A!DS: The Women. tited by fnes Riede: 2-d P&iicie RslpPe!t Pitiburgh: Cleis Press, 1988.251 pages. $9.95, paperback. Reviewed by: Ann Kurth, RN, MPH, Graduate Student, Maternal-Newborn Department, Yale School of Nursing and Research Director. Dixwell Preventive Health Progmm/Dixwell Neighborhood Corporation, New Haven, Connecticut. The editors of tbii 1988 anthology, Ines Rieder and Patricia Ruppelt, are journalists with personal and professional experience in AIDS work. Ms. Rteder csrerl for a close hiend until his death from AIDS in 1986, and Ms. Ruppelt is a member of the San Francisco Women’s AIDS Network. The compikng of the storiesin AIDS: The Women appears to have been a c&b&: expzience As Ms. Rieder says of her friend’s death, “It took getting involved in eiitfng this anthology to put my own expaiences into a larger context,” (Intro=ductlon, page 10). The goal of the book seems to be to give the reader a vital sense of that “larger context” The book is divided into eight sections, each constituting a different theme and preceded by a short editorial summmy. Section I, “Family, Lovers and Friends,” tells the story of living on the periphery of AIDS 118
from the perspecttver of a sister, a mother, a mend, and iite partners (heterosexual and lesbian). The last stop in this section, “Life and Death with Joan,” provides a particularly searing communication of the pain of losing e loved one, in this case from suicide while In the terminal of AIDS. Section II. “Women with AfDS/ ARC ana HIV-Positive Women,” chronicles the kvesof women in Baltimore, Copenhagen, San Francisco, Berlin, London, and Vienna. Thls global snapshot is interesting in several ways. It highlights how similar so many of the issuesfacing women with Hl%pectrum disease are, yet how individually each woman’s stop stands out One of the drawbacks, however, in this and other sectionsis that some of the stories are ghost. written by the editors. Though the profiles are mmpeiiing. this iTLE:bod somewhat diminishes the emotional directnessof the content “The Professional Care ‘vers,” (Section 111)comprises t ‘_ vlewpoints of a medical docto$! so&l worker, a test site co~ime:f, a health educator. a substance-abuse specialist, a nurse. and a counselor. Nurse-midwives may find these stories particularly relevant, although there is a noticeeble gap of information directly relevant to the
stages
clinical cere of HIV-positive women. Denise Ribble’s “A Uay in the Llfr” contribution is one of the shortest and most paverfully unforgettable in the anthology. One of the few explicitly political analyses in the book is contained in Section N, “Lesbians Facing AIDS.” Entitled ‘A Selfish Kind of Giving,” by Deborah Stone, the article discussesthe positive and negative effects that have been wrought on the lesbian communiw by its members’ extensive involvement in volun:txr activities against the AIDS epidemic. There is a long history 111this county of sex workers {e.g., prostitutes) being scapegoated for the spread of venereal diseases. Tine contributors to Section V, “Prosttb~don in the Age of AIDS,” provide a welcome w!ldote to this vfew by giving the reader access w the an!hmpo!ogical and epidemtological realtttesof eex work. The articles in the sixth section, “Becoming Visible: Women AIDS Educators.” are not es cor&:entlu thematic es the others. Section VII, “AIDS Prevention Polldes,” looks at prcgmms in Zimbabwe, Nicaragua. Haiti, Holland, Bmzil and, somewhat incongtuously, reproductive rights in the Unlted States. Here and elsewhere in the book, the editors’ laudable attempt
Journal of Nurse-Mtdwifeiy . Vol. 35, No. 3. May/June 1590
to try to present a comprehensive picture ~~rnetitnesreads as a sketchy attempt to spdnkle in a little so&thing from everywhere. Despite the effort at completeness, there ts a regrettable dearth of focus reqardtna important issues, such a5 th; so&l and psychological impediments to care fadng HN-seropositive women. Among the most haunang sentences wre these, written by a medtcal Mcial worker and vsvchotheraoist: “No matter what the~cause[of iheir HIV infccdon], these women face isolation, and they are afraid to teli others. There is not enouqh social support for them ha& found that many of my female clients have the lowest attendance rate for medical or psychologicalappointments at our clinic” (Forbes. pp. 127-128). Despite these drawback. the book provides a senee of the scope of the epidemic. For nume-midwives who have just begun to grapple wttb the top&, AIDS: The Women provides an accessible guide to some of the human stodes behlnd the numbers A final appendix contains some useful information in the form of a glossary of AIDS terms, an AlDS resource directory, and a selected bibIlogmphy.
