NUR502 Maternity Nursing Lecture 1 PDF

1 NUR502 MATERNITY NURSING LECTURE 1: BASIC...

1 NUR502 MATERNITY NURSING LECTURE 1: BASIC UNDERSTANDING OF MATERNAL NURSING Candy Tsoi / NUR502 AY24-25 Candy Tsoi  2 LEARNING OBJECTIVES After this lesson, students will: 1. Understand the course content; 2. Describe roles of nurse / midwife in the care of childbearing women and newborns; 3. State the social, cultural and spiritual context of childbearing; 4. Describe the major components, concepts, and influences associated with the nursing management of women, children, and families; 5. Grasp the terminology of obstetric nursing 6. Describe the basic anatomy and physiology in obstetric nursing 7. Understand the physiology of fertility, conception and pregnancy Candy Tsoi / NUR502 AY24-25 Candy Tsoi / NUR502 AY24-25 3 INTRODUCTION TO MATERNAL NURSING  4 MATERNITY NURSING: FAMILY-CENTERED CARE Basic principles of family-centered care 1. Childbirth is considered as a normal, healthy event in the life of a family 2. Childbirth affect the entire family, and relationships and roles will change 3. Families are capable of making decisions about their own care if given adequate information and professional support Candy Tsoi / NUR502 AY24-25  5 MIDWIFERY –THAT HELPS PREGNANT WOMAN Recognized as professional who works in partnership with women Covers care of women during pregnancy, labour, and the postpartum period, as well as care of the newborn. Candy Tsoi / NUR502 AY24-25  6 MIDWIFERY It includes measures Aim 1. Preventing health problems in pregnancy 2. Detection of abnormal conditions 3. Giving medical assistance when necessary 4. Carrying out of emergency measures in the absence of medical help. Candy Tsoi / NUR502 AY24-25  7 MIDWIFE Midwives are one of the roles who prepare women for the delivery of new life and during all stages of pregnancy, labour and the early postnatal period. Midwives provide care and support to women and their families while pregnant, throughout labour and during the period after a baby’s birth. Promotes Maternal and Infant wellbeing Leads the professional advancement Cultivates an environment conducive to mother and infant friendly community Candy Tsoi / NUR502 AY24-25  8 MIDWIFE Mother, fetus and newborn safety Infection control precaution Aseptic technique Candy Tsoi / NUR502 AY24-25  9 ASEPTIC TECHNIQUE Practicing aseptic technique during the process of child birth remains a global concern Puerperal sepsis constitutes the second leading cause of maternal mortality world wide Practicing aseptic technique during the process of childbirth can contribute to reduction of puerperal sepsis Candy Tsoi / NUR502 AY24-25  10 THE PRINCIPLES OF ASEPTIC TECHNIQUE Reducing activity in the immediate vicinity of the area in which the procedure is to be performed Keeping the exposure of a susceptible site to a minimum Checking all sterile packs to be used for evidence of damage or moisture penetration Ensuring all fluids and materials to be used are in date Not re-using single use items Ensuring contaminated/non-sterile items are not placed in the sterile field Ensuring appropriate hand decontamination prior to the procedure Protecting uniform/clothing with a disposable apron Using sterile gloves Candy Tsoi / NUR502 AY24-25  11 GOOD PRACTICE Use standard precautions. Dispose of single use items after use. Do not re-use. Dispose of single patient use items after the patient’s treatment Store sterile equipment in clean, dry conditions, off the floor and away from potential damage. Dispose of waste as per local policy. Candy Tsoi / NUR502 AY24-25 Candy Tsoi / NUR502 AY24-25 12 COMMON TERMINOLOGIES USED IN OBSTETRIC NURSING  13 COMMON TERMINOLOGIES USED IN OBSTETRIC NURSING Common Explanations Terms Zygote Fertilized ovum produced by the fusion of ovum and spermatozoon (from fertilization to implantation) Embryo Developmental stage of the zygote (from implantation to 5-8 weeks) Fetus An unborn child from 8th week until term Candy Tsoi / NUR502 AY24-25  14 COMMON TERMINOLOGIES USED IN OBSTETRIC NURSING Common Explanations Terms Term Period of time at the end of a