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Becoming a midwife
to some nurse-midwives. A maneuver described on pages 99- 100, the “pelvic press,” is controversial. Presented as a possible technique in management of mild degrees of CPD, its success would rely on the relaxation of the pelvic joints. Some may have reservations about suggesting its use, or have concern about Davis’s recommendation of manual flexion of the head or rotation of OP. Skilled midwives may find these techniques useful, and worth trying before higher tech options are tried. Not everyone will agree on the author’s management of shoulder dystocia, nor will all concur about the use of various delivery positions, olive oil massages, or perineal hot compresses. Due to the time lag in publishing, some information on HIV is dated and incorrect, but current sources of information on this abound. The material in this current edition would be appropriate for any parent with some high school background. The woman-centered approach of this book is important. The book will be useful to parent educators, physicians, and nursemidwives in education or clinical practice. It will open discussion about the role of the midwife as an independent practitioner with a “sensitive perspective which takes [the mother’s] feelings and overall state of being into account.” Becoming A Midwife. By Carolyn Steiger. Portland: Hoogan House, 1987. 186 pages. $19.95, softcover. Reviewed by: Margaret Egeland, CNM, Nurse, Family Maternity Center, Holy Family Hospital, Spokane, Washington. MN, Staff
In Becoming A Midwije Carolyn Steiger offers an apprenticeship program “in the hope it will strengthen midwifery, validate and revitalize the tradition of apprenticeship, inspire midwives to take on apprentices, and guide women who wonder ‘should I become a midwife? ” She addresses her book primarily to midwifery apprentices and their teachers. However, between the book’s covers is an abundance of midwifery-related wisdom and insight from this seasoned midwife who has a home birth practice in Portland, Oregon. Trained through apprenticeship herself, and having trained several apprentices, Steiger convincingly upholds her view that apprenticeship remains a viable means of midwifery education. Although
190
she recognizes that some of its aspects may be applicable to other settings for midwifey education, she discusses apprenticeship solely in the context of home birth practice. Among the potential advantages of apprenticeship that Steiger touts are: individualization of teaching to meet the unique needs of each apprentice; nurturation of personal growth in the student; opportunity to study birth in its natural environment, i.e., the home, versus the hospital; midwifery control over midwifery education; and more accessible, less costly education. Steiger acknowledges that, despite its apparent potential, apprenticeship education may have some drawbacks, for example, too little birth experience for the apprentice or little opportunity to learn more than one practitioner’s midwifery style. Other difficulties that teachers and students commonly report are lack of a structured curriculum, lack of role definition for teacher and student, and inadequate communication. Addressing these problems, Steiger offers a well-defined, detailed curriculum for midwifery apprentices. The three phase program guides the student from novice/observer to intermediate/assistant to primary supervised midwife. Each phase includes a lengthy reading list, a skills list, required projects, and a list of equipment and supplies to be acquired. The author’s remarkable creativity as well as her sense of the broadness of midwifery are evident in the diverse projects and readings which she suggests. The curriculum fosters the apprentice’s development in a range of subjects, including anatomy and physiology, physical assessment, childbirth education, nutrition, exercise, herbs, labor enhancement techniques, consumer advocacy, histoy of midwifery, politics, grief counseling, spirituality, and others. One shortcoming of the curriculum is the author’s emphasis on textbooks, rather than journal articles, as the basis of clinical practice. However, Steiger’s intent is not to offer a shortcut to excellence in midwifely. She expects that apprentices will usually require two to three years to complete the program. Many suggestions for role clarification are provided and an entire chapter is devoted to defining the tasks of the apprentice in the “assistant” role in prenatal, labor, and postnatal settings. Although
these guidelines are detailed, teachers may easily adapt them to suit their style or apprentices’ needs. Steiger includes many useful forms for evaluation and assessment to facilitate communication between apprentice and teacher. Additionally, communication is discussed in depth in a chapter on “Relationships,” with respect, honesty, and the desire to understand the other being paramount. “The way we teach midwifery should reflect our ideals. Our style of education should emanate from our beliefs about birth. We should use the art and spirit of midwifery to teach the art and spirit of midwifey.” The author clearly articulates the philosophy that forms the basis of her approach to midwifery education. She calls it the “Midwifery Model” of care. Drawn from the many tenets cited (which are undoubtedly familiar to most nurse-midwives) are these samples. The Midwifery Model: -Sees pregnancy and birth as a fundamentally healthy process, that has many normal variations. -Sees this process as doing best without interference and understands that attempts to control the process inevitably alter it and frequently harm it. -Considers each woman and birth unique, calling for an individual, nonroutine response. -Believes the birth experience belongs to the family, not to the birth attendant. -Recognizes that choice of birthplace, birth attendant, and other decisions about childbirth are basic rights of all women and their families. -Sees that, although the birth of a baby is the ultimate goal of pregnancy and labor, the process itself has intrinsic value and great importance in the life and psyche of each woman. -Generally sees a spiritual aspect to childbirth and midwifey. Steiger does not define the spiritual aspect, but encourages midwives to define it for themselves. She includes essays from five midwives who share their diverse spiritual views of childbirth and midwifey. The final chapter, “Attributes and Issues,” focuses on intangible qualities such as honesty, humility, compassion, and patience, that Steiger believes are as essential in a midwife as technical ability.
