This is the first study to develop scales for pregnancy-related discomforts in Japanese women in order to evaluate psychosomatic states during each trimester of pregnancy. Because the number of scale items had decreased by more than half as compared to previous scales, this new, more feasible scale may be useful in clinical settings.

This study was to clarify the characteristics and changes of the sleep-wake rhythm in mothers from late pregnancy to four months postpartum. Methods Participants were 57 women in late pregnancy to four months postpartum. The subjects were 57 mothers after 35 weeks of pregnancy who gave informed consent to participate. Of these, forty-seven mothers 1 month postpartum and thirty-four at 4 months postpartum, were surveyed longitudinally at. Participant recorded 24 hours sleep-and-wakefulness using a day-by-day plot method on Sleep Log at intervals of 30 minutes for one week. We calculated sleep parameters: total sleep time (TST), nocturnal sleep time (NST), diurnal sleep time (DST), longest sustained sleep period (LSP), LSP onset and offset times, numbers of total sleep hours and diurnal sleep hours, time of waking after sleep onset (WASO), number of WASO and sleep-wake cycle. Results TST were 7.79 hours in late pregnancy, 6.73 hours 1 month postpartum and 6.91 hours in 4 month after delivery (F=18.21, p<0.001). NST were 6.75 hours, 5.85 hours and 6.36 hours (F=12.27, p<0.001) respectively. LSP were 6.39 hours, 3.46 hours and 4.13 hours (F=87.61, p<0.001). TST, NST and LSP in postpartum were shorter than those late pregnancy. WASO were 0.42 hours, 1.70 hours and 1.14 hours (F=45.42, p<0.001). Number of WASO were 0.3 times, 1.7 times and 1.5 times (F=78.60, p<0.001). WASO in postpartum was longer than those late pregnancy, and number of WASO in postpartum was larger than those late pregnancy. It was found that LSP showed significant negative correlation with LSP onset in late pregnancy (r=-0.481, p<0.001), and 4 months postpartum (r=-0.396, p<0.05). In addition, LSP were predominantly between 0:22 and 6:50, while cycle of sleep-and-wakefulness rhythm was approximately 24 hours, which showed a range of 24.04 hours to 24.08 in the mothers in this study. Conclusion The sleep-wakefulness rhythm in mothers is disturbed from late pregnancy to postpartum, although TSP, NSP, LSP decrease and WASO increases. The mothers who go to bed early are able to sleep longer during nighttime hours and sleep-and-wakefulness was approximately 24 hours cycle in all mothers.

Using five locations in Japan that are taking the lead in establishing in-hospital birth centers as model cases, we are developing factors for the establishment of in-hospital birth centers. Subjects and Methods We surveyed midwives at five general hospitals that have established in-hospital birth centers (one midwife at each facility). We collected data using a structured interview survey, focusing on the preparations that were made to establish the in-hospital birth center. To conduct our analysis, we recorded the interviews, transcribed the interviews, and then integrated the transcribed data using the KJ method. We examined and diagrammed the relationships between the categories chronologically. Results The data sampled from the transcriptions was ultimately combined into groups: "Background behind the establishment of an in-hospital birth center," "Infrastructural system creation," "Skills development of midwives," and "Staff placements and cooperation". When these four elements were expressed in a structural drawing, the path toward the establishment of an in-hospital birth center promoted by midwives was shown to be comprised of two phases: (1) an uphill portion reflecting the "Background behind the establishment of an in-hospital birth center," and (2) a flat portion, reflecting the "Infrastructural system creation," "Skills development of midwives," and "Staff placements and cooperation." Moving toward the establishment of an in-hospital birth center required the presence of midwives dedicated to the development of such a facility. When these midwives moved forward in their efforts, the uphill slope expressed in the "Background behind the establishment of an in-hospital birth center" was important. Some of the factors that facilitated the progress made by these midwives as they struggled uphill toward their goal included "positive reasons for establishing the facility" and "the involvement and support of key persons." The factors impeding their progress included "negative reasons for establishing the facility." When the supporting factors won out over the impeding factors, forward progress could be made. Progress along the flat road that followed the uphill slope could then proceed smoothly. Conclusions Making progress toward the establishment of in-hospital birth centers requires the strong dedication of midwives to this cause, as well as an environment that is supportive of their efforts.

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