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Obstetrics: Normal and Problem Preg- very technical, understanding is en- ration for childbirth.

Advanced discus-
nancies. Edited by: Steven G. Gabbe, hanced through the use of excellent illus- sion of the client’s desires for the “peri-
Jennifer R. Niebyl, and Joe L. Simpson. trations and photographs. Despite this partum experience” is encouraged. The
New York: Churchill Livingstone, 1986. being an edited text with over forty con- chapter ends with a discussion of clinical
1148 pages. $75.00, hardcover. tributing authors, all of the writing styles assessment of gestational age. Emphasis
are clear. Specific clinical applications is placed on gathering sound clinical data
Reviewed by: Lisa L. Paine, CNM, MS, help the reader stay focused and relate for dating a pregnancy, reserving the use
MPH, Instructor, Department of Gyne- content to clinical practice. For example, of routine ultrasound technology for
cology and Obstetrics, Johns Hopkins the chapter on the placenta includes a cases when clinical information is either
University, School of Medicine, Balti- very relevant discussion of clinical exami- missing or conflicting.
more, Maryland, and Deborah L. nation of the placenta; the chapter on Though this chapter is the only one in
Greener, CNM, MS, Assistant Professor, antepartum fetal evaluation contains which the provision of care by nurse-
Nurse-Midwifey Program, University of numerous illustrations and the discussion midwives is mentioned, it is a marked im-
Utah, Salt Lake City, Utah. of whether routine ultrasound is justifi- provement over other popular obstetric
able and safe; and, the chapter on drugs texts whose only reference to midwifey
This comprehensive textbook on normal in pregnancy and lactation provides a is that of the origin of the word or of the
and problem pregnancies has already re- brief, up-to-date overview of prescrip- “dangers” and “problems” of midwifery
placed others as a core reference for stu- tion, recreational, and over-the-counter care. The following passage is an ex-
dents and practitioners of obstetrics at drugs and their effects during pregnancy ample of the obstetrical team concept
the Johns Hopkins Hospital. The editors and lactation. This book does not include which is stressed throughout the prenatal
herald this book, as do its reviewers, as content related to newborn manage- care chapter:
one for a new generation of practitioners ment, a topic which the perinatologist ed-
Prenatal care is given in a variety of
of obstetrics; those who must base the itors may have felt prudent to leave to
sites, ranging from the private office to
application of rapidly accumulating tech- their neonatology colleagues.
the public health and county hospital
nology on a sound foundation of knowl- One of the reviewers (DG) is a nurse-
clinics, or even the patient’s home. A
edge about anatomy, embyology, physi- midwifey educator and has found this
variety of practitioners are involved,
ology, pathology, genetics, and terato- text, unlike many others, to be particu-
including the public health nurse,
logy. Such a group of practitioners larly useful in nurse-midwifey education.
nurse practitioner, nurse-midwife,
should definitely include nurse-midwives. In the program at the University of Utah,
physician-in-training, family practi-
The three editors of this text are all this book is used as the major obstetric
tioner, obstetrician, and perinatologist.
prominent perinatologists who met as reference, supplemented with nurse-mid-
Each of these practitioners has his or
residents at Cornell School of Medicine. wifery articles and texts. Almost all of the
her own interests, experience and ex-
Gabbe specializes in diabetes in preg- chapters are required reading at some
pertise. . . . In fact, most pregnant
nancy, Niebyl in preterm labor and drugs point in the curriculum. While the sec-
women are healthy, with normal preg-
in pregnancy, and Simpson in genetics. tions on physiology are considered quite
nancies, and they can be followed by
The editors’ commitment to the pre- technical by most nurse-midwifey stu-
an obstetric team including nurses,
sentation of basic obstetric principles dents, they are very useful if supple-
nurse practitioners, and midwives with
along with vey up-to-date technological mented with appropriate lecture and dis-
an obstetrician available for consulta-
information is evident throughout the cussion. Students also appreciate using a
tion. These women can be followed by
text. The early sections provide an es- single major obstetrical reference text,
midwives with much time to spend on
sential foundation of reproductive which they can continue to rely upon
patient education and parenting prep-
anatomy, placental endocrinology, and when they enter independent clinical
aration, while the physicians can ap-
maternal-fetal physiology. The next sec- practice.
propriately concentrate on compli-
tions discuss the normal processes and The chapter on prenatal care is an ex-
cated problems requiring their medical
management of the antepartum, intra- cellent example of the richness of scope
skills. This also provides for improved
partum, and postpartum periods, in- of the text, and its applicability to nurse-
quality of care, which is recognized as
cluding the most commonly encountered midwifery. The chapter begins with an
extremely important for patient satis-
problems in clinical practice. The final overview of the public health issues of
faction. (page 160)
chapters are devoted to high-risk ob- prenatal care, including perk-rata1 and
stetrics, pregnancy termination, and legal maternal morbidity and mortality. It then Emphasis on the inclusion of nurse-
and ethical issues in perinatology. Each moves on to a comprehensive discussion midwives as members of the obstetric
chapter is followed by a comprehensive of the multi-faceted concept of risk as- care team clearly indicates that the role of
and current reference list. In fact, the sessment, including the increasingly im- nonphysicians in the provision of obstet-
chapter on medical complications of portant social and demographic risk rical care is recognized by the authors.
pregnancy includes over 600 references. factors as well as the more established In summary, the reviewers of this book
Indexing is extensive and assists the medical and obstetric ones. The authors give it their highest recommendation-
reader to locate topics of interest. consider the physiologic changes of for clinicians as well as students and fac-
Although some chapters in this text, pregnancy to be important components ulty members. While the intended audi-
particularly those on placental endocri- of prenatal education, and also stress ence is the obstetrician and perinatolo-
nology, placental and fetal physiology, preconceptional counseling, appropriate gist, this book should be on the shelves
and the physiology of parturition, are utilization of support groups, and prepa- of every nurse-midwifery educational