Journal of Nurse-Midwifery
l
Vol. 33, No. 4, July/August 1988
These attributes, like clinical skills, are nurtured in an effective apprenticeship. Steiger’s self-assessment exercises exploring beliefs, feelings, and fears are excellent. In sections on politics and accountability, the author develops her view that a mature midwife not only provides quality care, but is politically aware and involved, and engages in peer review within the midwifery community. From the opening words (“One rainy .“I, this book is Oregon afternoon alive. The author liberally intersperses throughout the book her own experiences and those of many other midwives and apprentices. The numerous black and white photographs, mostly of midwives, are stunning and greatly enhance the book’s appeal. The cover photograph of two midwives enjoying tea and conferring over a textbook, as well as the calligraphic lettering of title and author, aptly convey the homeyness that pervades the book’s contents. Steiger’s choice of laser printing rather than typesetting, and her conversational writing style also contribute to the overall grassroots feel of this book. The book’s chief problem arises from the wealth of information included in the curriculum. Organization and format of the material is sometimes confusing, and requires a concerted effort on the part of the reader to put together a whole picture of the multidimensional program. Professional editing would probably improve the books readability without destroying the author’s intentionally personal approach to her topic. In conclusion, the sections on role clarification and communication in the clinical learning situation will be of exceptional value to nurse-midwifery students and educators. Students as well as practicing nurse-midwives who wish to increase the breadth of their knowledge will appreciate the reading lists and recommended projects. Nurse-midwives interested in midwifery education will find the book’s curriculum thought-provoking. In addition, nurse-midwives finding accord with Steiger’s “Midwifery Model” will enjoy reading how those ideals can be expressed in midwifery education and practice. Pre- and Peri-NataI Psychology: An Introduction. Edited by Thomas R. Vemy, MD. New York: Human Sciences Press, 1987. 296 pages. $36.95, hardcover.
