Effectiveness of In-Hospital Midwife-Led Careand In-Hospital Midwifery Clinics in Japanto Protect Future Births :Satisfaction of Expectant/Nursing Mothers and Reduction of Obstetrician’s Workload
Background

Objectives

In Japan, approximately 84% of midwives work in hospitals or clinics

1.Understand the facts surrounding In-Hospital Midwife-Led Care and In-Hospital Midwifery Clinics

and approximately 6.2% work in maternity homes. Midwives play a

2.Clarify the factors to maintain and continue In-Hospital Midwife-Led Care and In-Hospital Midwifery
Clinics after their establishment

comprehensive role in protecting the maternal and infant health innormal births.

3.Clarify the effect of In-Hospital Midwife-Led Care and In-Hospital Midwifery Clinics on pregnant andparturient women, midwives and OB/GYN

A challenge for hospitals and other institutions is the construction ofsystems for midwives to provide seamless care from pregnancy toMethods

parenting. Challenges include dividing responsibilities between themidwives and the physicians, building systems to provide care, andJNA conducted a “Survey on the Effectiveness of Establishing In-Hospital Midwife-Led Care andcooperate with physicians, for the increasing number of high-risk pregnant

In-Hospital Midwifery Clinics”.

and parturient women. To address these issues, JNA uses guidelines(2018) to promote the establishment of In-Hospital Midwife-Led Care and●Study time: September 3-October 12, 2018●

Subjects: 1047 facilities across Japan handling births, excluding clinics and maternity homes

In-Hospital Midwifery Clinics at medical institutions capable of providing●emergency care, as well as building systems for providing continual
midwife-led care, in cooperation with physicians, that respects the views
and wishes of pregnant and parturient women.

Method: Questionnaires were sent by post to hospitals handling births, with a request for the nursing
administrator to provide responses.
The head of the hospital’s OB/GYN was asked to provide responses to questions relating toOB/GYN. The responses were received by post.

Results
Answers were received from 688 hospitals across Japan handling births. Of
these, three hospitals had discontinued or ceased handling births were excluded
from the survey. Response rate: 65.7%
The number of medical institutions providing In-Hospital Midwife-Led Care and In-Hospital Midwifery Clinics
was roughly the same as in the 2016 survey.
Chart 1

Chart 2 In-Hospital Midwifery Clinics

In-Hospital Midwife-Led Care

ProvidedWas previously
provided

13.2%
Total569

Chart 3 Background to the establishment of In-Hospital
Midwife-Led Care (multiple answers accepted)■ To raise the motivation of midwives

68.5%

31.7%

■ Proposal from OB/GYN

40.4%

32.9%

13.5%

■ Rebuilt / refurbished hospital

10.1%■ Other

12.4%(%) 02.0%

The most important factor cited in maintaining/continuing In-Hospital Midwife-Led
Care and In-Hospital Midwifery Clinics was “improving midwife competency”.

204060Chart 6 After starting In-Hospital Midwife-Led Clinic,
what do you think is the most importantfactor in maintaining/ continuing the service(multiple answers accepted)■ Improving midwife competency

92.0%■ An adequate number of midwives

89.8%

86.5%

■ Cooperation and understandingof physicians

88.6%

86.5%

■ Thoroughly inform the service to potential users

76.1%■ Grand round (holding conferences) with OB/GYN■ Utilization of Temporary Transfer System of Midwives

48.9%(%) 020602) Effect on OB/GYN
67.9% of respondents agreed that In-Hospital Midwife-Led
Care and In-Hospital Midwifery Clinics had reduced thework burden on OB/GYN.

20（n=400）
40

60

7.7%
（n=89）

2040

60

Don’t reallyagree

26.0%
Chart 11 Do you agree with work burden on OB/GYN
is reduced by In-Hospital Midwife-Led Care andIn-Hospital Midwifery Clinics?

2.5%
Very muchagree

27.1%
Total27780

Chart 9 Reason it was possible to set up In-Hospital
Midwife-Led Care (multiple answers accepted)

100（n=391）

4.3%
020

40

60

80

10036.8%

(%) 0

51.9%

50.6%

■ Government guidelines and notiﬁcations■ Other

28.7%
42.6%
19.1%
16.4%

23.0%

8.8%

18.4%
3.4%

5.0%

14.9%
20（n=87）403) Satisfaction among pregnant
and parturient womenAmong answers provided by nurse administrators,
94.2% of respondents agreed that users of In-Hospital
Midwife -Led Care and In-Hospital Midwifery Clinics
are satisﬁed with the service they received.

