What is it about?

As well as or more than depression during pregnancy, complications of pregnancy and childbirth and postnatal care, companionship support during childbirth, including cesarean births, too, may impact (prevent from) postpartum depression. It is not enough that the birth support was "just okay, overall", but there is a need for companionship support during labor and birth to fulfill or exceed women's expectations, like the mother can say "it was perfect☆"! 「妊娠中のうつ症状」、「難産や妊娠・出産の合併症」、「産後ケア」と同様かそれ以上に、「出産中の付き添い支援」(経腟分娩だけでなく帝王切開も含みます)は、産後うつの発症に影響を与える(産後うつを予防する)可能性があります。しかし、「概して良かった」というのでは不十分であり、妊産婦の期待を満たし、越えるようなケア、つまり「完璧だった☆」と振り返ってもらえるような出産中の付き添い支援が求められているようなのです。

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Why is it important?

The importance of respectful maternity care and a human rights-based approach has been emphasized globally. Prioritizing the time-consuming support of non-medical care during childbirth in healthcare facilities can be particularly difficult in busy settings, such as when there is a shortage of staff. When you wonder "Is this pregnant woman being selfish?" or "We are busy too and don't need to listen to them this much," we would like them to know that 'whether or not they leave a little bit of dissatisfaction' may greatly influence the onset of postnatal depression for your clients. Also, this study would like to reiterate to the medical professionals in clinical settings that the majority of mothers are satisfied with and grateful for maternity care they received during labor and childbirth. It is a point that needs more research to determine whether the tendency to express even a small amount of dissatisfaction or unfulfillment might actually be a very serious situation, and whether this is only the case in Japan.  妊産婦を尊重したケアや、人権に基づくアプローチの大切さが近年強調されています。医療施設での出産において医療ケア以外の手間のかかる支援を優先するのは人手不足など多忙な現場では特に難しいことですが、「この妊産婦さんはワガママなのか?」「私たちも忙しいし、ここまで叶えてあげる必要はないだろう」と思う時、「少しでも不満を残してしまうかどうか」が産後うつ発症に影響する可能性があるとしたらどうでしょうか。日本のデータで、大半の母親は出産ケアにとても満足していたこと、感謝していたということも改めてわかりました。同時に、妊産婦が不満や未充足感を少しでも表明する場合は、実はよほど酷い状態であるかもしれないという傾向は日本だけなのか、もっと研究が必要な点だと思います。


It is a relief to finally publish a paper on research data that is more than 10 years old. The Japanese data for this secondary analysis were collected just before the Great East Japan Earthquake. The Downer et al. systematic review (2018), which was repeatedly referred to in the WHO guidelines (2018), stated that antenatal care should be designed to meet or exceed women's personal and social beliefs and expectations. I feel that this study proved the importance of maternity care to the extent that it meet and exceed the expectations of women. In near future, I would like to re-analyze the hypotheses with more recent (post-COVID-19 pandemic) data. More mothers' lives are being lost to suicide in Japan than to obstetric complications such as hemorrhage during childbirth. Despite having one of the lowest neonatal and maternal mortality rates in the world and a country where childbirth is safe, I would like to use the power of research to improve a society with a rapidly declining birth rate where people are reluctant to become pregnant and give birth. 10年以上前に集めた研究データをようやく論文発表できてほっとしています。日本で、東日本大震災の直前に収集したデータの二次分析です。WHOガイドライン(2018)で繰り返し参照されていたDownerらの系統的レビュー(2018)で、「妊産婦のケアは、女性の個人的・社会的信念や期待を満たし、あるいは超えるようにデザインされるべきである」と述べていましたが、この研究は、女性の期待を完璧に満たし、超えるほどの出産ケアの大切さが証明された研究になったのではと思います。 今後、もっと最近の(コロナ禍後の)データで再検証したいと思っています。出産中の出血などの合併症よりも、自殺で多くの母親の命が失われている日本。新生児・妊産婦死亡率は世界トップクラスで低く、出産が安全にできる国であるにもかかわらず、人々が妊娠・出産に消極的で、「また産みたい」「もっと産みたい」と思えない、少子化が急速に進んでいく社会。研究の力を使って良くしていきたいです。 Reference: Downe S, Finlayson K, Oladapo OT, Bonet M, Gülmezoglu AM. What matters to women during childbirth: A systematic qualitative review. PloS one. 2018;13(4):e0194906. Epub 20180417. doi: 10.1371/journal.pone.0194906. PubMed PMID: 29664907; PubMed Central PMCID: PMC5903648.

Rieko Fukuzawa

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This page is a summary of: Role of Intrapartum Social Support in Preventing Postpartum Depression, The Journal of Perinatal Education, May 2023, Springer Publishing Company,
DOI: 10.1891/jpe-2022-0003.
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