Preface

Customization

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Art Attribution

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Errata

All OpenStax textbooks undergo a rigorous review process. However, like any professional-grade textbook, errors sometimes occur. In addition, the wide range of evidence, standards, practices, data, and legal circumstances in nursing change frequently, and portions of the text may become out of date. Since our books are web-based, we can make updates periodically when deemed pedagogically necessary. If you have a correction to suggest, submit it through the link on your book page on OpenStax.org. Subject matter experts review all errata suggestions. OpenStax is committed to remaining transparent about all updates, so you will also find a list of past and pending errata changes on your book page on OpenStax.org.

Format

You can access this textbook for free in web view or PDF through OpenStax.org, and for a low cost in print. The web view is the recommended format because it is the most accessible—including being WCAG 2.1 AA compliant—and most current. Print versions are available for individual purchase, or they may be ordered through your campus bookstore.

Summary

Nurses in every area of specialty will care for persons assigned female at birth (AFAB). Therefore, nurses should be aware of the nuances of care across the life stages, including adolescence, pregnancy, postpartum, perimenopause, and menopause. People are unique, and nurses are in unique positions to promote health, detect vulnerability, intimate partner violence, homelessness, depression, and impacts of social determinates of health. This text introduces these concepts and encourages students to consider individual patient-centered care.

Maternal-Newborn Nursing is written with a focus on pregnancy, birth, postpartum, breastfeeding, and newborn care. This text presents normal physiology and abnormal conditions specific to maternal/newborn care. The student will be able to implement the Clinical Judgement Measurement Model to recognize, analyze, prioritize, create, act on, and evaluate outcomes throughout the many normal and abnormal conditions presented. After reading Maternal-Newborn Nursing, students will be able to provide patient education regarding contraception, pregnancy, labor, or chronic pelvic pain; screen for mental health issues such as postpartum depression and anxiety, grief, or fear; determine a patient’s access to care questioning transportation, insurance, employment; and integrate inclusive care by addressing patients by their preferred name, recognizing populations at higher risk for health disparities or complications, and providing a safe place for care.

Pedagogical Foundation

Maternal-Newborn Nursing uses cognitivism and connectivism as the learning framework. The text provides visual tools such as pictures, charts, and graphs that allow students to internalize information and create long-term knowledge. The text also builds on the students’ knowledge and skills likely obtained in previous courses, and expands their learning of new concepts of maternal/newborn nursing. The technology and formats of the offering allows for teachers to build and expand on the existing information, rearrange chapters to fit the needs of the class, and connect students to resources through suggested websites and links. These unique abilities increase active learning, leading to increased cognitive development.

Organizational Framework

The table of contents for Maternal-Newborn Nursing presents content in 27 chapters, organized into 6 thematic units.

• Unit 1 introduces the foundations of maternal-newborn and women’s health nursing. It covers trends and standards across all areas, alongside current ethical and legal concerns. The focus on culturally competent care highlights issues affecting families and introduces foundational knowledge.
• Unit 2 explores health promotion and prevention strategies, addressing fertility, family planning, and common reproductive system disorders, including both malignant and benign neoplasms. It explores sexually transmitted infections, vaginal and urinary tract infections, and breast disorders. Additionally, it tackles violence against women, including sexual abuse, human trafficking, and the resultant psychological trauma and its effects on families.
• Unit 3 focuses on the physiological and psychological changes during pregnancy, detailed through prenatal care, screening, and education segmented by trimesters. The unit also presents abnormal pregnancy conditions and reviews various childbirth education models.
• Unit 4 breaks down the birthing process into stages of labor, discussing physiological and psychological adaptations, maternal and fetal monitoring options, and detailed nursing care for each stage. Pain management techniques and interventions for labor complications, such as labor dystocia, cesarean births, and obstetrical emergencies, are thoroughly explored.
• Unit 5 presents normal and abnormal postpartum adaptations, breastfeeding techniques, and the management of postpartum mood and psychiatric disorders. It also introduces postpartum nursing care and screening tools.
• Unit 6 covers immediate post-birth recovery and ongoing care for the newborn. It presents newborn assessments, gestational age estimation, typical newborn care, and parent education for newborn care. The importance of discharge planning is emphasized, alongside discussions on complications like congenital malformations, newborn resuscitation, and various aspects of newborn loss. The final chapter brings all the information together in an unfolding case study. The case study uses the CJMM model and encompasses care from preconception to the newborn stage.