pregnancy when a baby might be expected to be born normally Normal duration of a human pregnancy: 37-42 weeks Abortion Ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus before 24 weeks of gestation Can be spontaneous or induced Stillbirth The fetus born without sign of life at or after 24 weeks of gestation, or with birth weight over 500 gm when the gestation is uncertain Candy Tsoi / NUR502 AY24-25  15 COMMON TERMINOLOGIES USED IN OBSTETRIC NURSING Common Terms Explanations Natal (-birth) Antenatal, Antepartum, Prenatal – before birth Intra-natal, Intrapartum – during labour Postnatal, Postpartum – after birth Labour – the process by which the fetus, placenta and membranes are expelled through the birth canal after the 24th week of gestation Gestational age The length of pregnancy after the first day of last menstrual period (LMP) Full term: fetus born between 37 –42 weeks of gestation Preterm: fetus born before 37 weeks of gestation Post-term: fetus after 42 weeks of gestation Candy Tsoi / NUR502 AY24-25  16 COMMON TERMINOLOGIES USED IN OBSTETRIC NURSING Common Terms Explanations Estimated date of Estimated delivery date for a pregnant woman Confinement (EDC) Average 280 days = 40 weeks Also known as expected date of delivery/estimated due date (EDD) Trimester A period of one third of a pregnancy 1st trimester: conception –13weeks6days 2nd trimester: 14wks –27weeks6days 3rd trimester: from 28wks till delivery Maturity Age of fetus, same as gestational age Candy Tsoi / NUR502 AY24-25  17 COMMON TERMINOLOGIES USED IN OBSTETRIC NURSING Common Terms Explanations Gravida (G) Gravid -pregnant Gravida (G) – The number of pregnancies of a pregnant woman Para / Parity (P) Description the number of given birth to an infant, alive or dead, after 24weeks or over 500 gm Nullipara (P0): woman who has never given birth to a viable child Primipara(P1): woman who has delivered one viable child Multipara (P2 or above): woman who has delivered more than one viable child Grand multipara (P5): a woman who has delivered five or more viable children Candy Tsoi / NUR502 AY24-25  18 COMMON TERMINOLOGIES USED IN OBSTETRIC NURSING Common Terms Explanations Primigravida Woman who is pregnant for the first time Advanced maternal age Pregnant above age 35 (calculated by EDC) Elderly primigravida Woman who is pregnant for the first time at/above age 35 Multigravida Woman who is pregnant for more than once Candy Tsoi / NUR502 AY24-25  19 EXAMPLE OF DESCRIBING THE PREGNANT HISTORY A woman who is in first time of pregnancy, with no history of abortion -> Gravida: ? Write as ______ Parity: ? Candy Tsoi / NUR502 AY24-25  20 EXAMPLE OF DESCRIBING THE PREGNANT HISTORY A woman who is in first time of pregnancy, with no history of abortion Gravida: 1 Write as G1P0 Parity: 0 Candy Tsoi / NUR502 AY24-25  21 EXERCISE OF DESCRIBING THE PREGNANT HISTORY 1. A woman who is in first time of pregnancy, with no history of abortion Gravida: __ Parity: __ Write as ______ 2. Woman who is now the third time of pregnancy, she tells you now has 1 boy and 1 girl Gravida: __ Parity: __ Write as ______ 3. A woman just told you she is now pregnant, before she had 4 times abortions and currently has 1 baby girl Gravida: __ Parity: __ Write as ______ 4. A pregnant woman comes to you for history taking, she had a pair of 5 year old twin babies, and 1 abortion last year Gravida: __ Parity: __ Write as ______ Candy Tsoi / NUR502 AY24-25 Candy Tsoi / NUR502 AY24-25 22 BASIC ANATOMY AND PHYSIOLOGY IN OBSTETRIC NURSING  23 BIRTH CANAL It composed of: 1. Rigid bony pelvis and uterus 2. Soft tissues and muscles of the cervix, pelvic floor and vagina Magill-Cuerden, J. & Macdonald, S. (2012) Candy Tsoi / NUR502 AY24-25  24 WOMAN PELVIS Size and shape of pelvis can affect her ability to deliver vaginally Protects the internal and external reproductive organs Candy Tsoi / NUR502 AY24-25  25 WOMAN PELVIS Types of pelvis 4 types of pelvis: Anthropoid Platypelloid Gynaecoid Android Candy Tsoi / NUR502 AY24-25  26 GYNAECOID PELVIS Gynaecoid pelvis is most favourable for labour or vaginal delivery Magill-Cuerden, J. & Macdonald, S. (2012) Candy