Additional Information
Book Details
Abstract
Mayes’ Midwifery, an established key textbook for students and qualified midwives, contains essential knowledge for professional practice. For this 14th edition, each section and chapter has been fully updated and enhanced by leading authors to ensure the text complies with contemporary practice and current guidelines. Added benefits are the availability of a variety of additional online resources for each chapter, including case studies, video and website links, and a bank of multiple-choice questions to test knowledge.
With a strong emphasis on normal birth, the book covers the spectrum of midwifery-related topics applied to practice, providing a foundation of knowledge, and encouraging independent thought through the use of reflective exercises in each chapter and online. The book provides midwives with material that meets individual ways of learning and supports current modes of midwifery education.
Mayes’ Midwifery is the text for initial preparation and for ongoing midwifery practice.
- New chapters on essential contemporary issues:
- Vulnerable women
- Perspectives on the future of midwifery, in a global context
- Evidence-based information to guide best practice
- Learning outcomes and Key Points in all chapters
- Reflective activities
Now with an integrated website offering additional resources and material including:
- Multiple-choice questions for self-testing
- Case studies
- Reflective activities to consolidate your professional development
- Useful additional reading, resources and weblinks
- Expanded topics
- Downloadable materials including illustrations
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Mayes' Midwifery: A Textbook for Midwives | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Contributors | vii | ||
| Foreword | xi | ||
| Preface | xiii | ||
| References | xv | ||
| Acknowledgements | xvii | ||
| Part 1 The midwife in context | 1 | ||
| Chapter 1 The global midwife | 3 | ||
| Learning Outcomes | 3 | ||
| Challenges in global midwifery for the 21st century | 3 | ||
| Contrasts and inequalities | 3 | ||
| Causes of maternal death | 3 | ||
| Main causes | 3 | ||
| Predisposing factors | 4 | ||
| Maternal morbidity | 5 | ||
| Inequalities associated with being a mother | 5 | ||
| The Safe Motherhood Initiative | 7 | ||
| The impact of modernization and development | 8 | ||
| Ensuring skilled care during childbirth | 9 | ||
| Epidemiological factors | 9 | ||
| International organizations | 9 | ||
| The place of the midwife in the global context | 9 | ||
| Important considerations for midwives intending to work overseas | 10 | ||
| Conclusion | 11 | ||
| Key Points | 11 | ||
| References | 11 | ||
| Chapter 2 A history of the midwifery profession in the United Kingdom | 13 | ||
| Learning Outcomes | 13 | ||
| The office of midwife: a female domain | 13 | ||
| What manner of women were midwives? | 13 | ||
| Midwifery knowledge | 14 | ||
| ‘In the straw’ | 14 | ||
| The midwife, the church and the law | 14 | ||
| Governing the midwife | 15 | ||
| Advent of the man-midwife | 16 | ||
| Maternal mortality | 16 | ||
| Midwives under threat | 17 | ||
| Lying-in hospitals and ‘out-door’ charities | 17 | ||
| Continental comparisons | 17 | ||
| ’Towards a complete new system of midwifery’ | 18 | ||
| The decline of the midwife | 19 | ||
| Maternal mortality and the State | 19 | ||
| The end of the midwife? | 19 | ||
| The Royal Maternity Charity and maternal mortality | 20 | ||
| The midwives institute, midwife registration and maternal mortality | 20 | ||
| The Midwives Act 1902 | 21 | ||
| The Central Midwives Board | 21 | ||
| ‘Certified Midwife’ | 21 | ||
| The continuing problem of maternal mortality | 22 | ||
| State midwifery | 22 | ||
| The National Health Service, maternity care and the midwife | 22 | ||
| Place of birth | 23 | ||
| Pathways to abnormality: the ‘new obstetrics’ | 24 | ||
| Responses of the midwifery profession | 24 | ||
| User protest and the ‘Active Childbirth’ Movement | 25 | ||
| Nurses, Midwives and Health Visitors Act, 1979 | 25 | ||
| Finding a new voice | 26 | ||
| ‘Choice in childbirth’ | 26 | ||
| Whose choice in childbirth? | 27 | ||
| Childbirth a ‘surgical operation?’ | 27 | ||
| Governmental views | 28 | ||
| ‘Choice, Continuity and Control’?: Winterton revisited | 28 | ||
| Can we measure ‘risk’? | 29 | ||
| Strait-jacket for labour: the partogram | 29 | ||
| Has the midwife a future? | 30 | ||
| A leadership for our times? | 30 | ||
| Key Points | 30 | ||
| References | 31 | ||
| Chapter 3 Statutory framework for practice | 33 | ||
| Learning Outcomes | 33 | ||
| Introduction | 33 | ||
| Legislation regulating the midwifery profession | 33 | ||
| Historical background | 33 | ||
| Reform of the health professions | 34 | ||
| Current legislation regulating midwifery | 34 | ||
| Health Act 1999 (Section 60) (DH 1999) | 34 | ||
| Modernising regulation – the new Nursing and Midwifery Council – a consultation document (NHS Executive 2000) | 34 | ||
| Establishing the new Nursing and Midwifery Council (DH 2001a) | 34 | ||
| Modernising regulation in the health professions – NHS consultation document (DH 2001b) | 34 | ||
| Nursing and Midwifery Order 2001 Statutory Instrument 2002 No. 253 (DH 2002b) | 34 | ||
| Trust, assurance and safety – the regulation of health professionals in the 21st century CM 7013 (DH 2007a) | 35 | ||
| The Nursing and Midwifery (Amendment) Order 2008 (DH 2008b) | 35 | ||
| Nursing and midwifery council | 35 | ||
| Core functions | 35 | ||
| Membership | 36 | ||
| Role and functions of the NMC Statutory Committees | 36 | ||
| 1. Midwifery Committee | 36 | ||
| 2. Investigating Committee | 36 | ||
| 3. Health Committee | 36 | ||
| 4. Conduct and Competence Committee | 36 | ||
| Conduct and Competence Committee and Health Committee Panels’ sanctions | 36 | ||
| Restoration to the Register of practitioners who have been struck off | 37 | ||
| Other requirements | 37 | ||
| Civil Standard of Proof | 37 | ||
| Role and functions of the NMC Non-Statutory Committees | 37 | ||
| 1. Appointments Board | 37 | ||
| 2. Audit, Risk and Assurance | 37 | ||
| 3. Business Planning and Governance | 37 | ||
| 4. Fitness to Practise | 37 | ||
| 5. Professional Practice and Registration | 37 | ||
| Functions of the NMC | 37 | ||
| Function 1: The Register | 37 | ||
| Function 2: Setting standards for education and practice | 38 | ||
| Pre-registration midwifery | 38 | ||
| Pre-registration midwifery standards and fitness to practise | 38 | ||
| Function 3: Regulating Fitness to Practise, Conduct and Performance | 38 | ||
| Midwives rules and standards (NMC 2004b) | 39 | ||
| Confidentiality (NMC 2006a) | 39 | ||
| Gifts and gratuities (NMC 2008e) | 39 | ||
| Environment of care (NMC 2008f) | 39 | ||
