Brief

Contents

Part I Midwifery

Chapter 1 History of Midwifery in the United States

Chapter 2 Professional Midwifery Today

Chapter 3 Midwifery: Clients, Context, and Care

Part II Midwives as Primary Care Providers

Chapter 4 Introduction to the Care of Women

Chapter 5 Health Promotion Across the Lifespan

Chapter 6 Common Conditions in Primary Care

Chapter 7 Nutrition

Chapter 8 Mental Health Conditions

Chapter 9 Pharmacotherapeutics

Part III Gynecology

Chapter 10 Anatomy and Physiology of the Female Reproductive System

Chapter 11 Menstrual Cycle Abnormalities

Chapter 12 Gynecologic Disorders

Chapter 13 Breast Conditions

Chapter 14 Reproductive Tract and Sexually Transmitted Infections

 Chapter 15 Family Planning

Chapter 16 Nonhormonal Contraception

Chapter 17 Hormonal Contraception

Chapter 18 Midlife, Menopause, and Beyond

Part IV Antepartum

Chapter 19 Anatomy and Physiology of Pregnancy

Chapter 20 Genetics

Chapter 21 Prenatal Care

Chapter 22 Pregnancy-Related Conditions

Chapter 23 Medical Complications in Pregnancy

Part V Intrapartum

Chapter 24 Anatomy and Physiology During Labor and Birth

Chapter 25 First Stage of Labor

Chapter 26 Fetal Assessment During Labor

Chapter 27 Support for Women During Labor

Chapter 28 Second Stage of Labor and Birth

Chapter 29 Complications During Labor and Birth

Chapter 30 Third Stage of Labor

Chapter 31 Birth in the Home and Birth Center

Part VI Postpartum

Chapter 32 Anatomy and Physiology of Postpartum

Chapter 33 Postpartum Care

Chapter 34 Postpartum Complications

 Chapter 35 Breastfeeding and the Mother–Newborn Dyad

Part VII Newborn

Chapter 36 Anatomy and Physiology of the Newborn

Chapter 37 Examination of the Newborn

Chapter 38 Neonatal Care

Index
 Contents

Preface
Acknowledgments
Contributors

Part I Midwifery
With Introduction by Holly Powell Kennedy

Chapter 1 History of Midwifery in the United States

Anne Z. Cockerham
Introduction
Evolution of Nurse-Midwifery’s Professional Image and Organization
Evolution of Legal Practice Authority for Nurse-Midwives
Evolution of the Midwifery Scope of Practice
Caring for Underserved Populations
Place of Birth
Nurse-Midwife/Physician Collaboration: Opportunities and Challenges
Documenting the Outcomes of Midwifery Care and Midwifery Research
Nurse-Midwifery Education
Conclusion
References

Chapter 2 Professional Midwifery Today

Deanne R. Williams
Introduction
The Profession of Midwifery
Types of Midwives
Core Competencies
Hallmarks of Midwifery
Accreditation
Certification
Licensure and Regulation
Code of Ethics
Midwives in the United States
Scope of Practice
Practice Patterns
 Other Roles for the Modern Midwife
Midwifery as a Worldwide Profession
Conclusion
Resources
References
Appendix 2A Worksheet for Engaging in Global Midwifery
Joyce E. Thompson

Chapter 3 Midwifery: Clients, Context, and Care

Jyesha Wren Serbin, Simon Adriane Ellis, Elizabeth Donnelly, and Kim Q. Dau with Betty
Jane Watts Carrington, Heather Clarke, Carolyn Curtis, Nicolle L. Gonzales, Patricia O.
Loftman, Felina M. Ortiz, M. Susan Stemmler, and Karline Wilson-Mitchell
Introduction
Social Structure: Power, Privilege, and Bias
Social Determinants of Health and Health Disparities
Socioeconomic Status
Racial Disparities
Sexual Orientation and Gender Identity
Gender-Based Violence
Techniques and Tools to Address Health Disparities in Midwifery Practice
Conclusion
Resources
References
Appendix 3A Reproductive Health Statistics
Mary C. Brucker and Tekoa L. King

