Additional Information
Book Details
Abstract
The most-popular midwifery textbook in the world!
The sixteenth edition of this seminal textbook, Myles Textbook for Midwives, has been extensively revised and restructured to ensure that it reflects current midwifery practice, with an increased focus on topics that are fundamental to midwifery practice today.
- Well illustrated to assist visual learning
- Boxes highlighting significant information to aid study
- Introduction, Aims of the chapter and Conclusion for each chapter
- References, Further Reading and Useful websites to promote further learning
- Glossary of terms and acronyms provide simple definition of more complex terminologies
Additional online resources
- Over 500 multiple-choice questions enable students to test their knowledge
- Unlabelled illustrations help reinforce learning
- Full image bank of illustrations to make study more visual and assist with projects.
- Up-to-date guidance on professional regulation, midwifery supervision, legal and ethical issues, risk management and clinical governance
- Recognises that midwives increasingly care for women with complex health needs, in a multicultural society
- Increases confidence in empowering women to make appropriate choices
- Looks at the dilemmas involved in caring for women with a raised body mass index
- Chapter on optimising care of the perineum for women with perineal trauma, including those who have experienced female genital mutilation
- Additional coverage of basic neonatal resuscitation, to reflect the trend for midwives to carry out the neonatal physiological examination
- Streamlined chapters with similar themes and content, to facilitate learning
- Full colour illustrations now used throughout the book, in response to student feedback.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Myles Textbook for Midwives, 16/e | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Evolve page | vii | ||
| Contributors | ix | ||
| Foreword | xiii | ||
| Reference | xiv | ||
| Preface | xv | ||
| Acknowledgements | xvii | ||
| 1 The midwife in context | 1 | ||
| 1 The midwife in contemporary midwifery practice | 3 | ||
| Chapter contents | 3 | ||
| The chapter aims to: | 3 | ||
| Internationalization/globalization | 4 | ||
| Definition and scope of the midwife | 4 | ||
| The ICM Global Midwifery Education Standards | 4 | ||
| The ERASMUS programme | 8 | ||
| The Millennium Development Goals (MDGs) | 8 | ||
| The emotional context of midwifery | 8 | ||
| What is ‘emotion work’? | 9 | ||
| Sources of emotion work in midwifery practice | 9 | ||
| Midwife-woman relationships | 10 | ||
| Intelligent kindness | 10 | ||
| Collegial relationships | 11 | ||
| The organization of maternity care | 11 | ||
| Managing emotions in midwifery | 11 | ||
| Affective neutrality | 11 | ||
| Affective awareness | 12 | ||
| Challenges | 12 | ||
| Developing emotional awareness | 12 | ||
| The social context of pregnancy, childbirth and motherhood | 13 | ||
| Disadvantaged groups | 13 | ||
| Women from disadvantaged groups | 14 | ||
| Young mothers | 14 | ||
| Why teenage pregnancy matters | 14 | ||
| Women with disability | 14 | ||
| Women living in poverty | 15 | ||
| Women from black and minority ethnic (BME) communities | 15 | ||
| Women seeking refuge/asylum | 16 | ||
| Women from travelling families | 17 | ||
| Women who are lesbian | 17 | ||
| Midwives meeting the needs of women from disadvantaged groups | 17 | ||
| Meeting information needs | 17 | ||
| Advocacy | 17 | ||
| Working in partnership | 18 | ||
| Research | 18 | ||
| Evidence | 18 | ||
| The stated rationale for evidence-based practice (EBP) | 18 | ||
| The randomized controlled trial (RCT) | 18 | ||
| Discussion | 19 | ||
| References | 20 | ||
| Further reading | 23 | ||
| Useful websites | 23 | ||
| 2 Professional issues concerning the midwife and midwifery practice | 25 | ||
| Chapter contents | 25 | ||
| The chapter aims to: | 26 | ||
| Statutory midwifery regulation | 26 | ||
| Self-regulation | 26 | ||
| Historical context | 27 | ||
| Statutory Instruments (SI) | 28 | ||
| The Nursing and Midwifery Order 2001: SI 2002 No: 253 | 28 | ||
| The nursing and midwifery council | 29 | ||
| Functions of the NMC | 29 | ||
| Membership | 29 | ||
| Committees | 29 | ||
| The Audit Committee | 29 | ||
| The Midwifery Committee | 29 | ||
| The Remuneration Committee | 29 | ||
| Practice Committees | 29 | ||
| The Investigating Committee | 30 | ||
| The Conduct and Competence Committee | 30 | ||
| The Health Committee | 30 | ||
| Decisions made by the Practice Committees | 30 | ||
| Consensual panel determination | 30 | ||
| Voluntary removal from the Register | 31 | ||
| Restoration to the Register following a striking off order | 31 | ||
| Responsibility and accountability | 31 | ||
| Legal issues and the midwife | 32 | ||
| Legislation | 32 | ||
| The Human Rights Act 1998 | 32 | ||
| Legal frameworks: rules and standards | 32 | ||
| Midwives Rules and Standards | 33 | ||
| Rule 5: Scope of practice | 33 | ||
| Rule 6: Records | 34 | ||
| The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives | 34 | ||
| The Post Registration Education and Practice (PREP) Standards | 34 | ||
| Standards for Medicines Management | 35 | ||
| Litigation | 35 | ||
| Consent | 35 | ||
| Negligence | 36 | ||
| Vicarious liability | 37 | ||
| Ethical issues and the midwife | 37 | ||
| Ethical frameworks and theories | 37 | ||
| Level one: Judgements | 38 | ||
| Level two: Rules | 38 | ||
| Level three: Principles | 38 | ||
| Level four: Ethical theories | 38 | ||
| Utilitarianism | 38 | ||
| Deontology | 39 | ||
| The statutory supervision of midwives | 39 | ||
| Historical context | 39 | ||
| Supervision of midwives in the 21st century | 40 | ||
| Local Supervising Authorities | 40 | ||
| Role of the LSA Midwifery Officer | 41 | ||
| Selection and preparation of supervisors of midwives | 42 | ||
| Role and responsibilities of the supervisor of midwives | 42 | ||
| Statutory supervision in action | 42 | ||
| Partnership between supervisor and midwife/supervisee | 43 | ||
| Supervisory reviews | 43 | ||
| Clinical governance | 44 | ||
| The key components of clinical governance | 44 | ||
| Policies, protocols, guidelines and standards | 44 | ||
| Audit | 46 | ||
