- Email: [email protected]
Media reviews
MEDIA REVIEWS — Cheri Van Hoover,
CNM, MS
EDITOR’S NOTE
Childbirth is both an involuntary biological process and a learned social event. As children, we begin to learn about birth’s challenges and rewards by hearing the stories of our female relatives and friends. This is how our most fundamental views about this great transformative event are shaped. As adults, we continue in the storytelling tradition, the stories we hear and tell assuming greater immediacy as we reflect upon our personal and professional experiences. As midwifery students, we discover our priorities and develop skills that define the art and science of our profession through stories told by our instructors and mentors. As midwives, we refine our practice by listening to the stories of our peers and the women we serve. Birth stories teach us our ancient art. Evidence-based texts give us the science we need to be safe and responsible practitioners in today’s world. This issue of the Journal of Midwifery and Women’s Health offers valuable resources for those at every step along this lifelong path to learning. From children’s literature to midwife’s memoir, from evidence-based text and Web-based learning program to a very personal examination of the realities of life with a premature infant, this issue offers tools that can help us be better parents, midwives, and friends. And all through the shared pleasure of storytelling! Baby Catcher: Chronicles of a Modern Midwife. By Peggy Vincent. New York: Scribner, 2001. 336 pages. $25.00, hardcover. Reviewed by: Vanessa Ross, CNM, MSN, Midwife, The Women’s Health and Birth Center, Santa Rosa, CA 6020 Orchard Station, Road, Petaluma, CA 94952. Baby Catcher: Chronicles of a Modern Midwife reveals that Peggy Vincent is not only a seasoned midwife, but a consummate storyteller as well. Her offering to the body of writing on midwifery and childbirth is a welcome reprieve from the instructional or academic, as she vividly narrates her own journey from timid nursing student to independent homebirth midwife. Vincent deftly weaves together the personal and political, locating her own life and more than three decades of practice as either a nurse or midwife within the broader context of midwifery in the United States. Above all, however, this
book is about birth and sharing stories about birth, a tradition no doubt as ancient as midwifery itself. Baby Catcher begins in 1962 when Vincent witnesses her first unmedicated labor as a nursing student. Zelda’s refusal to “lie down” and insistence that she needs to “walk and sing and dance [her] pains away” opens Vincent’s eyes to an entirely different way of birthing. Vincent’s frustration at her own inability to help this woman have the kind of birth she wants inspires her “to do more”. As a labor and delivery nurse in Berkeley in the 1970s, Vincent goes on to help found an alternative birthing center within the hospital where she works. Despite the success of her efforts, the realization that she is “following the orders of physicians who believe that normal childbirth is a retrospective diagnosis” leads Vincent to pursue midwifery and a career in homebirth. Vincent’s adventures as a midwife and the stories of the births she attends are the heart of her book. The level of detail with which Vincent recalls people, places, and words exchanged at births attended over decades of practice suggests either a phenomenal memory or a devoted journal-writer, or both. Her passion for midwifery is clearly met by the passion of women and families who wish to birth on their own terms, whether at home or in the alternative birth center. There is the Christian Scientist who transitions into second stage so quietly that her husband and midwife almost miss the birth, the woman whose sister members of a commune “finger-dance” to maintain her aura throughout labor and birth, the client who describes labor pain as “interesting”. There are also emergency transports for a missed breech, thick meconium, and two prolapsed cords, one of which results in a severely damaged baby. Vincent learns at her first homebirth that she can either “panic and deliver the baby, or stay calm and deliver the baby”, and her choice of the latter serves her well in many difficult situations. She also reveals her humanity in details about the pitfalls of being a midwife and in the stories of her own births and the challenges they present to her. Vincent’s self-identification in the book as an independent midwife and particularly as a “licensed midwife,” as opposed to a nurse midwife or CNM, may lead to confusion about her credentials to those unfamiliar with paths to midwifery. In California, where Vincent practices, the term “licensed midwife” refers to a direct-entry midwife who has obtained state licensure, as opposed to
Journal of Midwifery & Women’s Health • Vol. 47, No. 5, September/October 2002 © 2002 by the American College of Nurse-Midwives Issued by Elsevier Science Inc.
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someone like Vincent who went through a nurse-midwifery training program and is certified to practice under an RN license. Vincent also fails to mention whether or not she obtained the consent of each of her clients to share their stories in so much detail, or whether any or all of their names have been changed to protect their confidentiality. The homebirth culture depicted in Baby Catcher will be new to many readers, particularly in the United States where the vast majority of births occur in hospitals. Equally foreign to some may be the desire of Vincent’s clients to give birth without drugs or anesthesia. While Vincent shows a clear preference for natural childbirth, she herself uses pain medication during her first birth, in a hospital, and at no point makes judgments about women who choose this option. She does criticize prevailing attitudes within the medical community and routine hospital practices that disempower women and deny them choices during labor and birth. Although some readers may not identify with the alternative choices of Vincent’s clients, these stories could inspire many others to think about birth in a new way. Baby Catcher is a book for anyone interested in childbirth and one for midwives to recommend to their clients. The writing is clear and narrative style engaging. While Vincent includes clinical details, she does so without using jargon or explains medical terminology used, making the book accessible to anyone with a high school reading level or greater. The diverse nature of the clients represented makes the book relevant for people of various ethnic, religious and socioeconomic backgrounds. The appendices with statistics and references supporting midwifery care will help those unfamiliar with midwives find more information. Midwives and other birth professionals will benefit greatly from reading this book, both for its pure enjoyment and for the inspiration instilled by Vincent’s dedication to women and normal birth. Students and new midwives may find reading Vincent’s book an experience akin to the once strictly oral tradition of receiving wisdom from an elder midwife. Regardless of years of experience or practice setting, Vincent’s story contains “Pearls of Wisdom” for all baby catchers: “Childbirth is normal until proven otherwise”; and “If you think you’ve seen it all, you’re wrong”.