Part II Midwives as Primary Care Providers

With Introduction by Lisa L. Paine

Chapter 4 Introduction to the Care of Women

Jan M. Kriebs
Midwife Means “With Woman”
Communication
Approaching the Woman
Collecting the Health History
The Physical Examination
In-Office Laboratory Testing
Establishing a Differential Diagnosis: Making an Assessment
Designing a Plan
Conclusion
Resources
References
Appendix 4A Standard Precautions
Jan M. Kriebs
Appendix 4B Collecting a Health History
Jan M. Kriebs
Appendix 4C The Physical Examination
Jan M. Kriebs
Appendix 4D Breast Examination
 Jan M. Kriebs
Appendix 4E Pelvic Examination
Jan M. Kriebs
Appendix 4F Collecting Urinary, Vaginal, Cervical, and Rectal Specimens for Testing and
Interpretation of Saline and KOH Slides
Jan M. Kriebs

Chapter 5 Health Promotion Across the Lifespan

Kathryn Osborne
Introduction
Health Promotion: Primary Prevention
Evidence-Based Counseling Interventions
Immunizations
Health Maintenance: Secondary Prevention
Reproductive Life Planning and Preconception Care
Conclusion
Resources
References
Appendix 5A Preconception Care Visit
Mary C. Brucker and Mary Ann Faucher

Chapter 6 Common Conditions in Primary Care

Jan M. Kriebs and Barbara K. Hackley
Introduction
Primary Care
Hematologic Conditions
Cardiovascular Conditions
Respiratory Conditions
Gastrointestinal Disorders and Abdominal Pain
Hepatitis
Conditions of the Genitourinary System
Endocrine Conditions
Neurologic Conditions
Musculoskeletal Disorders
Dermatologic Conditions
Substance Use: Screening and Counseling
Conclusion
Resources
References

Chapter 7 Nutrition
Mary K. Barger
Nutrition and Health
Nomenclature for Nutritional Standards
Macronutrients
Fats
Physiologic Response to Food Intake
Micronutrients: Vitamins and Minerals
Fat-Soluble Vitamins
 Water-Soluble Vitamins
Minerals
Role of Vitamin and Mineral Supplementation
Dietary Patterns
Weight Management Counseling and Dietary Patterns
Nutrition Across the Lifespan
Nutrition and Selected Conditions
Conclusion
Resources
References

Chapter 8 Mental Health Conditions

Barbara W. Graves
Screening for Mental Conditions
Overview: Psychotherapy and Pharmacotherapy
Mood Disorders
Depression
Anxiety and Stress Disorders
Mental Health Disturbances Related to the Menstrual Cycle
Perinatal Mental Health
Mental Health Disorders During Pregnancy
Postpartum Mood Disorders
Conclusion
Resources
References

Chapter 9 Pharmacotherapeutics
Mary C. Brucker and Tekoa L. King
Introduction
The Lexicon of Pharmacology
Drug Development and Regulation
Principles of Clinical Pharmacology
Pharmacotherapeutics in Primary Care
Use of Drugs During Pregnancy
Pharmaceuticals Commonly Used During Pregnancy
Conclusion
Resources
References

Part III Gynecology

With Introduction by Patricia Aikins Murphy and Frances E. Likis

Chapter 10 Anatomy and Physiology of the Female Reproductive System

Tekoa L. King and Mary C. Brucker
Introduction
The Breast
The External Female Genitalia
The Internal Female Genitalia
 The Bony Pelvis
The Obstetric Pelvis
Clinically Important Aspects of the True Pelvis
The Menstrual Cycle: An Introduction
Steroidogenesis
The Hypothalamic–Pituitary–Ovarian Axis
The Ovarian Cycle
The Endometrial Cycle
Female Sexual Response
Conclusion
Resources
References

Chapter 11 Menstrual Cycle Abnormalities

Debora M. Dole and Mary C. Brucker
Introduction
The Normal Menstrual Cycle and Variations
Amenorrhea
Abnormal Uterine Bleeding
Dysmenorrhea
Conclusion
Resources
References
Appendix 11A Endometrial Biopsy
Wendy Grube and William F. McCool

