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Perinatal parental behavior: Nursing research and implications for newborn health
for decisions in client care. This book will help to raise the conscious awareness of some of its readers. Certainly the conflicts inherent in nurse-doctor relationships and the ethics of power struggles may sound familiar to many nurse-midwives. The Basson volume highlights one of the teaching/learning strategies in ethical decision-making, that of utilizing a case study, offering an analysis of options by speakers, and then submitting the questions to a discussion group for further analysis and decision. Nurse-midwives do not always have the luxury of group discussion of ethical issues in practice, but such discussions in book form can be helpful to readers in their application of ethics to practice situations. As noted earlier, many questions raised in the case studies are quite applicable to nursemidwifery practice and education. The final volume in this series by Jonsen et al. is probably the most practical book of the three. Once again the discussion of elements considered in making decisions of an ethical nature can be most helpful to nurse-midwives in practice. We agree wholeheartedly that good clinical nurse-midwifery is also ethical practice, and we urge midwives to read these volumes in order to facilitate their understanding of the ethical realm of such a practice discipline. Perinatal Parental Behavior: Nursing Research and Implications for Newborn Health. March of Dimes Birth De-
fects Foundation. Birth Defects: Original Article Series, Vol. XVII, No. 6., 1981. Edited by Beverly S. Raff, Regina P. Lederman, and Patricia Carroll. New York: Alan R. Lii, Inc. 1981. x + 310 pages. $46.00, hardcover. Reviewed
by: Henry 0. Thompson, Ph.D., Senior Fellow in Ethics, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
Pennatal Parental Behavior: Nursing Reand implications for Newborn Health consists of 11 research papers, each with a prepared critique and discussion, which were presented at a conference held September 1980 in Ann Arbor, Michigan. The papers cover such topics as maternal prenatal development and progress in labor, fetal-newborn health, nurse-midwives, and health promotion in pregnancy, changes in fetal position by maternal posturing, maternal positions
search
46
(comfort and ease of labor), the increasing number of Cesareans, parent-infant interaction, first year maternal roles, and families with at-risk infants. The first study found a positive correlation between conflicts in pregnancy with maternal anxiety and stress-related biochemical factors that prolonged labor and fetal-newborn depression. The second report discussed pilot research on the impact of nurse-midwives on the health of pregnancies. Another study on maternal posture concluded that the hands and knees posture with pelvic rocking was helpful in moving a fetus into anterior position. The procedure uses the physical theories of gravity, buoyancy, and friction. The research on maternal positions included freedom to move: stand, sit, or lie down. Observation showed that in labor these women tended to move about early. They tended to sit in early stages and lie down more in later stages. This was in part a response to comfort but according to the researchers, with allowances for individual differences, it also promoted efficient labor. The dramatic increase in Cesareans (156% from 1968 1977) has decreased infant mortality while increasing maternal mortality. The rationale presented here for the increased use of sections was physician fear of malpractice suits. The report notes that a comparative cultural study showed only a minor increase in sections. The lack of informed consent or viable options for women in labor was also presented. The main concern of the research, however, is the parental reactions to Cesarean sections. The reactions tend to be negative; women feel inadequate, and there is a weakening of mother-infant bonding. The study suggests that nursing needs a greater awareness of the expectations of mothers recovering from major surgery (too much too soon) and the need for increased support. The several other studies extend concern for mothers to fathers and the nuclear family. As definitions of masculinity change, fathers are reported to have a strong capacity for parenting. Male support of the woman in labor with both vaginal and section deliveries is reported here to be an important factor in how she reacts, her satisfaction with the birth, the strength of bonding, and family relationships. This is expressed very well by Jacqueline Hott in her report, “Best Laid Journal of Nurse-Midwifery
Plans. . . . Pre- and Postpartum Comparison of Self and Spouse Concepts in Primiparous Lamaze Couples Who Share Delivery and Those Who Do Not.” She says: It is the nurse as a leader of the health team and a significant person in family centered maternity care who must broaden nursing’s professional role to meet the needs of new families, whether or not they choose to share their childbearing experience, but particularly when that free choice has been taken away from them. The nurse can encourage early and frequent contact between mother and newborn and father and newborn to enhance parent-infant bonding and attachment. Helping the mother to achieve other successes-in breastfeeding, in an awareness of the infant’s the newborn cues, in handling securely-may help relieve the sense of failure, defeat, and guilt and her loss of a positive self-image. Encouraging rooming-in and unlimited visiting for the father can be supportive and positive ways to provide the father with feelings of active involvement and control which the cesarean delivery denied him. (p. 171) In her summary of the conference, Kathyn Barnard noted the importance of small clinical trials and case studies in research, the realness of multivariate research (the wholeness of life) and nursing’s emphasis on self-regulation and self-improvement. Nursing research needs to examine how nurses provide the support that helps people help themselves. As nursing continues its move toward professional status, research will play an increasing role in the establishment of this status. Those nursing groups, such as nurse-midwifery, that are at the professional level now, need research to refine and maintain that status. As nursing moves toward higher academic preparation, nursing research will move into a more central role. Barnard’s support for small studies and even one-on-one reports suggest great possibilities for nurses in all settings. I would suggest, however, that nursing keep an eye on the goal. The goal is not statistics but in Barnard’s words, “nursing effectiveness, most importantly, . . family functioning, and surviving” (p. 288). The content of this text is invaluable because it is one of vey few texts dealing
??
