Japanese Midwives Research Articles

Work engagement influencing factors of Japanese midwives working in prenatal medical centers.

There have been significant changes in the work environment of midwives, such as the establishment of prenatal medical centers and shared wards for obstetrics and other departments. These changes in the work environment pose a psychological burden on midwives. Under these circumstances, the concept of work engagement is essential for overcoming the ensuing difficulties. However, no studies have yet investigated midwives working in prenatal medical centers in Japan. This study examined the factors affecting work engagement among midwives working in prenatal medical centers in Japan. A cross-sectional survey of 498 midwives working at prenatal medical centers nationwide was conducted. Data were analyzed using the Mann-Whitney U test or Kruskal-Wallis test, correlation analysis using Spearman's rank correlation coefficient, and multiple regression analysis as linear regression. The median of work engagement score was 3.00 (IQR: 2.40-3.60). The multiple linear regression analysis showed that professional identity (β=0.494, p<0.001), resilience (β=0.243, p<0.001), presence of in-hospital midwifery in the facility (β=0.138, p<0.011), and age (β=0.085, p=0.021) were significant. The adjusted R2 value was 0.490 (p<0.001). These results offer management insights into improving work engagement among midwives working in prenatal medical centers in Japan. The proposed measures include hospital/ward administrators establishing the professional identity of midwives and providing them with opportunities to demonstrate their expertise, for instance, within in-hospital midwifery systems at perinatal medical centers.

Japanese Midwives’ Perceptions of Goal Setting with Hospitalized Women with Pregnancy Complications: A Qualitative Descriptive Study

Background: Midwives aid hospitalized women with pregnancy complications in setting pregnancy duration goals for maternal and fetal well-being. However, there is little research regarding midwives’ views on goal setting among inpatients with pregnancy complications. Objective: This study examined how Japanese midwives perceive the significance of goal setting among women hospitalized for pregnancy complications. Methods: This qualitative descriptive study was conducted at five tertiary perinatal centers in Mie Prefecture, Japan, from January 2019 to June 2020. Data were collected through purposive sampling using semi-structured, one-on-one interviews with Japanese midwives experienced in antenatal care for high-risk pregnant women. Qualitative content analysis was used to analyze the data. Results: Thirteen midwives participated in this study. According to the data analysis, goal setting is significant in four ways: (a) relieving psychological distress among pregnant women, (b) helping pregnant women think positively about their efforts to continue the pregnancy, (c) promoting the transition to motherhood, and (d) contributing to the effective care of pregnant women. Conclusion: This study indicates midwives’ recognition that goal setting positively contributes to the psychosocial status of hospitalized pregnant women and the care provided to them. These results suggest that midwives support pregnant women in goal setting by considering their current situation and future mother–child relationships.

근대 일본인 산파의 한반도 월경(越境) 실태

In modern Japan, midwives were legally defined as medical professionals. And they were individuals who could operate their own businesses, making them Japanese women who crossed borders to the Korean Peninsula even before colonization. However, research on the crossing borders of midwives has been insufficient due to the approach of conducting studies by separating the research area based on national borders. Studying this will shed light on the labor conditions and way of life of midwives crossing borders, as modern Japanese women workers, and colonizers.&#x0D; Therefore, this paper aims to examine the reality of midwives crossing borders in the pre-colonial Korean peninsula through articles of Keijosinpo and statistics by the Japanese Residency-General.&#x0D; Through this paper, the following points have been confirmed: First, Japanese midwives were active in Gyeungseong, and Busan at least since the Japanese Legation era. Second, After the establishment of the Japanese Residency-General, some of midwives were sent by the Doujin-kai, which sought to infiltrate medical care in Korea and the Qing Dynasty following the victory of the Russo-Japanese War. Third, At the end of 1906, Busan had the largest number of midwives, but as the Japanese population in Gyeungseong surged, number of midwives also increased in Gyeungseong, and the number of midwives in other cities followed the trend of population growth and the number of females and births. Finally, their income was not evaluated as high, but it was perceived as good because it was recognized as a domestic job that women could do at home.

Development and validation of a professional autonomy scale for Japanese midwives.

