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and infant. Breastfeeding for the special needs infant is addressed, such as those born prematurely, with neurological impairment, cleft lip/palate, low birth weight, or from multiple gestation pregnancies. Iron supplementation during breastfeeding, a controversial concept, is covered from multiple perspectives. The conflicting information is supplied; leaving the management choice optional for the reader. Maternal factors impacting breastfeeding comfort include breast implants, maternal infections, medication use, and contraception. Also included in this module are induced lactation and relactation methods. The content of the series is well referenced from peer reviewed journal articles in a variety of disciplines. The illustrations are exquisite in clarity and content. The writing style is simple, allowing fast and easy reading. The table of contents and indexing are adequate for immediate use in a clinical setting. However, the bulky four-volume format slows the process of finding information. The promotion of breastfeeding and criticism of the use of formula as a health hazard are refreshing. One of the most important principles for breastfeeding specialists to encourage is the belief that breastfeeding is easy, normal, and the healthiest way to feed a baby. On the other hand, an inexperienced student, health care provider, or casual reader may be unnecessarily intimidated by the sheer volume of material in these four modules. For the targeted audience, this series is a job well done. For adult learners in educational programs or those obtaining or maintaining certification as a lactation consultant, this format and learning style promotes knowledge retention and ensures success on examinations. To broaden the audience to readers not pursuing certification, a future edition as a single volume reference with the essentials, and without the pre- and post-tests, would be a useful adjunct for the clinical setting. Although midwives are strong advocates of breastfeeding and the Journal of Nurse-Midwifery is used as a reference for this series of modules, midwifery is not noted for its contribution to breastfeeding. The ACNM position paper is not included in the discussion of organizations contributing to the promotion of breastfeeding. The ACNM is not listed as a resource for professional or lay breastfeeding information. This raises the question: How is the role of midwifery in the advocacy of breastfeeding perceived by other women’s health organizations? The Breastfeeding Answer Book. By Nancy Mohrbacher and Julie Stock. Schaumburg (Il): La Leche League International, 1997. 586 pages. $52.00, hardcover. Reviewed by: Donna B. Malmgren, RN, MSN, IBCLC, The
Nursing Mothers’ Place at Presbyterian Hospital, Charlotte, North Carolina. Breastfeeding counselors spend a great deal of time answering mothers’ questions. This is sometimes a daunting task to the novice counselor. Before the Breastfeeding Answer Book was available as a resource, counselors frequently needed to search in a variety of references or talk to a mentor before answering a mother’s questions. Breastfeeding Answer Book was first published in 1991. This second edition provides a new approach to breastfeeding counseling that is both practical and research based. The new approach to counseling includes offering the counselor many more different, and sometimes contradictory, viewpoints on breastfeeding problems. This gives the counselor more strategies to choose from in almost any breastfeeding situation. The information found in the first edition has been expanded by adding three chapters on 1) employment and breastfeeding; 2) sexuality, fertility, and contraception; and 3) nutrition, weight loss, exercise, and personal grooming of the mother. The format for both editions is the same. They are divided into easily located, tabbed sections on counseling techniques as well as almost all possible types of breastfeeding questions and answers. Each page is divided into two columns: basic information and background needed. Basic information consists of a brief summary or statement of the issue or problem addressed. The background needed column expands on the basic information with a comprehensive explanation of the issue or problem. For example, in the discussion of teen mothers, basic information includes the statement that teen mothers have similarities as well as differences when compared to other mothers. Background needed includes a detailed discussion of emotional, physical, birth, and breastfeeding concerns of the teenage mother. Each chapter is followed by a list of references that have been updated from the 1991 edition. Specific terms can be easily located in the index. The book has some weaknesses. The presentation of different perspectives and solutions on breastfeeding situations is helpful to the counselor, but could be confusing to both the counselor and the mother. For example, literature recommendations for storage of breast milk at room temperature, in the refrigerator, and in the freezer are listed with references; however, no recommendations are made for storage at room temperature, followed by refrigeration and/or freezing. This requires some interpretation on the part of either the counselor or the mother. Both authors are IBCLC certified consultants in private practice, but the role of the lactation consultant in breastfeeding management is not discussed. The lactation consultant is an expert trained in breastfeeding counseling, assessment, and management, and works closely
