Hiromi Eto

Self-administered questionnaire versus interview as a screening method for intimate partner violence in the prenatal setting in Japan: a randomised controlled trial.

BackgroundIntimate partner violence (IPV) is a serious social issue in Japan. In order to start effective interventions for abused women, the appropriate method of screening for IPV in healthcare settings needs clarifying. The objective of this study was to compare the effectiveness of a face-to-face interview with a self-administered questionnaire. We used the Violence Against Women Screen (VAWS), a Japanese screening instrument for intimate partner violence (IPV), for identifying pregnant women who have experienced abuse.MethodsWe conducted a randomised controlled trial to screen participants at three points in time in a prenatal clinic in Tokyo, Japan. There were 328 consenting women between 14 and 25 weeks of pregnancy who were consecutively selected and randomly assigned to either the interview or self-administered questionnaire group. Both groups completed the same screening instrument three times during their pregnancy. The primary outcome was the total number of women identified by each screening method and the secondary outcome was the effect of the screening as measured by the womens comfort level and their expressed need to consult with the nurse.ResultsFor all three screenings, the identification rate in the interview group was significantly lower than that for the self-administered questionnaire group (relative risk 0.66, 95% CI 0.46 to 0.97), even after controlling for smoking (adjusted odds ratio 0.59, 95% CI 0.35 to 0.98). The two groups did not differ for secondary outcomes.ConclusionsThe self-administered questionnaire identified more IPV than the face-to-face interview when screening pregnant women in a Japanese prenatal clinic.Trial RegistrationUMIN-CTRC000000353

Mothers’ wakefulness at night in the post-partum period is related to their infants’ circadian sleep–wake rhythm

The relationship between a post‐partum mother’s wakefulness at night and her infant’s circadian sleep–wake rhythm was examined. The subjects were seven primipara and their infants. Actigraphic recordings for the mothers and their infants were made over three to five continuous days during Weeks 3, 6, 9 and 12. A 24‐h peak of autocorrelograms of the infants’ movements appeared in two cases at Week 6, in six cases at Week 9, and in seven cases at Week 12. The mothers’ night‐time movements significantly decreased from Week 3 to Week 12. Mothers’ wakefulness during night sleep in the post‐partum period is related to their infants’ obtaining circadian sleep–wake rhythm.

Comparisons of sleep patterns between mothers in post-partum from 9 to 12 weeks and non-pregnant women

In order to evaluate two patterns of interrupted and non‐interrupted sleep for the post‐partum mothers from 9 to 12 weeks after delivery, we compared them with sleep patterns of non‐pregnant women. Subjects were 10 primipara and 12 non‐pregnant women. Their polysomnographic recordings were made using a Medilog recorder at home. In interrupted sleep, low sleep efficiency, decreased total sleep time, and a decreased percentage of stage 2 were significantly observed compared with non‐pregnant women. Sleep parameters of non‐interrupted sleep, except for increased percentage of stage 4, did not show any significant differences from non‐pregnant women. Mothers’ sleep fluctuated between interrupted sleep similar to the early post‐partum sleep from 1 to 6 weeks and non‐interrupted sleep with increased stage 4.

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

OBJECTIVE the 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. DESIGN a retrospective cohort study. SETTINGS birth centres and homes serviced by independent midwives in Tokyo. PARTICIPANTS of 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. METHODS researchers conducted a retrospective chart review of womens 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. FINDINGS of 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%). Infants 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. CONCLUSION our 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.

Intimate partner violence against Japanese and non-Japanese women in Japan: a cross-sectional study in the perinatal setting.

AIM To identify the prevalence of intimate partner violence (IPV) against Japanese women (JW) and non-Japanese women (NJW) in a perinatal setting. Additional purposes were to identify the associated factors of IPV, describe the characteristics of IPV against NJW, and assess the acceptability of the Violence Against Women Screen (VAWS) instrument as a screening tool. METHODS A cross-sectional survey was conducted from September to November 2007 in an urban hospital maternity clinic in Tokyo, Japan. Women who attended the maternity clinic received the VAWS instrument, which was translated into four languages (Japanese with Kanji and Hiragana, English, Chinese, and Tagalog) and was used to identify IPV. RESULTS A total of 400 women participated in the study: 357 were JW and 43 were NJW. The prevalence rate of IPV among the JW was 31.4% and 21.4% among the NJW. There was no statistical significance between the two groups. A multiple logistic regression with adjusted odds ratio identified two associated factors for IPV: being multipara and previous experience of physical violence from a partner. CONCLUSION The prevalence of IPV was not statistically different among JW and NJW. Screening for IPV, early intervention, and support should be expanded in hospitals and maternity clinics in Japan.

