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Mixed blessings: Intensive care for newborns
subtle and not-so-subtle pressures (eg, guilt, sympathy, fear, ridicule, etc) to engage in undesired sexual behavior. Part 2, “I Know You Really Want It,” deals with acquaintance or date rape. The final section, “Our Little Secret,” covers sexual abuse by adults. A teacher’s guide included with the film contains a summary of the program, questions for discussion, suggested activities, a list of learning objectives, a bibliography, and a complete script of the film. The adolescents featured in the program include black and white males and females from various socioeconomic backgrounds. Experiences and feelings described are realistic. The material is timely, highly relevant to teens, and written concisely. It presents an effective counterpoint to the mass media’s portrayal of all adolescents as sophisticated, knowledgeable, and ever ready for sexual interactions. The film includes some reasonable and specific suggestions for preventing some forms of sexual exploitation as well as for dealing with sexual abuse after the fact. When Sex Means Trouble is a useful program for teachers, counsellors, and others who work with groups of teens. Mixed Blessings: Intensive Care For Newborns. By Jeanne Harley Guillemin
and Lynda Lytie Holmstrom. New York: Oxford University Press, 1986. 317 pages. $18.95, hardcover. Reviewed
by: Kathryn McElroy, CNM, University Associates in OB/GYN, Burlington, Vermont.
MS,
Mixed Blessings: lntensiue Care For Newborns is an exhaustive look at the insular world of the newborn intensive care unit. The authors are medical sociologists who spent a year recording an unnamed unit’s structure, function, and consecutive follow-up of 103 infants from admission to discharge. The book dissects the organization of the unit and the responsibilities of the entire support staff. Interspersed throughout the chapters are conversations and depressing examples of “gallows humor.” In addition, the authors examine social issues related to the newborn patient and the national and international practice of newborn intensive care. Of all the revelations about the structure and function of the intensive care
nursery, perhaps the most significant is the incredible variation in each infant’s plan of management. The authors attribute this variation to the monthly rotation of the residents, fellows, and attendants. For example, one chapter presents the ups and downs of “Baby Darlene” a 740 g surviving twin with severe respiratory distress, intraventricular hemorrhage, and ductus arteriosus born to a 15 year old Gr2 PlOOl by cesarean section. Her 160 day life in the hospital is fraught with inconsistencies in management. The resident who was her sole advocate left for another rotation after the first month. The next month her primary care physician did not inform the following physician of the agreed respiratoy system management. The neurosurgeons pressured the neonatologists into surgery despite the fact as one attendant stated, “There are few if any survivors at this weight category” and so on. What is underscored in this presentation and throughout the book is that neonatologists, as a rule, make decisions solely on a physiologic basis and do not incorporate an evaluation of the baby’s and family’s adaptive mechanisms. The infant’s long term prognosis for survival, including its quality of life, are too often ignored. “Baby Darlene’s” case and others in this book raise painful questions that should be addressed by nurse-midwives. Unfortunately, there are no easy answers. The authors make excellent recommendations for policy change including designating 900 g babies as experimental patients. They argue that parents need to know that no matter the quality of intensive care, their child’s chances for survival are uncertain and should be honestly informed that neonatal care for less than 1000 g babies is the practice of medicine “on the frontier.” Some chapters will interest readers more than others. For example, the final chapter, which recommends policy change, is so well designed that it more than compensates for the tedious recounting of physician, nursing, and social service responsibilities in the early chapters. However, with this background, one has a better understanding of the intricacies involved in the case presentation of “Baby Darlene.” The chapter on international newborn inten-
Journal of Nurse-Midwifery
sive care is very informative and opens one’s eyes to the reality of socialized medicine. Obviously, this is an important book for those who are concerned with ethics in health care and how management decisions are made. This book is also recommended for nurse-midwifery students in the neonatology module. In addition, it will be especially helpful for those students with little or no theoretical knowledge and/or practical experience in the NICU. This reviewer hesitates to unreservedly recommend the book to all parents of infants in the intensive care nursery. For those parents with a need to know, understand, and participate in their child’s health care, this book will provide tremendous insight. However, for parents whose baby is in the unit for several days and has an excellent prognosis (the majority of admissions), the authors’ documented revelations about inconsistencies in management may make parents somewhat distrustful of the staff. As maternity and newborn care becomes more specialized, it is imperative that nurse-midwives know exactly what is happening in the intertwined fields of obstetrics and neonatoiogy. In the event that their client’s infant is admitted to a NICU, the information in this book will help CNMs to function more efficiently and effectively as advocates for the mother, father, and baby. In summary, Mixed Blessings is an excellent overview of newborn intensive care. Time
Out For Motherhood. By Lucy Scott, PhD, and Meredith Joan Angwin. Los Angeles: Jeremy P. Tarcher Inc., 1986. 252 pages. $15.95. hardcover. Reviewed by: Heather Dawn Reynolds, CMN,MSN, Instructor, Maternal-Newborn Nursing/Nurse-Midwifery Program, Yale University School of Nursing, New Haven, CT. Time Out For Motherhood is a “guide for today’s working woman to the financial, emotional, and career aspects of having a baby.” More specifically, its objective is to offer advice to those women who elect to delay childbearing until their thirties and for whom the balancing of career (other than motherhood) and motherhood itself may be an issue. Both authors write from personal experiences, having combined careers and mothering, thus
?? Vol.