I
Thlnktng AIDS. By Mary Catherine Bateson and Richard Goldsbv. Reading, MA: Addison-Wesley Pub!ishing Company, Inc., 1988. 153 pages. $12.95, hardcover Revlewd by: Barbara Decker, ctw, &to, Assistant Professor. Maternal Newborn Nursing/Nurse-Mldwifey Program, Yale University School of Nursiny, New Fiaven, Connecttcu!. The significance of AIDS, referrtng here to all stagesof HIV InfecUon, is that it is more than a disease. Acmrdinq to the authors. AIDS reflects and &es its successfulreproduction to the uniquely human tntertwtning of biology and culture. Evey biological organism lives in an envtronmental niche in which it can grow,
adapt, and reproduce. The AIDS vtrus’ niche is within the verv defense systemthat is suppaed to protect us against disease. Maintenance of its niche, meaning transmissionto new hosts. depends on some uniquely modem human behaviors This book takes a broad and scholarly view of the AIDS epidemic. different from the clinical perspes ttves we have become accustomed to. Now that ive !mow how HN is transmitted, continued new infections illuminate the flaws in our YJciety: the fatlure to give adequate infonnatton to the segmentsof our society who need 14 the failure to deal with social problems that lead people to engage in risky behaviors. Adaptation of personal, mct.1, and political behatior to prevent transmission could representa new step in human WOlUtiOn. The authors, one a biolo@t and the other the anthropologist daughter of systemstheodrt Gregoy Bateson and anthropologist Margaret Mead, explain AIDS to the layman according to the theories of their disciplines. There is a vey nice chapter on the ecology cf AIDS, comparing it to sexual:jr trawnined and other dttases. The chapter on the human immune @em is a fine piece of science writing for nonmedical people and a good review for cliniaans who may find xier?Xtc immunology tough going. This reviewer found the tendency to explain cell activity in terms oi human intention, I.e., cells “embracing,” “recognizing,” “searching,” etc.. somewhat distracting bit other readers may find the metaphors n&lll. Dlscusslon of the AIDS niche is a lttda dated now &i iiN in!ection IS increasingly found in women and others not directly involved with the gay male and IV drug-using populations. The authors explain the wildftre spread of AIDS through the gay male community as a result of more permissive attitudes toward gays in the 1970s and an explosion in gay
Journal of Nurse-Midwifery . Vol. 35. No. 3. M&tune
1990
male sexual behavior, prnitcularly indtsutmlnate sexual contactsin bathhouses.They point to the parallel in casual needle-sharing in “shooting ~allertes.” In a series of highly co&al discussions the au&o& AlI for so&&wide changes in sexual mores that recogntzethe need for dtwrse means of sexual expression whi!? limiting transmission of HIV and an end to rnoreltzin~about druq use in favor of working to reduce thi AIDS-ass&aid risk There is a remarkable series of recommendations for so&l reform toward the end of the book. All 01 the recomrr.&ations seem perfectty reasonab!e from a liberal point of view. Achievement, however. wuld be almost nirvana for public health. A sampk from the small s&on on medical recommendations t!lustrates the point: gtve equal care to all who are ill; curtail ~?aventions that are expenstve and am’t make a stgnificant difference to the patient consider the question of wkmtay euthanasia; support the morale of health care workers; and take better care of sexually transmmed diseaw. Thts is a though&d and provocative book for those interested in AlDS as a unique event in hventieth century life. The ways in which we, as a scctety, deal with the questins about ourselvesratsed bv the AlDS epidemic, whether or noi we follow the recommendat%ms of these authors, ti constitutea find testament of th!$ cent??ly we must try to see is a testament our chtin can ltve wxh.
thatit
Leo~lold’s Maneuvers. By Freddl Van ,Gemert, mi, MN. 198% Color, sound, IS rntnutes. AvaIlable in )ilw_h U-M& and M-irih VHS from Health Sciences Consorttum. 201 Silver Cedar Court, Chapel Hill, NC 27514. (919) 942.8731. Preview price is $30.00 and ‘I-day rental Is $8O.Of’. Purchase pdce ts $385.W, plus $3.00 postageand handling, for either format Ill-page study gutde IE Included.