Midwifery: Community Based Care During the Childbearing Year. By Linda V. Walsh. New York: WB Saunders Company, 2001. 550 pages. $69.95, hardcover. Reviewed by: Robin G. Jordan, CNM, MSN, Antepartum Course Coordinator: Community Based Midwifery Edu-
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cational Program (CNEP), 4141 Lake Grove Rd., Petoskey, MI 49770. “Midwifery is different from obstetrics. Midwifery is a discipline with its own unique body of knowledge.” These sentences, found on page one of the first chapter of Midwifery: Community Based Care During the Childbearing Year, set the tone for the clinical content found in this new midwifery text. The basic foundation of this book is the perspective that pregnancy is a normal life event. This thread is found throughout almost every chapter. While at the outset this may sound logical and reasonable for a midwifery text, it is especially important to have this philosophy as a clear focus in a basic educational text for students of our profession, as the required knowledge base of this discipline has both broadened and deepened over the years. This book brings our mission back into focus. The text covers material relevant to basic skills and critical thinking in midwifery practice. Evidence-based practice is a common thread, with rationale for aspects of care based on current evidence. Thought-provoking and relevant research related to clinical content is clearly presented in shaded boxes in most chapters. The early chapters present basic anatomy and physiology, as well as growth and development of the fetus, with pertinent drawings to enhance content presentation. These chapters lay the foundation for the following sections: dating and diagnosis of pregnancy; prenatal care; risk assessment; common discomforts of pregnancy; nutritional requirements in pregnancy; and care of the mother and child during labor, birth and postpartum. The chapter on second stage labor includes beautiful photographs of a woman supported by family members in a variety of positions. Midwifery pain management options such as hydrotherapy, physical presence of another supportive individual, acupressure, and pharmaceutical management of pain are well presented. Joyce Thompson, CNM, PhD, a well-known expert in health care ethics, contributes a chapter on ethical aspects of midwifery care. This section complements the text’s focus on the childbearing woman. A particular highlight of the text is the chapter covering psychological, emotional, and social aspects of pregnancy, which includes pertinent material necessary for competent midwifery practice. Concepts are well referenced and integrated into the broad picture of the pregnancy experience. Appropriate midwifery interventions to promote wholeness and health are linked to these concepts. Culturally competent care of women during the childbearing is addressed in several chapters and, while not presented in depth, provides a holistic framework for caring for a variety of populations. Another chapter that stands out is titled “Midwives as Teachers: The 5 Minute Curriculum,” written by Pam
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England, CNM, and Rob Horowitz, PhD, the coauthors of Birthing From Within: an Extraordinary Guide to Childbirth Preparation. Their discussion centers on methods midwives can utilize to enhance the clients’ self-reliance and empowerment in childbirth. It is presented in a succinct format suitable for inclusion in prenatal office visits, even in busy and demanding settings. The last chapter discusses ways to maintain the midwifery model of care within a medical environment—a concerning issue faced by almost all midwives. The discussion is factual, well referenced, and presents our woman-centered style of care as a strength in promoting effective policy decisions. Additionally, the text uses the term “midwife” rather than “nurse-” throughout. This reflects the growing number of midwives without a nursing background, as well as the emergence in the United States of midwifery as its own field and body of knowledge This text has several shortcomings. I found the index to be limited in some aspects, such as listing “labor” as one heading with many sub-categories to search through to find the desired topic. Few photographs are used within the text. More pictures would enhance certain sections, egg, the chapter on the newborn. The discussion of antepartum complications is lacking in detail, however I don’t find this to be a major drawback to the text, as the primary content is intended to be normal midwifery care. The author includes solid information about pregnancy complications, but does not attempt to focus on this medical aspect of care, instead providing in detail the midwifery model of care. Medical obstetrical texts can easily complement the basic information provided here about maternity complications. Every step of the way throughout this text we are reminded of our focus—the women we serve. The book continually stresses the advocacy role of the midwife while maintaining a climate that recognizes the normal aspects of pregnancy. As a midwifery program faculty member, I highly recommend this outstanding text for midwifery students, as it will help them to learn the art and science of our profession.
Lactation for Clinicians. By Lori Feldman-Winter, MD, FAAP, Chris Mulford, FN, BSN, IBCLC, and Riva TougerDecker, PhD, RD, FADA, University of Medicine and Dentistry of New Jersey. Web and CD Interactive Education Program, $140.00. Reviewed by: Deborah Karsnitz, CNM, MSN, FacultyPostpartum and Newborn, and Director of Midwifery, Faculty Practice for Frontier School of Midwifery and Family Nursing. Lactation for Clinicians is a Web and CD Interactive Education program designed to teach lactation diagnostic
and management skills. The CD Rom is composed of seven modules, complete with goals and objectives. The web-based portion includes 3 cases studies, each of which includes historical information and separate quizzes. After completing the activities, the participant may submit the evaluation forms online for continuing education credit. Requirements for utilizing this program include: access to a PC, Windows 95 or higher, Internet Access, Netscape 4.0 or higher, Internet Explorer 5.0 or higher, a CD-ROM drive, and speakers. Many educational programs, as well as private practices, are utilizing multimedia services. This educational CD Rom and Web site were developed for this purpose. The program is easily accessed, simple to follow, contains concise and accurate information, and takes up a very small amount of space. The modules are well organized and presented in a fashion that is appropriate for learning. Objectives are measurable and designed to provide educators and clinicians with objective clinical evaluation strategies. The module on Anatomy & Physiology is an excellent teaching tool utilizing clear and colorful graphics. Physiology is illustrated with feedback loops describing the impact of various hormones. The pictures add visual comprehension of a subject that is often difficult to follow. The segment described as “Anatomy in Motion” shows positioning of the anatomical features of the infant to mother’s breast in relation to suckling and swallowing. In some areas, however, the captions are difficult to see, as they are placed over the pictures, without sufficient contrast to allow easy viewing. Breastfeeding mothers often have a difficult time achieving correct positioning of the baby at the breast and attaining a perfect latch. It is imperative that the individual assisting these moms knows how to facilitate a good breastfeeding experience. Often, mothers will quit breastfeeding because they do not have adequate help in completing this goal. Frustration ensues and they believe that either the baby does not want to nurse, or that they are inadequate. It takes a well-trained assistant to correctly guide a new mother through the beginning stages of breastfeeding. Several modules explore different positions and teach proper techniques.. Video clips are used to show proper alignment and latch-on, as well as correct suckling. A module on feeding alternatives describes and demonstrates the different methods that can be utilized to assist the mother with feeding when the baby does not latch on adequately or when supplementation is needed. Explanations are given about various techniques that will not disrupt breastfeeding or cause nipple confusion to the baby. Feeding methods such as spoon, syringe, and tube are illustrated. Management skills are diagramed in another module, which discusses the management process in detail and
