Hesperian Health Guides and the contributors to A Book for Midwives do not assume liability for the use of information contained in this book. All health workers have a responsibility to be honest with themselves and the people they care for about the limits of their skills. This means: only perform the procedures you are trained to. Find help from other, more experienced health workers when a woman needs a kind of care that you are not experienced with. Seek the advice of local health workers and medical authorities about the safest ways to practice in your area. This manual can help you learn new skills, but no book can take the place of hands-on training with a skilled and experienced teacher. Keep watching, reading, listening, and learning more whenever you have the chance. Copyright © 2004, 2013 by Hesperian Health Guides. All rights reserved.
Credits Project coordination: Fiona Thomson Field-testing and networking: Starr Amrit Design and production: Sarah Wallis Copy editing: Rachel Markowitz Cover design: Sarah Wallis Indexing: Ty Koontz Additional writing and editing: Proofreading: Sunah Cherwin Darlena David, Todd Jailer, Jane Maxwell, Medical review: Ellen Israel, Lisa Keller, Melissa Susan McCallister, Sarah Shannon, Smith, Judith Standley Kathleen Vickery, Sarah Wallis Editorial and production management: Art coordination: Fiona Thomson Susan McCallister and Sarah Wallis Cover photographs: Additional production: Lora Santiago 1 Artists: Namrata Bali, Jennifer Barrios, Sara Boore, Heidi Broner, 2 May Florence Cadiente, Barbara Carter, Gil Corral, Elizabeth Cox, 3 Regina Faul-Doyle, Christine Eber, Iñaki Fernández de Retana, Sandy Frank, 4 5 6 Deborah Green, Susie Gunn, Jesse Hamm, Haris Ichwan, Anna Kallis, Delphine Kenze, Susan Klein, Joyce Knezevich, Gina Lee, 1. India by Starr Amrit June Mehra, Naoko Miyamoto, 2. Nepal by Curt Carnemark/World Bank Jeanne Muller, Mabel Negrete, 3. Mexico by Rick Maiman/David and Gabriela Núñez, Kate Peatman, Sara Reilly- Lucile Packard Foundation, courtesy of Baldeschwieler, Photoshare Diana Reiss-Koncar, Petra Röhr-Rouendaal, Leilani Roosman, 4. Democratic Republic of Congo by Lucy Sargeant, Mona Sfeir, Gilberte Vansintejan Akiko Aoyagi Shurtleff, Chengyu Song, 5. Tunisia by Curt Carnemark/World Bank Fiona Thomson, Dovile Tomkute- 6. Burma (Myanmar) by Peter Williams/WCC Veleckiene, Sarah Wallis, Lihua Wang, David Werner, Christine Wong, Back cover: Mexico by Rick Maiman/ Allan Woong, Mary Ann Zapalac David and Lucile Packard Foundation, courtesy of Photoshare The first edition of this book was imagined, written, and illustrated by Susan Klein. Sadly, she died before it was published. This new revision is still carried largely by her writing, her drawings, and we hope, her vision — that A Book For Midwives would be a tool enabling all those who attend women in childbirth, regardless of their educational background, to exercise independent judgment and to make the best possible decisions at each birth.
Sylvia Estrada-Claudio Christine Johnson Bill Parer Petra ten Hoope- Bender Aryn Faur Mary Johnson Juana Payva Carol Thuman Susan Fawcus Ralph Johnson Nimal Perera Linda Tietjen Juliet Fleischl John Kadyk Lucille Pilling de Lucena Jan Tritten Nina Frankel Angela Kamara Man Poon Greg Troll Carmen Frazier Robert Keast Jennifer Potts Mina Tulugak Frances Ganges Christie Keith Paula Quigley Laura Turiano Tracy Gary Beverly Kerr Sumana Reddy Gilberte Vansintejan Marlene Gerber-Fried Mary Kroeger Mary Ann Reiger Elmar Vinh-Thomas Julie Gerk Raven Lang Marina Rodriguez Donna Vivio Zafarullah Gill B.A. Laris Palma Claire Von Mollendorf Ruth Goehle Brian Linde Judith Rogers David Werner Lisa Gonzalves Julie Litwin Lorraine Rothman Sharon Wilconson Nadine Goodman David Loeb Sabala and Kranti Judith Winkler Suzan Goodman Roxane Lovell Shelly Sala Merrill Wolf Kristen Graser Ronnie Lovich Jason Sanders Juliana Yartley James Green Deborah Maine Shira Saperstein Karen Zack Sadja Greenwood Lorraine Mann Merrie Schaller Lisa Ziebel Cindy Haag Alan Margolis Katherine Sear Barb Hammes Margaret Marshall John Sellors Marcia Hansen Alberto Martinez Polis Katharine Shapiro Roxanne Henderson Luyanda Mavuya Lonny Shavelson Griselda Hernandez Nicky May Theresa Shaver Kathy Herschderfer Junice Melgar Mira Shiva Sarah Jane Holcombe Jose Luis Mendoza Christine Sienkiewicz Diana Hoover Elena Metcalf Jael Silliman Nap Hosang Laura Miranda Irene Sotelo Jennifer Houston Iris Moore Alvarez Mary Clare Hubert Syema Muzaffar Jennifer Stonier Kathleen Huggins Papa Djibril Niang Susan Sykes Pamela Hunt Sandy Niemann Michael Tan Robert Hurst Besem Obenson Vijayalaxmi Taskar Peter Ivey Deborah Ottenheimer Joe Taylor Nuriya Janss Lauri Paolinetti Additionally, the incredible patience and support of our families and friends during the long process of producing this book allowed us to see the project through.
