Additional Information
Book Details
Abstract
A new edition of a classic textbook fully updated to meet the needs of today’s midwifery student. Now available for the first time in full color, the 15th edition of Mayes Midwifery has an enhanced artwork program and comes with an extensive website which provides 600 MCQs and wide selection of case studies and reflective activities; a downloadable image bank assists with essay and assignment preparation.
- New edition of a classic textbook updated and designed for today’s midwifery student!
- Chapters authored by experts in their field, including midwifery academics and clinicians as well as allied professionals such as researchers, physiotherapists, neonatal nurse specialists, social scientists and legal experts
- Evidence and research based throughout to help facilitate safe clinical practice
- Learning outcomes and key points help readers structure their study and recap on what they have learned
- Reflective activities encourage the application of theory to practice
- Contains practice based tools and checklists
- Presents and discusses the latest national and international guidelines
- Associated website with over 600 MCQs, reflective activities to encourage the application of theory to practice, case studies and additional learning tools
- Downloadable image bank to assist readers with essay preparation and other assignments
- Suitable for use in normal community and midwife led arenas, high tech environments and more rural areas of clinical practice
- Brand new design - incorporating helpful learning features - aids reader engagement and retention of facts
- Updated artwork program helps clarify complex physiological processes and other challenging concepts
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Mayes' Midwifery | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Contributors | vii | ||
| Foreword | xi | ||
| Preface | xii | ||
| References | xiv | ||
| Acknowledgements | xv | ||
| One The midwife in context | 1 | ||
| 1 The global midwife | 2 | ||
| Learning Outcomes | 2 | ||
| Introduction | 2 | ||
| Global Challenges for Midwifery in the 2030 Era | 3 | ||
| Ending preventable maternal and newborn death | 3 | ||
| Gender, Inequality and Inequity | 4 | ||
| Maternal Mortality and Morbidity | 5 | ||
| Causes of maternal death | 5 | ||
| Predisposing factors | 7 | ||
| Maternal morbidity | 7 | ||
| Newborn Mortality | 9 | ||
| Inequities Associated With Being a Mother | 10 | ||
| The Impact of Modernization and Development | 14 | ||
| Coverage and Skilled Attendance at Birth | 14 | ||
| Socioeconomic factors | 15 | ||
| International Organizations | 16 | ||
| The Place of the Midwife in the Global Context | 17 | ||
| Important Considerations for Midwives Intending to Work Overseas | 19 | ||
| Conclusion | 19 | ||
| References | 21 | ||
| Resources and additional reading | 23 | ||
| 2 A history of the midwifery profession in the United Kingdom | 24 | ||
| Learning Outcomes | 24 | ||
| The Office of Midwife: A Female Domain | 24 | ||
| What manner of women were midwives? | 24 | ||
| Midwifery knowledge | 25 | ||
| ‘In the straw’ | 25 | ||
| The Midwife, the Church and the Law | 26 | ||
| Governing the midwife | 27 | ||
| Advent of the Man-Midwife | 27 | ||
| Maternal mortality | 27 | ||
| Midwives under threat | 28 | ||
| Lying-in hospitals and ‘out-door’ charities | 29 | ||
| Continental comparisons | 29 | ||
| ‘Towards a complete new system of midwifery’ | 29 | ||
| The Decline of the Midwife | 30 | ||
| Maternal mortality and the state | 30 | ||
| The end of the midwife? | 31 | ||
| The Royal Maternity Charity and maternal mortality | 31 | ||
| The Midwives Institute, Midwife Registration and Maternal Mortality | 32 | ||
| The Midwives Act of 1902 | 33 | ||
| The Central Midwives Board | 33 | ||
| ‘Certified Midwife’ | 33 | ||
| The continuing problem of maternal mortality | 34 | ||
| State midwifery | 34 | ||
| The National Health Service, Maternity Care and the Midwife | 34 | ||
| Place of birth | 35 | ||
| Pathways to abnormality: the ‘new obstetrics’ | 36 | ||
| Responses of the midwifery profession | 37 | ||
| User protest and the ‘Active Childbirth’ movement | 37 | ||
| Further Legislative Frameworks: Nurses, Midwives and Health Visitors Act of 1979, Nursing and Midwifery Order 2001 and Beyond … | 38 | ||
| Finding a new voice | 38 | ||
| ‘Choice, continuity and control’ | 39 | ||
| Whose choice in childbirth? | 39 | ||
| Childbirth a ‘surgical operation’? | 40 | ||
| Governmental views | 41 | ||
| ‘Choice, continuity and control’? From Winterton, to maternity matters to better births and beyond | 41 | ||
| Rise of the birth centre/ midwifery-led units | 42 | ||
| Risk, practices and research | 43 | ||
| Midwifery – Now and in the Future | 43 | ||
| Conclusion | 44 | ||
| References | 45 | ||
| Resources and additional reading | 48 | ||
| 3 Regulation of midwives | 49 | ||
| Learning Outcomes | 49 | ||
| Introduction | 49 | ||
| Summary of the History of Legislation Regulating the Midwifery Profession | 49 | ||
| Why Do We Have Regulation? | 49 | ||
| Core functions of the NMC | 49 | ||
| Membership | 50 | ||
| How Does the NMC Work? | 52 | ||
| 1. Midwifery Committee | 52 | ||
| 2. Investigating Committee | 52 | ||
| 3. Health Committee | 52 | ||
| 4. Conduct and Competence Committee | 52 | ||
| Conduct and Competence Committee and Health Committee Panels’ sanctions | 52 | ||
| Restoration to the Register of practitioners who have been struck off | 53 | ||
| Other requirements | 54 | ||
| Civil standard of proof | 54 | ||
| Non-statutory NMC committees | 54 | ||
| 1. Appointments Board | 54 | ||
| 2. Audit, Risk and Assurance Committee | 54 | ||
| 3. Business Planning and Governance Committee | 54 | ||
| 4. Fitness to Practise Committee | 54 | ||
| 5. Professional Practice and Registration Committee | 54 | ||
| Functions of the NMC | 54 | ||
| Function 1: The Register | 54 | ||
| Function 2: Setting standards for education and practice | 54 | ||
| Pre-registration midwifery education | 54 | ||
| Standards for Competence for Registered Midwives | 55 | ||
| Function 3: Regulating Fitness to Practise, Conduct and Performance | 55 | ||
| Getting Registered | 55 | ||
| Staying Registered | 55 | ||
| NMC Revalidation for Nurses and Midwives | 55 | ||
| Continued competence | 56 | ||
| The Code – for nurses and midwives (NMC 2015e) | 56 | ||
| Raising Concerns: Guidance for Nurses and Midwives (NMC 2015f) | 56 | ||
| Guidance on the Professional Duty of Candour (NMC 2015g) | 56 | ||
| Advice and Information for Employers of Nurses and Midwives (NMC 2015h) | 56 | ||
| Midwives Rules and Standards (NMC 2012) | 57 | ||
| Standards for Medicines Management (NMC 2008d) | 57 | ||
| Supervision of Midwives | 57 | ||
| What is the purpose of a supervisor of midwives? | 57 | ||
| History of statutory supervision of midwives | 57 | ||
| Education and training for supervisors of midwives | 57 | ||
| The local supervising authority midwifery officer | 57 | ||
| Midwifery Education | 60 | ||
| HEE has five key functions: | 60 | ||
| Pre-registration midwifery standards and fitness to practise | 62 | ||
| Quality Assurance for Midwifery Education | 62 | ||
| Funding for Midwifery Students | 62 | ||
| Midwifery education internationally | 62 | ||
| Conclusion | 63 | ||
| References | 63 | ||
| Resources and additional reading | 66 | ||
| 4 Clinical governance and the midwife | 67 | ||
| Learning Outcomes | 67 | ||
| Clinical Governance: A Definition | 67 | ||
| NHS Governance Systems | 67 | ||
| International governance | 68 | ||
| Learning From Clinical Incidents: Human Factors Science | 69 | ||
| The Impact of Public Inquiry on Clinical Governance in the UK | 70 | ||
| The Francis Report | 70 | ||
| The Berwick Report | 70 | ||
| The Kirkup Inquiry | 70 | ||
| The Pillars of Healthcare Governance | 71 | ||
| Staff training and revalidation | 71 | ||
| Clinical audit and research | 72 | ||
| Risk management | 73 | ||
| Patient experience | 73 | ||
| Leadership | 74 | ||
| Outcomes and measures | 75 | ||
| Policies and guidelines | 75 | ||
| Conclusion | 75 | ||
| References | 76 | ||
| Resources and additional reading | 77 | ||
| 5 The midwife as a lifelong learner | 78 | ||
| Learning Outcomes | 78 | ||
| Introduction | 78 | ||
| Midwifery Education – From Apprenticeship to Reflective Practice | 78 | ||
| Moving into higher education | 80 | ||
| Diplomas, degrees and scholarship | 81 | ||
| The Cost of Education | 84 | ||
| Commissioning Education | 84 | ||
| Student support | 84 | ||
| Lifelong Learning | 85 | ||
| Lifelong learning in practice | 85 | ||
| After Qualification and Registration: Continuing Professional Development | 86 | ||
| Revalidation | 86 | ||
| The Professional Portfolio | 86 | ||
| Future Developments: Degrees, Masters and PhD/APEL/APL | 88 | ||
| Computers, E-Learning and the Net | 89 | ||
| Learning and Development | 90 | ||
| Learning | 90 | ||
| From andragogy to reflection | 94 | ||
| Reflection and reflective practice | 95 | ||
| Reflection for you … and others | 96 | ||
| New Approaches in Education | 98 | ||
| Mentorship and the Midwife as a Role Model | 99 | ||
| Conclusion | 100 | ||
| References | 101 | ||
| Resources and additional reading | 104 | ||
| 6 Evidence-based practice and research for practice | 106 | ||
| Learning Outcomes | 106 | ||
| Introduction | 106 | ||
| Defining Research and ‘Midwifery’ Research | 107 | ||
| An interpretation of evidence in practice | 107 | ||
| Evidence-Based Practice in Nursing and Midwifery | 108 | ||
| How does evidence influence our practice? | 108 | ||
| Evidence types and implementation | 108 | ||
| Process Steps to Improve Practice | 111 | ||
| Asking the question | 111 | ||
| Finding the evidence | 112 | ||
| Critical appraisal | 112 | ||
| Applying the evidence in practice | 113 | ||
| Assessing the outcomes and dissemination of the results | 114 | ||
| Research Excellence Framework | 114 | ||
| Conclusion | 115 | ||
| References | 115 | ||
| Resources and additional reading | 117 | ||
| 7 Leadership and management in midwifery | 118 | ||
| Learning Outcomes | 118 | ||
| Introduction | 118 | ||
| Why Leadership Matters to Midwifery | 118 | ||
| Leadership: Traditional and Contemporary Thinking | 120 | ||
| A development of theory | 120 | ||
| Contemporary thinking in leadership theory | 120 | ||
| Distributed leadership | 120 | ||
| The place of followers | 121 | ||
| Transactional and transformational leadership | 121 | ||
| Leadership and Management in the NHS | 122 | ||
| Leadership and management: two sides of the same coin? | 122 | ||
| NHS leadership, past and present | 123 | ||
| The rise of clinical leadership | 123 | ||
| Challenges in clinical leadership | 124 | ||
| Developing clinical leaders | 125 | ||
| A talent management approach | 125 | ||
| Implications for Midwifery Leadership | 126 | ||
| Conclusion | 127 | ||
| References | 128 | ||
| Resources and additional reading | 130 | ||
| 8 An introduction to ethics and midwifery practice | 131 | ||
| Learning Outcomes | 131 | ||
| Introduction | 131 | ||
| What Is Ethics? | 131 | ||
| Moral theories | 132 | ||
| Utilitarian theory – consequentialism | 132 | ||
| Applying the utilitarian principle | 132 | ||
| Kantian theory – Deontology | 132 | ||
| Applying Kantian theory | 133 | ||
| Moral conflict | 133 | ||
| Moral dilemma | 133 | ||
| How are dilemmas solved? | 133 | ||
| The duty of care | 134 | ||
| The duty of fidelity | 135 | ||
| The duty of beneficence | 135 | ||
| The duty of nonmaleficence | 135 | ||
| The duty of justice | 135 | ||
| Principles | 135 | ||
| Autonomy | 135 | ||
| Conclusion | 137 | ||
| References | 137 | ||
| Resources and additional reading | 138 | ||
| 9 The law and the midwife | 139 | ||
| Learning Outcomes | 139 | ||
