Japanese couples' childbirth experiences in Michigan: implications for care

Sacred space: a qualitative interpretive meta-synthesis of women's experiences of supportive birthing environments

BACKGROUND

In the United States there are roughly three million births a year, ranging from cesarean to natural births. A major aspect of the birthing process is related to the healing environment, and how that helps or harms healing for the mother and child. Using the theoretical framework, Theory of Supportive Care Settings (TSCS), this study aimed to explore what is necessary to have a safe and sacred healing environment for mothers.

METHOD

This study utilized an updated Qualitative Interpretive Meta-synthesis (QIMS) design called QIMS-DTT [deductive theory testing] to answer the research question, What are mother's experiences of environmental factors contributing to a supportive birthing environment within healthcare settings?

RESULTS

Key terms were run through multiple databases, which resulted in 5,688 articles. After title and abstract screening, 43 were left for full-text, 12 were excluded, leaving 31 to be included in the final QIMS. Five main themes emerged from analysis: 1) Service in the environment, 2) Recognizing oneself within the birthing space, 3) Creating connections with support systems, 4) Being welcomed into the birthing space, and 5) Feeling safe within the birthing environment.

CONCLUSIONS

Providing a warm and welcoming birth space is crucial for people who give birth to have positive experiences. Providing spaces where the person can feel safe and supported allows them to find empowerment in the situation where they have limited control.

Japanese Women's Concerns and Satisfaction With Pregnancy Care in the United States

Immigrant women report a high level of stress during pregnancy due to language barriers, cultural differences, and differences in the standard of prenatal care. In this study, we evaluated the level of concern Japanese women in the United States feel during pregnancy and their level of satisfaction with their care. This data can be used to modify prenatal care programs and education to address these concerns. Data collected from 96 women showed there was a high level of prenatal concern regarding their baby's health, pain control, the short length of hospitalization after birth, and the lack of breastfeeding support. Despite these concerns, postpartum women ended up being satisfied with all items except the short duration of their hospital stay.

Women's epidural decision-making in labour: A Townsville perspective

BACKGROUND

Despite being an efficacious means of pain relief, there is a broad range of usage rates of epidural analgesia among countries worldwide. Australia sits between common usage in North America and more conservative usage in the UK. The reason for this is unclear, raising the question of whether there is a difference between Australia and other Western countries in pregnant women's attitudes toward epidural use, or the hospital context.

AIM

To explore predictors for epidural analgesia request among pregnant women in Townsville, Australia.

MATERIALS AND METHODS

A three-phase mixed methods exploratory study design, with Phase One involving 12 one-on-one interviews with pregnant and post-partum women regarding attitudes toward labour analgesia decision-making and epidural preferences. Interview data were analysed thematically to develop a survey distributed to 265 third-trimester women in Phase Two. Phase Three involved a chart review of survey participants to record delivery mode, epidural request and indication. Bivariate and logistic regression analysis of Phases Two and Three data were used to develop predictive models for epidural decision-making.

RESULTS

Interviews revealed several themes influencing analgesia preferences in Townsville women: concerns regarding personal safety, trust in health professionals, and previous experiences with labour. The logistic regression identified epidural request in labour to be predicted by: primiparity, epidural experience, induction or augmentation of labour, and perceived sense of control associated with epidural use.

CONCLUSIONS

This study suggests that the most significant influencers on Townsville women's epidural decision-making were parity, induction or augmentation of labour, previous experience of epidurals and attitude toward epidurals.

Women's health literacy and the complex decision-making process to use complementary medicine products in pregnancy and lactation

BACKGROUND

Little is known about women's decision-making processes regarding using complementary medicine products (CMPs) during pregnancy or lactation.

OBJECTIVES

To explore the decision-making processes of women choosing to use CMPs in pregnancy and lactation; and to investigate how women's health literacy influences their decisions.

DESIGN, SETTING AND PARTICIPANTS

In-depth interviews and focus group discussions were held with twenty-five pregnant and/or breastfeeding women. Data were analysed using thematic analysis.