Vol. 28, No. 2, March/April
1983
with recent research by nurses in this area. Nurses without a strong background in statistics may find it heavy going at times. However, summary statements and descriptions help guide one through the maze of statistical measures. This book is highly recommended for nurse-midwives. (This review was written without bias or collaboration with the reviewer’s wife, Joyce Beebe Thompson, author of the second report.)
1981. 16 mm, video, l/2”, l/4” Beta, VHS. Color, sound, 24 min. Directed by Linda Jassim. Produced by and available from Churchill Films, 662 North Robertson Blvd., Los Angeles, CA 90069. Purchase price: $395, 16 mm; $315, video (not available for rental); free preview with intent to purchase.
Help!
I’m a New
Parent,
Reviewed by: Jeanne M. Perino, R.N., B.A.N., Childbirth Educator and Student, Neonatal Nurse Practitioner Program, University of Colorado, Denver, CO.
Problems and pleasures of parenting are presented in this delightfully humorous but very realistic film that explores the various changes that occur after the births of the first babies in three families. Realistically portraying life with a new baby and providing ideas for dealing with the sudden changes that parenthood brings are important aspects of preparation for parenthood. Presenting these often unexpected conflicts is the film’s greatest contribution to its viewers. The parents are a diverse group from a variety of social and cultural backgrounds. We meet them during pregnancy as they share romantic fantasies of parenthood. After childbirth many changes in lifestyles, relationships, and routines create a need for adaptation by both parents. The film captures effective methods of dealing with these changes. I would recommend this film most highly to those considering parenthood as well as those preparing for imminent parenthood. The film is presented in a manner that could easily be understood by audiences of teenagers as well as adults. It provides basic information in a manner that would be of interest and comprehension to audiences with a variety of educational levels. Health care providers and educators could easily utilize this film in prenatal Journal of Nurse-Midwifery
??
and childbirth preparation classes or as part of a patient education program.
ment it can provide helpful information and guidelines for care.
An Atlas of Intrauterine
Childbirth Picture Book. Childbirth Picture Book Flip Char&. By Fran P. Hosken;
Contraception
By Russel J. Thomsen, M.D. Washington, D.C.: Hemisphere Publishing Corporation, 1982. 169 pages. $49.50, hardcover. Reviewed by: Evelyn E. Brown, C.N.M., M.P.H., Clinical Instructor, NurseMidwifey Educational Program, Downstate Medical Center, State University of New York, Brooklyn, NY.
The author notes that this text is a pictorial atlas in which he has illustrated many types of intrauterine contraceptive devices and instruments for the insertion and removal of some of these devices. The author has provided a wealth of historical information in a concise and interesting manner with a selective bibliography to be used as a basic reference. The purpose of the text, as presented by the author, has been accomplished. I recommend this book to those individuals who have an interest in the historical aspects of the invention and use of intrauterine contraceptive devices. The clinician will not find this text useful as a clinical reference. Protocols
for High-Risk
Pregnancies.
