Midwifery Management of Hiesho in Pregnant Women: A Nationwide Survey in Japan

Objective The symptom of cold extremities, known in Japan as Hiesho, may be associated with risks of complications during pregnancy and delivery. Thus, Hiesho care is clinically important for improving comfort and for preventing potential complications. The purpose of this study is to describe the actual practices of Hiesho care provided to pregnant women by midwives working in hospitals, clinics, and maternity homes across Japan. Methods This study employed a descriptive cross-sectional survey design. A questionnaire survey was conducted from January to April 2021, targeting midwives working at obstetric facilities nationwide. The survey included questions on the effect of Hiesho on pregnancy, which pregnant women were considered to require Hiesho care, and the specific care methods used. Chi-square tests were conducted to analyze the response rates from hospitals, clinics, and maternity homes. Free-text responses were categorized based on similarities and differences. Results A total of 1,677 midwives responded (response rate: 58.8%). Also, 1,494 midwives (89.1%) reported having experiences providing health guidance, and 1,136 midwives (67.7%) reported having experiences providing physical care as Hiesho care. Compared to their counterparts at hospitals and clinics, midwives at maternity homes were significantly more likely to possess experience in both health guidance (p<i> </i>< 0.001) and physical care (p<i> </i>< 0.001). Impaired maternal circulation was the most frequently reported health effect of Hiesho in pregnant women (1,535 midwives, 91.5%), with no significant variation across facility types. Among pregnant women identified as needing health guidance or physical care, the most frequently cited reason for providing health guidance was "wearing light clothing" (reported by 973 midwives, 65.5%), whereas the most common reason for providing physical care was symptoms of Hiesho (reported by 830 midwives, 73.5%). No significant differences were found in these responses across different types of facilities. Regardless of facility type, the most common item of health guidance was wearing socks (1,313 midwives, 87.9%; p = 0.705). Other items of guidance were significantly more common among midwives at maternity homes, who also reported providing a greater number of health guidance items. Regarding physical care, the most frequently used method was foot bath (971 midwives, 85.8%), with no significant differences in response rates between facilities (p = 0.772). Moxibustion and Thermie therapy were performed by 150 midwives (13.3%) and 58 midwives (5.1%), respectively, with significantly higher response rates among midwives at maternity homes (moxibustion: p < 0.001; Thermie therapy: p < 0.001). Conclusion A total of 1,494 midwives (89.1%) reported having experience providing health guidance as Hiesho care, and 1,136 midwives (67.7%) reported having experience providing treatment. Significantly more midwives working in maternity homes had experience with both health guidance and physical care compared to those working in hospitals and clinics. Midwives recognized that Hiesho negatively affects maternal circulation in pregnant women. The midwives working in maternity homes frequently implemented Hiesho care and often incorporated complementary and alternative medicine (CAM) into their practice. Further research is needed to examine the evidence and effectiveness of the Hiesho care practices that have been implemented thus far.