Tsoi / NUR502 AY24-25  27 UTERUS Pear shape organ Contains: Thick muscular wall Mucous membrane lining Rich blood supply Normal bent slightly forward (anteflexion) Candy Tsoi / NUR502 AY24-25  28 UTERUS STRUCTURE Three sections Three layer Fundus- Upper portion Endometrium – inner layer, contains Corpus- Body rich blood supply Cervix Myometrium – thick muscular wall Perimetrium- the outer layer Candy Tsoi / NUR502 AY24-25  29 UTERUS FUNCTION Support bladder and bowel Allow fetus development Accept fertilized ovum from fallopian tube Allow ovum implanted into the endometrium, and derives nourishment from blood (Marshall & Raynor, 2014) Candy Tsoi / NUR502 AY24-25  30 CERVIX Constitutes the lower third of the uterus, half of the cervix projecting into the vagina Cervical canal : hollow part of the cervix presence of mucus plug-in the cervical canal to prevent ascending infection Consists of external and internal os Candy Tsoi / NUR502 AY24-25  31 ROLE OF CERVIX OS IN PREGNANCY From the second to third trimester: Remain closed until onset of labour Provide stable support for the baby’s head Allow descend into the uterus in preparation for birth Candy Tsoi / NUR502 AY24-25  32 ROLE OF CERVIX OS IN PREGNANCY During labour: Effacement and dilatation occurs during onset of labour Key determination of labour progress (Dilatation from 0cm-10cm) by examination of the external os Allow descent of fetus and pass the birth canal Candy Tsoi / NUR502 AY24-25  33 VAGINA Structure Consists muscle layers - Vaginal walls are pink and the linings are arranged into small folds (rugae) in pre-pregnant stage Allow the vaginal walls to stretch and become smooth during childbirth Candy Tsoi / NUR502 AY24-25  34 VAGINA Functions Passage for menstrual flow Passage for spermatozoa which deposited during sexual intercourse Barrier to prevent ascending infection because of its acid secretion Exit for the fetus during delivery Candy Tsoi / NUR502 AY24-25  35 PELVIC FLOOR Formed by the soft tissues covering the outlet of the pelvis Through it pass the urethra, the vagina and the anal canal https://commons.wikimedia.org/wiki/File:1115_Muscles_of_the_Pelvic_Floor.jpg Candy Tsoi / NUR502 AY24-25  36 FUNCTIONS OF PELVIC FLOOR 1. Supports the weight of the abdominal and pelvic organs 2. Responsible for the voluntary control of elimination 3. During childbirth: Supports the weight of uterus Control movements of the fetus through the birth canal by contraction and relaxation * Pelvic floor injury during childbirth will lead to incontinence and uterine prolapse Candy Tsoi / NUR502 AY24-25  37 UTERUS & PELVIC Candy Tsoi / NUR502 AY24-25 Candy Tsoi / NUR502 AY24-25 38 FETAL SKULL  39 FETAL SKULL Frontal bones (left and right) Parietal bones (left and right) Occipital bone Temporal bones (left and right) JaypeeDigital https://medlineplus.gov/ency/imagepages Candy Tsoi / NUR502 AY24-25  40 SUTURES Areas of membranes which have not been ossified 1. Frontal Suture fused in the early adulthood when ossification of the skull completes 2. Coronal Suture 3. Sagittal Suture 4. Lambdoid Suture Magill-Cuerden, & Macdonald (2012). Candy Tsoi / NUR502 AY24-25  41 FONTANELLES A membranous, non-ossified area of the skull found where three or more sutures meet Anterior Fontanelle (Bregma) Shape: diamond / kite-shaped Closes at 18 months Posterior Fontanelle (Lambda) Size and shape : small size and triangular shape Closes at 6 weeks Candy Tsoi / NUR502 AY24-25 Magill-Cuerden, & Macdonald (2012)  42 CLINICAL SIGNIFICANCE Sutures and fontanelles allow overriding of the fetal skull during labour temporary alter the shape as guiding point in vaginal examination in locating position https://medlineplus.gov/ency/imagepages Candy Tsoi / NUR502 AY24-25  43 VERTEX PRESENTATION (FULLY FLEXED HEAD) Most favourable shape for dilating the cervix and vaginally delivered Magill-Cuerden, & Macdonald (2012). Candy Tsoi / NUR502 AY24-25  44 MOLDING OF FETAL SKULL Change of shape of fetal head that takes place during its passage through the birth canal Bones of vault allow a slight degree of bending and override at the