Japanese midwives are required to autonomously perform midwifery diagnosis and maternity care. However, education to promote the professional autonomy of midwives is inadequate, and previous studies have not been able to identify a measure for it. This study aimed to develop a professional autonomy scale for midwives, to be used for the education and career advancement of Japanese midwives. The Midwives Professional Autonomy Scale extracted items from the midwives' "autonomy" and "specialty" literature, and 10 professionals verified the surface and content validity of the scale. Overall, 695 Japanese midwives participated in a survey, of which a sample of 399 was recovered. Exploratory factor analysis was performed using the sample to confirm the validity of the construct and internal consistency of the scale (Cronbach's alpha value 0.95). Additionally, the validity of the criteria was confirmed using the self-efficacy scale, self-esteem scale, and job satisfaction, and the stability was confirmed by test-retest reliability. Consequently, the professional autonomy scale for Japanese midwives comprised 24 items and 5 factors. This scale can thus be used to evaluate the professional autonomy of Japanese midwives and for midwifery education.

Job satisfaction of Japanese midwives in the Tokyo metropolitan area.

We explore job satisfaction among Japanese midwives working in different institutions within the Tokyo metropolitan area and relate this to midwives' age. The study involved a questionnaire survey of 423 midwives working in 113 general hospitals, 70 clinics, and 58 midwifery centers in the Tokyo Metropolitan Area of Japan. The questionnaire consisted of items related to demographic and job satisfaction. Questionnaires were returned by 199 participants (47%). Of the 199 midwives, 142 worked in general hospitals (71%), 26 worked in maternity clinics (13%), and 31 worked in midwifery centers (16%). Factor analysis extracted six job satisfaction factors labelled as: F1 'midwifery services', F2 'interpersonal relations', F3 'rewarding and autonomy', F4 'working environment', F5 'working conditions', and F6 'collaboration with doctors'. Job satisfaction scores for all factors were the highest among midwives working in midwifery centers, followed by those working in maternity clinics and hospitals. Job satisfaction of F1 and F3 of those working in midwifery centers was significantly higher than those working in hospitals and maternity clinics for the younger age group, while the scores of those working in maternity clinics became higher and closer to those working in midwifery centers for other age groups. Job satisfaction of midwives varies by different institutions, particularly lowest for those working in hospitals than those working in midwifery clinics and centers. It is necessary to devise useful strategies for midwives in hospitals to enhance their satisfaction with midwifery services and to feel rewarded by and autonomy at work.

Development and Evaluation of a Cervical Cancer Screening Training Program for Midwives in Japan

Background: In Japan, cervical cancer incidence has increased over the last decade and screening coverage is extremely low (35.8%). In 2016, the Japanese government allowed nursing professionals to perform cervical screening for the first time if instructed to do so by a gynecologist. Following this, a training program was developed for midwives to perform cervical screening. Objective: To evaluate a training program for Japanese midwives to perform cervical screening. Methods: Eight experienced midwives participated at 1 medical center in November 2019. After a lecture, skills-lab and 3-week practice using a manikin, midwives who passed the skills-check proceeded to the practicum for routine screening. After passing the practicum, each midwife took 20 samples under indirect supervision. Evaluations by supervising gynecologists and 160 screened women, as well as midwives’ self-reports were analyzed. Results: The pass rate was 86%. In 21 (13%) of 160 cases, midwives needed assistance from a gynecologist to locate the cervix, including 5 cases which were taken over by a gynecologist. None of the samples were unsatisfactory. Women’s evaluation of midwives as screeners was both positive and high. Conclusions: This training program enabled experienced Japanese midwives to take adequate samples while methods of evaluation should be elaborated. Women were highly satisfied with midwives performing cervical screening. Implications for Practice: Task shifting to midwives may be an important policy approach to improving cervical screening coverage. Foundational: This study was the first in Japan to give foundation to task shifting of cervical screening from physicians to midwives.

Traumatic stress experienced by Japanese midwives and its relation to burnout and work engagement.

