Purpose

This study aimed to clarify and establish a midwife's judgment index of fetal head movement during the third rotational movement and contribute to the education of novice midwives and midwifery research.

Methods

The subjects were 14 advanced midwives or midwives with equivalent years of work experience and number of deliveries. They were asked to cooperate in the study using the kinship method. The subjects were asked to assist in delivery using two delivery simulators and select the simulator with a higher reproducibility of the third rotational movement. The subjects were then interviewed using semi-structured interviews regarding their reasons for selecting the simulators and how they judged the third rotational movement in the delivery. After obtaining their consent, we recorded the interview data using an IC recorder and made a verbatim transcript of the recorded data, from which we extracted data related to their judgment of the third rotational movement. The extracted data were categorized according to their similarity in semantic content. This study was conducted with the approval of the Okayama University Department of Medical Sciences Clinical Research Review Expert Committee.

Results

All of the study subjects indicated that the simulator with better reproducibility was the Sophie and Sophie's Mum Birth Simulator 4.0. (MODEL-med^®). The verbatim record of the indicators of occipital node slippage was analyzed, paying attention to the time of delivery. Consequently, 11 indicators were extracted and categorized as “before,” “during,” and “after” occipital tubercle slippage. They were as follows: before occipital tubercle slippage, the midwife “feel the roundness of the infant's head”, “palpate the strong infant's counter flexion pressure”, and “the perineum has room to extend to the occipital tuberosity glides off”; during occipital tuberosity slippage, “the infant's head can be grasped with the entire palm of the caregiver's hand”, “the caregiver can feel changes in the shape of the infant's head and delivery pressure in the caregiver's finger joints”, “the infant's forehead can be seen”, “the balance between caregiver pressure and infant anteflexion pressure changes”, and “the perineum changes as the limits are approached”; and after occipital tuberosity slippage “roundness of the infant's head becomes unfeasible to palpate”, “direction of delivery of the infant's head changes from horizontal to vertical”, and “perineum is restored” were applicable.

Conclusion

Eleven categories were extracted as judgment indicators of the third rotational movement. The three categories of indicators along the progression of the third rotational movement made it possible to specify which indicators were present before and after the infant's occipital-temporal node slipped.