| Risk management | 47 | ||
| Clinical Negligence Scheme for Trusts (CNST) | 47 | ||
| Clinical governance, risk management and statutory supervision of midwives | 47 | ||
| References | 49 | ||
| Cases | 50 | ||
| Statutes, orders and directives | 51 | ||
| Further reading | 51 | ||
| Useful websites | 51 | ||
| 2 Human anatomy and reproduction | 53 | ||
| 3 The female pelvis and the reproductive organs | 55 | ||
| Chapter contents | 55 | ||
| The chapter aims to: | 55 | ||
| Female external genital organs | 55 | ||
| Blood supply | 56 | ||
| Lymphatic drainage | 56 | ||
| Innervation | 56 | ||
| The perineum | 56 | ||
| The urogenital triangle | 56 | ||
| Superficial muscles of the perineum | 57 | ||
| Superficial transverse perineal muscle | 57 | ||
| Bulbospongiosus muscle | 57 | ||
| Ischiocavernosus muscle | 57 | ||
| Innervation | 57 | ||
| The anal triangle | 57 | ||
| Anal canal | 57 | ||
| Anal sphincter complex | 57 | ||
| External anal sphincter | 60 | ||
| Internal anal sphincter | 60 | ||
| The longitudinal layer and the conjoint longitudinal coat | 60 | ||
| Innervation of the anal sphincter complex | 60 | ||
| Vascular supply | 60 | ||
| Lymphatic drainage | 60 | ||
| The ischioanal fossa | 61 | ||
| The perineal body | 61 | ||
| The pelvic floor | 61 | ||
| Innervation of the levator ani | 62 | ||
| Vascular supply | 62 | ||
| The pudendal nerve | 62 | ||
| The pelvis | 62 | ||
| The pelvic girdle | 62 | ||
| Innominate bones | 62 | ||
| The sacrum | 63 | ||
| The coccyx | 64 | ||
| Pelvic joints | 64 | ||
| Pelvic ligaments | 64 | ||
| The pelvis in relation to pregnancy and childbirth | 65 | ||
| The true pelvis | 65 | ||
| The pelvic brim | 65 | ||
| The pelvic cavity | 65 | ||
| The pelvic outlet | 65 | ||
| The false pelvis | 66 | ||
| Pelvic diameters | 66 | ||
| Diameters of the pelvic inlet | 66 | ||
| Diameters of the cavity | 67 | ||
| Diameters of the outlet | 67 | ||
| Orientation of the pelvis | 67 | ||
| Pelvic planes | 67 | ||
| Axis of the pelvic canal | 67 | ||
| The four types of pelvis | 68 | ||
| The gynaecoid pelvis (Fig. 3.19) | 68 | ||
| The android pelvis | 68 | ||
| The anthropoid pelvis | 69 | ||
| The platypelloid pelvis | 69 | ||
| Other pelvic variations | 69 | ||
| The female reproductive system | 70 | ||
| The vagina | 70 | ||
| Function | 70 | ||
| Relations | 70 | ||
| Structure | 71 | ||
| Layers | 72 | ||
| Blood supply | 72 | ||
| Lymphatic drainage | 72 | ||
| Nerve supply | 72 | ||
| The uterus | 72 | ||
| Function | 72 | ||
| Relations | 72 | ||
| Supports | 72 | ||
| Structure | 73 | ||
| Layers | 73 | ||
| Blood supply | 74 | ||
| Lymphatic drainage | 74 | ||
| Nerve supply | 74 | ||
| Uterine malformations | 74 | ||
| The fallopian tubes | 75 | ||
| Function | 75 | ||
| Position | 75 | ||
| Relations | 75 | ||
| Supports | 75 | ||
| Structure | 75 | ||
| Layers (Fig. 3.29) | 76 | ||
| Blood supply | 76 | ||
| Lymphatic drainage | 76 | ||
| Nerve supply | 76 | ||
| The ovaries | 76 | ||
| Function | 77 | ||
| Position | 77 | ||
| Relations | 77 | ||
| Supports | 77 | ||
| Structure | 77 | ||
| Blood supply | 77 | ||
| Lymphatic drainage | 77 | ||
| Nerve supply | 77 | ||
| The male reproductive system | 77 | ||
| The scrotum | 78 | ||
| 3 Pregnancy | 125 | ||
| 8 Antenatal education for birth and parenting* | 127 | ||
| Chapter contents | 127 | ||
| The chapter aims to: | 127 | ||
| Parent education: the research and policy background | 127 | ||
| Antenatal education: the evidence | 129 | ||
| Leading antenatal sessions: aims and skills | 129 | ||
| Sharing information | 129 | ||
| Promoting discussion | 131 | ||
| Practical skills work | 132 | ||
| Content of antenatal education in groups | 133 | ||
| Getting to Know Our Unborn Baby | 133 | ||
| Changes for Me and Us | 133 | ||
| Giving Birth and Meeting Our Baby | 134 | ||
| Our Health and Wellbeing | 134 | ||
| Caring for Our Baby | 136 | ||
| Who Is There for Us? People and Resources | 136 | ||
| Defining learning outcomes | 136 | ||
| Maximizing attendance at antenatal sessions | 137 | ||
| Including fathers | 138 | ||
| How many mothers and fathers in the group? | 139 | ||
| How many sessions and how long? | 139 | ||
| Conclusion | 140 | ||
| References | 140 | ||
| Further reading | 142 | ||
| 9 Change and adaptation in pregnancy | 143 | ||
| Chapter contents | 143 | ||
| The chapter aims to: | 143 | ||
| Physiological changes in the reproductive system | 144 | ||
| The uterus | 144 | ||
| Perimetrium | 144 | ||
| Myometrium | 144 | ||
| Phases of myometrial development | 144 | ||
| Myometrial layers | 144 | ||
| Endometrium (decidua) | 146 | ||
| Changes in uterine shape and size | 147 | ||
| 12th week of pregnancy | 147 | ||
| 16th week of pregnancy | 147 | ||
| 20th week of pregnancy | 147 | ||
| 30th week of pregnancy | 147 | ||
| 36th week of pregnancy | 147 | ||
| 38th week of pregnancy | 148 | ||
| Uterine divisions | 148 | ||
| The cervix | 148 | ||
| The vagina | 149 | ||
| Changes in the cardiovascular system | 149 | ||
| Anatomical changes in the heart and blood vessels | 149 | ||
| Blood volume | 150 | ||
| Cardiac output | 152 | ||
| Blood pressure and vascular resistance | 152 | ||
| Regional blood flow | 153 | ||
| Haematological changes | 153 | ||
| Iron metabolism | 154 | ||
| Plasma protein | 154 | ||
| Clotting factors | 156 | ||
| White blood cells (leucocytes) and immune function | 156 | ||
| Changes in the respiratory system | 157 | ||
| Blood gases | 159 | ||
| Changes in the central nervous system | 159 | ||
| Changes in the urinary system | 159 | ||
| Changes in the gastrointestinal system | 161 | ||
| Changes in metabolism | 164 | ||
| Maternal weight | 165 | ||
| Musculoskeletal changes | 167 | ||
| Skin changes | 167 | ||
| Changes in the endocrine system | 168 | ||
| Placental hormones | 168 | ||
| The pituitary gland and its hormones | 169 | ||
| Thyroid function | 169 | ||
| Adrenal glands | 170 | ||
| Diagnosis of pregnancy | 171 | ||
| Hegar’s (or Goodell’s) sign | 171 | ||
| Chadwick’s sign | 171 | ||
| Osiander’s sign | 171 | ||
| Quickening | 171 | ||
| Common disorders arising from adaptations to pregnancy | 171 | ||
| References | 173 | ||
| 10 Antenatal care | 179 | ||
| Chapter contents | 179 | ||
| The chapter aims to: | 179 | ||