| Accountability (NMC 2008g) | 39 | ||
| The PREP handbook (NMC 2008h) | 39 | ||
| The code (NMC 2008i) | 39 | ||
| Standards for medicines management (NMC 2008j) | 39 | ||
| Record keeping: guidance for nurses and midwives (NMC 2009e) | 40 | ||
| Guidance on professional conduct for nursing and midwifery students (NMC 2010h) | 40 | ||
| Raising and escalating concerns: guidance for nurses and midwives (NMC 2010b) | 40 | ||
| Advice and information for employers of nurses and midwives (NMC 2010c) | 41 | ||
| Midwifery supervision | 41 | ||
| History of midwifery supervision | 41 | ||
| Education and training for supervisors of midwives | 41 | ||
| The Local Supervising Authority Midwifery Officer (LSAMO) | 41 | ||
| The Supervisor of Midwives (SOM) | 41 | ||
| Statutory supervision and management | 42 | ||
| Statutory supervision and clinical governance | 42 | ||
| Conclusion | 44 | ||
| Key Points | 44 | ||
| References | 44 | ||
| Chapter 4 The midwife as a lifelong learner | 47 | ||
| Learning Outcomes | 47 | ||
| Introduction | 47 | ||
| Lifelong learning | 47 | ||
| Midwifery education | 47 | ||
| Moving into higher education | 48 | ||
| Diplomas, degrees and scholarship | 50 | ||
| ‘PREP’, portfolios and practice | 50 | ||
| Future developments: degrees, masters and PhDs/APEL/APL | 53 | ||
| Computers, e-learning and the Net | 53 | ||
| New approaches in education | 54 | ||
| Learning and development | 54 | ||
| Learning | 54 | ||
| From andragogy to reflection | 58 | ||
| Reflection and reflective practice | 58 | ||
| Reflection for you … and others | 59 | ||
| Mentorship and the midwife as a role model | 59 | ||
| Conclusion | 61 | ||
| Key Points | 61 | ||
| References | 62 | ||
| Chapter 5 Evidence-based practice and research for practice | 65 | ||
| Learning Outcomes | 65 | ||
| Introduction | 65 | ||
| Definition | 65 | ||
| What is evidence? | 65 | ||
| Research | 66 | ||
| Systematic review: | 67 | ||
| Meta-analysis: | 67 | ||
| Hierarchy of evidence | 67 | ||
| What stimulates the search for evidence to use in practice? | 67 | ||
| Why search for evidence? | 68 | ||
| Resumé of case scenario | 68 | ||
| Framing an answerable question | 68 | ||
| Composing an answerable question | 69 | ||
| Searching for the evidence | 69 | ||
| The searching process | 69 | ||
| Some helpful hints in undertaking a search | 69 | ||
| Judging the evidence | 70 | ||
| Contexts for implementing the evidence | 70 | ||
| Evidence in practice for individual women | 71 | ||
| Getting research into practice | 71 | ||
| Evaluating the implementation of evidence in practice | 72 | ||
| Conclusion | 72 | ||
| Key Points | 72 | ||
| References | 72 | ||
| Chapter 6 Leadership and management in midwifery | 75 | ||
| Learning Outcomes | 75 | ||
| Introduction | 75 | ||
| The development of leadership and management theory | 76 | ||
| Leadership | 77 | ||
| Traditional theories of leadership | 77 | ||
| Trait theory | 77 | ||
| Behavioural theory | 78 | ||
| Behavioural theory and the midwife leader | 78 | ||
| Alternative leadership styles | 78 | ||
| Transformational leadership | 78 | ||
| Transformational leadership in contemporary midwifery practice | 79 | ||
| Competence-based leadership and supervision | 80 | ||
| Statutory midwifery supervision | 80 | ||
| Leadership of self, failure, self-efficacy and emotional intelligence | 80 | ||
| Emotional Intelligence and the midwife leader | 81 | ||
| Authentic leadership | 82 | ||
| Authentic leadership in midwifery | 83 | ||
| Conclusion: leadership and management within contemporary midwifery | 83 | ||
| References | 84 | ||
| Chapter 7 Governance in midwifery | 87 | ||
| Learning Outcomes | 87 | ||
| Introduction | 87 | ||
| NHS governance systems | 87 | ||
| The NHS | 87 | ||
| The NHS management and governance | 87 | ||
| Strategic health authorities (see website) | 88 | ||
| Multi-agency bodies | 88 | ||
| NHS and quality | 89 | ||
| Developing a vision and strategy | 90 | ||
| Quality in maternity care | 90 | ||
| Clinical governance | 90 | ||
| Policies, guidelines and standards | 91 | ||
| Audit | 92 | ||
| Management of risk | 92 | ||
| When standards are not met – learning from failures … | 92 | ||
| The role of supervision of midwives | 93 | ||
| Future quality issues | 93 | ||
| What governance means for midwives | 94 | ||
| Conclusion | 95 | ||
| Key Points | 95 | ||
| References | 95 | ||
| Chapter 8 Ethics and midwifery practice | 97 | ||
| Learning Outcomes | 97 | ||
| What is ethics? | 97 | ||
| Why is ethics important in midwifery? | 98 | ||
| Moral conflict | 98 | ||
| Moral dilemma | 98 | ||
| How are dilemmas solved? | 99 | ||
| Utilitarianism | 99 | ||
| Deontology | 99 | ||
| The duty of care | 101 | ||
| The duty of fidelity | 101 | ||
| The duty of beneficence | 101 | ||
| The duty of non-maleficence | 101 | ||
| The duty of justice | 101 | ||
| Principles | 101 | ||
| Autonomy | 101 | ||
| Conclusion | 103 | ||
| Key Points | 103 | ||
| References | 103 | ||
| Further Reading | 103 | ||
| Chapter 9 Law and the midwife | 105 | ||
| Learning Outcomes | 105 | ||
| Introduction to the law: the courts and how laws are made | 105 | ||
| The courts (Fig. 9.1) | 105 | ||
| Classification of the law | 105 | ||
| Sources of the law | 106 | ||
| Legislation | 106 | ||
| Common law | 106 | ||
| The Human Rights Act 1998 | 106 | ||
| Midwives rules and the code of professional conduct | 107 | ||
| Supervision | 108 | ||
| Litigation | 108 | ||
| Negligence | 108 | ||
| What is negligence? | 108 | ||
| Duty of care | 108 | ||
| Breach of duty | 108 | ||
| Determining the standard of care | 108 | ||
| Has there been a breach of the duty of care? | 110 | ||
| Causation | 110 | ||
| Factual causation | 110 | ||
| Reasonably foreseeable harm | 110 | ||
| No intervening cause which breaks the chain of causation | 111 | ||
| Harm | 111 | ||
| Vicarious and personal liability | 111 | ||
| Liability for student, unqualified assistants: supervision and delegation | 111 | ||
| Defences to an action | 111 | ||
| Dispute allegations | 112 | ||
| Deny that all the elements of negligence are established | 112 | ||
| Contributory negligence | 112 | ||
| Exemption from liability | 112 | ||
| Limitation of time | 112 | ||
| Voluntary assumption of risk | 113 | ||
| Compensation | 113 | ||
| Current developments in civil law | 113 | ||
| Conditional fees | 114 | ||
| The NHS litigation authority (NHSLA) and the clinical negligence scheme for trusts (CNST) | 114 | ||
| Consent | 114 | ||
| Trespass to the person | 114 | ||
| Defences to an action for trespass to the person | 115 | ||
| Consent and negligence | 115 | ||
| Elements of consent | 115 | ||
| Voluntarily | 115 | ||
| Informed | 115 | ||
| Capacity | 115 | ||
| Refusal to consent | 116 | ||
| Mental Capacity Act 2005 | 116 | ||
