Myles Textbook for Midwives

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Content that is suitable for use internationally, for example, by including different approaches to manoeuvres or named movements used in obstetric emergencies Guidance to support the trend for midwives to undertake the neonatal physical examination of the healthy term infant

assessment, planning, implementation, evaluation and documentation of care are all crucial for midwifery practice, human factors also matter. In England, the Francis Report (Mid Staffordshire NHS Foundation Trust Public Inquiry 2013) was the outcome of a public inquiry into failings at Mid Staffordshire and relevant regulatory bodies. It represents a watershed moment in the history of the UK National Health Service (NHS). The scale of the problems highlighted by the report relates to the unusually high death rates amongst the sick and vulnerable at Mid Staffordshire in the late 2000s. The key lessons learnt convey the importance of transparent, compassionate, committed, competent and confident caring premised on strong leadership. It can be argued therefore that common standards and a shared vision established through global initiatives such as the MDGs and the ICM definition of a midwife are essential for midwives working within a global community. Not least because there is a strong correlation between outcomes for mothers and babies and the specific professional competencies the midwife possesses.

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Karen Jackson, BSc (Hons) MPhil ADM RN RM Midwife Lecturer, University of Nottingham, Faculty of Medicine and Health Sciences, School of Health Sciences, Academic Division of Midwifery, University of Nottingham, UK Chapter 16 Physiology and care during the first stage of labour Chapter 27 Contraception and sexual health in a global society Carole England, BSc(Hons) ENB405 CertEd(FE) RGN RM Midwife Teacher, Academic Division of Midwifery, School of Health Sciences, University of Nottingham, Derby, UK Chapter 28 Recognizing the healthy baby at term through examination of the newborn screening Chapter 29 Resuscitation of the healthy baby at birth: the importance of drying, airway management and establishment of breathing Chapter 30 The healthy low birth weight baby Chapter 33 Significant problems in the newborn baby

IV Curriculum 1. The philosophy of the midwifery education programme is consistent with the ICM philosophy and model of care. 2. The purpose of the midwifery education is to produce a competent midwife who: a. has attained/demonstrated, at a minimum, the current ICM Essential Competencies for basic midwifery practice; b. meets the criteria of the ICM Definition of a Midwife and regulatory body standards leading to licensure or registration as a midwife; c. is eligible to apply for advanced education; and d. is a knowledgeable, autonomous practitioner who adheres to the ICM International Code of Ethics for Midwives, standards of the profession and established scope of practice within the jurisdiction where legally recognized. 3. The sequence and content of the midwifery curriculum enables the student to acquire essential competencies for midwifery practice in accord with ICM core documents. 4. The midwifery curriculum includes both theory and practice elements with a minimum of 40% theory and a minimum of 50% practice. a. Minimum length of a direct-entry midwifery education programme is 3 years; b. Minimum length of a post-nursing/health care provider (post-registration) midwifery education programme is 18 months. 5. The midwifery programme uses evidence-based approaches to teaching and learning that promote adult learning and competency based education. 6. The midwifery programme offers opportunities for multidisciplinary content and learning experiences that complement the midwifery content. Jenny Hassall, BSc(Hons) MSc MPhil RN RM School of Nursing and Midwifery, University of Brighton, Eastbourne, UK Chapter 9 Change and adaptation in pregnancy Margie Davies, RGN RM Midwifery Advisor, Multiple Births Foundation, Queen Charlotte’s and Chelsea Hospital, London, UK Chapter 14 Multiple pregnancyglobalization and internationalization with due consideration of the Millennium Development Goals, the European (EU) Directives and International Confederation of Midwives Education Standards Recognizing the healthy baby at term through examination of the newborn screening................................. 591 III Student body 1. The midwifery programme has clearly written admission policies that are accessible to potential applicants. These policies include: a. entry requirements, including minimum requirement of completion of secondary education; b. a transparent recruitment process; c. selection process and criteria for acceptance; and d. mechanisms for taking account of prior learning. 2. Eligible midwifery candidates are admitted without prejudice or discrimination (e.g., gender, age, national origin, religion). 3. Eligible midwifery candidates are admitted in keeping with national health care policies and maternity workforce plans. 