The second edition of the comprehensive and award-winning text on prenatal and postnatal careThe updated edition of Prenatal and Postnatal Care offers a comprehensive text for the care of the woman during the childbearing year. The expert author team presents information needed to master foundational knowledge in anatomy, physiology, psychology, culture, and structure of preconception, prenatal and postnatal care, and the management of common health problems in the childbearing year.This edition has been revised throughout and contains 6 new chapters on the following topics: prenatal ultrasound, triage of the pregnant woman, assisting women to development confidence for physiologic birth, pregnancy after infertility, oral health, and issues around diversity and inclusion in prenatal and postnatal care. Additional highlights include new and updated content on pregnant women in the workplace, prenatal genetic testing, trauma-informed care, and transgender pregnancy care. The second edition also includes commonly used complementary therapies and offers more detailed information on shared decision-making and planning for birth.Prenatal and Postnatal Care:* Provides expanded faculty resources with case studies and test questions for each chapter* Offers a comprehensive text that covers essential aspects of prenatal and postnatal care of the childbearing woman* Builds on the edition that won the Book of the Year award from the American College of Nurse Midwives (ACNM) in 2015.This revised, authoritative text is an ideal resource for midwifery, nurse practitioner and physician assistant students, and healthcare providers working with pregnant and postpartum women.
Prenatal and Postnatal Care: A Woman-Centered Approach
About the Editors xxiContributors xxiiiPreface xxviiAbout the Companion Website xxixPart I Physiological Foundations of Prenatal and Postnatal Care 31 Reproductive Tract Structure and Function 5Patricia W. CaudleAnatomy of the Female Reproductive System 6Menstrual Cycle Physiology 11Resources for Women 17Resources for Healthcare Providers 17References 172 Conception, Implantation, and Embryonic and Fetal Development 19Patricia W. CaudleIntroduction 20Conception and Implantation 20The Placenta 21The Embryo 25The Fetus 30Summary 31Resources for Healthcare Providers 31Resources for Women, Their Families, and Healthcare Providers 32References 323 Maternal Physiological Alterations during Pregnancy 33Patricia W. CaudleIntroduction 33Hematologic System Adaptations 33Cardiovascular System Adaptations 35Respiratory System Adaptations 37Renal System Adaptations 38Gastrointestinal System Adaptations 38Metabolic System Adaptations 39Immune System Adaptations 42Neurological System and Sensory Adaptations 44Musculoskeletal System Adaptations 44Endocrine System Adaptations 45Summary 46Resources for Women and Their Families 46Resources for Healthcare Providers 46References 464 Physiological Alterations during the Postnatal Period 49Kaitlin Wilson and Cindy L. FarleyIntroduction 49Uterus 49Lochia 50Cervix 51Vagina 51Labia and Perineum 51Rectal Anatomy 52Additional Maternal Alterations during the Postpartum Period 52Summary 55Resource for Women 55Resource for Healthcare Providers 55References 55Part II Preconception, Prenatal Care, and Postnatal Care 575 Preconception Care 59Cynthia NypaverIntroduction 59Challenges to Providing Preconception Care 59Benefits of Preconception Health Care 60Evidence Supporting Preconception Health Care 60Preconception Care 61Risk Assessment and Screening 61Preconception Health Care for Women with Chronic Illnesses 67Unique Considerations 74Summary 76Resources for Women and Their Families 76Resources for Healthcare Providers 77References 776 Prenatal Care: Goals, Structure, and Components 81Carrie S. KlimaIntroduction 82A Brief History of Prenatal Care 82Current Goals of Prenatal Care 83Structure