MIDWIFERY
CAREER
IN JAPAN
Aug 28, 2018 ㏂9:45～10:45
GOAL!
1 To share perinatal situation
in Japan
2 To share a Midwifery career and
care in Japan
MENU
1. What’s occurring in Japan?
1. Changing of Birth place from 1950
2. Changing of Population pyramid
3. New issues of perinatal situation
Ⅱ. Midwifery career and primary health care in Japan.
1. Midwifery career after graduated
2. Midwives’ activity and care in maternity home
INTRODUCE MYSELF
HOW TO BECOME A MIDWIFE
Graduate from High School
Nursing University/College 4-year Nursing Junior College 3-year Nursing School (Diploma program) 3-year Public Health Nurse
course
(1-year or more)
Midwifery course
(1-year or more)
Public Health Nurse school, Junior college,
University/College, Graduate school
Midwifery school, Junior college,
University/College, Graduate school
Nurse
Midwife, ‘94
Public Health Nurse National Public Health
Nurse Examination National Midwife Examination National Nurse Examination
Hospital & maternity home
Master & Ph.D
INTRODUCE MYSELF
As a FacultyEducation of nursing, midwifery, and research for undergraduate and graduate students in Osaka-university.
• A professor in Department of women’s health and children health from 2017.
• A lecture and assistant professor in Department of Midwifery and women’s health,
INTRODUCE MYSELF
As a Researcher1. Exercise : Maternity yoga (kusaka,2016 Matsuzaki,2017)
2. Diet : Maternity nutrition (Haruna,2016)
3. Assessment tool : Ultrasound for breastfeeding
INTRODUCE MYSELF
As a Midwife1. Hospital for 6 years
in Chiyoda-ku, Tokyo 2. Maternity home for 5 years
in Kokubunji-shi Tokyo Kokubunji-shi
Chiyoda-ku
BIRTH IN HOSPITAL
Relax and deep breathing during labour on delivery table
Relieved from back pain by staff
BIRTH IN MATERNITY HOME
Relax and deep breathing during labour on Futon on
Mother takes up her baby with midwife.
The husband supports with all his soul.
Immediately after childbirth
MENU
1. What’s occurring in Japan?
1. Changing of Birth place from 1950
2. Changing of Population pyramid
3. New issues of perinatal situation
Ⅱ. Midwifery career and primary health care in Japan.
1. Midwifery career after graduated
2. Midwifery activity in maternity home
CHANGING OF BIRTH PLACE AND
MATERNAL MORTALITY RATE
12 Home VS Hospital; 1:1, 1960y Hospital Clinic Home Maternity home Almost 100% home birth until 1950y Almost 100% hospital and clinic birth 1975y Maternal mortality rate 425/100,0 00 1900y Maternal mortality rate 5/100,000 2017y Maternal mortality rate
AGEING SOCIETY
DECREASING: NUMBER OF
POPULATION
14
https://gefira.org/en/2017/12/05/in-300-years-there-are-only-300-japanese-left/
Working reform how to work to protect young people
INDONESIA VS JAPAN
Indonesia Japan
Number of midwives 325,000 37,572
Population (in thousands) 257,563.8 126,573.5
Maternal mortality rate (per 100,000 live births) 126 5
Neonatal mortality rate (per 1,000 live births) 13.5 0.9
Contraception prevalence rate 59.5 44.4
Maternal age at birth of first child 22.5 29.9
C-section rate (%) 12 10-40
Breastfeeding initiated within the first hour 49.3 ?
Exclusive breastfeeding until 6 months 41.5 ?
INCREASING: MATERNAL ADVANCED AGE
16
Mean age of marriage among female
29.4 years old /2016 Mean age of maternal
age of first baby 30.7 years old /2016
INCREASING HIGH-RISK
PREGNANCY
•
Complication: GDM, HDP, and so on.
