AIDS: The Women, edited by Ines Rieder and Patricia Ruppelt. Pittsburgh: Cleis Press, 1988. 251 pages. $9.95, paperback.

Reviewed by: Ann Kurth, RN, MPH, Graduate Student, Maternal-Newborn Department, Yale School of Nursing and Research Director, Dixwell Preventive Health Program/Dixwell Neighborhood Corporation, New Haven, Connecticut.

The editors of this 1988 anthology, Ines Rieder and Patricia Ruppelt, are journalists with personal and professional experience in AIDS work. Ms. Rieder cared for a close friend until his death from AIDS in 1986, and Ms. Ruppelt is a member of the San Francisco Women's AIDS Network. The compiling of the stories in AIDS: The Women appears to have been a Cathartic experience. As Ms. Rieder says of her friend's death, “It took getting involved in editing this anthology to put my own experiences into a larger context,” (Introduction, page 10). The goal of the book seems to be to give the reader a vital sense of that “larger context”

The book is divided into eight sections, each constituting a different theme and preceded by a short editorial summary. Section I, “Family, Lovers and Friends,” tells the story of living on the periphery of AIDS from the perspectives of a sister, a mother, a friend, and life partners (heterosexual and lesbian). The last story in this section, “Life and Death with Joan,” provides a particularly searing communication of the pain of losing a loved one, in this case from suicide while in the terminal stages of AIDS.

Section II, “Women with AIDS/ARC and HIV-Positive Women,” chronicles the lives of women in Baltimore, Copenhagen, San Francisco, Berlin, London, and Vienna. This global snapshot is interesting in several ways. It highlights how similar so many of the issues facing women with HIV-spectrum disease are, yet how individually each woman's story stands out. One of the drawbacks, however, in this and other sections is that some of the stories are ghost-written by the editors. Though the profiles are compelling, this method somewhat diminishes the emotional directness of the content.

“The Professional Caregivers,” (Section III) comprises the viewpoints of a medical doctor, a social worker, a test site counselor, a health educator, a substance-abuse specialist, a nurse, and a counselor. Nurse-midwives may find these stories particularly relevant, although there is a noticeable gap of information directly relevant to the clinical care of HIV-positive women. Denise Ribble's “A Day in the Life” contribution is one of the shortest and most powerfully unforgettable in the anthology.

One of the few explicitly political analyses in the book is contained in Section IV, “Lesbians Facing AIDS.” Entitled “A Selfish Kind of Giving,” by Deborah Stone, the article discusses the positive and negative effects that have been wrought on the lesbian community by its members' extensive involvement in volunteer activities against the AIDS epidemic.

There is a long history in this country of sex workers (e.g., prostitutes) being scapegoated for the spread of venereal diseases. The contributors to Section V, “Prostitution in the Age of AIDS,” provide a welcome antidote to this view by giving the reader access to the anthropological and epidemiological realities of sex work.

The articles in the sixth section, “Becoming Visible: Women AIDS Educators,” are not as consistently thematic as the others.

Section VII, “AIDS Prevention Policies,” looks at programs in Zimbabwe, Nicaragua, Haiti, Holland, Brazil and, somewhat incongruously, reproductive rights in the United States. Here and elsewhere in the book, the editors' laudable attempt to try to present a comprehensive picture sometimes reads as a sketchy attempt to sprinkle in a little something from everywhere. Despite the effort at completeness, there is a regrettable dearth of focus regarding important issues, such as the social and psychological impediments to care facing HIV-seropositive women. Among the most haunting sentences were these, written by a medical social worker and psychotherapist: “No matter what the cause [of their HIV infection], these women face isolation, and they are afraid to tell others. There is not enough social support for them…. I have found that many of my female clients have the lowest attendance rate for medical or psychological appointments at our clinic” (Forbes, pp. 127–128).

Despite these drawbacks the book provides a sense of the scope of the epidemic. For nurse-midwives who have just begun to grapple with the topic, AIDS: The Women provides an accessible guide to some of the human stories behind the numbers. A final appendix contains some useful information in the form of a glossary of AIDS terms, an AIDS resource directory, and a selected bibliography.

Thinking AIDS. By Mary Catherine Bateson and Richard Goldshy. Reading, MA: Addison-Wesley Publishing Company, Inc., 1988, 153 pages. $12.95, hardcover.