sutures Reduction in the size of the presenting A protective mechanism and prevents the fetal brain from being compressed as long as it is not excessive, too rapid or in an unfavorable direction Candy Tsoi / NUR502 AY24-25  45 CAPUT SUCCEDANEUM Area of edema over presenting part of fetus / newborn resulting from the pressure against the cervix during labour Edema occurs in the skin superficial to skull & periosteum Usually heal without any major medical intervention Candy Tsoi / NUR502 AY24-25  46 CEPHALOHAEMATOMA Pressure during birth that cause bleeding between periosteum (the membrane that covers the skull) & skull Reason for cephalohaematoma: ❖ Difficult or prolonged birth ❖ cephalopelvic disproportion (the baby’s head is larger than the mother’s pelvic opening) ❖ Big baby ❖ Abnormal presentation ❖ Use of birth-assisting tools such as forceps or vacuum delivery Candy Tsoi / NUR502 AY24-25  47 CEPHALOHAEMATOMA Usually heal without any major medical intervention If improperly treated ❖Permanent brain damage ❖Anaemia ❖Meningitis Candy Tsoi / NUR502 AY24-25  48 (Nichols & Zwelling, 1997) Candy Tsoi / NUR502 AY24-25  49 COMPARISON OF CAPUT SUCCEDANEUM AND CEPHALOHAEMATOMA Caput Succedaneum Cephalohaematoma Present at birth Not present at birth, present after birth May cross a suture line Never cross a suture line Size depends on rate of labour progress Size depends on degree of trauma Tends to grow less as it gradually subsides May increase in the first 1 to 2 days Pits on pressure (oedematous swelling) Does not pit on pressure Disappear completely within 24-48 hours Disappear completely at about 4-6 weeks Unilateral ( Double caput is rare) Bilateral is common (Double Cephalhaematoma) No harm done Harmful – Neonatal jaundice, anaemia, brain damage Candy Tsoi / NUR502 AY24-25  50 DIFFERENTIAL DIAGNOSIS 1. History taking 2. Physical examination 3. Nursing observation & Assessment Candy Tsoi / NUR502 AY24-25  51 TREATMENT / MANAGEMENT Caput succedaneum Cephalohematoma Observational & Reassurance Observational & Reassurance Majority of cases will self-resolve within Nursing monitoring for growing size & forty-eight hours hyperbilirubinemia Nursing monitoring for neonatal The swelling typically resolves itself jaundice between two weeks to six months Parent Education / Anticipatory Parent Education / Anticipatory Guidance - Discuss variances and Guidance - Discuss variances and when they should resolve when they should resolve Care when handling infant’s head Care when handling infant’s head Refer to appropriate Neonatal care Candy Tsoi / NUR502 AY24-25 Candy Tsoi / NUR502 AY24-25 52 BREAST  53 BREAST Anatomy of breast : Composed of fat, fibrous tissue & mammary glands; Rich in lymphatic network Hormonal influences during pregnancy begin in the first trimester → Increase level of oestrogen and progesterone → Fat and fibrous tissue are sensitive to hormones → cause milk ductal sprouting and branching Candy Tsoi / NUR502 AY24-25  54 Candy Tsoi / NUR502 AY24-25  55 BREAST Initiation of milk production Estrogen and progesterone levels decrease after delivery Prolactin level increases and initiates milk production Alveoli contract and eject milk into the ducts through the nipple Mammary glands can produce colostrum before birth Mammary glands can produce milk several days after birth Milk is transported in lactiferous ducts and stored in lactiferous sinus Candy Tsoi / NUR502 AY24-25  56 REGULATION OF MILK PRODUCTION 1. By hormones: Oestrogen & progesterone prepare the breasts for lactation Prolactin: hypothalamus anterior pituitary gland stimulates mammary glands to produce milk Oxytocin: hypothalamus posterior pituitary gland stimulates milk ejection 2. By stimulus (Let-down reflex): Mental: seeing the baby Physical: baby suckling Both Tsoi Candy stimulate / NUR502 AY24-25 the secretion of prolactin & oxytocin Candy Tsoi / NUR502 AY24-25 57 THE ANATOMY AND PHYSIOLOGY OF FERTILITY, CONCEPTION AND PREGNANCY  58 FERTILITY Fertility is the natural capability to produce offspring Human fertility depends on the following factors: nutrition sexual behavior culture, instinct