Journal of Midwifery & Women’s Health • Vol. 45, No. 3, May/June 2000
281
with physicians and other health care providers to provide comprehensive care for the breastfeeding dyad. The book is an excellent reference for any health professional who works with breastfeeding mothers and babies. Lay counselors, nurses, midwives, nurse practitioners, lactation consultants, and physicians would find this book a valuable addition to their reference library. The word difficulty is high school level according to the Flesch Kincaid scale. The hardcover book is somewhat bulkier than the first edition, but the spiral binding allows the book to remain open while being read. The retail price of $52 seems a reasonable price for this excellent reference. The authors state in the introduction that the book was developed primarily for La Leche League Leaders, but that both lay and medical counselors will find this book helpful. La Leche League Leaders receive education and training for a year with an assigned mentor before they begin counseling independently. No recommendations for preparation of counselors is mentioned. It is the reviewer’s belief that the book should be used by counselors with some basic education in counseling techniques and breastfeeding before beginning to work with breastfeeding mothers. How Weaning Happens. By Diane Bengson. Schaumburg (IL): La Leche League International, 1999. 156 pages. $10.95, paperback. Reviewed by: Donna B. Malmgren, RN, MSN, IBCLC, The Nursing Mothers’ Place at Presbyterian Hospital, Charlotte, North Carolina. Worldwide, children are not weaned until after the age of 2. In the United States, approximately 20% of babies are breastfed until they are 6 months old, and only a fraction of those are breastfed until they are 2 or older. For this reason, mothers cannot always rely on health care providers, friends, or family members for advice on weaning. How Weaning Happens provides information that families need in a time that can be very stressful for the mother, baby, and the entire family. The book is written by Diane Bengson, a La Leche League Leader who guides the reader through weaning processes in a gentle, positive way. Breastfeeding, weaning, and the relationship after weaning are presented as a continuum of the important relationship between the mother and baby. The book contains current research-based information, but much of the book consists of the personal experiences of mothers who have weaned their babies in a wide variety of ways. The monologues are engaging to the reader because they describe real situations. The author discusses many reasons a mother may choose to wean, including physician recommendation, as well as pressure from friends, family members, and the community at large. She divides weaning into four
282
categories: abrupt weaning, planned or gradual, partial, and natural weaning. Abrupt weaning is a sudden end to breastfeeding without warning or planning. This is the most difficult type of weaning because it can be physically and emotionally traumatic for both the mother and baby. Physically, the mother is at risk for engorgement and mastitis, while the baby must learn to take formula from a bottle. Emotionally, the baby misses the closeness and comfort of breastfeeding, while the mother may suffer mood swings from hormonal shifts that occur during weaning. Planned weaning can occur as fast or slowly as the mother and baby choose. The mother omits one feeding every 2 to 3 days and substitutes other food or distractions. In partial weaning, the mother omits some nursings that are difficult for her, or that the baby has little interest in, but continues to nurse a few times each day. Natural weaning is discussed in greater length than other weaning methods because it is unique to each mother and baby dyad, and therefore is unpredictable. Natural weaning is influenced by the mother, but allows the child to wean at his or her own pace. From a developmental perspective, natural weaning allows the child to nurse until he or she outgrows the need. Many mothers choose to extend nursing past the first year because of the advantages for both mother and baby. With prolonged nursing, the milk supply declines slightly, becoming more concentrated with higher levels of antibodies, immune factors, and