Awhonn`s Perinatal Nursing, 5/e
Kathleen Rice Simpson PhD Rnc Faan (Author), Patricia A Creehan Msn Rnc
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Leave the self-doubt behind — get fully grounded in effective perinatal care, with Perinatal Nursing, 5th Edition, an official publication of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). This freshly updated, comprehensive resource offers expert guidelines and best practices for the full range of patient care issues, from cultural practices and pregnancy complications to newborn assessments and nutrition. Stay current with this must-have, evidence-based support for both perinatal and labor and delivery nursing.


Strengthen and upgrade your perinatal nursing strengths and expertise:

NEW and expanded content on pregnancy complications – Bleeding in pregnancy, preterm labor and birth, diabetes, cardiac disease, pulmonary complications, multiple gestation, obesity and more

NEW content on newborn nutrition – The infant feeding decision, breastfeeding benefits, nutritional components, and preterm milk and lactation

NEW and updated content on patient safety and maternal morbidity and mortality in the United States – Instructions on how to make maternity units safer based on the most current evidence, and through application of various care bundles

Evidence-based information on clinical conditions – Includes chapter on obesity that covers risks to the mother and fetus, care from preconception to postpartum, and bariatric surgery

Text boxes emphasize crucial care standards and guidelines

Practical guidance and current best practices for areas including:

Perinatal patient safety and quality care

Integrating patient cultural beliefs and practices into perinatal care

Physiologic changes of pregnancy

Antenatal care

Hypertensive disorders of pregnancy

Pregnancy complications

Multiple gestation

Maternal-fetal transport

Labor and birth

Fetal assessment

Managing pain during labor

Postpartum care

Newborn care – Adaptation to extrauterine life, physical assessment and nutrition

Common neonatal complications

All chapters written by expert nurse clinicians and researchers to support positive perinatal outcomes

Nursing staffing standards are included as they apply to each patient population

Ideal for those seeking certification in obstetrics nursing (RNC-OB) and maternal newborn nursing (RN-MNN, RNC-LRN)

Perfect on-the-job resource and review text for all perinatal nurses, maternal units, and students


Your book purchase includes a complimentary download of the enhanced eBook for iOS™, Android™, PC and Mac. Take advantage of these practical features that will improve your eBook experience:


The ability to download the eBook on multiple devices at one time — providing a seamless reading experience online or offline

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The ability to highlight text and add notes with one click


About the Clinical Editors

Kathleen Rice Simpson, PhD, RNC, FAAN is Perinatal Clinical Nurse Specialist and Editor-in-Chief MCN, The American Journal of Maternal Child Nursing in Saint Louis, Missouri.


Patricia A. Creehan, MSN, RNC is Manager of Clinical Operations, Labor and Delivery at Advocate Christ Medical Center in Oak Lawn, Illinois.


Nancy O’Brien-Abel, MSN, RNC is Perinatal Clinical Nurse Specialist at Perinatal Consulting, LLC and Affiliate Instructor at the School of Nursing, University of Washington in Seattle, Washington.


Cheryl K. Roth, PhD, WHNP-BC, RNC-OB, RNFA is a Nurse Practitioner, Labor and Delivery at HonorHealth Scottsdale Shea/Osborn Medical Centers in Scottsdale, Arizona.


Annie J. Rohan, PhD, RN, NNP-BC, CPNP-PC,FAANP is Director of the Doctor of Nursing Practice Program and Director of Pediatric Research at the School of Nursing, Office of Nursing Research and Innovation at Stony Brook University (SUNY at Stony Brook) in Stony Brook, New York.