of Prenatal Care 85Group Prenatal Care: CenteringPregnancy 88Components of Prenatal Care 89Preventative Care 95Health Promotion and Education 96Summary 99Resources for Women and Their Families 100Resources for Healthcare Providers 100References 1007 Nutrition during Pregnancy 103Robin G. JordanIntroduction 104Understanding Food Units and Recommendations 104Prenatal Nutrition and Health Outcomes 104Nutritional Needs in Pregnancy 106Food Safety during Pregnancy 113Factors Influencing Nutritional Intake 116Making a Nutritional Assessment 117Using Nutrition Resources 118Counseling for Optimal Prenatal Nutrition 121Special Issues in Prenatal Nutrition 121Summary 126Resources for Women and Their Families 126Resources for Healthcare Providers 126References 1268 Pregnancy Diagnosis and Gestational Age Assessment 131Janet L. Engstrom and Joyce D. CappielloIntroduction 132Benefits of Early Pregnancy Diagnosis and Gestational Age Assessment 132Pregnancy Diagnosis 132Gestational Age Assessment 138Counseling for Pregnancy Diagnosis 146Summary 150Resources for Women and Their Families 151Resources for Healthcare Providers 151References 1519 Risk Assessment during Pregnancy 155Robin G. JordanIntroduction 155Process and Purpose of Risk Assessment 155Benefits of Risk Assessment 156Limitations of Risk Assessment 156Disadvantages of Risk Assessment and Risk Management 156Labeling Women as High Risk 157Misapplication of Risk Assessment and Risk Management 157Perspective of Risk and Risk Assessment 159Explaining Risk to Women 160Informed Consent 162Summary 163Resources for Healthcare Providers and Women and Their Families 163References 16310 Prenatal Ultrasound 167Cynthia Parke and Robin G. JordanIntroduction 168The Physics and Mechanics of Ultrasound 168Types of Scans 169Use of Prenatal Ultrasound 170Interpreting and Communicating Results 174The Woman's Experience of Ultrasound 175Safety 176Overuse of Ultrasound 177Recreational Prenatal Ultrasound 177Who Performs Prenatal Ultrasounds 178Adding Ultrasound to Scope of Practice 178Resources for Women and Their Families 178Resources for Healthcare Providers 178References 17811 Genetic Counseling, Screening, and Diagnosis 181Robin G. JordanIntroduction 182Family History and Risk Evaluation 182Genetic Screening Tests 182Screening for Neural Tube Defects 183Screening for Aneuploidy 183Genetic Screening by Ultrasound 186Carrier Screening 187Diagnostic Prenatal Genetic Testing 189The Role of Genetic Counselors 190Psychosocial Considerations in Genetic Testing 190Genetic Testing Counseling during Prenatal Care 191Summary 193Resources for Women, Their Families, and Healthcare Providers 193References 19412 Assessment of Fetal Well-Being 197Jenifer FaheyIntroduction 197Physiologic Principles 198Indications 199Interprofessional Care 199Fetal Testing Methods 200Education and Counseling 210Cultural, Personal, and Family Considerations 211Health Disparities and Vulnerable Populations 211Legal and Liability Issues 211Summary 212Resource for Healthcare Providers 213References 21313 Common Discomforts of Pregnancy 215Robin G. JordanIntroduction 215Back Pain and Pelvic Girdle Pain 216Bleeding Gums 218Breast Tenderness 219Carpal Tunnel Syndrome (CTS) 220Cervical Pain 220Constipation 220Dizziness/Syncope 222Edema 222Emotional Changes 223Fatigue 223Flatulence 224Headache 225Heartburn 225Heart Palpitations 226Hemorrhoids 227Increased Warmth and Perspiration 227Leukorrhea 227Leg Cramps 228Nasal Congestion 228Epistaxis 229Nausea and Vomiting of Pregnancy (NVP) 230Ptyalism 233Restless Leg Syndrome (RLS) 233Round Ligament Pain 234Shortness of Breath 235Skin, Hair, and Nail Changes 235Hyperpigmentation 236Vascular Changes 237Hair and Nail Changes 237Sleep Disturbances 238Supine Hypotension Syndrome (SHS) 239Urinary Frequency and Nocturia 240Urinary Incontinence 240Varicosities (Legs/Vulva) 241Vision Changes 243Resources