| The aim of antenatal care | 180 | ||
| Historical background | 180 | ||
| Current practice | 181 | ||
| Public health role of the midwife | 181 | ||
| Access to care | 182 | ||
| Models of midwifery care | 182 | ||
| The initial assessment (booking visit) | 183 | ||
| Meeting the midwife | 183 | ||
| Communication | 183 | ||
| Personal information | 184 | ||
| Social circumstances | 184 | ||
| Menstrual history and expected date of birth | 184 | ||
| Obstetric history | 185 | ||
| Previous childbearing experiences | 185 | ||
| Medical and surgical history | 185 | ||
| Family history | 186 | ||
| Lifestyle | 186 | ||
| Healthy eating | 186 | ||
| Exercise | 186 | ||
| Smoking | 187 | ||
| Alcohol and drug misuse | 187 | ||
| Risk assessment | 187 | ||
| Physical examination | 187 | ||
| Weight | 187 | ||
| Blood pressure | 188 | ||
| Urinalysis | 188 | ||
| Blood tests | 188 | ||
| ABO blood group and Rhesus (Rh) factor | 188 | ||
| Full blood count | 188 | ||
| Other screening tests | 188 | ||
| Venereal disease research laboratory (VDRL) test | 188 | ||
| HIV antibodies | 189 | ||
| Rubella immune status | 189 | ||
| Haemoglobinopathies | 189 | ||
| Hepatitis B | 189 | ||
| Screening for fetal anomaly | 189 | ||
| Infections NOT routinely screened for in pregnancy | 189 | ||
| Hepatitis C | 189 | ||
| Chlamydia | 189 | ||
| Cytomegalovirus and toxoplasmosis | 189 | ||
| Group B streptococcus | 189 | ||
| The midwife’s examination | 189 | ||
| Oedema | 190 | ||
| Varicosities | 190 | ||
| Abdominal examination | 190 | ||
| Preparation | 190 | ||
| Inspection | 190 | ||
| Skin changes | 190 | ||
| Palpation | 191 | ||
| Measuring fundal height | 191 | ||
| Fundal palpation | 191 | ||
| Lateral palpation | 191 | ||
| Pelvic palpation | 192 | ||
| Engagement | 193 | ||
| Presentation | 193 | ||
| Auscultation | 194 | ||
| Lie | 194 | ||
| Attitude | 194 | ||
| Denominator | 196 | ||
| Position | 196 | ||
| Findings | 196 | ||
| Ongoing antenatal care | 196 | ||
| Indicators of maternal wellbeing | 196 | ||
| Indicators of fetal wellbeing | 196 | ||
| Preparation for labour | 198 | ||
| Perineal massage | 198 | ||
| Stretch and sweep | 199 | ||
| Birth plans | 199 | ||
| Home visit and safe sleeping advice | 199 | ||
| References | 199 | ||
| Further reading | 202 | ||
| Useful websites | 202 | ||
| 11 Antenatal screening of the mother and fetus | 203 | ||
| Chapter contents | 203 | ||
| The chapter aims to: | 203 | ||
| Screening principles | 204 | ||
| Limitations of screening | 204 | ||
| Social and psychological impact of screening investigations | 204 | ||
| How screening is set up and the midwife’s role and responsibilities | 205 | ||
| Documentation | 205 | ||
| Discussion of options | 206 | ||
| The process of consent | 206 | ||
| Issues to consider when presenting information | 207 | ||
| Explaining risk | 207 | ||
| Individual screening test considerations | 208 | ||
| Fetal screening tests | 208 | ||
| Screening for Down syndrome | 208 | ||
| Diagnostic testing for Down syndrome | 209 | ||
| Screening for haemoglobinopathies | 210 | ||
| Pre-test information for antenatal haemoglobinopathy screening | 211 | ||
| Ultrasonography for fetal screening | 211 | ||
| Safety aspects of ultrasound | 211 | ||
| Women’s experiences of ultrasound | 211 | ||
| The midwife’s role concerning ultrasound scans | 212 | ||
| First trimester pregnancy scans | 212 | ||
| Dealing with increased nuchal translucency | 212 | ||
| Second trimester ultrasound scans | 213 | ||
| The detailed fetal anomaly screening scan | 213 | ||
| Advantages and disadvantages of fetal anomaly scans | 213 | ||
| New and emerging technologies | 214 | ||
| Fetal imaging techniques | 214 | ||
| Free fetal DNA | 214 | ||
| Screening for maternal conditions | 214 | ||
| Infectious diseases | 214 | ||
| Human immune deficiency virus (HIV) | 214 | ||
| Hepatitis B (HB) | 214 | ||
| Syphilis | 215 | ||
| Rubella | 215 | ||
| New screening | 215 | ||
| Mid-stream urine testing | 215 | ||
| Screening for anaemia | 215 | ||
| Screening for red cell antibodies | 216 | ||
| How the results are presented | 216 | ||
| What parents need to know | 216 | ||
| Management when an antibody is detected | 216 | ||
| On-going surveillance | 217 | ||
| Conclusion | 217 | ||
| References | 217 | ||
| Further reading | 219 | ||
| Useful websites | 219 | ||
| 12 Common problems associated with early and advanced pregnancy | 221 | ||
| Chapter contents | 221 | ||
| The chapter aims to: | 222 | ||
| The midwife’s role | 222 | ||
| Abdominal pain in pregnancy | 222 | ||
| Bleeding before the 24th week of pregnancy | 222 | ||
| Implantation bleed | 222 | ||
| Cervical ectropion | 223 | ||
| Cervical polyps | 223 | ||
| Carcinoma of the cervix | 223 | ||
| Spontaneous miscarriage | 224 | ||
| Recurrent miscarriage | 225 | ||
| Ectopic pregnancy | 225 | ||
| Other problems in early pregnancy | 226 | ||
| Inelastic cervix | 226 | ||
| Gestational trophoblastic disease (GTD) | 226 | ||
| Uterine fibroid degeneration | 227 | ||
| Induced abortion/termination of pregnancy | 227 | ||
| Pregnancy problems associated with assisted conception | 228 | ||
| Nausea, vomiting and hyperemesis gravidarum | 228 | ||
| Pelvic girdle pain (PGP) | 229 | ||
| Bleeding after the 24th week of pregnancy | 229 | ||
| Antepartum haemorrhage (APH) | 229 | ||
| Effect on the mother | 230 | ||
| Effect on the fetus | 230 | ||
| Initial appraisal of a woman with APH | 230 | ||
| Assessment of maternal condition | 230 | ||
| Assessment of fetal condition | 230 | ||
| Placenta praevia | 230 | ||
| Degrees of placenta praevia | 230 | ||
| Type 1 placenta praevia | 230 | ||
| Type 2 placenta praevia | 231 | ||
| Type 3 placenta praevia | 231 | ||
| Type 4 placenta praevia | 231 | ||
| Incidence | 231 | ||
| Management | 231 | ||
| Conservative management | 231 | ||
| Immediate management of life-threatening bleeding | 232 | ||
| Complications | 232 | ||
| Placental abruption | 233 | ||
| Incidence | 233 | ||
| Mild separation of the placenta | 233 | ||
| Moderate separation of the placenta | 233 | ||
| Severe separation of the placenta | 234 | ||
| Blood coagulation failure | 234 | ||
| Normal blood coagulation | 234 | ||
| Disseminated intravascular coagulation (DIC) | 234 | ||
| Management | 234 | ||
