- Email: [email protected]
Childbirth in America: Anthropological perspectives
program for use as a primary reference. The combination of comprehensiveness, current information, clarity, and clinical application, with an emphasis on client education, family-centered care, and an obstetric team approach to management, makes this text unique.
PDQ Statistics.
By Geoffrey R. Norman and David L. Streiner. Philadelphia: B.C. Decker, Inc., 1986. 172 pages. $9.95, softcover. Reviewed by: Deborah L. Greener, CNM, Assistant Professor, Nurse-Midwifery Program, University of Utah, Salt Lake City, Utah, and Lisa L. Paine, CNM,MS, MPH, Instructor, Department of GynlOb, Johns Hopkins University School of Medicine, Baltimore, Maryland.
MS,
The authors of this small book are both faculty in Epidemiology and Biostatistics at McMaster University School of Medicine in Ontario, Canada. The intent of the authors, as described in the introduction, is to help the reader understand statistical results in research papers and presentations, and begin to learn to identify the times when statistics are used incorrectly. Indeed, the authors seem to be striving to turn the reader into a “healthy skeptic” when it comes to research consumption and utilization-even providing so-called “C.R.A.P. Detectors” (Circular Reasoning or Anti-Intellectual Pomposity Detectors) throughout the book. Such aids are designed to help the skeptical consumer identify the common pitfalls in statistics, in order to prevent errors in interpretation or research utiliition. The beauty of this text is the way it very briefly, succinctly, and clearly provides an overview of all of the most commonly used univariate and multivariate statistical procedures; accomplishing this Herculean task with absolutely minimal use of the usual non-English statistical jargon. It even does so with wry humor (we both laughed out loud while reading this book); no mean feat when you consider the topic is STATISTICS! The range of this pocket-sized book is incredible. It begins with a simplified and clear discussion of variables and how data can be described, and then quickly moves into coverage of the common inferential methods, such as the t-test, analysis of variance and covariance, regression analysis, and techniques for time series Journal of Nurse-Midwifery
??
analyses. Such nonparametric tests as the chi-square, Fischer exact, MannWhitney U, and other tests of significance are reviewed, as well as the nonparametric tests of association, including the contingency coefficient, phi, Cohen’s kappa, Spearman’s rho, and Kendall’s tau. In addition, nonparametric approaches to considering the relations between multiple independent variables and a single dependent variable, such as the Mantel-Haenzel chi square, logistic regression, and log-linear analysis are clearly presented. It may come as a surprise that the authors would also attempt to cover such multivariate tests as MANOVA, Hotelling’s T2, discriminant function analysis, canonical correlation, factor analysis, and cluster analysis. While condensed and simplified, these sections are liberally sprinkled with clinically oriented examples that clarify proper uses of the tests. Numerous ’‘C.R.A. P. Detectors” are also included after each multivariate test, perhaps reflecting the stated bias of the authors that with the advent of simpler “canned” computer statistics packages, any fool can act like a statistician. In other words, they believe that while not all researchers who use multivariate analyses are charlatans, highly complex statistical analyses are frequently performed on totally inappropriate data. The book closes with a helpful annotated bibliography and an “Unabashed Glossary.” This glossary epitomizes the humorous approach of the authors to such a usually dy topic; the glossary includes “various arcane statistical terms, with which you can amaze your friends and colleagues” (p. 167). A sampling of entries which nurse-midwives might smile at include ANOVA, or one egg; MANOVA, or the missionary position; and Orthogonal, a birth control pill for males. In summary, Norman and Streiner have provided a humorous, clearly written, and very useful guidebook for the adventurer who wants to explore the jungles of research and statistics. Any nurse-midwife who reads, uses, or conducts research will benefit from reading this book. And who knows, she or he might even (gasp) enjoy it!
Childbirth in America: Anthropological Perspectives. By Karen L. Mi-
chaelson
and
Contributors.
