,
,Maternal-Newborn Nursing
SENIOR CONTRIBUTING AUTHORS
AMY GILES, BAYLOR UNIVERSITY
REGINA PRUSINSKI, OTTERBEIN UNIVERSITY
LAURA WALLACE, BRENAU UNIVERSITY
,OpenStax
Rice University
6100 Main Street MS-375
Houston, Texas 77005
To learn more about OpenStax, visit https://openstax.org.
Individual print copies and bulk orders can be purchased through our website.
©2024 Rice University. Textbook content produced by OpenStax is licensed under a Creative Commons
Attribution 4.0 International License (CC BY 4.0). Under this license, any user of this textbook or the textbook
contents herein must provide proper attribution as follows:
- If you redistribute this textbook in a digital format (including but not limited to PDF and HTML), then you
must retain on every page the following attribution:
“Access for free at openstax.org.”
- If you redistribute this textbook in a print format, then you must include on every physical page the
following attribution:
“Access for free at openstax.org.”
- If you redistribute part of this textbook, then you must retain in every digital format page view (including
but not limited to PDF and HTML) and on every physical printed page the following attribution:
“Access for free at openstax.org.”
- If you use this textbook as a bibliographic reference, please include
https://openstax.org/details/books/maternal-newborn-nursing in your citation.
For questions regarding this licensing, please contact .
Trademarks
The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, OpenStax CNX logo,
OpenStax Tutor name, Openstax Tutor logo, Connexions name, Connexions logo, Rice University name, and
Rice University logo are not subject to the license and may not be reproduced without the prior and express
written consent of Rice University.
Kendall Hunt and the Kendall Hunt Logo are trademarks of Kendall Hunt. The Kendall Hunt mark is registered
in the United States, Canada, and the European Union. These trademarks may not be used without the prior
and express written consent of Kendall Hunt.
COLOR PAPERBACK BOOK ISBN-13 978-1-711472-87-4
B&W PAPERBACK BOOK ISBN-13 978-1-711472-86-7
DIGITAL VERSION ISBN-13 978-1-961584-43-3
ORIGINAL PUBLICATION YEAR 2024
1 2 3 4 5 6 7 8 9 10 OF 24
,OPENSTAX
OpenStax provides free, peer-reviewed, openly licensed textbooks for introductory college and Advanced
Placement® courses and low-cost, personalized courseware that helps students learn. A nonprofit ed tech
initiative based at Rice University, we’re committed to helping students access the tools they need to complete
their courses and meet their educational goals.
RICE UNIVERSITY
OpenStax is an initiative of Rice University. As a leading research university with a distinctive commitment to
undergraduate education, Rice University aspires to path-breaking research, unsurpassed teaching, and
contributions to the betterment of our world. It seeks to fulfill this mission by cultivating a diverse community
of learning and discovery that produces leaders across the spectrum of human endeavor.
PHILANTHROPIC SUPPORT
OpenStax is grateful for the generous philanthropic partners who advance our mission to improve educational
access and learning for everyone. To see the impact of our supporter community and our most updated list of
partners, please visit openstax.org/foundation.
Arnold Ventures Burt and Deedee McMurtry
Chan Zuckerberg Initiative Michelson 20MM Foundation
Chegg, Inc. National Science Foundation
Arthur and Carlyse Ciocca Charitable Foundation The Open Society Foundations
Digital Promise Jumee Yhu and David E. Park III
Ann and John Doerr Brian D. Patterson USA-International Foundation
Bill & Melinda Gates Foundation The Bill and Stephanie Sick Fund
Girard Foundation Steven L. Smith & Diana T. Go
Google Inc. Stand Together
The William and Flora Hewlett Foundation Robin and Sandy Stuart Foundation
The Hewlett-Packard Company The Stuart Family Foundation
Intel Inc. Tammy and Guillermo Treviño
Rusty and John Jaggers Valhalla Charitable Foundation
The Calvin K. Kazanjian Economics Foundation White Star Education Foundation
Charles Koch Foundation Schmidt Futures
Leon Lowenstein Foundation, Inc. William Marsh Rice University
The Maxfield Foundation
, Study where you want, what
you want, when you want.