Edited by John T. Queenan and John C. Hobbins. Oradell, New Jersey: Medical Economics Books, 1982. 322 pages. $16.95, paperback. Reviewed by: Jeanne M. Perino, R.N., B.A.N., Student-Neonatal Nurse Practitioner, University of Colorado, Denver, CO.
Forty-nine physicians from a variety of geographic locations provide the reader with guidelines for the management of high-risk pregnancies. Topics vary from specific hazards in pregnancy to maternal disease and obstetrical complications. This text does not provide in-depth information on pathophysiology or disease processes, nor was it the author’s intention to do so. However, the book does contribute a great deal in that it offers quick access to guidelines for the management of pregnancy. References are relatively current. There is an abundance of information that is concise and accurate. I would highly recommend this book to those working with high-risk as well as low-risk pregnancies. When utilized as a supple-
Vol. 28, No. 2, March/April
1983
The Universal
and The Universal
Pictures by Marcia L. Williams. Lexington, MA: Women’s International Network News, 1981. The Universal Childbirth Picture Book: 76 pages; $7.00, paperback. The Universal Childbirth Picture Book Flip Chart: 34 pages; $17.00. Reviewed by: Linda V. Walsh, C.N.M., M.P.H., Baltimore Birth Center, Baltimore, MD.
It is indeed refreshing to find a teaching tool that is applicable to all ages and cultures. The Universal Childbirth Picture Book (CBPB) recognizes that all women experience “the same joys and tribulations of childbearing, and the same health concerns.” The author’s approach emphasizes a healthy attitude toward childbearing. The text addresses many topics that are a routine part of nurse-midwifey prenatal teaching: nutrition, avoidance of drugs and alcohol, labor and delivery, and breastfeeding. In most cases, it is factual and supportive of alternatives in childbearing. For example, illustrations show the laboring woman in a variety of positions, and the text names the birth attendants as midwives and doctors. One reads that the baby “should be nursed right away, and as often as it wants.” However, for all the research that went into this endeavor, there are many misleading or erroneous points. For example, one reads the following: “The baby lying across (transverse) is the most difficult to deliver”; “When contractions are two minutes apart, the delivexy is about to begin”; “Baby should be given orange juice and vitamin drops at an early age.” The strong point of CBPB is the quality of the illustrations. Ms. Williams presents the anatomical changes of pregnancy, labor, and delivery in a vey clear manner. The CBPB Flip Chart presents 34 of these illustrations on 17 x 22-inch pages. Having used the chart in several childbirth education classes, my only concern is that the pages tear very easily, and after one month of use, most pages had pulled loose from the rings. Instructors choosing to use this visual tool might do well to mount the pages on more substantial backing. If one can overlook some of the errors 47
fects Foundation. Birth Defects: Original Article Series, Vol. XVII, No. 6., 1981. Edited by Beverly S. Raff, Regina P. Lederman, and Patricia Carroll. New York: Alan R. Lii, Inc. 1981. x + 310 pages. $46.00, hardcover. Reviewed
by: Henry 0. Thompson, Ph.D., Senior Fellow in Ethics, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
Pennatal Parental Behavior: Nursing Reand implications for Newborn Health consists of 11 research papers, each with a prepared critique and discussion, which were presented at a conference held September 1980 in Ann Arbor, Michigan. The papers cover such topics as maternal prenatal development and progress in labor, fetal-newborn health, nurse-midwives, and health promotion in pregnancy, changes in fetal position by maternal posturing, maternal positions
search
46
(comfort and ease of labor), the increasing number of Cesareans, parent-infant interaction, first year maternal roles, and families with at-risk infants. The first study found a positive correlation between conflicts in pregnancy with maternal anxiety and stress-related biochemical factors that prolonged labor and fetal-newborn depression. The second report discussed pilot research on the impact of nurse-midwives on the health of pregnancies. Another study on maternal posture concluded that the hands and knees posture with pelvic rocking was helpful in moving a fetus into anterior position. The procedure uses the physical theories of gravity, buoyancy, and friction. The research on maternal positions included freedom to move: stand, sit, or lie down. Observation showed that in labor these women tended to move about early. They tended to sit in early stages and lie down more in later stages. This was in part a response to comfort but according to the researchers, with allowances for individual differences, it also promoted efficient labor. The dramatic increase in Cesareans (156% from 1968 1977) has decreased infant mortality while increasing maternal mortality. The rationale presented here for the increased use of sections was physician fear of malpractice suits. The report notes that a comparative cultural study showed only a minor increase in sections. The lack of informed consent or viable options for women in labor was also presented. The main concern of the research, however, is the