While the ``postpartum care project'' in which midwives support mothers by temporarily taking care of babies is being promoted in local governments, in June this year, two months after birth at a midwifery clinic commissioned by Yokohama City. I found out that there was an accident in which the baby died.
Yokohama City says, ``We want to thoroughly implement safety management,'' because the person in charge of the midwifery hospital stopped breathing while he took his eyes off for about 30 minutes.
Mao, the 2-month-old eldest daughter of a couple living in Yokohama, died in June this year in a non-breathing state at a maternity hospital that provides postnatal care services commissioned by the city of Yokohama. found and then died.
According to the city of Yokohama and the maternity hospital, on this day, her mother and Mao-chan were staying at the maternity hospital as a mother and child, and while her mother was sleeping, the midwife took care of Mao-chan in a separate room.
However, when her midwife left her room to prepare breakfast and other things, and returned about 30 minutes later, Mao was not breathing and she died at the hospital to which she was taken.
The exact cause of her death is still unknown.
What is the response of the midwifery clinic and Yokohama City?
After explaining the circumstances to the parents, the midwifery hospital apologized, saying, ``The care method was not unified, and there was a naiveness that 'it was okay until now.'''
In addition, he said that he was "reflecting on the naivety of the management system" about leaving the baby unattended for 30 minutes. It means that we have created a new manual that includes things such as checking the situation once every 10 minutes.
the course of the accident
It was June this year when Mao, who was two months old, died during postnatal care at a maternity hospital in Yokohama.
According to the city of Yokohama and the midwifery clinic, the mother and child used an accommodation-type postnatal care service, where midwives take care of the baby while the mother sleeps and provide childcare consultation.
On the morning of June 8, the mother took Mao-chan to her birth center and received her childcare consultation.
Her mother fed Mao-chan to her midwife around 9pm and laid her down in another room to rest.
Later, after 1:00 a.m. the next day, she became fussy, so the midwife gave her some milk, and after she fell asleep again, she left the room for about 30 minutes to wash and prepare breakfast. It means that the
However, when she returned to her room, Mao was not breathing and she was taken to the hospital, where she died.
The exact cause of her death is unknown.
According to the midwife, the midwife said she hadn't checked on her baby for about 30 minutes after she left her room.
Baby's parents: "Don't let this kind of accident happen again"
Parents who lost their two-month-old daughter while using the postnatal care service responded to NHK's interview, saying, "I think the postnatal care service is very good for mothers in difficult situations, but the safety aspect was insufficient. I feel that it may have happened. I want you to prevent such an accident from happening again."
After giving birth to her eldest daughter, Mao, in March, her mother reportedly felt burdened by frequent breastfeeding and not getting enough sleep.
Her mother "during her first month, she had trouble sleeping and was overwhelmed with the need to feed every two to three hours," she said.
The father said, "Since April, right after my first daughter was born, I entered a busy period at work, and it was quite difficult to take childcare leave. My wife had to bear the burden of raising children, and there were many things that I had to deal with by myself. I was there,” he said.
Under these circumstances, the person in charge of the public health center introduced postpartum care, and it is said that she used it for the first time in May this year, two months after she gave birth.
Regarding her impression at that time, her mother said, "She taught me how to breastfeed and took care of the baby so that I could rest. I slept slowly for the first time in a long time and took a bath. I felt that I was able to relax for the first time after giving birth. I said.
However, in June, when she used it for the third time, an accident occurred in which Mao-chan died.
The mother said, "My daughter smiled more often, and she started to respond to my questions. I was very relieved about her postpartum care, but the basics weren't done properly. I think it's very hard," he said.
The father also said, ``When I heard that midwives and other people, who we consider to be professionals, had taken their eyes off of me, it was very shocking, and I had a strong feeling of ``why?'' The postpartum care itself was very I think it's a good service, but I feel that the safety aspect was insufficient.I want you to prevent such an accident from happening again."
Nearly 80% of local governments across the country implement the expanding “postpartum care business”
The "postpartum care business" provides care for postpartum mothers and support for childcare so that they can raise their children with peace of mind.
Many of the municipalities that implement the program outsource to local medical institutions and midwifery clinics, and public health nurses and midwives provide mental and physical care and childcare advice.
In 2017, the Ministry of Health, Labor and Welfare published the "Postpartum Care Business Guidelines," which stipulates how to implement postpartum care.