Journal of Nurse-Midwifery
l
Reviewed by: Ronald K. McGraw, PhD, Clinical Psychologist, For-i Worth, TX; Medical student, Texas College of Osteopathic Medicine, Fort Worth, TX. Most of this book comes from presentations made at the First International Congress on Pre- and Perinatal Psychology, held in Toronto in 1983. The book is divided into five sections: Basic Sciences, Research, Childbirth, Psychotherapy, and Theory. In the first chapter, “Ontogenesis of the Faculty of Listening,” Tomatis makes some extraordinay claims: that babies speak in double sounds (e.g., papa, peepee) because the recurrent nerves innervating the larynx are of different lengths, that the voice changes at puberty because the ear at this time “opens up to a wider spectrum of sound,” and that children who had never seen a tree can still draw one because the tree symbolizes “uterine life.” This is followed by a chapter by Catano and Catano who relate perinatal stress to infantile amnesia. Then Buchheimer deals with the question of how people can supposedly recall events that happened before the processes of logic and verbal behavior have developed. The next section begins with Chamberlain’s chapter which reviews the evidence for the existence of consciousness at birth. In what this reviewer thinks is one of the better chapters, W. Ernest Freud discusses prenatal attachment and bonding. CarterJessop and Keller next describe a research study on early maternal bonding. The third section opens with Olkin’s descriptions of her prenatal yoga classes and techniques. Kestenberg’s chapter relating perceived fetal movements and maternal dreams tends to be rambling and confusing at times. She seems to be making the questionable argument that perceiving fetal movement and dreaming about it is evidence of empathy for the fetus. The next chapter is taken from Mothering magazine and is an interview with Michel Odent, the French physician famous for advocating labor and childbirth under water. The subsequent chapter, also about underwater birth, is written by a fashion designer who has also studied psychology, parapsychology, and spirituality. She recommends the presence of a “sensitive” or “baby advocate” at birth. This individual would “focus on the mother and child
Vol. 33, No. 4, July/August 1988
during labor to receive messages of distress and to communicate psychically and verbally to the baby that all is well, that he (the baby) is safe, that everyone is doing the best they can, and that everyone is there to serve the baby” (p. 161). Verny, in his introduction, refers to this chapter as a “comprehensive review” of the underwater birth literature, but there are only three references to the literature, none of which come from a referred journal. The next section opens with a chapter entitled, “Audio-Psycho-Phonology in the Cabine de Matemage.” It describes the treatment of various behavioral and developmental problems using a womblike setting and recordings of the mother’s voice. Although improvement is claimed, the treatment is rather lengthly and the effects of attention and maturation cannot be eliminated. This is followed by a chapter on “Ego-State Therapy and its Relationship to the PeriNatal Period.” The author admits that his ideas are controversial and that “logically and intellectually [they] might easily be knocked down by any third- or fourth-grade school child,” but that he is dreamer” and that an “impossible “many important realities evolve from an impossible dream.” This section closes with a confusing chapter on “Frank Lake’s Maternal-Fetal Distress Syndrome” and a chapter by a Jungian analyst on birth symbolism in dreams. In the last section Earnshaw proposes that there is a temporal transmission of life events from generation to generation. Specifically, she argues that people tend to have significant events in their lives at the same age that their same sex parent was when a sibling or themselves were born. Next, Rausch suggests that castration anxiety occurs not during the oedipal period but originates from the cutting of the umbilical cord. Support for his argument, however, essentially is limited to his contention that various objects seen in hallucinations (psychotic or druginduced), dreams, and drawings of psychiatric patients are symbols of the umbilical cord. This is similar to De Mause’s approach in the next chapter where he maintains such diverse objects as snakes, trees, spiders, the cross, flagpoles on militay posters, and an octopus in political cartoons are all symbols of the placenta or umbilical cord. He offers this as etidence that fetal life is so traumatic that “it
191
In Becoming A Midwije Carolyn Steiger offers an apprenticeship program “in the hope it will strengthen midwifery, validate and revitalize the tradition of apprenticeship, inspire midwives to take on apprentices, and guide women who wonder ‘should I become a midwife? ” She addresses her book primarily to midwifery apprentices and their teachers. However, between the book’s covers is an abundance of midwifery-related wisdom and insight from this seasoned midwife who has a home birth practice in Portland, Oregon. Trained through apprenticeship herself, and having trained several apprentices, Steiger convincingly upholds her view that apprenticeship remains a viable means of midwifery education. Although
190
