The third edition of the Clinical Practice Guidelines for Midwifery & Women’s Health (Tharpe & Farley, 2009) provides a revised and thoroughly updated approach to midwifery care. Presented from a clinical perspective for the midwife who practices in any setting.,the Guidelines are designed to stimulate critical thinking while providing key resources for support of midwifery care. A wide range of styles of midwifery care are included within the Guidelines. Included are current evidenced-based midwifery and medical care, as well as traditional, holistic, and empiric midwifery care. The primary focus is on meeting the needs of women in a manner that is both safe & woman-oriented. Click Here For More Information or to Buy the Third Edition of the Clinical Practice Guidelines for Midwifery & Women's Health   The Clinical Practice Guidelines for Midwifery & Women’s Health uses a standardized format to enhance the ease of use, and stimulate critical thinking in the clinical setting. EACH PRACTICE GUIDELINE IS PRESENTED IN AN EASY-TO-USE OUTLINE FORMAT: ·         Key Clinical Information ·         Components of the Client History to Consider ·         Components of the Physical Examination to Consider ·         Differential Diagnoses to Consider ·         Diagnostic Tests or Procedures to Consider ·         Therapeutic Measures to Consider ·         Alternative Measures to Consider ·         Client Education & Support Measures to Consider ·         Follow-up Care to Consider ·         Collaborative Practice: When to Consider Consultation or Referral
Damariscove Dreams – Nell Tharpe Unaware of summer’s late afternoon sun Fading into roiling storm-clouds I slept On the wide granite expanse of the Flat Ledges; I rested with the sounds of the surge as my lullaby And the granite As warm and yielding as a lover’s embrace I awoke to twilight’s chill, And ran sleepy still, and laughing, Through the flat metallic light As a sudden storm gust chased me Down the narrow pathway Winding through wild thickets (wind rustle, bird flutter, bee drone) Across the island (sweet scent of grasses, warm rock, fading light) To this cubbyhole of cottage Whose weathered boards Grant shelter from the tumult Now I sit by golden lamplight Watching as night follows evening Pondering the meaning of mystery While the wind roars across the ocean Churning into the narrow cut of cove And entering the harbor In a froth of foam and spray Outside my trembling window The grasses ripple In a tawny undulating wave Mimicking the motion of the seas The gulls scream and ride the wind In the darkening purple storm-sky Exultant with its force Reveling in the currents holding them aloft The insidious wind sneaks through every crack Stirring the cottage like a hundred tiny dancing ghosts; Memories of those who have called the island home The string of green sea-glass that hangs in the window (translucent against the fading light) Moves in the eddies That make the curtains dance, And rattle the damper in the flue The glow of the lamp casts soft shadows I carry it to the sleeping loft Where I snuggle deep into downy softness And dream Of running barefoot To the island’s eastern shore Along cool dewy paths In early morning sun-shadow Where I hear (in my sleep, what a lullaby) The remnants of the storm-surge Pound the rocky shore In the nascent dawn-light. .	Annotated Resource List for First Assisting   ACNM 1) The Midwife as Surgical First Assistant Handbook. Essential information for expansion of practice. Available at http://www.shopacnm.com/clinical.html 2) Position Statement: The certified nurse-midwife/certified midwife as first assistant at surgery. On-line at: http://www.midwife.org/position.cfm Texts a.       Assisting in Surgery: Patient Centered Care, edited by Jane Rothrock, PhD, RN, CNOR, FAAN & Patricia Seifert, RN, MSN, CNOR, CRNFA, FAAN. Strongly suggested, especially for the novice. Wonderful resource for the basics of first assisting. Available through the Competency and Credentialing Institute: http://www.cc-institute.org/ b.       William's Obstetrics. Cunningham et al. McGraw-Hill. Great segment on cesarean delivery that has probably been read by every OB-GYN in practice. c.       AORN Standards, Recommended Practices and Guidelines. Updated annually this resource provides you with current information on accepted perioperative standards. Your OR should have a copy, but it also available to purchase through the perioperative bookstore at http://www.aorn.org/ d.       Operative Obstetrics, 2nd Ed. Gilstrap, Cunninham & Vandorsten. McGraw-Hill. This is a fabulous must-read book. Offers top notch information and illustrations. Covers surgical instruments, techniques, and procedures, and a myriad of information that is applicable to midwifery but not relevant to this course. It can be challenging to find a copy, and it is very pricey. You can purchase it directly from the publisher: http://books.mcgraw-hill.com/getbook.php?isbn=0838573878&template e.       