| Care by the midwife | 235 | ||
| Hepatic disorders and jaundice | 235 | ||
| Obstetric cholestasis (OC) | 235 | ||
| Clinical presentation | 235 | ||
| Investigations | 236 | ||
| Management | 236 | ||
| Gall bladder disease | 236 | ||
| Viral hepatitis | 236 | ||
| Skin disorders | 236 | ||
| Abnormalities of the amniotic fluid | 236 | ||
| Hydramnios | 236 | ||
| Types | 236 | ||
| Chronic hydramnios | 236 | ||
| Acute hydramnios | 238 | ||
| 4 Labour | 309 | ||
| 15 Care of the perineum, repair and female genital mutilation | 311 | ||
| Chapter contents | 311 | ||
| The chapter aims to: | 311 | ||
| Factors associated with reduced incidence of perineal trauma | 312 | ||
| Definition of perineal trauma | 312 | ||
| Episiotomy | 313 | ||
| Diagnosis of perineal trauma | 313 | ||
| Importance of anorectal examination | 314 | ||
| Female genital mutilation/genital cutting/female circumcision | 314 | ||
| Background | 314 | ||
| The role of the midwife | 317 | ||
| Repair of perineal trauma | 318 | ||
| Basic principles prior to repairing perineal trauma (NICE 2007; Sultan and Thakar 2007) | 318 | ||
| First-degree tears and labial lacerations | 318 | ||
| Episiotomy and second-degree tears | 318 | ||
| Technique for perineal repair | 318 | ||
| Suturing the vagina (Fig. 15.7a) | 318 | ||
| Suturing the muscle layer (Fig. 15.7b) | 319 | ||
| Suturing the perineal skin (Figure 15.7c) | 319 | ||
| Obstetric anal sphincter injuries (OASIS) | 319 | ||
| Technique for OASIS repair (Sultan and Thakar 2007) | 320 | ||
| Basic principles after repair of perineal tears (NICE 2007; Sultan and Thakar 2007) | 320 | ||
| Postoperative care after OASIS | 320 | ||
| Follow-up | 321 | ||
| Medicolegal considerations | 321 | ||
| Training | 321 | ||
| References | 324 | ||
| Further reading | 325 | ||
| Useful websites | 325 | ||
| 16 Physiology and care during the first stage of labour | 327 | ||
| Chapter contents | 327 | ||
| The chapter aims to: | 328 | ||
| Defining labour | 328 | ||
| The onset of spontaneous physiological labour | 328 | ||
| Recognition of the onset of labour | 329 | ||
| Latent phase of labour | 329 | ||
| Active phase of labour | 329 | ||
| Transitional phase of labour | 329 | ||
| Physiology of the first stage of labour | 330 | ||
| Duration | 330 | ||
| Cervical effacement | 330 | ||
| Cervical dilatation | 330 | ||
| Uterine action | 330 | ||
| Fundal dominance (Fig. 16.2) | 330 | ||
| Polarity | 330 | ||
| Contraction and retraction | 331 | ||
| Intensity and resting tone | 331 | ||
| Formation of upper and lower uterine segments | 331 | ||
| The retraction ring | 331 | ||
| Show | 332 | ||
| Mechanical factors | 332 | ||
| Formation of the forewaters and hindwaters | 332 | ||
| General fluid pressure | 332 | ||
| Rupture of the membranes | 332 | ||
| Fetal axis pressure | 333 | ||
| Recognition of the first stage of labour | 333 | ||
| Initial meeting with the midwife | 334 | ||
| The language of childbirth | 334 | ||
| Communication | 334 | ||
| Interpreting services | 334 | ||
| Birth plan | 334 | ||
| Emotional and psychological care | 335 | ||
| Companion in labour | 335 | ||
| The concept of continuous support in labour | 336 | ||
| The physical environment | 336 | ||
| Reducing the risk of infection | 336 | ||
| The midwife’s initial physical examination of the woman | 337 | ||
| Past history | 337 | ||
| Consent | 337 | ||
| General assessment | 337 | ||
| Records | 338 | ||
| The partogram or partograph | 338 | ||
| Subsequent care in the first stage of labour | 338 | ||
| Assessing progress | 338 | ||
| Abdominal examination | 340 | ||
| Contractions | 340 | ||
| Vaginal examination | 340 | ||
| Indications for vaginal examination | 340 | ||
| Assessing the wellbeing of the woman | 340 | ||
| Maternal observations | 340 | ||
| Pulse rate | 340 | ||
| Temperature | 341 | ||
| Blood pressure | 341 | ||
| Fluid balance and urinalysis | 341 | ||
| Cleanliness and comfort | 343 | ||
| Enemas and perineal shaving | 343 | ||
| Bath or shower | 343 | ||
| Clothing | 343 | ||
| Position and mobility | 343 | ||
| Pressure ulcer prevention | 343 | ||
| Nutrition in labour | 343 | ||
| Bladder care | 344 | ||
| Medicine records | 344 | ||
| Assessing the wellbeing of the fetus | 344 | ||
| Intermittent auscultation | 344 | ||
| Continuous electronic fetal monitoring | 345 | ||
| Good practice points | 345 | ||
| Interpretation of the cardiotocograph | 345 | ||
| Baseline rate | 345 | ||
| Baseline variability | 346 | ||
| Decelerations | 346 | ||
| Typical variable decelerations | 346 | ||
| Atypical variable decelerations | 346 | ||
| Late decelerations | 346 | ||
| Accelerations | 346 | ||
| Overall classification of the fetal heart rate features | 346 | ||
| Normal | 346 | ||
| Suspicious | 347 | ||
| Pathological | 347 | ||
| Fetal blood sampling | 347 | ||
| Women’s control of pain during labour | 349 | ||
| The physiology of pain | 349 | ||
| Pain stimulus and pain sensation | 349 | ||
| Pain transmission | 349 | ||
| Somatosensory function | 350 | ||
| Endorphins and enkephalins | 351 | ||
| Theories of pain | 351 | ||
| Physiological responses to pain in labour | 352 | ||
| Non-pharmacological methods for pain control in labour | 352 | ||
| Aromatherapy | 352 | ||
| Homeopathy | 352 | ||
| Hydrotherapy | 352 | ||
| Music therapy | 353 | ||
| Transcutaneous electrical nerve stimulation (TENS) | 353 | ||
| Pharmacological methods for pain control | 353 | ||
| Inhalation analgesia | 353 | ||
| Opiate drugs | 354 | ||
| Pethidine | 354 | ||
| Diamorphine | 354 | ||
| Meptazinol | 354 | ||
| Regional (epidural) analgesia | 354 | ||
| Observations and care by the midwife | 355 | ||
| Complications of epidural analgesia | 356 | ||
| First stage of labour: vaginal breech at term | 356 | ||
| Incidence of breech presentation | 356 | ||
| Types of breech presentation and position | 357 | ||
| Breech with extended legs (frank breech) | 357 | ||
| Complete breech | 357 | ||
| Footling breech | 357 | ||
| Knee presentation | 357 | ||
| Causes of breech presentation | 357 | ||
| Diagnosis of breech presentation | 357 | ||
| In pregnancy | 357 | ||
| Abdominal palpation | 357 | ||
| Auscultation | 358 | ||
| During labour | 358 | ||
| Abdominal examination | 358 | ||
| Vaginal examination | 359 | ||