Physiologic Changes of Pregnancy 

Hormones and Other Mediators

C ardiovas c ula r S y st em 

H ema t o logic Cha n g es 

Resp ira t o r y S y st em 53

Renal S y st em 55

Gastr o in t estinal S y st em 57

M et a b o lic Cha n g es 58

Endo cr ine S y st em 59

I m m u ne S y st em 61

Neuromuscular and Sensory Systems 62

I n t egumen t a r y S y st em 62

Rep r o d uc ti v e Or ga n s 63

S umma r y 64


Antenatal Care . . . . . . . . . . . . . . . . . . . .66

E l lis e D . A d a m s

I n tr o d uc tio n 66

P r eco n cep tio n C a r e 66

P r ena t al C a r e 68

Prenatal Risk Assessment 71

Ongoing Prenatal Care 85

F e t a l S ur v eilla n ce 90

Nursing Assessment and Interventions 91

S umma r y 94


H y p er t en si v e Dis o r der s

of Pregnancy . . . . . . . . . . . . . . . . . . . . . .99

A dr i ane Burgess

H yp er t en si v e Dis o r der s 99

C ur r en t Classifi cation and Defi nitions 99

Contributors vi

Reviewers viii

Previous Edition Contributors x

Previous Edition Reviewers xi

Preface xii


Perinatal Patient Safety and Quality . . .1

K a t h leen Rice S im p s o n

I n tr o d uc tio n 1

Maternal–Infant Outcomes in the United States 2

Th reats to Patient Safety 9

E v o l v in g S o l u t io n s 9

S umma r y 15


I n t egra t in g C u l t ural B e liefs

and Practices When Caring for

Childbearing Women and Families . . .18

L y nn Cla r k C allist er

I n tr o d uc tio n 18

C u l t ural F ra m e w o r ks a n d C u l t ural

Assessment Tools 20

Practices Associated with Childbearing 23

G ender Ro les 23

Childbirth Pain and Culture 24

Major Cultural Groups 24

H e a l t h D iff erences in Populations of

Childbearing Women 33

Barriers to Culturally Competent Care 34

T e c hniq ues t o I n t egra t e C u l t ur e in t o

Nursing Care 36

S umma r y 42 xiv Contents


Diabetes in Pregnancy . . . . . . . . . . . . .182

Cher y l K. Ro t h

S ig nifi cance and Incidence 182

D e fi nitions and Classifi cation 184

S c r e enin g a n d Diagnosis o f G est a t io nal

Diabetes Mellitus 185

Clinical M a nif est a tio n s 186

N ur sin g A s s essmen ts a n d I n t er v en tio n s f o r

Diabetes Mellitus 187

Ambulatory and Home Care Management 187

Timing and Mode of Birth 193

I n pa tien t M a nag emen t 193

P ost pa r t um M a nag emen t 196

S umma r y 197


Cardiac Disease in Pregnancy . . . . . .200

J u lie Ara f e h

S ig nifi cance and Incidence 200

Th e Cardiovascular System 201

Cardiac Adaptations of Pregnancy 203

Obstetric Outcomes and Assessment of Risk 205

Congenital Heart Disease in Pregnancy 208

Acquired Cardiac Disease in Pregnancy 209

Clinical M a nag emen t 211

N ur sin g C a r e 218

S umma r y 219


Pulmo n a r y C o m p lica t io n s in

Pregnancy . . . . . . . . . . . . . . . . . . . . . . .221

Cher y l K. Ro t h

I n tr o d uc tio n 221

Anatomic and Physiologic Changes of Pregnancy

that Aff ect the Respiratory System 221

Recognizing Respiratory Compromise 222

F et a l S u r v eilla n ce wi t h M a t er n al Pulmo n a r y

Complications 222

A s t hma 225

P n eumo nia 231

Pulmo n a r y Edema 236

Amniotic Fluid Embolism 238

V e n o u s Th romboembolism 239

C y stic Fib r osis 244

Special Considerations for the Respiratory System

in Pregnancy 245

S umma r y 246

S ig nifi cance and Incidence 101

Morbidity and Mortality 102

Risk F ac t o r s 104

P r e v en tio n S t ra t e gies 104

Pathophysiology of Preeclampsia 105

Clinical M a nif est a tio n s o f

Preeclampsia–Eclampsia 108

P r eec la m psia wi t h o u t S e v er e F e a t ur es v er s us

Preeclampsia with Severe Features 109

N ur sin g A s s essmen t a n d I n t er v en tio n s f o r

