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Myles Textbook for Midwives

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SECTION 2 Human anatomy and reproduction 3 The female pelvis and the reproductive organs..................................55 4 The female urinary tract........................... 81 5 Hormonal cycles: fertilization and early development.................................... 91 6 The placenta............................................ 101 7 The fetus...................................................111 Over 500 multiple-choice questions enable students to test their knowledge. • Full image bank of illustrations to make study more visual and assist with projects. 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. Foreword The strength and longevity of Myles Textbook for Midwives lies in its ability to juxtapose continuity and change from the first edition in 1953 to this sixteenth edition, over 60 years later. In continuity, some of the excellent early illustrations have been replicated throughout the editions. These provide clarity of understanding of essential anatomy for students. Changes of and additional colours in this edition have made a dramatic improvement to this clarity. In addition the clearly set out sections, chapter titles and index, aid systematic learning as well as facilitating easy reference when a new situation is encountered in practice. Of equal importance is how this text demonstrates the changes that have taken place in midwifery practice. Unlike the early editions, when midwives relied on one textbook and teachers alone, this sixteenth edition draws together theory, current practices, research and best evidence. In contrast to the first edition where Myles, in the Preface,wrote: ‘No bibliographical references have been given because of the vast number of sources which have been tapped in compiling the text (by Margaret Myles herself) and because pupil midwives become confused when they study from more than one or two textbooks’, this edition signposts students to further resources to increase their depth and breadth of knowledge. This is essential as no textbook can capture all the information needed for contemporary midwifery practice. In all editions the needs of women and their families have been central and this edition continues to emphasize the emotional, socio-economic, educational and physical needs of women during the life changing experience of pregnancy and parenthood, or bereavement. These events have a lasting impact on women’s lives. Of importance is always how well women are listened to and involved in making decisions about their or their babies’ care. Running through this edition is an emphasis on the need for midwives to be emotionally aware and develop good communication and interpersonal relationships with women, their partners and colleagues in the interdisciplinary team. The midwife has a key role to play in assisting women to make choices and feel in control, even when presented with difficult options and dilemmas. This text demonstrates the midwife’s role as lead professional when pregnancy is straightforward and co-ordinator of care when others need to be involved. The maternity services have seen major changes in recent years, in particular the massive increase in the birth rate, the changing demographics of women who become pregnant and the politics surrounding childbirth. Section One effectively brings together the issues that midwives need to understand, not just during their education programme, but also as part of their future responsibility in helping to bring about improvements in maternity care both in the UK and internationally. The vision for UK midwifery set out in Midwifery 2020 (Midwifery 2020 UK Programme, 2010) and the global initiatives of the International Confederation of Midwives are well summarized. Whilst Margaret Myles in her first 10 editions drew upon the knowledge of obstetricians and paediatricians in England and Scotland, she wrote the entire book herself. Recent edited editions demonstrate the need to draw upon the expertise of other midwives and health professionals in chapter writing. Thakar’s and Sultan’s inclusion of diagrams and photographs of perineal anatomy and trauma in chapter three are very timely given the increasing number of students who now learn to suture. These will help understanding of the importance of accurate diagnosis and effective perineal repair to aid women’s physical and emotional recovery. The value of antenatal education has been emphasized since the inception of this textbook, yet today not all women or their partners attend. Mary Nolan stresses the importance of sessions to be women-centred and expertly facilitated, not lecture based. She reminds readers that many women Ninth edition 1981 Tenth edition 1985 Eleventh edition 1989 Twelfth edition 1993 Thirteenth edition 1999 Fourteenth edition 2003 Fifteenth edition 2009 Sixteenth edition 2014

Smart study tools such as note sharing and subscription, review mode, and Microsoft OneNote integration. VitalSource Bookshelf gives you access to content when, where, and how you want. When you read an eBook on VitalSource Bookshelf, enjoy such features as: The book covers key frameworks that govern midwifery practice, exploring ethical and legal frameworks that are essential to every accountable, autonomous, professional midwife.