| Forms of consent and consent forms | 117 | ||
| What if someone wishes to leave hospital? | 117 | ||
| Laws regulating pregnancy, birth and children | 117 | ||
| Abortion Act 1967 as amended (Box 9.4) | 117 | ||
| Registration of births and stillbirths; births under 24 weeks | 117 | ||
| Human Fertilisation and Embryology Acts 1990, 1992 and 2008 | 118 | ||
| Criminal law and attendance at birth | 118 | ||
| Children Acts 1989 and 2004 | 118 | ||
| Health and safety laws | 118 | ||
| Legal aspects of record-keeping | 118 | ||
| Medicines | 119 | ||
| Complaints | 119 | ||
| Miscellaneous legal issues of relevance to the midwife | 119 | ||
| Care of property | 119 | ||
| Vaccine damage | 119 | ||
| Congenital Disabilities (Civil Liability) Act 1976 | 119 | ||
| Negligent advice | 120 | ||
| Statutory duties and the duty of quality | 120 | ||
| Clinical governance and the duty of quality | 120 | ||
| National Service Frameworks (NSFs) | 120 | ||
| Future changes | 120 | ||
| Conclusion | 121 | ||
| Key Points | 121 | ||
| References | 121 | ||
| Statutes | 122 | ||
| Cases | 122 | ||
| Chapter 10 Pharmacology and the midwife | 123 | ||
| Learning Outcomes | 123 | ||
| Therapeutics in childbirth | 123 | ||
| Adverse reactions | 123 | ||
| Dose-dependent adverse reactions | 123 | ||
| Adverse reactions unrelated to dose: hypersensitivity responses | 124 | ||
| Transgenerational adverse reactions | 124 | ||
| Drugs in pregnancy | 124 | ||
| Drugs in childbirth | 124 | ||
| Pharmacology in pregnancy and lactation | 124 | ||
| Breastfed infants | 125 | ||
| Drug administration and absorption | 125 | ||
| Routes of administration | 125 | ||
| Therapeutic range | 125 | ||
| Drug distribution | 126 | ||
| Pregnancy | 126 | ||
| Childbirth | 126 | ||
| Lactation | 126 | ||
| Neonates | 126 | ||
| Elimination or clearance of drugs | 126 | ||
| Drug metabolism | 126 | ||
| Drug excretion | 126 | ||
| Pharmacodynamics | 127 | ||
| Tolerance or desensitization | 127 | ||
| Supersensitivity | 127 | ||
| Drugs in labour | 127 | ||
| Analgesics | 127 | ||
| Inhalational analgesia: nitrous oxide with oxygen (Entonox) | 127 | ||
| Actions and adverse reactions | 128 | ||
| Interactions | 128 | ||
| Cautions | 128 | ||
| Opioids | 128 | ||
| Epidural and intrathecal opioids and local anaesthetics | 129 | ||
| Actions | 129 | ||
| Adverse reactions | 129 | ||
| Respiratory depression | 129 | ||
| Bradycardia | 129 | ||
| Hypotension | 129 | ||
| Thermoregulation | 130 | ||
| Breastfeeding | 130 | ||
| Prolonged labour | 130 | ||
| Retention of urine and dysuria | 130 | ||
| Gastrointestinal effects | 130 | ||
| Pruritus | 130 | ||
| Other potential problems | 130 | ||
| Cautions and contraindications | 130 | ||
| Interactions | 130 | ||
| Uterotonics (for more information, see the website) | 130 | ||
| Prostaglandins | 131 | ||
| Actions and adverse reactions | 131 | ||
| Oxytocin | 131 | ||
| Adverse reactions | 131 | ||
| Overstimulation of the uterus | 131 | ||
| Fluid retention | 131 | ||
| Changes in blood pressure | 132 | ||
| Postpartum haemorrhage | 132 | ||
| Cautions and contraindications | 132 | ||
| Cautions | 132 | ||
| Interactions | 132 | ||
| Ergometrine | 132 | ||
| Actions and adverse reactions | 132 | ||
| Contraction of the uterus | 132 | ||
| Vomiting and diarrhoea | 132 | ||
| Vasoconstriction | 132 | ||
| Breastfeeding | 133 | ||
| Cautions and contraindications | 133 | ||
| Drugs for third stage | 133 | ||
| Drugs for symptom relief | 133 | ||
| Preventive medicines | 133 | ||
| Legal aspects | 133 | ||
| Midwives and controlled drugs | 134 | ||
| Conclusion | 134 | ||
| Key Points | 134 | ||
| References | 134 | ||
| Part 2 Childbirth in context | 137 | ||
| Chapter 11 Social, cultural and spiritual context of childbearing | 139 | ||
| Learning Outcomes | 139 | ||
| Introduction | 139 | ||
| Social class and social disadvantage | 140 | ||
| Ethnicity | 141 | ||
| Gender and family patterns | 142 | ||
| SpirItuality | 144 | ||
| Conclusion | 144 | ||
| Key Points | 144 | ||
| References | 145 | ||
| Chapter 12 Psychological context | 147 | ||
| Learning Outcomes | 147 | ||
| Introduction | 147 | ||
| Relationship | 147 | ||
| Trust | 148 | ||
| Respect | 148 | ||
| Communication | 149 | ||
| The dynamics of communication processes | 149 | ||
| Specific communication skills | 149 | ||
| Active listening | 150 | ||
| Therapeutic counselling | 151 | ||
| Improving midwifery care | 151 | ||
| Interpreters | 151 | ||
| Psychological aspects of pregnancy | 151 | ||
| Family relationships | 152 | ||
| Adapting to pregnancy | 152 | ||
| Psychological health during pregnancy | 152 | ||
| Psychological aspects of caesarean section | 153 | ||
| Post birth, the early days of motherhood | 153 | ||
| Baby in the neonatal unit | 154 | ||
| Physiological event | 154 | ||
| Conclusion | 155 | ||
| Key Points | 155 | ||
| References | 155 | ||
| Chapter 13 Sexuality | 157 | ||
| Learning Outcomes | 157 | ||
| Sexuality | 157 | ||
| Puberty and teenage pregnancy | 157 | ||
| Sex during pregnancy | 157 | ||
| Sexuality and labour | 158 | ||
| Women requiring specialized care | 159 | ||
| Survivors of sexual abuse | 159 | ||
| Caring for the lesbian client | 160 | ||
| Female genital mutilation (FGM) | 160 | ||
| Sexually transmitted infections (STIs) | 160 | ||
| Paternal presence at the birth | 160 | ||
| Perineal care | 160 | ||
| Sex after childbirth | 160 | ||
| Breastfeeding and sexuality | 161 | ||
| Breastfeeding, sexuality and sexual difficulties | 161 | ||
| The menopause | 161 | ||
| Conclusion | 161 | ||
| Key Points | 161 | ||
| References | 162 | ||
| Chapter 14 The health service context and midwifery | 163 | ||
| Learning Outcomes | 163 | ||
| Introduction | 163 | ||
| A little history | 164 | ||
| The new NHS | 164 | ||
| The challenges of modernization | 165 | ||
| Looking to the future | 167 | ||
| Midwifery in the future nhs | 168 | ||
| What is a midwife? | 168 | ||
| Who is in the maternity care team? | 168 | ||
| Redefining partnerships | 168 | ||
| Defining priorities, making best use of resources | 168 | ||
| Positioning the profession | 169 | ||
| Conclusion | 169 | ||
| Key Points | 169 | ||
| References | 170 | ||
| Chapter 15 Legal frameworks for the care of the child | 171 | ||
| Learning Outcomes | 171 | ||
| Introduction | 171 | ||
| The Children Act 1989 | 171 | ||
| Key features of the Children Act 1989 | 172 | ||
| Content and structure of the Children Act | 173 | ||
| Part 1 (section 1): Welfare of the child | 173 | ||
| Part 1 (section 2): Parents and parental responsibility | 173 | ||
| Who has parental responsibility? | 173 | ||
| Support for children and families | 174 | ||
| The changing nature of family | 174 | ||
| Poverty and social exclusion | 174 | ||
| Employment rights | 174 | ||
| Family support and the Children Act | 174 | ||