Vol. 33, No. 6, November/December
1988
South
Hadley, MA: Bergin and Garvey Publishers, Inc., 1988. 304 pages. $49.95, hardcover; $18.95, softcover. Reviewed by: Karen Staff Nurse-Midwife, New York, Health Brooklyn, Brooklyn,
B. Burgin, CNM,MA, State University of Science Center at New York.
In this readable volume the anthropologist Karen Michaelson has brought together many contemporay studies, most of them the fieldwork of other women anthropologists, with contributions also from nursing, sociology, sociomedical sciences, psychology, biostatistics, and nurse-midwifery. It will certainly be gratifying to clinical practitioners of women’s health care to encounter the work of such a thoughtful group of scholars whose conclusions, without exception, support the women-centered goals for which concerned clinicians have been striving. Anthropologists have long claimed birth as one of their legitimate areas of concern, recognizing that while the basic biological phenomena are universal, the act of birth and the events surrounding it are largely culturally produced. Thus, a unifying theme of all of the studies is the way in which birth-related issues in contemporary America fit into the context of American culture; how that culture has affected conscious and subconscious attitudes toward childbirth and family relationships; and, how these attitudes have influenced behavior related to the birth process. This theme is reflected in the book’s pervasive concern with the way those members of American society who are “in charge” of birth events have adopted increasingly technological behavior in their interventions and how the recipients of their ministrations, particularly low-income women, have come to accept this technological approach as a matter of course. In articles ranging from prenatal diagnosis to neonatal intensive care the cultural, moral, and ethical issues involved in the use or non-use of technology are explored. These pieces provide some of the books most fascinating reading. The analysis by the anthropologist and folklorist Robbie E. Davis-Floyd on “Birth as an American Rite of Passage” is a brilliant illustration of the way in which hospital birth in America has taken on ritualistic aspects more elaborate than any primitive ones, designed to assure women’s acceptance of the dominant belief of contemporary 291
society that birth is a highly technol@cal event, Two comparisons of high-tech versus low-tech birth are also presented. One of the comparisons by Ronnie Lichtman, CNM, contrasts the medical model of birth with the midwifery model. The striking differences in the models are analyzed in terms of the policies and power structures of two inner-city hospitals and their implications for practitioners and recipients of care, as well as for society as a whole. Other articles dealing with political and policy issues can be found in the first section of the book, “Decisions in Pregnancy,” in which several authors address the subjects of access to care and of women’s control of birth. Particular concern is expressed for low-income women’s access to prenatal care, with poverty rather than ethnic@ shown to be the critical element in reproductive health. Decision-making in prenatal diagnosis is presented in studies by two authors, Rayna Rapp and Barbara Katz Rothman. Policy issues of neonatal intensive care are covered in the third section of the book in several excellent pieces, one of them by Betty Wolder Levin of the Hastings Center, who examines public policy in the treatment of catastrophically ill newborns as exemplified in the 1983 Baby Jane Doe case. The book is rounded out by a final section on postpartum and family relationships which, for the most part, will probably have a familiar ring to most CNM clinicians. The most interesting part of thii section is the material on breastfeeding by Janice M. Morse and her associates, whose studies have been published previously in the Journal of NurseMidwifery. An extensive 26-page bibliography of current references concludes the book. The Seven Ages. By Eva Figes. New York: Pantheon, 1986. 186 pages. $14.95 hardcover; $3.95, softcover. Reviewed by: Cynthia S. Bechtel, MSN, St. Louis,
CNM,
MiSSOUti.
The Seven Ages, by British feminist Eva
Figes, is an intriguing novel. Spanning nearly a thousand years, it recreates the history of English women healers and midwives. This histoy, though fictionalized to an extent, is significant because it represents female experience, told in the voices of women themselves. The primay narrator is an unnamed 292
contemporay midwife who retires to the rural village where she grew up. Now reflecting upon her life and practice, she wanders the woods and fields picking herbs and recalling old remedies used by her grandmother. This return to the natural world allows her to reach back through her heritage. With these memories, some old diaries she discovers in her attic, and a series of mystical/spiritual encounters with the voices of her ancestors, the midwife pieces together a story of centuries of women’s oppression and survival. Each ancestor tells her own story which is tightly interwoven with that of the main narrator. Occasionally, difficulty in determining who is “speaking” interrupts the flow of the story. Nevertheless, such narrative blending underscores the close connection with the past and seems to suggest that one woman’s experiences must become every woman’s concern. Figes is an experimental novelist and writer of nonfiction, including the classic feminist