•
Child rearing: child maltreatment
•
Mental health: depression and suicide
C O M M I T T E E O F E VA L U AT I O N O F M AT E R N A L M O R TA L I T Y 2 0 1 6 ( I K E D A , 2 0 1 6 ;
A S S O C I AT I O N O F O B S T E T R I C I A N S A N D G Y N E C O L O G I S T S , 2 0 1 8 )
Frequency of the cause of maternal
death (n=277) 2010-'16
Obstetric hemorrhage 23% Cerebral hemorrhage 15% Amniotic fluid embolism 13% Cardiovascular disease 10% Lung disease 8% Infection 7% Accidental 7% Others 8% Unknown 9%Frequency of the cause of obstetric
hemorrhage (n=64) 2010-'16
Amniotic fluid embolism 49% Uterine rapture 10% Atonic bleeding 10% Premature separation of normally implanted placenta 8% Uterine inversion 6% Others 17%COMPARED WITH RATE OF SUICIDE DURING
PERINATAL PERIOD IN UK, SWEDEN, AND
TOKYO JAPAN
政府統計 e-statより
UK & NI Sweden Tokyo
Period 2009-’13 1980–’07 2005-’14
Rate of maternal mortality ( per100,000 maternities)
3.7 4.7 3.9
Rate of perinatal suicide ( per100,000 maternities)
JAPAN PPD STUDY GROUP (中野班）,
JAPAN MINISTRY OF HEALTH, LABOUR AND WELFARE, 1994
Kitamura T, Yoshida K, Okano T, Kinoshita K, Hayashi M, Toyoda N, Ito M, Kudo N, Tada K, Kanazawa K, Sakumoto K, Satoh S, Furukawa T, Nakano H.
Multicentre prospective study of perinatal depression in Japan: incidence and correlates of antenatal and postnatal depression.
Arch Womens Ment Health. 2006 May;9(3):121-30. Epub 2006 Mar 20. Abstract
A multicentre study on the epidemiology of perinatal depression was conducted among Japanese women expecting the first baby (N = 290). The incidence rate of the onset of the DSM-III-R Major Depressive Episode during pregnancy (antenatal depression) and within 3 months after delivery (postnatal depression) were 5.6% and 5.0%,
respectively. Women with antenatal depression were characterised by young age and negative attitude towards the current pregnancy, whereas women with postnatal
depression were characterised by poor accommodation, dissatisfaction with sex of the newborn baby and with the emotional undermining. Antenatal depression was a major risk factor for postnatal depression.
Therefore, women are evaluated their mental health using EPDS at 3 times during pregnancy and 3 times during postpartum until 1-month postpartum by midwives.
BREAK
BIRTH IN MATERNITY HOME
Maternity home can perform humanized care for women and their family .
MENU
1. What’s occurring in Japan?
1. Changing of Birth place from 1950
2. Changing of Population pyramid
3. New issues of perinatal situation
Ⅱ. Midwifery career and primary health care in Japan.
1. Midwifery career after graduated
2. Midwifery activity in maternity home
MIDWIFERY CORE COMPETENCY
24
Ability to sympathy of ethical responsibility;
Ethical understanding
:
Midwifery philosophy
Ability of professional autonomy
Women’s health
care ability
Maternity care
ability
Respect for life
Respect for knowledge Respect for nature
MIDWIFERY CAREER
Clinical ladder of competencies for midwifery practice career (CLoCMIP) 2013
Novice 1 Ⅱ
Ⅳ
Ⅲ
Why was this ladder made?
々to the decrease of child birth and increase high risk pregnant women ⇒ less opportunities to attend childbirth and improve midwifery skills. 々to provide a high quality care for women by midwives.
Japanese midwives don’t need to up-date for midwife license by law. What is this ladder?
々midwifery alibies are based on 3 framework, “ethical understanding”, “maternity care ability,” and “professional autonomy”.
MIDWIFERY CAREER
26
Certification system of midwives at “level III” of the clinical laddar
Novice 1 Ⅱ
Ⅳ
Ⅲ Certifying “level III” midwives? 々Four midwife organizations and nursing association has established a certification system of midwives at “level III” of the clinical ladder.
The aim of certifying “level III”? 々 To acknowledge them
々It is expected that the standards of midwifery to raise, securing the quality of care for mothers and their newborns.
MIDWIFERY CAREER
The required status to achieve each level of ClocMip
Novice 1 Ⅱ
Ⅳ
Ⅲ
Able to provide midwifery care safely and securely in
1. Able to provide midwifery care safely and securely, having acquired knowledge, skills, and a proper attitude to assist healthy living.