| Family support services | 175 | ||
| Children living away from home (see website) | 175 | ||
| Accommodation for young babies | 175 | ||
| Adoption (see website) | 175 | ||
| Children with disabilities (see website) | 175 | ||
| Female genital mutilation | 175 | ||
| The protection of children | 175 | ||
| Local Safeguarding Children Boards | 176 | ||
| Significant harm | 177 | ||
| Assessing children ‘in need’ and their families | 177 | ||
| Making a referral | 178 | ||
| Consent and confidentiality | 178 | ||
| The midwife’s role in assessment | 178 | ||
| Pre-birth assessment | 179 | ||
| The emergency protection order | 179 | ||
| The child protection conference | 180 | ||
| Child protection plan | 180 | ||
| Conclusion | 181 | ||
| Key Points | 181 | ||
| References | 181 | ||
| Part 3 Public health, health promotion and childbirth | 183 | ||
| Chapter 16 Epidemiology | 185 | ||
| Learning Outcomes | 185 | ||
| Introduction | 185 | ||
| Notification and registration of births | 185 | ||
| Facts and figures surrounding fertility and birth rates | 185 | ||
| General fertility rate | 185 | ||
| Total fertility rate | 186 | ||
| Birth rate | 186 | ||
| Teenage pregnancy rate | 186 | ||
| Fetal and infant deaths | 187 | ||
| Stillbirths | 187 | ||
| Perinatal deaths | 187 | ||
| Neonatal deaths | 187 | ||
| Infant mortality | 187 | ||
| Predisposing causes and risk factors for fetal, perinatal and infant death | 189 | ||
| Social factors | 189 | ||
| Biological and lifestyle factors | 189 | ||
| Obstetric factors | 189 | ||
| Medical conditions | 189 | ||
| Teratogenic factors | 189 | ||
| Dietary deficiencies | 190 | ||
| Maternal DEATHS | 190 | ||
| Confidential Enquiries into Maternal Deaths | 190 | ||
| Thrombosis and thromboembolism | 192 | ||
| Hypertensive disorders of pregnancy | 192 | ||
| Haemorrhage (Chs 54 & 68) | 193 | ||
| Genital tract sepsis (Ch. 52) | 193 | ||
| Amniotic fluid embolism | 193 | ||
| Indirect causes of maternal death | 194 | ||
| Statistics influencing change: reducing maternal, fetal and perinatal mortality | 194 | ||
| Key Points | 195 | ||
| References | 195 | ||
| Chapter 17 Nutrition | 197 | ||
| Learning Outcomes | 197 | ||
| The importance of good nutrition before and during pregnancy | 197 | ||
| Weight in pregnancy | 198 | ||
| Essential nutrients | 198 | ||
| Proteins and amino acids | 198 | ||
| Required for: | 198 | ||
| Protein foods: | 199 | ||
| Essential fatty acids | 199 | ||
| Part 4 The anatomy and physiology of fertility, conception and pregnancy | 275 | ||
| Chapter 24 Anatomy of male and female reproduction | 277 | ||
| Learning Outcomes | 277 | ||
| Introduction | 277 | ||
| The pelvis | 277 | ||
| Joints and ligaments of the pelvis | 277 | ||
| The true pelvis | 279 | ||
| Pelvic measurements (Fig. 24.4) | 279 | ||
| Pelvic conjugates | 282 | ||
| Anatomical conjugate | 282 | ||
| Obstetric conjugate | 282 | ||
| Internal or diagonal conjugate | 282 | ||
| Angles and planes | 282 | ||
| Pelvic variations | 283 | ||
| Other pelvic types identified | 283 | ||
| Pelvic assessment | 283 | ||
| Female reproductive anatomy | 286 | ||
| Fetal development | 287 | ||
| External genitalia | 287 | ||
| Blood supply | 287 | ||
| Lymphatic drainage | 287 | ||
| Nerve supply | 287 | ||
| Internal genitalia | 287 | ||
| Vagina | 289 | ||
| Part 5 Pregnancy | 395 | ||
| Chapter 31 Maternal and fetal responses to pregnancy | 397 | ||
| Learning Outcomes | 397 | ||
| Introduction | 397 | ||
| Pulmonary and cardiovascular adaptations | 397 | ||
| Adaptations in fluid regulation | 398 | ||
| Renal haemodynamic adaptations | 399 | ||
| Hormonal regulation | 400 | ||
| Cardiovascular adaptations | 401 | ||
| Peripheral arterial vasodilatation | 401 | ||
| Blood volume | 402 | ||
| Adaptations in the vascular renin–angiotensin– aldosterone system | 403 | ||
| Renin, angiotensins and angiotensin-converting enzymes | 403 | ||
| Aldosterone, progesterone and deoxycorticosterone | 403 | ||
| Atrial natriuretic peptide | 404 | ||
| Erythropoiesis | 405 | ||
| Ventilation | 405 | ||
| Oxygen consumption | 406 | ||
| The mammary glands/breasts | 407 | ||
| Uterine adaptations | 407 | ||
| Myometrial changes | 407 | ||
| Conclusion | 407 | ||
| Key Points | 408 | ||
| References | 408 | ||
| Chapter 32 Confirming pregnancy and care of the pregnant woman | 411 | ||
| Learning Outcomes | 411 | ||
| Introduction | 411 | ||
| Confirmation of pregnancy | 412 | ||
| First 4 weeks | 412 | ||
| Amenorrhoea: | 412 | ||
| Part 6 Labour and birth | 461 | ||
| Chapter 35 Physiological changes from late pregnancy until the onset of lactation | 463 | ||
| Learning Outcomes | 463 | ||
| Introduction | 463 | ||
| Acquiring brain capacities for mothering | 463 | ||
| Maternal HPA axis, social aggression and anxiety-related behaviours | 464 | ||
| Brain mechanisms underlying neuroendocrine and behavioural adaptations | 464 | ||
| Prolactin – maternal stress and anxiety | 464 | ||
| The maternal emotional brain – oxytocin and prolactin | 464 | ||
| Gestational analgesia | 464 | ||
| Neuroendocrine and central oxytocin systems – late pregnancy to weaning | 464 | ||
| Central oxytocin | 464 | ||
| Myometrial quiescence | 465 | ||
| Placental steroids | 465 | ||
| Placenta and fetal membranes | 465 | ||
| From pregnancy to labour | 465 | ||
| Fetal preparations for labour and lactation | 465 | ||
| The fetal adreno-placental ‘clock’ | 466 | ||
| Myometrial actions of placental CRH | 466 | ||
| CRH activity in placenta and membranes | 467 | ||
| Uterine oxytocin receptors | 467 | ||
| Nocturnal myometrial activation and cervical ripening | 467 | ||
| Cervical and uterine muscles | 468 | ||
| Uterocervical changes and inflammation | 469 | ||
| Remodelling gestational tissues | 469 | ||
| From late pregnancy to birth | 469 | ||
| Maternal–fetal readiness for labour | 470 | ||
| Neuroendocrine oxytocin | 470 | ||
| Towards the expulsive phase | 471 | ||
| Spontaneous maternal breathing | 472 | ||
| Fetal responses to labour and birth | 473 | ||
| Cardiovascular responses | 473 | ||
| Birth and placental separation | 473 | ||
| From fetus to neonate | 474 | ||
| Initiation of maternal behaviour and attachment | 475 | ||
| Conclusion | 476 | ||
| Key Points | 476 | ||
| References | 476 | ||
| Chapter 36 Care in the first stage of labour | 483 | ||
| Learning Outcomes | 483 | ||
| Introduction | 483 | ||
| The continuum of labour | 484 | ||
| Characteristics of labour | 485 | ||
| Physiology of labour | 485 | ||
| Cervical effacement and dilatation | 485 | ||
| Uterine contractions | 486 | ||
| Coordination of contractions | 487 | ||
| Retraction | 487 | ||
| Polarity | 487 | ||
| Intensity or amplitude | 487 | ||
| Resting tone | 487 | ||
| Formation of the forewaters and hindwaters (Fig. 36.4) | 487 | ||