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provides step-by-step evaluation. This module includes practical ideas for all healthcare providers on constructing appropriate questions. As practitioners, we often find that our clients already have very strong opinions and ideas about breastfeeding. When asked whether they plan to breastfeed, or what their feelings are relating to breastfeeding, we are often met with negative thoughts or conceptions. This module explores various ideas to evaluate negative feelings about breastfeeding. The authors support the idea that practitioners give informed consent. This promotes breastfeeding by facilitating teaching, discovering family support for her decision, and discussing the fears and negative beliefs that some clients hold. Cultural variation in relation to breastfeeding is briefly examined. The authors discuss the importance of recognizing cultural influences and the ways these may impact breastfeeding. This reviewer found no specific guidance for cultural differences. There are many different cultures and a vast array of beliefs in most of our practices. It would be very helpful to include a source containing information on cultural beliefs among lactating women. The web connection provides learners with an interactive multimedia learning experience and the three clinical case studies provide individualized learning experiences through self-paced study and quizzes. The turn-around-time on these quizzes is immediate, with information provided about each correct and incorrect answer. The learner may repeat the quizzes as needed or desired. The case studies cover topics such as engorgement, sore nipples, single mothers, adolescent mothers, lack of family support, and lack of breastfeeding knowledge. The information is accurate and up-to-date. These interactive case studies are a great learning tool for students and may serve as a valuable review for practitioners. There are no specific case studies designed to study mastitis or nipple candidiasis. Information on pharmacology, herbal remedies, and alternative therapies is also lacking. Overall, this program will be a very good addition to the practitioner/student’s library. Used in conjunction with a text on lactation, it will enhance the learning curve. It may encourage practitioners to change their way of thinking in some areas and re-examine prior beliefs. It may also serve as an educational program for nurses on OB units and in Family Practice settings.
The Preemie Parents’ Companion. By Susan L. Madden. Boston: Harvard Common Press, 2000. 393 pages. $16.95, paperback. Reviewed by: Susan Murphy Cohen, BSN, SNM. University of Kansas School of Nursing, Kansas City, KS.
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Despite enormous efforts over the past decade, premature birth remains a significant problem in the United States. According to the March of Dimes, premature births comprised 11.6% of all births in the US between 1997 and 1999. The Preemie Parents’ Companion is an exceptional resource for parents experiencing the crisis of premature birth. This book is a comprehensive guide for parents coping with a premature infant, from the early chaotic days in the Neonatal Intensive Care Unit (NICU), through discharge and beyond. Madden is an accomplished science writer who is also the mother of a son born eleven weeks early in 1991. In the preface, she explains that the book was the product of her and her husband’s quest for information as the parents of a preemie. The result is a book that seeks to educate with almost missionary zeal. The text is a veritable treasure trove of detailed and accurate information about life with a premature baby from birth through school age. Madden addresses a dizzying number of aspects and permutations of “preemie life.” The book is divided logically into three sections, titled Born Early, Coming Home, and As Your Child Grows, respectively. Beginning with the chapter titled “First Questions”, Madden guides the reader through topics ranging from navigating the high-tech hospital environment, coping with the complications of extended hospitalization, and how to care for an NICU “graduate” at home. She captures with great insight the unique mix of shock, grief, and hope that accompanies the unexpected birth of a premature baby. Complicated medical topics are presented in a comprehensible manner, so parents have a foundation for discussion with caregivers and family members. Madden cites experts in the fields of perinatology, neonatology, nursing, psychology and special education to present the most current trends in the immediate and continuing care of the premature infant. A sampling of issues addressed in the book include: deciphering NICU jargon; parenting in the hospital; financial issues; issues with twins, triplets and higher multiples; weight gain; apnea; and interpreting research studies. Madden emphasizes the importance of hands-on parenting in the NICU. She explains the therapeutic value of kangaroo care, infant massage, and comforting touch for parents and preemies alike. Breast, formula and tube feeding techniques are fully described and well illustrated. The chapters on discharge planning and the transition to the home environment are excellent, offering dozens of practical tips and a convenient checklist. Early Intervention programs are similarly discussed in a thorough and balanced manner. Throughout the book, Madden conveys reassurance and honesty, while acknowledging the fear and frustration associated with parenting a preemie. The overall tone of the text is quite positive, as Madden points out that “at least 85%” of preemies will
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grow to be healthy children. However, Madden doesn’t avoid discussion of difficult realities such as neonatal surgery, intraventricular bleeds, severe developmental delays, cerebral palsy, autism, and even death. She presents these topics straightforwardly, and with great sensitivity. Parents of premature infants will appreciate the clarity of language, the empathic tone and the many helpful illustrations. The text is interspersed throughout with quotes from parents of preemies, sharing advice and experiences “from the trenches”. Midwives, nurses, social workers and other providers will find that the text offers a unique perspective on the complexity of a preemie parent’s inner and outer life, apart from and after the NICU. The appendices and bibliography display an impressive array of references including an annotated list of national and regional resources for parents, many of which include website addresses. This book would be a valuable addition to the midwife’s “lending library” of parent education materials. One wish for a future edition of the book is to vary the ethnicities depicted in the photos and illustrations. While there is one photo of an African-American family in the book, the great majority of illustrations depict Caucasianlooking subjects. This conveys a message that is out of synch with American childbearing families, particularly considering the greater prevalence of premature birth in non-white populations. Another problem noted by this reviewer is the slightly discouraging attitude toward breastfeeding a premature infant. Madden acknowledges that she was unable to fully breastfeed her own son, and unfortunately this bias is subtly communicated in the text. Although there are ample numbers of pages devoted to the proven benefits of breastmilk and many skilled resources listed to assist parents with nursing a premature infant, the reader is nevertheless left with the impression that breastfeeding a preemie successfully is a nearly impossible challenge. Overall, The Preemie Parent’s Companion is a thorough, accurate and well-written book that succeeds in providing practical advice and a wealth of needed information to parents of premature infants. In addition, the paperback’s handy size (6 ⫻ 10 inches) and legible print style makes it portable and parent-friendly.