| Introduction to the Law: the Courts and How Laws Are Made | 139 | ||
| The courts | 139 | ||
| Classification of the law | 139 | ||
| Sources of the law | 140 | ||
| Legislation | 140 | ||
| Common law | 140 | ||
| The Human Rights Act 1998 | 141 | ||
| The NMC Code, rules and other guidance | 141 | ||
| Supervision | 142 | ||
| Litigation | 142 | ||
| Negligence | 142 | ||
| What is negligence? | 142 | ||
| Duty of care | 143 | ||
| Breach of duty | 143 | ||
| Determining the standard of care | 143 | ||
| Which standards apply? | 144 | ||
| Causation | 145 | ||
| Factual causation | 145 | ||
| Reasonably foreseeable harm | 145 | ||
| Harm | 145 | ||
| Vicarious and personal liability | 145 | ||
| Liability for students and unqualified assistants: supervision and delegation | 146 | ||
| Defences to an action | 146 | ||
| Dispute allegations | 146 | ||
| Deny that all the elements of negligence are established | 146 | ||
| Contributory negligence | 146 | ||
| Exemption from liability | 146 | ||
| Limitation of time | 147 | ||
| Voluntary assumption of risk | 147 | ||
| Compensation | 147 | ||
| Developments in the Civil Law | 147 | ||
| Conditional fees | 148 | ||
| NHS Indemnity Schemes | 148 | ||
| Consent | 148 | ||
| Trespass to the person | 149 | ||
| Defences to an action for trespass to the person | 149 | ||
| Consent and negligence | 149 | ||
| Elements of consent | 150 | ||
| Voluntarily | 150 | ||
| Informed consent | 150 | ||
| Capacity | 150 | ||
| Mental Capacity Act 2005 | 150 | ||
| Refusal to consent | 151 | ||
| What if someone wishes to leave hospital? | 152 | ||
| Laws Regulating Pregnancy, Birth and Children | 152 | ||
| Abortion Act of 1967 as amended | 152 | ||
| Registration of births and stillbirths; births under 24 weeks | 152 | ||
| Human Fertilisation and Embryology Acts 1990, 1992 and 2008 | 152 | ||
| Criminal law and attendance at birth | 152 | ||
| Children Acts of 1989 and 2004 | 153 | ||
| Health and Social Care Act of 2008 | 153 | ||
| Public Services Reform (Scotland) Act of 2010 | 153 | ||
| Health and Safety Laws | 153 | ||
| Legal Aspects of Record Keeping | 153 | ||
| Medicines | 153 | ||
| Complaints | 154 | ||
| Negligent advice | 154 | ||
| Statutory Duties | 154 | ||
| The Duty of Quality | 154 | ||
| Clinical governance and the duty of quality | 155 | ||
| Future Changes | 155 | ||
| Miscellaneous Legal Issues of Relevance to the Midwife | 155 | ||
| Conclusion | 156 | ||
| Acknowledgement | 156 | ||
| References | 156 | ||
| Statutes, orders and regulations | 157 | ||
| Legal cases | 157 | ||
| 10 Pharmacology and the midwife | 158 | ||
| Learning Outcomes | 158 | ||
| Therapeutics in Pregnancy and Childbirth | 158 | ||
| Adverse reactions | 158 | ||
| Dose-dependent adverse reactions | 158 | ||
| Adverse reactions unrelated to dose: hypersensitivity responses | 159 | ||
| Transgenerational adverse reactions | 159 | ||
| Drugs in Pregnancy | 159 | ||
| Drugs in childbirth | 159 | ||
| Pharmacology in pregnancy and lactation | 160 | ||
| Breastfed infants | 160 | ||
| Drug Administration and Absorption | 160 | ||
| Routes of administration | 160 | ||
| Therapeutic range | 161 | ||
| Drug distribution | 161 | ||
| Pregnancy | 161 | ||
| Childbirth | 161 | ||
| Lactation | 161 | ||
| Neonates | 161 | ||
| Elimination or clearance of drugs | 161 | ||
| Drug metabolism | 161 | ||
| Drug excretion | 162 | ||
| Pharmacodynamics | 162 | ||
| Tolerance or desensitization | 162 | ||
| Supersensitivity | 163 | ||
| Drugs in Labour | 163 | ||
| Analgesics | 163 | ||
| Inhalational analgesia: nitrous oxide with oxygen (Entonox) | 163 | ||
| Actions and adverse reactions | 163 | ||
| Interactions | 163 | ||
| Cautions | 163 | ||
| Opioids | 164 | ||
| Epidural and intrathecal administration | 164 | ||
| Actions of opioids | 164 | ||
| Adverse reactions | 164 | ||
| Respiratory depression | 164 | ||
| Bradycardia | 165 | ||
| Hypotension | 165 | ||
| Thermoregulation | 165 | ||
| Breastfeeding | 165 | ||
| Prolonged labour | 165 | ||
| Retention of urine and dysuria | 165 | ||
| Gastrointestinal effects | 165 | ||
| Pruritus | 165 | ||
| Other potential problems | 165 | ||
| Cautions and contraindications | 166 | ||
| Interactions | 166 | ||
| Uterotonics | 166 | ||
| Prostaglandins | 166 | ||
| Actions and adverse reactions | 166 | ||
| Oxytocin | 166 | ||
| Adverse reactions | 167 | ||
| Overstimulation of the uterus | 167 | ||
| Fluid retention | 167 | ||
| Changes in blood pressure | 167 | ||
| Postpartum haemorrhage | 167 | ||
| Breastfeeding | 167 | ||
| Cautions and scontraindications | 167 | ||
| Cautions | 168 | ||
| Interactions | 168 | ||
| Ergometrine | 168 | ||
| Actions and adverse reactions | 168 | ||
| Contraction of the uterus | 168 | ||
| Vomiting and diarrhoea | 168 | ||
| Vasoconstriction | 168 | ||
| Breastfeeding | 168 | ||
| Cautions and contraindications | 169 | ||
| Drugs for third stage | 169 | ||
| Drugs for symptom relief | 169 | ||
| Preventive medicines | 169 | ||
| Legal Aspects | 169 | ||
| Midwives and controlled drugs | 170 | ||
| Principles of administering medicines safely | 170 | ||
| Conclusion | 170 | ||
| Acknowledgement | 170 | ||
| References | 171 | ||
| Resources and additional reading | 174 | ||
| Two Childbirth in context | 175 | ||
| 11 Sociocultural and spiritual context of childbearing | 176 | ||
| Learning Outcomes | 176 | ||
| Introduction | 176 | ||
| Cultural Competence, Culture and Ethnicity | 176 | ||
| Midwives and Cultural Competence | 177 | ||
| The Papadopoulos, Tilki and Taylor model of cultural competence | 177 | ||
| Cultural awareness | 178 | ||
| Cultural knowledge | 178 | ||
| Cultural sensitivity | 178 | ||
| Cultural competence | 178 | ||
| Applying the PTT model: The story of Amal | 178 | ||
| Cultural awareness: The influence and relevance of cultural identity | 178 | ||
| Cultural knowledge | 179 | ||
| Aristotle’s golden mean and wise compassion | 180 | ||
| Cultural sensitivity: Developing therapeutic relationships | 180 | ||
| Asylum seekers and midwifery | 180 | ||
| Intercultural communication and the midwife | 180 | ||
| Cultural competence: The challenge | 181 | ||
| Summary of the key points of the enacted midwifery care | 181 | ||
| Family and Gender | 182 | ||
| Religion and Spirituality | 182 | ||
| The challenges | 183 | ||
| Prejudice | 184 | ||
| Conclusion | 184 | ||
| References | 184 | ||
| Resources and additional reading | 185 | ||
| 12 Psychological context of childbirth | 186 | ||
| Learning Outcomes | 186 | ||
| Introduction | 186 | ||
| Psychological Adjustment Across the Perinatal Period | 187 | ||
| Antenatal context | 187 | ||
| Developing a maternal identity | 187 | ||
| Body image | 187 | ||
| Interpersonal relationships and social support | 187 | ||
| Responsibility to the baby | 188 | ||
| Physical health and functioning | 188 | ||
| Current or previous mental health disorder | 188 | ||
| Summary of antenatal context | 188 | ||
| Labour and birth | 189 | ||
| Sense of control | 189 | ||
| Traumatic birth | 189 | ||
| Fear of childbirth | 190 | ||
| Mode of birth | 190 | ||
| Summary of birth | 190 | ||
| Postnatal context | 191 | ||
| Physical recovery | 191 | ||
| Baby blues and postnatal depression | 191 | ||
| The reality of change | 191 | ||
| When a baby dies or is ill | 192 | ||
| Assessing women’s psychological health status | 193 | ||
| Midwife–Woman Relationship | 193 | ||
| Trust | 194 | ||
| Respect | 194 | ||
| Communication | 194 | ||
| Making a first impression | 194 | ||
| Building and/or maintaining a woman–midwife relationship | 195 | ||
| Key concepts that underpin effective communication | 195 | ||
| Summary | 197 | ||
| Conclusion | 197 | ||
| References | 197 | ||
| Resources and additional reading | 199 | ||
| 13 Sexuality | 200 | ||
| Learning Outcomes | 200 | ||
| Sexuality | 200 | ||
| Sex During Pregnancy | 200 | ||
| Sexuality and Labour | 201 | ||
| Women Requiring Specialized Care | 202 | ||
| Survivors of sexual abuse | 202 | ||
| Caring for the lesbian client | 203 | ||
| Paternal presence at the birth | 203 | ||
| Sex After Childbirth | 204 | ||
| Breastfeeding and Sexuality | 204 | ||
| Breastfeeding, sexuality and sexual difficulties | 204 | ||
| Menopause | 205 | ||
| Conclusion | 205 | ||
| References | 205 | ||
| 14 National Health Service policy and midwifery | 207 | ||
| Learning Outcomes | 207 | ||
| Introduction | 207 | ||
| The Policy Context | 207 | ||
| What are we talking about? | 207 | ||
| The Structure of the NHS | 208 | ||
| The starting point | 208 | ||
| Politics and Policy | 208 | ||
| What is health policy? | 208 | ||
| Who makes policy and how? | 210 | ||
| Determinants of Healthy Policy | 210 | ||
| Ministers, civil servants and ‘evidence-based policy’ | 210 | ||
| Special advisers and media managers | 211 | ||
| Think Tanks | 211 | ||
| The influence of academics | 211 | ||
| Adverse events | 211 | ||
| A highly politicized service | 212 | ||
| Affording the NHS – the political football | 213 | ||
| Causes of funding pressure | 213 | ||
| Raising the revenue | 213 | ||
| Conclusion | 215 | ||
| References | 217 | ||
| Resources and additional reading | 218 | ||
| 15 Legal frameworks for the care of the child | 219 | ||
| Learning Outcomes | 219 | ||
| Introduction | 219 | ||
| The Children Act 1989 | 220 | ||
| Key features of the Children Act 1989 | 221 | ||
| Content and Structure of the Children Act | 222 | ||
| Part 1 (Section 1): Welfare of the child | 222 | ||
| Part 1 (Section 2): Parents and parental responsibility | 222 | ||
| Who has parental responsibility? | 222 | ||
| Support for Children and Families | 222 | ||
| The changing nature of the family | 222 | ||
| Poverty and social exclusion | 223 | ||
| Employment rights | 223 | ||
| Family support and the Children Act | 223 | ||
| Family Support Services | 223 | ||
| Children living away from home | 224 | ||
| Accommodation for young babies | 224 | ||
| Adoption | 224 | ||
| Children With Disabilities | 224 | ||
| Genital mutilation | 224 | ||
| The Protection of Children | 225 | ||
| Local Safeguarding Children Boards | 225 | ||
| Significant harm | 226 | ||
| Assessing Children ‘in Need’ and Their Families | 226 | ||
| Making a referral | 227 | ||
| Consent and confidentiality | 227 | ||
| The midwife’s role in assessment | 227 | ||
| Pre-birth assessment | 228 | ||
| Post-birth assessment | 228 | ||
| The Emergency Protection Order (EPO) | 228 | ||
| The child protection conference | 229 | ||
| Child protection plan | 229 | ||
| Conclusion | 230 | ||
| References | 230 | ||
| Resources and additional reading | 232 | ||
| Three Public health, health promotion in the context of childbirth | 233 | ||
| 16 Epidemiology | 234 | ||
| Learning Outcomes | 234 | ||
| Introduction | 234 | ||
| Notifying and Registering Births | 234 | ||
| Definitions and Sources of Data | 236 | ||
| Live birth and fertility rates | 237 | ||
| Multiple births | 238 | ||
| Teenage conception rates | 239 | ||
| Outcome of pregnancy | 240 | ||
| Mortality | 241 | ||
| Maternal Mortality | 241 | ||
| Confidential enquiries | 242 | ||
| Surveillance of maternal mortality | 243 | ||
| Confidential reviews of maternal deaths | 245 | ||
| Confidential enquiries into maternal morbidities | 245 | ||
| Stillbirth and Infant Mortality Rates | 245 | ||
| Confidential enquiries into stillbirths and neonatal deaths | 248 | ||
| Classifying causes of stillbirth and infant death | 249 | ||
| Interpreting Differences in the Outcome of Pregnancy | 251 | ||
| Inequalities in the outcome of pregnancy | 251 | ||
| Parents’ countries of birth | 251 | ||
| Ethnicity | 252 | ||
| Social class based on occupation | 252 | ||
| Area deprivation scores | 253 | ||
| Care in Pregnancy and at Birth | 253 | ||
| International Comparisons | 254 | ||
| Strategic development goals | 257 | ||
| Conclusion | 258 | ||