| Rupture of the membranes | 488 | ||
| Show | 488 | ||
| Care during the first stage of labour | 488 | ||
| Partnership in care | 488 | ||
| Emotional and psychological care | 488 | ||
| The role of the birth supporter | 489 | ||
| Advocacy | 489 | ||
| Birth environment | 489 | ||
| Home | 490 | ||
| Birth centres or midwifery-led units | 490 | ||
| Onset of labour | 492 | ||
| Uterine contractions | 493 | ||
| Show | 493 | ||
| Rupture of the membranes | 493 | ||
| Contact with the midwife | 493 | ||
| Observations | 493 | ||
| General examination | 493 | ||
| Abdominal examination | 494 | ||
| Vaginal examination | 494 | ||
| Records | 494 | ||
| General midwifery care in labour | 494 | ||
| Assessment of progress | 494 | ||
| Origins of the progress paradigm | 494 | ||
| Organizational factors | 494 | ||
| Rhythms in early labour | 495 | ||
| Rhythms in mid labour | 496 | ||
| Vaginal examinations | 496 | ||
| Indications for vaginal examination | 496 | ||
| Method | 497 | ||
| Cervix | 497 | ||
| Consistency: | 497 | ||
| Effacement and dilatation: | 497 | ||
| Membranes | 497 | ||
| Presentation | 497 | ||
| Position | 497 | ||
| Flexion and station | 498 | ||
| Alternative skills for ‘sussing out’ labour | 498 | ||
| ‘Being with’, not ‘doing to’, labouring women | 499 | ||
| Loss per vaginam and rupture of the membranes | 499 | ||
| Bladder care | 499 | ||
| Mobility and ambulation | 500 | ||
| Upright posture | 500 | ||
| Moving and handling | 500 | ||
| Prevention of infection | 500 | ||
| Nutrition in labour | 502 | ||
| Assessing the fetal condition | 502 | ||
| Monitoring the fetal heart | 502 | ||
| Healthy fetal heart patterns | 503 | ||
| Electronic fetal monitoring | 503 | ||
| Conclusion | 504 | ||
| Key Points | 504 | ||
| References | 504 | ||
| Chapter 37 Care in the second stage of labour | 509 | ||
| Learning Outcomes | 509 | ||
| Introduction | 509 | ||
| Signs of progress | 509 | ||
| Transition | 509 | ||
| Expulsive phase | 510 | ||
| Physiology of the second stage of labour | 510 | ||
| Contractions | 510 | ||
| Secondary powers | 510 | ||
| The pelvic floor | 510 | ||
| Mechanism of labour | 511 | ||
| Descent | 511 | ||
| Flexion | 511 | ||
| Internal rotation | 511 | ||
| Crowning of the head | 512 | ||
| Extension | 512 | ||
| Restitution | 512 | ||
| Internal rotation of the shoulders | 512 | ||
| Lateral flexion | 513 | ||
| After the birth | 513 | ||
| Duration of the second stage of labour | 513 | ||
| Positions in the second stage of labour | 514 | ||
| Midwifery care | 514 | ||
| Hygiene and comfort measures | 514 | ||
| Support during transition | 514 | ||
| Support during the expulsive phase of labour | 514 | ||
| Early bearing-down efforts | 514 | ||
| Delayed bearing-down efforts | 515 | ||
| Pushing technique | 515 | ||
| Perineal practices | 515 | ||
| Assessing the need for episiotomy | 515 | ||
| Other midwifery techniques | 515 | ||
| Optimal fetal positioning | 515 | ||
| Waterbirth | 515 | ||
| Temperature of the water | 516 | ||
| Time of entry to water | 516 | ||
| Infection of mother or baby | 516 | ||
| Water embolism | 516 | ||
| Perineal trauma | 516 | ||
| Monitoring maternal and fetal health | 516 | ||
| The baby | 516 | ||
| Preparation for the birth | 516 | ||
| The activities of the midwife during the birth | 516 | ||
| Observations and recordings | 518 | ||
| Future research in this area | 519 | ||
| Conclusion | 519 | ||
| Key Points | 519 | ||
| References | 519 | ||
| Chapter 38 Pain, labour and women’s choice of pain relief | 521 | ||
| Learning Outcomes | 521 | ||
| Introduction | 521 | ||
| An exploration of pain in labour | 521 | ||
| Uterine nerve supply and nerve transmission | 522 | ||
| Pain gate theory | 523 | ||
| Psychological aspect of pain | 523 | ||
| Cultural aspect of pain | 523 | ||
| Impact of the environment on childbirth pains | 524 | ||
| Choices for pain relief in labour | 524 | ||
| Preparation for pain in childbirth | 524 | ||
| Concept of support in labour | 525 | ||
| Complementary and alternative therapies for pain relief | 525 | ||
| Hydrotherapy | 526 | ||
| Transcutaneous electrical nerve stimulation (TENS) | 526 | ||
| Pharmacological pain relief | 526 | ||
| Nitrous oxide | 527 | ||
| Systemic analgesia | 528 | ||
| Pethidine | 528 | ||
| Physiological action on the mother | 528 | ||
| Physiological effects on the fetus | 528 | ||
| Antagonist to pethidine | 528 | ||
| The lumbar epidural | 528 | ||
| Physiological effects of the epidural | 529 | ||
| Other complications | 530 | ||
| Respiratory arrest | 530 | ||
| Dural tap | 530 | ||
| Long-term backache | 530 | ||
| Conclusion | 530 | ||
| Key Points | 530 | ||
| References | 530 | ||
| Chapter 39 Care in the third stage of labour | 535 | ||
| Learning Outcomes | 535 | ||
| Introduction | 535 | ||
| Physiology of the third stage | 536 | ||
| Cord clamping | 536 | ||
| Presentation of the placenta at the vulva | 537 | ||
| Schultze. | 537 | ||
| Matthews Duncan. | 537 | ||
| Control of bleeding | 537 | ||
| Management of the third stage of labour | 539 | ||
| Expectant management | 539 | ||
| Principles of expectant management | 539 | ||
| Positioning the baby after birth | 539 | ||
| When to cut the cord | 539 | ||
| Position of the woman during the third stage of labour | 539 | ||
| Detection of separation and descent of the placenta | 540 | ||
| Delivery of the placenta and membranes | 540 | ||
| Active management | 540 | ||
| History of active management | 540 | ||
| Uterotonic drugs | 540 | ||
| Lack of skill in expectant management among midwives. | 541 | ||
| Difficulty in defining what constitutes excessive blood loss. | 541 | ||
| Variation in practice. | 541 | ||
| Current options | 541 | ||
| Syntocinon. | 541 | ||
| Intramuscular Syntometrine® 1 mL. | 542 | ||
| Intramuscular ergometrine 500 mcg. | 542 | ||
| Intravenous ergometrine 250–500 mcg. | 542 | ||
| Prostaglandins | 542 | ||
| Nipple stimulation | 542 | ||
| Principles of active management | 542 | ||
| Positioning the baby after birth | 542 | ||
| When to give the uterotonic | 542 | ||
| When to cut the cord | 542 | ||
| Position of the woman during the third stage of labour | 542 | ||
| Detection of separation and descent of the placenta | 543 | ||
| Signs of separation and descent | 543 | ||
| Delivery of the placenta and membranes | 543 | ||
| Examination of the placenta and membranes | 543 | ||
| Care following birth (the fourth stage) | 544 | ||
| Records | 545 | ||
| The placenta at term | 545 | ||
| Abnormalities of the placenta | 545 | ||
| Succenturiate lobe | 545 | ||
| Circumvallate placenta | 545 | ||
| Bipartite placenta | 546 | ||
| Placenta accreta | 546 | ||
| Infarcts | 546 | ||
| Calcification | 546 | ||
| Fetal membranes | 546 | ||
| The chorion. | 546 | ||
| The amnion. | 546 | ||