17Y
Reviewed by: Ronald K. McGraw, POD,w, Fort Worth, Texas.
Stratton, Inc.. 1987. 301 pages. $49.50, hardcover.
This video first briefly explains the terms “presentalion,” “lie,” “position,” “attitude,” and “engagement,” as they pertain to the fetus near term Then Ms. Van Gemert. who also wrote the script, demon: skates how these characteristicsmay be assessedusing the four Leopold’s maneuvers. The patient-model is noted to be at 37 weeks gestation The information obtalned from Leopold’s maneuvers is then used to easily locate the fetal heart beat, using a doppler stethoscope. The importance of the patient’s comfort and safety is stressed:with such suggestions as helping her on and off the table, having warm hands and short fingernails, aud elevating her head slishilv. The &I&, sound, photo9raphy. and editins are all quite good. The presentation is cl&r and easy to follow with one exception. The statement is made both in the video and in the study guide that in addition to determining position, presentation, en9a9ement, and location of the fetal heart, these maneuvers “can point to the possible emergence of st~eaors that may give rise to highrisk situations for either mother or baby during pregnancy, labor, or deIlvey.” This statement is not explained furthe.. The
Reviewed by: Heather Reynolds, CNM, MSN, Instructor, Maternal-Newborn NursingfNurse-Midwifery Prcgram, Yale University School of Nursing, New Haven, Connecticut.
Women’s Health: Crisis and Ulness In Childbearing. Volume III. Edited by Lois J. Sonstegard, RN. POD,FAAN, Karen Mundell Kowalski, RN. POD, FARN,and Betty Jennings, RN, CNM MSW. Orlando, Florida: Grune &
1.39
This is the third volume in a seriesof books on women’s health. The series’ philosophy Is based on a holistic approach to health and illness and promotes nurses as primary health-care providers. Volume I, Womeni He&h: Ambulatory Care, deals with critical aspects of outpatient women’s health care. Volurxe II. Women’s Health: Childbeorfng focilses on issuesthat pertain to care of the healthy woman during childbearing. The third volume’s objective is to critically analyze elements that facilitate good pertnatal outcomes In atrisk women. A corollary to this objective is to provide nurses wlrh information that enables them to baante the technology with a “humanistic and caring” approach. The 22 authors, whichin&ie the three editors, encompass a wealth of apedence and expertise in can”9 for the childbearing family. This volume is divided into seven carts. Each oart addressesDertinent components of high-risk bbstetric care. The first oart. entitled “Framework for Nu&g &ctice,” offers a guide for the development of nursing assessment and interventions that address the m&faceted aspects of caring for at-risk obstetric clients. A systematic approach to decision making is offered to es&t the nurse in this process. Chapter 1. Part 1, “Family Centered Models for Pro &ling U!nessCare” by Kowalskl and Sonstegard, gives a brief and Interesting historical perspective on the development of models for familycentered care. It does a good job of integrating the impact the feminist movement clearly had on the development of these models. The remaining two chapters,
“Ethical Dilemmas in Women’s Health” by Joyce and Henry Thompson and “Perinatal Loss and Bereavement” by Karen Kowalski. offer a good theoretical framework and practical clinical information. “Ethical Dilemmas in Women’s Health” utilizes a case present&on format. It hlshllqhts the ethical dilemmas an& the decision makin processthat may occur in a high-risk PTegnhliCy. Part 2, “Age ConsideraHons in Childbearing,” contains two chapters that examine inherent risks in “Adolescent Pregnancy” and “Mature Childbearins.” In the adolescent pregnancy chapter. Ramona Mercer proF.osesaspectsof the adolescent’s life style that should be assessed and from which a basis for nursing interventions may be developed. Sample styles of questioning and specific questions that might assist the clinician in establishing rapoort with the adolescent are orofiered. Part 3, “Fetal Therapy,” moves from genetic risk issuesthrough prenatalhiagnostic methods to intrapartal risks and interventions. Some of the information in the three chaptas here is informative but redundant For example, AFP and amniocentesisare discussedIn Chapten 6 and 7. The overall title of this section does not quite capture its contents. “Fetal therapy” conjures images of fetal lntetventions rather than the broader issue of fetal assessment. Occaslondly. helpful information is given regarding specific nursing roles in anticipating problems and appropriafe intervections. althouoh thii is not done consiste&ly or c&nprehensively. Part 4, “Special Considerations in Pregnancy Maintenance,” has hw chapters entitled “Obstetric Hemorrhage” and “Preterm r bar.” Thev are well written SC.’ rvrtain important information. Again, the title of this section does not adequately describe the chapters’ contents. For example, postpartum hemorrhage is
