “2016 Guidelines” and evidence of maternity care.