| References | 260 | ||
| Resources and additional reading | 261 | ||
| 17 Nutrition | 262 | ||
| Learning Outcomes | 262 | ||
| What Is Nutrition? | 262 | ||
| Essential Nutrients and Functions | 262 | ||
| Proteins and amino acids | 262 | ||
| Required for: | 262 | ||
| Protein foods: | 262 | ||
| Essential fatty acids | 263 | ||
| Four The anatomy and physiology of fertility, embryology and fetal development | 357 | ||
| 24 Anatomy of male and female reproduction | 358 | ||
| Learning Outcomes | 358 | ||
| Introduction | 358 | ||
| The Pelvis | 358 | ||
| Joints and ligaments of the pelvis | 358 | ||
| The true pelvis | 360 | ||
| Pelvic measurements | 361 | ||
| Pelvic conjugates | 363 | ||
| Anatomical conjugate | 363 | ||
| Obstetric conjugate | 363 | ||
| Internal or diagonal conjugate | 363 | ||
| Angles and planes | 363 | ||
| Pelvic variations | 364 | ||
| Other pelvic types identified | 364 | ||
| Pelvic assessment | 364 | ||
| Female Reproductive Anatomy | 367 | ||
| Fetal development | 368 | ||
| External genitalia | 368 | ||
| Internal genitalia | 369 | ||
| Vagina | 370 | ||
| Uterus | 370 | ||
| Cervix | 374 | ||
| Male Reproductive Anatomy | 374 | ||
| Fetal development | 374 | ||
| Midwifery Implications | 375 | ||
| Conclusion | 376 | ||
| References | 376 | ||
| Resources and additional reading | 377 | ||
| 25 Female reproductive physiology: timed interactions between hypothalamus, anterior pituitary and ovaries | 378 | ||
| Learning Outcomes | 378 | ||
| Introduction | 378 | ||
| Hypothalamic Control of Reproduction | 378 | ||
| Novel aspects of GnRH neurons | 379 | ||
| Neuronal orchestration of GnRH pulsatility | 379 | ||
| GnRH surge release | 381 | ||
| GnRH hourly pulsatile release | 381 | ||
| The Ovarian Cycle | 383 | ||
| Dynamics of follicular activity | 384 | ||
| Sequences of events in the cohort of growing follicles | 384 | ||
| Oocyte growth | 385 | ||
| Follicular fluid – the microenvironment of the cumulus–oocyte complex | 386 | ||
| Follicular hormonal preparation for ovulation and creation of the corpus luteum | 386 | ||
| Ovulation | 388 | ||
| Luteinization | 388 | ||
| The corpus luteum – reprogramming the postovulatory follicle | 388 | ||
| Cyclical Changes in Reproductive Organs | 388 | ||
| The endometrial cycle | 388 | ||
| Cyclical endometrial activity | 389 | ||
| The proliferative phase | 390 | ||
| The secretory phase | 390 | ||
| Pre-decidualization | 390 | ||
| Cyclical changes in the cervix and vagina | 391 | ||
| The mammary cycle | 391 | ||
| Conclusion | 391 | ||
| References | 392 | ||
| 26 Genetics | 395 | ||
| Learning Outcomes | 395 | ||
| Introduction | 395 | ||
| Genes, Chromosomes and DNA | 395 | ||
| The Human Genome | 397 | ||
| Cell Division | 397 | ||
| Chromosomal Analysis and Anomalies | 398 | ||
| Types of chromosome abnormalities | 400 | ||
| Modes of Inheritance | 400 | ||
| Autosomal characteristics/diseases | 400 | ||
| Sex-linked characteristics/diseases | 402 | ||
| Polygenic and multifactorial characteristics | 405 | ||
| Origin of Genetic Diseases | 405 | ||
| Assessment of Embryo and Fetus | 406 | ||
| Genetic Counselling/Advice | 406 | ||
| Screening for Risk Indicators | 407 | ||
| History taking | 408 | ||
| Ultrasound scanning | 408 | ||
| Biochemical/maternal serum screening | 408 | ||
| Integrated (combined) testing | 408 | ||
| Diagnostic Tests | 409 | ||
| Preimplantation genetic diagnosis (PGD) | 409 | ||
| Comparative genomic hybridization | 409 | ||
| Chorionic villus sampling | 409 | ||
| Amniocentesis | 410 | ||
| Fetoscopy | 410 | ||
| Cordocentesis | 410 | ||
| Applications of Genetics | 410 | ||
| Conclusion | 411 | ||
| References | 411 | ||
| 27 Fertility and its control | 413 | ||
| Learning Outcomes | 413 | ||
| Resuming Sexual Relationships Following Childbearing | 413 | ||
| Methods of Fertility Control | 414 | ||
| The ideal method | 414 | ||
| Female contraception | 414 | ||
| Physiological methods | 414 | ||
| The standard days method | 415 | ||
| The 2 day method | 415 | ||
| Lactational amenorrhoea method | 415 | ||
| Personal fertility monitors | 415 | ||
| Fertility computer ‘apps’ | 416 | ||
| Barrier methods | 416 | ||
| Occlusive caps | 416 | ||
| The diaphragm or Dutch cap | 416 | ||
| Other caps | 416 | ||
| Female condoms | 417 | ||
| Hormonal contraception | 417 | ||
| Oral contraception | 417 | ||
| Combined pill | 417 | ||
| Progestogen-only pill | 417 | ||
| Combined transdermal patch | 417 | ||
| Combined vaginal ring | 418 | ||
| Long-acting reversible contraception | 418 | ||
| Intra-uterine contraceptives and intra-uterine systems | 418 | ||
| Levonorgestrel-releasing intra-uterine system | 419 | ||
| Injectable contraceptives | 419 | ||
| Progestogen-only implants | 419 | ||
| Emergency Contraception | 419 | ||
| Emergency contraception (oral) | 420 | ||
| Emergency IUC contraception | 420 | ||
| Female Sterilization | 420 | ||
| Male Contraception | 420 | ||
| Coitus interruptus (withdrawal method) | 420 | ||
| Condom or sheath | 420 | ||
| Future developments | 421 | ||
| Vasectomy | 421 | ||
| The Role of the Midwife in the Provision of Contraceptive Advice | 421 | ||
| Factors to be considered | 422 | ||
| Timing to start contraception | 422 | ||
| Special Groups | 422 | ||
| Adolescent women | 422 | ||
| Older women | 423 | ||
| Medical disorders | 423 | ||
| References | 424 | ||
| 28 Infertility and assisted conception | 426 | ||
| Learning Outcomes | 426 | ||
| Introduction | 426 | ||
| Human Fertilisation and Embryology Authority | 427 | ||
| Causes of Infertility | 427 | ||
| Anovulation | 427 | ||
| Polycystic ovary syndrome | 427 | ||
| Ovarian failure | 428 | ||
| Endometriosis | 428 | ||
| Tubal factors | 428 | ||
| Unexplained infertility | 429 | ||
| Male infertility | 429 | ||
| Female infertility – treatment and management | 430 | ||
| Ovulation induction | 430 | ||
| Donor insemination | 430 | ||
| Intra-uterine insemination | 431 | ||
| Gamete intrafallopian tube transfer | 431 | ||
| In vitro fertilization | 431 | ||
| Drug management | 431 | ||
| Oocyte collection | 431 | ||
| Sperm preparation | 431 | ||
| Fertilization | 432 | ||
| Embryo grading | 432 | ||
| Fragmentation | 433 | ||
| Embryo transfer | 433 | ||
| In vitro maturation | 434 | ||
| Advantages of IVM treatment compared with IVF | 435 | ||
| Factors affecting success in IVM treatment | 435 | ||
| Cryopreservation | 435 | ||
| Egg donation | 436 | ||
| Surrogacy | 436 | ||
| Outcome From IVF Treatments | 436 | ||
| Stress and Infertility | 437 | ||
| Conclusion | 437 | ||
| References | 438 | ||
| Resources and additional reading | 439 | ||
| 29 Fertilization, embryo formation and feto-placental development | 440 | ||
| Learning Outcomes | 440 | ||
| Introduction | 440 | ||
| The fallopian tubes | 441 | ||
| Cyclical changes in the epithelial lining | 442 | ||
| Cumulus-oocyte-complex | 442 | ||
| Sperms within the genital tract | 443 | ||
| Microenvironment of the tubal – uterine lumen | 443 | ||
| Maternal nutrition and fluids within the genital tract | 444 | ||
| Towards Fertilization – Sperm Capacitation | 444 | ||
| Fusion of oocyte and spermatozoon | 444 | ||
| From zygote to … | 444 | ||
| … morula | 446 | ||
| … to blastocyst | 446 | ||
| Adaptations in the Maternal Brain, Ovary and Uterus | 446 | ||
| The Corpus Luteum of Pregnancy | 447 | ||
| Ovarian relaxin | 448 | ||
| Preparation for Implantation | 448 | ||
| Blastocyst–Endometrial Communication | 448 | ||
| Adhesion and attachment | 449 | ||
| Implantation – Endometrial Response | 449 | ||
| Formation of the Cytotrophoblast Shell and Gestational Sac | 449 | ||
| Histiotrophic Nutrition | 449 | ||
| Conditions for Embryogenesis and Early Placental Formation | 449 | ||
| Formation of Extraembryonic Fluid Compartments and Differentiation of the ICM | 450 | ||
| The Secondary Yolk Sac | 451 | ||
| The Deciduochorial Placenta | 452 | ||
| From Embryo to Fetus | 453 | ||
| Growth of the amniotic compartment | 454 | ||
| The Definitive Placenta | 455 | ||
| Fetal oxygen requirements | 456 | ||
| Fetal regulation of amniotic fluid volume | 456 | ||
| Functions of amniotic fluid | 457 | ||
| Lung Formation | 457 | ||
| Hormonal regulation of lung development and maturation | 459 | ||
| Feto-placental Circulation | 459 | ||
| Maternal–Feto-placental Neurohormonal Interactions | 461 | ||
| Central role of adrenal cortex and placenta | 461 | ||
| Development of the adrenal cortex | 461 | ||
| Adrenal medulla | 461 | ||
| Conclusion | 462 | ||
| References | 462 | ||
| Resources and additional reading | 466 | ||
| 30 The fetal skull | 467 | ||
| Learning Outcomes | 467 | ||
| Introduction | 467 | ||
| Development of the Fetal Skull | 467 | ||
| The External Structures of the Newborn Skull | 469 | ||
| Layers of the external structures of the skull | 469 | ||
| The Skull | 469 | ||
| Sutures | 469 | ||
| Fontanelles | 469 | ||
| Sinuses | 469 | ||
| The bones and regions of the skull | 469 | ||
| Measurements of the fetal skull | 469 | ||
| Internal Structures of the Fetal Skull | 474 | ||
| The anatomy of the brain | 474 | ||
| Regions of the cerebrum | 475 | ||
| Meninges of the brain | 475 | ||
| Moulding of the Fetal Skull During Labour | 475 | ||
| Injuries to the Fetal Skull and Surrounding Tissues | 477 | ||
| Caput succedaneum | 477 | ||
| Characteristics of caput succedaneum | 478 | ||
| Cephalhaematoma | 478 | ||
| Characteristics of cephalhaematoma | 479 | ||
| Lacerations | 479 | ||
| Chignon | 479 | ||
| Subaponeurotic haemorrhage/subgaleal haemorrhage | 479 | ||
| Internal Injuries | 480 | ||
| Tentorial tear | 480 | ||
| The Relevance of the Fetal Skull to Parents | 480 | ||
| Conclusion | 480 | ||
| References | 482 | ||
| Resources and additional reading | 482 | ||
| Five Pregnancy | 483 | ||
| 31 Maternal neurohormonal and systemic adaptations to feto-placental development | 484 | ||
| Learning Outcomes | 484 | ||
| Introduction | 484 | ||
| Pulmonary and Cardiovascular Adaptations | 485 | ||
| Adaptations in Fluid Regulation | 485 | ||
| Renal Haemodynamic Adaptations | 487 | ||
| Hormonal Regulation of Maternal Cardiovascular Adaptations | 489 | ||
| From Corpus Luteum to Placenta | 489 | ||
| Cardiovascular Adaptations | 489 | ||
| Peripheral arterial vasodilatation | 490 | ||
| Blood volume | 491 | ||
| Adaptations in the Vascular Renin–Angiotensin–Aldosterone System | 491 | ||
| Renin, angiotensins and angiotensin-converting enzymes | 491 | ||
| Aldosterone, progesterone and deoxycorticosterone | 492 | ||
| Atrial natriuretic peptide | 493 | ||
| Erythropoiesis | 493 | ||
| Ventilation | 493 | ||
| Oxygen consumption | 494 | ||
| Adaptations in the Mammary Glands/Breast | 494 | ||
| Adaptations in the Reproductive Tract | 494 | ||
| Myometrial changes | 496 | ||
| Neurohormonal regulation | 496 | ||
| Cervical changes | 496 | ||
| Maternal Neuroendocrine Adaptations to the Fertile Cycle: Synchronized Interactions and Interdependent Development of Mother and Fetus | 497 | ||
| Conclusion | 498 | ||
| References | 498 | ||
| Resources and additional reading | 502 | ||
| 32 Confirming pregnancy and care of the pregnant woman | 503 | ||
| Learning Outcomes | 503 | ||
| Introduction | 503 | ||
| Confirmation of Pregnancy | 503 | ||
| First 4 weeks | 504 | ||
| Around 8 weeks | 504 | ||
| Around 12 weeks | 504 | ||
| Around 16 weeks | 506 | ||
| Around 20 weeks | 506 | ||
| Around 24 weeks | 506 | ||
| From 28 to 40 weeks | 506 | ||
| Signs of pregnancy found by vaginal examination | 507 | ||
| Positive signs of pregnancy | 507 | ||
| Laboratory diagnosis of pregnancy | 507 | ||
| Pseudocyesis | 508 | ||
| Antenatal Care | 508 | ||
| Aims of antenatal care | 509 | ||
| Care during pregnancy | 509 | ||
| Outline of present pattern of maternity services in the UK | 510 | ||
| Birth settings | 510 | ||