for Women and Their Families 243References 24314 Oral Health 247Julia Lange KesslerIntroduction 247Anatomy of the Oral Cavity 247Initial Assessment of the Oral Cavity 248Influence of Oral Health on Pregnancy Outcomes 249Conditions Affecting Oral Health 250Postpartum and Newborn Oral Health 251Summary 251Resources for Women and Their Families 251Resources for Healthcare Providers 251References 25115 Medication Use during Pregnancy 253Mary C. Brucker and Tekoa L. KingIntroduction 254Types of Pharmaceutical Agents 254Prescriptive Authority 254Governmental Oversight of Pharmaceutical Agents 254Pre-Marketing Drug Testing 255The Prescription: Essential Components 256Pharmacokinetics in Pregnancy 261Common Medications Used During Pregnancy 261Vaccines during Pregnancy 261Rational Use of Drugs in Pregnancy 261Summary 264Resources for Healthcare Providers 267Resources for Women and Their Families 267References 26716 Substance Use during Pregnancy 271Daisy J. Goodman, Kelley A. Bowden,and Alane B. O'ConnorIntroduction 271Prevalence of Prenatal Substance Use 272Terminology 272Historical Approaches to Prenatal Substance Use 273Harm Reduction Approaches to Prenatal Substance Use 274Common Comorbid Conditions 275Prenatal Screening 275Treatment Types 278Commonly Used Substances, Pregnancy Implications, and Recommended Treatment 279Perinatal Care of Women with Substance Use Disorders 285Summary 290Resources for Healthcare Providers 291References 29117 Health Disparities and Social Issues in Pregnancy 297Nena R. HarrisIntroduction 297Poverty 298Incarceration during Pregnancy 300Intimate Partner Violence during Pregnancy 302Reproductive Coercion 303Human Trafficking 303Pregnancy and a History of Childhood Sexual Abuse 305Summary 307Resources for Healthcare Providers 307Resources for Women and Their Families 308References 30818 Diversity and Inclusiveness in the Childbearing Year 313Cindy L. Farley and Michal J. WrightIntroduction 314Inequities in Perinatal Care and Outcomes 314Contributors to Perinatal Health Disparities 314Developing Cultural Competence 316Communication 317Selected Cultural Traditions in the Childbearing Year 317Summary 320Resources for Healthcare Providers 320Resources for Women 320References 32019 Exercise, and Sexual, Occupational, and Environmental Health in Pregnancy 323Meghan GarlandIntroduction 323Exercise 323Environmental Exposures 329Sexuality 333The Workplace and Pregnancy 335Resources on Pregnancy and Environmental Exposure for Women 337Resources on Pregnancy and Environmental Exposure for Healthcare Providers 337Resource on Work during Pregnancy for Women 338References 33820 Psychosocial Adaptations in Pregnancy 341Cindy L. Farley, Eva M. Fried, and Amy R. ChavezIntroduction 342Developing Relationship: A Trauma-Informed Approach 342Maternal-Newborn Attachment and Adaptation 343Maternal Role Development 346Body Image 352Sibling Preparation 354Partner Adaptation and Attachment 354Pregnancy in Transgender Men 358Summary 359Resources for Women and Their Families 359Resources for Healthcare Providers 359References 35921 Health Education during Pregnancy 363Lisa Hanson, Karen Robinson, Leona VandeVusse, and Kathryn HarrodIntroduction 363Sources and Quality of Consumer Childbirth Education 363Prenatal Visit Approach to Individual Childbirth Education 365Class Education and Group Prenatal Care 366Developmental Considerations 366Issues Integral to Prenatal Education 367Summary 369Resources for Women and Their Families (Government Websites) 373Resources for Women and Their Families (Nongovernment Websites) 373References 37322 Preparing for Birth 375Melissa D. Avery, Carrie E. Neerland, and Melissa A. SaftnerIntroduction 375What Is Physiologic Birth? 