she recognizes that some of its aspects may be applicable to other settings for midwifey education, she discusses apprenticeship solely in the context of home birth practice. Among the potential advantages of apprenticeship that Steiger touts are: individualization of teaching to meet the unique needs of each apprentice; nurturation of personal growth in the student; opportunity to study birth in its natural environment, i.e., the home, versus the hospital; midwifery control over midwifery education; and more accessible, less costly education. Steiger acknowledges that, despite its apparent potential, apprenticeship education may have some drawbacks, for example, too little birth experience for the apprentice or little opportunity to learn more than one practitioner’s midwifery style. Other difficulties that teachers and students commonly report are lack of a structured curriculum, lack of role definition for teacher and student, and inadequate communication. Addressing these problems, Steiger offers a well-defined, detailed curriculum for midwifery apprentices. The three phase program guides the student from novice/observer to intermediate/assistant to primary supervised midwife. Each phase includes a lengthy reading list, a skills list, required projects, and a list of equipment and supplies to be acquired. The author’s remarkable creativity as well as her sense of the broadness of midwifery are evident in the diverse projects and readings which she suggests. The curriculum fosters the apprentice’s development in a range of subjects, including anatomy and physiology, physical assessment, childbirth education, nutrition, exercise, herbs, labor enhancement techniques, consumer advocacy, histoy of midwifery, politics, grief counseling, spirituality, and others. One shortcoming of the curriculum is the author’s emphasis on textbooks, rather than journal articles, as the basis of clinical practice. However, Steiger’s intent is not to offer a shortcut to excellence in midwifely. She expects that apprentices will usually require two to three years to complete the program. Many suggestions for role clarification are provided and an entire chapter is devoted to defining the tasks of the apprentice in the “assistant” role in prenatal, labor, and postnatal settings. Although
these guidelines are detailed, teachers may easily adapt them to suit their style or apprentices’ needs. Steiger includes many useful forms for evaluation and assessment to facilitate communication between apprentice and teacher. Additionally, communication is discussed in depth in a chapter on “Relationships,” with respect, honesty, and the desire to understand the other being paramount. “The way we teach midwifery should reflect our ideals. Our style of education should emanate from our beliefs about birth. We should use the art and spirit of midwifery to teach the art and spirit of midwifey.” The author clearly articulates the philosophy that forms the basis of her approach to midwifery education. She calls it the “Midwifery Model” of care. Drawn from the many tenets cited (which are undoubtedly familiar to most nurse-midwives) are these samples. The Midwifery Model: -Sees pregnancy and birth as a fundamentally healthy process, that has many normal variations. -Sees this process as doing best without interference and understands that attempts to control the process inevitably alter it and frequently harm it. -Considers each woman and birth unique, calling for an individual, nonroutine response. -Believes the birth experience belongs to the family, not to the birth attendant. -Recognizes that choice of birthplace, birth attendant, and other decisions about childbirth are basic rights of all women and their families. -Sees that, although the birth of a baby is the ultimate goal of pregnancy and labor, the process itself has intrinsic value and great importance in the life and psyche of each woman. -Generally sees a spiritual aspect to childbirth and midwifey. Steiger does not define the spiritual aspect, but encourages midwives to define it for themselves. She includes essays from five midwives who share their diverse spiritual views of childbirth and midwifey. The final chapter, “Attributes and Issues,” focuses on intangible qualities such as honesty, humility, compassion, and patience, that Steiger believes are as essential in a midwife as technical ability.
Journal of Nurse-Midwifery
l
Vol. 33, No. 4, July/August 1988
These attributes, like clinical skills, are nurtured in an effective apprenticeship. Steiger’s self-assessment exercises exploring beliefs, feelings, and fears are excellent. In sections on politics and accountability, the author develops her view that a mature midwife not only provides quality care, but is politically aware and involved, and engages in peer review within the midwifery community. From the opening words (“One rainy .“I, this book is Oregon afternoon alive. The author liberally intersperses throughout the book her own experiences and those of many other midwives and apprentices. The numerous black and white photographs, mostly of midwives, are stunning and greatly enhance the book’s appeal. The cover photograph of two midwives enjoying tea and conferring over a textbook, as well as the calligraphic lettering of title and author, aptly convey the homeyness that pervades the book’s contents. Steiger’s choice of laser printing rather than typesetting, and her conversational writing style also contribute to the overall grassroots feel of this book. The book’s chief problem arises from the wealth of information included in the curriculum. Organization and format of the material is sometimes confusing, and requires a concerted effort on the part of the reader to put together a whole picture of the multidimensional program. Professional editing would probably improve the books readability without destroying the author’s intentionally personal approach to her topic. In conclusion, the sections on role clarification and communication in the clinical learning situation will be of exceptional value to nurse-midwifery students and educators. Students as well as practicing nurse-midwives who wish to increase the breadth of their knowledge will appreciate the reading lists and recommended projects. Nurse-midwives interested in midwifery education will find the book’s curriculum thought-provoking. In addition, nurse-midwives finding accord with Steiger’s “Midwifery Model” will enjoy reading how those ideals can be expressed in midwifery education and practice. Pre- and Peri-NataI Psychology: An Introduction. Edited by Thomas R. Vemy, MD. New York: Human Sciences Press, 1987. 296 pages. $36.95, hardcover.
