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It is essential to equip midwives and nurses working in the perinatal period with comprehensive knowledge and awareness regarding child abuse prevention. However, most midwives and nurses in Japan do not have the opportunity to learn about abuse prevention during their basic education. We aimed to develop an e-learning program to assist obstetric midwives and nurses in acquiring the knowledge needed to provide support and handle cases with a high risk of abuse, as well as to assess the program’s usefulness. This study employed a single-group pre–post design; e-learning served as the intervention. Seventy-one obstetric midwives and nurses were recruited. The program’s usefulness was the difference between the participants’ pretest and post-test knowledge and efficacy scores. The score data were analyzed using the t-test. A paired t-test revealed that the post-test scores of knowledge and efficacy were significantly higher than those of the pretest, with a large effect size (d = 1.71). Platforms where basic knowledge on how to respond to high-risk abuse cases are lacking in nursing education; thus, this e-learning program is recommended for nurses working in the perinatal field throughout Japan. This educational opportunity for perinatal midwives and nurses will increase awareness and contribute to abuse prevention.

This study aimed to conduct a pilot randomized controlled trial (RCT) to examine the appropriateness and feasibility of a midwife-led cognitive behavioral therapy (CBT)-based, three-session program delivered remotely to pregnant women at risk for anxiety disorders. The study design was a pilot RCT. Outcome was the difference between the two groups in the change in generalized anxiety disorder-7 (GAD-7), Kessler6 (K6) and Edinberg Postnatal Depression Scale (EPDS) etc. Recruitment was conducted from August 2020 to July 2021 in clinics and web-based survey monitors in Japan, with follow-up through November 2021. This program involving 63 pregnant women were administered. Although the intervention was remote, a total of three sessions was completed during pregnancy. The change in GAD-7 scores from pre- to 1 month postpartum, was mean -1.77 in the intervention group and mean -0.97 in the control group, with a p-value of .521, indicating no significant difference between the two groups, although GAD-7 scores were lower in the intervention group. The change in K6 score from pre- to 1 month postpartum, was mean -3.55 in the intervention group and mean -1.62 in the control group, with a p-value of .168, indicating no significant difference between the two groups, although the intervention group showed a greater decrease. In particular, in primiparas, the change in GAD-7 scores in the intervention group was large, and some expressed a desire for a postpartum session, suggesting that a follow-up session after delivery may be effective. In multiparas, the control group showed an increase in both GAD-7 and K6 scores from late pregnancy to 1 month postpartum, while the intervention group showed a decrease in scores. The program was implemented using CBT conducted by midwife, anxiety decreased in primiparas. In future RCTs, it was suggested that additional postpartum sessions may be effective. UMIN Clinical trial registry ID: UMIN000040304.

Background Intimate partner violence (IPV) against pregnant women is associated with many negative maternal and fetal outcomes and is a common public health problem all over the world. However, the issue has not been fully explored in Japan. This study aimed to explore the prevalence and risk factors of IPV against pregnant women in urban areas of Japan. Methods This study was a secondary data analysis of a cross-sectional survey that was conducted on women beyond 34 weeks’ gestation in five perinatal facilities in urban areas of Japan, from July to October 2015. The sample size was calculated to be 1230. The Violence Against Women Screen was used for IPV screening. Multiple logistic regression analysis was used to calculate the adjusted odds ratio (AOR) with 95% confidence interval (CI) for risks of IPV while adjusting for confounding factors. Results Of the 1346 women who participated in this study, 180 (13.4%) were identified as experiencing IPV. Compared to those who did not experience IPV ( n  = 1166 (86.6%)), women experiencing IPV had higher odds of being single mothers (AOR = 4.8; 95%CI: 2.0, 11.2), having lower household income (< 3 million yen, AOR = 2.6; 95%CI: 1.4, 4.6; ≥ 3 million yen and < 6 million yen, AOR = 1.9; 95%CI: 1.2, 2.9), having junior high school education background (AOR = 2.3; 95%CI: 1.0, 5.3) and being multipara (AOR = 1.6; 95%CI: 1.1, 2.4). Conclusions 13.4%, or about one in seven women, experienced IPV while pregnant. This high proportion indicates the need for policy to address the issue of violence against pregnant women. There is an urgent need to build a system for the early detection of victims that offers appropriate support to prevent the recurrence of violence while encouraging victim recovery.