text, Patriarchal Attitudes. She typically explores the experiences of being a woman in a patriarchal world. In The Seven Ages the male-female experiential dichotomy is clearly exposed. While men are becoming heroes in wars of their own creation, women cope with the resulting realities of life: poverty, disease, rape, enslavement, bearing and caring for families under frightening and nearly impossible conditions. Figes also indicts, subtly at times, the politico-religious influence of the Church on women in general and on midwives and healers in particular. Branded as witches and heretics, these women often paid with their lives or the lives of their families. In spite of oppressive obstacles, the women in the novel survive to pass on their knowledge and traditions. These, then, are the ancestors who “speak” of their experiences through generations of male social domination. Their stories, though often primitive, sound much the same as our own stories in a sophisticated, highly technological world. Men continue to lust after personal and political power and domination, even at the expense of human lives. Women are still oppressed; poverty has been “feminized,” and families are still primarily the woman’s responsibility. And in some circles, midwives are still considered heretics. Much truth can be found in Figes’ fiction, and that is both appealing and sobering. Journal of Nurse-Midwifery
The Seven Ages is an attractive book. The hardcover edition is printed on heavy paper and offers a cover design nearly suitable for framing. The novel is slim but tightly compressed into its 186 pages. Figes’ style is economical yet rich and satisfying. Her prose is beautiful, almost poetic, conjuring up sights and sounds and smells that transport the reader across time and space-to times when stories are told around ancient cooking fires, in drafty castles, during World War II blackouts, and as women chant antinuclear slogans through the night. Figes writes, early in the book, that “past, present and future merge in the contours of this unremarkable landscape.” The novel ends with a Greenham-like women’s encampment protesting deployment of nuclear weapons at a nearby military base. The stoy has come full-circle. Nature is the prevailing metaphor in the book. Figes recognizes that human history, like the natural world, is cyclic and “female.” She emphasizes the strength of women-as healers, midwives, and individuals-to persevere, to create, and to preserve life. Most importantly, she celebrates the empowerment of women’s community and the necessity of doing as Virginia Woolf suggests: “looking back through our mothers.” The Seven Ages is a woman-centered historical novel that will appeal to CNMs and other individuals involved in caring for women and families. It is remarkable for its universality, timelessness, and the sheer beauty of its words.
A Software Guide to Physical Examination. By George Marsh, EdD, and Barrie Jo Price, END. Nursing Consultant: Susanne Langner, RN, MSN, ANP. Philadelphia: J.B. Lippincott, 1987. 12&k tutorial/competency testing program, with one self-assessment disk and instructor’s guide, $1495.00. Individual disks may be purchased for $135.00 each. Reviewed by: Mayann H. Bromberg, MPH, Assistant Professor, NurseMidwifery Program, State University of New York Health Science Center at Brooklyn, Brooklyn, New York. CNM,
This physical examination software is available in IBM PC, PC-XT, and Apple II versions. The IBM version, reviewed here, requires 256K RAM, DOS 2.0 or
??Vol.
33, No. 6, November/December 1988
PDQ Statistics.
By Geoffrey R. Norman and David L. Streiner. Philadelphia: B.C. Decker, Inc., 1986. 172 pages. $9.95, softcover. Reviewed by: Deborah L. Greener, CNM, Assistant Professor, Nurse-Midwifery Program, University of Utah, Salt Lake City, Utah, and Lisa L. Paine, CNM,MS, MPH, Instructor, Department of GynlOb, Johns Hopkins University School of Medicine, Baltimore, Maryland.
MS,
The authors of this small book are both faculty in Epidemiology and Biostatistics at McMaster University School of Medicine in Ontario, Canada. The intent of the authors, as described in the introduction, is to help the reader understand statistical results in research papers and presentations, and begin to learn to identify the times when statistics are used incorrectly. Indeed, the authors seem to be striving to turn the reader into a “healthy skeptic” when it comes to research consumption and utilization-even providing so-called “C.R.A.P. Detectors” (Circular Reasoning or Anti-Intellectual Pomposity Detectors) throughout the book. Such aids are designed to help the skeptical consumer identify the common pitfalls in statistics, in order to prevent errors in interpretation or research utiliition. The beauty of this text is the way it very briefly, succinctly, and clearly provides an overview of all of the most commonly used univariate and multivariate statistical procedures; accomplishing this Herculean task with absolutely minimal use of the usual non-English statistical jargon. It even does so with wry humor (we both laughed out loud while reading this book); no mean feat when you consider the topic is STATISTICS! The range of this pocket-sized book is incredible. It begins with a simplified and clear discussion of variables and how data can be described, and then quickly moves into coverage of the common inferential methods, such as the t-test, analysis of variance and covariance, regression analysis, and techniques for time series Journal of Nurse-Midwifery
??