Jaumal of Name-Midwifery . Vol. 35. No. 3, May/June 1990
not a” ksue with pregnancy m?in,ename. In “Obstetric Hemorrhage” (Chapter 91, Betty Jennings. a nurse-midwifery educator, clearly delineates early versus late bleeding in pregnancy and offers both medical and nursing management plans that till be quite useful to the practitioner. Chapter 10. “Preterm Labor” is quite comprehensive. It &aim some useful tables culled from other sourceson preterm risk care, sources of stress for women with preterm labor, and includes a sample protocol on dtcdline and terbutaline administration. Nursing interventions that incorporate the physical and psychological needs of the woman and family are presented. Part 5, “Problems with Powers, Passagesanr! Passengers,” has hvo chapters that address dysfunctional labor issues and the use of pitocin as well as operative obstebics. The chapter on operative obstetrics, written by Karen Kowalski. gives a brief and interesting historical perspective on cesarean section and forceps use. Current issues relevant to cesarean section and nursing interventions are discussed. Part 6, “Special Systemic Considerations of Pregnancy,” includes six chapters on several systemicchronic an&or acute diseasesand how they impact on pregnancy. Chapter 14, “Hypertension and Renal Considerations in Pregnancy,” is excellent. The illustrative tables and figures on some management issuesare usef??l. Chapter 17 is extremely well-organized and informative. It provides a” interesting histodcal background on the use of drugs in pregnancy and a wealth of research data and references on the effect of certain drugs 0” “re-9”a”cv. ihe-final &on, Part 7. entitled “Family and the Neonate.” has two chapters thai iddress the needs of the high-risk neonate and how the *ass of ;hose needs impacts on the family. Chapter 18, “Stabilization and Other Immediate Post Delivery Needs of the Newborn,” has some Journal of N”,se.“,dw,f~
basic information in table fwnat on the various adjustments in organ systemsthat occlu in the “eons’,? for extrauterine existence. In addition, there are several well-designed tables cm newborn problems that include not onlv information on e&v signs but also treatment/intervention modalities. The author offers sound advice to clinkians on how to ensure that one’s Institution, reqardlessof its level of care. will be pIepAred to fa&ate the stabilization d a high-risk infant. The last chapter, “Family Stress and the Neonatal Period,” ends the book as It began by focusingon ihe family aspects of care. Some vwy practical guIdelines are presented on helping the practitioner recognize healthy versus unhealthy behaviors in families. Though scme of the infomlation on *of reaction is rep&i.. tious, it actually augmenk the content found in Chapter 3 on “Perinatal Loss and Bereavement” The orientation of the information presented here is based on crisis and s;iess theory. Excellent inteweniions are suggested that may be used to facilitate healthy mourning behaviors in parents. On the other hand, a figure devised to ~aphically represent variables that may effect prenting behavior is so congas&d *hat it obfuscates rather than elucidates how these valiables in:nrelate. In summa~, !his J)cY)~b a !atidable attempt at applying a holistic apprcach to working with women at dsk in childbzaring. Sweral chapters do propound a feminist perspective in their presentations. but this is not con~lstently de&strated throuqhout the book. The authors’ hum&tic and caring approach to management, however, is evident throughout the paws. Although a fewchapters ha6 a strong medIcal orientation with only brief reference to nursing perspecti&, the book, in general. does offer some practical and excellent suggestions51 nurses to use in their clinical practice. Certainly, for nurse-midwives and nurse-midwifey students. this book
. Vol. 35, No. 3. MaylJune 1990
mlg.ht be a useful reference when in-