375Benefits of Physiologic Birth 376Fear of Childbirth 376Maternal Confidence for Physiologic Birth 376Evidence Related to Women's Prenatal Confidence for Physiologic Birth 378Individual Strategies 380Summary 381Resources for Healthcare Providers 381Resources for Women and Their Families 382References 38223 Triage during Pregnancy 385Cathy RuhlIntroduction 385Objectives and Goals of Triage Care and Evaluation 385Obstetric Triage in the Hospital Setting 386Primary Responsibilities of Professionals during Triage and Evaluation 386Common Reasons Women Seek Urgent/ Emergent Care during Pregnancy 386Collaboration Between Obstetric and Emergency Departments 387Obstetric Triage Unit Organization 387Elements of Triage 387Elements of Healthcare Provider Evaluation 388Best Practices in Triage Units 388Liability Issues in Obstetric Triage and Evaluation 390Quality Measures in Triage 391Anticipatory Guidance about Triage during Prenatal Care 391Summary 391Resources for Women and Their Families 391Resources for Healthcare Providers 391References 39124 Assessment and Care at the Onset of Labor 393Amy MarowitzIntroduction 393Determining the Onset of Labor 393Timing of Admission to the Birth Setting 394Reframing "False Labor" 394Determining Active Labor 395Anticipatory Guidance during the Prenatal Period 395Assessment of the Woman with Report of Labor Onset 396Plan of Care 397Summary 398References 39825 Components of Postnatal Care 401Tia P. Andrighetti and Deborah Brandt KarsnitzIntroduction 401Fourth-Trimester Tasks 402Immediate Postpartum Care 402Later Postpartum Care 402Assessment of Maternal Physical and Emotional Adjustment 404Maternal Role Development 407Infant Feeding 407Activity and Exercise 407Diet and Nutrition 408Lochia 408Afterbirth Pain 409Perineal Discomfort 410Diureseis and Diaphoresis 410Constipation and Hemorrhoids 410Sleep 410Sexuality 411Resumption of Menses and Ovulation 411Contraception 412Postpartum Physical Examination 412Postpartum Depression and Intimate Partner Violence Screening 414Postpartum Warning Signs 415Cultural Considerations 415Health Disparities and Vulnerable Populations 416Interprofessional Care 417Recovery and Employment 417Summary 418Resources for Women 418Resources for Healthcare Providers 418References 41826 Lactation and Breastfeeding 423Marsha WalkerIntroduction 423Benefits of Breastfeeding 423Breastfeeding as a Public Health Issue 426Promoting and Supporting Breastfeeding 427Maternal and Infant Anatomy and Physiology of Lactation and Breastfeeding 428Basics of Breastfeeding Support and Assessment 432Care of the Breastfeeding Mother 436Summary 440Resources for Women and Healthcare Providers 440References 44027 Contraception in the Postnatal Period 445Leah N. TorresIntroduction 445Postpartum Care and Return to Fertility after Childbirth 445Selecting a Postpartum Contraceptive Method 446Contraceptive Methods 448Tier One Methods 448Tier Two Methods 451Tier Three Methods 455Emergency Contraception 457Summary 457Resources for Women and Healthcare Providers 458References 458Part III Complex Prenatal and Postnatal Conditions 46128 Bleeding during Pregnancy 463Robin G. JordanIntroduction 463Early Pregnancy Bleeding 464Subchorionic Hemorrhage 466Leiomyomas 466Spontaneous Pregnancy Loss 466Ectopic Pregnancy 470Gestational Trophoblastic Disease 472Bleeding during the Second Half of Pregnancy 474Placenta Previa 474Placental Abruption 476Vasa Previa 477Diagnosis and Management of Bleeding in the Second Half of Pregnancy 478Resources for Women and Their Families 478References 47929 Amniotic Fluid and Fetal Growth Disorders 481Victoria H. Burslem and Cindy L. FarleyIntroduction 482Amniotic Fluid Dynamics 482Placentation and Perinatal Outcomes 483Amniotic Fluid Disorders 484Fetal Growth Disorders 488Summary 492Resources for Women and Their Families 492Resources for Healthcare Providers 492References 49230 Preterm Labor and Birth 495Robin G. Jordan and Nancy Jo ReedyIntroduction 495Social and Racial Disparities 496Pathophysiology of Preterm Birth 497Perinatal Morbidity