Feasibility of a Smartphone website to support antenatal Perineal massage in pregnant women

Background

In Japan, 85% of pregnant women do not practice antenatal perineal massage. Therefore, we developed a smartphone website to support the practice of antenatal perineal massage. The purpose of the present study was to evaluate the feasibility of our smartphone website.

Methods

Pregnant women were recruited at five hospitals or clinics in Tokyo, Japan. Participants assigned to the smartphone website group (n = 74) were asked to register on the smartphone website. After completing registration, they could login and use all the contents of the website. After giving birth, participants completed a 5-item questionnaire evaluating the acceptability of the smartphone website. Participants assigned to the leaflet group (n = 71) received a leaflet on antenatal perineal massage and completed a similar 4-item questionnaire evaluating the leaflet. Data were collected from April 2014 to November 2014. Data analysis was performed using chi-square and t-tests to analyze responses to close-ended questions, and content analysis was conducted to analyze responses of open-ended questions.

Results

In the smartphone website group, 9 women (12.2%) did not register on the smartphone website. Approximately 80% of the women who responded indicated that the smartphone site was easy to understand and useful for practicing antenatal perineal massage. In the smartphone website group, the reply rate for reporting the frequency of massage was 43.6%. Although the ratings and frequency at which the material was accessed tended to be higher in the smartphone website group than in the leaflet group, there were no significant differences.

Conclusions

Most pregnant women in the smartphone website group provided a favorable evaluation for the smartphone website. However, some participants had suggestions for improvement, which need to be incorporated in a revised version of the website. Therefore, the present study’s results demonstrate the feasibility of a smartphone website to support the practice of antenatal perineal massage, and they may aid in the development of similar web-based educational material for pregnant women.

Trial registration

This trial was registered with the UMIN Clinical Trials Registry (UMIN000013979) on May 16, 2014.

A cross-sectional survey of policies guiding second stage labor in urban Japanese hospitals, clinics and midwifery birth centers

Background

The Japan Academy of Midwifery developed and disseminated the ‘2012 Evidence-based Guidelines for Midwifery Care (Guidelines for Midwives)’ for low-risk births to achieve a more uniform standard of care during childbirth in Japan. The objective of this study was to cross-sectional survey policy implementation regarding care during the second stage of labor at Japanese hospitals, clinics, and midwifery birth centers, and to compare those policies with the recommendations in Guidelines for Midwives.

Methods

This study was conducted in the four major urbanized areas (e.g. Tokyo) of the Kanto region of Japan. Respondents were chiefs of the institutions (obstetricians/midwives), nurse administrators (including midwives) of the obstetrical departments, or other nurse/midwives who were well versed in the routine care of the targeted institutions. The Guidelines implementation questionnaire comprised 12 items. Data was collected from October 2010 to July 2011.

Results

The overall response was 255 of the 684 institutions (37 %). Of the total responses 46 % were hospitals, 26 % were clinics and 28 % were midwifery birth centers. Few institutions reported perineal massage education for ‘almost all cases’. Using ‘active birth’ were all midwifery birth centers, 56 % hospitals and 32 % clinics. Few institutions used water births. The majority of hospitals (73 %) and clinics (80 %) but a minority (39 %) of midwifery birth centers reported ‘not implemented’ about applying warm compress to the perineum. Few midwifery birth centers (10 %) and more hospitals (38 %) and clinics (50 %) had a policy for valsalva as routine care. Many hospitals (90 %) and clinics (88 %) and fewer midwifery birth centers (54 %) offered hands-on technique to provide perineal support during birth. A majority of institutions used antiseptic solution for perineal disinfection. Few institutions routinely used episiotomies for multiparas, however routine use for primiparas was slightly more in hospitals (21 %) and clinics (25 %). All respondents used fundal pressure as consistent with guidelines. Not many institutions implemented the hands and knees position for correcting fetal abnormal rotation.

Conclusions

This survey has provided new information about the policies instituted in three types of institutions guiding second stage labor in four metropolitan areas of Japan. There existed considerable differences among institutions’ practice. There were also many gaps between reported policies and evidence-based Guidelines for Midwives, therefore new strategies are needed in Japan to realign institution’s care policies with evidenced based guidelines.

Randomised controlled trial using smartphone website vs leaflet to support antenatal perineal massage practice for pregnant women

BACKGROUND

In Japan, the rate of pregnant women who practice antenatal perineal massage was only 15.1%.

AIM

The aim of this study was to develop and evaluate a smartphone website and a leaflet to support antenatal perineal massage practice for primiparous women.

METHODS

In a randomised control trial, 161 primiparous women were randomly assigned to a smartphone website group (n=81) or a leaflet group (n=80). Data analysis were by per protocol analysis and intention to treat analysis.

FINDINGS

Of the 161 women participants, 47 in the smartphone website group and 49 in the leaflet group completed all questionnaires. Primary outcome was continuance rate (three times a week over a three week period) of antenatal perineal massage practice. The rates by a per protocol analysis were 51.1% in the smartphone website group and 51.0% in the leaflet group, respectively. There was no significant difference between the groups. Moreover, the rates by an intention to treat analysis were 29.6% in the smartphone website group and 31.3% in the leaflet group, respectively. There was also no significant difference between the groups. There were no significant differences in the evaluation of perineal massage, childbirth self-efficacy, satisfaction with efforts towards childbirth, and perineal outcomes following childbirth which were measured as secondary outcomes between the groups.

CONCLUSION

There was no significant difference in continuance rate of antenatal perineal massage practice between those using a smartphone website and those with a leaflet, however, the rate was better than no instructions.