4. The midwifery programme has clearly written student policies that include: a. expectations of students in classroom and practical areas; b. statements about students’ rights and responsibilities and an established process for addressing student appeals and/or grievances; c. mechanisms for students to provide feedback and ongoing evaluation of the midwifery curriculum, midwifery faculty, and the midwifery programme; and d. requirements for successful completion of the midwifery programme. 5. Mechanisms exist for the student’s active participation in midwifery programme governance and committees. 6. Students have sufficient midwifery practical experience in a variety of settings to attain, at a minimum, the current ICM Essential Competencies for basic midwifery practice. The ICM Global Midwifery Education Standards The ICM acknowledges that all midwifery programmes should be accountable to the public, mothers and their families, the profession, employers, students as well as one another. It is therefore the responsibility of the provider education institution to ensure that the undergraduate or Jayne E Marshall, PhD MA PGCEA ADM RM RGN Head of School of Midwifery and Child Health, Faculty of Health, Social Care and Education, St Georges, University of London/Kingston University, UK Chapter 1 The midwife in contemporary midwifery practice Chapter 2 Professional issues concerning the midwife and midwifery practice Chapter 13 Medical conditions of significance to midwifery practice Chapter 16 Physiology and care during the first stage of labour Chapter 17 Physiology and care during the transition and second stage phases of labour

preregistration curricula they provide have a stated philosophy, transparent, realistic, achievable goals and outcomes that prepare students to be fully qualified competent and autonomous midwives. The Global Standards for Midwifery Education 2010 as developed, outlined and amended by the ICM (2013) are deemed as the mainstays to strengthen midwifery education and practice. These standards, outlined in Box 1.3, were developed alongside two further documents: Companion Guidelines and Glossary, which are all available on the ICM website. In order to meet the needs of childbearing women and their families, the ICM (2013) highlights that these publications are ‘living’ documents subjected to continual scrutiny, evaluation and amendment as new evidence regarding midwifery education and practice unfolds. Therefore it is recommended by the ICM (2013) that all three documents should be reviewed together in the following order: the Glossary followed by the Global Standards for Education and concluding with the Companion Guidelines. Senior Lecturer in Midwifery/Course Leader, College of Nursing, Midwifery and Health Care, University of West London, Brentford, UK Chapter 12 Common problems associated with early and advanced pregnancy SECTION 3 Pregnancy 8 Antenatal education for birth and parenting.................................................127 Jenny Brewster, MEd(Open) BSc(Hons) PGCert RM RN Senior Lecturer in Midwifery, College of Nursing, Midwifery and Health Care, University of West London, Brentford, UK Chapter 12 Common problems associated with early and advanced pregnancy Stephen P Wardle, MB ChB MD FRCPCH Consultant Neonatologist, Neonatal Intensive Care Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK Chapter 33 Significant problems in the newborn babyRowena Doughty, PGDE BA(Hons) MSc ADM RM RN Senior Lecturer – Midwifery, School of Nursing and Midwifery, De Montfort University, Leicester, UK Chapter 13 Medical conditions of significance to midwifery practice Physiology and care during the puerperium..............................................499 24 Physical health problems and complications in the puerperium.......... 515 25 Perinatal mental health.......................... 531 26 Bereavement and loss in maternity care...........................................................555 27 Contraception and sexual health in a global society.......................................569

Foreword are not being provided with sufficient opportunity to attend, yet classes can make a big difference to women’s experiences of birth and parenting. In addition she draws attention to the value they have in giving women social networks. This has been evident in my daughter’s experience of classes in Germany. Whilst she was critical of some of the content of the classes, she and four other women who birthed one to 10 days apart, have supported each other in parenting. Two years on they remain good friends. Chapter 13 skilfully draws together the most significant medical conditions a midwife is likely to encounter in her practice. Much attention is given to obesity. The authors qualify that although obesity is not in itself a disease it is considered abnormal in western cultures and is now a key health concern affecting society. They discuss the additional risks to pregnant women who are obese and the association of obesity with poor socioeconomic