These guidelines
stipulate three types of services:
▽ Short-term admission type, in which the mother and child stay at a facility ; ▽ Outpatient type
, in which the mother and child
attend the facility ;
I'm here.
Of these, in the "short-term admission type", one or more nurses such as midwives are assigned 24 hours a day, and the maximum number of users is about 20 from the viewpoint of providing meticulous and high-quality care. I'm doing it.
In addition, we are asking municipalities to create manuals so that there are no differences in quality between facilities in terms of care content, safety and hygiene.
Postpartum care is also spreading as a countermeasure against postpartum depression, which is said to affect 1 in 10 women.
This is more than 20 times higher than in fiscal 2015, when the project was subsidized by the government for the first time.
Eligibility has also been expanded, initially targeting parents with children up to about 4 months old, but the revised Maternal and Child Health Law, which came into effect in April last year, extended the coverage to children under the age of 1.
Yokohama City does not have a manual, many local governments are not progressing
As the postpartum care business spreads nationwide, the issue is how to prevent variations in the quality of care.
The Ministry of Health, Labor and Welfare is asking municipalities to create manuals so that there are no differences in care content and safety for each facility and person in charge.
However, there was no manual in Yokohama City where the accident occurred.
Not only Yokohama City, but also other local governments have not sufficiently developed manuals.
When NHK interviewed 28 municipalities, including the 23 wards of Tokyo, the prefectural capitals of Kanagawa, Saitama, and Chiba prefectures, as well as ordinance-designated cities, only 4 municipalities had already formulated a plan, while 23 municipalities had not.
(1 municipality did not respond).
Of the four local governments, two responded that they included content related to safety management such as accident prevention.
On the other hand, when asked why they did not create a manual, they answered, "Because the guidelines of the Ministry of Health, Labor and Welfare are unclear," and "Since the manual is outsourced to a medical institution with know-how, I can't see any reason why it should be created." has been sent.
In addition, when asked about whether the outsourcees have specific standards and manuals for safety management,
▽“all outsourcers make them” in 4 local governments, and
▽“partially make them”. There were 2 municipalities,
▽ 3 municipalities said they hadn't made it, and
▽ 18 municipalities said they didn't know.
On-site calls for specific guidelines for safety measures
A postpartum care facility in Toyama City has created its own manual to prevent serious accidents and is reviewing it on a daily basis. '' was raised.
The facility in the center of Toyama City was opened in 2017 and can accommodate up to 3 mothers and children for lodging.
Upon opening, the facility has its own manual to prevent serious accidents.
For example, choking prevention stipulates that a sleeping baby should not be placed on its stomach or placed near its face.
In addition, to prevent falls, when midwives take care of a baby from a mother, they always use a crib with a fence.
In addition, six or more midwives are stationed during the day and two midwives are stationed at night to check the condition of the baby frequently.
A mother in her thirties who used the service with her 4-month-old child said, "My husband is away from home, so I am very grateful that I can consult with a midwife about childcare and take a break. I am very grateful. If he cries while he is in the care, he will let me know right away, so I can leave him with peace of mind and rest."
The facility has been discussing among the staff that there is a "near miss" incident and is proceeding with the revision of the manual, but there are times when opinions are divided among the staff about what kind of response is desirable, so trial and error continues. .
I don't think it's desirable to leave the creation of such manuals to the field, and midwife Hiromi Tanaka says, "When a near-miss occurs, when you worry about how to prevent it Rather than creating manuals from scratch for each facility, I think it would be better if national guidelines or the like showed certain standards.”
Expert "Need to create guidelines similar to childcare sites"
Tatsuhiro Yamanaka, a pediatrician and chairman of the non-profit organization Safe Kids Japan, said, ``It is well known that there is a risk of sudden death in sleeping babies. In order to prevent accidents at childcare sites, the Ministry of Health, Labor and Welfare and municipalities are conducting fairly strict checks, such as checking every five minutes to make sure that children are not lying on their stomachs and that they are breathing. This time, I felt that it was a long time for the midwife to keep an eye on me for 30 minutes."
On top of that, ``Even if the site of postpartum care is a medical institution or a midwifery clinic, the national government and municipalities have set specific safety standards similar to those at childcare sites in order to prevent sudden death during sleep. I think it is necessary to create a