RESULTS

Key to women's decision making was the desire to establish a CMPs safety and to receive information from a trustworthy source, preferably their most trusted health-care practitioner. Women wanted positive therapeutic relationships with health-care practitioners and to be highly involved in the decisions they made for the health of themselves and their children. Two overarching components of the decision-making process were identified: (a) women's information needs and (b) a preference for CMP use. Women collated and assessed information from other health-care practitioners, other mothers and published research during their decision-making processes. They showed a strong preference for CMP use to support their pregnancy and breastfeeding health, and that of their unborn and breastfeeding babies.

DISCUSSION AND CONCLUSIONS

Complex decision-making processes to use CMPs in pregnancy and lactation were identified. The participants showed high levels of communicative and critical health literacy skills in their decision-making processes. These skills supported women's complex decision-making processes.

Complementary medicine products used in pregnancy and lactation and an examination of the information sources accessed pertaining to maternal health literacy: a systematic review of qualitative studies

BACKGROUND

The prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products (CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally, it aimed to explore the resources women used, and to examine the role of maternal health literacy in this process.

METHODS

Seven databases were comprehensively searched to identify studies published in peer-reviewed journals (1995-2017). Relevant data were extracted and thematic analysis undertaken to identify key themes related to the review objectives.

RESULTS

A total of 4574 articles were identified; 28 qualitative studies met the inclusion criteria. Quantitative studies were removed for a separate, concurrent review. Herbal medicines were the main CMPs identified (n = 21 papers) in the qualitative studies, with a smaller number examining vitamin and mineral supplements together with herbal medicines (n = 3), and micronutrient supplements (n = 3). Shared cultural knowledge and traditions, followed by women elders and health care professionals were the information sources most accessed by women when choosing to use CMPs. Women used CMPs for perceived physical, mental-emotional, spiritual and cultural benefits for their pregnancies, their own health, the health of their unborn or breastfeeding babies, and/or the breastfeeding process. Two over-arching motives were identified: 1) to protect themselves or their babies from adverse events; 2) to facilitate the normal physiological processes of pregnancy, birth and lactation. Decisions to use CMPs were made within the context of their own cultures, reflected in the locus of control regarding decision-making in pregnancy and lactation, and in the health literacy environment. Medical pluralism was very common and women navigated through and between different health care services and systems throughout their pregnancies and breastfeeding journeys.

CONCLUSIONS

Pregnant and breastfeeding women use herbal medicines and micronutrient supplements for a variety of perceived benefits to their babies' and their own holistic health. Women access a range of CMP-related information sources with shared cultural knowledge and women elders the most frequently accessed sources, followed by HCPs. Culture influences maternal health literacy and thus women's health care choices including CMP use.

Transcultural Modifications of a Japanese Language Group Prenatal Care Program for Transcultural Adaptation

INTRODUCTION

The CenteringPregnancy model has been demonstrated to improve birth outcomes for certain cultural and ethnic groups, but the literature lacks examples on how to modify their guidelines for socioculturally isolated women. Our aim is to examine the modifications we made to the CenteringPregnancy group prenatal care for Japanese women and to examine the implications for transcultural modification.

METHODS

Using a descriptive case study design, we examined the cultural fit and modifications of our Japanese prenatal group approach. We report the aspects that do not require modifications and the transcultural modifications that are needed. Based on this descriptive case, we discuss the lessons learned for making transcultural modifications that may apply to other cultural groups.

RESULTS

Many aspects of the CenteringPregnancy were readily adopted. We made 10 substantive transcultural modifications and articulate considerations for transcultural modifications.

DISCUSSION/CONCLUSION

This research illustrates transcultural considerations for modifying the CenteringPregnancy model and provides implications for use in other isolated populations of pregnant women.

NegotiatingWa(Harmony): A Qualitative Study About the Challenges Japanese Women Who Live in New Zealand Have in Maintaining Their Birth Traditions

Cultural birth customs play an important role in maintaining women’s psychological well-being throughout childbearing. The goals of this study were (a) to explore how Japanese women living in New Zealand keep or perform their birth traditions, (b) to educate caregivers about the importance of these traditions to Japanese women, and (c) to provide an environment within which Japanese women feel able to express and negotiate their cultural practices.

