Birthing techniques and ways of thinking of skillful midwives at independent birth centers in Japan

Abstract

Purpose The purpose of this study is to investigate and analyze the techniques and ways of thinking that skilled midwives at independent birth centers in Japan use to ensure safe delivery, and thereupon to appraise the perineal management techniques introduced in two commonly used midwifery textbooks. Methods Participation in this study was requested from 25 managers of independent birthing centers in the Tokyo metropolitan and Kansai areas, eight of whom gave consent. Eight skilled midwives became the subjects of this study. With reference to the techniques used in the second stage of labor that was clarified by author's previous study, skillful midwives' techniques using a phantom and their ways of thinking were documented by a movie camera and IC recorders, and semi-structured interviews were conducted. The data collection period lasted from July to August 2017, and the data were analyzed qualitatively using the descriptive method. Results Eight midwives were considered for analysis. The midwives did not control or promote the third rotation, and during the delivery of the shoulders, they waited for the mother's contractions and delivered the fetus slowly by holding with both hands so as to optimize the fetus's rotation and the compact tucked-in position. Based on the belief that fetuses are to be delivered slowly through natural contraction and rotation, skilled midwives did not perform perineal management or actively intervene throughout the birthing process. Conclusion Fetal delivery techniques implemented by skilled midwives at birthing centers differ from the delivery assistance technique (perineal protection method) found in the two main textbooks of midwifery basics. Skillful midwives at independent birth centers used techniques to keep the fetuses in tucked-in position by optimizing their rotation. The midwives thought that slow delivery with natural contraction was not only important for preventing injury but also for the child's continued well-being.