Chapter 12 Gynecologic Disorders

Sharon M. Bond, William F. McCool, and Mary C. Brucker
Introduction
Screening for Malignancies
Cancer of the Uterine Cervix
Gynecologic Evaluation and Pelvic Pain
Adnexal Masses in Reproductive-Age Women
Disorders of Uterine Origin
Uterine Cervical Variations and Disorders
Disorders of the Vulva
Pelvic Floor Dysfunction Disorders
Fertility/Infertility
Alterations in Women’s Sexual Function
Cancer of the Uterus, Ovary, Vulva, and Vagina
Congenital Uterine Anomalies
Conclusion
Resources
References
Appendix 12A Fitting a Pessary
Kathryn Osborne

Chapter 13 Breast Conditions

Joyce L. King
 Introduction
Breast Development
Evaluation of Breast Symptoms
Benign Breast Disorders
Breast Cancer
Screening for Women at Low or Average Risk for Breast Cancer
Screening for Women at High Risk for Breast Cancer
Breast Conditions During Pregnancy and Lactation
Conclusion
Resources
References

Chapter 14 Reproductive Tract and Sexually Transmitted Infections

Julia C. Phillippi
Introduction
History and Physical Examination for Vaginal Symptoms and Sexually Transmitted
Infections
Vaginal Microbiome
Vaginitis
Bacterial Vaginosis
Vulvovaginal Candidiasis
Atrophic Vaginitis
Other Causes of Vaginitis
Sexually Transmitted Infections
General Management Considerations Specific to
Sexually Transmitted Infections
Indications for Sexually Transmitted Infection Screening
Communicating Information About Sexually Transmitted Infections
Chlamydia
Gonorrhea
Pelvic Inflammatory Disease
Syphilis
Chancroid
Lymphogranuloma Venereum
Granuloma Inguinale
Human Papillomavirus
Herpes Simplex Virus
Hepatitis
Human Immunodeficiency Virus
Zika Virus
Protozoal and Parasitic Infections
Trichomoniasis
Pubic Lice (Pthiriasis)
Other Infectious Agents Spread by Sexual Contact
Resources
References

Chapter 15 Family Planning

Mary C. Brucker
 Introduction
Common Terms and Definitions
Family Planning Counseling and the Role of the Midwife
Counseling Women Who Have an Unintended Pregnancy
Induced Abortion
Emergency Contraception
Emerging Trends and Future Contraceptive Methods
Conclusion
Resources
References

Chapter 16 Nonhormonal Contraception

Mary C. Brucker
Introduction
The Effectiveness of Nonhormonal Methods in Preventing Pregnancy
Behavioral Methods
Spermicidal Agents
Barrier Methods
The Intrauterine Device
Permanent Contraception: Sterilization
Conclusion
Resources
References
Appendix 16A Fertility Awareness Methods
Mary C. Brucker
Appendix 16B Fitting Diaphragms
Mary C. Brucker
Appendix 16C Intrauterine Device Insertion and Removal
Melicia Escobar

Chapter 17 Hormonal Contraception

Mary C. Brucker
Introduction
Evolution of Hormonal Contraceptive Methods
Mechanism of Action of Hormonal Contraceptives
General Considerations for Hormonal Contraceptives
Clinical Evaluation for Women Initiating or Changing a Hormonal Contraceptive Method
Initiation of Hormonal Contraceptives
Changing from One Hormonal Method to Another
Managing Common Side Effects Associated with Hormonal
Contraceptive Methods
Short-Acting Reversible Contraceptives
Combined Oral Contraceptives
Progestin-Only Pills
Transdermal Contraception (The Patch)
Intravaginal Contraceptive Ring
Injectable Depot Medroxyprogesterone Acetate Contraceptives
Long-Acting Reversible Contraceptives
Subdermal Implants
 Hormonal Intrauterine Devices
Conclusion
Resources
References

Chapter 18 Midlife, Menopause, and Beyond

Julia Lange Kessler
Introduction
Physiology of Midlife, Menopause, and Aging
Menopause
Terms and Definitions for Menopause
Stages of Reproductive Aging
Diagnosing Menopause
Hallmark Symptoms of the Perimenopausal/Menopausal Period
Lifestyle Strategies for Treatment of Perimenopausal or
Menopausal Symptoms
Hormone Therapy for Treatment of Menopausal Symptoms
Nonhormonal Prescription Options for Treatment
of Menopausal Symptoms
Complementary and Alternative Therapies
Common Conditions Experienced by Women During Midlife and Beyond
Bone Health, Osteopenia, and Osteoporosis
Conclusion
Resources
References