Baby, Come Out! By Fran Manushkin. New York: Star Bright Books, 2001. 28 pages. $15.95, hardcover. Reviewed by: Lisa Hardy, BA, SNM, Yale University School of Nursing, 40 Sea Street, #1, New Haven, CT 06519, Mrs. Tracy’s baby does not want to be born—she is enjoying herself right where she is! Grandma, grandpa,
brother, and sister each try to coax Baby out, but it is father who is finally able to woo Baby with love. Everything about this book portrays birth as an active process, equally involving the mother, family, and baby. Expectant families and birth professionals alike will appreciate its message of family-centered birth. It is a simple story that could be read and understood by school-aged children, and it might be useful to childbirth educators conducting New Sibling classes. The book focuses on themes treasured by those working to make birth a more family-centered process. Emphasizing safety, love, and acceptance surrounding the arrival of a new baby, Baby, Come Out! is a peaceful birth story that will delight readers on many levels. The book does not include the biology of birth. Baby plays a central role in the story and is illustrated not as passively hidden inside her mother’s womb, but as an active little being (resembling a toddler much more than a fetus) with a mind of her own who decides why and when she will be born. There is a pronounced absence of technology or birthing details. There is no hospital, no birth scene, and, unfortunately, no midwife! The family doctor arrives at the Tracy home once Baby decides she wants to be born; his role is merely to hold Baby briefly. “Where is my kiss?” She asks him. The story focuses specifically on the relationship between the family and Baby. The setting is not modern. From the dress of the characters in the story, the story has a European, Old World tone. The women wear long dresses; the men wear suspenders and suits. (Baby wears nothing but her mop of curly, brown hair!) The characters are white, but there is no definite identifiable cultural setting or time frame. “Traditional” is an apt description, and it is this traditional theme that also informs the family structure, the presence of the male family doctor, the sweet but somewhat passive Mrs. Tracy. Yet it is precisely this focus on the past that creates the simple and positive theme of the story. Originally published in 1972 under the title Baby, the book was translated into seven languages and reissued in paperback before going out of print twenty years later. It was the first book for author Fran Manushkin and illustrator Ronald Himler. Baby, Come Out! now has been reissued by Star Bright Books, an independent publishing house specializing in “inclusion and multicultural” high-quality children’s books. After the original Baby, author Fran Manushkin went on to write numerous other children’s books, many revolving around traditional Jewish stories and holidays and emphasizing the strength and power of women. Illustrator Ronald Himler became an award-winning children’s illustrator. For Baby, Come Out!, Himler has
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added pastel watercolor washes to the original pen and ink drawings. The result is an understated simplicity that compliments the tone of the story. Baby, Come Out! succeeds by capturing the essence of birth that many birth professionals dedicate themselves to preserving and that many expectant families hope to experience—family-centered, loving, and natural. It is a book that empowers the preparation for a new member by emphasizing the positive influence a family can have on the birth of a new baby.
Transcultural Aspects of Perinatal Health Care: A Resource Guide Edited by Mary Ann Shah, CNM, MS, FACNM Published by National Perinatal Association, 3500 E. Fletcher Ave., Suite 205; Tampa, FL 33613; Tel (813) 971-1008; [email protected]; www. nationalperinatal.org 14 Chapters; Cost $79. Reviewed by: Lily Hsia, CNM, MS, FACNM, Chairperson, State University of New York Health Science Center at Brooklyn Midwifery Education Program This resource guide is the culmination of a project envisioned by the National Perinatal Association (NPA) several years ago. The contributors to the various sections of the resource guide were recruited because of their familiarity with, or first hand knowledge of, the traditions, customs, and ethnocultural practices of specific ethnic and/or religious groups. Because NPA plans to periodically update the current chapters and to add new ones in the future, this compendium can be considered a work in progress. To facilitate the replacement of updated material and the addition of new sections as they become available, the resource guide has been assembled in a practical 3-ring binder. In its current version, the resource guide features selected perinatal health care issues and cultural practices associated with Amish, African American, Cambodian, Chinese, Cuban, Hmong, Jamaican, Japanese, Jewish, Korean, Mexican, Mormon, Muslim, and Native American women. Each chapter focuses on one of these 14 diverse ethnic or religious groups and provides useful and practical information related to health and illness, pregnancy/prenatal care, labor and birth, postpartum and newborn care, family planning, and death/burial rites; in addition, a brief orientation to cultural and spiritual competence helps to set the tone. The real contribution of this resource guide is its illustration of how health
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choices and decisions can be influenced by traditions, family values, religious orientation, and outlook on life. Health care providers must be sensitive to and accepting of alternative belief systems, practices, and cultural norms as long as they do not pose harm to the mother or baby. Implications for the care of families from the cultural groups featured can readily be drawn from the material presented. For example, when caring for an immigrant Muslim woman with a positive TB skin test, it is important to remember that she probably received BCG vaccination as a child, which may account for her positive response to subsequent skin testing. Additionally, Muslims should be supported in their preferences for natural childbirth, breastfeeding, and circumcision of male infants during the first few days of life. On the other hand, a pregnant immigrant from Cambodia perceives labor and delivery as a woman’s domain and men are usually not involved in supporting their wives during labor. Cambodian couples do not attend childbirth classes as a rule and, unlike the practices of Muslims, circumcision of the male child is not done. Because of lactose intolerance, many women from various ethnic and national origins in the Far East and Southeast Asia do not regularly drink milk; in addition, their dietary habits are also strongly influenced by the belief that certain foods are “hot” while others are “cold.” This is part of the traditional “Yin and Yang” belief system that is thousands of years old, deeply embedded in the culture, and difficult for health care providers to change. Thus, it might be necessary to modify food subsidies accordingly to ensure adequate nutrition within the constraints of clients’ belief systems. Other examples abound within each chapter. This down-to-earth resource guide conveniently follows a uniform template design and the content is presented in both narrative and outline form, with key points bulleted succinctly. The references provided at the end of each section are an excellent starting point for information on transcultural perinatal health care for readers who wish to explore the subject further. Stereotypical inferences based upon the limited discussions provided should be avoided. The book’s real value is as a reference—not from reading it cover to cover. The reader can select the part that is most relevant when the need arises. It would be a useful desk reference for any health care provider who works in a multicultural community.
