木村 佳代子

日本において超高齢妊産婦への多職種連携の必要性が高まっているが、その実践知の蓄積は殆どない。超高齢妊産婦の妊娠期から産後１年にわたり、保健医療専門職の多職種連携の経験を明らかにすることを目的とした。研究参加者は看護職24名、医師７名、医療社会福祉士１名、計32名であった。超高齢妊産婦の妊娠期から産後１年にわたる多職種連携の経験を半構成的面接法にて調査し、内容分析を行った。超高齢妊産婦の多職種連携の経験は、【既存の多職種連携システムの活用】、【日常的な交流からの円滑な連携】、【超高齢妊産婦の多様性を踏まえた連携】、【産前から産後までの切れ目のない連携】等10テーマが導出された。超高齢妊産婦に対する多職種連携は、妊娠期から出産施設退院までは既存の周産期医療システムを活用して円滑に行われていた。しかし、出産施設初診までと施設退院後の育児期の多職種連携において課題があることが示唆された。<br>

日本において超高齢妊産婦への多職種連携の必要性が高まっているが、その実践知の蓄積は殆どない。超高齢妊産婦の妊娠期から産後1年にわたり、保健医療専門職の多職種連携の経験を明らかにすることを目的とした。研究参加者は看護職24名、医師7名、医療社会福祉士1名、計32名であった。超高齢妊産婦の妊娠期から産後1年にわたる多職種連携の経験を半構成的面接法にて調査し、内容分析を行った。超高齢妊産婦の多職種連携の経験は、【既存の多職種連携システムの活用】、【日常的な交流からの円滑な連携】、【超高齢妊産婦の多様性を踏まえた連携】、【産前から産後までの切れ目のない連携】等10テーマが導出された。超高齢妊産婦に対する多職種連携は、妊娠期から出産施設退院までは既存の周産期医療システムを活用して円滑に行われていた。しかし、出産施設初診までと施設退院後の育児期の多職種連携において課題があることが示唆された。(著者抄録)

INTRODUCTION: The objective of this scoping review is to map the literature describing preventive interventions for paternal perinatal depression. Depression is a common mental disorder experienced by fathers as well as mothers around childbirth. Perinatal depression has negative consequences for men, and suicide is the most serious adverse effect. Impaired father-child relationships can also result from perinatal depression, negatively impacting child health and development. Considering its severe effects, early prevention of perinatal depression is important. However, little is known about preventive interventions for paternal perinatal depression including Asian populations. METHODS AND ANALYSIS: This scoping review will consider studies of preventive interventions for perinatal depression in men with a pregnant wife or partner, and new fathers (less than 1 year post partum). Preventive intervention includes any form of intervention intended to prevent perinatal depression. Primary prevention intended to promote mental health will also be included if depression is included as an outcome. Interventions for those with a formal diagnosis of depression will be excluded. MEDLINE (EBSCOhost), CINAHL (EBSCOhost), APA PsycINFO (EBSCOhost), Cochrane Central Register of Controlled Trials and Ichushi-Web (Japan's medical literature database) will be searched for published studies, and Google Scholar and ProQuest Health and Medical Collection will be searched for grey literature. Beginning in 2012, the search will include the last 10 years of research. Screening and data extraction will be performed by two independent reviewers. Data will be extracted using a standardised data extraction tool and presented in diagrammatic or tabular form, accompanied by a narrative summary. ETHICS AND DISSEMINATION: As this study involves no human participants, approval from a human research ethics committee is not required. Findings of the scoping review will be disseminated through conference presentations and publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: https://osf.io/fk2qe/.

本研究は、リモート立会い出産のケアの提供方法とその課題を明らかにすることを目的とした。リモート立会い出産に関わっている助産師に対して半構成的面接によりデータを収集し、質的帰納的に分析した結果、8テーマに集約された。【産婦が望むリモート立会い出産に向けた準備の促し】、【リモートで立会う夫の出産・誕生への巻き込み】を含む6テーマは助産師が工夫しているケアの提供方法であり、【立会者と離れていることにより生じる混乱】、【立会者が出産の場にいないことによる弊害】の2テーマは助産師がケア提供時に認識した課題であった。以上より、助産師は当事者が望むリモート立会い出産を実現できるように、出産前から産婦と立会者双方を意識して出産準備教育を行うとともに、出産時には対面ケアとリモートへのケアを同時並行で実践していることが明らかになった。また、立会い中に想定外の出来事が生じることもあり、妊娠中からのケアの重要性が示唆された。(著者抄録)

OBJECTIVE: This systematic review aimed to identify and synthesize available qualitative evidence regarding the experiences of the transition to motherhood among pregnant women following assisted reproductive technology. INTRODUCTION: Pregnant women following assisted reproductive technology experience unique challenges to their identity when transitioning to motherhood. It is important that health care professionals understand the context and complexity of emotional adaptation to pregnancy following assisted reproductive technology. INCLUSION CRITERIA: Any qualitative data from empirical studies that described experiences of the transition to motherhood during pregnancy among women who conceived through assisted reproductive technology were considered for inclusion. METHODS: Several databases were searched for published and unpublished studies in English or Japanese from 1992 to 2019, including MEDLINE, CINAHL, PsycINFO, ProQuest Health and Medical Collection, Google Scholar, and Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). All included studies were assessed by two independent reviewers. Any disagreements were resolved through discussion. We used the recommended JBI approach to critical appraisal, data extraction, and data synthesis. RESULTS: This review included seven studies that considered pregnant women's (n = 110) experiences of transition to motherhood following assisted reproductive technology, and were assessed as moderate to high quality (scores 7-10) based on the JBI critical appraisal checklist for qualitative research. All studies used qualitative methodologies or methods including phenomenology, narrative approach, qualitative description, and qualitative content analysis. There were two studies from Japan, one from Brazil, one from Iran, one from Israel, one from the UK, and one from the USA. In total, 51 supported findings were aggregated into 14 categories, and five synthesized findings: i) Pregnant women following assisted reproductive technology require support to decrease anxiety and improve their belief in pregnancy to internalize a maternal identity; ii) Pregnant women following assisted reproductive technology need reassurance of their lifestyles to ensure a safe passage through pregnancy because of ambivalent feelings about becoming a mother; iii) Pregnant women following assisted reproductive technology develop a maternal identity with affection for the fetus if they switch their mindset from infertility to pregnancy; iv) Pregnant women following assisted reproductive technology need to review their self-image of being infertile and prepare for childbirth or motherhood; v) Pregnancy following assisted reproductive technology contributes to the emergence of positive feelings and changing the women's sense of self and other personal relationships. Based on the ConQual approach, the confidence in the synthesized findings was rated as moderate to low. CONCLUSIONS: The synthesized findings highlight the importance of understanding the uncertainty and ambivalent feelings women have about their pregnancy, delayed development of attachment to their fetus and formation of a maternal identity, alteration in their relationships, and the social context of pregnancy via assisted reproductive technology among pregnant women following assisted reproductive technology. Health care professionals need to be aware of the specific care needs relating to the unique pathway in the identity transition to motherhood following assisted reproductive technology for these women. More research on development and implementation of specific intervention programs for expectant mothers following assisted reproductive technology is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019138200.