Part IV Antepartum
With Introduction by Joyce E. Roberts

Chapter 19 Anatomy and Physiology of Pregnancy

Tekoa L. King
Introduction
The Reproductive Organs During Pregnancy
The Breast
The Uterus
Cervical Remodeling During Pregnancy
Hormones of Pregnancy
Fertilization and Implantation
The Placenta
Amniotic Fluid
The Umbilical Cord
The Embryo
The Fetus
Maternal Adaptations to Pregnancy
Fetopelvic Relationships
Conclusion
References
Chapter 20 Genetics
Gwen A. Latendresse
Introduction
Foundations in Genetics
Inheritance Patterns of Genetic Mutations
Chromosomal Disorders
Birth Defects, Incidence, and Risk Identification
Family History and Pedigree Evaluation as Risk Assessment Tools
Screening Tests Versus Diagnostic Tests
Factors That Influence Women’s Decision Making
Tests for Genetic and Chromosomal Disorders
Carrier Screening
Screening Tests
Diagnostic Tests
Ultrasound
Genetic Disorder Prevention and Risk Reduction
When Genetic Disorders Are Identified
Financial, Ethical, Legal, and Social Issues in Genetics
Future Trends in Genetic Testing
Conclusion
Resources
References
Appendix 20A Steps in Constructing a Three-Generation Pedigree
Gwen A. Latendresse

Chapter 21 Prenatal Care

Maria Openshaw, Cecilia M. Jevitt, and Tekoa L. King
Introduction
Overview of Prenatal Care
Initial Prenatal Visit
Interval Prenatal Visits
Gestational Weight Gain and Nutrition
Psychosocial Risk Screening and Counseling
Health Education During Pregnancy
Conclusion
Resources
References
Appendix 21A Abdominal Examination During Pregnancy
Tekoa L. King and Cecilia M. Jevitt
Appendix 21B Clinical Pelvimetry
Jennifer M. Demma, Karen Trister Grace, and Tekoa L. King

Chapter 22 Pregnancy-Related Conditions

Nancy Jo Reedy, Esther R. Ellsworth Bowers, and Tekoa L. King
Introduction
Overview of Midwifery Management of Women with Pregnancy-Related Conditions
Common Discomforts of Pregnancy
Early Pregnancy Loss
Fetal Conditions
 Placental, Amniotic Fluid, and Umbilical Cord Abnormalities
Cervical and Uterine Abnormalities
Preterm Birth
Premature Prelabor Rupture of Membranes
Membrane Sweeping
Dermatoses of Pregnancy
Peripartum Cardiomyopathy
Red Cell Alloimmunization
Population-Specific Special Considerations During Pregnancy
Techniques for Fetal Surveillance
Conclusion
Resources
References
Appendix 22A Auscultated Acceleration Test
Tekoa L. King

Chapter 23 Medical Complications in Pregnancy

Tekoa L. King and Mayri Sagady Leslie
Introduction
Autoimmune Disorders in Pregnancy
Diabetes
Gastrointestinal Conditions
Hematologic Disorders in Pregnancy
Hepatic Disorders
Hypertension During Pregnancy
Infectious Diseases
Neurologic Conditions
Respiratory Conditions
Thyroid Disorders
Urinary Disorders
Conclusion
Resources
References

Part V Intrapartum
With Introduction by Nancy K. Lowe

Chapter 24 Anatomy and Physiology During Labor and Birth

Cindy M. Anderson and Melissa D. Avery
Introduction
Premonitory Signs and Symptoms of Labor
Factors That Influence the Onset of Labor
Endocrinology of Labor: Parturition Cascade
Clinical Stages of Labor
Maternal Fetopelvic Relationships During Labor
Cardinal Movements of Labor
Maternal Systemic Adaptations in Labor
Fetal Response to Labor
 Conclusion
Resource
References