Contents Introduction Chapter 1: Words to midwives .1 Learning is lifelong. 1 Work to improve women’s health. 8 Share what you know. 3 Work for the joy of it . 11 Respectful and compassionate care . 6 Chapter 2: Treating health problems .12 Finding the causes of health Finding root causes of problems. 13 health problems. 21 Finding the best treatment. 16 Midwives can make change . 25 Chapter 3: A woman’s body in pregnancy .26 A woman’s sexual and How women become pregnant. 29 reproductive parts. 27 Chapter 4: Helping women stay healthy .32 Eating well. 33 Things to avoid during pregnancy and breastfeeding . 45 Caring for the body for good health. 42 Chapter 5: Preventing infection .48 Preventing infection saves lives. 49 Clean the space and bedding. 57 Prevent infection by keeping Clean and sterilize tools. 59 germs away. 52 Get rid of wastes safely. 67 Clean your hands and wear protective clothing. 53 PREGNANCY Introduction .70 Chapter 6: Common changes in pregnancy .72 Changes in eating and sleeping. 73 Changing feelings and emotions . 82 Body changes and discomforts . 76 Chapter 7: Learning a pregnant woman’s health history .84 Questions in a pregnancy Malaria. 98 health history . 86 HIV and AIDS . 99 Does she have signs of pregnancy?. 86 What else in her life might affect How pregnant is she now? her pregnancy and birth?.104 When is the baby due?. 88 Making a transport plan.106 Has she had any problems with past pregnancies or births? . 93 A Book for Midwives (2013).
Chapter 8: Prenatal checkups .108 Talk with the mother .109 Check the baby .130 Check the mother’s body .116 Measure the mother’s womb .130 Check for signs of anemia .116 Find the position of the baby. 135 Weigh the mother.118 Listening to the baby’s heartbeat.139 Check the mother’s temperature .119 What to do if you find warning signs .142 Check the mother’s pulse.120 After the checkup .144 Check the mother’s blood pressure.122 Record of prenatal care.145 Check for signs of pre-eclampsia.125 Signs of bladder or kidney infection.128 LABOR AND BIRTH Introduction .146 Chapter 9: Getting ready for labor and birth .148 Signs that labor will start soon .149 What to bring to a birth.151 When to go to the birth .151 Sterilize your tools and wash up .153 Chapter 10: Giving good care during labor and birth .154 What happens during labor Be ready for emergencies .163 and birth.155 Keep a record of what happens Care for the mother during labor .157 during labor . . . . . . . . . . . . . . . . . . . 164 Chapter 11: Opening: stage 1 of labor .166 What happens during stage 1 .167 The mother’s pulse .178 When you first arrive.168 The mother’s temperature .178 Helping the mother relax in stage 1 .169 The mother’s blood pressure .180 Signs for the midwife to check Bleeding during labor .183 in stage 1.170 Pain in the womb .183 The baby’s position.170 Watch for signs of progress .185 The baby’s heartbeat.172 Safe ways to encourage labor.191 The bag of waters .174 Chapter 12: Pushing: stage 2 of labor .194 Watch for signs that stage 2 is near Help the mother give birth .206 or starting.195 Baby is breech .215 What happens during stage 2 .197 Delivering twins .219 Help the mother have a safe birth.199 Baby is very small or more than Watch for warning signs .202 5 weeks early.221 A Book for Midwives (2013).
Chapter 13: The birth of the placenta: stage 3 of labor .222 Check the mother’s physical signs.223 Help her push out the placenta .227 Bleeding after birth.224 Watch for bleeding after the placenta is born .236 Watch for signs the placenta has separated .226 What to do for the baby . . . . . . . . . . . 240 Chapter 14: The first few hours after the birth .246 What to do for the mother.247 Breathing, heartbeat, temperature.254 What to do for the baby . . . . . . . . . . . 252 The baby’s body .256 General appearance.253 Clean up and answer questions.267 Chapter 15: The first weeks after the birth .268 What to do for the mother.269 Encourage the baby to breastfeed and watch how she grows.274 Watch her womb and bleeding .270 Care for the cord.277 Watch for signs of womb infection.271 Look for signs of infection.277 Watch for signs of vaginal infection .272 Watch the color of the baby’s skin What to do for the baby . . . . . . . . . . . 274 and eyes .279 Chapter 16: Breastfeeding .280 Breast is best .281 Common difficulties while breastfeeding .286 How to breastfeed.282 Situations that affect breastfeeding .291 When the mother works outside the home.284 Alternatives to breastfeeding .294 HEALTH SKILLS Introduction .296 Chapter 17: Family planning .298 Choosing a family planning method.300 Making family planning work for the community.318 Chart: family planning methods.301 Chapter 18: Sexually transmitted infections (STIs) .320 What are STIs?.321 Teaching women how to prevent STIs .336 Discharge from the vagina.323 How to help stop STIs in your Sores on the genitals.329 community.337 STIs that affect the whole body .334 Chapter 19: Advanced skills for pregnancy and birth .338 Vaginal exams during labor.339 Episiotomy .354 Home methods for starting labor .341 Sewing a tear or an episiotomy .356 Injections.345 Caring for a woman after female genital cutting (circumcision).367 How to give fluid through a vein .350 Turning a breech or sideways baby .369 Catheters .352 A Book for Midwives (2013).