status. Midwives have a key role in educating these women and their families to develop healthier life styles, but the women will only be receptive if they do not experience judgemental attitudes. Myles advice to midwives in the 1960s that, ‘nature is capable of performing her function without aid in most instances; meddlesome midwifery increases the hazards of birth’, is still as relevant today. In this edition, given all the technological advances in the maternity services, Section 4 on labour begins by reminding students that: ‘birth is a physiological process characterized by non-intervention, a supportive environment and empowerment of the woman’. However, an appropriate reflection of multi-cultural changes in UK society is the inclusion of female genital mutilation in chapter 15. Whilst many students will not be involved in the care of women who have undergone such a procedure, it is essential that all midwives understand the mutilation some young women have undergone and the special care they will need in childbirth. The inclusion of Kinsi’s poignant and brave story of her own experiences should help midwives develop the empathy they will need when caring for women who have been subject to similar mutilation. Perinatal mental health has figured since the early days of the textbook but only in recent editions have students been provided with the necessary information to understand the complexity of the psychology of childbearing and psychiatric disorders. A useful inclusion in this edition is tocophobia, fear of giving birth. Students need to take this fear seriously in supporting women and they cannot afford to trivialize these very real phobias. As ever this textbook includes a comprehensive section on the newborn baby, often neglected in other general texts for midwives. This is so important when parents turn to midwives for advice and reassurance or explanations. With many midwifery curricula including a module on the specialist education for the Newborn and Infant Physical Examination, chapter 28 clearly differentiates between the midwife’s and the doctor’s responsibilities when undertaking this examination. The publishers have brought about major improvements also, through locating the colour photographs in these newborn baby chapters close to where they are described in the text rather than as a separate colour plate section. Midwifery is the best career you can have. It is a privilege to work with women and their families as they experience pregnancy, birth and parenting. The knowledge, skills and attitudes that students need to be competent midwives and professional friends to women have been skilfully interwoven in this sixteenth edition. The chapter authors and editors have summarized where appropriate, elaborated when needed, referenced liberally and used illustrations effectively to enhance understanding. Given the infinite depth and breadth of information available in written and electronic forms, they have succeeded in producing a textbook that remains invaluable for the next generation of midwives. Up-to-date guidance on professional regulation, midwifery supervision, legal and ethical issues, risk management and clinical governance Freelance Lecturer and Writer; Clinical Midwife, Salisbury NHS Trust, Salisbury, UK Chapter 20 Malpositions of the occiput and malpresentations Chapter 22 Midwifery and obstetric emergencies Preface It is a great privilege to have been approached by Elsevier to undertake the editorship of the sixteenth edition of Myles Textbook for Midwives. It is over 60 years since the Scottish midwife Margaret Myles wrote the first edition and this book remains highly regarded as the seminal text for student midwives and practising midwives alike throughout the world. Over the ensuing decades, many changes have taken place in the education and training of future midwives alongside increasing demands and complexities associated with the health and wellbeing of childbearing women, their babies and families within a global context. Furthermore, the development of evidence-based practice and advances in technology have also contributed to major reviews of how undergraduate midwifery curricula are delivered to ensure that today’s graduate midwives are able to rise to the many challenges of the midwife’s multi-faceted role: being fit for both practice and purpose. It is with these issues in mind that the sixteenth edition of Myles has been developed as, without a doubt, women expect midwives to provide safe and competent care that is tailored to their individual needs, with a professional and compassionate attitude. The content and format of this edition of Myles has been developed in response to the collated views from students and midwives regarding the fifteenth edition. Midwifery practice clearly should always be informed by the best possible up-to-date evidence and, whilst it is acknowledged that it is impossible to expect any new text to contain the most contemporary of research and systematic reviews, this edition provides the reader with annotated further