Reviewed by: Barbara Decker, CNM, EdD, Assistant Professor, Maternal Newborn Nursing/Nurse-Midwifery Program, Yale University School of Nursing, New Haven, Connecticut.

The significance of AIDS, referring here to all stages of HIV infection, is that it is more than a disease. According to the authors, AIDS reflects and owes its successful reproduction to the uniquely human intertwining of biology and culture, Every biological organism lives in an environmental niche in which it can grow, adapt, and reproduce. The AIDS virus' niche is within the very defense system that is supposed to protect us against disease. Maintenance of its niche, meaning transmission to new hosts, depends on some uniquely modern human behaviors.

This book takes a broad and scholarly view of the AIDS epidemic, different from the clinical perspectives we have become accustomed to. Now that we know how HIV is transmitted, continued new infections illuminate the flaws in our society: the failure to give adequate information to the segments of our society who need it, the failure to deal with social problems that lead people to engage in risky behaviors. Adaptation of personal, social, and political behavior to prevent transmission could represent a new step in human evolution.

The authors, one a biologist and the other the anthropologist daughter of systems theorist Gregory Bateson and anthropologist Margaret Mead, explain AIDS to the layman according to the theories of their disciplines. There is a very nice chapter on the ecology of AIDS, comparing it to sexually transmitted and other diseases. The chapter on the human immune system is a fine piece of science writing for nonmedical people and a good review for clinicians who may find scientific immunology tough going. This reviewer found the tendency to explain cell activity in terms of human intention, i.e., cells “embracing,” “recognizing,” “searching,” etc., somewhat distracting but other readers may find the metaphors useful.

Discussion of the AIDS niche is a little dated now that HIV infection is increasingly found in women and others not directly involved with the gay male and IV drug-using populations. The authors explain the wildfire spread of AIDS through the gay male community as a result of more permissive attitudes toward gays in the 1970s and an explosion in gay male sexual behavior, particularly indiscriminate sexual contacts in bathhouses. They point to the parallel in casual needle-sharing in “shooting galleries.” In a series of highly political discussions the authors call for society-wide changes in sexual mores mat recognize the need for diverse means of sexual expression while limiting transmission of HIV and an end to moralizing about drug use in favor of working to reduce the AIDS-associated risk.

There is a remarkable series of recommendations for social reform toward the end of the book. All of the recommendations seem perfectly reasonable from a liberal point of view. Achievement, however, would be almost nirvana for public health. A sample from the small section on medical recommendations illustrates the point: give equal care to all who are ill; curtail interventions that are expensive and won't make a significant difference to the patient; consider the question of voluntary euthanasia; support the morale of health care workers; and take better care of sexually transmitted diseases.

This is a thoughtful and provocative book for those interested in AIDS as a unique event in twentieth century life. The ways in which we, as a society, deal with the questions about ourselves raised by the AIDS epidemic, whether or not we follow the recommendations of these authors, will constitute a final testament of this century. We must try to see that it is a testament our children can live with.

Leopold's Maneuvers. By Freddi Van Gemert, RN, MSN, 1983. Color, sound, 15 minutes. Available in ¾-inch U-Matic and ½-inch VHS from Health Sciences Consortium, 201 Silver Cedar Court, Chapel Hill, NC 27514. (919) 942-8731. Preview price is $30.00 and 7-day rental is $80.00. Purchase price is $385.00, plus $3.00 postage and handling, for either format. 14-page study guide is included.

Reviewed by: Ronald K. McCraw, PhD, DO. Fort Worth, Texas.

This video first briefly explains the terms “presentation,” “lie,” “position,” “attitude,” and “engagement,” as they pertain to the fetus near term. Then Ms. Van Gemert, who also wrote the script, demonstrates how these characteristics may be assessed using the four Leopold's maneuvers. The patient—model is noted to be at 37 weeks gestation. The information obtained from Leopold's maneuvers is then used to easily locate the fetal heart beat, using a doppler stethoscope. The importance of the patient's comfort and safety is stressed, with such suggestions as helping her on and off the table, having warm hands and short fingernails, and elevating her head slightly.