| Umbilical cord | 546 | ||
| Abnormalities of the umbilical cord | 547 | ||
| Abnormalities of insertion | 547 | ||
| Conclusion | 547 | ||
| Key Points | 548 | ||
| References | 548 | ||
| Chapter 40 The pelvic floor | 551 | ||
| Learning Outcomes | 551 | ||
| Introduction | 551 | ||
| The pelvic floor | 551 | ||
| Structure | 551 | ||
| Pelvic peritoneum | 551 | ||
| Pelvic fascia | 552 | ||
| Deep muscle layer | 552 | ||
| Blood, lymph and nerve supply | 552 | ||
| Superficial perineal muscles | 552 | ||
| Sphincters | 553 | ||
| Ischiorectal fossa | 554 | ||
| Blood, lymph and nerve supply | 554 | ||
| Subcutaneous fat and skin | 554 | ||
| Perineal body | 554 | ||
| Midwifery implications | 554 | ||
| Perineal trauma | 554 | ||
| Prevalence | 554 | ||
| Aetiology and risk factors | 554 | ||
| Short- and long-term effects | 555 | ||
| Antenatal preparation | 555 | ||
| Spontaneous trauma | 555 | ||
| Cervical tears | 555 | ||
| Surgical incision (episiotomy) | 556 | ||
| Timing of the incision | 556 | ||
| Indications | 556 | ||
| Risks | 557 | ||
| Complications | 558 | ||
| Episiotomy rate | 558 | ||
| Discussion | 558 | ||
| Suturing the perineum | 558 | ||
| Suture materials for primary repair of perineal trauma | 558 | ||
| Non-suturing of perineal skin | 558 | ||
| Tissue adhesive | 559 | ||
| Procedure (see Table 40.2) | 559 | ||
| Labial lacerations | 559 | ||
| Non-suturing of perineal trauma | 559 | ||
| Third- and fourth-degree tears | 559 | ||
| Identification of anal sphincter injury | 561 | ||
| Professional and legal issues | 561 | ||
| Conclusion | 561 | ||
| Key Points | 562 | ||
| References | 562 | ||
| Part 7 The newborn baby | 565 | ||
| Chapter 41 Physiology, assessment and care | 567 | ||
| Learning Outcomes | 567 | ||
| Introduction | 567 | ||
| The baby as an individual | 567 | ||
| Assessment of the newborn | 568 | ||
| Applied physiology | 568 | ||
| Respiratory system | 568 | ||
| Development (see also Ch. 45) | 568 | ||
| Lung fluid | 568 | ||
| Factors affecting lung maturity | 568 | ||
| Fetal breathing movements | 569 | ||
| Respiration in the neonate | 569 | ||
| Abnormal signs | 569 | ||
| Control of respiration | 569 | ||
| Cardiovascular system (CVS) in the embryo and fetus | 569 | ||
| Fetal circulation (see Ch. 45) | 569 | ||
| Changes at birth | 569 | ||
| Changes in the blood | 570 | ||
| Temperature control | 570 | ||
| Skin | 570 | ||
| Gastrointestinal system (see website) | 570 | ||
| Renal system | 571 | ||
| Glucose metabolism | 571 | ||
| Metabolic adjustments after birth | 571 | ||
| Musculoskeletal system | 571 | ||
| Central nervous system | 572 | ||
| Protection against infection | 572 | ||
| Care at birth | 572 | ||
| Preparation | 572 | ||
| The Apgar score | 573 | ||
| Maternal–infant relationship | 574 | ||
| Warmth | 574 | ||
| Identification | 574 | ||
| Vitamin K | 574 | ||
| Oral use of vitamin K | 575 | ||
| Prophylaxis against late-onset haemolytic haemorrhagic disease of the newborn (HDN) | 575 | ||
| Examination of the newborn | 575 | ||
| Initial post-birth examination | 575 | ||
| The holistic examination | 575 | ||
| Examination of the newborn assessment tool | 575 | ||
| Preparation | 576 | ||
| Communication | 576 | ||
| Informed consent | 576 | ||
| Daily examination | 576 | ||
| Physical assessment of the newborn | 576 | ||
| Formal assessment of the newborn | 576 | ||
| History | 576 | ||
| General appearance | 578 | ||
| Observation | 578 | ||
| Gestational assessment | 579 | ||
| Measurements | 579 | ||
| The UK WHO growth charts | 579 | ||
| Weight | 579 | ||
| Length | 579 | ||
| Head circumference | 579 | ||
| Vital signs | 580 | ||
| Skin | 580 | ||
| Haemangiomata | 580 | ||
| Dry skin | 580 | ||
| Cardiorespiratory system | 580 | ||
| Observation | 580 | ||
| Colour | 580 | ||
| Chest | 581 | ||
| Palpation | 581 | ||
| Auscultation | 581 | ||
| Congenital heart disease | 582 | ||
| Pulse oximetry | 582 | ||
| Morphological examination | 582 | ||
| The head | 582 | ||
| The hair | 582 | ||
| The face | 582 | ||
| The eyes | 583 | ||
| The ears | 583 | ||
| Hearing: | 583 | ||
| The mouth | 583 | ||
| The nose | 583 | ||
| The neck | 583 | ||
| Sharing information with parents | 583 | ||
| Musculoskeletal system | 584 | ||
| History | 584 | ||
| Examination | 584 | ||
| Upper extremities | 584 | ||
| Abdomen | 584 | ||
| Cleaning the cord: | 585 | ||
| Peristaltic movement | 585 | ||
| Palpation | 585 | ||
| Vomiting | 586 | ||
| The groin | 586 | ||
| Genitourinary | 586 | ||
| Male infant genitalia | 586 | ||
| Scrotum: | 586 | ||
| Testes: | 586 | ||
| Hydrocele: | 586 | ||
| Undescended testes (UDT) | 586 | ||
| Hypospadias: | 586 | ||
| Female infant genitalia | 587 | ||
| Ambiguous genitalia | 587 | ||
| Anus and rectum | 587 | ||
| Stools. | 587 | ||
| Constipation | 587 | ||
| Urinary output | 587 | ||
| Lower extremities | 587 | ||
| Ankles and feet | 587 | ||
| Assessment of the back | 587 | ||
| Hips | 588 | ||
| Examination | 588 | ||
| Observation | 589 | ||
| Ortolani and Barlow tests | 589 | ||
| Ortolani test | 589 | ||
| Barlow test | 589 | ||
| Additional investigations | 589 | ||
| Neurological examination | 589 | ||
| Physical examination | 590 | ||
| Level of consciousness: | 590 | ||
| Cry: | 590 | ||
| Head: | 590 | ||
| Face: | 590 | ||
| Eye examination: | 590 | ||
| Skin: | 590 | ||
| Skeletal system: | 590 | ||
| Tone: | 590 | ||
| Reflexes | 590 | ||
| Cranial nerves | 591 | ||
| Assessment of the autonomic nervous system | 591 | ||
| Identifying and managing pain and stress in the term newborn | 591 | ||
| Causes of pain | 591 | ||
| Signs of pain | 591 | ||
| Sucrose administration | 592 | ||
| Jitteriness versus seizures | 592 | ||
| Assessment of feeding | 592 | ||
| Bad news | 592 | ||
| Mother–baby attachment | 592 | ||
| Newborn behaviour | 593 | ||
| Sleep versus play time | 594 | ||
| Postnatal care | 594 | ||
| Follow-up of the baby | 594 | ||
| Hygiene | 594 | ||
| Sources of infection | 595 | ||
| Attendants. | 595 | ||
| Hands and clothing. | 595 | ||
| Dust. | 595 | ||
| Fomites. | 595 | ||
| Cross-infection. | 595 | ||
| Bathing the baby | 595 | ||
| Dermatitis of the groin, buttocks and anus | 595 | ||
| Treatment and care | 595 | ||
| Newborn screening tests | 596 | ||
| Blood spot screening test | 596 | ||
| Hearing tests | 596 | ||
| Vaccinations at birth | 596 | ||
| Record-keeping | 596 | ||
| Conclusion | 597 | ||
| Key Points | 597 | ||
| References | 597 | ||
| Chapter 42 Thermoregulation | 601 | ||
| Learning Outcomes | 601 | ||
| Introduction | 601 | ||
| Physiology of thermoregulation | 601 | ||
| Fetal perspective | 602 | ||
| Neonatal perspective | 602 | ||
| Internal and external gradients | 602 | ||
| Heat loss and gain | 603 | ||
| Neonatal heat production | 603 | ||
