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Aim: To clarify the factor structure of "expectant mothers of concern" for whom midwives anticipate difficulties in future childrearing. Methods: The participants were 2633 midwives working at hospitals and clinics in Japan. Data were collected using a 108‐item, five‐point Likert scale questionnaire about the behaviors, appearance, and family relationships of the expectant mothers of concern to the nurses. Items with a mean equal to or greater than 4.0 were selected as items considered relevant to expectant mothers of concern by midwives. Exploratory factor analysis, confirmatory factor analysis, and further secondary factor analysis were conducted. Results: The factor structure of the expectant mothers of concern as perceived by midwives comprised seven factors, including 23 items: "Suspected of being a victim of intimate partner violence," "Uneasy feeling about the expectant mother's marital relationship," "Perception that the expectant mother is conflicted about her pregnancy," "Uneasy feeling about the expectant mother's actions/behaviors concerning her medical checkups," "Engages in physically risky actions and behaviors," "Does not appear to be able to build relationships with children," and "Makes remarks that indicate possible bonding disorder" (goodness‐of‐fit index = 0.910, adjusted goodness‐of‐fit index = 0.879, comparative fit index = 0.939, and root mean square error of approximation = 0.070). Further, a secondary factor, "Expectant mothers who must urgently be connected to support," was extracted. Conclusions: The elucidation of the factor structure of the expectant mothers of concern could help midwives identify expectant mothers who may face difficulties in future childrearing. [ABSTRACT FROM AUTHOR]

Aim: To clarify the state of screening and support systems for socially high‐risk pregnant women at obstetric facilities across Japan and identify the characteristics of facilities related to the implementation of screening. Methods: This cross‐sectional study used a self‐administered questionnaire. Participants were managers of hospitals, clinics, and midwifery birth centers handling deliveries in 47 prefectures across Japan. The questionnaire comprised items regarding the characteristics of participants and their facilities, service provision related to socially high‐risk women available at the facility, the number of specified pregnant women (tokutei ninpu) per year, methods of screening, and support systems within the obstetric facilities. Descriptive statistics and multivariate logistic regression analysis were performed using IBM‐SPSS version 24 for the association between facility characteristics and screening practices for socially high‐risk pregnant women. Results: Valid responses were received from 716 of 2512 obstetric facilities. Rates of specified expectant mothers per annual number of deliveries were identified as follows: perinatal medical centers (2.7%), general hospitals (1.6%), obstetrics and gynecology hospitals (1.0%), and clinics (0.8%). A total of 426 facilities (60.6%) reported screening all expectant mothers to identify socially high‐risk pregnant women. Multiple logistic regression analysis revealed that facility characteristics and service/care provision related to screening practices included availability of in‐hospital midwife‐led care and in‐hospital midwifery clinics (adjusted odds ratio 1.61; 95% CI [1.30, 1.47]), one‐on‐one care by midwife (1.73; 95% CI [1.15, 2.59]), multidisciplinary meetings within the facility (1.70; 95% CI [1.14, 2.56]), follow‐up support systems after discharge (1.90; 95% CI [1.17, 3.09]), and participation in the regional council for children in need of protection (2.33; 95% CI [1.13, 4.81]). Conclusions: Approximately 60% of surveyed obstetric facilities screen for socially high‐risk women. Increasing service provision at facilities may be necessary to implement screening. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to determine whether cognitive behavioral therapy (CBT) started in pregnancy can prevent depression and anxiety. Methods: We conducted an overview review by selecting systematic reviews (SRs) that compared CBT with usual care, no CBT, or interventions other than CBT in perinatal women. We restricted the review to studies that included randomized controlled trials. The results of included SRs were descriptively integrated according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Results: Seven SRs met our eligibility criteria. One SR was limited to CBT interventions, whereas others included psychoeducation and interpersonal psychotherapy. There was some variation in the number of sessions and timing of CBT, and whether there was a postpartum intervention. Five SRs showed that CBT reduced depression compared with usual care, an educational intervention, or no intervention. One SR that analyzed the effect on anxiety found that psychotherapy, including CBT, reduced anxiety compared with usual care or no intervention. Discussion: CBT starting from pregnancy may be effective as a preventive intervention for postpartum depression and anxiety, although the degree of effectiveness varied. Conclusions: This overview review aimed to clarify whether CBT is effective in preventing depression and anxiety from pregnancy. CBT may be effective in reducing perinatal depression and anxiety. [ABSTRACT FROM AUTHOR]

Aim: The World Health Organization has recommended intrapartum care for a positive childbirth experience through respectful care based on women‐centered care. This study aimed to explore women's experiences of facility‐based childbirth to gain insights into their perceptions of women‐centered care, including humanized childbirth and respectful maternity care during intrapartum care. Methods: Used the Joanna Briggs Institute method as the framework for this meta‐synthesis, we searched the PubMed, EMBASE, CINAHL, PsycINFO, and LILCAS databases, and included qualitative studies and interviews of women's experiences and perceptions of women‐centered care during facility‐based childbirth published from 1990 to 2020 in English. Study quality was assessed using the Critical Appraisal Skills Programme checklist. NVivo software was used for data extraction and synthesis. Results: There were 22 studies from 19 countries that met the established inclusion criteria. Five categories of experiences of facility‐based childbirth and perceptions of women‐centered care from the synthesized voices of women were generated: (i) value of women through childbirth; (ii) overwhelmed by unpleasant childbearing experiences; (iii) a sense of being respected and valued; (iv) a sense of being disrespected and abused; and (v) inadequate systems and resources. Our meta‐synthesis indicated that respectful and helpful interaction between women and healthcare providers produced positive perceptions among women. Conclusions: This study emphasizes the importance of respectful interactions and intrapersonal experiences. Strong systems and positive environments lead to positive interactions between women and healthcare providers. Future studies need to consider cultural and economic differences in women‐centered care and respectful care for childbirth in different contexts. [ABSTRACT FROM AUTHOR]

