References
Psychological care provided by midwives in residential postpartum care facilities in Japan
Abstract
Background/Aims
In Japan, residential postpartum care facilities admit mothers after discharge from the facility where they gave birth. The psychological elements of postpartum care provided at these facilities is unknown. This study aimed to explore the psychological care (especially care intended to prevent postpartum depression) usually provided by midwives in residential postpartum care facilities.
Methods
Qualitative induction was used to analyse questionnaires and semi-structured interviews conducted with seven midwives at different facilities providing residential postpartum care in Japan.
Results
Care was generally focused on acceptance and listening, promoting rest and allowing for reflection on childbirth. Care specifically intended to prevent postpartum depression was focused on initial assessments and prioritised relationships with husbands and family members, while avoiding providing excessive advice or altering mothers' established childcare practices.
Conclusions
Midwives practices were founded on respect for mothers and providing health guidance and family interactions that matched mothers' needs. Initial assessments were key to preventing postpartum depression, and midwives involved mothers' husbands and other family members in this care. These practices build trusting relationships and help mothers gain confidence in childrearing.
Implications for practice
Midwives providing psychological care to prevent postpartum depression should focus on initial assessments, and involve the woman's husband and family members.
In Japan, there has been a decline in family‑supported postpartum care in the home, thought to be linked with women's entry into the workforce (Ministry of Internal Affairs and Communications, 2022), the rise in childbearing age (National Institute of Population and Social Security Research, 2023) and the growth of nuclear families (Ministry of Internal Affairs and Communications, 2020).
In addition, the COVID‑19 pandemic meant that people were raising children in isolation, resulting in negative social impacts such as increases in postpartum depression cases (Matsushima, 2022) and child abuse consultations (Ministry of Health, Labour and Welfare (MHLW), 2021).
There was a decline in the incidence of postpartum depression in Japan from the first recorded rate of 13.4% in 2000 to 9.0% in 2013 (Yamagata, 2013). However, postpartum depression is associated with maternal suicide (Takeda, 2017), child abuse (Mishina et al, 2013; Tokuhiro et al, 2015), prolonged maternal childcare fatigue and associated effects on child development (Nakamura et al, 2021) and depression in the husband and family members (Takehara and Sudo, 2012). In Japan, maternal postpartum suicide is the number one cause of death of expectant and nursing mothers, half of whom had no previous history of psychological conditions, indicating an urgent need to address this issue (Takeda, 2017).
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