Background Japan is facing a significant shortage of obstetricians, particularly in rural areas. To address this problem, the government has been promoting in-hospital midwife-led care to shift certain responsibilities from obstetricians to midwives. The essence of in-hospital midwife-led care lies in the midwives’ judgement and effective practices. This study aimed to understand the clinical judgement process of midwives who provide in-hospital midwife-led births. Methods This study employed a qualitative exploratory design using participant observation and think-aloud with nine midwives across three hospitals in Japan. Observations focused on midwives’ clinical behaviours during the first stage of birth. The midwives verbalised their clinical judgements as soon as possible. When they were unable to verbalise, we asked them to describe how they perceived the labouring woman and the type of care or actions they considered engaging in. Data from participant observations and linguistic data gathered during think-aloud were recorded on video. We analysed the data by combining participant observation with clinical judgement using content analysis. Results We extracted seven key categories that characterise the clinical judgement processes for midwives during delivery: (1) Predicting the condition of labouring women and determining the initial direction of care upon taking responsibility; (2) Gathering information by asking questions in different ways to identify minor changes in labouring women’s condition; (3) Examining the cause of the problem from available information to uncover and determine the root cause; (4) Predicting birth progress and determining care based on information beyond internal examinations; (5) Instantly modifying the direction of care based on labouring women’s condition; (6) Determining what care should be provided immediately based on predictions of birth progression; and (7) Providing continuous care based on labouring women’s responses to care. Conclusions Midwives engaged in in-hospital midwife-led births demonstrated heightened sensitivity to even subtle changes during delivery. They gathered nuanced information through the five senses to predict the progress of birth and provide care. They modified the direction of their care based on the women’s responses and provided the best care for the women on a continuous basis.

Background Intimate partner violence (IPV) is physical, sexual or psychological violence by a current or former intimate partner. IPV threatens women’s health, and during pregnancy women are more vulnerable to violence. Therefore, IPV screening has been recommended during antenatal care; however, health care providers have expressed concern about the negative impact on women and therefore have been reluctant in conducting IPV screening. Consequently our objective was to investigate pregnant women’s experiences of reading and completing an IPV screening questionnaire. Methods Semi-structured interviews were conducted with postpartum women who had received IPV screening during pregnancy to investigate their experiences using the IVP Violence Against Women Screen (VAWS). Qualitative data were analyzed based on content analysis. Results A total of 43 women participated in this study. There were eight (18.6%) women positive for IPV screening during pregnancy. Content analysis for all participants revealed three themes: necessity, acceptability and optimality. ‘Necessity’ referred to benefits for women from IPV screening, and was supported by three categories: ‘redefining the relationship’, ‘promoting IPV awareness’ and ‘opportunity to initiate support’. ‘Acceptability’ of IPV screening was also supported by three categories: ‘comfortable’, ‘quickly completed’ and ‘difficulty’. ‘Optimality’ meant IPV screening during pregnancy was appropriate timing for women who had been screened as either positive or negative. Conclusions The majority of women, including women experiencing IPV, had positive responses to IPV screening during pregnancy. Future diffusion of IPV screening requires safe environments for IPV screening and improved awareness of health care providers towards IPV.