The purpose of this study was to: (1) clarify the traumatic stress experienced by Japanese midwives using the Traumatic Stress Scale for Midwives (TSSM); (2) identify the traumatic stress experience with the highest frequency and greatest impact; and (3) clarify the relationship of the frequency and impact of the traumatic stress experience with burnout and work engagement. A quantitative exploratory study was conducted using a self-administered questionnaire. The target midwives were those employed in hospitals, clinics, and midwifery centers throughout Japan. TSSM item 7 "Disregarded oneself when providing care" showed the highest average frequency score (1.70, SD=0.8). TSSM item 2 "Experience of intrauterine fetal death" showed the highest average impact score (2.84, SD=1.2). There was a significant difference in the average scores of frequency and impact of traumatic stress by current workplace, marital status, and living with family members. There was no significant difference in the average scores of frequency and impact of traumatic stress by midwife educational background. The frequency and impact of traumatic stress showed a positive correlation with burnout, but a negative correlation with work engagement. TSSM is a valid measure to determine traumatic stress. It correlated with burnout and work engagement. TSSM may be used to prevent turnover. Additional research to understand traumatic stress is needed.

Exploring Japanese midwives' clinical decision making for onset of labor

Exploring Japanese midwives' clinical decision making for onset of labor

The Current State of Professional Midwives in Japan and their Traditional Virtues

th , 2016 ABSTRACT Traditionally, Japanese women endure labor pain. They are then pleased by the sense of ac- complishment after a successful vaginal childbirth, a concept based on the Japanese Buddhism. Therefore, Japanese midwives place importance on the process and devote care for pregnant women throughout the experience. Professional midwives in Japan strive to monitor the child- birth process with devotion and identify any abnormality with modern scientific knowledge in the small midwifery rooms of hospitals and clinics, in cooperation with obstetricians. Recently a new midwifery category has evolved called advanced midwife that do not work under a physician's direct supervision, but rather practice independently and in harmony with the doc- tors.

Outcome evaluation of an educational program for Japanese midwives to promote breast awareness for women.

The objective of this study was to evaluate educational approaches for midwives to promote breast awareness for postnatal women by measuring the knowledge, attitude and practice of midwives. A nonequivalent control design comparing two intervention groups and control group was used. Participants were Japanese midwives agreeing to this study. Midwives in the program group attended the program; those in the text group only read the textbook. Midwives in the control group neither attended the program nor learned by textbook. All measurements were administered at baseline, one-month post-program, and three-month post-program. Among 215 participants, 168 midwives (45 program, 62 text, and 61 control) remained until three month follow-up. The knowledge test score was found to have significant mutual interactions between the three groups and time (F=14.2, df=4, p<0.001). However, the attitudes did not differ between the three groups. Implementation rates for midwifery practice incorporating breast awareness education for postpartum women were different at one month and three months between the three groups. Implementation of breast awareness education at three months revealed the following factors: program group (OR 5.4, 95%CI [1.3-21.8]; text group: OR 0.7, 95%CI [0.2-2.7]) and implementation of breast awareness education at the first time measurement (OR 18.6, 95%CI [4.6-73.9]). The results of this study showed that the educational program increased midwives' knowledge and contributed to the continuation implementing breast awareness education for postpartum women about three months after testing.

Continuity, Confidence, Compassion and Culture: Lessons learned from Japanese midwives

PurposeTo explore midwifery practice through the eyes of Japanese midwives and midwifery students, with the aim of identifying traditional childbirth practices and models of midwifery care that lead to higher rates of physiologic birth as experienced by women in Japan.Research QuestionsWhat specific cultural factors influence pregnancy care and childbirth practices in Japan? What factors and practices are associated with physiologic birth in Japan? How could traditional Japanese practices be utilized by midwives in the United States to improve birth outcomes?SignificanceDespite its relationship with Western culture, Japan continues to promote physiologic birth without complications, at lower rates than many other developed nations. With a comparatively low cesarean rate of 18.6% in 2011 and one of the lowest maternal mortality rates in the world, cultural factors are clearly important. Recognition of traditional Japanese midwifery practices and unique models of midwifery care that can increase opportunities for physiologic birth have the potential to reverse the increasing trend for birth intervention in other countries.MethodsMixed methods were used to explore midwifery practices in Japan. A pilot survey, translated into Japanese, was administered to midwives (n = 9) and midwifery students (n = 9) in 2 prefectures in Japan (one urban, one rural). Two focus groups were conducted to further explore culturally specific midwifery attitudes, practices, and future challenges in maintaining low birth‐intervention rates in Japan. Visits to hospital and community settings (Josanin or birthing homes) enhanced understanding of described practices.ResultsThe prominent role of midwives in all low‐risk pregnancies in Japan was felt to increase opportunities for women to achieve physiologic birth. Interventions commonly used in the United States were reserved for complicated pregnancy. Japanese midwives recognized danger in increasing epidural use and the value of midwifery care in preventing unnecessary intervention. Important aspects of care included midwifery presence, compassion, confidence in women, non‐pharmacologic pain relief, movement/upright labor positions, and education provided by midwives.DiscussionGreater access to continuity of midwifery care in the United States could contribute to better birth outcomes. A larger study of Japanese midwives is planned to further explore effective practices that could be used in US settings to improve opportunities for physiologic birth.