| Team midwifery | 511 | ||
| Independent midwifery services | 512 | ||
| Place of birth | 512 | ||
| Pattern of care | 512 | ||
| The First Antenatal Visit | 513 | ||
| History taking | 513 | ||
| Personal details | 514 | ||
| Present pregnancy | 514 | ||
| Previous pregnancies | 515 | ||
| Medical and surgical history | 515 | ||
| Drugs and medications | 516 | ||
| Smoking in pregnancy | 516 | ||
| Alcohol consumption during pregnancy | 517 | ||
| Diet and supplements in pregnancy | 518 | ||
| Family history | 518 | ||
| Domestic abuse | 519 | ||
| Antenatal screening | 519 | ||
| Subsequent Antenatal Appointments | 519 | ||
| Infant feeding | 519 | ||
| Assessments in pregnancy | 520 | ||
| Maternal weight | 520 | ||
| Blood pressure and urinalysis | 520 | ||
| Blood testing | 521 | ||
| Anaemia | 521 | ||
| Abdominal examination | 521 | ||
| Observation | 521 | ||
| Palpation | 522 | ||
| Pelvic palpation | 525 | ||
| Fundal palpation | 527 | ||
| Lateral palpation | 527 | ||
| Auscultation | 527 | ||
| Abdominal findings throughout pregnancy | 527 | ||
| Engagement of the fetal head | 528 | ||
| Helping women to manage and cope with pregnancy changes | 528 | ||
| Physiological Changes in Pregnancy | 528 | ||
| The gastrointestinal tract | 528 | ||
| Periodontal disease | 528 | ||
| Nausea and vomiting | 529 | ||
| Heartburn | 529 | ||
| Constipation | 529 | ||
| Haemorrhoids | 529 | ||
| The circulatory system | 530 | ||
| Varicose veins | 530 | ||
| The vaginal tract | 530 | ||
| Vaginal discharge | 530 | ||
| The skin in pregnancy | 530 | ||
| Connective tissue changes | 531 | ||
| The musculoskeletal system in pregnancy | 531 | ||
| Backache | 531 | ||
| Pregnancy-related pelvic girdle pain | 531 | ||
| Leg cramp | 532 | ||
| Carpal tunnel syndrome | 532 | ||
| Continuous Assessment of Maternal and Fetal Well-Being | 532 | ||
| Conclusion | 533 | ||
| References | 533 | ||
| Resources and additional reading | 536 | ||
| 33 Antenatal investigations | 537 | ||
| Learning Outcomes | 537 | ||
| Introduction | 537 | ||
| Screening and Diagnosis | 537 | ||
| Blood Tests | 538 | ||
| Blood tests for assessment of maternal well-being | 538 | ||
| ABO and Rhesus blood grouping | 538 | ||
| Antibodies | 538 | ||
| Full blood count | 539 | ||
| Haemoglobin | 539 | ||
| Mean corpuscular volume | 539 | ||
| Platelets | 539 | ||
| White cell count | 539 | ||
| Haemoglobinopathies | 539 | ||
| Maternal infection screening | 539 | ||
| Rubella | 539 | ||
| Hepatitis | 540 | ||
| Hepatitis B (HBV) | 540 | ||
| Hepatitis C (HCV) | 540 | ||
| Human immunodeficiency virus infection | 540 | ||
| Toxoplasmosis | 540 | ||
| Listeriosis | 540 | ||
| Cytomegalovirus | 540 | ||
| Serology | 540 | ||
| Blood glucose screening | 540 | ||
| Antenatal Maternal Blood Tests to Assess the Fetus | 541 | ||
| Maternal serum screening for Down syndrome (MSSDS) | 541 | ||
| Non-invasive prenatal testing (NIPT) | 541 | ||
| Assessment of Fetal Well-Being | 541 | ||
| Fetal heart rate | 541 | ||
| Fetal movements | 542 | ||
| Ultrasound | 542 | ||
| Indications for first trimester ultrasound | 542 | ||
| Booking/early/dating scans | 542 | ||
| Diagnosis of pregnancy | 543 | ||
| Ectopic pregnancy | 543 | ||
| Miscarriage/missed abortion/vaginal bleeding | 543 | ||
| Hydatidiform mole | 543 | ||
| Multiple pregnancies | 543 | ||
| Nuchal translucency scan | 543 | ||
| Indications for second trimester ultrasound | 543 | ||
| Estimation of fetal age | 543 | ||
| Placental location | 543 | ||
| Identification of fetal anomalies | 544 | ||
| Cervical incompetence | 544 | ||
| Indications for third trimester ultrasound | 544 | ||
| Assessment of fetal growth | 544 | ||
| Estimation of fetal weight | 544 | ||
| Malpresentations/malpositions | 544 | ||
| Additional fetal assessment | 544 | ||
| Doppler ultrasound | 544 | ||
| Amniotic fluid measurement | 545 | ||
| Invasive Tests | 545 | ||
| Chorionic villus sampling | 545 | ||
| Amniocentesis | 545 | ||
| Cordocentesis | 545 | ||
| Conclusion | 545 | ||
| References | 546 | ||
| Resources and additional reading | 547 | ||
| 34 Choice, childbearing and maternity care: the choice agenda and place of birth | 548 | ||
| Learning Outcomes | 548 | ||
| Introduction | 548 | ||
| Choice Rhetoric and Maternity Care | 548 | ||
| Choice constrained | 549 | ||
| Birth place – challenging choices | 550 | ||
| Where Do Women Give Birth? | 552 | ||
| Why is this happening? | 552 | ||
| Communicating choice | 553 | ||
| Managing risk or facilitating safety? | 554 | ||
| Human rights and birth choice | 555 | ||
| Facilitating choice: what can the midwife do? | 555 | ||
| Conclusion | 557 | ||
| References | 557 | ||
| Resources and additional reading | 560 | ||
| Six Labour and birth | 561 | ||
| 35 Physiological changes from late pregnancy until the onset of lactation: from nesting to suckling-lactation and parent-infant attachment | 562 | ||
| Learning Outcomes | 562 | ||
| Introduction | 562 | ||
| Maternal Autonomic and Neuroendocrine Adaptations | 563 | ||
| Prolactin – maternal stress and anxiety | 563 | ||
| Regulation of myometrial quiescence | 563 | ||
| Myometrial quiescence – placental steroids | 564 | ||
| Changing balance of placental steroid hormone receptors | 564 | ||
| Myometrial quiescence – placenta and fetal membranes | 564 | ||
| Circadian rhythms and maternal–fetal synchronization | 564 | ||
| Circadian rhythms in the myometrium | 565 | ||
| Gestational analgesia | 565 | ||
| Maternal sleep and melatonin | 565 | ||
| Fetal Preparations for Labour | 566 | ||
| The Fetal Adreno-Placental ‘Clock’ | 566 | ||
| Myometrial actions of placental CRH | 567 | ||
| CRH activity in placenta and membranes | 567 | ||
| Neuroendocrine and Central Oxytocin Systems From Late Pregnancy | 567 | ||
| Central oxytocin | 567 | ||
| Central oxytocin receptors | 567 | ||
| Uterine oxytocin receptors | 568 | ||
| Nocturnal Myometrial Activation and Cervical Ripening | 568 | ||
| Cervical and uterine muscles | 569 | ||
| Uterocervical changes and inflammation | 570 | ||
| Remodeling gestational tissues | 570 | ||
| From Late Pregnancy to Birth | 570 | ||
| Maternal–Fetal Readiness for Labour | 571 | ||
| Neuroendocrine oxytocin | 571 | ||
| Established labour | 572 | ||
| Towards the expulsive phase | 573 | ||
| Spontaneous maternal breathing | 574 | ||
| Fetal neurohormonal responses to labour and birth | 574 | ||
| Cardiovascular responses | 574 | ||
| Birth, placental separation and cardiorespiratory adaptations | 575 | ||
| Haemostasis and fibrinolysis | 576 | ||
| From Utero-Placenta Circulation to Mammary Secretions | 576 | ||
| Initiation of maternal behaviour and attachment | 578 | ||
| Conclusion | 578 | ||
| References | 578 | ||
| Resources and additional reading | 585 | ||
| 36 Care in the first stage of labour | 586 | ||
| Learning Outcomes | 586 | ||
| Introduction | 586 | ||
| The Continuum of Labour | 587 | ||
| Characteristics of Labour | 588 | ||
| Physiology of Labour | 588 | ||
| Cervical effacement and dilatation | 588 | ||
| Uterine contractions | 589 | ||
| Coordination of contractions | 590 | ||
| Retraction | 590 | ||
| Polarity | 590 | ||
| Intensity or amplitude | 590 | ||
| Resting tone | 590 | ||
| Formation of the forewaters and hindwaters | 590 | ||
| Rupture of the membranes | 591 | ||
| Show | 591 | ||
| Hormones of labour | 591 | ||
| Care During the First Stage of Labour | 591 | ||
| Partnership in care | 591 | ||
| Emotional and psychological care | 592 | ||
| The role of the birth supporter | 593 | ||
| Advocacy | 593 | ||
| The Birth Environment | 594 | ||
| Home | 594 | ||
| Midwifery units | 594 | ||
| Midwifery-led care | 597 | ||
| Onset of Labour | 597 | ||
| Uterine contractions | 597 | ||
| Show | 597 | ||
| Rupture of the membranes | 597 | ||
| Contact with the midwife | 597 | ||
| Observations | 598 | ||
| General examination | 598 | ||
| Abdominal examination | 598 | ||
| Vaginal examination | 598 | ||
| Records | 598 | ||
| General Midwifery Care in Labour | 598 | ||
| Assessment of progress | 598 | ||
| Origins of the progress paradigm | 598 | ||
| Organizational factors | 599 | ||
| Rhythms in early labour | 600 | ||
| Rhythms in mid labour | 600 | ||
| Vaginal examinations | 601 | ||
| Indications for vaginal examination | 602 | ||
| Method | 602 | ||
| Cervix | 602 | ||
| Membranes | 602 | ||
| Presentation | 602 | ||
| Position | 602 | ||
| Flexion and station | 603 | ||
| Alternative skills for ‘sussing out’ labour | 604 | ||
| ‘Being with’, not ‘doing to’, labouring women | 604 | ||
| Loss per vagina and rupture of the membranes | 605 | ||
| Bladder care | 605 | ||
| Mobility and ambulation | 605 | ||
| Upright posture | 605 | ||
| Moving and handling | 605 | ||
| Prevention of infection | 607 | ||
| Nutrition in Labour | 607 | ||
| Assessing the Fetal Condition | 607 | ||
| Monitoring the fetal heart | 608 | ||
| Healthy fetal heart patterns | 608 | ||
| Electronic fetal monitoring | 608 | ||
| Conclusion | 609 | ||
| References | 610 | ||
| Resources and additional reading | 613 | ||
| 37 Care in the second stage of labour | 614 | ||
| Learning Outcomes | 614 | ||
| Introduction | 614 | ||
| Signs of Progress | 614 | ||
| Transition | 614 | ||
| Expulsive phase | 615 | ||
| Physiology of the Active Second Stage of Labour | 616 | ||
| Contractions | 616 | ||
| Secondary powers | 616 | ||
| The pelvic floor | 616 | ||
| Mechanism of Labour | 616 | ||
| Descent | 616 | ||
| Flexion | 617 | ||
| Internal rotation | 617 | ||
| Crowning of the head | 617 | ||
| Extension | 617 | ||
| Restitution | 617 | ||
| Internal rotation of the shoulders | 617 | ||
| Lateral flexion of the shoulders | 618 | ||
| After the birth | 618 | ||
| Duration of the Second Stage of Labour | 619 | ||
| Positions in the Second Stage of Labour | 619 | ||
| Midwifery Care | 619 | ||
| Hygiene and comfort measures | 620 | ||
| Support during transition | 620 | ||
| Support during the expulsive phase of labour | 620 | ||
| Early bearing-down efforts | 620 | ||
| Delayed bearing-down efforts and the passive second stage of labour | 620 | ||
| Pushing technique | 621 | ||
| Perineal practices | 621 | ||
| Assessing the need for episiotomy | 621 | ||
| Other Midwifery Techniques | 621 | ||
| Optimal fetal positioning | 621 | ||
| Water birth | 621 | ||
| Temperature of the water | 621 | ||
| Infection of mother or baby | 622 | ||
| Water embolism | 622 | ||
| Perineal trauma | 622 | ||
| Cord snapping | 622 | ||
| Monitoring maternal and fetal health | 622 | ||
| The baby | 622 | ||
| Preparation for the Birth | 622 | ||
| The Activities of the Midwife During the Birth | 622 | ||
| Observations and Recordings | 624 | ||
| Future Research in This Area | 625 | ||
| Conclusion | 625 | ||
| References | 626 | ||
| Resources and additional reading | 627 | ||
| 38 Supporting choices in reducing pain and fear during labour | 628 | ||
| Learning Outcomes | 628 | ||
| Introduction | 628 | ||
| An Exploration of Pain in Labour | 628 | ||
| Uterine, cervical and perineal nerve supply | 629 | ||
| Nociceptors | 629 | ||
| Transduction, transmission and interpretation of pain signals in labour | 629 | ||
| Modulation of pain signals during childbirth | 630 | ||
| Endorphins | 631 | ||
| Fear and Other Psychological Elements Related to Pain | 631 | ||
| Cultural Aspect of Pain | 632 | ||
| The birthing environment | 632 | ||
| Antenatal education and preparation for birth | 633 | ||
| Continuous support in labour | 633 | ||
| Complementary and Alternative Therapies | 634 | ||
| Hydrotherapy | 634 | ||
| Transcutaneous electrical nerve stimulation | 635 | ||
| Pharmacological Pain Relief | 636 | ||
| Nitrous oxide (Entonox) | 636 | ||
| Parenteral opioids | 637 | ||
| Pethidine | 637 | ||
| Diamorphine | 638 | ||
| Epidural anaesthesia | 638 | ||
| Conclusion | 641 | ||