| Heat production and brown adipose tissue (BAT) | 604 | ||
| Feeding | 604 | ||
| Drugs | 604 | ||
| The role of the midwife | 604 | ||
| During pregnancy | 604 | ||
| Labour and birth | 605 | ||
| Waterbirth | 605 | ||
| Delivery room | 605 | ||
| Risk factors in labour | 605 | ||
| Initial newborn care | 605 | ||
| Bathing | 606 | ||
| Where | 606 | ||
| When | 606 | ||
| How | 606 | ||
| Resuscitation | 606 | ||
| Home environment | 606 | ||
| Oxygen therapy | 607 | ||
| Examination of the newborn | 607 | ||
| Temperature | 607 | ||
| Transfer | 607 | ||
| Monitoring and maintaining temperature | 608 | ||
| Monitoring | 608 | ||
| Maintaining temperature | 608 | ||
| Minimizing the risks of hypothermia | 609 | ||
| Wrapping and swaddling | 609 | ||
| Hats and clothes | 609 | ||
| Bathing | 609 | ||
| Parent education | 609 | ||
| The sick neonate | 609 | ||
| Hypothermia | 609 | ||
| Management | 610 | ||
| Moderate hypothermia (temperature 32–35.9°C) | 610 | ||
| Severe cold stress | 610 | ||
| Hyperthermia | 611 | ||
| Reversal of heat stress | 611 | ||
| Effects and signs of hyperthermia | 611 | ||
| Equipment | 611 | ||
| Incubators. | 611 | ||
| The transport incubator. | 611 | ||
| Heated mattress. | 611 | ||
| Phototherapy. | 611 | ||
| Heat shields. | 611 | ||
| Oxygen therapy. | 611 | ||
| Conclusion | 612 | ||
| Key Points | 612 | ||
| References | 612 | ||
| Chapter 43 Infant feeding | 615 | ||
| Learning Outcomes | 615 | ||
| Introduction | 615 | ||
| Gold standard | 615 | ||
| Public health issues | 616 | ||
| The full-term neonate – nutritional requirements | 617 | ||
| Physiology of the gastrointestinal tract | 617 | ||
| Normal neonatal metabolism | 617 | ||
| Constituents of colostrum and breast milk | 618 | ||
| Protein | 618 | ||
| Carbohydrates | 618 | ||
| Fats | 618 | ||
| Vitamins | 619 | ||
| Minerals | 619 | ||
| Defence agents | 619 | ||
| Advantages of breastfeeding | 619 | ||
| The normal neonate | 619 | ||
| The preterm neonate | 621 | ||
| The woman | 621 | ||
| Contraindications to breastfeeding | 621 | ||
| Neonatal conditions (WHO/UNICEF 2009) | 621 | ||
| Galactosaemia | 621 | ||
| Maple-syrup urine disease | 621 | ||
| Phenylketonuria | 621 | ||
| Maternal conditions | 621 | ||
| HIV | 621 | ||
| Drugs – maternal medication | 621 | ||
| Substance misuse | 622 | ||
| Conditions where a woman can continue to breastfeed but health problems may be of concern | 622 | ||
| Hepatitis B | 622 | ||
| Hepatitis C | 622 | ||
| Pollutants in breast milk | 622 | ||
| The role of the midwife | 622 | ||
| Knowledge of breastfeeding | 622 | ||
| Anatomy of the breast | 623 | ||
| Physiology of lactation | 623 | ||
| Puberty to pregnancy (mammogenesis) | 623 | ||
| Initiation of lactation (lactogenesis) | 623 | ||
| Maintenance of established lactation (galactopoiesis) | 625 | ||
| Assisting breastfeeding | 625 | ||
| Early initiation of breastfeeding | 625 | ||
| Positions for feeding and good attachment/latching-on | 625 | ||
| Positioning (‘nose to nipple’): | 625 | ||
| Attachment (‘baby to breast’) | 625 | ||
| Expressing | 626 | ||
| Storage of breast milk | 627 | ||
| Neonatal nutrition | 627 | ||
| Public health issues | 628 | ||
| Common problems | 628 | ||
| Insufficient milk | 628 | ||
| Engorgement – venous/milk | 629 | ||
| Sore/cracked nipples | 629 | ||
| Management | 629 | ||
| Mastitis | 630 | ||
| Causes | 630 | ||
| Signs and symptoms | 630 | ||
| Management | 630 | ||
| Neonatal problems | 630 | ||
| Tongue tie (ankyloglossia) | 630 | ||
| Cleft lip and palate | 630 | ||
| Down (or Down’s) syndrome | 630 | ||
| Breastfeeding the preterm baby | 630 | ||
| Twins and triplets | 630 | ||
| Going back to work | 631 | ||
| Artificial feeding | 631 | ||
| Reasons why some women may artificially feed their baby | 631 | ||
| Regulations surrounding infant formulae | 631 | ||
| Types of feed available | 631 | ||
| Methods of artificial feeding | 631 | ||
| Other methods | 632 | ||
| Complementary/supplementary feeds | 632 | ||
| Disadvantages of artificial feeding | 632 | ||
| Advantages of artificial feeding | 632 | ||
| The role of the midwife in artificial feeding | 635 | ||
| Preparation of feeds | 635 | ||
| Conclusion | 635 | ||
| Key Points | 635 | ||
| References | 636 | ||
| Chapter 44 The preterm baby and the small baby | 641 | ||
| Learning Outcomes | 641 | ||
| Introduction | 641 | ||
| Gestation | 641 | ||
| Centiles | 643 | ||
| Birthweight | 643 | ||
| The preterm baby | 644 | ||
| Causes | 644 | ||
| Characteristics (Fig. 44.4) | 646 | ||
| Management | 646 | ||
| Labour and delivery | 646 | ||
| Common problems | 647 | ||
| Respiratory | 647 | ||
| Respiratory distress syndrome | 647 | ||
| Apnoeas | 647 | ||
| Oxygen therapy | 647 | ||
| Temperature control | 647 | ||
| Hypoglycaemia | 647 | ||
| Jaundice | 648 | ||
| Patent ductus arteriosus (PDA) | 648 | ||
| Nutrition | 648 | ||
| Feeding methods | 648 | ||
| Intravenous feeding | 649 | ||
| Naso/orojejunal feeding | 649 | ||
| Naso/orogastric feeding | 649 | ||
| Nutritional supplements | 649 | ||
| Parent–baby relationship | 649 | ||
| Complications of prematurity | 650 | ||
| Chronic lung disease (CLD) | 650 | ||
| Infection | 650 | ||
| Hypocalcaemia | 650 | ||
| Hypoxic ischaemic encephalopathy (HIE) (birth asphyxia) | 650 | ||
| Cerebral haemorrhage and associated lesions | 651 | ||
| Anaemia | 651 | ||
| Vitamin K deficiency bleeding (VKDB) | 652 | ||
| Retinopathy of prematurity (ROP) | 652 | ||
| Necrotizing enterocolitis (NEC) | 652 | ||
| The neonatal intensive care unit (NICU) environment | 652 | ||
| Small-for-gestational-age (SGA) babies | 653 | ||
| Incidence | 653 | ||
| Causes | 653 | ||
| Characteristics (Fig. 44.8) | 654 | ||
| Asymmetrical growth restriction: | 654 | ||
| Symmetrical growth restriction: | 654 | ||
| Management | 654 | ||
| Labour and delivery | 654 | ||
| Complications | 655 | ||
| Hypoxic ischaemic encephalopathy (HIE) (birth asphyxia) | 655 | ||
| Meconium aspiration syndrome | 655 | ||
| Hypothermia | 655 | ||
| Hypoglycaemia | 655 | ||
| Polycythaemia | 655 | ||
| Poor feeding | 655 | ||
| Pulmonary haemorrhage | 655 | ||
| Substance abuse | 655 | ||
| Follow-up care for small and preterm babies | 656 | ||
| Outcomes | 656 | ||
| Ethical issues | 656 | ||
| Conclusion | 656 | ||
| Key Points | 657 | ||
| References | 657 | ||
| Chapter 45 Respiratory and cardiac disorders | 659 | ||
| Learning Outcomes | 659 | ||
| Introduction | 659 | ||
| Respiratory and cardiac development in the fetus | 659 | ||
| Respiratory development (Table 45.1) | 659 | ||
| Cardiac development | 659 | ||
| The fetal circulation | 660 | ||
| Transition to extrauterine life | 661 | ||
| Resuscitation of the newborn | 661 | ||
| Equipment for newborn resuscitation (Box 45.2) | 661 | ||
| Personnel | 662 | ||
| Thermal control | 662 | ||