Following ethical approval from the Otago Polytechnic Research Ethics Committee (ETHICS 470), 13 Japanese women, who had given birth in New Zealand within the previous 3 years, were interviewed individually, or in a focus group. Transcripts of the interviews were analyzed using thematic analysis. The women were all born in Japan, had moved to New Zealand in their 20s, and lived in New Zealand for a period between 2 and 19 years.

The women valued their birth traditions and tried to practice these throughout their pregnancy and following birth. This was not always possible within the New Zealand maternity and cultural setting where there was a lack of support or understanding from family and care providers. There was also limited access to shrines where they could perform the rituals. This caused some of the women to experience cultural conflicts.

The desire to maintain harmony with others and the environment is embedded in Japanese culture, and this made it difficult for the women in this study to express their need to fulfill these practices and rituals.

Although this study focused on Japanese women’s attitudes and cultural practices, it highlights the importance of being able to maintain a woman’s cultural links, particularly around childbirth. It is essential for caregivers to understand that each woman brings her own cultural understandings and traditions to her birth experience and that the support to practice birth rituals contributes to her peace of mind and well-being.

Immigrant women's perspective on prenatal and postpartum care: systematic review

Female migration represents a major public health challenge faced today because its heterogeneity and gender issues placing immigrant women among the most vulnerable and at-risk group. To identify and analyze studies dealing with immigrant women's perspectives with prenatal and postpartum health care. A systematic literature review was conducted to assess studies published between 2000 and 2010 using Cumulative Index to Nursing and Allied Health Literature, EMBASE, PubMed and Cochrane Database of Systematic Reviews. The studies explored the relation between socio-demographic characteristics of immigrant women participants and its impact on the main factors identified as influencing prenatal and postpartum care, characterizing the manifested knowledge and behaviors expressed and describing the women's experience with health care services and the incidence of postpartum depression symptoms. The less favorable socio-economic status of migrant women participants seems to have been influential in the quality of health service in prenatal and postpartum periods. The language barrier was the main negative factor interfering with communication between women and health professionals, followed by health care professionals' lack of cultural sensitivity, leading to women's reluctance in using health services.

Immigrants' experiences of maternity care in Japan

Language and cultural differences can negatively impact immigrant women’s birth experience. However, little is known about their experiences in Japan’s highly homogenous culture. This cross-sectional study used survey data from a purposive sampling of immigrant women from 16 hospitals in several Japanese prefectures. Meeting the criteria and recruited to this study were 804 participants consisting of 236 immigrant women: Chinese (n = 83), Brazilian (n = 62), Filipino (n = 43), South Korean (n = 29) and from variety of English speaking nations (n = 19) and 568 Japanese women. The questionnaire was prepared in six languages: Japanese (kana syllables), Chinese, English, Korean, Portuguese, and Tagalog (Filipino). Associations among quality of maternity care, Japanese literacy level, loneliness and care satisfaction were explored using analysis of variance and multiple linear regression. The valid and reliable instruments used were Quality of Care for Pregnancy, Delivery and Postpartum Questionnaire, Rapid Estimate of Adult Literacy in Medicine Japanese version, the revised UCLA Loneliness Scale-Japanese version and Care satisfaction. Care was evaluated across prenatal, labor and delivery and post-partum periods. Immigrant women scored higher than Japanese women for both positive and negative aspects. When loneliness was strongly felt, care satisfaction was lower. Some competence of Japanese literacy was more likely to obstruct positive communication with healthcare providers, and was associated with loneliness. Immigrant women rated overall care as satisfactory. Japanese literacy decreased communication with healthcare providers, and was associated with loneliness presumably because some literacy unreasonably increased health care providers’ expectations of a higher level of communication.

Conceptualizing prenatal care: recent research and the application of Tae-Kyo, Korean traditional beliefs and practices

The value of prenatal care has long been recognized by various cultures. The author's purpose in this article is to propose a framework to conceptualize prenatal care using the traditional Korean practice of prenatal care called Tae-Kyo, which means education for the fetus. The philosophy of Tae-Kyo shows the importance of children's development from the very beginning of life and indicates the moral and social responsibilities of pregnant women, family members, and communities in delivering healthy babies. This comprehensive view implies a framework for conceptualizing prenatal care that encompasses multidimensional aspects of prenatal care.