Relationship between infant and mother circadian rest-activity rhythm pre- and postpartum, in comparison to an infant with free-running rhythm.

Some infants show a free-running rhythm in their rest-activity. We do not know why, nor do we know exactly what the entrainment factors are for the development of the normal 24-h rest-activity rhythm. Actigraphic recordings on 10 primiparae during late pregnancy and these mothers and their infants during the 2nd, 6th, and 12th wks after birth were made over 3–5 continuous days to investigate maternal and infant entrainment. One infant showed a free-running rest-activity circadian rhythm. In late pregnancy, the period in the autocorrelogram of the mother with the free-running infant was longer than the significant period of the mean autocorrelogram of the mothers with non-free-running infants. The finding of this study indicates the free-running rhythm of infant is not reset by maternal entrainment factors. (Author correspondence: nishihara-kk@igakuken.or.jp)

Comparison of Policies for the Management of Care for Women and Newborns During the Third Stage of Labor Among Japanese Hospitals, Clinics, and Midwifery Birth Centers

OBJECTIVE: To determine the care policies for both mothers and newborns implemented during and after the third stage of labor and to compare the rate of adoption of these care policies among hospitals, clinics, and midwifery birth centers in Japan. METHOD: A cross-sectional survey of the care policies affecting mothers and newborns during and after the third stage of labor was conducted from October 2010 to July 2011. A postal questionnaire with follow-up was sent to all 684 maternity institutions in Tokyo metropolitan areas. RESULTS: The overall response rate was 255 (37%). Most hospitals and clinics had a policy of early cord clamping; however, nearly 70% of the midwifery birth centers adopted the policy of waiting until the cord stopped pulsating. The policy of administering prophylactic uterotonics was adopted by 50% of the hospitals and 63% of the clinics, although midwifery birth centers did not adopt this policy. All midwifery birth centers, 50% of the hospitals, and 50% of the clinics routinely adopted the policy of early skin-to-skin contact. CONCLUSION: Adoption of various care policies differed considerably among the hospitals, clinics, and midwifery birth centers. In addition, there were several gaps between evidence-based care and care policies.

Maternal and neonatal outcomes in birth centers versus hospitals among women with low‐risk pregnancies in Japan: A retrospective cohort study

AIM In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan. METHODS The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis. RESULTS The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of <7, compared to the hospitals. CONCLUSION This study was the first to compare important maternal and neonatal outcomes of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes.

Factors contributing to postpartum blood-loss in low-risk mothers through expectant management in Japanese birth centres

OBJECTIVE To describe aspects of expectant midwifery care for low-risk women conducted in midwifery-managed birth centres during the first two critical hours after delivery and to compare differences between midwifery care, client factors and postpartum blood loss volume. METHOD As a secondary analysis from a larger study, this descriptive retrospective study examined data from birth records of 4051 women who birthed from 2001 to 2006 at nine (21%) of the 43 midwifery centres in Tokyo. Nonparametric and parametric analyses identified factors related to increased blood loss. Interviews to establish sequence of midwifery care were conducted. FINDINGS The midwifery centres provided care based on expectant management principles from birth to after expulsion of the placenta. Approximately 63.3% of women were within the normal limits of blood loss volume under 500g. A minority of women (12.9%) experienced blood loss between 500 and 800g and 4% had blood loss exceeding 1000g. Blood loss volume tended to increase with infant birth weight and duration of delivery. The total blood loss volume was significantly higher for primiparas than for multiparas during the critical two hours after delivery and for immediately after delivery, yet blood loss volume was significantly higher for multiparas than for primiparas during the first hour after delivery. Preventive uterine massage and umbilical cord clamping after placenta expulsion resulted in statistically significant less blood loss. Identified were two patterns of midwifery care based on expectant management principles from birth to after expulsion of the placenta. The practice of expectant management was not a significant factor for increased postpartum blood loss. CONCLUSION These results detail specific midwifery practices and highlight the clinical significance of expectant management with low risk pregnant women experiencing a normal delivery.