Background Despite the benefits of breastfeeding for women with Gestational Diabetes Mellitus (GDM) and their infants, breastfeeding is less likely to be performed by this group. This study aimed to examine the current levels of implementation of breastfeeding support to women with GDM in Japan and to clarify barriers to promoting breastfeeding among this population. Methods A 25-item questionnaire was developed by the authors to investigate the current levels of implementation of breastfeeding support for women with GDM provided in hospitals, and to explore barriers for promoting breastfeeding among these women. The questionnaire was sent to all 1046 hospitals facilitating childbirth in Japan. Descriptive statistics were used to analyze the quantitative data, and content analysis was used to analyze qualitative data from the open-ended questions. Results All 296 respondents were included in this study. Regarding breastfeeding support, 95.2% of the respondents provided general information on breastfeeding to GDM women during antenatal midwife consultations. However, the benefits of breastfeeding for preventing type 2 diabetes were addressed by only 48.0%. Likewise, although follow-up services (e.g., telephone support or breastfeeding consultations) were conducted in 88.9% of hospitals, only 50.7% of hospitals informed women that breastfeeding decreases the risk of developing type 2 diabetes after GDM. Regarding barriers, seven categories and 20 subcategories about promoting breastfeeding for women with GDM were extracted and abstracted into the following three themes: Barriers associated with mother and infant, Barriers associated with health professionals, and Organizational barriers. Conclusions In Japan, most hospitals that responded provided general breastfeeding support from the antenatal to postpartum periods. However, the benefits of breastfeeding in terms of preventing the incidence of type 2 diabetes following GDM were insufficiently communicated to women with GDM. Furthermore, there were numerous barriers to promoting breastfeeding among women with GDM.

Background Marital satisfaction is a key determinant of maternal mental health during the perinatal period. Identifying psychosocial factors associated with changes in marital satisfaction can help inform early preventive interventions. Methods This longitudinal study examined associations between psychosocial factors measured during pregnancy and changes in marital satisfaction from pregnancy to 52 weeks postpartum. Participants were 752 pregnant women in Japan (mean age = 32.0 ± 4.3 years) who completed online surveys during pregnancy and at 52 weeks postpartum. Marital satisfaction was assessed using the Quality of Marriage Index (QMI), a validated measure of relationship satisfaction, and categorized into three groups based on QMI score differences: improved (≥ 1-point increase), unchanged (0-point difference), and worsened (≥ 1-point decrease). Psychosocial variables included depressive symptoms assessed by the Edinburgh Postnatal Depression Scale (EPDS), household income, perceived burden of household chores and childcare, parity, and perceived family support. Multinomial logistic regression was used to examine associations between these variables and changes in marital satisfaction. Results Higher levels of depressive symptoms during pregnancy, as measured by the EPDS, were significantly associated with worsening marital satisfaction after childbirth (RRR = 2.38, 95% CI: 1.30–4.37, p  = 0.005). Lower household income also predicted a decline in satisfaction (RRR = 0.999, 95% CI: 0.999–1.00, p  = 0.017). Participants who reported extremely long hours of household chores and childcare were less likely to experience improved satisfaction (RRR = 0.15, 95% CI: 0.04–0.65, p  = 0.011). First-time childbirth was negatively associated with improvement (RRR = 0.41, 95% CI: 0.20–0.87, p  = 0.019). Higher levels of perceived family support were also associated with less improvement in marital satisfaction (RRR = 0.89, 95% CI: 0.80–0.98, p  = 0.017). Conclusion Psychosocial factors during pregnancy, including depressive symptoms, economic hardship, and perceived domestic burden, were significantly associated with subsequent changes in marital satisfaction. These findings underscore the importance of early mental health screening and supportive interventions for expectant couples.

The Japanese version of the mother-to-infant bonding scale (MIBS-J), a self-report of postpartum bonding disorder, is used in clinical settings for screening postpartum bonding disorder at various time points. However, its psychometric properties, particularly measurement invariance, have rarely been reported, and the validity of comparing scores across time points and sex is unclear. We aimed to select and validate the MIBS-J items suitable for parents at three time points. Postpartum mothers (n = 543) and fathers (n = 350) were surveyed at 5 days, 1 month, and 4 months postpartum. All participants were randomly divided into two subgroups, one for exploratory factor analyses (EFAs) and another for confirmatory factor analyses. Measurement invariance of the best model was tested using the entire sample, between fathers and mothers, and across the three observation periods. A three-item structure (items 1, 6, and 8) extracted through EFAs showed acceptable configural invariance. This model was accepted for scalar invariance between fathers and mothers and for metric invariance across the three time points. Our findings suggest that the three-item MIBS-J is sufficient for diagnosis of postpartum parental bonding disorder through continuous observation for at least 4 postpartum months, in order to detect the priority of parents who need support.