reading and appropriate websites in addition to comprehensive reference lists. There has been a major revision of chapters, which have been streamlined and structured into reflect similar themes and content. Throughout its history, Myles Textbook for Midwives has always included clear and comprehensible illustrations to compliment the text. In this sixteenth edition, full colour has been used throughout the book, and new diagrams have been added where appropriate. It is pleasing that a number of chapter authors have continued their contribution to successive editions of this pivotal text and we also welcome the invaluable contributions from new authors. Whilst it is vital to retain the ethos of the text being a textbook for midwives that is written by midwives with the appropriate expertise, it is also imperative that it reflects the eclectic nature of maternity care and thus, some of the chapters have been written in collaboration with members of the multiprofessional team. This clearly demonstrates the importance of health professionals working and learning together in order to enhance the quality of care women and their families receive, especially when complications develop in the physiological process throughout the childbirth continuum. The presence of the midwife is integral to all clinical situations and the role is significant in ensuring the woman always receives the additional care required from the most-appropriate health professional at the most-appropriate time. A significant change has been to the first section of the text where content from the final section has been included. From an international perspective, we believe that issues such as the globalization of midwifery education and practice, best depicted by the Millennium Development Goals, professional regulation and midwifery supervision, legal and ethical issues as well as risk management and clinical governance are fundamental to every midwife practising in the twenty-first century and should therefore be given more prominence. We acknowledge that medicalization and the consequential effect of a risk culture in the maternity services have eroded some aspects of the Resuscitation of the healthy baby at birth: the importance of drying, airway management and establishment of breathing.....................611 30 The healthy low birth weight baby....... 617 31 Trauma during birth, haemorrhages and convulsions......................................629 32 Congenital malformations.....................645 33 Significant problems in the newborn baby.........................................667 34 Infant feeding..........................................703Consultant Obstetrician and Gynaecologist, Croydon University Hospital, Croydon, UK Chapter 3 The female pelvis and the reproductive organs Chapter 15 Care of the perineum, repair and female genital mutilation Ninth edition 1981 Tenth edition 1985 Eleventh edition 1989 Twelfth edition 1993 Thirteenth edition 1999 Fourteenth edition 2003 Fifteenth edition 2009 Sixteenth edition 2014 The concept of resilience is introduced for the reader to contemplate their personal contribution in creating an environment that is conducive to protecting the wellbeing of themselves and colleagues within the workplace. I Organization and administration 1. The host institution/agency/branch of government supports the philosophy, aims and objectives of the midwifery education programme. 2. The host institution helps to ensure that financial and public/policy support for the midwifery education programme are sufficient to prepare competent midwives. 3. The midwifery school/programme has a designated budget and budget control that meets programme needs. 4. The midwifery faculty is self-governing and responsible for developing and leading the policies and curriculum of the midwifery education programme. 5. The head of the midwifery programme is a qualified midwife teacher with experience in management/ administration. 6. The midwifery programme takes into account national and international policies and standards to meet maternity workforce needs. VI Assessment strategies 1. Midwifery faculty uses valid and reliable formative and summative evaluation/assessment methods to measure student performance and progress in learning related to: a. knowledge; b. behaviours; c. practice skills; d. critical thinking and decision-making; and e. interpersonal relationships/communication skills. 2. The means and criteria for assessment/evaluation of midwifery student performance and progression, including identification of learning difficulties, are written and shared with students. 3. Midwifery faculty conducts regular review of the curriculum as a part of quality improvement, including input from students, programme graduates, midwife practitioners, clients of midwives and other stakeholders. 4. Midwifery faculty conducts ongoing review of practical learning sites and their suitability for student learning/experience in relation to expected learning outcomes. 5. Periodic external review of programme effectiveness takes place.