Nursing Features

To further enhance learning, Maternal-Newborn Nursing includes the following features:

• Clinical Judgment Measurement Model boxes guide students through the application of the Clinical Judgment Measurement Model in maternal-newborn nursing. The content explores the critical thinking and decision-making processes necessary to navigate patient care at different points in the process, from recognizing cues to evaluating outcomes.
• Clinical Safety and Procedures (QSEN) align with the Quality and Safety Education for Nursing competencies by providing detailed explanations of safety protocols and procedures specific to maternal-newborn nursing. This feature emphasizes the importance of patient safety and quality care and offers checklists, step-by-step, or tips on various safety practices.
• Cultural Context boxes explore the impact of cultural factors on maternal-newborn nursing. Some features describe care provided in other countries, while other features discuss cultural considerations for patients in the United States. Cultural Context boxes encourage students to approach each patient individually, respecting their culture and values.
• Ethical/Legal Issues features explore topics concerning ethical or legal issues related to maternal-newborn care. One feature might provide information on legality of prescribing birth control to adolescents, while another feature discusses ethical concerns of genetic testing.
• Life-Stage Context features describe topics that are affected by a patient’s age. Age-related topics, such as advanced maternal age, allow the students to critically think about what influences certain conditions.
• Link to Learning features provide a very brief introduction to online resources—videos, interactives, collections, maps, and other engaging resources that are pertinent to students’ exploration of the topic at hand.
• Pharmacology Connections features introduce students to specific medications utilized in maternal-newborn nursing. Each feature includes instructions on administration, mechanism of action, dosing, safety for pregnancy or breastfeeding, and patient education.
• Real RN Stories feature firsthand accounts from registered nurses in the field of maternal-newborn nursing. These stories help students make connections to topics on a deeper level.
• Unfolding Case Studies present a hypothetical client scenario that unfolds in three parts across chapters, with each subsequent part presenting new information on the same client, to help foster clinical judgment. In each part of an unfolding case feature, the scenario is followed by two questions that require students to apply their knowledge of evidence-based care and allow them to practice with questions that mimic the style of Next-Gen NCLEX. The answers to these questions, with explanations, are included in the Answer Key for students at the end of the book.

Pedagogical Features

To support student learning, Maternal-Newborn Nursing includes the following standard elements:

• Learning Outcomes: Every chapter section begins with a set of clear and concise student learning outcomes. These outcomes are designed to help the instructor decide what content to include or assign and can guide students on what they can expect to learn and be assessed on.
• Assessments: A variety of assessments allow instructors to confirm core conceptual learning, elicit brief explanations that demonstrate student understanding, and offer more in-depth assignments that enable learners to dive more deeply into a topic or history-study skill.
  • Review Questions test for conceptual apprehension of key concepts.
  • Check Your Understanding Questions require students to explain concepts in their own words.
  • Reflection Questions and Competency-Based Assessment Questions dive deeply into the material to support longer reflection, group discussion, or written assignments.
  • What Should the Nurse Do? and Critical Thinking About Case Study Questions assess students’ clinical judgment skills using case-based scenarios. Students review either a single case or an unfolding case that reveals information gradually. In response to their observations of the patient, students must decide how to navigate the Clinical Judgment Measurement Model process. This approach challenges them to apply theoretical knowledge to practical situations, determining the most appropriate interventions based on the patient’s specific circumstances.
• Answers to Questions in the Book: The assessments are intended for homework assignments or classroom discussion; thus, student-facing answers are not provided in the book. Answers and sample answers are provided in the Instructor Answer Guide for instructors to share with students at their discretion, as is standard for such resources.
• Chapter Summary: Chapter summaries assist both students and instructors by outlining the primary subtopics addressed within the chapter.
• Key Terms: Key terms are presented in bold text and are followed by an explanation in context. Definitions of key terms are also listed in the end-of-chapter glossary.
• References: References are listed at the end of each chapter.