Preeclampsia 110

HELLP S y ndr o me 118

Ec la m psia 119

Cardiovascular Implications of Preeclampsia 119

Quality Care of Women with Preeclampsia 120

S umma r y 120


Bleeding in Pregnancy . . . . . . . . . . . . .124

J e a n Salera-V ieira

S ig nifi cance and Incidence 124

D efi nitions and Clinical Manifestations 126

N u r sin g A s s essmen t 133

N ur sin g I n t er v en tio n s 135

Hemorrhagic and Hypovolemic Shock 136

Th rombophilias in Pregnancy 137

M a t er n al T r a uma 138

S umma r y 139


Preterm Labor and Birth . . . . . . . . . . .142

S h er y l E. P a r fi tt

S ig nifi cance and Incidence 142

Late Preterm Births 144

Early Term Births 145

Why Has the Rate of Preterm Birth

Increased? 146

What Is Preterm Labor? 148

Pathophysiology of Preterm Labor and Birth 149

Risk Factors for Preterm Labor and Birth 150

Preterm Birth Risk in the Context of the

Life Course 152

Can Preterm Labor and Birth Be Prevented? 154

I s Th ere Any Good News? 168

Nursing Care for the Prevention of

Preterm Birth 168

Intrapartum Nursing Care of the Woman in

Preterm Labor 173

F ur t her Res e a r c h 174

S umma r y 174 Contents xv


Labor and Birth . . . . . . . . . . . . . . . . . .326

Kathleen Rice Simpson and Nancy O’Brien-Abel

I n tr o d uc tio n 326

Overview of Labor and Birth 326

Emo t io nal a n d Ph ysical S u p p o r t d ur in g

Labor and Birth 363

Clinical Interventions for Women in Labor 367

Dosage and Rate Increase Intervals 380

A dministra tio n 381

V a ginal B ir t h 389

C es a r e a n B ir t h 389

S umma r y 400


Fetal Assessment during Labor . . . . .413

Nancy O’Brien-Abel and Kathleen Rice Simpson

I n tr o d uc tio n 413

H i st o r ical P er s p e c t i v es 413

D e fi nitions and Appropriate Use of Terms

Describing Fetal Heart Rate Patterns 415

Techniques of Fetal Heart Rate Monitoring 418

Physiologic Basis for Fetal Heart Rate

Monitoring 424

Cha rac t e r i stics o f t h e N o r m al F e t a l

Heart Rate 428

I n t er v en tio n s f o r I n det er mina t e o r A b no r m al

Fetal Heart Rate Patterns 430

Fetal Heart Rate Patterns 434

Clinical I m p lica t io n s f o r M o ni t o r in g t h e

Fetus Less Th an 32 Weeks’ Gestation

during Labor 445

Assessment of Pattern Evolution 448

Ancillary Methods for Assessing Fetal Acid–Base

Status 450

N ur sin g A s s e ssmen t a n d M a nag e men t

Strategies 453

Issues in the Use of Fetal Heart Rate Monitoring

during Labor 457

S umma r y 459


P a in in L a b o r : N o n p ha r m aco logic

and Pharmacologic Management. . . .466

C a r o l B urk e

I n tr o d uc tio n 466

Physiologic Basis for Pain 466

N o n p ha r m aco logic A p p r oac h es 470

Pha r maco logic A p p r oac h es 485

S umma r y 499


Multiple Gestation . . . . . . . . . . . . . . . .249

N a nc y A. B o w er s

I n tr o d uc tio n 249

E p idemio log y 249

Physiology of Twinning 249

Role of Infertility and Assisted Reproductive

Technology 251

Diagnosis of Multiple Gestations 254

M a t er n al A d a p t a tio n 255

P e r ina t a l C o m p lica t io n s 256

An t epa r t um M a nag e men t 264

I n tra p a r t um M a nag e men t 268

P ost pa r t um C a r e 273

Multiple Birth Infants 274

P sy c ho logical I ssues wi t h M u l t i p le

Gestations 281

S umma r y 286


Obesity in Pregnancy . . . . . . . . . . . . . .296

M a r y Ann M a her

S ig nifi cance and Incidence 296

Obesity-Related Risks to the Mother and

Fetus 298

P r eco n cep tio n C a r e 300

An t e na t a l C a r e 301

I n tra p a r t um C a r e 302

I n trao p era ti v e C a r e 305

P ost pa r t um C a r e 307

Bariatric Surgery and Pregnancy 308

