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Abstract: Aim: To describe changes in prevalence of shoulder stiffness, back pain, and wrist pain during the first 6 months postpartum, and to examine the association of these symptoms with maternal age and parity. Methods: Participants were recruited from 13 Japanese hospitals between 2012 and 2013. A total of 2709 (response rate 71.9%) women provided longitudinal data, using self‐report questionnaires at 5 time points: during their hospital stay, and at 1, 2, 4, and 6 months postpartum. Shoulder stiffness, back pain, and wrist pain were measured, using checklists with yes‐no responses. The effects of age and parity were assessed in 4 groups of younger (<35 years) and older (≥35 years) mothers: 983 younger primiparas, 481 older primiparas, 649 younger multiparas, and 596 older multiparas. Chi‐square tests and Cochran's Q tests were used to assess effects of group and time. Results: Prevalence of shoulder stiffness, back pain, and wrist pain during the hospital stay significantly increased up to 1 month postpartum for older primiparas, who were also the most vulnerable to back pain and wrist pain at 1 month postpartum. Conclusion: Special attention should be given to older primiparas in assessing and providing nursing care for physical symptoms, especially during the first month postpartum. [ABSTRACT FROM AUTHOR]

Aim This cross-sectional and longitudinal study explored primiparous mothers' functioning and parenting stress on the basis of infant-feeding method over the first 6 months postpartum. Methods Participants were Japanese primiparae who delivered live singleton infants (N = 1120). Questionnaires, completed at 1, 2, 4, and 6 months postpartum, included demographics, feeding method, frequency of feedings, time required from infant's feeding to falling asleep, mother's sleep time, Postnatal Accumulated Fatigue Scale, and the original Japanese version of Parenting Stress Short-Form Scale. Chi-square tests and Welch F tests for one-way analysis of variance were conducted. Results Exclusively breastfeeding mothers fed their infants more frequently, but required less time from infant's feeding to falling asleep than either mixed or formula-feeding mothers. Mixed feeding mothers required more time for infant feeding and reported more severe fatigue and greater parenting stress than breastfeeding mothers at 1 and 2 months postpartum. Exclusively formula-feeding mothers required more time to get their infant back to sleep and reported greater parenting stress than the other groups at 6 months postpartum. Nearly 25% of mothers continued breastfeeding exclusively through the first 6 months postpartum. Mothers often changed feeding methods, with many exclusively breastfeeding by 6 months. Conclusion Feeding methods may affect maternal functioning and parenting stress across the postpartum period. [ABSTRACT FROM AUTHOR]