32, No. 5, September/October
1987
and Lynda Lytie Holmstrom. New York: Oxford University Press, 1986. 317 pages. $18.95, hardcover. Reviewed
by: Kathryn McElroy, CNM, University Associates in OB/GYN, Burlington, Vermont.
MS,
Mixed Blessings: lntensiue Care For Newborns is an exhaustive look at the insular world of the newborn intensive care unit. The authors are medical sociologists who spent a year recording an unnamed unit’s structure, function, and consecutive follow-up of 103 infants from admission to discharge. The book dissects the organization of the unit and the responsibilities of the entire support staff. Interspersed throughout the chapters are conversations and depressing examples of “gallows humor.” In addition, the authors examine social issues related to the newborn patient and the national and international practice of newborn intensive care. Of all the revelations about the structure and function of the intensive care
nursery, perhaps the most significant is the incredible variation in each infant’s plan of management. The authors attribute this variation to the monthly rotation of the residents, fellows, and attendants. For example, one chapter presents the ups and downs of “Baby Darlene” a 740 g surviving twin with severe respiratory distress, intraventricular hemorrhage, and ductus arteriosus born to a 15 year old Gr2 PlOOl by cesarean section. Her 160 day life in the hospital is fraught with inconsistencies in management. The resident who was her sole advocate left for another rotation after the first month. The next month her primary care physician did not inform the following physician of the agreed respiratoy system management. The neurosurgeons pressured the neonatologists into surgery despite the fact as one attendant stated, “There are few if any survivors at this weight category” and so on. What is underscored in this presentation and throughout the book is that neonatologists, as a rule, make decisions solely on a physiologic basis and do not incorporate an evaluation of the baby’s and family’s adaptive mechanisms. The infant’s long term prognosis for survival, including its quality of life, are too often ignored. “Baby Darlene’s” case and others in this book raise painful questions that should be addressed by nurse-midwives. Unfortunately, there are no easy answers. The authors make excellent recommendations for policy change including designating 900 g babies as experimental patients. They argue that parents need to know that no matter the quality of intensive care, their child’s chances for survival are uncertain and should be honestly informed that neonatal care for less than 1000 g babies is the practice of medicine “on the frontier.” Some chapters will interest readers more than others. For example, the final chapter, which recommends policy change, is so well designed that it more than compensates for the tedious recounting of physician, nursing, and social service responsibilities in the early chapters. However, with this background, one has a better understanding of the intricacies involved in the case presentation of “Baby Darlene.” The chapter on international newborn inten-
Journal of Nurse-Midwifery
sive care is very informative and opens one’s eyes to the reality of socialized medicine. Obviously, this is an important book for those who are concerned with ethics in health care and how management decisions are made. This book is also recommended for nurse-midwifery students in the neonatology module. In addition, it will be especially helpful for those students with little or no theoretical knowledge and/or practical experience in the NICU. This reviewer hesitates to unreservedly recommend the book to all parents of infants in the intensive care nursery. For those parents with a need to know, understand, and participate in their child’s health care, this book will provide tremendous insight. However, for parents whose baby is in the unit for several days and has an excellent prognosis (the majority of admissions), the authors’ documented revelations about inconsistencies in management may make parents somewhat distrustful of the staff. As maternity and newborn care becomes more specialized, it is imperative that nurse-midwives know exactly what is happening in the intertwined fields of obstetrics and neonatoiogy. In the event that their client’s infant is admitted to a NICU, the information in this book will help CNMs to function more efficiently and effectively as advocates for the mother, father, and baby. In summary, Mixed Blessings is an excellent overview of newborn intensive care. Time
Out For Motherhood. By Lucy Scott, PhD, and Meredith Joan Angwin. Los Angeles: Jeremy P. Tarcher Inc., 1986. 252 pages. $15.95. hardcover. Reviewed by: Heather Dawn Reynolds, CMN,MSN, Instructor, Maternal-Newborn Nursing/Nurse-Midwifery Program, Yale University School of Nursing, New Haven, CT. Time Out For Motherhood is a “guide for today’s working woman to the financial, emotional, and career aspects of having a baby.” More specifically, its objective is to offer advice to those women who elect to delay childbearing until their thirties and for whom the balancing of career (other than motherhood) and motherhood itself may be an issue. Both authors write from personal experiences, having combined careers and mothering, thus
?? Vol.
32, No. 5, September/October
1987