Alexander's Care of the Patient in Surgery. Meeker & Rothrock. Mosby. One of the classic texts that covers surgical care from a clinical perspective. A great resource. An alternative text is Berry & Kohn's Operating Room Technique. Both are available from the AORN bookstore at http://www.aorn.org/ f.        Surgical Techniques in Obstetrics & Gynecology. Darryl Maxwell (Ed.) British text covers GYN as well as c-sections, instruments, complications. g.       Atlas of Pelvic Surgery. Clifford Wheeless (1997) Excellent detailed illustrations of procedures. h.       Anatomy, Pathophysiology, and Physical Assessment texts of your choice i.         Core Curriculum for the RN First Assistant. Basis of the AORN RNFA program. Covers all essential skills, techniques, and resources. Available through the AORN bookstore (see above). j.         What Every Pregnant Woman Needs To Know About Cesarean Section. Excellent booklet with detailed evidence-based references. Available on line at http://www.childbirthconnection.org/   Journal Articles There are many wonderful clinical articles about techniques for cesarean or gyn surgery. Participants are encouraged to perform a literature search for topics of particular interest. The following are general articles that may be useful. 1.       Clinical Obstetrics and Gynecology: Volume 47, Number 2. The entire issue is on cesarean from multiple perspectives. A great resource! 2.       Cyr, R. (2005) Myth of the ideal cesarean section rate: Commentary and historical perspective. Am J Obstet & Gynecol. 194, 932-6. 1.       Durnwald C, Mercer B. Uterine rupture, perioperative and perinatal morbidity after single-layer and double-layer closure at cesarean delivery. Am J Obstet Gynecol 2003; 189: 925. 2.       Hamar BD, Saber SB, Cackovic M, Magloire LK, Pettker CM, Abdel-Razeq SS, et al. Ultrasound Evaluation of the Uterine Scar After Cesarean Delivery: A Randomized Controlled Trial of One- and Two-Layer Closure. 2007; Obstet. Gynecol. 110: 808-813. 3.       Kiley JW, Ahn JT, Ismail M. Infection Rates After Cesarean Delivery With Exteriorized Versus Intraperitoneal Uterine Closure. Obstet. Gynecol. 2006; 107: 68S-b-69S-b. 4.       Lowe, NK. A Review of Factors Associated With Dystocia and Cesarean Section in Nulliparous Women. J Midwifery Women's Health. 2007;52(3):216-228. 5.       Moes, C.B., Thatcher, F. The midwife as first assistant for Cesarean section. J Midwifery & Wm's Hlth. 2001;46:305-312. 6.       Nisenblat V, Barak S, Griness OB, Degani S, Ohel G, Gonen R. Maternal Complications Associated With Multiple Cesarean Deliveries. Obstet. Gynecol., Jul 2006; 108: 21-26. 7.       Phipps MG, Watabe B, Clemons JL, Weitzen S, Myers DL. Risk Factors for Bladder Injury During Cesarean Delivery. Obstet. Gynecol. 2005; 105: 156-160. 8.       Spong CY, Landon MB, Gilbert S, Rouse DJ, Leveno KJ, Varner MW, et al. Risk of Uterine Rupture and Adverse Perinatal Outcome at Term After Cesarean Delivery. Obstet. Gynecol. 2007; 110: 801-807. 9.       Tharpe, N. First Assisting in Obstetrics: A Primer for Women's Healthcare Professionals. Journal of Perinatal & Neonatal Nursing. 21(1):30-38, January/March 2007. 10.   Varner MW, Thom E, Spong CY, Landon MB, Leveno KJ, Rouse DJ, et al. Trial of Labor After One Previous Cesarean Delivery for Multifetal Gestation. Obstet. Gynecol. 2007;110: 814-819. 11.  Visco AG, Viswanathan M, Lohr KN, Wechter ME, Gartlehner G, Wu JM, et al. Cesarean Delivery on Maternal Request: Maternal and Neonatal Outcomes. Obstet Gynecol 2006; 108: 1517-1529. Web Sites Please note that web sites may change at will. Additional websites may be accessed through the midwife publications website: http://www.midwifepublications.com/ 1.       Competency and Credentialing Institute: http://www.cc-institute.org/ The CC offers a wide range of perioperative educational materials (click on Education and Publications). For the midwife who is new to the surgical environment the Competency Assessment Modules offer a wonderful tool to develop the skills needed to feel confident in the surgical suite. The modules may be available through your OR via an institutional purchase, or you may purchase them individually. 2.       Cesarean Delivery. E-medicine: http://www.emedicine.com/med/topic3283.htm 3.       Northern New England Perinatal Quality Improvement Network: http://www.nnepqin.org/ NNEPQIN offers detailed risk management information for practitioners and facilities who offer VBAC to their clients, and a wonderful guideline on emergency cesarean training and simulation. 4.       OB/GYN Surgical Primer: http://www.med.umich.edu/obgyn/resdir/protocols/Surgicalprimer.html This site offers a brief outline of the technical steps used during select OB/GYN surgical procedures. 5.       OBGYN.net - Fetal Laceration Injury at Cesarean Delivery:  http://www.obgyn.net/journal-review/journal-review.asp?page=review3 A retrospective review article on fetal injury during cesarean. 