Journal of Nurse-Midwifery
l
Reviewed by: Ronald K. McGraw, PhD, Clinical Psychologist, For-i Worth, TX; Medical student, Texas College of Osteopathic Medicine, Fort Worth, TX. Most of this book comes from presentations made at the First International Congress on Pre- and Perinatal Psychology, held in Toronto in 1983. The book is divided into five sections: Basic Sciences, Research, Childbirth, Psychotherapy, and Theory. In the first chapter, “Ontogenesis of the Faculty of Listening,” Tomatis makes some extraordinay claims: that babies speak in double sounds (e.g., papa, peepee) because the recurrent nerves innervating the larynx are of different lengths, that the voice changes at puberty because the ear at this time “opens up to a wider spectrum of sound,” and that children who had never seen a tree can still draw one because the tree symbolizes “uterine life.” This is followed by a chapter by Catano and Catano who relate perinatal stress to infantile amnesia. Then Buchheimer deals with the question of how people can supposedly recall events that happened before the processes of logic and verbal behavior have developed. The next section begins with Chamberlain’s chapter which reviews the evidence for the existence of consciousness at birth. In what this reviewer thinks is one of the better chapters, W. Ernest Freud discusses prenatal attachment and bonding. CarterJessop and Keller next describe a research study on early maternal bonding. The third section opens with Olkin’s descriptions of her prenatal yoga classes and techniques. Kestenberg’s chapter relating perceived fetal movements and maternal dreams tends to be rambling and confusing at times. She seems to be making the questionable argument that perceiving fetal movement and dreaming about it is evidence of empathy for the fetus. The next chapter is taken from Mothering magazine and is an interview with Michel Odent, the French physician famous for advocating labor and childbirth under water. The subsequent chapter, also about underwater birth, is written by a fashion designer who has also studied psychology, parapsychology, and spirituality. She recommends the presence of a “sensitive” or “baby advocate” at birth. This individual would “focus on the mother and child
Vol. 33, No. 4, July/August 1988
during labor to receive messages of distress and to communicate psychically and verbally to the baby that all is well, that he (the baby) is safe, that everyone is doing the best they can, and that everyone is there to serve the baby” (p. 161). Verny, in his introduction, refers to this chapter as a “comprehensive review” of the underwater birth literature, but there are only three references to the literature, none of which come from a referred journal. The next section opens with a chapter entitled, “Audio-Psycho-Phonology in the Cabine de Matemage.” It describes the treatment of various behavioral and developmental problems using a womblike setting and recordings of the mother’s voice. Although improvement is claimed, the treatment is rather lengthly and the effects of attention and maturation cannot be eliminated. This is followed by a chapter on “Ego-State Therapy and its Relationship to the PeriNatal Period.” The author admits that his ideas are controversial and that “logically and intellectually [they] might easily be knocked down by any third- or fourth-grade school child,” but that he is dreamer” and that an “impossible “many important realities evolve from an impossible dream.” This section closes with a confusing chapter on “Frank Lake’s Maternal-Fetal Distress Syndrome” and a chapter by a Jungian analyst on birth symbolism in dreams. In the last section Earnshaw proposes that there is a temporal transmission of life events from generation to generation. Specifically, she argues that people tend to have significant events in their lives at the same age that their same sex parent was when a sibling or themselves were born. Next, Rausch suggests that castration anxiety occurs not during the oedipal period but originates from the cutting of the umbilical cord. Support for his argument, however, essentially is limited to his contention that various objects seen in hallucinations (psychotic or druginduced), dreams, and drawings of psychiatric patients are symbols of the umbilical cord. This is similar to De Mause’s approach in the next chapter where he maintains such diverse objects as snakes, trees, spiders, the cross, flagpoles on militay posters, and an octopus in political cartoons are all symbols of the placenta or umbilical cord. He offers this as etidence that fetal life is so traumatic that “it
191