Preface

Pregnancy and the birth of a baby are significant life‐changing events for a woman and her family. A woman transforms into a mother, and a family is created. Optimal care not only focuses on the physical process but also on the emotional experience of pregnancy and the postpartum period. The context of a woman’s culture, life experiences, social roles, and physical and mental health status on the childbearing experience influence her options, choices and outcomes.

This book both describes and challenges current prenatal and postnatal care practices. Prenatal care visits within the current pathology‐centered model of care are brief and focused on testing, legalities, and reimbursement. Too often this approach emphasizes the needs of the provider within the office setting rather than the woman’s needs during pregnancy. Postnatal care is often limited in scope and connection at a time when the new family needs guidance and support from professionals as well as family members. This is a disservice to women and their families. Opportunities to promote health and well‐being for the woman and her family during pregnancy, birth, and beyond are being missed in contemporary practice. These missed opportunities are reflected in the rising maternal mortality rate in the United States.

The woman herself and her unique needs are the rightful focus of prenatal and postnatal care. Woman‐centered care is the term used to describe a philosophy of maternity care that is based on the needs and preferences of the woman. This care emphasizes the importance of informed choice, continuity of care, active participation, best care practices, provider responsiveness, and accessibility. Pregnancy, childbirth, and the postpartum period are the start of family life. A full account of the meaning and values that each woman brings to her experience of pregnancy and motherhood should be included in care.

The fundamental principles of woman‐centered care encompass the following tenets:

• Women are co‐creators of their maternity care with their healthcare providers.
• Women have the right to informed choice in the options available to them during pregnancy, labor, birth, and the postnatal period, including the place of birth, who provides care, and where care is provided.
• Women have the ultimate authority over the key decisions that affect the content and progress of their care.
• Women have the moral and legal right to decisions regarding their bodily integrity.
• Women have the right to care that supports their optimal health and that of their baby.

Prenatal and postnatal care provided within the context of the woman’s own experience, focused on both the life‐changing nature of the pregnancy experience as well as physical adaptations and needs, leads to improved maternal and infant outcomes. The views, beliefs, and values of the woman, her partner, and her family in relation to her care and that of her baby are sought and respected at all times. Adequate time is spent in providing optimal prenatal and postnatal care with kindness, respect, and dignity.

The Need for This Text

A growing body of scientific evidence supports physiological childbearing for healthy pregnant women at low risk for complications. Several decades of escalating pregnancy and birth medicalization have shown that interventions applied on a large scale and without medical indication lead to significant negative iatrogenic consequences. However, care supporting physiological labor and birth does not begin with the first contraction; rather, it begins with the first prenatal appointment and continues into the postpartum period. Too much faith is placed in technology and too little faith is placed in human connection and caring. This book brings balance to the fore; it adds a holistic framework from which to enter into dialogue with the woman who presents for care. Midwives, nurse practitioners, physicians, physician assistants and other prenatal and postnatal healthcare providers, and students with common practice foundations in providing holistic care, emphasizing patient education and health maintenance in the context of an ongoing relationship, will find this book useful.

The editors of this book are experienced clinicians and educators of midwives, nurse practitioners, medical students, and other healthcare providers. We have found that many available obstetrical and maternity care texts offer limited content on prenatal and postnatal care. Additionally, an appreciation of the effects of the mind–body connection and the background social dynamics of the pregnant woman and her family on her overall health and childbearing experience has been lacking. This appreciation, in addition to a solid understanding of normal childbearing processes, will increase healthcare providers’ competency in supporting the normal and recognizing the abnormal. This text provides a breadth and depth of knowledge on normal pregnancy and postpartum processes and care not found in other texts.

New in the Second Edition

This edition has been updated in all chapters to reflect current standards and care recommendations. An intentional focus is placed on the needs of diverse populations. The following new chapters have been added:

• Prenatal Ultrasound
• Oral Health
• Diversity and Inclusiveness in the Childbearing Year
• Preparing for Birth
• Triage during Pregnancy
• Pregnancy after Infertility

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 planning for birth and on select prenatal and postpartum complications. Faculty resources have been expanded within the electronic text version.

Gender and Language

The editors recognize that some readers may take strong exception to and may feel marginalized by the use of the term woman throughout this textbook, including in its title. In our clinical practices and in our scholarly work, it is our aim to honor the full range of gender identities of the pregnant people who we and other prenatal care providers care for. And as writers, we are especially attuned to the politics and the power of language. We recognize that some providers care for people who were assigned female at birth but who seek pregnancy and identify as male or gender nonconforming, and that the language in this book may leave them wondering if their patients and their clinical experiences are represented here. We have added content in this edition about prenatal and postnatal care for transgender individuals that we feel is important for all prenatal care providers to know. We aimed for the most inclusive language possible without losing the “woman‐centered” focus we originally set out to provide. We wish to state, in unequivocal terms, our unwavering support for pregnant people of all genders, and the providers who offer a person‐centered approach to caring for this vulnerable population.

We are pleased that the first edition has been well received by clinicians and faculty in educational programs of various health professions. The first edition was honored with the 2015 Book of the Year award from the American College of Nurse Midwives. We are extremely fortunate to have many highly regarded contributors to the second edition and to mentor some talented new writers. All contributing authors have a background in clinical practice and are established content experts in their field. Most of our contributors are also educators, bringing an understanding of the needs of students to the text. We want to acknowledge our co‐editors of the first edition, Julie A. Marfel and Janet L. Engstrom, and their work in launching the first edition. We are excited to welcome Karen Trister Grace to our editorial team for the second edition.

Just as second labors differ from the first when considering pregnancy and birth, so too do second editions differ from first edition texts. We knew what to expect and were prepared, but met a few surprises along the way. Throughout the process, we held true to our goal—to give birth to a text that will assist clinicians and students to provide exemplary prenatal and postnatal care. We hope our efforts on this second edition will inform and inspire you as you serve the childbearing women and families of your community.

This book was written as a resource for all those interested in providing woman‐centered prenatal and postnatal care. While aspects of this care are timeless and do not change, certain elements of prenatal and postnatal care are refined as new evidence is incorporated into existing bodies of knowledge. Healthcare providers are responsible for their ongoing learning in the field and should read critically and widely among the many resources available to them. Evidence‐based health care encompasses psychosocial and cultural aspects of care applied in a mutual dialogue and determination with each individual woman.

The authors, editors, and publisher have made every effort to assure accuracy of information as this book goes to press. Nevertheless, they are not responsible for errors, omissions, or outcomes related to the application of this information in the clinical setting. This is at the healthcare provider’s own discretion.