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CNM, MS
EDITOR’S NOTE
Childbirth is both an involuntary biological process and a learned social event. As children, we begin to learn about birth’s challenges and rewards by hearing the stories of our female relatives and friends. This is how our most fundamental views about this great transformative event are shaped. As adults, we continue in the storytelling tradition, the stories we hear and tell assuming greater immediacy as we reflect upon our personal and professional experiences. As midwifery students, we discover our priorities and develop skills that define the art and science of our profession through stories told by our instructors and mentors. As midwives, we refine our practice by listening to the stories of our peers and the women we serve. Birth stories teach us our ancient art. Evidence-based texts give us the science we need to be safe and responsible practitioners in today’s world. This issue of the Journal of Midwifery and Women’s Health offers valuable resources for those at every step along this lifelong path to learning. From children’s literature to midwife’s memoir, from evidence-based text and Web-based learning program to a very personal examination of the realities of life with a premature infant, this issue offers tools that can help us be better parents, midwives, and friends. And all through the shared pleasure of storytelling! Baby Catcher: Chronicles of a Modern Midwife. By Peggy Vincent. New York: Scribner, 2001. 336 pages. $25.00, hardcover. Reviewed by: Vanessa Ross, CNM, MSN, Midwife, The Women’s Health and Birth Center, Santa Rosa, CA 6020 Orchard Station, Road, Petaluma, CA 94952. Baby Catcher: Chronicles of a Modern Midwife reveals that Peggy Vincent is not only a seasoned midwife, but a consummate storyteller as well. Her offering to the body of writing on midwifery and childbirth is a welcome reprieve from the instructional or academic, as she vividly narrates her own journey from timid nursing student to independent homebirth midwife. Vincent deftly weaves together the personal and political, locating her own life and more than three decades of practice as either a nurse or midwife within the broader context of midwifery in the United States. Above all, however, this
book is about birth and sharing stories about birth, a tradition no doubt as ancient as midwifery itself. Baby Catcher begins in 1962 when Vincent witnesses her first unmedicated labor as a nursing student. Zelda’s refusal to “lie down” and insistence that she needs to “walk and sing and dance [her] pains away” opens Vincent’s eyes to an entirely different way of birthing. Vincent’s frustration at her own inability to help this woman have the kind of birth she wants inspires her “to do more”. As a labor and delivery nurse in Berkeley in the 1970s, Vincent goes on to help found an alternative birthing center within the hospital where she works. Despite the success of her efforts, the realization that she is “following the orders of physicians who believe that normal childbirth is a retrospective diagnosis” leads Vincent to pursue midwifery and a career in homebirth. Vincent’s adventures as a midwife and the stories of the births she attends are the heart of her book. The level of detail with which Vincent recalls people, places, and words exchanged at births attended over decades of practice suggests either a phenomenal memory or a devoted journal-writer, or both. Her passion for midwifery is clearly met by the passion of women and families who wish to birth on their own terms, whether at home or in the alternative birth center. There is the Christian Scientist who transitions into second stage so quietly that her husband and midwife almost miss the birth, the woman whose sister members of a commune “finger-dance” to maintain her aura throughout labor and birth, the client who describes labor pain as “interesting”. There are also emergency transports for a missed breech, thick meconium, and two prolapsed cords, one of which results in a severely damaged baby. Vincent learns at her first homebirth that she can either “panic and deliver the baby, or stay calm and deliver the baby”, and her choice of the latter serves her well in many difficult situations. She also reveals her humanity in details about the pitfalls of being a midwife and in the stories of her own births and the challenges they present to her. Vincent’s self-identification in the book as an independent midwife and particularly as a “licensed midwife,” as opposed to a nurse midwife or CNM, may lead to confusion about her credentials to those unfamiliar with paths to midwifery. In California, where Vincent practices, the term “licensed midwife” refers to a direct-entry midwife who has obtained state licensure, as opposed to
Journal of Midwifery & Women’s Health • Vol. 47, No. 5, September/October 2002 © 2002 by the American College of Nurse-Midwives Issued by Elsevier Science Inc.
395 1526-9523/02/$22.00 • PII S1526-9523(02)00269-6
someone like Vincent who went through a nurse-midwifery training program and is certified to practice under an RN license. Vincent also fails to mention whether or not she obtained the consent of each of her clients to share their stories in so much detail, or whether any or all of their names have been changed to protect their confidentiality. The homebirth culture depicted in Baby Catcher will be new to many readers, particularly in the United States where the vast majority of births occur in hospitals. Equally foreign to some may be the desire of Vincent’s clients to give birth without drugs or anesthesia. While Vincent shows a clear preference for natural childbirth, she herself uses pain medication during her first birth, in a hospital, and at no point makes judgments about women who choose this option. She does criticize prevailing attitudes within the medical community and routine hospital practices that disempower women and deny them choices during labor and birth. Although some readers may not identify with the alternative choices of Vincent’s clients, these stories could inspire many others to think about birth in a new way. Baby Catcher is a book for anyone interested in childbirth and one for midwives to recommend to their clients. The writing is clear and narrative style engaging. While Vincent includes clinical details, she does so without using jargon or explains medical terminology used, making the book accessible to anyone with a high school reading level or greater. The diverse nature of the clients represented makes the book relevant for people of various ethnic, religious and socioeconomic backgrounds. The appendices with statistics and references supporting midwifery care will help those unfamiliar with midwives find more information. Midwives and other birth professionals will benefit greatly from reading this book, both for its pure enjoyment and for the inspiration instilled by Vincent’s dedication to women and normal birth. Students and new midwives may find reading Vincent’s book an experience akin to the once strictly oral tradition of receiving wisdom from an elder midwife. Regardless of years of experience or practice setting, Vincent’s story contains “Pearls of Wisdom” for all baby catchers: “Childbirth is normal until proven otherwise”; and “If you think you’ve seen it all, you’re wrong”.