6080（n=397）

9.1%

10002040

Don’t reallyagree 2.4%6080

100Don't know

3.4%

Don’t agree
at all 0.0%

Chart 12 Do you agree with that pregnant and parturient
women feel satisﬁed with In-Hospital Midwife-Led
Care and In-Hospital Midwifery Clinics?

Agree toan extent

86.9%

56.3%
40.2%

■ Cooperation and support from prefectural nursing association

Chart 10 Reason it was possible to set up In-Hospital
Midwifery Clinics (multiple answers accepted)

92.0%■ Venues were made available

80 100

Don’t know

Don’t agree
at all 3.6%

39.4%

15.7%

■ Availability of advanced midwives

0.0%

80 100 01004.9%■ Availability of an appropriate number of midwives

3.8%

40

80

41.7%

10.1%

■ Budgetary support from prefectural authorities(%) 060

78.3%

69.7%

■ Understanding and cooperation of OB/GYN

46.8%（n=88）

40“Understanding and cooperation of OB/GYN” was selected as the most frequent answer
for the ability to establish In-Hospital Midwife-Led care and In-Hospital Midwifery Clinics.

10.8%■ Nothing 0.0%

20Chart 8 What makes the In-Hospital Midwifery Clinic
work better? (multiple answers accepted)■ Nothing 0.0%

59.8%

6.6%

058.4%■ Hospital policy■ Other100（n=398）

84.3%■ Training midwives

91.5%

25.0%

80

Chart 7 What makes the In-Hospital Midwife-Led Carework better? (multiple answers accepted)■ Other■ Securing operating budget

4.8%（n=89）“Training midwives” was the most frequently cited idea for improving the running of the services.

1) Factors inﬂuencing the maintenance/continuation■ Availability of training

10.1%

The average time spent at the In-Hospital Midwifery Clinic (by the length of thereserved appointment) was 38.5 minutes.

Was previously
provided 7.0%

■ Evaluations and responses fromusers equiring the service

12.8%

33.7%

■ Request from pregnant / parturient women

Never provided

Chart 5 After starting In-Hospital Midwife-Led Care,
what do you think is the most important factor
in maintaining / continuing the service?
(multiple answers accepted)

42.0%

47.2%
41.6%

58.7%

84.3%

66.6%

■ Midwives were available to provide midwife-led care

Provided

681

Background to the establishment of In-HospitalMidwifery Clinics (multiple answers accepted)

75.4%

68.5%

■ Hospital policy

34.2% Total

Chart 4

■ Proposal from midwife■ To reduce the burden on OB/GYN

Never
provided

2.5%

Establishment of In-Hospital Midwife-Led Care and In-Hospital Midwifery Clinics mostfrequently follow “proposal from midwife".

Very muchagree

Agree toan extent

Total
292

40.1%

54.1%

40.8%

4) Evaluations and responses from users

Conclusion◎Peace of mind : “Meeting the midwife at the hospital before the delivery gave me peace of mind".

Requirements for and effectiveness from the establishment and ongoing managementof In-Hospital Midwife-Led Care and In-Hospital Midwifery Clinics are;◎Easy to consult : “I was able to consult with a midwife about detailed things”.
◎Satisfaction : “Following repeated pre-delivery consultations regarding the sort of delivery
I wanted to have, I was satisﬁed with my experience of giving birth”.

●In many cases, the In-Hospital Midwife-Led Care or In-Hospital Midwifery
Clinic was established following a proposal from a midwife◎Removal of worry : “I was able to take time to communicate with the midwife, which removed
my concerns”.

●Improving competencies for midwifery practice was key tothe continuation after establishment of the service◎Feel relaxed : “I could talk with the midwife in a relaxed manner, knowing that a physician wasavailable in the event of an emergency, and this helped me relax prior togiving birth”.

●Establishing these services contributed to the reduction ofobstetrician’s work burden◎Desire to use services again : “I still have many things to learn from the midwife and I felt sad toleave the hospital. I would like to give birth here again”.

●More than 90% of nurse administrators recognized that pregnant andparturient women were satisﬁed with their use of these services

Key message
Establishing In-Hospital Midwife-Led Care and In-Hospital Midwifery Clinics and accomplishing the role of a midwife is important forbuilding future systems for maternal and perinatal care in Japan.