| References | 642 | ||
| Resources and additional reading | 645 | ||
| 39 Care in the third stage of labour | 646 | ||
| Learning Outcomes | 646 | ||
| Introduction | 646 | ||
| Physiology of the Third Stage | 647 | ||
| Cord clamping | 648 | ||
| Schultze | 650 | ||
| Matthews Duncan | 650 | ||
| Control of bleeding | 650 | ||
| Management of the Third Stage of Labour | 651 | ||
| Expectant management | 651 | ||
| Principles of expectant management | 651 | ||
| Detection of separation and descent of the placenta | 652 | ||
| Delivery of the placenta and membranes | 652 | ||
| Principles of active management | 652 | ||
| History of active management | 652 | ||
| Uterotonic drugs | 653 | ||
| Active versus expectant management | 653 | ||
| Current options | 654 | ||
| Prostaglandins | 654 | ||
| Nipple stimulation | 655 | ||
| Principles of active management | 655 | ||
| Positioning the baby after birth | 655 | ||
| When to give the uterotonic | 655 | ||
| When to cut the cord | 655 | ||
| Detection of separation and descent of the placenta | 655 | ||
| Signs of separation and descent | 655 | ||
| Delivery of the placenta and membranes | 655 | ||
| Examination of the placenta and membranes | 656 | ||
| Care After Birth (the Fourth Stage) | 657 | ||
| Records | 658 | ||
| Abnormalities of the placenta | 658 | ||
| Succenturiate lobe | 658 | ||
| Circumvallate placenta | 658 | ||
| Bipartite placenta | 658 | ||
| Placenta accreta | 659 | ||
| Infarcts | 659 | ||
| Calcification | 659 | ||
| Abnormalities of the umbilical cord | 659 | ||
| Abnormalities of insertion | 660 | ||
| Conclusion | 660 | ||
| References | 661 | ||
| 40 The pelvic floor | 664 | ||
| Learning Outcomes | 664 | ||
| Introduction and Background | 664 | ||
| The Pelvic Floor | 664 | ||
| Situation and structure | 664 | ||
| Pelvic peritoneum | 665 | ||
| Endopelvic fascia | 665 | ||
| Pelvic floor muscles | 665 | ||
| Properties of perineal muscle structure | 665 | ||
| The functional characteristics of pelvic floor muscle | 665 | ||
| Ischiorectal fossa | 668 | ||
| Perineal body | 668 | ||
| Blood, lymph and nerve supply | 669 | ||
| Fat | 669 | ||
| Skin | 669 | ||
| Considerations for Midwifery Practice | 669 | ||
| Perineal Trauma | 670 | ||
| Definition | 670 | ||
| Types of trauma | 670 | ||
| Classification of trauma | 670 | ||
| Labial tears or lacerations | 670 | ||
| Clitoral and periurethral tears | 671 | ||
| Cervical tears | 671 | ||
| Prevalence of perineal trauma | 671 | ||
| Short- and long-term effects of perineal trauma | 672 | ||
| Risk factors associated with perineal trauma | 672 | ||
| Maternal risk factors include | 672 | ||
| Midwives’ Duties and Responsibilities | 672 | ||
| Interventions that may prevent or minimize perineal trauma | 673 | ||
| Interventions that require further research or remain controversial: | 673 | ||
| No sound evidence available | 673 | ||
| Episiotomy (Surgical Incision) | 674 | ||
| Structures involved in an episiotomy | 675 | ||
| Episiotomy rate | 676 | ||
| Indications | 676 | ||
| Contraindications | 676 | ||
| When to make the incision | 676 | ||
| Risks associated with episiotomy | 676 | ||
| Complications | 676 | ||
| The ‘unkindest cut’ | 678 | ||
| The Principles of Perineal Repair | 678 | ||
| Methods and materials for repair | 679 | ||
| Two-stage technique leaving perineal skin unsutured | 679 | ||
| ‘To suture or not to suture’ second degree perineal tears? | 679 | ||
| Tissue adhesive | 679 | ||
| Rationale for perineal repair | 679 | ||
| Recommendations for clinical practice | 679 | ||
| Systematic Assessment of Perineal Trauma | 680 | ||
| Procedure | 680 | ||
| Advice after perineal repair | 684 | ||
| Third and fourth degree tears | 684 | ||
| Labial and clitoral tears | 685 | ||
| Cervical tears | 685 | ||
| Discussion | 685 | ||
| Professional and legal responsibilities | 686 | ||
| Conclusion | 686 | ||
| References | 687 | ||
| Resources and additional reading | 691 | ||
| Useful websites | 691 | ||
| Seven Postnatal care and the care of the newborn baby | 693 | ||
| 41 Content and organization of postnatal care | 694 | ||
| Learning Outcomes | 694 | ||
| Introduction | 694 | ||
| Aims of Postnatal Care | 694 | ||
| The organization of postnatal care | 695 | ||
| The content of postnatal care | 695 | ||
| Physiological changes during the postnatal period | 695 | ||
| Involution of the uterus | 697 | ||
| Hormonal changes | 697 | ||
| Cardiovascular system | 697 | ||
| Respiratory system | 697 | ||
| Musculoskeletal system | 697 | ||
| Urinary system | 697 | ||
| Care of Women’s Health During the Postnatal Period | 698 | ||
| Uterine involution and vaginal loss | 698 | ||
| Perineal care | 698 | ||
| Micturition and bowels | 699 | ||
| Infant feeding | 699 | ||
| Care of Women’s Psychological Health | 699 | ||
| Postpartum ‘blues’ | 700 | ||
| Postnatal depression | 700 | ||
| Puerperal psychosis | 700 | ||
| Postnatal debriefing and psychosocial support | 700 | ||
| The Role of Health Professionals During the Postnatal Period | 701 | ||
| Conclusion | 701 | ||
| Acknowledgement | 702 | ||
| References | 702 | ||
| 42 Physiology, assessment and care of the newborn | 705 | ||
| Learning Outcomes | 705 | ||
| Introduction | 705 | ||
| The baby as an individual | 705 | ||
| Assessment of the newborn | 706 | ||
| Applied Physiology | 706 | ||
| Respiratory system | 706 | ||
| Respiration in the neonate | 707 | ||
| Abnormal signs | 707 | ||
| Cardiovascular system in the embryo and fetus | 707 | ||
| Fetal circulation | 707 | ||
| Changes at birth | 708 | ||
| Changes in the blood | 708 | ||
| Skin and temperature control | 708 | ||
| Gastrointestinal system | 708 | ||
| Renal system | 709 | ||
| Glucose metabolism | 709 | ||
| Musculoskeletal system | 710 | ||
| Central nervous system | 710 | ||
| Protection against infection | 710 | ||
| Care at Birth | 711 | ||
| Preparation | 711 | ||
| The Apgar score | 711 | ||
| Maternal–infant relationship | 712 | ||
| Warmth | 712 | ||
| Identification | 713 | ||
| Vitamin K | 713 | ||
| Oral use of vitamin K | 713 | ||
| Examination of the Newborn | 713 | ||
| Initial post-birth examination | 713 | ||
| The NIPE screening examination and the holistic examination | 715 | ||
| Examination of the newborn assessment tool | 715 | ||
| Preparation | 715 | ||
| Communication | 716 | ||
| Informed consent | 716 | ||
| Daily examination | 716 | ||
| Physical Assessment of the Newborn | 716 | ||
| Birth | 716 | ||
| Formal assessment of the newborn | 717 | ||
| History | 717 | ||
| General appearance | 717 | ||
| Observation | 717 | ||
| Gestational assessment | 717 | ||
| Measurements | 718 | ||
| The UK World Health Organisation growth charts | 718 | ||
| Weight | 718 | ||
| Length | 718 | ||
| Head circumference | 718 | ||
| Vital signs | 719 | ||
| Skin | 719 | ||
| Haemangiomata | 719 | ||
| Dry skin | 719 | ||
| Cardiorespiratory system | 719 | ||
| Observation | 719 | ||
| Colour | 719 | ||
| Chest | 720 | ||
| Palpation | 720 | ||
| Auscultation | 720 | ||
| Congenital heart disease | 721 | ||
| Pulse oximetry | 721 | ||
| Morphological examination | 721 | ||
| The head | 721 | ||
| The hair | 722 | ||
| The face | 722 | ||
| The eyes | 722 | ||
| The ears | 722 | ||
| The mouth | 722 | ||
| The nose | 723 | ||
| The neck | 723 | ||
| Sharing information with parents | 723 | ||
| Musculoskeletal system | 723 | ||
| History | 723 | ||
| Examination | 723 | ||
| Lower extremities | 724 | ||
| Examination | 725 | ||
| Ortolani and Barlow tests | 726 | ||
| Ortolani test | 726 | ||
| Barlow test | 726 | ||
| Additional investigations | 726 | ||
| Gastrointestinal system | 726 | ||
| Abdomen | 726 | ||
| Peristaltic movement | 727 | ||
| Palpation | 727 | ||
| Vomiting | 728 | ||
| The groin | 728 | ||
| Genitourinary system | 728 | ||
| Male infant genitalia | 728 | ||
| Female infant genitalia | 729 | ||
| Disorders of sex development (DSDs) | 729 | ||
| Anus and rectum | 729 | ||
| Neurological examination | 730 | ||
| Physical examination | 730 | ||
| Reflexes | 730 | ||
| Cranial nerves | 731 | ||
| Assessment of the autonomic nervous system | 731 | ||
| Identifying and managing pain and stress in the term newborn | 731 | ||
| Causes of pain | 731 | ||
| Signs of pain | 731 | ||
| Comfort measures – sucrose and breastfeeding | 732 | ||
| Jitteriness versus seizures | 732 | ||
| Assessment of feeding | 732 | ||
| Bad news | 732 | ||
| Mother–baby attachment | 732 | ||
| Newborn behaviour | 733 | ||
| Sleep versus play time | 734 | ||
| Postnatal Care | 734 | ||
| Hygiene | 734 | ||
| Sources of infection | 734 | ||
| Bathing the baby | 735 | ||
| Dermatitis of the groin, buttocks and anus | 735 | ||
| Treatment and care | 735 | ||
| Newborn screening tests | 735 | ||
| Blood spot screening test | 736 | ||
| Metabolic Diseases | 736 | ||
| Hearing tests | 736 | ||
| Vaccinations | 736 | ||
| Follow-Up of the Baby | 736 | ||
| Record-Keeping | 737 | ||
| Conclusion | 737 | ||
| References | 737 | ||
| Resources and additional reading | 740 | ||
| 43 Thermoregulation | 741 | ||
| Learning Outcomes | 741 | ||
| Introduction | 741 | ||
| Physiology of Thermoregulation | 741 | ||
| Fetal perspective | 742 | ||
| Neonatal perspective | 742 | ||
| Internal and external gradients | 742 | ||
| Heat loss and gain | 743 | ||
| Neonatal heat production | 743 | ||
| Heat production and brown adipose tissue | 744 | ||
| Feeding | 744 | ||
| Drugs | 744 | ||
| The Role of the Midwife | 745 | ||
| During pregnancy | 745 | ||
| Labour and birth | 745 | ||
| Water birth | 745 | ||
| Birth room | 745 | ||
| Risk factors in labour | 745 | ||
| Initial newborn care | 745 | ||
| Skin-to-skin contact | 746 | ||
| Bathing | 746 | ||
| Resuscitation | 747 | ||
| Home environment | 747 | ||
| Hospital/birth centre | 747 | ||
| Oxygen therapy | 748 | ||
| Examination of the newborn | 748 | ||
| Temperature assessment | 748 | ||
| Transfer | 749 | ||
| Monitoring and Maintaining Temperature | 749 | ||
| Monitoring | 749 | ||
| Maintaining temperature | 750 | ||
| Minimizing the Risks of Hypothermia | 750 | ||
| Wrapping and swaddling | 750 | ||
| Hats and clothes | 750 | ||
| Bathing | 750 | ||
| Parent education | 751 | ||
| The Sick Neonate | 751 | ||
| Hypothermia | 751 | ||
| Management | 752 | ||
| Mild hypothermia (temperature range 36–36.4°C) | 752 | ||
| Moderate hypothermia (temperature range 32–35.9°C) | 752 | ||
| Severe cold stress | 753 | ||
| Hyperthermia | 753 | ||
| Reversal of heat stress | 753 | ||
| Effects and signs of hyperthermia | 753 | ||
| Equipment | 753 | ||
| Conclusion | 754 | ||
| References | 754 | ||
| Resources and additional reading | 756 | ||
| 44 Infant feeding and relationship building | 757 | ||
| Learning Outcomes | 757 | ||
| Introduction | 757 | ||
| Why Are BreastMilk and Breastfeeding so Important? | 758 | ||
| Public Health and Infant Feeding | 758 | ||
| The Baby Friendly Initiative | 759 | ||
| The UN Convention on the Rights of the Child | 760 | ||
| The needs of the newborn baby – food and love | 761 | ||
| Physiology of the Infant Gastrointestinal Tract | 761 | ||
| Normal Neonatal Metabolism | 761 | ||
| Constituents of Colostrum and BreastMilk | 762 | ||
| Protein | 762 | ||
| Carbohydrates | 762 | ||
| Fats | 762 | ||
| Vitamins | 763 | ||
| Minerals | 763 | ||
| The risks to the infant of not being breastfed | 765 | ||
| Breastfeeding and the preterm baby | 766 | ||
| Protective effects of breastfeeding for the mother | 766 | ||
| Contraindications to Breastfeeding | 766 | ||
| Neonatal conditions (WHO/Unicef 2009) | 766 | ||
| Galactosemia | 766 | ||
| Maple-syrup urine disease | 766 | ||
| Phenylketonuria | 766 | ||
| Maternal conditions | 767 | ||
| HIV | 767 | ||
| Drugs – maternal medication | 767 | ||
| Substance misuse | 767 | ||