Understanding childbirth practices as an organizational cultural phenomenon: a conceptual framework

Understanding the main values and beliefs that might promote humanized birth practices in the specialized hospitals requires articulating the theoretical knowledge of the social and cultural characteristics of the childbirth field and the relations between these and the institution. This paper aims to provide a conceptual framework allowing examination of childbirth practices through the lens of an organizational culture theory. A literature review performed to extrapolate the social and cultural factors contribute to birth practices and the factors likely overlap and mutually reinforce one another, instead of complying with the organizational culture of the birth place. The proposed conceptual framework in this paper examined childbirth patterns as an organizational cultural phenomenon in a highly specialized hospital, in Montreal, Canada. Allaire and Firsirotu's organizational culture theory served as a guide in the development of the framework. We discussed the application of our conceptual model in understanding the influences of organizational culture components in the humanization of birth practices in the highly specialized hospitals and explained how these components configure both the birth practice and women's choice in highly specialized hospitals. The proposed framework can be used as a tool for understanding the barriers and facilitating factors encountered birth practices in specialized hospitals.

The Lived Childbirth Experience of Korean First-Time Mothers in the United States

OBJECTIVE: To explore the lived experience of Korean first-time immigrant mothers giving birth in the United States from their own perspectives.

DESIGN: Hermeneutic phenomenological study using semistructured interviews with seven Korean first-time mothers who recently gave birth in the United States. The interview data were analyzed to identify emerging themes, which were centered on both positive and negative perceptions of the experience.

RESULTS: The emerged positive perceptions included friendly health care providers, husband’s active involvement, strengthened bonding with husband, freedom from traditional rituals and taboos, and giving the baby a U.S. citizenship. Difficulty in making medical decisions, health literacy, a different health system, different postpartum food culture, and lack of support system were identified as negative perceptions.

CONCLUSIONS: The findings of this study may help health care providers in obstetrical settings better understand the meaningful aspects of childbirth experienced by Korean immigrant first-time mothers while they gave birth and received perinatal care in the U.S. sociocultural context. Immigrants’ childbirth experience in a foreign country has multidimensional aspects that suggest further research on their perinatal health needs evolving from a different health culture, culturally embedded health practices, and lack of support system.

Experiences with epidural anesthesia of Japanese women who had childbirth in the United States

PURPOSE

Cultural views are purported to be critical barriers to the use of epidural anesthesia during childbirth in Japan, even though it is not routinely available. We sought to understand the importance of the asserted cultural barriers for Japanese women living in Michigan in the United States where access to epidural anesthesia is routine.

METHODS

We used a mixed-methods approach including self-administered, cross-sectional mail surveys and semi-structured qualitative interviews. Participants were Japanese women who received prenatal care at the University of Michigan Japanese Family Health Program.

RESULTS

Of 78 participants in the mail survey, 63% used epidural anesthesia. Positive influences to have epidural anesthesia came from friends (58%), husbands (42%), and knowledge of the epidural anesthesia experiences of others (50%). Seventeen respondents participated in qualitative interviews. Most had learned little about epidural anesthesia while living in Japan, and some respondents had heard unsettling rumors. Many mentioned obtaining their first detailed knowledge about epidural anesthesia from friends in the United States, and expressed fear or concerns about the side effects of anesthesia. Thirteen out of fourteen interviewed participants who used or wanted epidural anesthesia expressed a desire to use it for the next childbirth.

CONCLUSIONS

While Japanese women in this United States setting considered previously reported cultural barriers to epidural anesthesia for birth pain, many chose to have it during their labor. This finding implicates limited access as a barrier at least as important as cultural barriers to epidural anesthesia use in Japan.

Japanese women's experiences from pregnancy through early postpartum period

Declining availability and accessibility of perinatal health care are emergent social concerns. Based on the Listening to Mothers-II (LTM-II) surveys, we describe a total of 20 Japanese women's perinatal experiences. Data were qualitatively compared with those of U.S. women, using a theoretical framework for evaluation of primary health care. Japanese women overcame their worries by engaging in healthy behaviors, accepting hardships such as labor pain, and receiving assurance from health professionals and modern technology. We found that while U.S. and Japanese women's perinatal experiences reflected their unique cultural values and social context, a cross-cultural universality of birthing women's experiences exists.