The color, sound, photography, and editing are all quite good. The presentation is clear and easy to follow with one exception. The statement is made both in the video and in the study guide that in addition to determining position, presentation, engagement, and location of the fetal heart, these maneuvers “can point to the possible emergence of stressors that may give rise to high-risk situations for either mother or baby during pregnancy, labor, or delivery.” This statement is not explained further. The study guide includes a list of objectives, content outline, procedural checklist for performing the maneuvers, and a post-test. The guide identifies the intended audience only as “obstetric nurses and nursing students.” However, the video would seem valuable for medical or nurse-midwifery students and physician assistants as well.

Women's Health: Crisis and Illness in Childbearing, Volume III. Edited by Lois J. Sonstegard, RN, PhD, FAAN, Karen Mundell Kowalski, RN, PhD, FAAN, and Betty Jennings, RN, CNM, MSW. Orlando, Florida: Grune & Stratton, Inc., 1987. 301 pages. $49.50, hardcover.

Reviewed by: Heather Reynolds, CNM, MSN, Instructor, Maternal-Newborn Nursing/Nurse-Midwifery Program, Yale University School of Nursing, New Haven, Connecticut.

This is the third volume in a series of books on women's health. The series' philosophy is based on a holistic approach to health and illness and promotes nurses as primary health-care providers. Volume I, Women's Health: Ambulatory Care, deals with critical aspects of outpatient women's health care. Volume II, Women's Health: Childbearing focuses on issues that pertain to care of the healthy woman during child-bearing.

The third volume's objective is to critically analyze elements that facilitate good perinatal outcomes in at-risk women. A corollary to this objective is to provide nurses with information that enables them to balance the technology with a “humanistic and caring” approach. The 22 authors, which include the three editors, encompass a wealth of experience and expertise in caring for the childbearing family.

This volume is divided into seven parts. Each part addresses pertinent components of high-risk obstetric care. The first part, entitled “Framework for Nursing Practice,” offers a guide for the development of nursing assessment and interventions that address the multifaceted aspects of caring for at-risk obstetric clients. A systematic approach to decision making is offered to assist the nurse in this process. Chapter 1, Part 1, “Family Centered Models for Providing Illness Care” by Kowalski and Sonstegard, gives a brief and interesting historical perspective on the development of models for family-centered care. It does a good job of integrating the impact the feminist movement clearly had on the development of these models.

The remaining two chapters, “Ethical Dilemmas in Women's Health” by Joyce and Henry Thompson and “Perinatal Loss and Bereavement” by Karen Kowalski, offer a good theoretical framework and practical clinical information. “Ethical Dilemmas in Women's Health” utilizes a case presentation format. It highlights the ethical dilemmas and the decision making process that may occur in a high-risk pregnancy.

Part 2, “Age Considerations in Childbearing,” contains two chapters that examine inherent risks in “Adolescent Pregnancy” and “Mature Childbearing.” In the adolescent pregnancy chapter, Ramona Mercer proposes aspects of the adolescent's life style that should be assessed and from which a basis for nursing interventions may be developed. Sample styles of questioning and specific questions that might assist the clinician in establishing rapport with the adolescent are proffered.

Part 3, “Fetal Therapy,” moves from genetic risk issues through prenatal diagnostic methods to intrapartal risks and interventions. Some of the information in the three chapters here is informative but redundant. For example, AFP and amniocentesis are discussed in Chapters 6 and 7. The overall title of this section does not quite capture its contents. “Fetal therapy” conjures images of fetal interventions rather than the broader issue of fetal assessment. Occasionally, helpful information is given regarding specific nursing roles in anticipating problems and appropriate interventions, although this is not done consistently or comprehensively.

Part 4, “Special Considerations in Pregnancy Maintenance,” has two chapters entitled “Obstetric Hemorrhage” and “Preterm [Text missing]bor.” They are well written and contain important information. Again, the title of this section does not adequately describe the chapters' contents. For example, postpartum hemorrhage is not an issue with pregnancy maintenance. In “Obstetric Hemorrhage” (Chapter 9), Betty Jennings, a nurse-midwifery educator, clearly delineates early versus late bleeding in pregnancy and offers both medical and nursing management plans that will be quite useful to the practitioner.