Chapter 25 First Stage of Labor

Jeremy L. Neal, Nancy K. Lowe, Sharon L. Ryan, and Linda A. Hunter
Introduction
Normal Physiologic Childbirth
Definitions of Labor
Premonitory Signs and Symptoms of Labor Onset
The Normal First Stage of Labor
Clinical Correlates of Duration of Labor Studies
Midwifery Management During the First Stage of Labor
Components of Midwifery Care for Laboring Women
Continuing Evaluation During Labor
Conclusion
Resources
References
Appendix 25A Evaluation and Diagnosis of Ruptured Membranes
Jeremy L. Neal, Nancy K. Lowe, Sharon L. Ryan, Linda A. Hunter, and Amy Marowitz

Chapter 26 Fetal Assessment During Labor

Tekoa L. King
Introduction
History of Fetal Heart Rate Monitoring
Fetal Physiology
Methods of Fetal Assessment During Labor
Fetal Heart Rate Patterns
Fetal Heart Rate Pattens That Reflect Fetal Acidemia
Relationship Between Fetal Heart Rate Patterns and Newborn Outcomes
Interpretation and Management of Fetal Heart Rate Patterns
Special Populations
Conclusion
Resources
References
Appendix 26A Intermittent Auscultation During Labor
Tekoa L. King
Appendix 26B Fetal Scalp Electrode
Tekoa L. King

Chapter 27 Support for Women During Labor

Elizabeth Nutter
Introduction
Physiology of Pain
Labor Pain
Women’s Experience of Labor
General Principles for Assessment of Labor Pain and Provision
of Labor Support
Labor Pain Relief Methods Used in the United States
 Nonpharmacologic Methods of Mitigating Pain
Pharmacologic Methods of Mitigating Labor Pain
Conclusion
Resources
References
Appendix 27A Injection of Intradermal Sterile Water Papules for Relief of Low Back
Pain in Labor
Tekoa L. King

Chapter 28 Second Stage of Labor and Birth

Lisa Kane Low and Kathryn Osborne
Introduction
Definition of Second-Stage Labor
Normal Course of the Second Stage of Labor
Prolonged Duration of Second-Stage Labor
Descent Abnormalities in Second-Stage Labor
Assessment of Maternal and Fetal Well-Being in Second-Stage Labor
Midwifery Management of the Second Stage of Labor
Preparing for the Birth
Management of the Birth
Hydrotherapy and Waterbirth
Immediately Following the Birth
Conclusion
Resources
References
Appendix 28A Hand Maneuvers for Birth
Barbara J. Reale
Appendix 28B Umbilical Cord-Clamping at Birth
Debra A. Erickson-Owens and Judith S. Mercer
Appendix 28C Genital Tract Injury: Immediate Postpartum Inspection of the Vulva,
Perineum, Vagina, and Cervix
Barbara J. Reale
Appendix 28D Local Infiltration for Laceration Repair
Barbara J. Reale and Tekoa L. King
Appendix 28E Pudendal Nerve Block for Vaginal Birth
Deborah Anderson
Appendix 28F Repair of Genital Tract Lacerations and Episiotomy
Barbara J. Reale

Chapter 29 Complications During Labor and Birth

Amy Marowitz
Introduction
Preterm Labor/Birth
Post-Term and Late Term Pregnancy
Prelabor Rupture of Membranes
Intrauterine Infection
Induction of Labor
Labor Abnormalities
Trial of Labor After Cesarean
 Intrapartum Management for Women with Coexisting
Medical Conditions
Obstetric Emergencies
Twin Gestation
Fetal Malpresentations
Breech Birth
Special Clinical Situations
Conclusion
Resources
References
Appendix 29A Shoulder Dystocia
Amy Marowitz
Appendix 29B Emergency Interventions for Umbilical Cord Prolapse
Amy Marowitz
Appendix 29C Intrapartum Management of Twin Gestation
Amy Marowitz
Appendix 29D Breech Birth
Amy Marowitz

Chapter 30 Third Stage of Labor

Mavis N. Schorn
Introduction
Definitions
Physiology of the Third Stage of Labor
Management of the Third Stage of Labor
Midwifery Management of the Third Stage of Labor
Complications of the Third Stage of Labor
Conclusion
Resources
References
Appendix 30A Management of the Third Stage of Labor
Mavis N. Schorn
Appendix 30B Inspection of the Umbilical Cord, Placenta,
and Membranes
Mavis N. Schorn
Appendix 30C Manual Removal of the Placenta
Mavis N. Schorn
Appendix 30D Initial Management of Uterine Inversion
Mavis N. Schorn
Appendix 30E Management of Immediate Postpartum Hemorrhage
Mavis N. Schorn
Appendix 30F Intrauterine Exploration
Mavis N. Schorn
Appendix 30G Sudden Postpartum Cardiovascular
or Neurologic Emergencies
Mavis N. Schorn