2. Know the contents of midwifery led care for inpatients and outpatients.
3. Able to understand the pathological conditions of high risk patients and proper way to cope with them.
28
Novice 1
1. Able to provide individualized care based on the midwifery process.
2. Able to provide care in the in-hospital midwifery clinic with support.
3. Able to provide midwifery care together with the senior midwives in the in-hospital midwifery care unit.
4. Able to judge whether the symptom is high or low risk and provide the initial intervention.
Ⅱ Ⅳ
Ⅲ
Novice 1
1. Able to responsibly provide midwifery care of the
pregnant/puerperant woman and the newborn throughout the hospitalization period.
2. Able to autonomously provide individualized care in the in-hospital midwifery clinic.
3. Able to play an instructive role in the in-hospital midwifery clinic.
4. Able to autonomously provide care in the in-hospital midwifery care unit.
5. Able to detect transition from low risk to high risk Ⅱ
Ⅳ
Ⅲ
Ladder Ⅲ〆Pass a examination: Certified advanced midwife Update every 5 years
BREAK
BIRTH IN MATERNITY HOME
Midwives can provide safe, satisfactory, emotional, pleasant birth for mothers. We call “feeling birth”.
CLINICAL LADDER OF COMPETENCIES
FOR MIDWIFERY PRACTICE (CLOPMIP)
• Conditions for Approval (Level Ⅲ）
Midwife who has midwifery career more than 5 years can propose Ⅲ.
maternity care ability
1 Conduct of labor: more than 100 women
2 Physical assessment of newborn: more than 100 babies 3 Physical assessment of pregnant: more than 100 women 4 Physical assessment of postpartum: more than 200 women
5 Continuous care of women in own charge: more than 20 women 6 Small group guidance: to be able to implement
7 Parents and mothers class : to be able to implement
CLINICAL LADDER OF COMPETENCIES
FOR MIDWIFERY PRACTICE (CLOPMIP)
• Mandatory training (Level Ⅲ）: maternity care ability They have to receive a seminar as follows;
– Neonatal resuscitation
– Cardiotocogram
– Physical assessment (pregnancy々nerve々respiratory /circulation々 metabolism々newborn)
– Use and management of pitocin
– Midwifery records
– Diet and nutrition from pregnancy and breastfeeding period
– Perinatal mental health
– Maternal infection and dealing and coping
– Coping of bleeding (premature separation of normally implanted placenta)
CLINICAL LADDER OF COMPETENCIES
FOR MIDWIFERY PRACTICE (CLOPMIP)
• Step up training (Level Ⅲ）
Ability to sympathy of ethical responsibility; Ethical understanding They have to receive a seminar as follows;
– Ethics about perinatal period
– Way to education for midwife and junior
– Participation of academic conference
If they can approve from a hospital and get the completion certificate, they can provide the proposal for level Ⅲ examination. After pass,
34
Novice 1
1. Able to provide creative midwifery practice.
2. Able to play an instructive role in the in-hospital midwifery clinic.
3. Able to play an instructive role in the in-hospital midwifery care unit.
4. Able to provide instruction to staff in both low and high risk cases.
Ⅱ Ⅳ
Ⅲ
MIDWIFERY CAREER
Thus Japanese midwives is getting level Ⅲ certification. Their hospital can also use level Ⅲ as a advertisement.
MENU
1. What’s occurring in Japan?
1. Changing of Birth place from 1950
2. Changing of Population pyramid
3. New issues of perinatal situation
Ⅱ. Midwifery career and primary health care in Japan.
1. Midwifery career after graduated
2. Midwifery activity in maternity home
MIDWIVES’ ACTIVITY
36
Mother Class Children Class
Midwives act as mother.
For witnessing childbirth.
Mothers practice how to give birth.
MIDWIVES’ ACTIVITY
Education of midwifery student
TAKE HOME MESSAGE
1 To share perinatal situation in Japan
々Increasing women who advanced maternal age
々New perinatal issues occur; high risk, suicide etc.
2 To share a Midwifery career in Japan
々Midwifery core competency
々Clinical ladder of competencies for
midwifery practice (CLoCMIP) 2013
THANK YOU FOR YOUR ATTENTION
• If you want further information, please let me know using email.