endocrinology timing economics way of life emotions Candy Tsoi / NUR502 AY24-25  59 STAGE OF FETAL DEVELOPMENT (TOTAL OF 40 WEEKS) 1. Pre-embryonic stage – first 2 weeks beginning with fertilization 2. Embryonic stage – from week 3 through week 8 3. Fetal stage – from week 8 through birth (Marshall & Raynor, 2014) Candy Tsoi / NUR502 AY24-25  60 ZYGOTE TO EMBRYO Fertilization takes place in ampulla of the fallopian tube Once the sperm enters the ovum, the head of the sperm swells to form the male pronucleus The 23 unpaired chromosomes of the male and female pronucleus align themselves to form a full chromosomal complement in the fertilized ovum At the same time (within 30 minutes of the sperm entering the ovum), the two cell membranes fuse to form a single cell called the zygote Candy Tsoi / NUR502 AY24-25  61 FETAL DEVELOPMENT : PRE-EMBRYONIC STAGE Period: Begins from fertilization to the 2nd week Union of sperm and ovum forms a zygote (46 chromosomes) Cell division continues to form a morula The inner cell mass of morula is called blastocyst The outer cell mass is called trophoblast Implantation occurs 7-8 days after conception in the endometrium Candy Tsoi / NUR502 AY24-25  62 FETAL DEVELOPMENT: EMBRYONIC STAGE Period: End of 2nd week through the 8th week Basic structures of major body developed The trophoblast (outer cell) continue to develop into: **Placenta: Consists of chorionic villi and invade into the endometrium Allow exchange of oxygen, nutrients and removes waste products from fetal blood **Chorion: Outermost protective membrane around the embryo combine with the amnion together form the amniotic sac Amniotic sac contains amniotic fluid to protect the floating embryo Candy Tsoi / NUR502 AY24-25  63 FETAL DEVELOPMENT: EMBRYONIC STAGE The blastocyst (inner cell mass) continue to develop into embryonic cells (fetal parts): Ectoderm: forms central nervous system, special senses, skin and glands Mesoderm: forms the skeletal, urinary, circulatory and reproductive system Endoderm: forms respiratory system, liver, pancreas and digestive system Amnion: Innermost thin protective membrane combine with chorion to from amniotic sac Umbilical cord: Developed from amnion which supply blood and nutrients from placenta to fetus Candy Tsoi / NUR502 AY24-25  64 PLACENTA Means of metabolic & nutrient exchange between the embryonic & maternal circulation Located at site where embryo attaches to uterine wall, normally in upper uterine segment Purplish red in colour and round shape Candy Tsoi / NUR502 AY24-25  65 PLACENTA Size: about 20 cm in diameter, 2.5-3 cm in thickness Weight: about 1/6 of birth weight of baby (400-600 gm) 2 surfaces : a. Maternal - dark red in colour with cotyledons each cotyledon is a vascular unit for exchange of gases & nutrients b. Fetal - shiny white covered by amnion and chorion with insertion of umbilical cord Candy Tsoi / NUR502 AY24-25  66 PLACENTA Candy Tsoi / NUR502 AY24-25  67 FUNCTIONS OF PLACENTA 1. Respiratory actual pulmonary respiration does not take place fetus obtains oxygen from maternal circulation by simple diffusion and give off CO2 to maternal circulation 2. Nutrition all nutrients transport to fetus from mother through placenta: amino acid (tissue building), glucose (energy release) calcium and phosphate (bone and teeth development) iron (blood formation), water, vitamins Candy Tsoi / NUR502 AY24-25  68 FUNCTIONS OF PLACENTA 3. Excretion waste products excreted through maternal circulation e.g. CO2, urea 4. Protective barrier Limited barrier to some bacterial infection and drug from mother protect infection except virus & certain smaller organisms provide passive immunity to fetus e.g. some IgG can be passed on from the mother Candy Tsoi / NUR502 AY24-25  69 EXCHANGE SYSTEM OF THE PLACENTA The fetal side of the placenta consists of chorionic villi Fetal blood flow through the umbilical cord to the chorionic villi Projects into the surrounding maternal capillaries with pool of maternal blood Oxygen, nutrients and other substances exchange through the capillaries of maternal and fetus by diffusion and active transport Candy Tsoi / NUR502 AY24-25  70 EXCHANGE SYSTEM OF THE PLACENTA The fetal side of the placenta consists of chorionic villi Fetal blood flow through the umbilical cord to the chorionic villi Projects into the surrounding maternal capillaries with pool of maternal blood Oxygen, nutrients and other substances exchange through the capillaries of maternal and fetus by diffusion and active transport Candy Tsoi / NUR502 AY24-25  71 Candy Tsoi / NUR502 AY24-25  72 UMBILICAL CORD Extend from placenta to the umbilicus of fetus About 50 cm in length, 2cm in diameter, surrounded by Wharton’s jelly Cord vessels (2A1V): 2 umbilical arteries (carry deoxygenated blood) 1 umbilical vein (carry oxygenated blood) Adapted from Perry S.E et. al. (2014) Candy Tsoi / NUR502 AY24-25  73 UMBILICAL CORD Functions : Transport oxygen and nutrients to fetus from mother Transport waste products away from fetus to mother for excretion Umbilical cord abnormalities: True knot Jelly cord Adapted from Perry S.E et. al. (2014) Candy Tsoi / NUR502 AY24-25  74 FETAL MEMBRANES 2 membranes : Chorion-outer membrane lining the uterine cavity continuous with edge of placenta thick, opaque and friable Amnion-inner membrane lining the umbilical cord & chorion smooth, transparent and tough Amniotic sac (cavity) contains amniotic fluid Candy Tsoi / NUR502 AY24-25  75 AMNIOTIC FLUID Fluid that surrounds the growing fetus during pregnancy Clear, pale straw-coloured, slight alkaline fluid in amniotic sac surrounding fetus Volume : about 1,000 ml in singleton pregnancy Composition: 98% water 2% organic matter * nutrients, electrolytes, metabolites/waste products, other biochemicals * fetal skin cells, vernix, lanugo/fine hair Candy Tsoi / NUR502 AY24-25  76 FUNCTIONS OF AMNIOTIC FLUID : DURING PREGNANCY maintain constant temperature maintain fluid and electrolyte balance permit symmetric growth and development promote fetal movement cushion the fetus from trauma Prevent umbilical cord compression provide some nutritive substances for fetus Candy Tsoi / NUR502 AY24-25  77 FUNCTIONS OF AMNIOTIC FLUID: DURING LABOUR During labour (as long as the membranes remain intact) Equalize uterine pressure during contractions to protect the placenta and umbilical cord Aids effacement of cervix and dilatation of the cervical os Candy Tsoi / NUR502 AY24-25  78 FETAL DEVELOPMENT Candy Tsoi / NUR502 AY24-25  79 FETAL DEVELOPMENT- FETAL STAGE Period: End of 8th week until birth Dramatic growth and refinement of all organ system First fetal movement (quickening) started to be detected by primigravida mother: 16-22 weeks Usually earlier in multiparity mother, can be as early as 13 weeks Normal weight for full-term (born after 37 weeks) infants: 2,500 grams (about 5.5 lbs. or 2.5 kg) to 4,000 grams (about 8.75 lbs. or 4 kg) Candy Tsoi / NUR502 AY24-25  80 REFERENCE D. Keith Edmonds (2018). Dewhurst’s Textbook of Obstetrics & Gynaecology (9th ed.). Blackwell Publishing Davidson, M. C., London, M. L., & Ladewig, P. W. (2020). Old’s maternal-newborn nursing and women’s health across the lifespan (11th ed.). Pearson. Gardosi J. & Geirsson R. (1998). Routine ultrasound is the method of choice for dating pregnancy. Br J Obstet Gynaecol105, 933–36. Ladewig, P., London, M, & Dividson, M. (2017). Contemporary maternal-newborn nursing care. (9th ed.). Pearson Prentice Hall. Magill-Cuerden, J. & Macdonald, S. (2012). Maye’s midwifery (14th ed.). Elsevier Marshall, J.E., & Raynor, M.D., (2014). Myles textbook for midwives. (16th ed.). Churchill Livingstone. Midwifery : http://www.midwives.org.hk/vm.html Midwives Council of Hong Kong. (2014). Handbook for Midwives. https://www.mwchk.org.hk/docs/Handbook for Midwives e.pdf Murray, S. S. & McKinney, E. S. (2019). Foundations of Maternal-Newborn and Women's Health Nursing (7th ed.). Elsevier. Nevid, J. S., Fichner-rathus, L., & Rathus, S. A. (2007). Human sexuality in a world of diversity. (7th ed.). Allyn & Bacon. Silbert-Flagg, J. & Pillitteri, A. (2017). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. (8th ed.). Williams & Wilkins Candy Tsoi / NUR502 AY24-25  81 THANK YOU Candy Tsoi / NUR502 AY24-25