S umma r y 310


Maternal–Fetal Transport . . . . . . . . . .315

J ud y W i ls o n-G r i ffi n

I n tr o d uc tio n 315

Emer g enc y M e dical T r e a tmen t a n d A c ti v e

Labor Act 315

Types of Inter-Maternal–Fetal Transport 316

Mode of Transport 317

T ra n sp o r t Eq ui p m en t 317

T r a n sp o r t P er s o nnel 318

C o mm unica t io n Pla n 318

Transport Plan and Patient Preparation 318

S umma r y 325 xvi Contents

C a r dio vas c ula r A s s essmen t 593

A b do minal A s s essmen t 595

G eni t o ur ina r y A s s essmen t 597

M u s c ulosk e let al A s s essmen t 599

N eur o logic A s s essmen t 602

S umma r y 604


Newborn Nutrition . . . . . . . . . . . . . . .609

J ill J a nk e

O v er vie w 609

Infant Feeding Decision 609

B e n e fi ts of Breastfeeding 609

Incidence of Breastfeeding 610

B r e a stf eedin g P r o m o t io n 615

Physiology of Milk Production 615

B iosp e cifi city of Human Milk 617

N u tr i t io nal C o m p o n en ts 617

Preterm Milk and Lactation 618

B r e a stf eedin g P r o cess 619

B r e a stf eedin g M a nag emen t 623

Potential Breastfeeding Problems 631

L a t e P r et er m 638

Medications and Breastfeeding 638

Postpartum Surgery and Breastfeeding 639

F o r m ula F eedin g 639

L ac t a t io n S u p p r essio n 642

S umma r y 643


Co m m o n N e o n a t al Co m p l i c a t i o n s . . . 651

Annie J . Ro ha n

I n tr o d uc tio n 651

Neonatal Resuscitation and Stabilization 651

Resp ira t o r y Distr ess 652

Congenital Heart Disease 655

H yp o g l y cemia 658

H yp erb ilir ub inemia 660

N e o n a t al S epsis 665

Perinatal HIV Infection 667

Neonatal Substance Exposure 670

P a t h o p h ysio log y 671

Late Preterm Infants 674

Hypoxic Ischemic Encephalopathy 680

Transport and Return Transport 683

S umma r y 683


I t em B a nk Questio n s a n d

Answer Key . . . . . . . . . . . . . . . . . . . . . .689

N a nc y O ’ B r ien-A b e l

Index . . . . . . . . . . . . . . . . . . . . . . . . . . .732


Postpartum Care . . . . . . . . . . . . . . . . . .509

Dotti C. James and Patricia D. Suplee

I n tr o d uc tio n 509

Planning for the Transition to Parenthood 509

Anatomic and Physiologic Changes during the

Postpartum Period 515

N ur sin g A s s essmen t a n d C a r e d ur in g

Postpartum 521

Complications during Postpartum 526

I n di vid u alizin g C a r e f o r W o men wi t h

Special Needs 544

Postpartum Learning Needs 547

P sy c ho logical A d a p t a tio n t o t h e

Postpartum Period 550

F a tigue 552

Family Transition to Parenthood 552

Postpartum Discharge Follow-up 554

S umma r y 561


N e w b or n A d a p t a t ion t o

Extrauterine Life . . . . . . . . . . . . . . . . . .564

D e bb ie F ras er

I n tr o d uc tio n 564

M a t er n al M e dical a n d Obst etr ic C o ndi t io n s

Infl uencing Newborn Adaptation 564

U niq ue M e c h a nism s o f N e w b o r n Ph ysio logic

Adaptation 564

A pga r S co r e 572

Ph ysical A s s essmen t 572

N e w b o r n I den tifi cation 574

V i t a min K 574

E y e P r o p h y laxis 574

Umbilical Cord Care 575

P sy c ho logical A d a p t a tio n 575

C o m p lica t io n s Aff ecting Transition 576

H e pa ti tis B 577

S umma r y 577


Newborn Physical Assessment . . . . . .579

Annie J . Ro ha n

I n tr o d uc tio n 579

S t a t e , W eig h t, a n d G e st a t io nal A g e

Assessment 579

S k in A s s essmen t 581

H e ad A s s essmen t 584

E y e A s s e ssmen t 586

E a r A s s e ssmen t 588

N os e A s s essmen t 589

M o u t h A s s essmen t 590

N e c k A s s essmen t 591

Chest and Lung Assessment 592


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