| Mode of birth: the evidence | 359 | ||
| Place of birth | 360 | ||
| Posture for labour and birth | 360 | ||
| Care in labour | 360 | ||
| Prelabour rupture of fetal membranes at term (PROM) | 360 | ||
| Preterm prelabour rupture of the membranes (PPROM) | 361 | ||
| The responsibilities of the midwife | 361 | ||
| References | 361 | ||
| Further reading | 366 | ||
| Useful websites | 366 | ||
| 17 Physiology and care during the transition and second stage phases of labour | 367 | ||
| Chapter contents | 367 | ||
| The chapter aims to: | 368 | ||
| The nature of the transition and second stage phases of labour | 368 | ||
| Uterine action | 368 | ||
| Soft tissue displacement | 369 | ||
| Recognition of the commencement of the second stage of labour | 369 | ||
| Presumptive evidence | 369 | ||
| Expulsive uterine contractions | 369 | ||
| Rupture of the forewaters | 369 | ||
| Dilatation and gaping of the anus | 369 | ||
| Anal cleft line | 369 | ||
| Appearance of the rhomboid of Michaelis | 369 | ||
| Upper abdominal pressure and epidural analgesia | 369 | ||
| Show | 369 | ||
| Appearance of the presenting part | 369 | ||
| Confirmatory evidence | 370 | ||
| Phases and duration of the second stage | 370 | ||
| The latent phase | 370 | ||
| The active phase | 370 | ||
| Duration of the second stage | 370 | ||
| Maternal response to transition and the second stage | 370 | ||
| Pushing | 370 | ||
| Position | 371 | ||
| Left lateral position | 371 | ||
| Upright positions: squatting, kneeling, all-fours, standing, using a birthing ball | 371 | ||
| Maternal and fetal condition | 373 | ||
| The mechanism of normal labour (cephalic presentation) | 373 | ||
| Main movements of the fetus | 373 | ||
| Descent | 373 | ||
| Flexion | 373 | ||
| Internal rotation of the head | 373 | ||
| Extension of the head | 374 | ||
| Restitution | 374 | ||
| Internal rotation of the shoulders | 374 | ||
| Lateral flexion | 374 | ||
| Midwifery care in transition and the second stage | 374 | ||
| Care of the parents | 374 | ||
| Observations during the second stage | 376 | ||
| Uterine contractions | 376 | ||
| Descent, rotation and flexion | 376 | ||
| Fetal condition/suspicious or pathological changes of the fetal heart | 376 | ||
| Maternal condition | 376 | ||
| Maternal comfort | 377 | ||
| Preparation for the birth | 377 | ||
| Birth of the baby | 377 | ||
| Birth of the head | 377 | ||
| Birth of the shoulders | 378 | ||
| Vaginal breech birth at term | 380 | ||
| Mechanism of right sacro-anterior position | 380 | ||
| Compaction | 380 | ||
| Internal rotation of the buttocks | 380 | ||
| Lateral flexion of the body | 380 | ||
| Restitution of the buttocks | 380 | ||
| Internal rotation of the shoulders | 380 | ||
| Internal rotation of the head | 381 | ||
| External rotation of the head | 381 | ||
| Birth of the fetal head | 381 | ||
| Undiagnosed breech presentation | 381 | ||
| Types of breech birth | 381 | ||
| Position for breech birth | 381 | ||
| Facilitating a vaginal breech birth in an upright/kneeling position | 382 | ||
| The birth of the after-coming head | 382 | ||
| Burns Marshall manoeuvre | 382 | ||
| Mauriceau–Smellie–Veit manoeuvre | 383 | ||
| Forceps birth | 384 | ||
| Manoeuvres to assist the breech birth | 384 | ||
| The birth of extended legs | 384 | ||
| The birth of extended arms: the Løvset manoeuvre | 384 | ||
| Delay in the birth of the head | 385 | ||
| Potential complications of breech birth | 387 | ||
| Professional responsibilities and term breech birth | 387 | ||
| Record-keeping | 387 | ||
| Conclusion | 388 | ||
| References | 389 | ||
| Further reading | 392 | ||
| Useful websites | 393 | ||
| 18 Physiology and care during the third stage of labour | 395 | ||
| Chapter contents | 395 | ||
| The chapter aims to: | 396 | ||
| Physiological processes | 396 | ||
| Separation and descent of the placenta | 396 | ||
| Mechanical factors | 396 | ||
| Haemostasis | 397 | ||
| Caring for a woman in the third stage of labour | 398 | ||
| Expectant (or physiological) care during the third stage of labour (EMTSL) | 398 | ||
| Active management of the third stage of labour (AMTSL) | 400 | ||
| Administration of uterotonics | 400 | ||
| Intravenous ergometrine 0.25–0.5 mg | 400 | ||
| Combined ergometrine and oxytocin (a commonly used brand is Syntometrine) | 400 | ||
| Oxytocin | 400 | ||
| Prostaglandins | 401 | ||
| Clamping of the umbilical cord | 401 | ||
| Delivery of the placenta and membranes | 402 | ||
| Controlled cord traction (CCT) | 402 | ||
| Is the timing of uterotonic administration, cord clamping and/or CCT clinically important in influencing the incidence of PPH? | 403 | ||
| Evidence for active versus expectant management | 403 | ||
| Asepsis | 404 | ||
| Cord blood sampling | 404 | ||
| Completion of the third stage | 404 | ||
| Blood loss estimation | 404 | ||
| Examination of placenta and membranes | 404 | ||
| Immediate care | 405 | ||
| Record-keeping | 406 | ||
| Transfer from the birth room | 406 | ||
| Complications of the third stage | 406 | ||
| Postpartum haemorrhage | 406 | ||
| Primary postpartum haemorrhage | 406 | ||
| Causes | 406 | ||
| Atonic uterus | 406 | ||
| Incomplete placental separation | 407 | ||
| Retained placenta, cotyledon, placental fragment or membranes | 407 | ||
| Precipitate labour | 407 | ||
| Prolonged labour | 407 | ||
| Polyhydramnios, macrosomia or multiple pregnancy | 407 | ||
| Placenta praevia | 407 | ||
| Placental abruption | 407 | ||
| Induction or augmentation of labour with oxytocin | 407 | ||
| Episiotomy, and need for perineal sutures | 407 | ||
| General anaesthesia | 407 | ||
| Mismanagement of the third stage of labour | 407 | ||
| A full bladder | 407 | ||
| Aetiology unknown | 407 | ||
| Previous history of PPH or retained placenta | 407 | ||
| Fibroids (fibromyomata) | 408 | ||
| Anaemia | 408 | ||
| HIV/AIDS | 408 | ||
| Ketosis | 408 | ||
| Caesarean section | 408 | ||
| Signs of PPH | 408 | ||
| Prophylaxis | 408 | ||
| Treatment of PPH | 409 | ||
| Call for medical aid | 409 | ||
| Stop the bleeding | 409 | ||
| Rub up a contraction | 409 | ||
| Give a uterotonic to sustain the contraction | 409 | ||
| Empty the uterus | 409 | ||
| Resuscitate the mother | 409 | ||
| Placenta delivered | 409 | ||
| Bimanual compression | 409 | ||