日本助産師会会員における妊婦への食生活支援に関する調査 「妊産婦のための食生活指針」の活用状況を中心に

日本助産師会会員における妊婦への食生活支援に関する調査 「妊産婦のための食生活指針」の活用状況を中心に

Occupational stress experienced by Japanese midwives

Studies have shown that half of Japanese midwives experience depression ( Akizuki and Fujimura, 2006 ), but the stress experienced by them is not well understood. This study examines job stress among midwives in hospitals and clinics in the Tokyo area. The Brief Job Stress Questionnaire (BJSQ) was distributed to 1397 midwives at 90 facilities. Responses were received from 606, and the valid responses of 556 respondents were analysed. The results showed that 442 midwives (79.5%) experienced a qualitative burden, 513 (92.3%) experienced a physical burden, and 25–35% reported high stress reactions. Progress is needed in the identification of tasks that contribute to qualitative job overload. A survey is needed to determine the specific workload that will lead to a reduction of midwives’ stress and an improvement of their workplace environment.

Outcomes of independent midwifery attended births in birth centres and home births: A retrospective cohort study in Japan

Objectivethe objective of this study was to describe and compare perinatal and neonatal outcomes of women who received care from independent midwives practicing home births and at birth centres in Tokyo. Designa retrospective cohort study. Settingsbirth centres and homes serviced by independent midwives in Tokyo. Participantsof the 43 eligible independent midwives 19 (44%) (10 assisted birth at birth centres, nine assisted home birth) participated in the study. A total of 5477 women received care during their pregnancy and gave birth assisted by these midwives between 2001 and 2006. Methodsresearchers conducted a retrospective chart review of women’s individual data. Collected data included demographic characteristics, process of pregnancy and perinatal and neonatal outcomes. We also collected data about independent midwives and their practice. Findingsof the 5477 women, 83.9% gave birth at birth centres and 16.1% gave birth at home. The average age was 31.7 years old and the majority (70.6%) were multiparas. All women had vaginal spontaneous deliveries, with no vacuum, forceps or caesarean section interventions. No maternal fatalities were reported, nor were breech or multiple births. The average duration of the first and second stages of labour was 14.9 hours for primiparas and 6.2 hours for multiparas. Most women (97.1%) gave birth within 24 hours of membrane rupture. Maternal position during labour varied and family attended birth was common. The average blood loss was 371.3mL, while blood loss over 500mL was 22.6% and over 1000mL was 3.6%. Nearly 60% of women had intact perinea. There were few preterm births (0.6%) and post mature births (1.3%). Infant’s average birth weight was 3126g and 0.5% were low-birthweight-infants, while 3.3% had macrosomia. Among primiparas, the birth centre group had more women experiencing an excess of 500mL blood loss compared to the home birth group (27.2% versus 17.6% respectively; RR 1.54; 95%CI 1.10 to 2.16). Multiparas delivering at birth centres were more likely to have a blood loss over 500mL (RR1.28; 95%CI 1.07 to 1.53) and over 1000mL (RR1.75; 95%CI 1.04 to 2.82) compared to women birthing at home. Conclusionour results for birth outcomes with independent midwives at birth centres and home births in Japan indicated a high degree of safety and evidence-based practice. This study had some limitations because of its incomplete data and low response rate. However, this is one of the few studies that reported outcomes of Japanese independent midwives and the safety of their practice. A birth registry system would provide us with more accurate and complete information of all childbirths with which to evaluate the safety of independent Japanese midwives.