Senior Contributing Authors

Senior contributing authors: Amy Giles (left), Regina Prusinski (middle), Laura Wallace (right)

Amy Giles, Baylor University. Dr. Giles has been a nurse-midwife since 2002. She received her bachelor’s degree from Baylor University, master’s degree in nursing, and post-master’s certificate as a women’s health nurse practitioner from Texas Woman’s University, certificate in nurse-midwifery from University of Texas Southwestern Medical School/Parkland School of Nurse-Midwifery, and her Doctor of Nursing Practice from Touro University. She owns Allen Midwifery & Family Wellness, a birth-center, hospital practice, and wellness center outside of Dallas, Texas. Dr. Giles is also certified in Lifestyle Medicine and provides care for clients who struggle with preventable chronic diseases, as well as pregnancy, gynecological, and psychosocial issues through lifestyle modifications. Dr. Giles has taught undergraduate and graduate nursing students at Texas Woman’s University, Texas Tech Health Science Center, and is a Clinical Assistant Professor in the DNP program at the Louise Herrington School of Nursing at Baylor University where she teaches nurse-practitioner and nurse-midwifery students. Dr. Giles encourages the next generation of healthcare providers to treat each patient individually using compassion and shared decision-making. Dr. Giles has served on the Texas Mortality Task Force, Steering Committee for the Texas-Aim Birth Center Workshops, secretary and legislative representative of the Consortium of Texas Certified Nurse-Midwives, member of the American College of Nurse-Midwives’ Program Committee and Core Competency Committee, and member of the Southwest Association of Educators’ Exam Committee. She has presented at state and national conferences and has been published in peer reviewed journals. Recently she was inducted into the Fellowship of the American College of Nurse-Midwives.

Regina Prusinski, Otterbein University. Dr. Prusinski holds a BSN from the University of North Carolina, Chapel Hill, an MSN in Acute Care Pediatric Nurse Practitioner from Duke University, a post-master's certificate in Family Nurse Practitioner (FNP) from Otterbein University, and a Doctor of Nursing Practice (DNP) from The Ohio State University. Dr. Prusinski has been a nurse for over 20 years with clinical practice in pediatric and adult congenital health care. She has been a nursing professor since obtaining a DNP in 2013 from OSU, teaching at all levels within the nursing program at Otterbein university with a focus on critical care, pediatrics, and family health. She is the Graduate Nursing Director and FNP Director for Otterbein University Department of Nursing. She has been a clinical practitioner at Nationwide Children’s Hospital in the Heart Center since 2007. She was the co-writer for the successful Nurse Education Grant Program provided by the Ohio Board of Nursing from 2021 to 2023. She was awarded the Heart Center travel award in 2022 and the Otterbein Summer Writing Award in 2023. She is a member of the National League for Nursing (NLN) and the American Association of Critical-Care Nurses (AACN), a charter member of both the Beta Epsilon and Kappa Lambda Chapters of the Sigma Theta Tau International Honor Society of Nursing and a peer reviewer for both Open RN texts and the CIN: Computers, Informatics, Nursing Journal.

Laura Wallace, Mercer College. Dr. Wallace received a BSN from Spalding University in Louisville, an MS with a focus in Nurse-Midwifery from the University of Minnesota, and a PhD in Adult Education from Capella University. She is Assistant Professor-D at Chamberlain University, teaching in the BSN prelicensure program and Faculty Emeritus at Brenau University. Dr. Wallace’s nursing career spans more than 40 years as a maternity nurse and certified nurse-midwife. Her nursing education career began over 20 years ago in an ADN program. Throughout her nursing education experience, she has taught nurses across all academic levels, from ADN to PhD in both on-ground and online learning environments. Dr. Wallace is a member of the Georgia Association for Nursing Education.