volved in the collaborative care of high- or at-risk clients. Electronic Fetal Monitoring. By Cydney I. Afriat, CNM. Rockvil:e. Maryland: Aspen Publishers. Inc., 1989. 191 pages. $55.00, hardcover. Reviewed bv: Lee S. Clay. CNM. MS, private pm&e, Morristown Memarial Hospital, Morristown. New ‘fex;. Electronic Fetal Manawing is tinen by a cer&d nurse-midwIfe primarily as a rsr?urce for nurses. However the information it contains is useful for a variety of health care providers. Theforeu&wittenbyBaryS&f. rich, MD, Director of Matsmal F&i Medicine, AMI-Tanana Regional Medical Csnter in California, acknowled* that “f&i monibi-zg is the mGwidely appiied test of f&l ~welllance and probabb the most widely abused” Dr. Schihich further points out the lack of consistencyin educating practitioners about interpreting irtal monitor si$x. It s the intent of this bwk to explain the physiology of the fetus and how it relates to observed changes in fetal heart rate patterns. Witi a thorough “understanding of the underlying mechanisms of change, the pmctitioner [will be able to1 react and respond on the basis of cause arrd effeet relationships” (Preface). In the first section of the book, the author @es an excellent explanation d the physiology of the fetus and how ik delicate b&me w” be dtered by a “umber of factors. bath extrinsic and Inbinsk. Next, she describes how rhese changes are reflected in fetal heart rate patterns. Her writing is thorough. ye! cotise and therefore easy to comprehend Throughout the book, the author LE.ZStables effectively to summadze the text. The tables are gwd references as they outline potential causes of fetal heart rate changes, the physiologic basis for these changes, as well as possible inter181
ventionswith rationale to improve the fetus’ status. There are a,~, numerous examplesof monitor ships to help the reader identify varying heart rate patterns end their implications. The wde range of patterns used is the learner bytng to syn~x+str.ethe material. Unfntunately, a few o! the monitor ships are somewhat difficult to read &e to reproduction techniaues. This difficultv. however. is not enough to hinder tie reader’s teaming A significant portion of the book allows for self-assessment b” the reader of her or his knowled& understandins. and intemretive skills of
: dtcialto
of the bwk. becauseit offers immediate feedback the reader who is !xytng to improve and vet@ her or his knowledse base. It is beneficialto be able to review several monitor ships and then compare one’s own interpretation with that of the expert. the author. Although the author makes reference to reassudng monitor ships that can then allow f x intermittent monitoring. it is not the intent of the author to discuss the pros and CON of continuous versus tntermittent monitming. Instead. the author’s intent is to provide a resource for clinicians to help them to understand and manage a variety of findings when using fetal monitoring. It is imwxtant for the reader to rec. ognize this difference. The author combines information throughout Electronic Fetal Monitoring for every level of learner. Early in the text, ths author includes a detailed section that explains the types of monitoring equipment currently available and cites their advantages and disadvantages.However, when &cussing uterine contraction monitoring, the author neglects to mention the l&an intrauterine pressure c&eta with a pressure qauqe selfcontained in the single &tit now replaces older svstems that deDend on press& and are often’dif& Cult to opi)‘rateaccurately. The specificsections on fetal heart rate changesand pattern interprera-
to
wata
182
tton will offer many readerr a comprehensive discussion of the scope and ~hwiolwic basis of fetal monitoring. For ox ‘ij, the tzGt will be a supplemen !, ~ladfy and chance basic kncwledge. In addition, for man” readers, the self-assessment section will serve as an excellent review and assessrmmt of one’s skills in interpreting fetal monitors. This section could be further enhanced by the addition of scalp or cord pH resuits with Xu~;rations of ominous pattem~ and tracings that show improvement after intewention. In swunaty, Efectmnic Fetal Monitoring is not only an excellent reference book for the beginning and intermediate practition& to use in understanding fetal heart rate patterns but also for the advanced practitioner whc ic interested in a retietu of skills and knowledae. BirthSong. 59 minutes. Prodr:ced and written by Claudia V&ii, 1989. Aveilable as audio cassette from C. V&d, Prop., 38291.10405 Jasper Ave., Edmonton, Alberta. Canada, T5J 352. (403) 451.5140. Purchase pdce: $10.50. plus $3.00 shipping. Reviewed by: Ronald K. MC&W. POD,W, Fmt Worth, Texas. Ms. Valeri has been a writer and broadcaster for 20 years and has a Canadian television program devoted to parenting. Because of a pelvic infection. which she attributed to a D&on Shield (ilD, she expertenced the loss of an ovary and hrbe. She reports that her other tube is blocked. Consequently. she has experienced two ectopic pregnancies and one failed invitro ferltliition attempt. Ms. Wed thus charactedzes thiswdio cassette as the “parrial fulfillment of a dram” becauseits creation provided her with her “closest expedenceso far of what it’s itke to create and give llh.” Judy Cochrane. a nurse, wdter, and childblrth educator for 14 y iais, served as project consultant for this tape. The program is divided into three sections. The section, “Night Medita-