Confusion and ethical issues surrounding the role of Japanese midwives in childbirth and abortion: A qualitative study

This qualitative study describes midwives' experiences in providing care in both pregnancy termination and childbirth in Japan. Midwives working in the general hospital maternity unit assist in both, which is an ethical issue warranting further exploration. Eleven midwives working in a general hospital were interviewed using a semistructured interview, and responses were coded using thematic analysis. Two major themes emerged: the experience of midwives involved in childbirth and pregnancy termination (three subthemes: confusion about care of the baby and aborted fetus, inability to cater to different mothers' needs, and establishing emotional control) and professional awareness and attitude as a midwife (three subthemes: consistency with professional principles, suppression of feelings in relation to aborted fetus, and previous and current professional identities). We found that midwives are isolated in this important social moral issue and its accompanying professional confusion. Suppressing their feelings remains the most common way of dealing with the ambivalence of the roles they fulfill. Improved working conditions and enhanced training on aspects of professional ethics would assist in reducing professional confusion.

Japanese American Midwives: Culture, Community, and Health Politics, 1880-1950. By Susan L. Smith (Urbana: University of Illinois Press, 2005. ix plus 280 pp. $25.00)

Japanese American Midwives: Culture, Community, and Health Politics, 1880-1950. By Susan L. Smith (Urbana: University of Illinois Press, 2005. ix plus 280 pp. $25.00)

SUSAN L. SMITH. Japanese American Midwives: Culture, Community, and Health Politics, 1880-1950. (The Asian American Experience.) Urbana and Chicago: University of Illinois Press. 2005. Pp. ix, 280. Cloth $50.00, paper $25.00

SUSAN L. SMITH. Japanese American Midwives: Culture, Community, and Health Politics, 1880-1950. (The Asian American Experience.) Urbana and Chicago: University of Illinois Press. 2005. Pp. ix, 280. Cloth $50.00, paper $25.00

Independent Japanese midwives: A qualitative study of their practise and beliefs

AbstractAim: In the midwifery literature in English, little attention is paid to midwifery practise in Asian countries. To remedy this, we explore the knowledge and beliefs of independent Japanese midwives.Methods: We collected data in natural settings through the active participation of the authors in midwifery work after receiving informed consent. We visited midwives’ practise settings and observed ante‐partum, intra‐partum, and post‐partum midwifery practise. We also interviewed the midwives. Throughout the study, the authors discussed the findings with the participating midwives.Results: The concepts that summarize what midwives and women in our study described as the desired outcomes of care were: (i) feelings of happiness and joy; (ii) positive change; (iii) mother–child bonding; and (iv) lifelong health. The concepts that guided the midwifery process were: (i) positive communication; (ii) the woman’s commitment to her health; (iii) supporting the woman’s own way; (iv) the support of other pregnant women; (v) food as care; (vi) warmth; and (vii) respect for the natural process. The two encompassing features of midwifery practise were: (i) awareness, which includes the assurance of normalcy and the prevention of abnormalities; and (ii) networking and collaboration, which describes the relationships of midwives with their colleagues, doctors, and other health professionals.Conclusion: The traditional knowledge of Japanese midwives offers concepts that might be useful to international midwifery and should be studied more in depth.

Japanese American Midwives: Culture, Community, and Health Politics, 1880–1950 (review)

Japanese American Midwives: Culture, Community, and Health Politics, 1880–1950 (review)

Japanese midwives as psychiatric diagnosticians: Application of criteria of DSM‐IV mood and anxiety disorders to case vignettes

It is believed in Japan that only psychiatrists are capable of providing reliable psychiatric diagnosis. However, more awareness of mental health issues related to perinatal care means that midwives are now required to have psychiatric diagnostic skills. The purpose of the present paper was to examine how well Japanese midwives agreed with a psychiatrist on diagnoses of different psychiatric disorders. Vignettes of 29 cases including DSM-IV mood disorders (major depressive disorder and bipolar disorder) and anxiety disorders (generalized anxiety disorder, panic disorder, phobic disorders, and obsessive-compulsive disorder) were distributed to 12 Japanese midwives. They decided the DSM-IV diagnoses independently and compared them with those made by an expert. The kappa coefficients of the diagnoses with a base rate of 0.1 or more were moderate to almost perfect (0.64-0.83). The accuracy of symptom assessment was also satisfactory. Appropriately trained Japanese midwives can use the diagnostic criteria for psychiatric disorders reliably. It is therefore feasible to dispatch midwives who are trained in psychiatric diagnosis to antenatal clinics.