When you access your book in our web view, you can use our new online
highlighting and note-taking features to create your own study guides.
Our books are free and flexible, forever.
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,Contents
Preface 1
UNIT 1 INTRODUCTION TO MATERNAL-
NEWBORN AND WOMEN'S HEALTH NURSING
CHAPTER 1
Foundations in Maternal-Newborn and Women’s Health Nursing
9
Introduction 9
1.1 Current Trends in Women’s Health Care 10
1.2 Standards of Maternal, Newborn, and Gynecologic Nursing Care 14
1.3 Perinatal Care: Regional and Levels of Care and Transport 18
1.4 Ethical and Legal Concerns 21
Summary 27
Key Terms 27
Assessments 28
References 33
CHAPTER 2
Culturally Competent Nursing Care 39
Introduction 39
2.1 Person- and Family-Centered Care 40
2.2 Family Health and Cultural Factors 47
2.3 Culturally Competent Care 52
2.4 Families at Higher Risk for Poor Health Outcomes 55
Summary 60
Key Terms 60
Assessments 61
References 65
UNIT 2 WOMEN'S HEALTH THROUGH THE
LIFESPAN
CHAPTER 3
Health Promotion, Disease and Injury Prevention, and Well-
Person Care 71
Introduction 71
3.1 Factors Influencing the Health of Persons Assigned Female at Birth 72
3.2 Leading Causes of Death and Health Screenings 80
3.3 Health Promotion 93
3.4 Well-Person Care 111
3.5 Preconceptual Care 119
,Summary 130
Key Terms 131
Assessments 132
References 139
CHAPTER 4
Influences on Fertility 147
Introduction 147
4.1 Fertility and Conception 147
4.2 Genetics 155
4.3 Causes of Infertility 164
4.4 Treating Infertility 173
Summary 188
Key Terms 188
Assessments 190
References 194
CHAPTER 5
Family Planning 201
Introduction 201
5.1 Contraception: The Nurse’s Role 202
5.2 Natural Methods of Contraception 205
5.3 Barrier Methods of Contraception 210
5.4 Short-Acting Reversible Hormonal Methods of Contraception 219
5.5 Long-Acting Reversible Contraception 229
5.6 Emergency Contraception 235
5.7 Sterilization 238
5.8 Induced Abortion 241
Summary 245
Key Terms 246
Assessments 247
References 255
CHAPTER 6
Structural and Tissue Disorders of the Reproductive System
261
Introduction 261
6.1 Functional Disorders 262
6.2 Structural Disorders 275
6.3 Benign Growths 279
6.4 Malignant Neoplasms 283
Summary 291
Key Terms 291
Assessments 292
References 296
CHAPTER 7
Commonly Occurring Reproductive and Genitourinary System
Access for free at openstax.org
,Infections 301
Introduction 301
7.1 Sexually Transmitted Infections 302
7.2 Vaginal Infections and Other Conditions 324
7.3 Urinary Tract Infections 331
Summary 337
Key Terms 337
Assessments 338
References 340
CHAPTER 8
Disorders of the Breast 345
Introduction 345
8.1 Benign Disorders of the Breast 346
8.2 Cancer of the Breast 352
Summary 375
Key Terms 375
Assessments 376
References 378
CHAPTER 9
Violence Against Women 383
Introduction 383
9.1 Incidence, History, and Psychosocial Factors 383
9.2 Domestic and Intimate Partner Violence 388
9.3 Sexual Abuse and Assault 391
9.4 Human Trafficking 397
9.5 Social and Cultural Practices of Violence Against Women 400
9.6 Psychological Trauma of Violence Against Women 403
Summary 407
Key Terms 407
Assessments 408
References 414
UNIT 3 CARE DURING PREGNANCY
CHAPTER 10
Pregnancy 421
Introduction 421
10.1 Physiologic Changes Due to Pregnancy 422
10.2 Psychosocial Aspects of Pregnancy 440
10.3 Common Discomforts of Pregnancy 444