• Masayo Matsuzaki
LECTURE SUBJECT 17 CREDITS
( M A S T E R )40
Lecture subject Contents Teachers Credits Credits Introduction to Midwifery Definition, regulation, and professionalism etc. Midwife From April to May 1
Women’s Health Prenatal diagnosis, STI, and
infertility treatment and Domestic violence, etc Midwife From June to August 1 Perinatal physiology and pathophysiology Complication of pregnancy, examination of
ultrasound, and Prenatal diagnosis Pediatrician From April to August 2 Neonatal pathophysiology Ob/Gy 2 Midwifery Ⅰ(Main: during pregnancy)
Perinatal health guidance, physical examination,
mother and perinatal class, etc. Midwife From April to August 2 Midwifery Ⅱ(Main: intrapartum and postpartum) Diagnosis of fetal monitoring, breast feeding,
family planning etc.. From April to August 2 Midwifery Ⅲ(Main; Newborn and Neonatal) Surgical disease, infection, anomaly, nutrients, first
aid for newborn baby etc….. Midwife From April to May 1 Perinatal High Risk Management
Treatment of complication of pregnancy, management of delivery, and anomaly by drug etc.
Midwife From April to May 1 Pharmacology for women’s health
Treatment fo complication of pregnancy, manegement of deliverly, and anomaly by drug. Etc
Ob/Gy From June to August 1 Seminar for perinatal care Clinical skill Ob/Gy For 2days in August 1 Public/Global Maternal and Child Health Global projects for mother and newborn baby
and presentation skill in English etc. Midwife and Ob/Gy From June to August 1 1 Administration for Midwifery Risk management, care at disaster, guidelines in
japan and global, innovation, etc. Midwife From April to August 2 2 Total 17 credits
Public Maternal and Child Health Administration for Midwifery Practicum season Concept
Basic midwifery course
Midwifery diagnosis and care
6
PRACTICUM SUBJECT
(MASTER) Period 3weeks 1week 1week 5weeks 1week Practicum subject ContentsAssisted delivery for 3 intrapartum women
Assisted delivery for 7 intrapartum women from October from October from November Visiting training Visiting training from October 5 maternity home Practicum season
Clinical Practicum in Midwifery Ⅰ
Clinical Practicum in Women’s Health and Neonatal intensive care unit（NICU）
Clinical Practicum in
Administration for Midwifery
Clinical Practicum in Midwifery Ⅱ
Clinical Practicum in Integration of Midwifery
8days From October to February
Implementation of health guidance during pregnancy and postpartum period, assisted delivery and care during
maternity home admission.
Practicum institutions
Osaka university Hp or Osaka Hp
Outpatient in Osaka university Hp
5 maternity home
CLINICAL PRACTICUM
SCHEDULE IN MIDWIFERY
( M AS TER )42
Master course of midwifery 1st yearOsaka University
Jan-19 Feb-19 Week 1st 2nd 3rd 4th 1st 2nd 3rd 4th 5th 2nd 3rd 4th date 1-5 9-12 15-19 22-26 29-2 5-8 12-16 19-22 26-30 3-7 10-14 17-Students Group1 ① ② Group2 ③ ④ Group3 ⑤ ⑥ Group4 ⑦
⑧ Number of visiting of students
outpatient: 0.5day outpatient: 0.5day outpatient: 0.5day outpatient: 0.5day outpatient: 0.5day outpatient: 0.5day* 3day Birth 1 day, admission 0.5day*4day outpatient: 0.5day
Administration for Midwifery 1week
Integration of Midwifery Continuous care
continuous care including perinatal and postnatal checkup and at birth and postnatal care during admission 8days at maternity home 10 Sep-28 Sep Campus exercise 3weeks maternity home
maternal check ：10 times （9; in pregnancy and 1; 1 month postpartum） Birth 1times admission 4 times M anagement 5day outpatient: 0.5day Osaka rousai Hp maternity home NICU・ Outpatient Osaka Hp Extended preliminary period Aizenbashi Hp NICU・
Outpatient Osaka university Hp
Extended preliminary period
Izum Ootsu city Hp Rinku City Hp Osaka Hp Extended preliminary period maternity home NICU・ Outpatient
Yao City Hp Extendedpreliminary period, if a student is not to have less than 10 birth case.