290 Journal of Nurse-Midwifery ??Vol. 33, No. 6, November/December 1988


program for use as a primary reference. analyses. Such nonparametric tests as Hadley, MA: Bergin and Garvey Pub-
The combination of comprehensiveness, the chi-square, Fischer exact, Mann- lishers, Inc., 1988. 304 pages. $49.95,
current information, clarity, and clinical Whitney U, and other tests of significance hardcover; $18.95, softcover.
application, with an emphasis on client are reviewed, as well as the nonpara-
Reviewed by: Karen B. Burgin, CNM,MA,
education, family-centered care, and an metric tests of association, including the
Staff Nurse-Midwife, State University of
obstetric team approach to management, contingency coefficient, phi, Cohen’s
New York, Health Science Center at
makes this text unique. kappa, Spearman’s rho, and Kendall’s
Brooklyn, Brooklyn, New York.
tau. In addition, nonparametric ap-
proaches to considering the relations be- In this readable volume the anthropolo-
PDQ Statistics. By Geoffrey R. Norman tween multiple independent variables gist Karen Michaelson has brought to-
and David L. Streiner. Philadelphia: B.C. and a single dependent variable, such as gether many contemporay studies, most
Decker, Inc., 1986. 172 pages. $9.95, the Mantel-Haenzel chi square, logistic of them the fieldwork of other women
softcover. regression, and log-linear analysis are anthropologists, with contributions also
clearly presented. It may come as a sur- from nursing, sociology, sociomedical
Reviewed by: Deborah L. Greener, CNM,
prise that the authors would also attempt sciences, psychology, biostatistics, and
MS, Assistant Professor, Nurse-Midwifery
to cover such multivariate tests as nurse-midwifery. It will certainly be grati-
Program, University of Utah, Salt Lake
MANOVA, Hotelling’s T2, discriminant fying to clinical practitioners of women’s
City, Utah, and Lisa L. Paine, CNM,MS,
function analysis, canonical correlation, health care to encounter the work of
MPH, Instructor, Department of GynlOb,
factor analysis, and cluster analysis. such a thoughtful group of scholars
Johns Hopkins University School of
While condensed and simplified, these whose conclusions, without exception,
Medicine, Baltimore, Maryland.
sections are liberally sprinkled with clini- support the women-centered goals for
The authors of this small book are both cally oriented examples that clarify which concerned clinicians have been
faculty in Epidemiology and Biostatistics proper uses of the tests. Numerous striving.
at McMaster University School of Medi- ’‘C.R.A. P. Detectors” are also included Anthropologists have long claimed
cine in Ontario, Canada. The intent of after each multivariate test, perhaps re- birth as one of their legitimate areas of
the authors, as described in the introduc- flecting the stated bias of the authors that concern, recognizing that while the basic
tion, is to help the reader understand sta- with the advent of simpler “canned” biological phenomena are universal, the
tistical results in research papers and pre- computer statistics packages, any fool act of birth and the events surrounding it
sentations, and begin to learn to identify can act like a statistician. In other words, are largely culturally produced. Thus, a
the times when statistics are used incor- they believe that while not all researchers unifying theme of all of the studies is the
rectly. Indeed, the authors seem to be who use multivariate analyses are char- way in which birth-related issues in con-