| Conditions where a woman can continue to breastfeed but health problems may be of concern | 767 | ||
| Hepatitis B | 767 | ||
| Hepatitis C | 767 | ||
| Pollutants in breastmilk | 767 | ||
| The Midwife’s Role in Supporting, Protecting and Promoting Breastfeeding and Helping a Mother to Build a Close and Loving Relationship With Her Baby | 767 | ||
| Understanding how breastfeeding works | 767 | ||
| Anatomy of the breast | 767 | ||
| Physiology of Lactation | 768 | ||
| Puberty to pregnancy (mammogenesis) | 768 | ||
| Initiation of lactation (lactogenesis) | 769 | ||
| Maintenance of lactation (lactogenesis) | 769 | ||
| Helping mothers to get breastfeeding off to a good start – antenatally | 770 | ||
| Supporting infant feeding at birth | 771 | ||
| The mother’s choice of position for feeding | 771 | ||
| Positioning the baby at the breast | 772 | ||
| Attachment of the baby to the breast | 772 | ||
| Assessing a breastfeed and transfer of breastmilk | 773 | ||
| Expression and storage of breastmilk | 774 | ||
| Storage of breastmilk | 774 | ||
| Common Problems | 774 | ||
| Insufficient milk | 774 | ||
| Engorgement – venous/milk | 776 | ||
| Sore/cracked nipples | 776 | ||
| Management | 776 | ||
| Mastitis | 777 | ||
| Signs and symptoms | 777 | ||
| Management | 777 | ||
| Neonatal problems | 777 | ||
| Tongue tie (ankyloglossia) | 777 | ||
| Cleft lip and palate | 777 | ||
| Down syndrome | 777 | ||
| Breastfeeding the preterm baby | 777 | ||
| Twins and triplets | 778 | ||
| Going back to work | 778 | ||
| Artificial Feeding | 778 | ||
| Regulations surrounding infant formulae | 778 | ||
| Types of feed available | 779 | ||
| Methods of artificial feeding | 779 | ||
| Sterilizing equipment and preparing infant formula | 779 | ||
| Other methods | 779 | ||
| When a mother artificially feeds her baby | 780 | ||
| Supporting a mother to responsively bottle feed her baby | 780 | ||
| The International Code of Marketing of Breastmilk Substitutes | 780 | ||
| Key points of the code | 780 | ||
| Conclusion | 781 | ||
| References | 781 | ||
| Resources and additional reading | 788 | ||
| Eight Women and babies with complex needs | 789 | ||
| 45 The preterm baby and the small baby | 790 | ||
| Learning Outcomes | 790 | ||
| Introduction | 790 | ||
| Prematurity | 790 | ||
| Definitions | 790 | ||
| Causes of prematurity | 791 | ||
| Outcomes | 791 | ||
| Characteristics | 791 | ||
| Assessing gestation | 792 | ||
| Problems of the Preterm Baby | 792 | ||
| Initial management | 792 | ||
| Common problems of prematurity | 792 | ||
| Respiratory | 792 | ||
| Respiratory distress syndrome | 792 | ||
| Chronic lung disease | 795 | ||
| Apnoeas | 795 | ||
| Cardiovascular/haematological | 795 | ||
| Anaemia | 795 | ||
| Patent ductus arteriosus | 795 | ||
| Immunological | 795 | ||
| Fluid and electrolyte balance | 796 | ||
| Digestive system | 796 | ||
| Necrotizing enterocolitis | 796 | ||
| Thermoregulation | 797 | ||
| Hypothermia | 797 | ||
| Metabolism | 797 | ||
| Hepatic system | 797 | ||
| Neurological and sensory systems | 798 | ||
| Intraventricular haemorrhage | 798 | ||
| Retinopathy of prematurity | 798 | ||
| Stress, pain and developmental problems | 798 | ||
| Skin | 799 | ||
| Low BirthWeight | 799 | ||
| Definitions | 799 | ||
| Asymmetrical growth restriction: | 799 | ||
| Symmetrical growth restriction: | 799 | ||
| Causes of low birthweight | 800 | ||
| Outcomes | 800 | ||
| Characteristics | 800 | ||
| Assessing weight | 800 | ||
| Problems of the low-birthweight baby | 801 | ||
| Initial management | 801 | ||
| Labour and delivery | 801 | ||
| Hypothermia | 802 | ||
| Hypoglycaemia | 802 | ||
| Hypoxic ischaemic encephalopathy | 803 | ||
| Meconium aspiration syndrome | 803 | ||
| Polycythaemia | 803 | ||
| Poor feeding | 804 | ||
| Long-Term Complications in the Preterm and Low-Birth-Weight Baby | 804 | ||
| Caring for the Family of the Preterm or Low-Birth-Weight Baby | 804 | ||
| Conclusion | 805 | ||
| References | 806 | ||
| Resources and additional reading | 807 | ||
| Books | 807 | ||
| Useful websites: | 807 | ||
| 46 Respiratory and cardiac disorders | 809 | ||
| Learning Outcomes | 809 | ||
| Introduction | 809 | ||
| Normal Respiratory and Cardiac Development | 809 | ||
| Respiratory development | 809 | ||
| Cardiac development | 810 | ||
| The fetal circulation | 811 | ||
| Transition to extrauterine life | 811 | ||
| Normal neonatal circulation and respiratory function | 811 | ||
| Compromised fetal cardiac and respiratory development | 811 | ||
| Compromised transitional circulation at birth | 811 | ||
| Abnormal neonatal cardiac and respiratory function | 812 | ||
| Resuscitation of the Newborn | 812 | ||
| Respiratory Disorders in the Newborn | 816 | ||
| Transient tachypnoea of the newborn | 816 | ||
| Meconium aspiration syndrome | 816 | ||
| Hypoxic ischaemic encephalopathy (birth asphyxia) | 817 | ||
| Respiratory distress syndrome | 817 | ||
| Chronic lung disease | 818 | ||
| Pneumonia | 819 | ||
| Congenital lung abnormalities | 819 | ||
| Cardiac Abnormalities | 819 | ||
| Management | 820 | ||
| Forms of congenital heart defects | 820 | ||
| Acyanotic heart defects | 820 | ||
| Patent ductus arteriosus | 820 | ||
| Atrial septal defect | 821 | ||
| Ventricular septal defect | 821 | ||
| Atrial–ventricular septal defects | 821 | ||
| Acyanotic, obstructive disorders | 822 | ||
| Coarctation of the aorta | 822 | ||
| Pulmonary stenosis | 822 | ||
| Aortic stenosis | 822 | ||
| Cyanotic defects | 822 | ||
| Transposition of the great arteries (TGA) | 822 | ||
| Tetralogy of Fallot | 823 | ||
| Hypoplastic left heart syndrome | 823 | ||
| Acquired cardiac problems | 823 | ||
| Parental Care | 823 | ||
| Conclusion | 825 | ||
| References | 826 | ||
| Resources and additional reading | 827 | ||
| Books | 827 | ||
| Online resources | 827 | ||
| Parent resources | 827 | ||
| 47 Neonatal jaundice | 828 | ||
| Learning Outcomes | 828 | ||
| Introduction | 828 | ||
| Physiology | 828 | ||
| Physiological Jaundice | 829 | ||
| Features of physiological jaundice | 829 | ||
| Evaluation of Jaundice | 829 | ||
| Records | 829 | ||
| Unconjugated Hyperbilirubinemia | 830 | ||
| Increased red cell breakdown | 830 | ||
| Haemolytic disease of the newborn | 830 | ||
| Rhesus isoimmunization | 830 | ||
| ABO incompatibility | 832 | ||
| Genetic causes | 832 | ||
| Failure of conjugation | 832 | ||
| Genetic reasons | 832 | ||
| Increased enterohepatic circulation | 832 | ||
| Complications of unconjugated hyperbilirubinemia | 833 | ||
| Kernicterus | 833 | ||
| Management of unconjugated hyperbilirubinemia | 833 | ||
| Phototherapy | 835 | ||
| Exchange transfusion | 837 | ||
| Complications | 839 | ||
| Immunoglobulin | 840 | ||
| Prolonged Jaundice | 840 | ||
| Conjugated Hyperbilirubinemia | 840 | ||
| Complications | 840 | ||
| General | 840 | ||
| Specific | 841 | ||
| Management of conjugated hyperbilirubinemia | 841 | ||
| Transfer from hospital to home | 841 | ||
| Before transfer from hospital/birth centre to home | 841 | ||
| The Role of the Midwife With the Parents | 841 | ||
| Follow-Up | 842 | ||
| The Future | 843 | ||
| Conclusion | 843 | ||
| References | 844 | ||
| Resources and additional reading | 845 | ||
| 48 Neonatal infection | 846 | ||
| Learning Outcomes | 846 | ||
| Introduction | 846 | ||
| Acquisition of Infection | 846 | ||
| Newborn Immunity | 847 | ||
| Pathogenesis | 847 | ||
| Maternal risk factors | 847 | ||
| Chorioamnionitis | 848 | ||
| Risk factors for early-onset sepsis | 848 | ||
| Neonatal septic screening and antibiotic therapy | 848 | ||
| Infections Acquired Around the Time of Birth | 850 | ||
| Bacterial infections | 850 | ||
| Group B streptococcus | 850 | ||
| Escherichia coli | 850 | ||
| Listeria monocytogenes | 850 | ||
| Viral infections | 850 | ||
| Herpes viruses | 850 | ||
| Herpes simplex virus (HSV) | 850 | ||
| Cytomegalovirus | 851 | ||
| Varicella zoster virus | 852 | ||
| Other viruses/organisms | 852 | ||
| Rubella | 852 | ||
| Hepatitis B virus | 852 | ||
| Hepatitis C | 852 | ||
| Human immunodeficiency virus | 853 | ||
| Parvovirus B19 | 853 | ||
| Toxoplasmosis | 853 | ||
| Syphilis | 853 | ||
| Localized superficial infections | 854 | ||
| Eye infections | 854 | ||
| Skin and soft tissue | 854 | ||
| Omphalitis | 854 | ||
| Rashes and abscesses | 854 | ||
| Conclusion | 855 | ||
| References | 855 | ||
| Useful websites: | 856 | ||
| 49 Congenital anomalies, neonatal surgery and pain management | 857 | ||
| Learning Outcomes | 857 | ||
| Introduction | 857 | ||
| Aetiology | 857 | ||
| Fetal Surgery | 858 | ||
| Abnormalities of the Alimentary Tract | 858 | ||
| Cleft lip and palate | 859 | ||
| Pierre-Robin sequence | 859 | ||
| Intestinal obstruction | 859 | ||
| Duodenal atresia | 859 | ||
| Small bowel atresias | 859 | ||
| Malrotation | 859 | ||
| Anorectal malformations | 860 | ||
| Hirschsprung’s disease | 861 | ||
| Abdominal wall defects | 861 | ||
| Disorders of the Respiratory System | 862 | ||
| Choanal atresia | 862 | ||
| Congenital diaphragmatic hernia | 862 | ||
| Tracheo-oesophageal fistula and oesophageal atresia | 863 | ||
| Disorders of the Central Nervous System | 863 | ||
| Neural tube defects | 863 | ||
| Anencephaly | 864 | ||
| Spina bifida occulta | 864 | ||
| Meningoceles | 864 | ||
| Myelomeningoceles | 864 | ||
| Hydrocephalus | 864 | ||
| Microcephaly | 864 | ||
| Disorders of the Genitourinary System | 864 | ||
| Pelviureteral junction anomalies | 864 | ||
| Posterior urethral valves | 865 | ||
| Hypospadias | 865 | ||
| Epispadias | 865 | ||
| Kidney disorders | 865 | ||
| Renal agenesis (absence) | 865 | ||
| Cystic disease of the kidney | 865 | ||
| Disorders of sexual development | 865 | ||
| Chromosomal Abnormalities | 866 | ||
| Trisomy 21 (Down syndrome) | 866 | ||
| Trisomy 18 (Edward syndrome) | 866 | ||
| Trisomy 15 (Patau syndrome) | 866 | ||
| Turner syndrome (45 XO) | 866 | ||
| Abnormalities of the Skeletal System | 866 | ||
| Polydactyly and syndactyly | 866 | ||
| Limbs and feet | 867 | ||
| Skeletal dysplasias | 867 | ||
| Developmental dysplasia of the hip | 867 | ||
| Amniotic band syndrome | 867 | ||
| Neonatal Pain Management | 867 | ||
| Conclusion | 868 | ||
| References | 868 | ||
| Resources and additional reading | 869 | ||
| 50 Metabolic and endocrine disorders | 870 | ||
| Learning Outcomes | 870 | ||
| Introduction | 870 | ||
| Glucose Homeostasis | 870 | ||
| Disorders of Glucose Balance | 871 | ||
| Hypoglycaemia | 871 | ||
| Hyperglycaemia | 872 | ||
| Disorders of Electrolyte Balance | 872 | ||
| Hypernatremia | 872 | ||
| Hyponatraemia | 872 | ||
| Hypocalcaemia | 872 | ||
| Neonatal Metabolic Screening | 872 | ||
| Inborn Errors of Metabolism | 873 | ||
| Phenylketonuria | 873 | ||
| Medium-chain acyl-CoA dehydrogenase deficiency | 873 | ||
| Cystic fibrosis | 873 | ||
| Congenital hypothyroidism | 874 | ||
| Sickle-cell disease | 874 | ||
| Congenital adrenal hyperplasia | 874 | ||
| Galactosemia | 874 | ||
| Conclusion | 874 | ||
| References | 875 | ||
| Useful websites: | 875 | ||
| 51 Stillbirth and sudden infant death syndrome | 876 | ||
| Learning Outcomes | 876 | ||
| Introduction | 876 | ||
| Terminology | 876 | ||
| Incidence | 876 | ||
| Incidence of Sudden Infant Death Syndrome | 878 | ||
| Risk Factors for Stillbirth and Neonatal Death | 878 | ||
| Obesity, malnourishment and poor diet | 880 | ||
| Obesity | 880 | ||
| Malnourishment and poor diet | 880 | ||
| Medical disorders and hypertension | 880 | ||
| Smoking and substance misuse | 880 | ||
| Intra-uterine growth restriction | 881 | ||
| Reduced fetal movements | 881 | ||
| Prolonged pregnancy | 881 | ||
| Human Factors in Stillbirths | 881 | ||
| Public Health Messages | 882 | ||
| Sudden Infant Death Syndrome | 882 | ||
| Terminology | 882 | ||
| Sleep practices and environment | 883 | ||