Bon.” is 27 miilutes long and is recommended for bedtime as one is fallinq aslew. when one’s subcohsc!o& is most suggestible. “Bonding with Babv.” a 17-minute seement. provides H briefer relaxation &pedcnce for use during the day. “Create Your Labour,” is 15 minutes In length and is recommended for use in the last six weeks of pregnancy. In all three segments a soothing female voice over a background of relaxing music takes the listener through a relaxation procedure. followed by visual imagery, and positive affirmations concerning the listaxer’s pregnancy and upcoming childbirth. The tape encourages eating weU and getttng plenty of rest. It stresses that there is no riqht or wrong way to have a baby, &at the woman will be able to handle whatever happens, and that the birth experience-whatever it is-will be light and perfect for her. The listener is not set up for possible disaptmintment by being told her labor will be quick or ~;etnless.A nice touch in the tape is the mduston of positive affirmations that the woman will be able to forgtve the baby’s father, her own mother, and herself for any past mis deeds that may have occurred. The purchaser of the cassette is correctly cautioned that the tape is no substitute for either her physician or her childbirth educator. This re. viewer is quite impressed with this tape. It is obvious that this project was indeed a “labor of love” for Ms. V&d. This cassettecan be used with pregna~~twomen to help twm repiacwwgative emotions (e.g., anx. i&y, ar.ger, frustration, st.lf-doubt) with positive emotions (e.g., con& dence, love, relaxation. acceptance), In so doing, their chances of having a; easier, mare emotionally satisfying pregnancyand chUrlbirth experience should be enhanced. The Stork Didn’t Bring Me. By Marie-Frandne Hebeit Illustiations by Darcia Labrosse. Deephaven, MN: Meadowbrook F’ress, 1988. A Read & Play Learnina Set, $12.95.
doumalof Nurse-hlldwtfety l Vol. 35, No. 5 May/June1990
gland, Sweden, and Australia and the resultsof questionnairesthey administered to more than 1.000 Australian college students. Their intenThis Reed & Play Learning Set is detion is to providr! readers with inforsigned for children aged 5 to 12. The mationabout normai sexual beliels, set includes a soft-cover book, a attitudes, nod experiences of chilboard game, and a parents’ guide. dren. They note that until recently The 24.page book is illustrated more was kncwn about sexxal pawith pastel cartoons and unitten in a thology in children than normal cute. breverant style reminiscent of sexual atatodes and experiences. tbe 1973 classic Where Did I Come The Introduction summalires what From? by Peter Mayle. Like Mayle’s expert? have found or hypothesized book, the primary topic is con. about gender identity, sexuality, and ception, but with less depth than sexual behavior of children. Part Mayle’s-enough information fnr coversthe Goldmans’ findings about younger children, but probably not what childzn at various ages and in enough for the 9. to 12.year-okls. different countries know (,r believe) The board game, on hewy cardabout sexual differences, coma;; board stoc!:. folds to fit inside the Bon, pregnancy, childbirth, contiebox that also holds the book, ception, nudity, and intercouxe. The parents’ guide, dice and four game authors found considerable ignopieces. The game, whose topic is rance regarding sex, even among f&A! developr”.%, .._..., ic ._ ”> L/“.,.l., I.... r.