striving to turn the reader into a “healthy latans, highly complex statistical analyses temporary America fit into the context of
skeptic” when it comes to research con- are frequently performed on totally inap- American culture; how that culture has
sumption and utilization-even pro- propriate data. affected conscious and subconscious atti-
viding so-called “C.R.A.P. Detectors” The book closes with a helpful anno- tudes toward childbirth and family rela-
(Circular Reasoning or Anti-Intellectual tated bibliography and an “Unabashed tionships; and, how these attitudes have
Pomposity Detectors) throughout the Glossary.” This glossary epitomizes the influenced behavior related to the birth
book. Such aids are designed to help the humorous approach of the authors to process. This theme is reflected in the
skeptical consumer identify the common such a usually dy topic; the glossary in- book’s pervasive concern with the way
pitfalls in statistics, in order to prevent cludes “various arcane statistical terms, those members of American society who
errors in interpretation or research utilii- with which you can amaze your friends are “in charge” of birth events have
tion. and colleagues” (p. 167). A sampling of adopted increasingly technological be-
The beauty of this text is the way it entries which nurse-midwives might havior in their interventions and how the
very briefly, succinctly, and clearly pro- smile at include ANOVA, or one egg; recipients of their ministrations, particu-
vides an overview of all of the most com- MANOVA, or the missionary position; larly low-income women, have come to
monly used univariate and multivariate and Orthogonal, a birth control pill for accept this technological approach as a
statistical procedures; accomplishing this males. matter of course. In articles ranging from
Herculean task with absolutely minimal In summary, Norman and Streiner prenatal diagnosis to neonatal intensive
use of the usual non-English statistical have provided a humorous, clearly care the cultural, moral, and ethical
jargon. It even does so with wry humor written, and very useful guidebook for issues involved in the use or non-use of
(we both laughed out loud while reading the adventurer who wants to explore the technology are explored. These pieces
this book); no mean feat when you con- jungles of research and statistics. Any provide some of the books most fasci-
sider the topic is STATISTICS! The nurse-midwife who reads, uses, or con- nating reading. The analysis by the
range of this pocket-sized book is incred- ducts research will benefit from reading anthropologist and folklorist Robbie E.
ible. It begins with a simplified and clear this book. And who knows, she or he Davis-Floyd on “Birth as an American
discussion of variables and how data can might even (gasp) enjoy it! Rite of Passage” is a brilliant illustration
be described, and then quickly moves of the way in which hospital birth in
into coverage of the common inferential America has taken on ritualistic aspects
methods, such as the t-test, analysis of Childbirth in America: Anthropolog- more elaborate than any primitive ones,
variance and covariance, regression ical Perspectives. By Karen L. Mi- designed to assure women’s acceptance
analysis, and techniques for time series chaelson and Contributors. South of the dominant belief of contemporary

Journal of Nurse-Midwifery ?? Vol. 33, No. 6, November/December 1988 291

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