analyses. Such nonparametric tests as the chi-square, Fischer exact, MannWhitney U, and other tests of significance are reviewed, as well as the nonparametric tests of association, including the contingency coefficient, phi, Cohen’s kappa, Spearman’s rho, and Kendall’s tau. In addition, nonparametric approaches to considering the relations between multiple independent variables and a single dependent variable, such as the Mantel-Haenzel chi square, logistic regression, and log-linear analysis are clearly presented. It may come as a surprise that the authors would also attempt to cover such multivariate tests as MANOVA, Hotelling’s T2, discriminant function analysis, canonical correlation, factor analysis, and cluster analysis. While condensed and simplified, these sections are liberally sprinkled with clinically oriented examples that clarify proper uses of the tests. Numerous ’‘C.R.A. P. Detectors” are also included after each multivariate test, perhaps reflecting the stated bias of the authors that with the advent of simpler “canned” computer statistics packages, any fool can act like a statistician. In other words, they believe that while not all researchers who use multivariate analyses are charlatans, highly complex statistical analyses are frequently performed on totally inappropriate data. The book closes with a helpful annotated bibliography and an “Unabashed Glossary.” This glossary epitomizes the humorous approach of the authors to such a usually dy topic; the glossary includes “various arcane statistical terms, with which you can amaze your friends and colleagues” (p. 167). A sampling of entries which nurse-midwives might smile at include ANOVA, or one egg; MANOVA, or the missionary position; and Orthogonal, a birth control pill for males. In summary, Norman and Streiner have provided a humorous, clearly written, and very useful guidebook for the adventurer who wants to explore the jungles of research and statistics. Any nurse-midwife who reads, uses, or conducts research will benefit from reading this book. And who knows, she or he might even (gasp) enjoy it!
Childbirth in America: Anthropological Perspectives. By Karen L. Mi-
chaelson
and
Contributors.
Vol. 33, No. 6, November/December
1988
South
Hadley, MA: Bergin and Garvey Publishers, Inc., 1988. 304 pages. $49.95, hardcover; $18.95, softcover. Reviewed by: Karen Staff Nurse-Midwife, New York, Health Brooklyn, Brooklyn,
B. Burgin, CNM,MA, State University of Science Center at New York.
In this readable volume the anthropologist Karen Michaelson has brought together many contemporay studies, most of them the fieldwork of other women anthropologists, with contributions also from nursing, sociology, sociomedical sciences, psychology, biostatistics, and nurse-midwifery. It will certainly be gratifying to clinical practitioners of women’s health care to encounter the work of such a thoughtful group of scholars whose conclusions, without exception, support the women-centered goals for which concerned clinicians have been striving. Anthropologists have long claimed birth as one of their legitimate areas of concern, recognizing that while the basic biological phenomena are universal, the act of birth and the events surrounding it are largely culturally produced. Thus, a unifying theme of all of the studies is the way in which birth-related issues in contemporary America fit into the context of American culture; how that culture has affected conscious and subconscious attitudes toward childbirth and family relationships; and, how these attitudes have influenced behavior related to the birth process. This theme is reflected in the book’s pervasive concern with the way those members of American society who are “in charge” of birth events have adopted increasingly technological behavior in their interventions and how the recipients of their ministrations, particularly low-income women, have come to accept this technological approach as a matter of course. In articles ranging from prenatal diagnosis to neonatal intensive care the cultural, moral, and ethical issues involved in the use or non-use of technology are explored. These pieces provide some of the books most fascinating reading. The analysis by the anthropologist and folklorist Robbie E. Davis-Floyd on “Birth as an American Rite of Passage” is a brilliant illustration of the way in which hospital birth in America has taken on ritualistic aspects more elaborate than any primitive ones, designed to assure women’s acceptance of the dominant belief of contemporary 291
society that birth is a highly technol@cal event, Two comparisons of high-tech versus low-tech birth are also presented. One of the comparisons by Ronnie Lichtman, CNM, contrasts the medical model of birth with the midwifery model. The striking differences in the models are analyzed in terms of the policies and power structures of two inner-city hospitals and their implications for practitioners and recipients of care, as well as for society as a whole. Other articles dealing with political and policy issues can be found in the first section of the book, “Decisions in Pregnancy,” in which several authors address the subjects of access to care and of women’s control of birth. Particular concern is expressed for low-income women’s access to prenatal care, with poverty rather than ethnic@ shown to be the critical element in reproductive health. Decision-making in prenatal diagnosis is presented in studies by two authors, Rayna Rapp and Barbara Katz Rothman. Policy issues of neonatal intensive care are covered in the third section of the book in several excellent pieces, one of them by Betty Wolder Levin of the Hastings Center, who examines public policy in the treatment of catastrophically ill newborns as exemplified in the 1983 Baby Jane Doe case. The book is rounded out by a final section on postpartum and family relationships which, for the most part, will probably have a familiar ring to most CNM clinicians. The most interesting part of thii section is the material on breastfeeding by Janice M. Morse and her associates, whose studies have been published previously in the Journal of NurseMidwifery. An extensive 26-page bibliography of current references concludes the book. The Seven Ages. By Eva Figes. New York: Pantheon, 1986. 186 pages. $14.95 hardcover; $3.95, softcover. Reviewed by: Cynthia S. Bechtel, MSN, St. Louis,
CNM,
MiSSOUti.