10.4 Fetal Growth and Development 453
10.5 Choosing a Health Care Provider 467
10.6 Choosing a Birthing Place 469
Summary 473
Key Terms 474
Assessments 475
References 481
, CHAPTER 11
Prenatal Care 485
Introduction 485
11.1 First Prenatal Visit 486
11.2 Care in the First Trimester of Pregnancy 513
11.3 Care in the Second Trimester of Pregnancy 515
11.4 Care in the Third Trimester of Pregnancy 519
11.5 Family Assessment and Nursing Interventions 525
Summary 528
Key Terms 528
Assessments 529
References 534
CHAPTER 12
Pregnancy at Risk 537
Introduction 537
12.1 Preconception Conditions Affecting Pregnancy 538
12.2 Conditions Limited to Pregnancy 554
Summary 578
Key Terms 578
Assessments 580
References 583
CHAPTER 13
Prenatal Testing 591
Introduction 591
13.1 Prenatal Testing during the First Trimester 592
13.2 Prenatal Testing during the Second Trimester 599
13.3 Prenatal Testing during the Third Trimester 610
Summary 622
Key Terms 622
Assessments 623
References 626
CHAPTER 14
Childbirth Education Options 631
Introduction 631
14.1 Lamaze International Childbirth Education 632
14.2 Bradley Method 637
14.3 Hypnobirthing: The Mongan Method 639
14.4 Alexander Technique 642
14.5 Birth Plans 646
Summary 648
Key Terms 648
Assessments 648
References 654
Access for free at openstax.org
,Maternal-Newborn Nursing
SENIOR CONTRIBUTING AUTHORS
AMY GILES, BAYLOR UNIVERSITY
REGINA PRUSINSKI, OTTERBEIN UNIVERSITY
LAURA WALLACE, BRENAU UNIVERSITY
,OpenStax
Rice University
6100 Main Street MS-375
Houston, Texas 77005
To learn more about OpenStax, visit https://openstax.org.
Individual print copies and bulk orders can be purchased through our website.
©2024 Rice University. Textbook content produced by OpenStax is licensed under a Creative Commons
Attribution 4.0 International License (CC BY 4.0). Under this license, any user of this textbook or the textbook
contents herein must provide proper attribution as follows:
- If you redistribute this textbook in a digital format (including but not limited to PDF and HTML), then you
must retain on every page the following attribution:
“Access for free at openstax.org.”
- If you redistribute this textbook in a print format, then you must include on every physical page the
following attribution:
“Access for free at openstax.org.”
- If you redistribute part of this textbook, then you must retain in every digital format page view (including
but not limited to PDF and HTML) and on every physical printed page the following attribution:
“Access for free at openstax.org.”
- If you use this textbook as a bibliographic reference, please include
https://openstax.org/details/books/maternal-newborn-nursing in your citation.
For questions regarding this licensing, please contact .
Trademarks
The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, OpenStax CNX logo,
OpenStax Tutor name, Openstax Tutor logo, Connexions name, Connexions logo, Rice University name, and
Rice University logo are not subject to the license and may not be reproduced without the prior and express
written consent of Rice University.
Kendall Hunt and the Kendall Hunt Logo are trademarks of Kendall Hunt. The Kendall Hunt mark is registered
in the United States, Canada, and the European Union. These trademarks may not be used without the prior
and express written consent of Kendall Hunt.
