# Obstetricians’ recognition and attitudes towards guidelines for managing group B Streptococcus-positive pregnant women in Japanese maternity homes: A nationwide study

## TL;DR

This study finds that many Japanese obstetricians are unaware of guidelines allowing midwives to manage GBS-positive pregnancies, which could impact care coordination and safety.

## Contribution

The study provides new insights into obstetricians' awareness and attitudes toward midwife-led GBS management in Japanese maternity homes.

## Key findings

- Only 31.9% of obstetricians were aware of the JMA guidelines for GBS management.
- Obstetricians with experience in maternity homes showed higher awareness and fewer concerns about midwife-led care.
- Discrepancies in care decisions were observed during high-risk scenarios like maternal fever or prolonged membrane rupture.

## Abstract

Midwives working at Japanese maternity homes are permitted to manage deliveries of women with group B Streptococcus (GBS), provided there is collaboration with obstetricians, as outlined in the Japanese Midwives Association (JMA) guidelines. However, obstetricians’ recognition of the guidelines remains limited, potentially affecting the continuity and safety of perinatal care.

A nationwide cross-sectional survey was conducted in 2017. Anonymous self-administered questionnaires were mailed to all 2423 obstetric institutions accredited by the Japan Council for Quality Health Care, and responses from obstetricians were analyzed. Analyses used SPSS v23.0; p<0.05 was considered significant. The survey assessed obstetricians’ recognition of the JMA guidelines, experience with midwife-led deliveries, and attitudes towards neonatal GBS prevention.

Valid responses from 941 obstetricians from the 2423 institutions (38.8%) were analyzed. Only 31.9% (300/941) of the obstetricians reported being aware of the JMA guidelines, and just 15.1% (142/941) correctly understood that midwives may manage GBS-positive deliveries. Obstetricians with experience as a commissioned doctor for maternity homes demonstrated significantly higher awareness and fewer concerns regarding midwife-led care (chi-squared test, p<0.05). Discrepancies in transfer decisions and neonatal management were observed, particularly when maternal fever or prolonged membrane rupture occurred.

Although the relatively low response rate may limit the generalizability of the findings, we determined that obstetricians’ limited recognition of the JMA guidelines may hinder effective interprofessional collaboration in maternity homes. Promoting mutual understanding through interprofessional education and establishing standardized clinical protocols for GBS-related care are essential to improve continuity and safety in maternal and neonatal care in Japan.