parental reactions to Cesarean sections. The reactions tend to be negative; women feel inadequate, and there is a weakening of mother-infant bonding. The study suggests that nursing needs a greater awareness of the expectations of mothers recovering from major surgery (too much too soon) and the need for increased support. The several other studies extend concern for mothers to fathers and the nuclear family. As definitions of masculinity change, fathers are reported to have a strong capacity for parenting. Male support of the woman in labor with both vaginal and section deliveries is reported here to be an important factor in how she reacts, her satisfaction with the birth, the strength of bonding, and family relationships. This is expressed very well by Jacqueline Hott in her report, “Best Laid Journal of Nurse-Midwifery
Plans. . . . Pre- and Postpartum Comparison of Self and Spouse Concepts in Primiparous Lamaze Couples Who Share Delivery and Those Who Do Not.” She says: It is the nurse as a leader of the health team and a significant person in family centered maternity care who must broaden nursing’s professional role to meet the needs of new families, whether or not they choose to share their childbearing experience, but particularly when that free choice has been taken away from them. The nurse can encourage early and frequent contact between mother and newborn and father and newborn to enhance parent-infant bonding and attachment. Helping the mother to achieve other successes-in breastfeeding, in an awareness of the infant’s the newborn cues, in handling securely-may help relieve the sense of failure, defeat, and guilt and her loss of a positive self-image. Encouraging rooming-in and unlimited visiting for the father can be supportive and positive ways to provide the father with feelings of active involvement and control which the cesarean delivery denied him. (p. 171) In her summary of the conference, Kathyn Barnard noted the importance of small clinical trials and case studies in research, the realness of multivariate research (the wholeness of life) and nursing’s emphasis on self-regulation and self-improvement. Nursing research needs to examine how nurses provide the support that helps people help themselves. As nursing continues its move toward professional status, research will play an increasing role in the establishment of this status. Those nursing groups, such as nurse-midwifery, that are at the professional level now, need research to refine and maintain that status. As nursing moves toward higher academic preparation, nursing research will move into a more central role. Barnard’s support for small studies and even one-on-one reports suggest great possibilities for nurses in all settings. I would suggest, however, that nursing keep an eye on the goal. The goal is not statistics but in Barnard’s words, “nursing effectiveness, most importantly, . . family functioning, and surviving” (p. 288). The content of this text is invaluable because it is one of vey few texts dealing
??
Vol. 28, No. 2, March/April
1983
with recent research by nurses in this area. Nurses without a strong background in statistics may find it heavy going at times. However, summary statements and descriptions help guide one through the maze of statistical measures. This book is highly recommended for nurse-midwives. (This review was written without bias or collaboration with the reviewer’s wife, Joyce Beebe Thompson, author of the second report.)
1981. 16 mm, video, l/2”, l/4” Beta, VHS. Color, sound, 24 min. Directed by Linda Jassim. Produced by and available from Churchill Films, 662 North Robertson Blvd., Los Angeles, CA 90069. Purchase price: $395, 16 mm; $315, video (not available for rental); free preview with intent to purchase.
Help!
I’m a New
Parent,
Reviewed by: Jeanne M. Perino, R.N., B.A.N., Childbirth Educator and Student, Neonatal Nurse Practitioner Program, University of Colorado, Denver, CO.
Problems and pleasures of parenting are presented in this delightfully humorous but very realistic film that explores the various changes that occur after the births of the first babies in three families. Realistically portraying life with a new baby and providing ideas for dealing with the sudden changes that parenthood brings are important aspects of preparation for parenthood. Presenting these often unexpected conflicts is the film’s greatest contribution to its viewers. The parents are a diverse group from a variety of social and cultural backgrounds. We meet them during pregnancy as they share romantic fantasies of parenthood. After childbirth many changes in lifestyles, relationships, and routines create a need for adaptation by both parents. The film captures effective methods of dealing with these changes. I would recommend this film most highly to those considering parenthood as well as those preparing for imminent parenthood. The film is presented in a manner that could easily be understood by audiences of teenagers as well as adults. It provides basic information in a manner that would be of interest and comprehension to audiences with a variety of educational levels. Health care providers and educators could easily utilize this film in prenatal Journal of Nurse-Midwifery
??
and childbirth preparation classes or as part of a patient education program.
ment it can provide helpful information and guidelines for care.