| Placenta undelivered | 411 | ||
| Partially adherent | 411 | ||
| Wholly adherent | 411 | ||
| Retained placenta | 411 | ||
| Breaking of the cord | 411 | ||
| Manual removal of the placenta | 411 | ||
| Management | 411 | ||
| At home | 412 | ||
| Morbid adherence of placenta | 412 | ||
| Trauma as a cause of PPH | 412 | ||
| Blood coagulation disorders causing PPH | 412 | ||
| Maternal observation following PPH | 412 | ||
| Secondary postpartum haemorrhage | 413 | ||
| Management | 413 | ||
| Haematoma formation | 413 | ||
| Care after a postpartum haemorrhage | 414 | ||
| Conclusion | 414 | ||
| References | 414 | ||
| Further reading | 416 | ||
| Useful website | 416 | ||
| 19 Prolonged pregnancy and disorders of uterine action | 417 | ||
| Chapter contents | 417 | ||
| The chapter aims to: | 417 | ||
| Prolonged pregnancy | 418 | ||
| Incidence | 418 | ||
| Possible implications for mother, fetus and baby | 418 | ||
| Predisposing factors | 419 | ||
| Plan of care for prolonged pregnancy | 419 | ||
| The midwife’s role | 420 | ||
| Induction of labour (IOL) | 420 | ||
| Indications for IOL | 421 | ||
| Methods of induction | 422 | ||
| Cervical membrane sweep | 422 | ||
| Prostaglandin E2 (PGE2) (Dinoprostone) | 423 | ||
| Risk associated with use of PGE2 | 424 | ||
| Artificial rupture of membranes (ARM) | 424 | ||
| Oxytocin | 424 | ||
| Midwife’s role when caring for the mother where labour is being induced | 425 | ||
| Alternative approaches to initiating labour | 426 | ||
| Failure to progress and prolonged labour | 426 | ||
| Delay in the latent phase of labour | 426 | ||
| Delay in the active first stage of labour | 427 | ||
| The influence of the 3 ‘Ps’ | 427 | ||
| The midwife’s role in caring for a woman in prolonged labour | 428 | ||
| Delay in the second stage of labour | 429 | ||
| Obstructed labour | 429 | ||
| Precipitate labour | 430 | ||
| Making birth a positive experience | 430 | ||
| References | 431 | ||
| Further reading | 433 | ||
| Useful websites | 433 | ||
| 20 Malpositions of the occiput and malpresentations | 435 | ||
| Chapter contents | 435 | ||
| This chapter aims to: | 436 | ||
| Introduction | 436 | ||
| Occipitoposterior positions | 436 | ||
| Causes | 436 | ||
| Antenatal diagnosis | 436 | ||
| Abdominal examination | 436 | ||
| On inspection | 436 | ||
| On palpation | 436 | ||
| On auscultation | 437 | ||
| Antenatal preparation | 437 | ||
| Intrapartum diagnosis | 438 | ||
| Vaginal examination | 438 | ||
| Midwifery care | 439 | ||
| First stage of labour | 439 | ||
| Second stage of labour | 439 | ||
| Manual rotation | 439 | ||
| Mechanism of right occipitoposterior position (long rotation) (Figs 20.7–20.10) | 440 | ||
| Flexion | 440 | ||
| Internal rotation of the head | 440 | ||
| Crowning | 440 | ||
| Extension | 440 | ||
| Restitution | 441 | ||
| Internal rotation of the shoulders | 441 | ||
| External rotation of the head | 441 | ||
| Lateral flexion | 441 | ||
| Possible course and outcomes of labour | 441 | ||
| Long internal rotation | 441 | ||
| Short internal rotation | 441 | ||
| Cause | 441 | ||
| Diagnosis | 442 | ||
| The birth (Figs 20.14–20.17) | 442 | ||
| Undiagnosed face to pubis | 442 | ||
| Deep transverse arrest | 442 | ||
| Management | 442 | ||
| Conversion to face or brow presentation | 442 | ||
| Complications | 442 | ||
| Obstructed labour | 443 | ||
| Maternal trauma | 443 | ||
| Neonatal trauma | 443 | ||
| Face presentation | 444 | ||
| Causes | 444 | ||
| Anterior obliquity of the uterus | 444 | ||
| Contracted pelvis | 444 | ||
| Hydramnios (polyhydramnios) | 444 | ||
| Congenital malformation | 444 | ||
| Antenatal diagnosis | 445 | ||
| Intrapartum diagnosis | 445 | ||
| Abdominal palpation | 445 | ||
| Vaginal examination | 445 | ||
| Mechanism of a left mentoanterior position | 445 | ||
| Extension | 445 | ||
| Internal rotation of the head | 445 | ||
| Flexion | 446 | ||
| Restitution | 446 | ||
| Internal rotation of the shoulders | 446 | ||
| External rotation of the head | 446 | ||
| Lateral flexion | 446 | ||
| Possible course and outcomes of labour | 446 | ||
| Prolonged labour | 446 | ||
| Mentoanterior positions | 446 | ||
| Mentoposterior positions | 446 | ||
| Persistent mentoposterior position | 447 | ||
| Reversal of face presentation | 447 | ||
| Management of labour | 447 | ||
| First stage of labour | 447 | ||
| Birth of the head (Fig. 20.29) | 447 | ||
| Complications | 448 | ||
| Obstructed labour | 448 | ||
| Cord prolapse | 448 | ||
| Facial bruising | 448 | ||
| Cerebral haemorrhage | 448 | ||
| Maternal trauma | 448 | ||
| Brow presentation | 448 | ||
| 5 Puerperium | 497 | ||
| 23 Physiology and care during the puerperium | 499 | ||
| Chapter contents | 499 | ||
| The chapter aims to: | 499 | ||
| The postnatal period | 499 | ||
| Historical background | 500 | ||
| Framework and regulation for postnatal care | 501 | ||
| Midwives and postpartum care | 501 | ||
| Public health care | 501 | ||
| The provision of and need for postnatal care | 502 | ||
| Midwifery postpartum contact and visits | 503 | ||
| Physiological changes and observations | 504 | ||
| Returning to non-pregnant status | 504 | ||
| Vital signs: general health and wellbeing | 504 | ||
| Observations of temperature, pulse, respiration (TPR) and blood pressure (BP) | 504 | ||
| Blood pressure | 505 | ||
| Circulation | 505 | ||
| Skin and nutrition | 505 | ||
| Breast care | 505 | ||
| The uterus | 505 | ||
| Uterine involution | 505 | ||
| Assessment of postpartum uterine involution | 506 | ||
| ‘Afterpains’ | 506 | ||
| Postpartum vaginal blood loss | 506 | ||
| Continence after birth | 507 | ||
| Perineal trauma | 507 | ||
| Perineal pain | 507 | ||
| Alleviating perineal pain and discomfort | 508 | ||
| Tiredness and fatigue | 508 | ||
| Expectations of health | 508 | ||
| Balancing exercise and healthy activity with rest and relaxation | 508 | ||
| Future health, future fertility | 509 | ||
| Record-keeping and documentation | 509 | ||
| Evidence and best practice | 509 | ||
| Transition to parenthood | 509 | ||
| References | 510 | ||
| Further reading | 514 | ||
| Useful websites | 514 | ||
| 24 Physical health problems and complications in the puerperium | 515 | ||
| Chapter contents | 515 | ||
| The chapter aims to: | 515 | ||
