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

The text covers the UN 2030 Agenda for Sustainable Development, highlighting the importance of midwives as global citizens with common goals, and together they form a strong global community prepared to challenge social inequalities and take action to help end extreme poverty. 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.

Sally Inch, RN RM Honorary Research Fellow, Applied Research Centre Health and Lifestyles Interventions, Coventry University, Coventry, UK Chapter 34 Infant feeding 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 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. 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

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 Content Strategist: Mairi McCubbin Content Development Specialist: Carole McMurray Project Manager: Caroline Jones Designer/Design Direction: Miles Hitchen Illustration Manager: Jennifer Rose Illustrator: Antbits The book covers key frameworks that govern midwifery practice, exploring ethical and legal frameworks that are essential to every accountable, autonomous, professional midwife.

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The midwife in contemporary midwifery practice 3 2 Professional issues concerning the midwife and midwifery practice 25 Senior Lecturer – Midwifery, School of Nursing and Midwifery, University of Brighton, Eastbourne, UK Chapter 19 Prolonged pregnancy and disorders of uterine action Recognizing the healthy baby at term through examination of the newborn screening................................. 591 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 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

Access-restricted-item true Addeddate 2020-12-09 12:06:01 Associated-names Myles, Margaret F; Bennett, V. Ruth; Brown, Linda K Boxid IA40009003 Camera Sony Alpha-A6300 (Control) Collection_set printdisabled External-identifier SECTION 4 Labour 15 Care of the perineum, repair and female genital mutilation........................311 16 Physiology and care during the first stage of labour........................................327 17 Physiology and care during the transition and second stage phases of labour..................................................367 18 Physiology and care during the third stage of labour........................................395 19 Prolonged pregnancy and disorders of uterine action..................................... 417 20 Malpositions of the occiput and malpresentations....................................435 21 Operative births......................................455 22 Midwifery and obstetric emergencies.............................................475 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. ISBN 9780702051456 International ISBN 9780702051463 2 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library 3 Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.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

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.pdf Margie Davies, RGN RM Midwifery Advisor, Multiple Births Foundation, Queen Charlotte’s and Chelsea Hospital, London, UK Chapter 14 Multiple pregnancy 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 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 practicalurn:lcp:mylestextbookfor0000unse_m4q1:epub:4659b5a4-edd7-426a-a65f-38c9eff95242 Foldoutcount 0 Identifier mylestextbookfor0000unse_m4q1 Identifier-ark ark:/13960/t8jf4mn79 Invoice 1652 Isbn 0443055866 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. Kinsi Clarke Advocacy Worker, Nottingham, UK Chapter 15 Care of the perineum, repair and female genital mutilation robust training programme(s) but are striving to meet the country’s needs for outputs of qualified midwives to establish basic midwifery. 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