Facilitators and barriers in the humanization of childbirth practice in Japan

BACKGROUND

Humanizing birth means considering women's values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process. Reducing over-medicalized childbirths, empowering women and the use of evidence-based maternity practice are strategies that promote humanized birth. Nevertheless, the territory of birth and its socio-cultural values and beliefs concerning child bearing can deeply affect birthing practices. The present study aims to explore the Japanese child birthing experience in different birth settings where the humanization of childbirth has been identified among the priority goals of the institutions concerned, and also to explore the obstacles and facilitators encountered in the practice of humanized birth in those centres.

METHODS

A qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed.

RESULTS

All the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were women's own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions.

CONCLUSIONS

The Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and beliefs of Japanese women regarding natural birth is an important factor promoting the humanization of childbirth in Japan.

A patient perspective in research on intercultural caring in maternity care: A meta-ethnography

The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare's meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested.

Patient choice cesarean--the Maine experience

BACKGROUND

Patient choice cesarean refers to elective primary cesarean in the absence of a medical or obstetrical indication. The purpose of this study was to determine obstetricians' attitudes and practices with respect to patient choice cesarean in Maine, United States.

METHODS

A questionnaire was sent to all Maine Fellows of the American College of Obstetricians and Gynecologists actively practicing obstetrics, after receiving institutional review exemption. Data were analyzed using descriptive statistics, Fisher exact, or chi-square tests.

RESULTS

Seventy-eight of 110 (70.9%) obstetricians responded. Of these, 60 of 71 (84.5%) respondents performed or were willing to perform patient choice cesarean. However, 15 of 71 (21.1%) preferred a cesarean delivery for themselves (women) or partners (men). Indications included urinary continence (53.3%), adverse previous birth experience (41.7%), anal continence (35.0%), concern for fetal death or injury (33.3%), and fear of childbirth, preservation of sexual function, or pelvic organ prolapse (26.7% each). Less frequent were pain (11.7%), convenience (8.3%), and provider availability (10.0%). In addition, 82.1 percent believed medical evidence and 85.9 percent believed ethical issues sometimes or always supported patient choice cesarean. Responses were similar by gender, age, and time interval from training completion with two exceptions. Women under age 35 years were more likely to opt for a cesarean delivery themselves (p = 0.04), and 42.9 percent of respondents under age 35 years interpreted the medical literature as supporting cesarean in all cases versus 4.2 percent of older colleagues (p = 0.008). Sixty-four of 78 (82.1%) respondents would find a randomized trial of planned vaginal versus planned cesarean delivery helpful in addressing the issue of patient choice cesarean.

CONCLUSIONS

Although Maine obstetricians were willing to perform patient choice cesarean, few preferred this delivery mode for themselves or their partners. A randomized trial of planned vaginal versus planned cesarean delivery is highly desired.

Preconception care by family physicians and general practitioners in Japan

BACKGROUND

Preconception care provided by family physicians/general practitioners (FP/GPs) can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan.

METHODS

A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents.

RESULTS

Two hundred and sixty-eight of 347 (77%) eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%), and the least was about folic acid supplementation (12%). Many participants reported providing smoking cessation in their practice (60%), though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10%) or folic acid supplementation (4%). About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care.

CONCLUSION

FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.

Childbirth Experiences of Professional Chinese Canadian Women

OBJECTIVE

To explore the connections between culture and expectations surrounding the childbirth experience for professional Chinese Canadian women.

DESIGN

Descriptive and qualitative, using ethnographic interview.

SETTING

Women were recruited from a community health care center in metropolitan Toronto.

PARTICIPANTS

Six professional Chinese Canadian women who had experienced at least one childbirth.

RESULTS

The respondents described adherence to many traditional values, beliefs, and practices throughout the pregnancy and childbirth experience. However, some practices were modified to address functioning in a context that could not support full expression of cultural traditions. Recent immigration to Canada was associated with less adherence to traditional Chinese rituals and beliefs.

CONCLUSION

Nurses cannot make assumptions about who will use traditional cultural practices or about the circumstances in which they are relevant. Nurses need to be aware of cultural expectations so they can provide culturally competent care, but they should also be aware of how to engage in discussions to clarify individual patient priorities.