Continuous care birth and care in maternity home admission
Health checkup for 1 month
postpartum at maternity home of mother's house
Clinical practicum schedule in 2018
practicum 1; 5weeks （3+1+1Credits）/ 1student practicum 2; 5weeks (5Credits) / 1student practicum 3; 5days (1 credits)/1 student
Oct-18 Nov-18 Dec-18
Tokyonaka city Hp Osaka university Hp Extended preliminary period NICU・ Outpatient maternity home
LECTURE SUBJECT 17 CREDITS
( U N D E R )Year Lecture subject Contents Teachers Credits Credits 3 Introduction to Midwifery Definition, regulation, and professionalism etc. Midwife From April to May 1
3 Reproductive science Ob/Gy From April to May 2
4 Neonatal pathophysiology Ob/Gy 2
3 Midwifery Ⅰ(Main: during pregnancy)
Perinatal health guidance, physical examination,
mother and perinatal class, etc. Midwife From April to August 2
4 Midwifery Ⅱ(Main: intrapartum and postpartum) Diagnosis of fetal monitoring, breast feeding,
family planning etc.. From April to August 2
4 Midwifery Ⅲ(Main; Newborn and Neonatal) Surgical disease, infection, anomaly, nutrients, firstaid for newborn baby etc….. Midwife From April to May 2
4 Seminar for perinatal care Clinical skill Ob/Gy For 2days in August 1
3 Public Maternal and Child Health Midwife From June to August 1 1
4 Administration for Midwifery Risk management, care at disaster, guidelines in
japan and global, innovation, etc. Midwife From April to August 2 2 Total 15 credits
Public Maternal and Child Health
Administration for Midwifery Midwifery diagnosis and care
Basic midwifery course Practicum season Concept
5
PRACTICUM SUBJECT
(UNDER)44
year Period credits
4 3weeks 3
4 1week 1
4 5weeks 5
4 1week 1
4 2week 3 community xenter 2
Total 10weeks (10credits) from November
Visiting training Clinical Practicum in community
health Visiting training from November
7 regional Hp Clinical Practicum in Midwifery
Diagnosis and skills Clinical Practicum in
Administration for Midwifery Visiting training from October 5 maternity home
Clinical Practicum in Midwifery Ⅱ
Assisted delivery for 7
intrapartum women from November 7 regional Hp
Clinical Practicum in Midwifery Ⅰ
Assisted delivery for 3
intrapartum women from October Osaka university Hp or Osaka Hp
CLINICAL PRACTICUM SCHEDULE IN
MIDWIFERY
( UND ER )undergraduate of midwifery 4th yearOsaka University
Week 1st 2nd 3rd 4th 1st 2nd 3rd 4th 5th 2nd 3rd 4th date 1-5 9-12 15-19 22-26 29-2 5-8 12-16 19-22 26-30 3-7 10-14
17-Students practicum 3; 5days (1 credits)/1 student Group1 ① ② Group2 ③ ④ Group3 ⑤ ⑥ Group4 ⑦ ⑧ Group5 ⑨ NICU・ Outpatient maternity home Osaka Hp Extended preliminary period
Izum Ootsu city Hp Rinku City Hp maternity NICU・ Osaka Hp Extended preliminary Aizenbashi Hp Rinku City Hp NICU・ Outpatient maternity
home Osaka university Hp
Extended preliminary period
Izum Ootsu city Hp Osaka rousai Hp Osaka Hp Extended preliminary period maternity home NICU・ Outpatient Yao City Hp Extended preliminary period, if a student is not to have less than 10 birth case. Tokyonaka city Hp Osaka university Hp Extended preliminary period NICU・ Outpatient maternity home
Saiseika suita city Hp Clinical practicum schedule in 2017
Oct-18 Nov-18 Dec-18
HOW TO BE A MIDWIFE IN JAPAN
FROM FOREIGN MIDWIFE
46
A applicant bring file proposal to Ministry of health and welfare . After certified the proposal, Applicant can take nursing and midwifery national examination. After certified the proposal, Applicant can take nursing and midwifery national examination.
https://www.mhlw.go.jp/stf/seisa kunitsuite/bunya/0000112869.ht ml