nutrients. Breast milk provides a good source of nutrition to toddlers who can be picky about eating. Breastfeeding provides comfort to busy or ill toddlers, and is a reason for the mother and child to sit down and relax. For the mother, increased levels of prolactin provide a calming effect and reduce fertility, and there is some indication that prolonged breastfeeding may provide protection against osteoporosis, breast cancer, and rheumatoid arthritis. The book is an excellent resource for the reference and lending library of any health care professional who works with breastfeeding mothers and babies, including lay counselors, nurses, midwives, nurse practitioners, lactation consultants, and physicians. From Midwives to Medicine: The Birth of American Gynecology. By Deborah Kuhn McGregor. Piscataway (NJ): Rutgers University Press, 1998. 273 pages, $23.00. Reviewed by: Kathryn McElroy, CNM, MS, Staff Midwife, Plainfield Health Center, Plainfield, New Jersey. From Midwives to Medicine: The Birth of American Gynecology is a revised edition of a book first published in 1989 as Sexual Surgery and the Origin of Gynecology: J. Marion Sims, His Hospital, and His Patients. In fact, the earlier title is a more accurate description of the content. Although Deborah Kuhn McGregor credits the
Journal of Midwifery & Women’s Health • Vol. 45, No. 3, May/June 2000
Nursing Mothers’ Place at Presbyterian Hospital, Charlotte, North Carolina. Breastfeeding counselors spend a great deal of time answering mothers’ questions. This is sometimes a daunting task to the novice counselor. Before the Breastfeeding Answer Book was available as a resource, counselors frequently needed to search in a variety of references or talk to a mentor before answering a mother’s questions. Breastfeeding Answer Book was first published in 1991. This second edition provides a new approach to breastfeeding counseling that is both practical and research based. The new approach to counseling includes offering the counselor many more different, and sometimes contradictory, viewpoints on breastfeeding problems. This gives the counselor more strategies to choose from in almost any breastfeeding situation. The information found in the first edition has been expanded by adding three chapters on 1) employment and breastfeeding; 2) sexuality, fertility, and contraception; and 3) nutrition, weight loss, exercise, and personal grooming of the mother. The format for both editions is the same. They are divided into easily located, tabbed sections on counseling techniques as well as almost all possible types of breastfeeding questions and answers. Each page is divided into two columns: basic information and background needed. Basic information consists of a brief summary or statement of the issue or problem addressed. The background needed column expands on the basic information with a comprehensive explanation of the issue or problem. For example, in the discussion of teen mothers, basic information includes the statement that teen mothers have similarities as well as differences when compared to other mothers. Background needed includes a detailed discussion of emotional, physical, birth, and breastfeeding concerns of the teenage mother. Each chapter is followed by a list of references that have been updated from the 1991 edition. Specific terms can be easily located in the index. The book has some weaknesses. The presentation of different perspectives and solutions on breastfeeding situations is helpful to the counselor, but could be confusing to both the counselor and the mother. For example, literature recommendations for storage of breast milk at room temperature, in the refrigerator, and in the freezer are listed with references; however, no recommendations are made for storage at room temperature, followed by refrigeration and/or freezing. This requires some interpretation on the part of either the counselor or the mother. Both authors are IBCLC certified consultants in private practice, but the role of the lactation consultant in breastfeeding management is not discussed. The lactation consultant is an expert trained in breastfeeding counseling, assessment, and management, and works closely
Journal of Midwifery & Women’s Health • Vol. 45, No. 3, May/June 2000
281