| Assessment | 662 | ||
| Airway management | 662 | ||
| Breathing | 663 | ||
| Circulation | 663 | ||
| Drugs | 663 | ||
| Resuscitating preterm babies | 664 | ||
| Post-resuscitation care | 664 | ||
| Discontinuing resuscitation | 665 | ||
| Respiratory disorders in the newborn – principles of care | 665 | ||
| Meconium aspiration syndrome (MAS) | 665 | ||
| Resuscitation when meconium is present in the liquor | 665 | ||
| Aftercare | 666 | ||
| Transient tachypnoea of the newborn (TTN) | 667 | ||
| Part 8 The postnatal and neonatal period | 723 | ||
| Chapter 51 Content and organization of postnatal care | 725 | ||
| Learning Outcomes | 725 | ||
| Introduction | 725 | ||
| Aims of Postnatal Care | 725 | ||
| Physiological Changes during the Puerperium | 725 | ||
| Involution of the uterus | 725 | ||
| Hormonal changes | 726 | ||
| Cardiovascular system | 726 | ||
| Respiratory system | 726 | ||
| Musculoskeletal system | 726 | ||
| Gastrointestinal system | 726 | ||
| Urinary system | 726 | ||
| The Role of Health Professionals during the Postnatal Period | 727 | ||
| The role of the midwife | 727 | ||
| The role of the GP | 727 | ||
| The role of the health visitor | 727 | ||
| Content of Midwifery Postnatal Care | 727 | ||
| Research Underpinning Care of Women’s Physical Health during the Postnatal Period | 729 | ||
| Uterine involution and vaginal loss | 729 | ||
| Pain relief | 729 | ||
| Perineal care | 729 | ||
| Micturition and bowels | 730 | ||
| Breastfeeding (see Ch. 43) | 730 | ||
| Care of Women’s Psychological Health | 730 | ||
| Postpartum blues | 730 | ||
| Postnatal debriefing and psychosocial support | 731 | ||
| Organization of Midwifery Postnatal Care | 731 | ||
| Could Postnatal Care be More Effective? | 731 | ||
| Implications for Midwives | 732 | ||
| Key Points | 732 | ||
| References | 732 | ||
| Chapter 52 Morbidity following childbirth | 735 | ||
| Learning Outcomes | 735 | ||
| Introduction | 735 | ||
| Causes of Postnatal Morbidity | 735 | ||
| Life-threatening conditions | 735 | ||
| Common health problems | 736 | ||
| Urinary problems | 736 | ||
| Bowel problems | 737 | ||
| Perineal problems | 738 | ||
| Musculoskeletal system | 738 | ||
| Backache | 739 | ||
| Pelvic girdle pain | 739 | ||
| Other problems | 739 | ||
| Headache | 739 | ||
| Fatigue | 739 | ||
| Depression | 740 | ||
| Extent of Longer- Term Morbidity | 740 | ||
| Medical Consultation | 740 | ||
| Implications for Midwives | 741 | ||
| Key Points | 741 | ||
| References | 741 | ||
| Part 9 Problems and disorders of pregnancy, childbearing and birth and their management | 745 | ||
| Chapter 53 Nausea and vomiting | 747 | ||
| Learning Outcomes | 747 | ||
| Mild and Moderate Vomiting in Pregnancy | 748 | ||
| Hyperemesis Gravidarum | 748 | ||
| Care and Management | 748 | ||
| Mild nausea and vomiting | 748 | ||
| Moderate vomiting and hyperemesis | 749 | ||
| Eating Disorders and Vomiting in Pregnancy | 749 | ||
| Conclusion | 750 | ||
| Key Points | 750 | ||
| References | 750 | ||
| Chapter 54 Bleeding in pregnancy | 753 | ||
| Learning Outcomes | 753 | ||
| Introduction | 753 | ||
| Bleeding before the 24th week of pregnancy | 753 | ||
| Implantation bleeding | 753 | ||
| Abortion | 753 | ||
| Spontaneous abortion | 753 | ||
| Causes | 754 | ||
| Inevitable abortion | 755 | ||
| Missed abortion (delayed abortion, silent abortion) | 755 | ||
| Recurrent abortion | 755 | ||
| Psychological effects | 756 | ||
| Induced abortion | 756 | ||
| Therapeutic abortion | 756 | ||
| Methods of surgical abortion (Fig. 54.3) | 757 | ||
| Criminal abortion | 757 | ||
| Septic abortion | 757 | ||
| Gestational trophoblastic disease (hydatidiform mole and choriocarcinoma) | 757 | ||
| Hydatidiform mole | 757 | ||
| Signs and symptoms | 758 | ||
| Treatment | 758 | ||
| Choriocarcinoma | 758 | ||
| Ectopic or extrauterine gestation | 758 | ||
| Tubal pregnancy | 758 | ||
| Diagnosis | 759 | ||
| Management | 760 | ||
| Heterotopic or combined pregnancy | 760 | ||
| Secondary abdominal pregnancy | 760 | ||
| Bleeding from associated conditions | 760 | ||
| Cervical polyp | 760 | ||
| Ectropion of the cervix | 760 | ||
| Carcinoma of the cervix | 760 | ||
| Bleeding after the 24th week – antepartum haemorrhage | 761 | ||
| Placenta praevia | 761 | ||
| Causes | 761 | ||
| Associated conditions | 761 | ||
| Signs and symptoms | 762 | ||
| Management | 763 | ||
| Active treatment | 763 | ||
| Third stage | 763 | ||
| Abruptio placentae | 764 | ||
| Causes | 764 | ||
| Types | 764 | ||
| Revealed bleeding: | 764 | ||
| Concealed bleeding: | 765 | ||
| Partially revealed bleeding: | 765 | ||
| Mild abruptio placentae: | 765 | ||
| Moderate abruptio placentae: | 765 | ||
| Severe abruptio placentae: | 765 | ||
| Outcome | 765 | ||
| Management of antepartum haemorrhage and the midwife’s role | 765 | ||
| At home | 765 | ||
| In hospital | 766 | ||
| Complications | 767 | ||
| Blood coagulation disorders (see Ch. 68): | 767 | ||
| Acute renal failure: | 768 | ||
| Postpartum haemorrhage: | 768 | ||
| Infection: | 768 | ||
| Anaemia: | 768 | ||
| Psychological disturbances/psychoses: | 768 | ||
| Vasa praevia | 768 | ||
| Conclusion | 768 | ||
| Key Points | 768 | ||
| References | 768 | ||
| Chapter 55 Medical disorders of pregnancy | 771 | ||
| Learning Outcomes | 771 | ||
| Introduction | 771 | ||
| Anaemia | 772 | ||
| Types of anaemia | 772 | ||
| Effects on pregnancy and childbirth | 772 | ||
| Signs and symptoms | 772 | ||
| Iron deficiency anaemia | 772 | ||
| Investigations | 772 | ||
| Management | 772 | ||
| Folic acid deficiency anaemia | 773 | ||
| Part 10 The future | 969 | ||
| Chapter 71 Midwifery for the 21st century | 971 | ||
| Learning Outcomes | 971 | ||
| Introduction | 971 | ||
| The Future | 971 | ||
| Clinical care | 972 | ||
| Working with women | 972 | ||
| A multi-social and multicultural society | 972 | ||
| Governance | 973 | ||
| Management structures meeting the needs of women | 973 | ||
| Midwives as leaders | 973 | ||
| Supervision of midwives: action imperatives | 973 | ||
| Organizations of learning | 974 | ||
| Continuing professional development | 974 | ||
| Communication and relationships | 974 | ||
| Quality enhancement structures | 974 | ||
| Technology and Health | 974 | ||
| The Midwife with Global Vision | 975 | ||
| Conclusion | 975 | ||
| Key Points | 975 | ||
| References | 976 | ||
| Index | 977 | ||
| A | 977 | ||
| B | 980 | ||
| C | 982 | ||
| D | 985 | ||
| E | 986 | ||
| F | 988 | ||
| G | 990 | ||
| H | 992 | ||
| I | 994 | ||
| J | 995 | ||
| K | 995 | ||
| L | 995 | ||
| M | 998 | ||
| N | 1002 | ||
| O | 1004 | ||
| P | 1005 | ||
| Q | 1010 | ||
| R | 1010 | ||
| S | 1011 | ||
| T | 1013 | ||
| U | 1015 | ||
| V | 1016 | ||
| W | 1017 | ||
| X | 1017 | ||
| Y | 1017 | ||
| Z | 1017 |