Midwifery: Community Based Care During the Childbearing Year. By Linda V. Walsh. New York: WB Saunders Company, 2001. 550 pages. $69.95, hardcover. Reviewed by: Robin G. Jordan, CNM, MSN, Antepartum Course Coordinator: Community Based Midwifery Edu-
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cational Program (CNEP), 4141 Lake Grove Rd., Petoskey, MI 49770. “Midwifery is different from obstetrics. Midwifery is a discipline with its own unique body of knowledge.” These sentences, found on page one of the first chapter of Midwifery: Community Based Care During the Childbearing Year, set the tone for the clinical content found in this new midwifery text. The basic foundation of this book is the perspective that pregnancy is a normal life event. This thread is found throughout almost every chapter. While at the outset this may sound logical and reasonable for a midwifery text, it is especially important to have this philosophy as a clear focus in a basic educational text for students of our profession, as the required knowledge base of this discipline has both broadened and deepened over the years. This book brings our mission back into focus. The text covers material relevant to basic skills and critical thinking in midwifery practice. Evidence-based practice is a common thread, with rationale for aspects of care based on current evidence. Thought-provoking and relevant research related to clinical content is clearly presented in shaded boxes in most chapters. The early chapters present basic anatomy and physiology, as well as growth and development of the fetus, with pertinent drawings to enhance content presentation. These chapters lay the foundation for the following sections: dating and diagnosis of pregnancy; prenatal care; risk assessment; common discomforts of pregnancy; nutritional requirements in pregnancy; and care of the mother and child during labor, birth and postpartum. The chapter on second stage labor includes beautiful photographs of a woman supported by family members in a variety of positions. Midwifery pain management options such as hydrotherapy, physical presence of another supportive individual, acupressure, and pharmaceutical management of pain are well presented. Joyce Thompson, CNM, PhD, a well-known expert in health care ethics, contributes a chapter on ethical aspects of midwifery care. This section complements the text’s focus on the childbearing woman. A particular highlight of the text is the chapter covering psychological, emotional, and social aspects of pregnancy, which includes pertinent material necessary for competent midwifery practice. Concepts are well referenced and integrated into the broad picture of the pregnancy experience. Appropriate midwifery interventions to promote wholeness and health are linked to these concepts. Culturally competent care of women during the childbearing is addressed in several chapters and, while not presented in depth, provides a holistic framework for caring for a variety of populations. Another chapter that stands out is titled “Midwives as Teachers: The 5 Minute Curriculum,” written by Pam
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England, CNM, and Rob Horowitz, PhD, the coauthors of Birthing From Within: an Extraordinary Guide to Childbirth Preparation. Their discussion centers on methods midwives can utilize to enhance the clients’ self-reliance and empowerment in childbirth. It is presented in a succinct format suitable for inclusion in prenatal office visits, even in busy and demanding settings. The last chapter discusses ways to maintain the midwifery model of care within a medical environment—a concerning issue faced by almost all midwives. The discussion is factual, well referenced, and presents our woman-centered style of care as a strength in promoting effective policy decisions. Additionally, the text uses the term “midwife” rather than “nurse-” throughout. This reflects the growing number of midwives without a nursing background, as well as the emergence in the United States of midwifery as its own field and body of knowledge This text has several shortcomings. I found the index to be limited in some aspects, such as listing “labor” as one heading with many sub-categories to search through to find the desired topic. Few photographs are used within the text. More pictures would enhance certain sections, egg, the chapter on the newborn. The discussion of antepartum complications is lacking in detail, however I don’t find this to be a major drawback to the text, as the primary content is intended to be normal midwifery care. The author includes solid information about pregnancy complications, but does not attempt to focus on this medical aspect of care, instead providing in detail the midwifery model of care. Medical obstetrical texts can easily complement the basic information provided here about maternity complications. Every step of the way throughout this text we are reminded of our focus—the women we serve. The book continually stresses the advocacy role of the midwife while maintaining a climate that recognizes the normal aspects of pregnancy. As a midwifery program faculty member, I highly recommend this outstanding text for midwifery students, as it will help them to learn the art and science of our profession.
Lactation for Clinicians. By Lori Feldman-Winter, MD, FAAP, Chris Mulford, FN, BSN, IBCLC, and Riva TougerDecker, PhD, RD, FADA, University of Medicine and Dentistry of New Jersey. Web and CD Interactive Education Program, $140.00. Reviewed by: Deborah Karsnitz, CNM, MSN, FacultyPostpartum and Newborn, and Director of Midwifery, Faculty Practice for Frontier School of Midwifery and Family Nursing. Lactation for Clinicians is a Web and CD Interactive Education program designed to teach lactation diagnostic
and management skills. The CD Rom is composed of seven modules, complete with goals and objectives. The web-based portion includes 3 cases studies, each of which includes historical information and separate quizzes. After completing the activities, the participant may submit the evaluation forms online for continuing education credit. Requirements for utilizing this program include: access to a PC, Windows 95 or higher, Internet Access, Netscape 4.0 or higher, Internet Explorer 5.0 or higher, a CD-ROM drive, and speakers. Many educational programs, as well as private practices, are utilizing multimedia services. This educational CD Rom and Web site were developed for this purpose. The program is easily accessed, simple to follow, contains concise and accurate information, and takes up a very small amount of space. The modules are well organized and presented in a fashion that is appropriate for learning. Objectives are measurable and designed to provide educators and clinicians with objective clinical evaluation strategies. The module on Anatomy & Physiology is an excellent teaching tool utilizing clear and colorful graphics. Physiology is illustrated with feedback loops describing the impact of various hormones. The pictures add visual comprehension of a subject that is often difficult to follow. The segment described as “Anatomy in Motion” shows positioning of the anatomical features of the infant to mother’s breast in relation to suckling and swallowing. In some areas, however, the captions are difficult to see, as they are placed over the pictures, without sufficient contrast to allow easy viewing. Breastfeeding mothers often have a difficult time achieving correct positioning of the baby at the breast and attaining a perfect latch. It is imperative that the individual assisting these moms knows how to facilitate a good breastfeeding experience. Often, mothers will quit breastfeeding because they do not have adequate help in completing this goal. Frustration ensues and they believe that either the baby does not want to nurse, or that they are inadequate. It takes a well-trained assistant to correctly guide a new mother through the beginning stages of breastfeeding. Several modules explore different positions and teach proper techniques.. Video clips are used to show proper alignment and latch-on, as well as correct suckling. A module on feeding alternatives describes and demonstrates the different methods that can be utilized to assist the mother with feeding when the baby does not latch on adequately or when supplementation is needed. Explanations are given about various techniques that will not disrupt breastfeeding or cause nipple confusion to the baby. Feeding methods such as spoon, syringe, and tube are illustrated. Management skills are diagramed in another module, which discusses the management process in detail and