COLOR PAPERBACK BOOK ISBN-13 978-1-711472-87-4
B&W PAPERBACK BOOK ISBN-13 978-1-711472-86-7
DIGITAL VERSION ISBN-13 978-1-961584-43-3
ORIGINAL PUBLICATION YEAR 2024
1 2 3 4 5 6 7 8 9 10 OF 24
,OPENSTAX
OpenStax provides free, peer-reviewed, openly licensed textbooks for introductory college and Advanced
Placement® courses and low-cost, personalized courseware that helps students learn. A nonprofit ed tech
initiative based at Rice University, we’re committed to helping students access the tools they need to complete
their courses and meet their educational goals.
RICE UNIVERSITY
OpenStax is an initiative of Rice University. As a leading research university with a distinctive commitment to
undergraduate education, Rice University aspires to path-breaking research, unsurpassed teaching, and
contributions to the betterment of our world. It seeks to fulfill this mission by cultivating a diverse community
of learning and discovery that produces leaders across the spectrum of human endeavor.
PHILANTHROPIC SUPPORT
OpenStax is grateful for the generous philanthropic partners who advance our mission to improve educational
access and learning for everyone. To see the impact of our supporter community and our most updated list of
partners, please visit openstax.org/foundation.
Arnold Ventures Burt and Deedee McMurtry
Chan Zuckerberg Initiative Michelson 20MM Foundation
Chegg, Inc. National Science Foundation
Arthur and Carlyse Ciocca Charitable Foundation The Open Society Foundations
Digital Promise Jumee Yhu and David E. Park III
Ann and John Doerr Brian D. Patterson USA-International Foundation
Bill & Melinda Gates Foundation The Bill and Stephanie Sick Fund
Girard Foundation Steven L. Smith & Diana T. Go
Google Inc. Stand Together
The William and Flora Hewlett Foundation Robin and Sandy Stuart Foundation
The Hewlett-Packard Company The Stuart Family Foundation
Intel Inc. Tammy and Guillermo Treviño
Rusty and John Jaggers Valhalla Charitable Foundation
The Calvin K. Kazanjian Economics Foundation White Star Education Foundation
Charles Koch Foundation Schmidt Futures
Leon Lowenstein Foundation, Inc. William Marsh Rice University
The Maxfield Foundation
, Study where you want, what
you want, when you want.
When you access your book in our web view, you can use our new online
highlighting and note-taking features to create your own study guides.
Our books are free and flexible, forever.
Get started at openstax.org/details/books/maternal-newborn-nursing
Access. The future of education.
openstax.org
,Contents
Preface 1
UNIT 1 INTRODUCTION TO MATERNAL-
NEWBORN AND WOMEN'S HEALTH NURSING
CHAPTER 1
Foundations in Maternal-Newborn and Women’s Health Nursing
9
Introduction 9
1.1 Current Trends in Women’s Health Care 10
1.2 Standards of Maternal, Newborn, and Gynecologic Nursing Care 14
1.3 Perinatal Care: Regional and Levels of Care and Transport 18
1.4 Ethical and Legal Concerns 21
Summary 27
Key Terms 27
Assessments 28
References 33
CHAPTER 2
Culturally Competent Nursing Care 39
Introduction 39
2.1 Person- and Family-Centered Care 40
2.2 Family Health and Cultural Factors 47
2.3 Culturally Competent Care 52
2.4 Families at Higher Risk for Poor Health Outcomes 55
Summary 60
Key Terms 60
Assessments 61
References 65
UNIT 2 WOMEN'S HEALTH THROUGH THE
LIFESPAN
CHAPTER 3
Health Promotion, Disease and Injury Prevention, and Well-
Person Care 71
Introduction 71
3.1 Factors Influencing the Health of Persons Assigned Female at Birth 72