~ *=*n ,“,,_ sexually-active teens. Part il deals from conception to the finish at bkth with the resultsof the questionnaires and conveys very simplisticinfomlaadministered to Australian college tion about fetal development, 1 students concerning their childhwd didn’t think it was particularly fun or sexual experiences and beliefs. Ineducation& but my 6%year-old cluded are tbe students’ perceptions sop wanted to play it h&e in B TOW. of their parents’ attitudes toward The seven-page parents’ duide dirly jokes, mastwba+Jon,nudity sex adds ideas about what qwstions play, etc. lniormation is also prochildren might esk after reading the vided about the frequency and types book and explains to adultz why the of sex play among children and of authors included certain ‘hings. The sexual ab&e by a&Its. authors make a conscistis effort to Part III discussesimdlcations of be nonsexistin text and illustrations. the findings and make; recommenThe set would be valuable in a dations as to how adults can help lending libray for sibling prepamtion children develop healthier sexual atof children aged 5 to 8. titudes by being more honest. semitive, and accepting.The final chapter Show Me Yours! Understanding explores some difficult and unreChildren’s Sexuality. By Ronald solved issues. such as AIDS and and Juliette Goldman. New York: herpes, morals and values, early Viking-Penguin, 1988. 269 pages. maturation, and sex education for $7.95, softcover. homosexuals. The authors argue that a new and more satisfactory Reviewed by: Ronald K. McGraw. theoy of human sexuality is needed who, TX). Fort Worth, Texas. to replace Freudian theory This is an interesting~and often Bo!h of the authors, psychologist amusing book that contains some Ronald Goldman and sociologistJugwd suggestions.However. it is priliette Goldman, have backgroundsm marily written for a lay audience and education. This book describes the does not offer much that is new or 01 results of their personal IntervIews immediate practical importance to titb almost 1,WO children aged 5 to health-care providers. 15 in the United States, Canada, En-
Reviewed by: Nancy Kraus. CNM, MAN, Associate Editor, Journal of Nurse-MidwiJey.
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Jou,,,.s,of NurwMid,&,y
. Vol. 35, No. 3, MayiJune 1990
Guide.
By tiay Crank and Caroline FUnt Lordon, England: Heineman Medical Books, 1939. 262 pages. $34.95, softcow Reviewed by: Edna 6. C&&m. no. CNM. ‘Jisiting Fulbright Professor, Jordan University of Science and Technology, Irbid, Jordan. Appreciation of thii book seems directly related to t+e reader’s respzct for the individudty of swo,oen,belief in the importance of continuity of care. cod zccqhxe of bktb a> ., normal physiologicaf process(unfor. hmately “medic&e&’ in modern society). The authors, two British midwives, have a zfrcshing sbili@ to communicate the “wonder, delight, and energy” they find in comtnuni~ practice. They advocate discarding “many of the ‘hmpital’ attitudes that have dominated c%e for the past 20 years or so” and rehxning to cornmuoilty midwifery and borne births. Convincing research is cited that supports the safety of home birth; for many women in Britain. For high-risk women the autbon recommend on-going care by a small goup of midwives working with ao obstetrician, and c~entoal hospital delivey. As the title implies, tbis ts not a midtiferg text, but a practical guide. replete with fresh insights and advice. It would instill confidence in shldents and those doing E delivery for the first time, and Is recommended fur all midwives and maternib nurses Obstetricianscould profit from reading it. One of the best thingsabout the book is the authors’ engaging style. TbS reviewer had an ongoing dialogue with them. Their anecdotes and examples are interesting and relevant and the text is enriched by numerous free-hand drawings. not sterile photcgmphs. The bwk covers the entire materhity cycle. A chapter .m pxqnancy care includes tips on borne remedies for comiilon discomforts. Another chapter describes the role the communtty midwife in the hospital,
of
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including several case histories to illustrate how care can be adapted to meet the needs of individual dlenb. An excellent chapter on home births outlines prerequisites to be met (for example, the home should be no more than half an hour away from a maternity unit; !herc must be a telephone or 24-hour access to a neighbor’s telephone). There are lists of the midwife’s equipment and supolies the mother must obtain. The chapter also details problems that can arise and indications for transfer to the hospital. Advice on rnana@ng problems is explicit In the authors’ opinion, potential problems are a serious concern, but should be put in perspective. Comfort measures in labor, including the midwife’s physical presence, her voice (sometimes her stlence), her hands, and her ears (itstenlng to women, “not just to their wori; but to the noises they make”). we discussed.At home or in the ho+ pital. the midwife must be sensitivr to each woman’s individual need.