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provides step-by-step evaluation. This module includes practical ideas for all healthcare providers on constructing appropriate questions. As practitioners, we often find that our clients already have very strong opinions and ideas about breastfeeding. When asked whether they plan to breastfeed, or what their feelings are relating to breastfeeding, we are often met with negative thoughts or conceptions. This module explores various ideas to evaluate negative feelings about breastfeeding. The authors support the idea that practitioners give informed consent. This promotes breastfeeding by facilitating teaching, discovering family support for her decision, and discussing the fears and negative beliefs that some clients hold. Cultural variation in relation to breastfeeding is briefly examined. The authors discuss the importance of recognizing cultural influences and the ways these may impact breastfeeding. This reviewer found no specific guidance for cultural differences. There are many different cultures and a vast array of beliefs in most of our practices. It would be very helpful to include a source containing information on cultural beliefs among lactating women. The web connection provides learners with an interactive multimedia learning experience and the three clinical case studies provide individualized learning experiences through self-paced study and quizzes. The turn-around-time on these quizzes is immediate, with information provided about each correct and incorrect answer. The learner may repeat the quizzes as needed or desired. The case studies cover topics such as engorgement, sore nipples, single mothers, adolescent mothers, lack of family support, and lack of breastfeeding knowledge. The information is accurate and up-to-date. These interactive case studies are a great learning tool for students and may serve as a valuable review for practitioners. There are no specific case studies designed to study mastitis or nipple candidiasis. Information on pharmacology, herbal remedies, and alternative therapies is also lacking. Overall, this program will be a very good addition to the practitioner/student’s library. Used in conjunction with a text on lactation, it will enhance the learning curve. It may encourage practitioners to change their way of thinking in some areas and re-examine prior beliefs. It may also serve as an educational program for nurses on OB units and in Family Practice settings.
The Preemie Parents’ Companion. By Susan L. Madden. Boston: Harvard Common Press, 2000. 393 pages. $16.95, paperback. Reviewed by: Susan Murphy Cohen, BSN, SNM. University of Kansas School of Nursing, Kansas City, KS.
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Despite enormous efforts over the past decade, premature birth remains a significant problem in the United States. According to the March of Dimes, premature births comprised 11.6% of all births in the US between 1997 and 1999. The Preemie Parents’ Companion is an exceptional resource for parents experiencing the crisis of premature birth. This book is a comprehensive guide for parents coping with a premature infant, from the early chaotic days in the Neonatal Intensive Care Unit (NICU), through discharge and beyond. Madden is an accomplished science writer who is also the mother of a son born eleven weeks early in 1991. In the preface, she explains that the book was the product of her and her husband’s quest for information as the parents of a preemie. The result is a book that seeks to educate with almost missionary zeal. The text is a veritable treasure trove of detailed and accurate information about life with a premature baby from birth through school age. Madden addresses a dizzying number of aspects and permutations of “preemie life.” The book is divided logically into three sections, titled Born Early, Coming Home, and As Your Child Grows, respectively. Beginning with the chapter titled “First Questions”, Madden guides the reader through topics ranging from navigating the high-tech hospital environment, coping with the complications of extended hospitalization, and how to care for an NICU “graduate” at home. She captures with great insight the unique mix of shock, grief, and hope that accompanies the unexpected birth of a premature baby. Complicated medical topics are presented in a comprehensible manner, so parents have a foundation for discussion with caregivers and family members. Madden cites experts in the fields of perinatology, neonatology, nursing, psychology and special education to present the most current trends in the immediate and continuing care of the premature infant. A sampling of issues addressed in the book include: deciphering NICU jargon; parenting in the hospital; financial issues; issues with twins, triplets and higher multiples; weight gain; apnea; and interpreting research studies. Madden emphasizes the importance of hands-on parenting in the NICU. She explains the therapeutic value of kangaroo care, infant massage, and comforting touch for parents and preemies alike. Breast, formula and tube feeding techniques are fully described and well illustrated. The chapters on discharge planning and the transition to the home environment are excellent, offering dozens of practical tips and a convenient checklist. Early Intervention programs are similarly discussed in a thorough and balanced manner. Throughout the book, Madden conveys reassurance and honesty, while acknowledging the fear and frustration associated with parenting a preemie. The overall tone of the text is quite positive, as Madden points out that “at least 85%” of preemies will
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grow to be healthy children. However, Madden doesn’t avoid discussion of difficult realities such as neonatal surgery, intraventricular bleeds, severe developmental delays, cerebral palsy, autism, and even death. She presents these topics straightforwardly, and with great sensitivity. Parents of premature infants will appreciate the clarity of language, the empathic tone and the many helpful illustrations. The text is interspersed throughout with quotes from parents of preemies, sharing advice and experiences “from the trenches”. Midwives, nurses, social workers and other providers will find that the text offers a unique perspective on the complexity of a preemie parent’s inner and outer life, apart from and after the NICU. The appendices and bibliography display an impressive array of references including an annotated list of national and regional resources for parents, many of which include website addresses. This book would be a valuable addition to the midwife’s “lending library” of parent education materials. One wish for a future edition of the book is to vary the ethnicities depicted in the photos and illustrations. While there is one photo of an African-American family in the book, the great majority of illustrations depict Caucasianlooking subjects. This conveys a message that is out of synch with American childbearing families, particularly considering the greater prevalence of premature birth in non-white populations. Another problem noted by this reviewer is the slightly discouraging attitude toward breastfeeding a premature infant. Madden acknowledges that she was unable to fully breastfeed her own son, and unfortunately this bias is subtly communicated in the text. Although there are ample numbers of pages devoted to the proven benefits of breastmilk and many skilled resources listed to assist parents with nursing a premature infant, the reader is nevertheless left with the impression that breastfeeding a preemie successfully is a nearly impossible challenge. Overall, The Preemie Parent’s Companion is a thorough, accurate and well-written book that succeeds in providing practical advice and a wealth of needed information to parents of premature infants. In addition, the paperback’s handy size (6 ⫻ 10 inches) and legible print style makes it portable and parent-friendly.
