Table Of ContentVarney’s Midwifery,
Fourth Edition
HELEN VARNEY, CNM, MSN, DHL,
(Hon.) FACNM
JAN M. KRIEBS, CNM, MSN,
FACNM
CAROLYN L. GEGOR, CNM, MSN,
FACNM
JONES AND BARTLETT PUBLISHERS
varney ’s
midwifery
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Varney ’s
midwifery
fourth edition
(cid:1)
helen varney, cnm, msn, dhl, (h .) FACNM
on
Professor, Nurse-Midwifery Specialty
Yale University School of Nursing
Jan M. KrIebs, cnm, msn, facnm
Assistant Professor, Department of Obstetrics,
Gynecology, and Reproductive Sciences
University of Maryland School of Medicine
carolyn l. gegor, cnm, msn, facnm
FORMERLY AssistantProfessor, Department of Obstetrics,
gynecology, and reproductive sciences
University of Maryland School of Medicine
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Library of Congress Cataloging-in-Publication Data
Varney, Helen.
Varney’s midwifery / Helen Varney Burst, Jan M. Kriebs, Carolyn L. Gegor. – 4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-7637-1856-4
1. Midwifery. 2. Gynecologic nursing. 3. Maternity nursing. I. Title: Midwifery. II.
Kriebs, Jan M. III. Gegor, Carolyn L. IV. Title.
[DNLM: 1. Nurse Midwives. 2. Midwifery. 3. Obstetrical Nursing. 4. Women’s Health.
WY 157 V318v 2003]
RG950. V37 2003
618.2—dc21
2003047512
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Printed in the United States of America
07 06 05 04 03 10 9 8 7 6 5 4 3 2 1
A rededication to the students, practitioners, and
profession of midwifery; and to the women, mothers,
babies, and families who receive health care from all
those who study this book.
Helen Varney
For the mentors, midwives, and mothers who have
shared with me their knowledge of midwifery and
birth; and for David, my partner in everything I do.
Jan M. Kriebs
To Lisa L. Paine, CNM, DrPH, my midwifery mentor
and friend, and to all those whose wisdom and vision
inspires us to go further and to give more than we ever
knew was possible to care for mothers and babies; and
to Andy, my husband and soul mate, with whom so
many dreams have come true.
Carolyn L. Gegor
Dedication to the Third Edition
In honor and memory of my beloved parents, Helene Hahn
Varney and Theodore Roosevelt Varney.
Dedication to the Second Edition
In tribute to Therese Dondero and all other Certified Nurse-
Midwives whose masterly contributions to our profession were
tragically curtailed because of untimely death.
Dedication to the First Edition
For my students, peers, and colleagues; the profession of nurse-
midwifery; and the women, mothers, babies, and families who
receive health care from those who study this book.
Holy Births and Howling Babies
In my backyard there are nuns who live in a shaded brick building
next to the St. Stanislaus church and elementary school.
Together we rise before the sun is in the sky.
Behind the kitchen curtain, in the damp haze of morning,
I watch them walk in shades of blue robe.
They glide in white sneakers across the parking lot.
They are cool, calm, brisk.
Some day, I’ll go see them
I’ll ask for some lesson on prayer.
Because the thing is... I pray now.
Not Dear God Almighty!
Just slow, easy, quiet thoughts.
I pray when my patience is worn.
When my shoulders ache.
When my own voice becomes tiring to my ears.
I pray when my heart sits heavy with stories and faces of women.
A prayer for the 32 week babe.
A prayer for the lady with the skinny, squawking twins.
A prayer for the woman without a mother, or a lover, or a friend.
I pray when my cold hands run across a pregnant belly
and I feel a kick from the inside.
I pray for all my babies, Be good to your mama.
I pray for all my mothers, Be strong, be good to this baby.
I pray secretly and I pray slowly.
I pray for us, the midwives and almost-midwives.
I pray that we make the right decisions.
And I pray for those of us who make bad decisions.
Decisions we regret with outcomes we can’t change.
I pray that we learn from our mistakes.
That with age comes wisdom.
I pray deeply and I pray completely.
For all of the hands and all of the bellies.
I pray for holy births and howling babies.