“whether it be for a back rub, a change of postlIon, or an epidural.” Examples of postpartum care responsibilities include Increasing the parents’ confidence in their ability to care for their child, as well as assessing the mother and newborn. Practical advice on teaching parents is excellent Other chapters give tips on ethical and legal fssuesand the logisiics of developing and running a practice. Topics such as caseloads, how to ‘-. calporate students in a practice, and group versus independent (solo) practice ae dealt wtth in detail. Even/thing the midwife needs to know, from organizing prenatal classes to keeping records and maintaining supplies, is discussed. The only major problem American readers may have with the book is that it is geared to British maternity care. The drugs mentioned have British tmde names, the appendix lists British organtzationsthe midwife may need to use, and the legal asp&s of midwifery have to do with 184
British law. Furthermore, the authors assume a level of ~reoaration and knowledge that ma; not be relevant to non-British midwives. For example, the British midwife’s equipment for home delivefies includes a laryngoscope with neonatal blade. endohacheal tubes. Spencer-Wells forreps, oxygen. and IV fluidsitems not usually included in the American nurwmldwlfe’s homebirth equipment Nevertheless, American midwives can enjoy and profit from this book. Perhaps, it may inspire an American midwife to write a similar guide, applying her knowledge and experience to the American scene. Examination of the Pregnant Woman. By Howard Sann, 1988. Color, sound. 19 minutes. Available in %-inch Urn&z and G-inch VHS formats ooly tram J. B. Lippinmtt. Ati. Audio-Visual Deoarirnent East Washington Sq&e,‘Philad&hia. Pennsylvania 19105. 1 iaOO)-523. 2945 In Canada and Pennsylvania, call collect f215j 2384443. Purchase price is $319.00, with 30.day free return. No rentals are available. Revlewed by: Ronald K. McGraw, POD.DO, Fort Worth, Texas. Examination of the Pregnant Woman is designed to show a professional audience how to properly conduct a physical assessmentof the pregnant wrnan at various etage.5of her pregnancy. This is done by showing B female examiner assessing three different grwidas, one during each trimester. The examiner and all three patients are white. The examiner’s professloo IS not identlfied during the video itself, but the ending rredits indicate that she is a family nurse-practitioner. The video begins with ai iiplanation of reasons for physical assessmen* during pregnancy. Then, facto!s that make the pregnant woman at high risk end in need of increased monitoring are listed The sigl.5 end symptoms of pregnancy are discussed. The narrator notes that ‘women, especially primigra-
vidas, may have many fears and misconceptions about pregnancy and thal these should be addressed. The first examination shows a complete physical performed during the initial visit of a woman in her first trimester. The examiner is instructed to collect various data. For example. he/she is advised to determine wlid!her the pelvic inlet is “large enough,” whether the sacrum is concave. whether the ischlal sdws are blunt or concave, whethe; the obstemcal con,uo,ateis “adequate.” and whether the sidewalis are straight or concave. There is no demonstration or explanation, however, as to how these factors are assessed. During this inilial visit the gravlda is advised to avoid smoking, alcohol, and drugs and to do same reading about pregnancy. The video also discussesnormal physiological changes associated with pregnancy, such as changes in blood pressure, resphatoy rate, and stroke volume. The second and third trimester examinations are shown. Assessment of fundal height, Leopold’s roane”vers, and auxultation bf fetal heart rate are explained and demonstrated. The indications for pelvic examlnatlon during the second and third trimester are MVered. Vartous laboratory testsrecornmended at different stages of pregnancy, such as the one-hour glucose screen and alpha fetoprotein. are also mentioned. The indications and iimlng of Rhogam in]ections are discussed. The content of this video is accurate, and the technical aspects are verygood. In the disc&n of retommended blood !ests. HIV testing should be Included. In addition, it would be useful to explain how to do some basic pelvimetry, especially stnce the video notes its importance. Other&e, the content appean thorough. This would be an excellent teaching video for medical, nursing, and nurse-midwifery students. It would also be a usefui review for family practice residents just before starting their obstetria rotation.
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Journal of Nurse-Midwifery . Vol. 35, No. 3. May/Juno 1990