Baby, Come Out! By Fran Manushkin. New York: Star Bright Books, 2001. 28 pages. $15.95, hardcover. Reviewed by: Lisa Hardy, BA, SNM, Yale University School of Nursing, 40 Sea Street, #1, New Haven, CT 06519, Mrs. Tracy’s baby does not want to be born—she is enjoying herself right where she is! Grandma, grandpa,
brother, and sister each try to coax Baby out, but it is father who is finally able to woo Baby with love. Everything about this book portrays birth as an active process, equally involving the mother, family, and baby. Expectant families and birth professionals alike will appreciate its message of family-centered birth. It is a simple story that could be read and understood by school-aged children, and it might be useful to childbirth educators conducting New Sibling classes. The book focuses on themes treasured by those working to make birth a more family-centered process. Emphasizing safety, love, and acceptance surrounding the arrival of a new baby, Baby, Come Out! is a peaceful birth story that will delight readers on many levels. The book does not include the biology of birth. Baby plays a central role in the story and is illustrated not as passively hidden inside her mother’s womb, but as an active little being (resembling a toddler much more than a fetus) with a mind of her own who decides why and when she will be born. There is a pronounced absence of technology or birthing details. There is no hospital, no birth scene, and, unfortunately, no midwife! The family doctor arrives at the Tracy home once Baby decides she wants to be born; his role is merely to hold Baby briefly. “Where is my kiss?” She asks him. The story focuses specifically on the relationship between the family and Baby. The setting is not modern. From the dress of the characters in the story, the story has a European, Old World tone. The women wear long dresses; the men wear suspenders and suits. (Baby wears nothing but her mop of curly, brown hair!) The characters are white, but there is no definite identifiable cultural setting or time frame. “Traditional” is an apt description, and it is this traditional theme that also informs the family structure, the presence of the male family doctor, the sweet but somewhat passive Mrs. Tracy. Yet it is precisely this focus on the past that creates the simple and positive theme of the story. Originally published in 1972 under the title Baby, the book was translated into seven languages and reissued in paperback before going out of print twenty years later. It was the first book for author Fran Manushkin and illustrator Ronald Himler. Baby, Come Out! now has been reissued by Star Bright Books, an independent publishing house specializing in “inclusion and multicultural” high-quality children’s books. After the original Baby, author Fran Manushkin went on to write numerous other children’s books, many revolving around traditional Jewish stories and holidays and emphasizing the strength and power of women. Illustrator Ronald Himler became an award-winning children’s illustrator. For Baby, Come Out!, Himler has
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added pastel watercolor washes to the original pen and ink drawings. The result is an understated simplicity that compliments the tone of the story. Baby, Come Out! succeeds by capturing the essence of birth that many birth professionals dedicate themselves to preserving and that many expectant families hope to experience—family-centered, loving, and natural. It is a book that empowers the preparation for a new member by emphasizing the positive influence a family can have on the birth of a new baby.
Transcultural Aspects of Perinatal Health Care: A Resource Guide Edited by Mary Ann Shah, CNM, MS, FACNM Published by National Perinatal Association, 3500 E. Fletcher Ave., Suite 205; Tampa, FL 33613; Tel (813) 971-1008; [email protected]; www. nationalperinatal.org 14 Chapters; Cost $79. Reviewed by: Lily Hsia, CNM, MS, FACNM, Chairperson, State University of New York Health Science Center at Brooklyn Midwifery Education Program This resource guide is the culmination of a project envisioned by the National Perinatal Association (NPA) several years ago. The contributors to the various sections of the resource guide were recruited because of their familiarity with, or first hand knowledge of, the traditions, customs, and ethnocultural practices of specific ethnic and/or religious groups. Because NPA plans to periodically update the current chapters and to add new ones in the future, this compendium can be considered a work in progress. To facilitate the replacement of updated material and the addition of new sections as they become available, the resource guide has been assembled in a practical 3-ring binder. In its current version, the resource guide features selected perinatal health care issues and cultural practices associated with Amish, African American, Cambodian, Chinese, Cuban, Hmong, Jamaican, Japanese, Jewish, Korean, Mexican, Mormon, Muslim, and Native American women. Each chapter focuses on one of these 14 diverse ethnic or religious groups and provides useful and practical information related to health and illness, pregnancy/prenatal care, labor and birth, postpartum and newborn care, family planning, and death/burial rites; in addition, a brief orientation to cultural and spiritual competence helps to set the tone. The real contribution of this resource guide is its illustration of how health
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choices and decisions can be influenced by traditions, family values, religious orientation, and outlook on life. Health care providers must be sensitive to and accepting of alternative belief systems, practices, and cultural norms as long as they do not pose harm to the mother or baby. Implications for the care of families from the cultural groups featured can readily be drawn from the material presented. For example, when caring for an immigrant Muslim woman with a positive TB skin test, it is important to remember that she probably received BCG vaccination as a child, which may account for her positive response to subsequent skin testing. Additionally, Muslims should be supported in their preferences for natural childbirth, breastfeeding, and circumcision of male infants during the first few days of life. On the other hand, a pregnant immigrant from Cambodia perceives labor and delivery as a woman’s domain and men are usually not involved in supporting their wives during labor. Cambodian couples do not attend childbirth classes as a rule and, unlike the practices of Muslims, circumcision of the male child is not done. Because of lactose intolerance, many women from various ethnic and national origins in the Far East and Southeast Asia do not regularly drink milk; in addition, their dietary habits are also strongly influenced by the belief that certain foods are “hot” while others are “cold.” This is part of the traditional “Yin and Yang” belief system that is thousands of years old, deeply embedded in the culture, and difficult for health care providers to change. Thus, it might be necessary to modify food subsidies accordingly to ensure adequate nutrition within the constraints of clients’ belief systems. Other examples abound within each chapter. This down-to-earth resource guide conveniently follows a uniform template design and the content is presented in both narrative and outline form, with key points bulleted succinctly. The references provided at the end of each section are an excellent starting point for information on transcultural perinatal health care for readers who wish to explore the subject further. Stereotypical inferences based upon the limited discussions provided should be avoided. The book’s real value is as a reference—not from reading it cover to cover. The reader can select the part that is most relevant when the need arises. It would be a useful desk reference for any health care provider who works in a multicultural community.
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