3.2 Leading Causes of Death and Health Screenings 80
3.3 Health Promotion 93
3.4 Well-Person Care 111
3.5 Preconceptual Care 119
,Summary 130
Key Terms 131
Assessments 132
References 139
CHAPTER 4
Influences on Fertility 147
Introduction 147
4.1 Fertility and Conception 147
4.2 Genetics 155
4.3 Causes of Infertility 164
4.4 Treating Infertility 173
Summary 188
Key Terms 188
Assessments 190
References 194
CHAPTER 5
Family Planning 201
Introduction 201
5.1 Contraception: The Nurse’s Role 202
5.2 Natural Methods of Contraception 205
5.3 Barrier Methods of Contraception 210
5.4 Short-Acting Reversible Hormonal Methods of Contraception 219
5.5 Long-Acting Reversible Contraception 229
5.6 Emergency Contraception 235
5.7 Sterilization 238
5.8 Induced Abortion 241
Summary 245
Key Terms 246
Assessments 247
References 255
CHAPTER 6
Structural and Tissue Disorders of the Reproductive System
261
Introduction 261
6.1 Functional Disorders 262
6.2 Structural Disorders 275
6.3 Benign Growths 279
6.4 Malignant Neoplasms 283
Summary 291
Key Terms 291
Assessments 292
References 296
CHAPTER 7
Commonly Occurring Reproductive and Genitourinary System
Access for free at openstax.org
,Infections 301
Introduction 301
7.1 Sexually Transmitted Infections 302
7.2 Vaginal Infections and Other Conditions 324
7.3 Urinary Tract Infections 331
Summary 337
Key Terms 337
Assessments 338
References 340
CHAPTER 8
Disorders of the Breast 345
Introduction 345
8.1 Benign Disorders of the Breast 346
8.2 Cancer of the Breast 352
Summary 375
Key Terms 375
Assessments 376
References 378
CHAPTER 9
Violence Against Women 383
Introduction 383
9.1 Incidence, History, and Psychosocial Factors 383
9.2 Domestic and Intimate Partner Violence 388
9.3 Sexual Abuse and Assault 391
9.4 Human Trafficking 397
9.5 Social and Cultural Practices of Violence Against Women 400
9.6 Psychological Trauma of Violence Against Women 403
Summary 407
Key Terms 407
Assessments 408
References 414
UNIT 3 CARE DURING PREGNANCY
CHAPTER 10
Pregnancy 421
Introduction 421
10.1 Physiologic Changes Due to Pregnancy 422
10.2 Psychosocial Aspects of Pregnancy 440
10.3 Common Discomforts of Pregnancy 444
10.4 Fetal Growth and Development 453
10.5 Choosing a Health Care Provider 467
10.6 Choosing a Birthing Place 469
Summary 473
Key Terms 474
Assessments 475
References 481
, CHAPTER 11
Prenatal Care 485
Introduction 485
11.1 First Prenatal Visit 486
11.2 Care in the First Trimester of Pregnancy 513
11.3 Care in the Second Trimester of Pregnancy 515
11.4 Care in the Third Trimester of Pregnancy 519
11.5 Family Assessment and Nursing Interventions 525
Summary 528
Key Terms 528
Assessments 529
References 534
CHAPTER 12
Pregnancy at Risk 537
Introduction 537
12.1 Preconception Conditions Affecting Pregnancy 538
12.2 Conditions Limited to Pregnancy 554
Summary 578
Key Terms 578
Assessments 580
References 583
CHAPTER 13
Prenatal Testing 591
Introduction 591
13.1 Prenatal Testing during the First Trimester 592
13.2 Prenatal Testing during the Second Trimester 599
13.3 Prenatal Testing during the Third Trimester 610
Summary 622
Key Terms 622
Assessments 623
References 626
CHAPTER 14
Childbirth Education Options 631
Introduction 631
14.1 Lamaze International Childbirth Education 632
14.2 Bradley Method 637
14.3 Hypnobirthing: The Mongan Method 639
14.4 Alexander Technique 642
14.5 Birth Plans 646
Summary 648
Key Terms 648
Assessments 648
References 654
Access for free at openstax.org