| Breastfeeding | 883 | ||
| Smoking | 883 | ||
| The Role of the Midwife in Reducing Sids | 884 | ||
| Aftermath of a Baby Death | 884 | ||
| Review of Perinatal Deaths | 884 | ||
| Follow-Up Care | 884 | ||
| Future Pregnancies | 884 | ||
| Conclusion | 885 | ||
| References | 885 | ||
| Resources and additional reading | 887 | ||
| 52 Nausea and vomiting in pregnancy | 888 | ||
| Learning Outcomes | 888 | ||
| Introduction | 888 | ||
| Aetiology | 888 | ||
| Mild and Moderate Nausea and Vomiting | 889 | ||
| Hyperemesis Gravidarum | 889 | ||
| Psychosocial Impact | 889 | ||
| Risk to the fetus | 889 | ||
| Care and Management of Mild Symptoms | 889 | ||
| Alternative therapies | 890 | ||
| Pharmacological treatment | 890 | ||
| Care and Management of Moderate to Severe Nausea and Vomiting in Pregnancy | 890 | ||
| Eating Disorders and Vomiting in Pregnancy | 891 | ||
| Conclusion | 892 | ||
| References | 892 | ||
| Resources and additional reading | 893 | ||
| See chapter website | 893 | ||
| Useful websites: | 893 | ||
| 53 Bleeding in pregnancy | 895 | ||
| Learning Outcomes | 895 | ||
| Introduction | 895 | ||
| Bleeding Before the 24th Week of Pregnancy | 895 | ||
| Implantation Bleeding | 895 | ||
| Abortion | 896 | ||
| Threatened abortion | 896 | ||
| Spontaneous abortion | 896 | ||
| Causes | 896 | ||
| Inevitable abortion | 897 | ||
| Missed abortion | 898 | ||
| Recurrent abortion | 898 | ||
| Psychological effects | 898 | ||
| Induced abortion | 899 | ||
| Therapeutic abortion | 899 | ||
| Criminal abortion | 899 | ||
| Septic abortion | 899 | ||
| Gestational Trophoblastic Disease (Hydatidiform or Carneous Mole and Choriocarcinoma) | 900 | ||
| Hydatidiform or carneous mole | 900 | ||
| Signs and symptoms | 900 | ||
| Treatment | 900 | ||
| Choriocarcinoma | 900 | ||
| Ectopic or Extrauterine Gestation | 901 | ||
| Tubal pregnancy | 901 | ||
| Diagnosis | 901 | ||
| Management | 902 | ||
| Heterotopic or combined pregnancy | 902 | ||
| Secondary abdominal pregnancy | 902 | ||
| Bleeding From Associated Conditions | 903 | ||
| Cervical polyp | 903 | ||
| Ectropion of the cervix | 903 | ||
| Carcinoma of the cervix | 903 | ||
| Bleeding After the 24th Week – Antepartum Haemorrhage | 903 | ||
| Placenta Praevia | 903 | ||
| Causes | 904 | ||
| Associated conditions | 904 | ||
| Signs and symptoms | 905 | ||
| Management | 905 | ||
| Active treatment | 905 | ||
| Third stage | 905 | ||
| Abruptio Placentae | 906 | ||
| Causes | 907 | ||
| Types | 907 | ||
| Mild abruptio placentae | 907 | ||
| Moderate abruptio placentae | 907 | ||
| Severe abruptio placentae | 908 | ||
| Vasa Praevia | 908 | ||
| Outcome | 908 | ||
| Management of Antepartum Haemorrhage and the Midwife’s Role | 908 | ||
| At home | 908 | ||
| In the hospital | 909 | ||
| Complications | 910 | ||
| Conclusion | 911 | ||
| References | 912 | ||
| Resources and additional reading | 913 | ||
| 54 Hypertensive and medical disorders in pregnancy | 914 | ||
| Learning Outcomes | 914 | ||
| Introduction | 914 | ||
| Hypertensive Disorders | 914 | ||
| Blood pressure | 914 | ||
| Urinalysis | 915 | ||
| Oedema | 916 | ||
| Pre–Existing (Chronic) Hypertension | 916 | ||
| Management | 916 | ||
| Gestational Hypertension | 916 | ||
| Pre-eclampsia | 917 | ||
| Pathophysiology | 917 | ||
| Identification and diagnosis of PET | 918 | ||
| Management of severe PET | 919 | ||
| Maternal and fetal assessment | 921 | ||
| Control of blood pressure | 921 | ||
| Fluid restriction and fluid balance | 921 | ||
| Magnesium sulphate | 921 | ||
| Labour care | 921 | ||
| Emotional care | 921 | ||
| Postnatal care | 921 | ||
| Follow-up | 921 | ||
| Anaemia | 922 | ||
| Investigations | 922 | ||
| Iron-deficiency anaemia | 922 | ||
| Management | 923 | ||
| Folic acid deficiency anaemia | 923 | ||
| Haemoglobinopathies | 923 | ||
| Sickle cell disorders | 923 | ||
| Management | 924 | ||
| Preconception and antenatal care | 924 | ||
| Labour and postnatal care | 924 | ||
| Thalassaemia | 925 | ||
| Cardiac Disorders | 925 | ||
| Preconception assessment | 925 | ||
| Antenatal care | 926 | ||
| Labour care | 927 | ||
| Postnatal care | 927 | ||
| Thyroid Disorders | 927 | ||
| Hyperthyroidism | 928 | ||
| Hypothyroidism | 929 | ||
| Renal Disorders | 929 | ||
| Chronic renal disorders | 931 | ||
| Antenatal care | 932 | ||
| Labour care | 932 | ||
| Postnatal care | 932 | ||
| Renal transplant | 932 | ||
| Acute renal failure | 933 | ||
| Diabetes | 933 | ||
| Testing for gestational diabetes | 934 | ||
| Management of diabetes | 934 | ||
| Preconception care | 934 | ||
| Antenatal care | 935 | ||
| Respiratory Disorders | 936 | ||
| Asthma | 936 | ||
| Tuberculosis (TB) | 937 | ||
| Summary of care of pregnant woman with tuberculosis | 938 | ||
| Preconception care | 938 | ||
| Antenatal care | 938 | ||
| Labour care | 938 | ||
| Postnatal care | 938 | ||
| Epilepsy | 938 | ||
| Seizures | 939 | ||
| Antiepileptic medication | 939 | ||
| Preconception care | 940 | ||
| Antenatal care | 940 | ||
| Labour care | 940 | ||
| Postnatal care | 940 | ||
| Intrahepatic Cholestasis of Pregnancy | 941 | ||
| Conclusion | 941 | ||
| References | 942 | ||
| Further Reading | 945 | ||
| 55 Sexually transmitted infections | 946 | ||
| Learning outcomes: | 946 | ||
| Introduction | 946 | ||
| Chlamydia | 947 | ||
| Chlamydia in pregnancy and in the neonate | 947 | ||
| Gonorrhoea | 948 | ||
| Gonorrhoea in pregnancy and in the neonate | 948 | ||
| Syphilis | 948 | ||
| Syphilis in pregnancy and in the neonate | 949 | ||
| Herpes | 949 | ||
| Herpes in pregnancy and the neonate | 950 | ||
| Genital Warts – Human Papilloma Virus | 950 | ||
| Genital warts in pregnancy and the neonate | 951 | ||
| Hepatitis B Virus | 951 | ||
| Hepatitis B in pregnancy and the neonate | 951 | ||
| Human Immunodeficiency Virus | 952 | ||
| HIV in pregnancy and the neonate | 952 | ||
| Interventions During Pregnancy | 953 | ||
| Ethical Principles for Midwives Relating to STI and HIV Screening and Treatment | 954 | ||
| Conclusion | 954 | ||
| References | 955 | ||
| 56 Abnormalities of the genital tract | 957 | ||
| Learning Outcomes | 957 | ||
| Introduction | 957 | ||
| Developmental Anomalies | 957 | ||
| Diethylstilbestrol | 957 | ||
| Unicornuate uterus | 957 | ||
| Double uterus (uterus didelphys) | 958 | ||
| Subseptate and bicornuate uterus | 958 | ||
| Vaginal septum | 958 | ||
| Associated problems | 958 | ||
| Displacements of the Uterus | 959 | ||
| Retroversion of the gravid uterus | 959 | ||
| Diagnosis | 959 | ||
| Treatment | 959 | ||
| Risks | 959 | ||
| Anteversion of the gravid uterus (pendulous abdomen) | 959 | ||
| Prolapse of the gravid uterus | 960 | ||
| Pelvic Masses | 960 | ||
| Fibromyomata (fibroids) | 960 | ||
| Ovarian cyst | 961 | ||
| Female Genital Mutilation | 961 | ||
| Conclusion | 963 | ||
| References | 963 | ||
| Resources and additional reading | 964 | ||
| 57 Multiple pregnancy | 965 | ||
| Learning Outcomes | 965 | ||
| The Incidence of Multiple Births | 965 | ||
| Facts About Multiples | 965 | ||
| How twins arise | 965 | ||
| Causes of twinning | 965 | ||
| Determination of Zygosity | 966 | ||
| Placentation | 966 | ||
| Importance of chorionicity | 967 | ||
| Zygosity determination after birth | 967 | ||
| DNA testing | 967 | ||
| Diagnosis of a Multiple Pregnancy | 968 | ||
| Ultrasound examination | 968 | ||
| Abdominal examination | 968 | ||
| Inspection | 968 | ||
| Palpation | 968 | ||
| Auscultation | 968 | ||
| Antenatal Screening | 968 | ||
| Antenatal Preparation | 969 | ||
| Parent education | 969 | ||
| Preparation for breastfeeding | 969 | ||
| Complications Associated With a Multiple Pregnancy | 969 | ||
| More serious complications | 970 | ||
| Fetal Abnormalities Associated With Monozygotic Twins | 970 | ||
| Antenatal Care | 971 | ||
| Intrapartum Care | 971 | ||
| Timing of birth | 971 | ||
| Complications during labour and birth | 971 | ||
| Onset of labour | 971 | ||
| Care in labour | 972 | ||
| First stage | 972 | ||
| Second stage | 972 | ||
| Undiagnosed twins | 973 | ||
| Third stage | 973 | ||
| Examination of placenta and membranes | 973 | ||
| Delivery of triplets and higher-order births | 973 | ||
| Postnatal Care | 973 | ||
| Feeding multiples | 974 | ||
| Going home from the hospital | 974 | ||
| Sources of help | 975 | ||
| Family relationships | 975 | ||
| Individuality and identity | 975 | ||
| Postnatal depression | 975 | ||
| Bereavement | 975 | ||
| Disability | 976 | ||
| Multifetal pregnancy reduction | 976 | ||
| Selective feticide | 976 | ||
| Planning ahead | 976 | ||
| References | 977 | ||
| Resources and additional reading | 978 | ||
| 58 Preterm labour | 979 | ||
| Learning Outcomes | 979 | ||
| Introduction | 979 | ||
| Epidemiology | 979 | ||
| Risk factors | 980 | ||
| Prediction and Prevention of Preterm Labour | 981 | ||
| Cervicovaginal fetal fibronectin | 981 | ||
| Transvaginal ultrasound | 981 | ||
| Socioeconomic status | 981 | ||
| Prophylactic treatments | 981 | ||
| Vaginal progesterone | 981 | ||
| Cervical cerclage | 981 | ||
| Preterm Prelabour Rupture of the Membranes | 982 | ||
| Diagnosing P-PROM | 982 | ||
| Diagnostic criteria of preterm birth | 984 | ||
| Management of Preterm Labour | 984 | ||
| Treatment of Preterm Labour | 984 | ||
| Tocolysis | 984 | ||
| Emergency cervical sutures (‘rescue sutures’) | 985 | ||
| Antibiotics | 985 | ||
| Corticosteroids | 985 | ||
| Magnesium sulphate for neuroprotection | 985 | ||
| Delayed cord clamping | 986 | ||
| Effect on Families Following Preterm Birth and the Role of Community Midwife | 986 | ||
| Conclusion | 987 | ||
| References | 987 | ||
| Resources and additional reading | 989 | ||
| Useful websites: | 989 | ||
| 59 Obstetric interventions | 990 | ||
| Learning Outcomes | 990 | ||
| Introduction | 990 | ||
| Operative Vaginal Deliveries | 990 | ||
| The history of forceps and ventouse | 990 | ||
| Forceps versus ventouse | 991 | ||
| Can an assisted birth be avoided? | 991 | ||
| Indications for an instrumental delivery | 991 | ||
| Contraindications for an instrumental delivery | 992 | ||
| Place of delivery | 992 | ||
| If an instrumental delivery is necessary | 992 | ||
| Procedure | 992 | ||
| Forceps delivery | 992 | ||
| Ventouse/vacuum extraction | 992 | ||
| Neonatal complications | 993 | ||
| Maternal complications | 995 | ||
| Postnatal care | 995 | ||
| Caesarean Section | 996 | ||
| Classification of caesarean section | 996 | ||
| Indications for caesarean section | 996 | ||
| Risks of a caesarean section to the mother | 997 | ||
| Risks of caesarean section to the fetus | 997 | ||
| Can a caesarean section be avoided? | 998 | ||
| The midwife’s role before surgery | 998 | ||
| Choice of anaesthesia | 998 | ||
| General anaesthesia | 998 | ||
| Regional anaesthesia – spinal and epidural blocks | 999 | ||
| In theatre | 999 | ||
| Care of the infant in theatres | 999 | ||
| Immediate postoperative care | 1000 | ||
| Observations on return to postnatal ward | 1000 | ||
| Vaginal birth after caesarean section | 1001 | ||
| Conclusion | 1002 | ||
| References | 1002 | ||
| Additional reading and resources | 1003 | ||
| 60 Induction of labour and prolonged pregnancy | 1004 | ||
| Learning Outcomes | 1004 | ||
| Induction of Labour | 1004 | ||
| Assessing the Need for Induction | 1004 | ||
| Maternal indications | 1004 | ||
| Fetal indications | 1005 | ||
| Contraindications | 1005 | ||
| Induction of labour in specific circumstances | 1005 | ||
| Methods of induction | 1006 | ||
| Cervical assessment | 1006 | ||
| Membrane sweeping | 1006 | ||
| Pharmacological methods of induction | 1007 | ||
| Prostaglandins | 1007 | ||
| Oxytocin | 1008 | ||
| Antiprogesterones | 1008 | ||
| Mechanical methods of induction | 1008 | ||
| Other methods for inducing labour | 1009 | ||