Contributing Authors

Leah Elliott, Bakersfield College

Rachel Hill, California State University, Sacramento

Debra Hrelic, University of North Carolina Wilmington

Kelly LaMonica, Penn Medicine Princeton Health

Emily Langley, Johns Hopkins All Children’s Hospital

Rachael Mooney, Northwood Technical College

JoAnn Peterson, University of Kansas

Courtney Watson, Georgetown University

Nicole Wheeler, Wayne State University

Reviewers

Ashley Anderson, Athena Health and Wellness

Stephane Blundell, University of Massachusetts Global

Beth Condley, University of Oklahoma Health Sciences Center

Jessica Crockett, Pensacola Christian College

Samantha Crouch, Baylor University

Janine Eagon, Marquette University

Amber Essman, Victoria Haynes, University of North Dakota The Ohio State University

Kelley Hicks, Managing Care Solutions

Stacey Hobbick, University of North Florida

Karyn Holt, Drexel University

Jennifer Johnson, Chamberlain University

Yuko Kawasaki, West Valley-Mission Community College

Brittney Kenney, University of Missouri-St. Louis

Thanayi Lambert, University of Texas at Arlington

Wendy Martin, Gordon State College

Angela McCain, Southern University Shreveport

Mikki Meadows-Oliver, New York University

Autumn Mels, University of Chicago

Jacqueline Mendoza-Lu, Herzing University

Melanie Mertz, Gordon State College

Michael Mooney, University of Michigan, Ann Arbor

Nicole M. Murry, University of Texas at Austin

Lauren Olvera, Baylor University

J. Paulat, Concordia-St. Paul University

Claudia Reed, Seattle University

Sarah Shealy, Mount Saint Mary’s University

Joy Ferretti Shoemaker, Otterbein University

Katie Sleaford, St. Ambrose University

Mary Williams, Gordon State University

Rachel Wooten, Jacksonville State University

Student and Instructor Resources

We have compiled additional resources for both students and instructors, including Getting Started Guides, an instructor’s answer guide, test bank, and image slides. Instructor resources require a verified instructor account, which you can apply for when you log in or create your account on OpenStax.org. Take advantage of these resources to supplement your OpenStax book.

Instructor’s answer guide. Each component of the instructor’s guide is designed to provide maximum guidance for delivering the content in an interesting and dynamic manner.

Test bank. With more than 1,100 assessments, instructors can customize tests to support a variety of course objectives. The test bank includes review questions (multiple-choice, identification, fill-in-the-blank, true/false), short answer questions, and long answer questions to assess students on a variety of levels. The test bank is available in Word format.

PowerPoint lecture slides. The PowerPoint slides provide learning objectives, images and descriptions, feature focuses, and discussion questions as a starting place for instructors to build their lectures.

Academic Integrity

Academic integrity builds trust, understanding, equity, and genuine learning. While students may encounter significant challenges in their courses and their lives, doing their own work and maintaining a high degree of authenticity will result in meaningful outcomes that will extend far beyond their college career. Faculty, administrators, resource providers, and students should work together to maintain a fair and positive experience.

We realize that students benefit when academic integrity ground rules are established early in the course. To that end, OpenStax has created an interactive to aid with academic integrity discussions in your course.

Visit our academic integrity slider. Click and drag icons along the continuum to align these practices with your institution and course policies. You may then include the graphic on your syllabus, present it in your first course meeting, or create a handout for students. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

At OpenStax we are also developing resources supporting authentic learning experiences and assessment. Please visit this book’s page for updates. For an in-depth review of academic integrity strategies, we highly recommend visiting the International Center of Academic Integrity (ICAI) website at https://academicintegrity.org/.

Community Hubs

OpenStax partners with the Institute for the Study of Knowledge Management in Education (ISKME) to offer Community Hubs on OER Commons—a platform for instructors to share community-created resources that support OpenStax books, free of charge. Through our Community Hubs, instructors can upload their own materials or download resources to use in their own courses, including additional ancillaries, teaching material, multimedia, and relevant course content. We encourage instructors to join the hubs for the subjects most relevant to your teaching and research as an opportunity both to enrich your courses and to engage with other faculty. To reach the Community Hubs, visit www.oercommons.org/hubs/openstax.

Technology partners

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Special Thanks

The Division of Digital Learning at the Texas Higher Education Coordinating Board (THECB) has a history of dedicated research initiatives, services, and programs that have advanced open education in Texas by providing support, advocacy, and resources to Texas institutions in their OER efforts. The Division maintains a diverse OER portfolio including OERTX, a digital library and community space for open education work. The leadership and collaboration of the Division of Digital Learning staff made the OER Nursing Essentials (ONE) project possible, throughout research, planning, and development phases of the eight-textbook series.

This work was supported in whole or in part by the THECB. The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policies of the THECB.