Related to Prematurity 497Risk Factors for Preterm Birth 497Predicting Preterm Birth 499Primary Prevention of Preterm Birth 500Prenatal Education on Signs and Symptoms of Preterm Labor 504Diagnosis and Management of Women with Preterm Labor 505Interprofessional Care 505Summary 505Resources for Women and Healthcare Providers 506References 50631 Hypertensive Disorders of Pregnancy 511Robin G. Jordan and Elizabeth GabzdylIntroduction 511Classification of Hypertensive Disorders in Pregnancy 512Screening for Hypertensive Disorders 512Preeclampsia-Eclampsia 513Chronic Hypertension 519Chronic Hypertension with Superimposed Preeclampsia 520Gestational Hypertension 521HELLP Syndrome 521Interprofessional Care 523Summary 523Resources for Women and Their Families 523Resources for Healthcare Providers 523References 52332 Gestational Diabetes 527Kimberly K. TroutIntroduction 527Pathophysiology and Potential Problems 527Prenatal Screening and Diagnosis 528Management 531Pharmacologic Treatments 533Social Considerations 534Fetal Surveillance and Timing of Birth 534Postpartum Follow-Up 535Interprofessional Care 536Perspective on GDM Risk 536Care of the Pregnant Woman withPregestational Diabetes 537Resources for Women and Their Families 537Resources for Healthcare Providers 537References 53733 Multifetal Gestation 541Heather M. Bradford and Cindy L. FarleyIncidence 541Embryology 541Diagnosis 543Potential Problems 543Prenatal Care 545Psychosocial Aspects 547Resources for Healthcare Providers 548Resources for Women and Their Families 548References 54834 Post-Term Pregnancy 551Heather M. BradfordIntroduction 551Potential Problems 552Prevention, Intervention, and Management Options 552Resources for Healthcare Providers 555Resources for Women and Their Families 555References 55535 Hyperemesis Gravidarum 557Karen Trister GraceIntroduction 557Etiology and Risk Factors 557Potential Problems 558Evaluation 558Care and Management 558Resource for Healthcare Providers 560Resources for Women and Their Families 560References 56036 Abdominal Pain 561Karen Trister GraceIntroduction 561Evaluation 561Appendicitis 562Gall Bladder Disease 562Abdominal Trauma 563CPR in Pregnancy 564Pancreatitis 564Resources for Healthcare Providers 564Resources for Women and Their Families 564References 56437 Pregnancy after Infertility 567Melicia EscobarIntroduction 567Prevalence of Infertility 567Context and Course of Infertility 568Preexisting Conditions and Perinatal Issues 569Pharmacologic Considerations 569Lifestyle Considerations 569Psychological Impacts of Infertility Treatment and Transition to Pregnancy 573Summary 574Resources for Women and Their Families 574Resources for Healthcare Providers 574References 57438 Common Complications during the Postnatal Period 577Deborah Brandt KarsnitzIntroduction 577Postpartum Morbidity and Mortality 578Postpartum Cultural Considerations 579Postpartum Disorders 579Summary 593Resources for Women and Their Families 594Resources for Healthcare Providers 594References 59439 Common Breastfeeding Problems 597Marsha WalkerIntroduction 597Common Infant-Related Breastfeeding Problems 597Common Maternal Breastfeeding Problems 602Low Milk Supply 607Summary 610Resources for Women and Their Families 610Resources for Healthcare Providers 610References 61040 Perinatal Loss and Grief 613Robin G. JordanIntroduction 613Stillbirth 613Care and Management of Women with Stillbirth 614Grieving and Emotional Care after Perinatal Loss 615Physical Care after Stillbirth 617Follow-Up Care 618Interconception and Subsequent Pregnancy Care 618Summary 619Resources for Women and Their Families 619Resources for Healthcare Providers 619References 620Part IV Common Primary Care Health Conditions during the Prenatal and Postnatal Periods 62341 Obesity 625Cecilia M. JevittIntroduction 625Prevalence 626Health Disparities and Cultural Considerations 626Personal and