Background Complementary and alternative medicine (CAM) are popular among women, and are used during their pregnancy in Japan. This study aimed to survey the prevalence of CAM use by healthy pregnant women as a health-care prescribed therapy or self-care and to investigate the factors associated with CAM use in Japan. Methods In this cross-sectional study, pregnant women after 34 weeks of gestation were asked to respond to a questionnaire at the clinic or online. The questionnaire comprised questions on the participants’ characteristics and their use of CAM for therapy and self-care. Descriptive statistics were calculated in the analyses, and bivariate and multivariate logistic analyses were performed to evaluate the associations between factors and CAM use. Results A total of 394 women responded from three hospitals, two clinics, and two midwifery birth centers. CAM was received as treatment by practitioners during pregnancy by 75 women (19.0%). The following therapies were used: traditional Chinese medicine (7.9%), chiropractic (6.9%), moxibustion (6.4%), and acupuncture (5.3%). One or more types of therapy were used as self-care by 348 women (88.3%). Highly used CAM for self-care were: folic acid supplementation (75.4%), other supplements (51.5%), herbs (20.8%), and yoga (19.0%). Multiple logistic regression analyses revealed that the factors associated with CAM use as a therapy were midwifery birth centers for planned childbirth settings (adjusted odds ratio [AOR] 3.64, 95% confidence interval [CI] [1.69–7.83]) and pregnancy complications diagnosed (AOR 2.46, 95%CI [1.38–4.39]). The factors associated with CAM use for self-care were age 30–39 years (AOR 4.48, 95%CI [2.14–9.73]) and over 40 years (AOR 3.92, 95%CI [1.10–13.91]), junior college education or above (AOR 2.30, 95%CI [1.18–4.51]), and primiparas (AOR 3.82, 95%CI [1.86–7.86]). The most common source of information was the “Internet” (43.8%). Conclusions Approximately 20% of Japanese pregnant women received CAM as therapy by practitioners, and the related factors were: tended to have baby at midwifery birth center and pregnancy complications. Almost 90% of respondents used CAM as self-care and the related factors were: older, had a higher educational level and tended to be primiparas. They used the Internet as their main source of information about CAM. Health care providers need to provide evidenced-based information on CAM and to help decision making to ensure safe and effective CAM utilization by pregnant women.

Cooling the lower abdomen is one of the Japanese traditional non-pharmacological prophylactic managements for postpartum hemorrhage. This study aimed to evaluate the effectiveness of cooling the lower abdomen in reducing postpartum blood loss compared with no intervention. In both cases, women delivered vaginally without prophylactic oxytocin in the third stage of labor. In this randomized controlled trial, the lower abdomen was cooled by placement of an 8.6°C icepack during the first 2 h after placental delivery. The primary outcome was measured as the total blood loss within 2 h after delivery. This study had 80% power at the two tails of 5% significance level to detect the mean difference (MD, 70 g) in total blood loss within 2 h after delivery between the two groups. The sample size was calculated as 144 women (72 women per group). Between January and May 2016, 160 women were randomly assigned to the intervention group (cooling the lower abdomen, n = 81) or the control group (n = 79). Baseline characteristics were similar between groups, with the exception of mean blood loss during the third stage of labor. The primary outcome was not reduced by cooling, compared with no intervention (mean blood loss, 513.3 vs. 478.1 g, respectively; MD = 35.2 g; 95% confidence interval = -65.3-135.7). No adverse events occurred; however, seven (8.7%) women in the intervention group declined to continue cooling the lower abdomen because of discomfort. Compared with the control group, cooling the lower abdomen did not reduce the total amount of blood loss up to 2 h after delivery. UMIN-CTR UMIN000019834.