Aim: Women who are diagnosed with cancer during pregnancy must make difficult, life‐changing decisions that affect their own life and that of their fetus. The psychological impact of distress and anxiety resulting from facing often conflicting choices can greatly influence survival in these women. We conducted this study to clarify the experience of pregnant women with cancer in decision‐making and to consider the role of nurses in providing care to pregnant women with cancer during their decision‐making. Methods: This qualitative study included post‐partum Japanese women diagnosed with cancer who had made any treatment or pregnancy decisions. Data collection was conducted using semi‐structured interviews and medical record review. Data were analyzed using qualitative content analysis and classified into subcategories, categories, themes, and phases. Results: Participants comprised eight women with leukemia and cervical, breast, and digestive cancers. The decision‐making experiences of these eight pregnant women with cancer were categorized into three phases: the interaction between the woman and her fetus, family members, and medical staff; confrontation with dilemma and uncertainty; and redefinition of the women's own decisions. Conclusions: The experience of Japanese pregnant women with cancer in decision‐making has two aspects: verbal and nonverbal communication with their surroundings and reflection. The role of a nurse is to guarantee these women continuous communication channels and frank dialogue, to empower them in expressing their thoughts and informational needs to medical staff and family members. [ABSTRACT FROM AUTHOR]

Aim: To compare the factors that affect maternal confidence at 1 month post‐partum between older (≥35 years old) and younger (20–34 years old) primiparous Japanese mothers. Methods: A multicenter prospective study of mothers who gave birth to live singleton infants in Japan was conducted. Following ethics approval, the participants completed questionnaires 1 day before discharge and 1 month after childbirth. The questionnaires included the Postpartum Maternal Confidence Scale, demographics and background information, prenatal and obstetric data, situational variables and perceptions of daily life, and social support. The obstetric data were extracted from the hospital medical records. Data from the older primiparae (n = 479) and the younger primiparae (n = 1033) were analyzed by using multiple stepwise regressions, controlling for the delivery mode. Results: Maternal confidence at 1 month post‐partum was positively associated with emotional support for the older primiparae and appraisal support and exclusive breastfeeding for younger primiparae. In both groups, feeling overwhelmed by daily life, a lack of communication with their partner about the parenting role, and a lack of prior experience in caring for babies were negatively related to maternal confidence. Family budget instability was negatively related to maternal confidence in the younger group. Conclusion: Providing care that is based on an understanding of the unique support needs of first‐time mothers in different age groups could promote more effective parenting. [ABSTRACT FROM AUTHOR]

Aim: There is a debate within the medical community regarding the safety of planned home births. The presumption of increased risk of maternal and infant morbidity and mortality at home due to limited access to life‐saving interventions is not clearly supported by research. The aim of the present study was to assess strengths and limitations of the methodological approaches of cohort studies that compare home births with hospital births by focusing on selected infant outcomes. Methods: Studies were identified that assess the risk for at least one of three infant outcomes (mortality, Apgar score, and admission to the neonatal intensive care unit [NICU]) of home births compared with hospital births. Results: Fifteen cohort studies were included. Two studies of low‐risk births and two including higher risk births found home births to be at an increased risk of neonatal mortality. However, mortality is rare in developed nations and may not be the best measure of safety. When studies focused on low‐risk pregnancies, planned birth location, and well‐trained birth attendants, there was no difference in neonatal morbidity (Apgar score and NICU admission). Conclusion: Many methodological challenges were identified among these studies. This review contributes to the home birth published work by identifying key strengths and limitations that need to be accounted for in the interpretation of study findings and the development of future studies. Based on this review, the key variables that would strengthen future studies are birth attendant identification, documented planned birth location, and specification of the birth risk level. Uniformity of data collection and minimizing missing data are also critical. [ABSTRACT FROM AUTHOR]

Aim: To explore the general applicability of women-centered care (WCC) as a philosophical foundation used for capacity-building (CB) through examining the results of international collaboration efforts in Bolivia and the Union of Myanmar. Methods: PubMed was used to search for articles related to WCC. The literature was sorted into the categories of “antecedents”, “characteristics”, and “outcomes”. The descriptors of WCC were extracted and applied to midwifery projects in Bolivia and the Union of Myanmar. Pre-assessments and postassessments captured recipients’ and health workers’“voices”. Case studies were used to illustrate the outcomes. Results: Extracted from the literature were two antecedents that typified pre-WCC: gender inequality and hierarchical, male-centered medical treatment. The characteristics of WCC were respect, safety, holism, and partnership. The consequences of WCC were the empowerment of women, autonomy for the care provider, and societal reform. Using these WCC characteristics as the philosophical foundation of our approach, our Bolivian and Union of Myanmar projects were implemented to improve maternal health through CB mother and baby-friendly care at the primary level of normal birth care. The two projects illustrated the WCC characteristics of respect, safety, and partnership, as well as the resulting empowerment of women and autonomy for the nursing profession. Conclusion: Women-centered care, as a universal philosophical foundation, transcends cultures and CB leads to reform for women, both as the providers and users of care. The field results indicated that WCC can be successfully applied to real-life situations. [ABSTRACT FROM AUTHOR]