| Location and timing of induction of labour | 1009 | ||
| Care during induction of labour | 1009 | ||
| International Perspectives | 1010 | ||
| Prolonged Pregnancy | 1010 | ||
| Risks of prolonged pregnancy | 1010 | ||
| Fetal | 1010 | ||
| Maternal | 1011 | ||
| Post-maturity syndrome | 1011 | ||
| Management of prolonged pregnancy | 1011 | ||
| Economic analysis | 1011 | ||
| Conclusion | 1012 | ||
| References | 1012 | ||
| Resources and additional reading | 1014 | ||
| Useful websites: | 1014 | ||
| 61 Rhythmic variations of labour | 1015 | ||
| Learning Outcomes | 1015 | ||
| Introduction | 1015 | ||
| The partogram | 1015 | ||
| Prolonged Labour | 1016 | ||
| Causes of prolonged labour | 1016 | ||
| Potential risks to the mother | 1017 | ||
| Risks to the fetus | 1017 | ||
| Principles of midwifery management | 1017 | ||
| Principles of the active management of labour | 1017 | ||
| Amniotomy | 1018 | ||
| Augmentation with oxytocin | 1018 | ||
| Use of oxytocin | 1018 | ||
| Management of a prolonged second stage of labour | 1019 | ||
| Management of a prolonged third stage of labour | 1019 | ||
| The psychological aspects of prolonged labour | 1020 | ||
| Overefficient Uterine Action (Precipitate Labour) | 1020 | ||
| Tonic Uterine Action | 1020 | ||
| Definition | 1020 | ||
| Midwifery management | 1020 | ||
| Cervical Dystocia | 1021 | ||
| Conclusion | 1021 | ||
| References | 1021 | ||
| Resources and Additional Reading | 1022 | ||
| Useful websites: | 1022 | ||
| 62 Malpositions and malpresentations | 1023 | ||
| Learning Outcomes | 1023 | ||
| Introduction | 1023 | ||
| Identifying Malpositions and Malpresentations of the Fetus | 1024 | ||
| Incidence | 1024 | ||
| Clinical Assessment | 1024 | ||
| Malposition of the Occiput | 1024 | ||
| Fetal positioning | 1024 | ||
| Diagnosis of the occipitoposterior position | 1026 | ||
| During pregnancy | 1026 | ||
| During labour | 1027 | ||
| Progress in labour | 1027 | ||
| Flexion of the fetal head | 1027 | ||
| Deflexion of the fetal head | 1027 | ||
| Persistent occipitoposterior position | 1028 | ||
| Deep transverse arrest | 1030 | ||
| Extension of the fetal head | 1030 | ||
| Complications of OPP | 1030 | ||
| Care in labour | 1030 | ||
| Malpresentations of the Fetus | 1030 | ||
| Breech presentation | 1031 | ||
| Types | 1032 | ||
| Causes | 1032 | ||
| Diagnosis during pregnancy | 1033 | ||
| Diagnosis during labour | 1034 | ||
| Associated risks | 1034 | ||
| Care and management – pregnancy | 1034 | ||
| Spontaneous cephalic version of the breech | 1035 | ||
| Mechanism of vaginal breech delivery | 1035 | ||
| Management of breech labour | 1037 | ||
| First stage of labour | 1039 | ||
| Second stage of labour | 1039 | ||
| Assisted breech delivery | 1039 | ||
| Complications of vaginal breech delivery | 1041 | ||
| Extended arms | 1041 | ||
| Extended head | 1042 | ||
| Entrapment of the fetal head | 1042 | ||
| Face presentation | 1042 | ||
| Identification in pregnancy | 1044 | ||
| Mechanisms | 1044 | ||
| Management | 1045 | ||
| Brow presentation | 1045 | ||
| Identification | 1046 | ||
| Management | 1046 | ||
| Oblique and transverse lie leading to shoulder presentation | 1047 | ||
| Identification | 1048 | ||
| Management | 1048 | ||
| Compound presentation | 1048 | ||
| Postnatal and Neonatal Implications | 1048 | ||
| Conclusion | 1049 | ||
| References | 1049 | ||
| Resources and additional reading | 1051 | ||
| General issues | 1051 | ||
| Antenatal examination of the abdomen | 1051 | ||
| Posterior fetal positions | 1051 | ||
| ‘Spinning Babies’ | 1051 | ||
| Breech | 1051 | ||
| 63 Obstructed labour and uterine rupture | 1052 | ||
| Learning Outcomes | 1052 | ||
| Introduction | 1052 | ||
| Morbidity and mortality associated with obstructed labour | 1052 | ||
| Obstructed Labour | 1053 | ||
| Causes | 1053 | ||
| Identifying obstructed labour | 1053 | ||
| Management | 1053 | ||
| Prevention | 1054 | ||
| Uterine Rupture | 1054 | ||
| Types of uterine rupture | 1055 | ||
| Risk factors | 1055 | ||
| Rupture in a scarred uterus | 1055 | ||
| Rupture in an unscarred uterus | 1055 | ||
| Signs and symptoms | 1056 | ||
| Management | 1056 | ||
| Aftercare | 1056 | ||
| Conclusion | 1057 | ||
| References | 1057 | ||
| Resources and additional reading | 1058 | ||
| 64 Shoulder dystocia | 1059 | ||
| Learning Outcomes | 1059 | ||
| Introduction | 1059 | ||
| Mechanism | 1059 | ||
| Initial actions | 1060 | ||
| Incidence and Risk | 1060 | ||
| Identification of risk factors | 1060 | ||
| Use of ultrasound to predict the macrosomic fetus | 1061 | ||
| Prediction of impending shoulder dystocia | 1061 | ||
| Manoeuvres for Management of Shoulder Dystocia | 1061 | ||
| McRoberts manoeuvre | 1061 | ||
| All-fours position | 1062 | ||
| Suprapubic pressure | 1063 | ||
| Episiotomy | 1063 | ||
| Rotational manoeuvres | 1063 | ||
| Abduction and adduction | 1063 | ||
| Woods’ manoeuvre | 1063 | ||
| Rubin manoeuvre | 1063 | ||
| Delivery of the posterior arm | 1064 | ||
| Zavanelli manoeuvre | 1064 | ||
| Other Procedures | 1065 | ||
| Symphysiotomy | 1065 | ||
| Cleidotomy | 1065 | ||
| Fundal pressure | 1065 | ||
| Maternal Outcomes | 1065 | ||
| Uterine rupture | 1066 | ||
| Postpartum haemorrhage and/or shock | 1066 | ||
| Soft tissue damage – cervix and vagina | 1066 | ||
| Infection | 1066 | ||
| The loss of the ‘perfect birth’ and the ‘perfect baby’ | 1066 | ||
| Birth Injury and Fetal Outcomes | 1066 | ||
| Brachial plexus injury | 1066 | ||
| Treatment for congenital brachial plexus injury | 1067 | ||
| Bony injury | 1067 | ||
| Notes and Record Keeping | 1068 | ||
| Education, Training and Development | 1068 | ||
| Conclusion | 1070 | ||
| References | 1070 | ||
| Resources and additional reading | 1072 | ||
| Useful websites: | 1072 | ||
| 65 Presentation and prolapse of the umbilical cord | 1073 | ||
| Learning Outcomes | 1073 | ||
| Introduction | 1073 | ||
| Causes | 1073 | ||
| Predisposing Factors | 1073 | ||
| General | 1073 | ||
| Clinician – iatrogenesis | 1074 | ||
| Diagnosis | 1074 | ||
| ‘See it’ | 1074 | ||
| ‘Hear it’ | 1074 | ||
| ‘Feel it’ | 1075 | ||
| Management of Cord Presentation | 1075 | ||
| Management of Cord Prolapse | 1075 | ||
| Bladder filling | 1076 | ||
| Psychological care | 1076 | ||
| Long-term outcomes for the mother may include: | 1077 | ||
| For the fetus/neonate: | 1077 | ||
| Conclusion | 1077 | ||
| References | 1078 | ||
| Resources and additional reading | 1078 | ||
| 66 Maternal morbidity following childbirth | 1079 | ||
| Learning Outcomes | 1079 | ||
| Introduction | 1079 | ||
| Role of Midwife | 1080 | ||
| Recognizing Maternal Morbidity | 1080 | ||
| Life-threatening health problems | 1080 | ||
| Haemorrhage | 1081 | ||
| Thromboembolism | 1082 | ||
| Infection | 1082 | ||
| Eclampsia | 1082 | ||
| Common Health Problems | 1083 | ||
| Breast problems | 1083 | ||
| Vaginal blood loss | 1083 | ||
| Urinary | 1083 | ||
| Bowel | 1083 | ||
| Perineal problems | 1084 | ||
| Caesarean section wounds | 1084 | ||
| Musculoskeletal | 1084 | ||
| Anaemia | 1085 | ||
| Tiredness and fatigue | 1085 | ||
| Headaches | 1085 | ||
| Longer Term Implications | 1085 | ||
| Culturally and Linguistically Diverse Considerations | 1086 | ||
| Influences of family and community | 1086 | ||
| Conclusion | 1086 | ||
| References | 1087 | ||
| Resources and additional reading | 1090 | ||
| 67 Complications related to the third stage of labour | 1091 | ||
| Learning Outcomes | 1091 | ||
| Introduction | 1091 | ||
| Postpartum Haemorrhage | 1091 | ||
| Definition | 1092 | ||
| Primary PPH | 1092 | ||
| Causes | 1092 | ||
| Risk factors | 1092 | ||
| Prevention | 1093 | ||
| During pregnancy | 1093 | ||
| Labour | 1093 | ||
| Third stage | 1094 | ||
| Accurate estimation of blood loss | 1094 | ||
| Managing PPH | 1094 | ||
| The principles of management | 1094 | ||
| Bleeding before the delivery of the placenta | 1094 | ||
| Managing a minor PPH | 1095 | ||
| Major obstetric haemorrhage | 1096 | ||
| Managing a major PPH | 1096 | ||
| Additional management of major obstetric haemorrhage | 1097 | ||
| Surgical procedures | 1098 | ||
| Radiological procedures | 1098 | ||
| Traumatic PPH | 1098 | ||
| Care following PPH | 1099 | ||
| Complications following PPH | 1099 | ||
| Hypovolaemic Shock | 1099 | ||
| Signs of deterioration/recognition of hypovolaemic shock | 1099 | ||
| Aids for recognizing shock: | 1100 | ||
| Disseminated intravascular coagulation | 1100 | ||
| Prolonged Third Stage and Retained Placenta | 1101 | ||
| Causes | 1101 | ||
| Morbid adherence of the placenta | 1102 | ||
| Acute Uterine Inversion | 1102 | ||
| Causes include: | 1103 | ||
| Diagnosis | 1103 | ||
| Management | 1103 | ||
| Amniotic Fluid Embolism | 1104 | ||
| Psychological Considerations | 1105 | ||
| Conclusion | 1105 | ||
| References | 1106 | ||
| 68 Pregnancy loss and the death of a baby | 1109 | ||
| Learning Outcomes | 1109 | ||
| Introduction | 1109 | ||
| Understanding Loss and Grief | 1110 | ||
| Worden’s tasks of mourning: 1. Accepting the reality of the loss | 1111 | ||
| Worden’s tasks of mourning: 2. Working through to the pain of grief | 1111 | ||
| Worden’s tasks of mourning: 3. Adjusting to an environment in which the deceased is missing | 1111 | ||
| Worden’s tasks of mourning: 4. To find an enduring connection in the midst of embarking on a new life | 1112 | ||
| The importance of the loss | 1112 | ||
| Different Parental Responses in Bereavement | 1113 | ||
| Supporting Parents | 1113 | ||
| Communication and listening | 1113 | ||
| Breaking Bad News | 1114 | ||
| The Scan – the Diagnosis | 1114 | ||
| Miscarriage | 1115 | ||
| Termination of Pregnancy for Fetal Anomaly | 1115 | ||
| Labour When a Baby Has Died Due to Miscarriage or TOPFA | 1116 | ||
| Practical Considerations of Birth | 1116 | ||
| Respecting parents | 1118 | ||
| Making memories | 1118 | ||
| The importance of memories | 1118 | ||
| Spiritual needs | 1119 | ||
| Washing and dressing the baby after death | 1119 | ||
| The value of photographs | 1119 | ||
| Involving Brothers and Sisters | 1120 | ||
| Family and Friends | 1122 | ||
| Organ Donation | 1122 | ||
| Postmortem Examination (Autopsy) | 1122 | ||
| Coroner’s postmortem | 1123 | ||
| Respectful Disposal | 1123 | ||
| Taking a Baby Home | 1123 | ||
| Leaving the hospital | 1123 | ||
| Registration of the Death | 1124 | ||
| Follow-up appointment and the postnatal period | 1124 | ||
| Return Visit to the Hospital Unit | 1124 | ||
| Aftercare and the Months Ahead | 1124 | ||
| How Professionals Can Help | 1125 | ||
| Therapeutic Use of Ourselves | 1125 | ||
| Looking after ourselves as professionals | 1125 | ||
| Support and Training for Midwives Working in Partnership With Families | 1126 | ||
| Support agencies | 1127 | ||
| Conclusion | 1127 | ||
| References | 1128 | ||
| Resources and additional reading | 1129 | ||
| 69 Maternal mental health and psychological issues | 1130 | ||
| Learning Outcomes | 1130 | ||
| Introduction | 1130 | ||
| A Global Perspective of Women’s Mental Health | 1131 | ||
| Violence Against Women | 1131 | ||
| Pregnancy, Childbirth and Mental Health | 1132 | ||
| Who Is ‘At Risk’? | 1132 | ||
| The Midwife’s Role in the Antenatal Period | 1133 | ||
| Assessment | 1133 | ||
| Risk of Suicide | 1134 | ||
| Common Maternal Mental Health Disorders | 1135 | ||
| Generalized anxiety disorder | 1135 | ||
| Index | 1159 | ||
| A | 1159 | ||
| B | 1162 | ||
| C | 1164 | ||
| D | 1169 | ||
| E | 1170 | ||
| F | 1172 | ||
| G | 1174 | ||
| H | 1175 | ||
| I | 1178 | ||
| J | 1179 | ||
| K | 1180 | ||
| L | 1180 | ||
| M | 1183 | ||
| N | 1187 | ||
| O | 1189 | ||
| P | 1191 | ||
| Q | 1196 | ||
| R | 1196 | ||
| S | 1198 | ||
| T | 1200 | ||
| U | 1202 | ||
| V | 1203 | ||
| W | 1204 | ||
| X | 1204 | ||
| Y | 1204 | ||
| Z | 1204 |