Consultant Obstetrician and Urogynaecologist, Department of Obstetrics and Gynaecology, 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 Kinsi Clarke Advocacy Worker, Nottingham, UK Chapter 15 Care of the perineum, repair and female genital mutilation Rowena 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 Individuals from other disciplines who teach in the midwifery programme are competent in the content they teach. 5. Midwife teachers provide education, support and supervision of individuals who teach students in practical learning sites. 6. Midwife teachers and midwife clinical preceptors/ clinical teachers work together to support (facilitate), directly observe and evaluate students’ practical learning. 7. The ratio of students to teachers and clinical preceptors/clinical teachers in classroom and practical sites is determined by the midwifery programme and the requirements of regulatory authorities. 8. The effectiveness of midwifery faculty members is assessed on a regular basis following an established process. Moira McLean, RGN RM ADM PGCEA PGDIP SOM Senior Lecturer – Midwifery and Supervisor of Midwives, School of Nursing and Midwifery, De Montfort University, Leicester, UK Chapter 13 Medical conditions of significance to midwifery practice

Edited by Jayne E. Marshall, FRCM, PFHEA, PhD, MA, PGCEA, ADM, RM, RN and Maureen D. Raynor, MA PGCEA ADM RMN RN RM SECTION 3 Pregnancy 8 Antenatal education for birth and parenting.................................................127Margie Davies, RGN RM Midwifery Advisor, Multiple Births Foundation, Queen Charlotte’s and Chelsea Hospital, London, UK Chapter 14 Multiple pregnancy Maureen D Raynor MA PGCEA ADM RMN RN RM Lecturer and Supervisor of Midwives, University of Nottingham, Academic Division of Midwifery, School of Health Sciences, Faculty of Medicine and Health Sciences, Postgraduate Education Centre, Nottingham, UK

V Resources, facilities and services 1. The midwifery programme implements written policies that address student and teacher safety and wellbeing in teaching and learning environments. 2. The midwifery programme has sufficient teaching and learning resources to meet programme needs. 3. The midwifery programme has adequate human resources to support both classroom/theoretical and practical learning. 4. The midwifery programme has access to sufficient midwifery practical experiences in a variety of settings to meet the learning needs of each student. 5. Selection criteria for appropriate midwifery practical learning sites are clearly written and implemented. Richard Hayman, BSc MB BS DFFP DM FRCOG Consultant Obstetrician and Gynaecologist, Gloucestershire Hospitals NHS Trust, Gloucester, UK Chapter 21 Operative births Box 1.2 European Union Standards for Nursing and Midwifery: Article 42 – Pursuit of the professional activities of a midwife The provisions of this section shall apply to the activities of midwives as defined by each Member State, without prejudice to paragraph 2, and pursued under the professional titles set out in Annex V, point 5.5.2. The Member States shall ensure that midwives are able to gain access to and pursue at least the following activities: (a) provision of sound family planning information and advice; (b) diagnosis of pregnancies and monitoring normal pregnancies; carrying out the examinations necessary for the monitoring of the development of normal pregnancies; (c) prescribing or advising on the examinations necessary for the earliest possible diagnosis of pregnancies at risk; (d) provision of programmes of parenthood preparation and complete preparation for childbirth including advice on hygiene and nutrition; (e) caring for and assisting the mother during labour and monitoring the condition of the fetus in utero by the appropriate clinical and technical means; (f) conducting spontaneous deliveries including where required episiotomies and in urgent cases breech deliveries; (g) recognizing the warning signs of abnormality in the mother or infant which necessitate referral to a doctor and assisting the latter where appropriate; taking the necessary emergency measures in the doctor’s absence, in particular the manual removal of the placenta, possibly followed by manual examination of the uterus; (h) examining and caring for the newborn infant; taking all initiatives which are necessary in case of need and carrying out where necessary immediate resuscitation; (i) caring for and monitoring the progress of the mother in the postnatal period and giving all necessary advice to the mother on infant care to enable her to ensure the optimum progress of the new-born infant; (j) carrying out treatment prescribed by doctors; (k) drawing up the necessary written reports. Source: WHO (World Health Organization) 2009 European Union Standards for Nursing and Midwifery: information for accession countries, 2nd edn. www.euro.who.int/__data/assets/pdf_ file/0005/102200/E92852.pdfThe 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. Senior Lecturer (retired), Lecturer (part time), Edinburgh Napier University, Edinburgh, UK Chapter 31 Trauma during birth, haemorrhages and convulsions 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 II Midwifery faculty 1. The midwifery faculty includes predominantly midwives (teachers and clinical preceptors/clinical teachers) who work with experts from other disciplines as needed. 2. The midwife teacher a. has formal preparation in midwifery; b. demonstrates competency in midwifery practice, generally accomplished with 2 years full scope practice; c. holds a current licence/registration or other form of legal recognition to practise midwifery; d. has formal preparation for teaching, or undertakes such preparation as a condition of continuing to hold the position; and e. maintains competence in midwifery practice and education. 3. The midwife clinical preceptor/clinical teacher a. is qualified according to the ICM definition of a midwife; b. demonstrates competency in midwifery practice, generally accomplished with 2 years full scope practice; c. maintains competency in midwifery practice and clinical education; d. holds a current licence/registration or other form of legal recognition to practice midwifery; and e. has formal preparation for clinical teaching or undertakes such preparation. Edited by Jayne E. Marshall, FRCM, PFHEA, PhD, MA, PGCEA, ADM, RM, RN, Foundation Professor of Midwifery and NMC Lead Midwife for Education, School of Allied Health Professions, College of Life Sciences, George Davies Centre, University of Leicester, UK and Maureen D. Raynor, MA PGCEA ADM RMN RN RM, Senior Lecturer (Midwifery), De Montfort University, Faculty of Health and Life Sciences, School of Nursing and Midwifery, Leicester, UK