The Seven Ages, by British feminist Eva
Figes, is an intriguing novel. Spanning nearly a thousand years, it recreates the history of English women healers and midwives. This histoy, though fictionalized to an extent, is significant because it represents female experience, told in the voices of women themselves. The primay narrator is an unnamed 292
contemporay midwife who retires to the rural village where she grew up. Now reflecting upon her life and practice, she wanders the woods and fields picking herbs and recalling old remedies used by her grandmother. This return to the natural world allows her to reach back through her heritage. With these memories, some old diaries she discovers in her attic, and a series of mystical/spiritual encounters with the voices of her ancestors, the midwife pieces together a story of centuries of women’s oppression and survival. Each ancestor tells her own story which is tightly interwoven with that of the main narrator. Occasionally, difficulty in determining who is “speaking” interrupts the flow of the story. Nevertheless, such narrative blending underscores the close connection with the past and seems to suggest that one woman’s experiences must become every woman’s concern. Figes is an experimental novelist and writer of nonfiction, including the classic feminist text, Patriarchal Attitudes. She typically explores the experiences of being a woman in a patriarchal world. In The Seven Ages the male-female experiential dichotomy is clearly exposed. While men are becoming heroes in wars of their own creation, women cope with the resulting realities of life: poverty, disease, rape, enslavement, bearing and caring for families under frightening and nearly impossible conditions. Figes also indicts, subtly at times, the politico-religious influence of the Church on women in general and on midwives and healers in particular. Branded as witches and heretics, these women often paid with their lives or the lives of their families. In spite of oppressive obstacles, the women in the novel survive to pass on their knowledge and traditions. These, then, are the ancestors who “speak” of their experiences through generations of male social domination. Their stories, though often primitive, sound much the same as our own stories in a sophisticated, highly technological world. Men continue to lust after personal and political power and domination, even at the expense of human lives. Women are still oppressed; poverty has been “feminized,” and families are still primarily the woman’s responsibility. And in some circles, midwives are still considered heretics. Much truth can be found in Figes’ fiction, and that is both appealing and sobering. Journal of Nurse-Midwifery
The Seven Ages is an attractive book. The hardcover edition is printed on heavy paper and offers a cover design nearly suitable for framing. The novel is slim but tightly compressed into its 186 pages. Figes’ style is economical yet rich and satisfying. Her prose is beautiful, almost poetic, conjuring up sights and sounds and smells that transport the reader across time and space-to times when stories are told around ancient cooking fires, in drafty castles, during World War II blackouts, and as women chant antinuclear slogans through the night. Figes writes, early in the book, that “past, present and future merge in the contours of this unremarkable landscape.” The novel ends with a Greenham-like women’s encampment protesting deployment of nuclear weapons at a nearby military base. The stoy has come full-circle. Nature is the prevailing metaphor in the book. Figes recognizes that human history, like the natural world, is cyclic and “female.” She emphasizes the strength of women-as healers, midwives, and individuals-to persevere, to create, and to preserve life. Most importantly, she celebrates the empowerment of women’s community and the necessity of doing as Virginia Woolf suggests: “looking back through our mothers.” The Seven Ages is a woman-centered historical novel that will appeal to CNMs and other individuals involved in caring for women and families. It is remarkable for its universality, timelessness, and the sheer beauty of its words.
A Software Guide to Physical Examination. By George Marsh, EdD, and Barrie Jo Price, END. Nursing Consultant: Susanne Langner, RN, MSN, ANP. Philadelphia: J.B. Lippincott, 1987. 12&k tutorial/competency testing program, with one self-assessment disk and instructor’s guide, $1495.00. Individual disks may be purchased for $135.00 each. Reviewed by: Mayann H. Bromberg, MPH, Assistant Professor, NurseMidwifery Program, State University of New York Health Science Center at Brooklyn, Brooklyn, New York. CNM,
This physical examination software is available in IBM PC, PC-XT, and Apple II versions. The IBM version, reviewed here, requires 256K RAM, DOS 2.0 or
??Vol.
33, No. 6, November/December 1988