An Atlas of Intrauterine
Childbirth Picture Book. Childbirth Picture Book Flip Char&. By Fran P. Hosken;
Contraception
By Russel J. Thomsen, M.D. Washington, D.C.: Hemisphere Publishing Corporation, 1982. 169 pages. $49.50, hardcover. Reviewed by: Evelyn E. Brown, C.N.M., M.P.H., Clinical Instructor, NurseMidwifey Educational Program, Downstate Medical Center, State University of New York, Brooklyn, NY.
The author notes that this text is a pictorial atlas in which he has illustrated many types of intrauterine contraceptive devices and instruments for the insertion and removal of some of these devices. The author has provided a wealth of historical information in a concise and interesting manner with a selective bibliography to be used as a basic reference. The purpose of the text, as presented by the author, has been accomplished. I recommend this book to those individuals who have an interest in the historical aspects of the invention and use of intrauterine contraceptive devices. The clinician will not find this text useful as a clinical reference. Protocols
for High-Risk
Pregnancies.
Edited by John T. Queenan and John C. Hobbins. Oradell, New Jersey: Medical Economics Books, 1982. 322 pages. $16.95, paperback. Reviewed by: Jeanne M. Perino, R.N., B.A.N., Student-Neonatal Nurse Practitioner, University of Colorado, Denver, CO.
Forty-nine physicians from a variety of geographic locations provide the reader with guidelines for the management of high-risk pregnancies. Topics vary from specific hazards in pregnancy to maternal disease and obstetrical complications. This text does not provide in-depth information on pathophysiology or disease processes, nor was it the author’s intention to do so. However, the book does contribute a great deal in that it offers quick access to guidelines for the management of pregnancy. References are relatively current. There is an abundance of information that is concise and accurate. I would highly recommend this book to those working with high-risk as well as low-risk pregnancies. When utilized as a supple-
Vol. 28, No. 2, March/April
1983
The Universal
and The Universal
Pictures by Marcia L. Williams. Lexington, MA: Women’s International Network News, 1981. The Universal Childbirth Picture Book: 76 pages; $7.00, paperback. The Universal Childbirth Picture Book Flip Chart: 34 pages; $17.00. Reviewed by: Linda V. Walsh, C.N.M., M.P.H., Baltimore Birth Center, Baltimore, MD.
It is indeed refreshing to find a teaching tool that is applicable to all ages and cultures. The Universal Childbirth Picture Book (CBPB) recognizes that all women experience “the same joys and tribulations of childbearing, and the same health concerns.” The author’s approach emphasizes a healthy attitude toward childbearing. The text addresses many topics that are a routine part of nurse-midwifey prenatal teaching: nutrition, avoidance of drugs and alcohol, labor and delivery, and breastfeeding. In most cases, it is factual and supportive of alternatives in childbearing. For example, illustrations show the laboring woman in a variety of positions, and the text names the birth attendants as midwives and doctors. One reads that the baby “should be nursed right away, and as often as it wants.” However, for all the research that went into this endeavor, there are many misleading or erroneous points. For example, one reads the following: “The baby lying across (transverse) is the most difficult to deliver”; “When contractions are two minutes apart, the delivexy is about to begin”; “Baby should be given orange juice and vitamin drops at an early age.” The strong point of CBPB is the quality of the illustrations. Ms. Williams presents the anatomical changes of pregnancy, labor, and delivery in a vey clear manner. The CBPB Flip Chart presents 34 of these illustrations on 17 x 22-inch pages. Having used the chart in several childbirth education classes, my only concern is that the pages tear very easily, and after one month of use, most pages had pulled loose from the rings. Instructors choosing to use this visual tool might do well to mount the pages on more substantial backing. If one can overlook some of the errors 47