Judith Simpson, MB ChB MD MRCPCH Consultant Neonatologist, Neonatal Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, UK Chapter 32 Congenital malformations Edited by Anna Nolte, PhD, RN, RM, Jayne E. Marshall, FRCM, PFHEA, PhD, MA, PGCEA, ADM, RM, RN and Maureen D. Raynor, MA PGCEA ADM RMN RN RM Professional Editor, RCM Journal, Professor of Midwifery, University of Chester, Chester, UK, Adjunct Professor of Midwifery, University of South Australia (UniSA), Adelaide, Australia Chapter 23 Physiology and care during the puerperium Chapter 24 Physical health problems and complications in the puerperium Senior Lecturer in Research (Maternal, Child and Family Health)/Supervisor of Midwives, University of the West of Scotland, Paisley, UK Chapter 4 The female urinary tract Soo Downe, BA(Hons) MSc PhD RM University of Central Lancashire, School of Health, Research in Childbirth and Health (ReaCH group), Preston, Lancashire, UK Chapter 17 Physiology and care during the transition and second stage phases of labour

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the increased interconnectedness and interdependence of people and countries, is generally understood to include two interrelated elements: the opening of borders to increasingly fast flows of goods, services, finance, people and ideas across international borders; and the changes in institutional and policy regimes at the international and national levels that facilitates or promote such flows. Globalization is not without its critics but it is acknowledged that the consequences of globalization are not predetermined and can have both positive and negative outcomes (Baumann and Blythe 2008). It is essential therefore to have an awareness of both the good and harm globalization may impose on a society. Conversely, internationalization has no agreed definition but from a midwifery perspective it can be defined as the international process of planning and implementing midwifery education and services in order that there is a shared vision that can easily be translated or adapted to meet the local and national needs of individual nations in both resource-rich and resource-poor countries. Internationalization is important for the midwifery profession because in a global society midwives are required to have a broad understanding of cross-cultural issues. They need to be flexible and adaptable in order to provide care that is sensitive and responsive to women’s dynamic healthcare needs. This requires the midwife to be an effective change agent, and the onus is very much on the midwife to keep pace with change. This means having a good comprehension of internationalization, learning to deal with uncertainty, embracing the ethos of life-long learning as well as the gains and challenges of interprofessional or multidisciplinary collaboration, contributing to quality assurance issues such as audit, research, risk assessment and the wider clinical governance agenda. Even though skills of problem-solving, clinical judgement, decision-making and clinical competence in the practical 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 Specialist Midwife (FGM), Nottingham University Hospitals NHS Trust (City Campus), Hucknall Road, Nottingham, UK Chapter 15 Care of the perineum, repair and female genital mutilation Box 1.1 An International definition of the midwife A midwife is a person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.

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