with physicians and other health care providers to provide comprehensive care for the breastfeeding dyad. The book is an excellent reference for any health professional who works with breastfeeding mothers and babies. Lay counselors, nurses, midwives, nurse practitioners, lactation consultants, and physicians would find this book a valuable addition to their reference library. The word difficulty is high school level according to the Flesch Kincaid scale. The hardcover book is somewhat bulkier than the first edition, but the spiral binding allows the book to remain open while being read. The retail price of $52 seems a reasonable price for this excellent reference. The authors state in the introduction that the book was developed primarily for La Leche League Leaders, but that both lay and medical counselors will find this book helpful. La Leche League Leaders receive education and training for a year with an assigned mentor before they begin counseling independently. No recommendations for preparation of counselors is mentioned. It is the reviewer’s belief that the book should be used by counselors with some basic education in counseling techniques and breastfeeding before beginning to work with breastfeeding mothers. How Weaning Happens. By Diane Bengson. Schaumburg (IL): La Leche League International, 1999. 156 pages. $10.95, paperback. Reviewed by: Donna B. Malmgren, RN, MSN, IBCLC, The Nursing Mothers’ Place at Presbyterian Hospital, Charlotte, North Carolina. Worldwide, children are not weaned until after the age of 2. In the United States, approximately 20% of babies are breastfed until they are 6 months old, and only a fraction of those are breastfed until they are 2 or older. For this reason, mothers cannot always rely on health care providers, friends, or family members for advice on weaning. How Weaning Happens provides information that families need in a time that can be very stressful for the mother, baby, and the entire family. The book is written by Diane Bengson, a La Leche League Leader who guides the reader through weaning processes in a gentle, positive way. Breastfeeding, weaning, and the relationship after weaning are presented as a continuum of the important relationship between the mother and baby. The book contains current research-based information, but much of the book consists of the personal experiences of mothers who have weaned their babies in a wide variety of ways. The monologues are engaging to the reader because they describe real situations. The author discusses many reasons a mother may choose to wean, including physician recommendation, as well as pressure from friends, family members, and the community at large. She divides weaning into four
282
categories: abrupt weaning, planned or gradual, partial, and natural weaning. Abrupt weaning is a sudden end to breastfeeding without warning or planning. This is the most difficult type of weaning because it can be physically and emotionally traumatic for both the mother and baby. Physically, the mother is at risk for engorgement and mastitis, while the baby must learn to take formula from a bottle. Emotionally, the baby misses the closeness and comfort of breastfeeding, while the mother may suffer mood swings from hormonal shifts that occur during weaning. Planned weaning can occur as fast or slowly as the mother and baby choose. The mother omits one feeding every 2 to 3 days and substitutes other food or distractions. In partial weaning, the mother omits some nursings that are difficult for her, or that the baby has little interest in, but continues to nurse a few times each day. Natural weaning is discussed in greater length than other weaning methods because it is unique to each mother and baby dyad, and therefore is unpredictable. Natural weaning is influenced by the mother, but allows the child to wean at his or her own pace. From a developmental perspective, natural weaning allows the child to nurse until he or she outgrows the need. Many mothers choose to extend nursing past the first year because of the advantages for both mother and baby. With prolonged nursing, the milk supply declines slightly, becoming more concentrated with higher levels of antibodies, immune factors, and nutrients. Breast milk provides a good source of nutrition to toddlers who can be picky about eating. Breastfeeding provides comfort to busy or ill toddlers, and is a reason for the mother and child to sit down and relax. For the mother, increased levels of prolactin provide a calming effect and reduce fertility, and there is some indication that prolonged breastfeeding may provide protection against osteoporosis, breast cancer, and rheumatoid arthritis. The book is an excellent resource for the reference and lending library of any health care professional who works with breastfeeding mothers and babies, including lay counselors, nurses, midwives, nurse practitioners, lactation consultants, and physicians. From Midwives to Medicine: The Birth of American Gynecology. By Deborah Kuhn McGregor. Piscataway (NJ): Rutgers University Press, 1998. 273 pages, $23.00. Reviewed by: Kathryn McElroy, CNM, MS, Staff Midwife, Plainfield Health Center, Plainfield, New Jersey. From Midwives to Medicine: The Birth of American Gynecology is a revised edition of a book first published in 1989 as Sexual Surgery and the Origin of Gynecology: J. Marion Sims, His Hospital, and His Patients. In fact, the earlier title is a more accurate description of the content. Although Deborah Kuhn McGregor credits the
Journal of Midwifery & Women’s Health • Vol. 45, No. 3, May/June 2000