Aim To examine the relationship between physical symptoms and depressive symptoms among new mothers during the first 6 months postpartum. Methods Prospective cohort study design was used in this study. Participants were recruited in 13 Japanese hospitals between 2012 and 2013. A total of 2709 women (response rate of those invited 71.9%) provided longitudinal data using self-report questionnaires at 5 time points: during the hospital stay and at 1, 2, 4, and 6 months postpartum. Depressive symptoms were measured using the Japanese version of the Edinburgh Postnatal Depression Scale. Also, 37 physical symptoms were measured using a yes-or-no checklist. To examine the association between physical symptoms and depressive symptoms, logistic regression analysis was used. Results There was a significant positive association between physical symptoms and depressive symptoms during the first 6 months postpartum. Fifteen physical symptoms were associated with significantly increased odds of depression at 1, 2, 4, and 6 months post-partum. These symptoms included: loss of appetite, tiredness/languor, and palpitation/shortness of breath. Conclusion Multiple physical symptoms after childbirth were associated with depressive symptomatology. Health professionals should assess for postpartum depression when puerperal women report multiple physical symptoms as independent complaints. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess fatigue, depressive symptoms, and maternal confidence or satisfaction among older primiparae during the first month postpartum. The number of older Japanese primiparae has rapidly increased. Older primiparae are believed to be at high risk for puerperal morbidity. A multicentre prospective cohort study design was used. Data were examined from 2854 Japanese women who participated in a 6-month prospective cohort study conducted between May 2012 and September 2013. The women were classified into 4 groups based on maternal age and parity. All participants completed the Postnatal Accumulated Fatigue Scale, Japanese Edinburgh Postnatal Depression Scale, Postpartum Maternal Confidence Scale, and Postpartum Maternal Satisfaction Scale. Primiparae in all age groups were more severely fatigued and had a higher risk of postpartum depression than multiparous mothers during the first month postpartum. Older primiparae had significantly lower scores on maternal confidence and maternal satisfaction than the other 3 groups at 1 month postpartum. These findings suggest that postpartum nursing should focus on promoting adequate sleep, providing emotional support, and fostering the process of maternal role adaptation among older Japanese primiparae, particularly during the first postpartum month. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify factors affecting maternal confidence and satisfaction in older Japanese primiparae during their postpartum hospital stay. Participants were Japanese primiparae (age ≥ 35) who delivered live singleton infants ( n = 479). Questionnaires completed 1 day before discharge from hospital included the Postpartum Maternal Confidence Scale and the Postpartum Maternal Satisfaction Scale. Data were analysed using stepwise multiple regression for maternal confidence and stepwise logistic regression for maternal satisfaction, after controlling for delivery mode. Maternal confidence was negatively affected by feeling overwhelmed by postpartum routines, needing a longer time for feeding, and a pregnancy with complications. Satisfaction with the birth experience and a longer rooming-in period were related to greater maternal satisfaction. Lack of prior experiences with caring for babies and lack of communication with their partner about parenting role were also associated with lower confidence and satisfaction. These findings provide an important framework for nurses to teach and counsel older first-time mothers. [ABSTRACT FROM AUTHOR]

The purpose of this mixed-method design study was to examine factors contributing to depression among immigrant Chinese women (primipara and multipara) ( n = 22) delivering a child for the first time in Japan. Data were obtained just after hospital discharge by using the Edinburgh Postnatal Depression Scale (EPDS), the Social Support Scale, a new scale to measure cross-cultural stressors in the postpartum setting and a visual analogue scale for stress and a demographic survey. The average EPDS score was 9.0 (SD ± 3.7) at 1-3 weeks postpartum; yet, more than half of the subjects ( n = 12; 54.5%) were high risk for depression (EPDS ≥ 10). Low household income and primiparous status were associated with depression scores. New mothers with depression also reported more general stress and more cross-cultural stress in the postpartum setting, although social support appeared to mediate cross-cultural stressors. Semi-structured interviews were held with two immigrant women at high risk for depression; these new mothers described additional stress because they could not follow Zuoyuezi, an important postpartum Chinese tradition, in the Japanese hospital. These findings suggest that immigrant Chinese women are at higher risk for postpartum depression when they give birth for the first time in Japan. [ABSTRACT FROM AUTHOR]

This study examined the psychometric properties of a 13-item fatigue scale for postpartum mothers. Japanese mothers ( n = 2026) from a cohort study completed questionnaires (e.g. fatigue scale, Japanese version of the Edinburgh Postnatal Depression Scale, demographics) during their hospital stay after childbirth (baseline) and at 1, 2, 4 and 6 months postpartum. Initial factor analysis of baseline data revealed that the fatigue scale had three factors or subscales (physical, emotional and cognitive). Within-group analysis across each measurement time revealed the same three-factor structure with acceptable fit. Between-group analysis also showed longitudinal factorial invariance across time. The fatigue subscales had acceptable divergent and convergent validities with the depression scale. The subscale scores differed significantly based on participant background. The Japanese Fatigue Scale is a concise and informative tool for assessing aspects of fatigue in clinical settings and in the community. [ABSTRACT FROM AUTHOR]