| The need for women-focused and family-centred postpartum care | 516 | ||
| Potentially life-threatening conditions and morbidity after the birth | 516 | ||
| Immediate untoward events for the mother following the birth of the baby | 516 | ||
| Maternal collapse within 24 hours of the birth without overt bleeding | 517 | ||
| Postpartum complications and identifying deviations from the normal | 517 | ||
| The uterus and vaginal loss following vaginal birth | 518 | ||
| Vulnerability to infection, potential causes and prevention | 519 | ||
| The uterus and vaginal loss following operative birth | 519 | ||
| Wound problems | 520 | ||
| Perineal problems | 520 | ||
| Caesarean section wounds | 521 | ||
| Circulation | 522 | ||
| Hypertension | 522 | ||
| Headache | 523 | ||
| Backache | 523 | ||
| Urinary problems | 523 | ||
| Bowel problems | 524 | ||
| Anaemia | 524 | ||
| Breast problems | 525 | ||
| Practical skills for postpartum midwifery care after an operative birth | 525 | ||
| Emotional wellbeing: psychological deviation from normal | 526 | ||
| Self-care and recovery | 526 | ||
| Talking and listening after childbirth | 526 | ||
| References | 527 | ||
| Further reading | 529 | ||
| Useful websites | 529 | ||
| 25 Perinatal mental health | 531 | ||
| Chapter contents | 531 | ||
| The aim of Part A is to: | 532 | ||
| The aim of Part B is to: | 532 | ||
| Part A: Pregnancy, childbirth, puerperium: the psychological context | 532 | ||
| Stress/anxiety | 532 | ||
| Fear of giving birth (tocophobia) | 533 | ||
| Transition to parenthood | 534 | ||
| Role change/role conflict | 534 | ||
| Communication | 534 | ||
| The ideology of motherhood | 534 | ||
| Social support | 535 | ||
| Normal emotional changes during pregnancy, labour and the puerperium | 535 | ||
| Pregnancy | 535 | ||
| Labour | 535 | ||
| The puerperium | 536 | ||
| Postnatal ‘blues’ | 536 | ||
| Distress or depression? | 537 | ||
| Emotional distress associated with traumatic birth events | 537 | ||
| Conclusion | 537 | ||
| Part B: Perinatal psychiatric conditions | 538 | ||
| Introduction | 538 | ||
| Types of psychiatric disorder | 538 | ||
| Serious mental illnesses | 538 | ||
| Mild to moderate psychiatric disorders | 538 | ||
| Adjustment reactions | 538 | ||
| Substance misuse | 539 | ||
| Personality disorders | 539 | ||
| Learning disability | 539 | ||
| Psychiatric disorder in pregnancy | 539 | ||
| Mild–moderate conditions | 539 | ||
| Prognosis and management | 540 | ||
| Serious conditions | 540 | ||
| Incidence | 540 | ||
| Prevalence | 540 | ||
| Group 1 | 540 | ||
| Group 2 | 540 | ||
| Group 3 | 540 | ||
| Psychiatric disorder after birth | 541 | ||
| Puerperal (postpartum) psychosis | 541 | ||
| Risk factors | 541 | ||
| Clinical features | 541 | ||
| Relationship with the baby | 542 | ||
| Management | 542 | ||
| Prognosis | 542 | ||
| Postnatal depressive illness | 542 | ||
| Severe depressive illness | 542 | ||
| Risk factors | 543 | ||
| Clinical features | 543 | ||
| Anxiety and obsessive–compulsive symptoms | 543 | ||
| 6 The neonate | 589 | ||
| 28 Recognizing the healthy baby at term through examination of the newborn screening | 591 | ||
| Chapter contents | 591 | ||
| The chapter aims to: | 591 | ||
| The first examination after birth | 592 | ||
| Assessment of the neonatal skin | 592 | ||
| A blue skin as a result of central cyanosis | 592 | ||
| A blue skin as a result of other factors | 592 | ||
| Common skin lesions found at birth | 593 | ||
| Cuts, abrasions and bruises | 593 | ||
| Vascular birth marks found at birth | 593 | ||
| The head | 593 | ||
| The face | 594 | ||
| The neck | 595 | ||
| The chest and abdomen | 596 | ||
| The anus | 596 | ||
| The genitalia | 596 | ||
| Male genitalia | 596 | ||
| Female genitalia | 597 | ||
| Disorders of sex development (ambiguous genitalia) | 597 | ||
| Limbs, hands and feet | 597 | ||
| The spine | 598 | ||
| Communication and documentation | 598 | ||
| The daily examination screen | 598 | ||
| Breathing | 598 | ||
| Thermoregulation – the importance of keeping warm | 598 | ||
| Skin care | 599 | ||
| Cardiovascular system and blood physiology | 600 | ||
| Renal system | 600 | ||
| Gastrointestinal system | 600 | ||
| Immunity | 601 | ||
| Reproductive system: genitalia and breasts | 601 | ||
| Skeleto-muscular system | 601 | ||
| The neonatal and infant physical examination (NIPE) | 601 | ||
| Examination of the heart | 602 | ||
| The cardiovascular examination | 602 | ||
| Inspection | 602 | ||
| Palpation | 602 | ||
| Auscultation | 603 | ||
| Examination of the eye | 605 | ||
| Examination of the hips | 606 | ||
| Examination of the genitalia | 607 | ||
| Neurological examination | 607 | ||
| References | 608 | ||
| Further reading | 609 | ||
| Useful websites | 609 | ||
| 29 Resuscitation of the healthy baby at birth: | 611 | ||
| Chapter contents | 611 | ||
| The chapter aims to: | 611 | ||
| Drying the baby | 611 | ||
| Airway management and breathing | 612 | ||
| Difficulties in establishing an open airway | 613 | ||
| Parental support through effective communication | 614 | ||
| References | 614 | ||
| Further reading | 615 | ||
| 30 The healthy low birth weight baby | 617 | ||
| Chapter contents | 617 | ||
| The chapter aims to: | 617 | ||
| Classification of babies by gestation and weight | 617 | ||
| Gestational age | 618 | ||
| Birth weight | 618 | ||
| Small for gestational age (SGA) | 618 | ||
| Types of intrauterine growth restriction (IUGR) | 619 | ||
| IUGR that begins early in the first trimester caused by a combination of intrinsic and extrinsic factors, results in symmetrical fetal growth | 619 | ||
| IUGR that begins in the last trimester, caused by extrinsic factors, results in asymmetrical fetal growth | 620 | ||
| The preterm baby | 621 | ||
| Characteristics of the preterm baby | 621 | ||
| Care of the healthy LBW baby | 622 | ||
| Management at birth | 622 | ||
| Assessment of gestational age | 622 | ||
| Thermoregulation | 623 | ||
| Hypoglycaemia | 623 | ||
| Feeding | 624 | ||
| Optimizing the care environment for the healthy LBW baby | 625 | ||
| Handling and touch | 625 | ||
| Noise and light hazards | 626 | ||
| Sleeping position | 626 | ||
| References | 627 | ||
| Further reading | 628 | ||
| Useful websites | 628 | ||
