Maureen D Raynor, MA PGCEA ADM RMN RN RM Lecturer and Supervisor of Midwives, Academic Division of Midwifery, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK Chapter 1 The midwife in contemporary midwifery practice Chapter 2 Professional issues concerning the midwife and midwifery practice Chapter 15 Care of the perineum, repair and genital mutilation Chapter 25 Perinatal mental health Recognizing the healthy baby at term through examination of the newborn screening................................. 591 Angie Godfrey, BSc(Hons) RM RN Midwife/Antenatal and NewbornScreening Coordinator, Nottingham University Hospitals NHS Trust, Nottingham, UK Chapter 11 Antenatal screening of the mother and fetus Contents Evolve online resources: http://evolve.elsevier.com/Marshall/Myles/ Evolve online resources.................................... vii Contributors....................................................... ix Foreword...........................................................xiii Preface................................................................ xv Acknowledgements......................................... xvii

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 For this edition several new chapters are introduced covering concealed pregnancy, fear of childbirth (tocophobia), care of the acutely unwell woman and end of life issues including rights of the fetus/neonate and ethical considerations. Preface midwife’s role over time. It is our aim to challenge midwives into thinking outside the box and to have the confidence to empower women into making choices appropriate for them and their personal situation. An example is the decision to incorporate breech presentation and vaginal breech birth at term into the first and second stage of labour chapters rather than within the malpresentations chapter. Recognizing that midwives increasingly care for women with complex health needs within a multicultural society and taking on specialist or extended roles, significant topics have been added to make the text more contemporary. Chapter 13 incorporates the dilemmas faced by midwives when caring for women who have a raised body mass index and chapter 15 is a new chapter that addresses how care of the perineum can be optimized alongside the physiological and psychosocial challenges when women present with some degree of female genital mutilation. Furthermore, as an increasing number of midwives are undertaking further training to carry out the neonatal physiological examination and neonatal life support, specific details have been included in chapter 28 and a new chapter 29 dedicated to basic neonatal resuscitation respectively, to provide a foundation for students to build upon. Additional online multiple-choice questions have been updated and revised to reflect the focus of the chapters in this edition, as readers appreciate their use in aiding self-assessment of learning. We hope that this new edition of Myles Textbook for Midwives will provide midwives with the foundation of the physiological theory and underpinning care principles to inform their clinical practice and support appropriate decision-making in partnership with childbearing women and members of the multi-professional team. We recognize that knowledge is boundless and that this text alone cannot provide everything midwives should know when undertaking their multi-faceted roles, however, it can afford the means to stimulate further enquiry and enthusiasm for continuing professional development. London and Nottingham, 2014Physiology 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 sixteenth edition of this seminal textbook, Myles Textbook for Midwives, has been extensively revised and restructured to ensure that it reflects current midwifery practice, with an increased focus on topics that are fundamental to midwifery practice today. Elsevier Ltd. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). First edition 1953 Second edition 1956 Third edition 1958 Fourth edition 1961 Fifth edition 1964 Sixth edition 1968 Seventh edition 1971 Eighth edition 1975 standardize the quality of their midwifery programme(s), ensuring that midwives are fit for both practice and purpose. 3. Offer a framework to countries with established programme(s) for midwifery education who may wish to compare the quality of their existing standards of midwifery education against the ICM minimum standards. This can be achieved during the design, implementation and evaluation of the ongoing quality of the midwifery programme. The ICM expects that the global standards for midwifery education outlined in Box 1.3 will be adopted by all those with a vested interest in the health and wellbeing of mothers, babies and their families. This requires engagement from policy-makers, governments/health ministers, midwives and wider healthcare systems. The standards not only promote an education process that prepares midwives with all the essential ICM competencies, it also supports the philosophy of life-long learning through continuing education. This approach it is hoped will foster and promote safe midwifery practice alongside quality and evidence-based care. A further goal is to strengthen and reinforce the autonomy of the midwifery profession as well as uphold the virtue of midwives as well-informed, reflective and autonomous practitioners. To ensure students are educated and prepared to be responsible global citizens, Tuckett and Crompton (2013) stress that undergraduate programmes for student nurses and midwives should expose learners to global health systems within a culturally diverse society. Maclean (2013) concurs with this view, highlighting that global health issues are much more mainstream in contemporary midwifery practice as a direct consequence of elective placements abroad. Elective placements enable students from high-income countries to gain an invaluable insight into the health challenges faced by resource-poor countries. Furthermore, the importance of global strides to reduce disadvantages and health inequalities, such as Millennium Development Goals 4 and 5 (see below), and the principles on which the safe motherhood initiative is based, have greater significance when students have first-hand experience of the struggles encountered on a daily basis by those who are socially and economically disadvantaged. 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 care. However, for a multiplicity of reasons, only a minority of students undertake the ERASMUS exchange.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.

Scope of practice The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures. The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care. A midwife may practice in any setting including the home, community, hospitals, clinics or health units. Revised and adopted by ICM Council 15 June 2011; due for review 2017 www.internationalmidwives.org 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.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 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 The ERASMUS programme ERASMUS is an acronym for EuRopean Action Scheme for the Mobility of University Students. Salient aspects of globalization have led to this initiative in Europe, incepted in 1987 to allow international mobility for university student exchange between European countries (Papatsiba 2006). Milne and Cowie (2013) extol the virtues of the ERASMUS scheme in preparing the future generation of healthcare professionals to provide culturally diverse and competent