Family Considerations 626Obesity Physiology 626Potential Problems 627Management of Pregestational Obesity 628Bariatric Surgery and Pregnancy Issues 632Prolonged Pregnancy 632Intrapartum and Postpartum Issues 632Interprofessional Care 633Legal and Liability Issues 633Summary 633Resources for Women and Their Families 634Resources for Healthcare Providers 634References 63442 Mood and Anxiety Disorders 637Heather ShlosserIntroduction 637Depression during Pregnancy 637Bipolar Disorder in Pregnancy 642Anxiety and Trauma-Related Disorders 645Interprofessional Care 647Summary 647Resources for Women and Their Families 648Resources for Healthcare Providers 648References 64843 Hematologic and Thromboembolic Disorders 651Jalana Lazar, Karen Trister Grace and Robin G. JordanIntroduction 652Anemia 652Alloimmunization of Pregnancy 654Hemoglobinopathies 658Folate Deficiency 659Vitamin B12 Deficiency 660Bleeding Disorders 660Thromboembolic Disorders 661Summary 663Resources for Women and Their Families 663Resources for Healthcare Providers 663References 66344 Respiratory Disorders 665Janyce Cagan AgrussIntroduction 665Respiratory Physiology and Pregnancy 665Asthma 665Influenza 668Upper Respiratory Infection 670Pneumonia 671Summary 671Resource for Healthcare Providers 671References 67145 Urinary Tract Disorders 673Rhonda Arthur and Nancy Pesta WalshIntroduction 673Urinary Tract Infection 673Evaluation 675Care of Women with Urinary Tract Infections 677Recurrent UTI 678Care of Women with Suspected Acute Pyelonephritis 678Nephrolithiasis 678Summary 679Resources for Women and Their Families 679Resource for Healthcare Providers 679References 67946 Gastrointestinal Disorders 681Debora M. DoleIntroduction 681Initial Evaluation 681Gastroenteritis 681Intraheptic Cholestasis of Pregnancy 683Cholecystitis and Cholelithiasis 684Acute Appendicitis 685Summary 686Resources for Healthcare Providers 686Resource for Women and Their Families 686References 68647 Endocrine Disorders 687Elizabeth GabzdylIntroduction 687Thyroid Disorders in Pregnancy 687Overt Hypothyroidism 689Hyperthyroidism 691Postpartum Thyroiditis 692Iodine in Pregnancy 692Pregestational Diabetes Mellitus 693Summary 695Resources for Women and Healthcare Providers 695References 69548 Neurological Disorders 697Lise HauserIntroduction 697Seizure Disorders 697Headache 701Multiple Sclerosis 704Restless Legs Syndrome/Willis-Eckbom Disease 705Carpal Tunnel Syndrome 706Central Nervous System Imaging in Pregnancy and Lactation 706Interprofessional Care 706Resources for Women and Their Families 706Resources for Healthcare Providers 706References 70649 Dermatological Disorders 709Nell L. TharpeIntroduction 709Atopic Eruption of Pregnancy 710Pruritic Urticarial Papules and Plaques of Pregnancy 712Pruritic Folliculitis of Pregnancy 713Pemphigoid Gestationis 714Pustular Psoriasis of Pregnancy 716Intrahepatic Cholestasis of Pregnancy 717Summary 718Resources for Healthcare Providers 718References 71950 Infectious Diseases 721Elizabeth A. ParrIntroduction 721Cytomegalovirus (CMV) 722Group B Streptococcus (GBS) 724Hepatitis A 725Hepatitis B 726Hepatitis C 728Parvovirus B19 729Rubella 730Toxoplasmosis 731Varicella 734Emerging Infectious Diseases 735Ebola 736Zika 736Summary 737Resources for Women and Their Families 737Resources for Healthcare Providers 738References 73851 Sexually Transmitted Infections and Vaginitis 741Eva M. Fried and Cindy L. FarleyIntroduction 741Sexually Transmitted Bacterial Infections 742Sexually Transmitted Viral Infections 744Sexually Transmitted Parasitic Infection 748Fungal Vaginitis 749Bacterial Vaginitis 749Partner STI Treatment 751Legal Requirements for Reporting STI Diagnosis 752Psychosocial Impact of STI Diagnosis 752Summary 753Resources for Healthcare Providers 753Resource for Women and Partners 754References 754Index 757
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