| 31 Trauma during birth, haemorrhages and convulsions | 629 | ||
| Chapter contents | 629 | ||
| The chapter presents information on: | 629 | ||
| Trauma during birth | 629 | ||
| Trauma to skin and superficial tissues | 629 | ||
| Skin | 629 | ||
| Superficial tissues | 630 | ||
| Caput succedaneum | 630 | ||
| Other injuries | 631 | ||
| Muscle trauma | 631 | ||
| Torticollis | 631 | ||
| Nerve trauma | 631 | ||
| Facial nerve | 631 | ||
| Brachial plexus | 632 | ||
| Fractures | 633 | ||
| Clavicle | 633 | ||
| Humerus | 633 | ||
| Femur | 633 | ||
| Skull | 633 | ||
| Haemorrhages | 633 | ||
| Haemorrhages due to trauma | 633 | ||
| Cephalhaematoma | 633 | ||
| Subaponeurotic haemorrhage | 634 | ||
| Subdural haemorrhage | 634 | ||
| Haemorrhages due to disruptions in blood flow | 635 | ||
| Subarachnoid haemorrhage | 635 | ||
| Germinal matrix haemorrhage, intraventricular haemorrhage and periventricular haemorrhagic infarction (intraparenchymal lesion) | 635 | ||
| Periventricular leucomalacia | 636 | ||
| Haemorrhages related to coagulopathies | 637 | ||
| Vitamin K deficiency bleeding | 637 | ||
| Thrombocytopenia | 638 | ||
| Disseminated intravascular coagulation (consumptive coagulopathy) | 638 | ||
| Haemorrhages related to other causes | 639 | ||
| Umbilical haemorrhage | 639 | ||
| Vaginal bleeding | 639 | ||
| Haematemesis and melaena | 639 | ||
| Haematuria | 639 | ||
| Bleeding associated with intravascular access | 639 | ||
| Convulsions | 639 | ||
| Support of parents | 641 | ||
| References | 641 | ||
| Further reading | 643 | ||
| Useful websites | 643 | ||
| 32 Congenital malformations | 645 | ||
| Chapter contents | 645 | ||
| The chapter aims to: | 646 | ||
| Communicating the news | 646 | ||
| Palliative care | 646 | ||
| Definition and causes | 647 | ||
| Chromosomal abnormalities | 648 | ||
| Gene defects (Mendelian inheritance) | 648 | ||
| Mitochondrial inheritance | 648 | ||
| Teratogenic causes | 648 | ||
| Multifactorial causes | 648 | ||
| Unknown causes | 649 | ||
| Chromosomal abnormalities | 649 | ||
| Trisomy 21 (Down syndrome) | 649 | ||
| Trisomy 18 (Edwards syndrome) | 650 | ||
| Trisomy 13 (Patau syndrome) | 650 | ||
| Turner syndrome (XO) | 650 | ||
| Gastrointestinal malformations | 650 | ||
| Gastroschisis and exomphalos | 650 | ||
| Atresias | 650 | ||
| Oesophageal atresia | 650 | ||
| Duodenal atresia | 652 | ||
| Anorectal malformations | 652 | ||
| Malrotation/volvulus | 652 | ||
| Meconium ileus (cystic fibrosis) | 653 | ||
| Hirschsprung’s disease | 653 | ||
| Cleft lip and cleft palate | 653 | ||
| Pierre Robin sequence | 654 | ||
| Malformations relating to respiration | 654 | ||
| Diaphragmatic hernia | 654 | ||
| Congenital pulmonary airway malformations (CPAM) | 655 | ||
| Choanal atresia | 655 | ||
| Laryngeal stridor | 656 | ||
| Congenital cardiac defects | 656 | ||
| Causes | 656 | ||
| Prenatal detection | 656 | ||
| Postnatal recognition | 656 | ||
| Cardiac defects presenting with cyanosis | 656 | ||
| ‘Acyanotic’ cardiac defects | 657 | ||
| Left-to-right shunts | 657 | ||
| Obstructive lesions | 658 | ||
| Central nervous system malformations | 658 | ||
| Anencephaly | 659 | ||
| Spina bifida | 659 | ||
| Spina bifida occulta | 659 | ||
| Hydrocephalus | 660 | ||
| Microcephaly | 660 | ||
| Musculoskeletal deformities | 660 | ||
| Polydactyly and syndactyly | 660 | ||
| Limb reduction deficiencies | 660 | ||
| Talipes | 661 | ||
| Developmental dysplasia of the hip | 661 | ||
| Achondroplasia | 662 | ||
| Osteogenesis imperfecta | 662 | ||
| Abnormalities of the skin | 662 | ||
| Vascular naevi | 662 | ||
| Capillary malformations | 662 | ||
| Port wine stain | 662 | ||
| Capillary haemangiomata (‘strawberry marks’) | 662 | ||
| Pigmented (melanocytic) naevi | 663 | ||
| Genitourinary system | 663 | ||
| Potter syndrome | 663 | ||
| Posterior urethral valve(s) | 663 | ||
| Cystic kidneys | 663 | ||
| Hypospadias | 664 | ||
| Cryptorchidism | 664 | ||
| Disorders of sex development (DSD) | 664 | ||
| Congenital adrenal hyperplasia | 664 | ||
| Androgen insensitivity syndrome | 664 | ||
| Teratogenic causes | 664 | ||
| Fetal alcohol syndrome/spectrum | 664 | ||
| Support for the midwife | 665 | ||
| References | 665 | ||
| Further reading | 666 | ||
| Useful websites | 666 | ||
| 33 Significant problems in the newborn baby | 667 | ||
| Chapter contents | 667 | ||
| The chapter aims to: | 668 | ||
| Introduction | 668 | ||
| Initial examination and recognition of problems | 668 | ||
| The skin | 668 | ||
| Pallor | 668 | ||
| Plethora | 669 | ||
| Cyanosis | 669 | ||
| Other factors that affect the appearance of the skin | 669 | ||
| Skin rashes | 669 | ||
| The respiratory system | 670 | ||
| Cardiorespiratory adaptations at birth | 670 | ||
| The importance of body temperature control | 670 | ||
| Central nervous system | 671 | ||
| Hypotonia | 671 | ||
| Systemic causes | 671 | ||
| Central (brain) causes | 671 | ||
| Peripheral nervous system causes | 671 | ||
| The renal and genitourinary system | 671 | ||
| The gastrointestinal tract | 672 | ||
| Bile-stained vomiting | 672 | ||
| Passage of meconium | 672 | ||
| Recognition of problems at the time of resuscitation, including neonatal encephalopathy | 672 | ||
| Neonatal encephalopathy | 672 | ||
| Which babies get encephalopathy? | 672 | ||
| Babies with less severe problems | 674 | ||
| Seizures and abnormal movements | 674 | ||
| Causes of seizures | 674 | ||
| Infection in the newborn | 674 | ||
| Umbilical cord | 675 | ||
| Bacterial infection in the newborn | 675 | ||
| Treatment of infection and management of babies with risk of infection | 675 | ||
| Group B streptococcus (GBS) infection | 675 | ||
| Meningitis | 676 | ||
| Viral infections acquired before or during birth | 676 | ||
| Rubella | 676 | ||
| Glossary of terms and acronyms | 737 | ||
| Acronyms | 742 | ||
| Index | 745 | ||
| A | 745 | ||
| B | 747 | ||
| C | 749 | ||
| D | 753 | ||
| E | 754 | ||
| F | 755 | ||
| G | 757 | ||
| H | 758 | ||
| I | 760 | ||
| J | 761 | ||
| K | 761 | ||
| L | 762 | ||
| M | 763 | ||
| N | 766 | ||
| O | 767 | ||
| P | 768 | ||
| Q | 772 | ||
| R | 772 | ||
| S | 774 | ||
| T | 776 | ||
| U | 777 | ||
| V | 778 | ||
| W | 779 | ||
| X | 780 | ||
| Y | 780 | ||
| Z | 780 |