Chapter 31 Birth in the Home and Birth Center

Marsha E. Jackson and Alice J. Bailes
Introduction
 Background
Comparison of Home and Birth Center Settings
Safety During Birth in Home and Birth Center Settings
Essential Elements of Birth Center and Home Birth
Prenatal Care
The Intrapartum Period at Home or in the Birth Center
The Early Postpartum Period and Follow-Up
Framework for Clinical Management
Management of Non-Urgent Clinical Situations
Management of Urgent Emergency Clinical Situations
Business Aspects of Home and Birth Center Settings
Conclusion
Resources
References

Part VI Postpartum
With Introduction by Cheryl Tatano Beck

Chapter 32 Anatomy and Physiology of Postpartum

Tekoa L. King
Introduction
Anatomy and Physiology of Lactation
Reproductive Organ Involution
Wound Healing
Postpartum Physiology in Nonreproductive Organs
Cardiovascular and Hematologic Changes
Endocrine Changes
Conclusion
References

Chapter 33 Postpartum Care

Ira Kantrowitz-Gordon
Introduction
Cultural Perspectives of the Postpartum Period
The First Hour Postpartum: The Fourth Stage of Labor
Initial Postpartum Period
Mid-Postpartum Period
The Journey to Parenthood: Psychological Adaptation to Childbearing
Special Considerations
Conclusion
Resources
References
Appendix 33A Management of the Fourth Stage of Labor Following Spontaneous
Vaginal Birth
Ira Kantrowitz-Gordon
Appendix 33B History and Physical Examination During the Early
Postpartum Period
Ira Kantrowitz-Gordon
 Chapter 34 Postpartum Complications
Deborah Brandt Karsnitz
Introduction
Urinary Retention
Puerperal Fever and Puerperal Infection
Postpartum Bleeding Complications
Preeclampsia/Eclampsia in the Postpartum Period
Peripartum Cardiomyopathy
Postpartum Thrombophlebitis and Thromboembolism
Thyroiditis and Thyroid Storm
Conclusion
Resources
References

Chapter 35 Breastfeeding and the Mother–Newborn Dyad

Linda J. Smith, Tekoa L. King, and Cecilia M. Jevitt
Introduction
Lactogenesis and the Composition of Human Milk
The Importance of Breastfeeding
Barriers to Breastfeeding
Practices That Facilitate Breastfeeding
Contraindications to Breastfeeding
Pharmaceuticals and Breastfeeding
Assessment of the Maternal–Newborn Dyad During Breastfeeding
Breastfeeding Problems
Special Populations
Nutrition for Lactating Women
Formula-Feeding
Conclusion
Resources
References

Part VII Newborn

With Introduction by Lily Hsia

Chapter 36 Anatomy and Physiology of the Newborn

Cecilia M. Jevitt
Respiratory Changes
Circulatory Changes
Thermoregulation
Glucose Regulation
Hematologic System
The Newborn Immune System
The Newborn Gastrointestinal Tract
The Newborn Microbiome
The Renal System
Conclusion
Resources
 References

Chapter 37 Examination of the Newborn

Cecilia M. Jevitt
Introduction
History
Gestational Age Assessment
Physical Examination of the Newborn
Becoming Confident at Newborn Physical Examination
Resources
References
Appendix 37A Physical Examination of the Newborn
Cecilia M. Jevitt

Chapter 38 Neonatal Care

Cecilia M. Jevitt
Introduction
The First Golden Hour
Newborn Assessment and Care in the First Hours After Birth
The First Hours: The Newborn with an Unexpected Immediate Health Condition
The First Golden Days: Normal Newborn Behavior
The First Golden Days of Life: Care of the Healthy Neonate
Maternal Conditions That Influence Newborn Care
Newborn Disorders
Discharging the Newborn from Early Newborn Care
The First Golden Month: Primary Care of the Newborn
Conclusion
Resources
References
Index