Dana Quealy, CNM, MSN
Brief Contents
Part I Midwifery
Chapter 1 The Profession and History of Midwifery in the United States 3
Chapter 2 Basics of Management of Care 29
Part II Primary Care of Women
Chapter 3 Cultural Competence in Midwifery Practice 49
Jo-Anna L. Rorie
Chapter 4 International Midwifery and Safe Motherhood 59
Margaret A. Marshall
Joyce E. Thompson
Chapter 5 Preconception Care 85
Chapter 6 Nutrition in Women’s Health 99
Jenifer O. Fahey
Chapter 7 Primary Care and Midwifery 135
Chapter 8 Chronic Infectious Diseases 165
Chapter 9 Women and Exercise 187
Ann Cowlin
Chapter 10 Pharmacology and Midwifery 249
Mary C. Brucker
Mary Ann Faucher
Chapter 11 Health Issues of Lesbian and Bisexual Women 299
Laura Zeidenstein
Chapter 12 Substance Abuse 313
Nancy Jo Reedy
Mary C. Brucker
Chapter 13 Health Care of Midlife and Aging Women 335
Mary Ellen Rousseau
Part III Reproductive Health Care
Chapter 14 Common Diagnoses in Women’s Gynecological Health 379
William F. McCool
Dawn Durain
Chapter 15 Infections of the Genital Tract 439
Chapter 16 Family Planning and Contraception 461
vii
viii Brief Contents
Chapter 17 Natural Methods of Family Planning 471
Carmela Cavero
Chapter 18 Nonhormonal Contraceptive Methods 481
Chapter 19 Intrauterine Contraceptive Devices 499
Chapter 20 Hormonal Contraception 513
Part IV Antepartal Care
Chapter 21 Normal Pregnancy Database: Adaptations of the Mother, Development and Growth of
the Embryo and the Fetus, and the Placenta 543
Chapter 22 Management Plan for Normal Pregnancy 571
Chapter 23 Fetal Assessment 623
Chapter 24 Screening for and Collaborative Management of Antepartal Complications 661
Chapter 25 Complications of Gestational Age Assessment and the Postdate Pregnancy 715
Carol L. Wood
Part V Intrapartal Care
Chapter 26 The Normal First Stage of Labor 737
Chapter 27 Fetal Assessment During Labor 793
Chapter 28 The Normal Second Stage of Labor 821
Chapter 29 Screening for and Collaborative Management of Selected Complications During the
First and Second Stages of Labor 853
Chapter 30 Management of Selected Obstetric Complications and Deviations from Normal 883
Chapter 31 The Normal Third Stage of Labor 905
Chapter 32 Third Stage Complications and Management 913
Chapter 33 The Normal Fourth Stage of Labor 917
Chapter 34 Management of Immediate Postpartum Hemorrhage 925
Chapter 35 Birth in the Home and in the Birth Center 929
Alice J. Bailes
Marsha E. Jackson
Part VI Newborn Care
Chapter 36 Physiological Transition to Extrauterine Life 961
Mary Kathleen McHugh
Chapter 37 Immediate Care and Assessment of the Healthy Newborn 973
Mary Kathleen McHugh
Chapter 38 Resuscitation at Birth 983
Mary Kathleen McHugh
Chapter 39 Examination of the Newborn 999
Mary Kathleen McHugh
Chapter 40 Primary Care of the Newborn: The First Six Weeks 1011
Mary Kathleen McHugh
Brief Contents ix
Chapter 41 Recognition and Immediate Care of Sick Newborns 1029
Mary Kathleen McHugh
Part VII Postpartal Care
Chapter 42 The Normal Puerperium 1041
Chapter 43 Infant Feeding 1067
Karin Cadwell
Cynthia Turner-Maffei
Sarah Coulter Danner
Chapter 44 Screening for and Midwifery Management of Puerperal Abnormality 1093
Part VIII Skills
Chapter 45 Universal Precautions 1107
Chapter 46 Finger Puncture 1109
Chapter 47 Venipuncture 1113
Chapter 48 Inserting an Intravenous Catheter 1121
Chapter 49 Giving Intravenous Medications 1125
Chapter 50 Spin-Down Hematocrit 1127
Chapter 51 Removal of Norplant 1131
Chapter 52 Breast Examination 1135
Chapter 53 Obstetric Abdominal Examination 1147
Chapter 54 Checking for Costovertebral Angle Tenderness 1161
Chapter 55 Checking for Deep Tendon Reflexes and Clonus 1163
Chapter 56 Pelvic Examination 1169
Chapter 57 Obtaining a Specimen for Papanicolaou (Pap) Diagnostic Evaluation 1195
Chapter 58 Obtaining a Specimen for Gonococcal (GC) and Chlamydia Diagnostic Testing 1199
Chapter 59 Making a Wet Smear Slide of Vaginal Secretions 1201
Chapter 60 Using a Microscope 1203
Chapter 61 Anatomy of the Pelvis, Pelvic Types, Evaluation of the Bony Pelvis, and Clinical
Pelvimetry 1205
Chapter 62 Breast Massage, Manual Expression, and Nipple Rolling 1217
Chapter 63 Injection of Intradermal Sterile Water Papules for Relief of Low
Back Pain in Labor 1219
Saraswathi Vedam
Chapter 64 Inserting an Intrauterine Pressure Catheter; Amnioinfusion 1223
Chapter 65 Attaching a Fetal Scalp Electrode 1227
Chapter 66 Perineal Prep (Cleaning) 1231
Chapter 67 Second Stage Pushing 1233
Chapter 68 Pudendal Block 1235
Chapter 69 Local Infiltration 1239
Chapter 70 Hand Maneuvers for Birth with the Mother in Lithotomy or Modified Lithotomy
Position 1241
