- Email: [email protected]
Heart and hands: A midwife's guide to pregnancy and birth, 2nd ed
Heart and Hands: A Midwife’s Guide to Pregnancy and Birth, 2nd Ed. By Elizabeth Davis. Berkeley, CA: Celestial Arts, 1987. 248 pages. $14.95, paper; $22.95, cloth. Reviewed by: Louise Aucott, RN, SNM, Nurse-Midwifery Education Program, SUNY Health Science Center at Brooklyn, NY. The stated purpose of this book is “to offer a practical guide to midwifery,” and “to demystify the medical elitism surrounding a very basic, natural body process.” This second edition of Heart and Hands provides the reader with an expanded, updated body of midwifery lore, and a reasoned consideration of practical and political issues and problems confronting professional midwives. Elizabeth Davis has been a lay midwife for more than eight years, and has been a consultant on legislative and educational issues in midwifery. She recently served on the Board of Directors for the Midwives’ Alliance of North America. This book is aimed at midwives of all levels, from students to skilled clinicians. It opens with an overview of midwifery as a profession, and a look at the role of the midwife in promoting normal birth. The sections which follow detail prenatal, labor, birth, and postpartum care and complications. The various educational pathways to becoming a midwife are covered, along with a succinct critique of relevant reference books and periodicals. The focus of the last section is coordinating midwifery practice with day-to-
Journal of Nurse-Midwifery
l
day living and finding a suitable style of practice. Over 30% of the material in this edition is new. Gloves have been added to the illustrations. Suzanne Arms-Wimberley has supplied new black and white photographs, that convey respect for women and depict the complex feelings and interactions at birth. The drawings by Linda Harrison are aesthetic and appropriate, showing internal structures and relationships without depersonalizing women. Noting the popularity of the first edition in the mass market, the author has included parent information blocks at the end of each part of the book. The blocks clarify important points for parents that are raised in the text. Although the section on childbirth education has been deleted, the new section devoted to the role of the father or support person is patticularly helpful. The author has meticulously updated technical information, presenting it in a clear, logical format. For example, the topic of prenatal screening for genetic abnormalities, alterations in glucose metabolism, and infections is covered in new detail. The book retains the flavor of a sharing session with a knowledgeable colleague; it uses terms that parents or others interested in birth can easily understand if they familiarize themselves with the vocabulary. Ms. Davis illuminates issues that are often ignored in standard medical practice. She offers a critical assessment of which means, technologic or otherwise,
Vol. 33, No. 4, July/August 1988
Copyright 0 1988 by the American College of Nurse-Midwives
may best serve human values at any given decision point. She looks at the woman above the fundus. Handling the care of single mothers, estranged couples, and others in stressful life situations is discussed. Psychological issues affecting birth outcome are described perceptively. Davis emphasizes vigilance in all phases of care, and sensitivity to the power of emotional, social, and psychological factors intertwined with physical well-being. She stresses the importance of taking adequate time getting to know the family prenatally. Refreshing and enlightening is her reminder that as a woman lives, so does she give birth. An image emerges of the midwife respectfully assisting mothers and their families through birth as one of life’s major passages. Ms. Davis is at her best when describing the ebb and flow of labor and birth. She illustrates how pauses often become excuses for intervention, when rest and reassurance may be as effective, in the absence of pathology. Her discussion of complications demonstrates that the procedures of responsible midwives are consonant with contemporay scientific principles. Davis directs attention to the many benefits of continuity of care, including close personal contact with the woman and her family and the establishment of firm baseline data for use in dynamic risk assessment. This continuity may provide women with a degree of safety beyond the consideration of immediate management techniques. Several areas contain information new
189 0091-2182/88/$03.50
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
Journal of Nurse-Midwifery
l
day living and finding a suitable style of practice. Over 30% of the material in this edition is new. Gloves have been added to the illustrations. Suzanne Arms-Wimberley has supplied new black and white photographs, that convey respect for women and depict the complex feelings and interactions at birth. The drawings by Linda Harrison are aesthetic and appropriate, showing internal structures and relationships without depersonalizing women. Noting the popularity of the first edition in the mass market, the author has included parent information blocks at the end of each part of the book. The blocks clarify important points for parents that are raised in the text. Although the section on childbirth education has been deleted, the new section devoted to the role of the father or support person is patticularly helpful. The author has meticulously updated technical information, presenting it in a clear, logical format. For example, the topic of prenatal screening for genetic abnormalities, alterations in glucose metabolism, and infections is covered in new detail. The book retains the flavor of a sharing session with a knowledgeable colleague; it uses terms that parents or others interested in birth can easily understand if they familiarize themselves with the vocabulary. Ms. Davis illuminates issues that are often ignored in standard medical practice. She offers a critical assessment of which means, technologic or otherwise,
Vol. 33, No. 4, July/August 1988
Copyright 0 1988 by the American College of Nurse-Midwives
may best serve human values at any given decision point. She looks at the woman above the fundus. Handling the care of single mothers, estranged couples, and others in stressful life situations is discussed. Psychological issues affecting birth outcome are described perceptively. Davis emphasizes vigilance in all phases of care, and sensitivity to the power of emotional, social, and psychological factors intertwined with physical well-being. She stresses the importance of taking adequate time getting to know the family prenatally. Refreshing and enlightening is her reminder that as a woman lives, so does she give birth. An image emerges of the midwife respectfully assisting mothers and their families through birth as one of life’s major passages. Ms. Davis is at her best when describing the ebb and flow of labor and birth. She illustrates how pauses often become excuses for intervention, when rest and reassurance may be as effective, in the absence of pathology. Her discussion of complications demonstrates that the procedures of responsible midwives are consonant with contemporay scientific principles. Davis directs attention to the many benefits of continuity of care, including close personal contact with the woman and her family and the establishment of firm baseline data for use in dynamic risk assessment. This continuity may provide women with a degree of safety beyond the consideration of immediate management techniques. Several areas contain information new
189 0091-2182/88/$03.50
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