The Japan Academy of Midwifery has developed the Evidence-Based Care During Childbirth Guideline for Midwives (2012 edition) containing care policies for healthy low risk women and newborns. In order to disseminate the guideline, contents of the guideline are introduced for midwives through the current paper. A total of twenty nine clinical questions were included in the guideline. For each clinical question, evidence statement, its explanations and references were prepared. Evidence-based and women-centered care would be promoted if midwives adopt care policy in the guideline at hospitals, clinics and independent midwives.

ObjectivesThis preliminary study aimed to 1) determine changes in the salivary oxytocin (OT) level during breast stimulation for promoting the spontaneous onset of labor in low-risk term pregnancies, and 2) clarify the feasibility of the breast stimulation intervention protocol in terms of practicality and acceptability.MethodsWe used a single arm trial design. Sixteen low-risk pregnant women between 38 and 40 weeks of gestation with cephalic presentation participated. They performed breast stimulation for 3 days with an attendant midwife in a single maternity hospital. Each breast was stimulated for 15 minutes for a total of 1 hour per day. Saliva was collected 10 minutes before the intervention and 15, 30, 60, 75, and 90 minutes after the intervention, yielding 18 samples per woman.ResultsAmong a total of 282 saliva samples from the 16 participants, OT level was measured in 142 samples (missing rate: 49.6%). The median OT level showed the highest values on day 3 of the breast stimulation, with a marked increase 30 min after the intervention. In the mixed models after multiple imputation for missing data, the OT level on the first day of intervention was significantly lower than that on the third day of intervention. Fatigue from breast stimulation decreased on subsequent days, and most of the women (75%) felt no discomfort with the protocol. Uterine hyperstimulation was not observed.ConclusionFollowing a 3-day breast stimulation protocol for spontaneous onset of labor, the mean OT level showed the highest values on day 3. The breast stimulation intervention protocol showed good feasibility in terms of practicality and acceptability among the pregnant women. Additional large-scale studies are warranted to confirm the protocol’s effectiveness.

Background Breast stimulation is performed to self-induce labor. However, there are apparently no reports on hormonal evaluation during stimulation for consecutive days in relation to induction effect. We evaluated the salivary oxytocin level following 3 consecutive days of own breast stimulation for 1 h each day compared with no breast stimulation. Methods We used a quasi-experimental design. The participants were low-risk primiparas between 38 and 39 gestational weeks. Eight saliva samples per participant were collected at preintervention and 30, 60, and 75 min postintervention on the first and third days. The primary outcome was change in the salivary oxytocin level on the third day after 3 consecutive days of breast stimulation for 1 h each day compared with no breast stimulation. The secondary outcomes were the rate of spontaneous labor onset and negative events including uterine hyperstimulation and abnormal fetal heart rate. Results Between February and September 2016, 42 women were enrolled into the intervention group (n = 22) or control group (n = 20). As there were differences in the basal oxytocin levels between the 2 groups, to estimate the change in the oxytocin level from baseline, we used a linear mixed model with a first-order autoregressive (AR1) covariance structure. The dependent variable was change in the oxytocin level from baseline. The independent variables were gestational weeks on the first day of intervention, age, education, rs53576 and rs2254298, group, time point, and interaction of group and time. After Bonferroni correction, the estimated change in the mean oxytocin level at 30 min on the third day was significantly higher in the intervention group (M = 20.2 pg/mL, SE = 26.2) than in the control group (M = − 44.4 pg/mL, SE = 27.3; p = 0.018). There was no significant difference in the rate of spontaneous labor onset. Although there were no adverse events during delivery, uterine tachysystole occurred in 1 case during the intervention. Conclusions The estimated change in the mean oxytocin level was significantly higher 30 min after breast stimulation on the third day. Thus, consecutive breast stimulation increased the salivary oxytocin level. Repeated stimulations likely increase the oxytocin level. Trial registration UMIN000020797 (University Hospital Medical Information Network; Prospective trial registered: January 29, 2016).

ObjectivesThis pilot study using a quasi-experimental design was conducted to evaluate the feasibility (i.e., limited efficacy, practicality, and acceptability) of our intervention protocol involving inhalation of the scent of clary sage essential oil by pregnant women and measurement of their preinhalation and postinhalation oxytocin levels.ResultsParticipants were women of singleton pregnancies between 38 and 40 gestation weeks (N = 11). The experiment group (n = 5) inhaled the scent of clary sage essential oil diluted 50-fold with 10 mL of odorless propylene glycol for 20 min. Regarding limited efficacy, the oxytocin level 15 min postinhalation increased in 3 women and was unmeasurable in 2. The control group (n = 6) inhaled similarly without the 50-fold dilution of clary sage essential oil. Their oxytocin level increased in 2 women, decreased in 2, and was unmeasurable in 2. Uterine contraction was not observed in both groups. Regarding practicality, 3 of the 11 women could not collect sufficient saliva. The cortisol level decreased in both groups postinhalation. The protocol had no negative effects. Regarding acceptability, burden of the protocol was not observed. Trial registration The Clinical Trials Registry of University Hospital Medical Information Network in Japan—UMIN000017830. Registered:  June 8, 2015Electronic supplementary materialThe online version of this article (10.1186/s13104-017-3053-3) contains supplementary material, which is available to authorized users.

In order to provide safe and comfortable care throughout the perinatal period, there must be a practical guideline, which midwives can follow. The Japan Academy of Midwifery published the "Evidence-based guidelines for midwifery care in pregnancy and childbirth-2016 edition", containing care policies for healthy low-risk women and newborns. In this 2016 edition, we added the new pregnancy section including 13 Clinical Question (CQ)s and the latest evidence was added to the existing 30 CQs in the intrapartum section of the "Evidence-based guidelines for midwifery care during childbirth-2012 edition". This guideline describes and answers those clinical questions midwives face when caring for women. Recommendations we describe here are based on the latest evidence. Therefore, we believe this updated guideline reflects the best practice at this point in time. We hope this guideline will: 1) enable midwives to provide evidence-based practice and support women's decision making, 2) assist midwifery students to recognize the importance of knowing the constantly advancing field, and 3) promote further research activities where evidence is needed. The aim of introducing this guideline in English is to: 1) introduce and distribute the guidelines, compiled by Japanese midwives, to other countries and 2) enable Japanese researchers to use the English version as a common understanding by referring to this guideline when submitting to international journals. In this 2016 edition, a total of 43 CQs and the recommendations for care are introduced. Although the following six CQs are commonly utilized medical treatments in the field of obstetrics, these practices require obstetrician's supervision. Therefore, we only described the evidence statements and not the recommendations: The following six CQs are: Intra-CQ1. Induction of labor; Intra-CQ2. Membrane sweeping; Intra-CQ7. Epidural anesthesia; Intra-CQ21. Episiotomy; Intra-CQ26. Perineal repair; and Intra-CQ28. Prophylactic uterotonic. Revisions in the recommendations from the 2012 edition are as follows: "Intra-CQ 3. Is nipple or breast stimulation effective to induce labor?"; "Intra-CQ9. Is acupressure or acupuncture effective to relieve labor pain?" and "Intra-CQ14. Is acupressure or acupuncture effective to augment labor?" This paper is composed of an excerpt from the "Evidence-based guidelines for midwifery care in pregnancy and childbirth-2016 edition" and the recommendations described here are fully translated.