This cohort study of primiparae was conducted to answer the following questions: Do older (≧ 35 years) and younger (20-29 years) Japanese primiparous mothers differ when comparing biomarkers of stress and measures of fatigue and depression? Are there changes in fatigue, depression and stress biomarkers when comparing older and younger mothers during the postpartum period? The Postnatal Accumulated Fatigue Scale and the Edinburgh Postnatal Depression Scale were administered in a time-series method four times: shortly after birth and monthly afterwards. Assays to measure biomarkers of stress, urinary 17-ketosteroids, urinary 17-hydroxycorticosteroids and salivary chromogranin-A, were collected shortly after delivery and at 1 month postpartum in both groups and a third time in older mothers at the 4th month. Statistical testing showed very little difference in fatigue, depression or stress biomarkers between older and younger mothers shortly after birth or 1 month later. Accumulated fatigue and depression scores of older mothers were highest 1 month after delivery. Additional cohort studies are required to characterize physical/psychological well-being of older Japanese primiparae. [ABSTRACT FROM AUTHOR]

This longitudinal study was designed to examine objective sleep parameters of older primiparous Japanese women during the first 4 months postpartum using actigraphy. The participants were 18 older primiparae (Mean (SD) = 37.06 (2.62) years, range 35-44 years) who gave birth to healthy neonates at one of three urban Japanese hospitals. Objective sleep quality was measured using actigraphy for 48 h at 1, 2 and 4 months postpartum. The Friedman test was used to test for differences in sleep parameters across time. Sleep duration (SMIN) increased significantly from 2 months (Mean (M) = 301.94 min) to 4 months (M = 372.78 min). Sleep efficiency (SE) increased significantly from 1 month (73.52%) to 2 (86.66%) and 4 months (89.05%). Waking after sleep onset (WASO) decreased significantly from 1 month (M = 114.64 min) to 2 (M = 40.18 min) and 4 months (M = 38.36 min) and long waking episodes (LWEP) significantly decreased from 1 month (4.67) to 2 (2.69) and 4 months (3.12). Persistent postpartum sleep problems can be a sign of postpartum depression as well as health problems among infants. [ABSTRACT FROM AUTHOR]

The purpose of this study was to gain a deeper understanding of the postpartum experiences of older primiparas at the time of their postpartum hospital stay. Participants were Japanese primiparas aged 35-44 years who gave birth, without abnormalities for either the mother or child. Data were obtained using a semi-structured interview with 22 participants. Thirteen themes emerged through content analysis. We found that there were distinctive experiences, which included 'the health and growth of the baby: relief and continued anxiety', 'awareness of strengths and of concerns of primiparas', 'meaning of the pregnancy and childbirth experience' and 'developing one's own child-care approach'. Findings suggest that nursing care during the post-delivery hospital stay should use the unique strengths of older primiparas to enable their smooth transition to maternal role attainment. [ABSTRACT FROM AUTHOR]

This study aimed to describe the postpartum experiences of older Japanese primiparas during the first month after childbirth. The participants were 21 primiparous women over 35 years of age who gave birth to a healthy child at three urban hospitals. Data were collected from July 2011 to April 2012 through a semi-structured interview about postpartum experiences after discharge. Data were analysed using content analysis. We obtained Institutional Review Boards' approval and written informed consent from all participants prior to study initiation. Thirteen themes of postpartum experiences were extracted. The findings revealed that the mothers' experiences varied greatly and were highly personal. Also, participants described common experiences, unique child-care support needs and the strengths of older primiparas. Understanding the postpartum experiences of older primiparas assists health-care professionals to identify better ways to provide appropriate support. [ABSTRACT FROM AUTHOR]

This study evaluated the effectiveness of a 2 day training course for a nursing intervention programme to promote maternal role attainment in pregnant Japanese women who have undergone assisted reproductive technology. Participants were 12 Japanese nurses with more than 3 years of clinical experience at reproductive institutions. The effectiveness of the training course was evaluated by assessing the following: (i) understanding of the nursing intervention programme; (ii) attitudes of nurses towards women who are pregnant following assisted reproductive technology; and (iii) self-efficacy for implementing the programme. The training course was effective in increasing basic understanding of the programme and in assisting self-evaluation of the attitudes of participants towards pregnant women. However, acquisition of effective interview skills and changes to make the programme clinically feasible are still needed. Findings suggest that researchers who use this training programme may need to evaluate and include training of nurses in interview skills suitable for their working environments. [ABSTRACT FROM AUTHOR]