6.       Sample OB/GYN Operative Reports: http://www.mtdaily.com/mt1/gynsampleops.html 7.       Tubal ligation: http://www.emedicine.com/med/topic3313.htm 8.       Surgical Emergencies in Obstetrics & Gynecology: http://www.brooksidepress.org/Products/Surgical_Emergencies_in_OBGYN/Surgical_Emergencies.doc 9.       Instruments in a cesarean section set: http://www.a1medicalsales.com/Merchant2/merchant.mvc?Screen=PROD&Store_Code=A&Product_Code=OG-CCS 10.   Handling of surgical instruments: http://www.residentnet.com/grips.htm 11.   American College of Surgeons. Statement on Principals: Qualifications of the first assistant in the operating room. Available at http://www.acs.org/ 12.   Regence Blue Shield. Working with Modifiers. Retrieved 1/6/06 from: http://www.wa.regence.com/provider/workshop/modifiers/mod80.html 13.   First Assistant Resource Guide: http://www.surgicalassistant.org/pdf/Surgical%20First%20Assistant%20Resource%20Guide.pdf  Written for surgical Technologist who are first assistants, this guide offers useful information to any first assistant. 14.   CDC Workbook for Designing, Implementing and Evaluating as Sharps Injury Prevention Program. CDC: http://www.cdc.gov/sharpssafety/wk_overview.html 15.   Sharps Injury Prevention On-line Course by EngenderHealth http://www.engenderhealth.org/ip/sharps/ns3.html 16.   Hillman, EJ. Otolaryngologic Manifestations of Pregnancy. Baylor Archives of Grand Rounds: http://www.bcm.edu/oto/grand/2295.html 17.   CDC (1999) Guideline for Prevention of Surgical Site Infection. In Infection Control and Hospital Epidemiology. Available on-line at http://www.cdc.gov/ncidod/dhqp/gl_surgicalsite.html 18.   American Society of Anesthesiologists. ASA Physical Classification System. Retrieved 1/31/06 from: http://www.asahq.org/clinical/physicalstatus.htm Videos Knot-tying and Suturing tutorials with streaming video from Boston University: http://www.bumc.bu.edu/generalsurgery/technical-training/basic-knots-sutures/  Knot-tying (two-hand and instrument ties) from University of New Mexico: http://hsc.unm.edu/SOM/surgery/students/knotTying.shtml Surgical Video: Cesarean Section. Available on-line at: http://anatomy.med.umich.edu/surgical_videos/cesarean.html Medline Cesarean Video. Pregnancy and Reproduction: Birth by Cesarean Section. Available on-line at: http://www.nlm.nih.gov/medlineplus/surgeryvideos.html   You will need to scroll down to the bottom of the page and look under the Women's Health heading. ACOG. ACOG has many OB and GYN surgical videos. Access from the ACOG Bookstore under ‘multimedia'. http://sales.acog.com/acb/stores/1/ Challenger Corp. Cesarean Delivery. Video, Monograph & CME program. http://www.chall.com/
	Green Landing at dawn
Everyday Miracle   The infant child sleeps. Her flawless skin a testament To the possibility Of perfection;   One cherubic hand, outstretched The other, curled at her mouth Like some small creature Nestled near its’ mother’s breast.   She carries the future On her small shoulders; Each day, all unknowing, She recreates the twisted path of Human evolution.   We come into this world Whole, innocent, Filled with Grace.   Before the mundane world Puts its’ mark upon us, For one brief moment Poised on the cusp between The spirit and the flesh   Perfection.       © Nell Tharpe, December 2007.	RULES FOR HAPPINESS Happiness is like a garden; it needs to be cultivated, watered, weeded and tended to flourish. Set yourself up for success, in life and in happiness. Set attainable goals, and move forward at your own pace.   Don’t give up. Be persistent, patient and polite.   Maintain a positive attitude. Choose to focus on what works, what is beautiful, what can be done.   Give thanks for the small things. Celebrate what you have, rather than pining for what you don’t have.   Make time each day to do things that bring you pleasure and enjoyment. We each only have today to live. Satisfaction is it’s own reward. Do things for others without needing anything in return. Maintain a vision of the future you want to live. Choose to sacrifice short-term pleasure and put up with short-term discomfort in order to achieve long-term positive changes in your life. Let go of negative thoughts. Learn to identify them, and replace then with positive or neutral thoughts.   Plan. Plan for happiness by arranging activities that nourish your spirit. Surround yourself with those who care for and about you, and the things that are important to you.   Accept the fallibility of others and yourself. Failure is simply another opportunity for growth. Don't take things personally, even when they are meant that way. Chose not to be hurt by other people’s anger, meanness, or attempts to manipulate you or the situation. Rather than focusing on your problems, dream about solutions, options, and creative avenues of change. Carpe Diem!