Chapter 10, “Preterm Labor,” is quite comprehensive. It contains some useful tables culled from other sources on preterm risk care, sources of stress for women with preterm labor, and includes a sample protocol on ritodrine and terbutaline administration. Nursing interventions that incorporate the physical and psychological needs of the woman and family are presented.

Part 5, “Problems with Powers, Passages and Passengers,” has two chapters that address dysfunctional labor issues and the use of pitocin as well as operative obstetrics. The chapter on operative obstetrics, written by Karen Kowalski, gives a brief and interesting historical perspective on cesarean section and forceps use. Current issues relevant to cesarean section and nursing interventions are discussed.

Part 6, “Special Systemic Considerations of Pregnancy,” includes six chapters on several systemic chronic and/or acute diseases and how they impact on pregnancy. Chapter 14, “Hypertension and Renal Considerations in Pregnancy,” is excellent. The illustrative tables and figures on some management issues are useful. Chapter 17 is extremely well-organized and informative. It provides an interesting historical background on the use of drugs in pregnancy and a wealth of research data and references on the effect of certain drugs on pregnancy.

The final section, Part 7, entitled “Family and the Neonate,” has two chapters that address the needs of the high-risk neonate and how the stress of those needs impacts on the family. Chapter 18, “Stabilization and Other Immediate Post Delivery Needs of the Newborn,” has some basic information in table format on the various adjustments in organ systems that occur in the neonate for extrauterine existence. In addition, there are several well-designed tables on newborn problems that include not only information on early signs but also treatment/intervention modalities. The author offers sound advice to clinicians on how to ensure that one's institution, regardless of its level of care, will be prepared to facilitate the stabilization of a high-risk infant.

The last chapter, “Family Stress and the Neonatal Period,” ends the book as it began by focusing on the family aspects of care. Some very practical guidelines are presented on helping the practitioner recognize healthy versus unhealthy behaviors in families. Though some of the information on grief reaction is repetitious, it actually augments the content found in Chapter 3 on “Perinatal Loss and Bereavement” The orientation of the information presented here is based on crisis and stress theory. Excellent interventions are suggested that may be used to facilitate healthy mourning behaviors in parents. On the other hand, a figure devised to graphically represent variables that may effect parenting behaviors is so congested that it obfuscates rather than elucidates how these variables interrelate.

In summary, this book is a laudable attempt at applying a holistic approach to working with women at risk in childbearing. Several chapters do propound a feminist perspective in their presentations, but this is not consistently demonstrated throughout the book. The authors' humanistic and caring approach to management, however, is evident throughout the pages. Although a few chapters have a strong medical orientation with only brief reference to nursing perspectives, the book, in general, does offer some practical and excellent suggestions for nurses to use in their clinical practice. Certainly, for nurse-midwives and nurse-midwifery students, this book might be a useful reference when involved in the collaborative care of high- or at-risk clients.

Electronic Fetal Monitoring. By Cydney I. Afriat, CNM. Rockville, Maryland: Aspen Publishers, Inc., 1989. 191 pages. $55.00, hardcover.

Reviewed by: Lee S. Clay, CNM, MS, private practice, Morristown Memorial Hospital, Morristown, New Jersey.

Electronic Fetal Monitoring is written by a certified nurse-midwife primarily as a resource for nurses. However. the information it contains is useful for a variety of health care providers. The foreword, written by Barry Schifrich, MD, Director of Maternal Fetal Medicine, AMI-Tarzana Regional Medical Center in California, acknowledges that “fetal monitoring is the most widely applied test of fetal surveillance and probably the most widely abused.” Dr. Schifrich further points out the lack of consistency in educating practitioners about interpreting fetal monitor strips. It is the intent of this book to explain the physiology of the fetus and how it relates to observed changes in fetal heart rate patterns. With a thorough “understanding of the underlying mechanisms of change, the practitioner [will be able to] react and respond on the basis of cause and effect relationships” (Preface).

In the first section of the book, the author gives an excellent explanation of the physiology of the fetus and how its delicate balance can be altered by a number of factors, both extrinsic and intrinsic. Next, she describes how these changes are reflected in fetal heart rate patterns. Her writing is thorough, yet concise and therefore easy to comprehend.

Throughout the book, the author uses tables effectively to summarize the text. The tables are good references as they outline potential causes of fetal heart rate changes, the physiologic basis for these changes, as well as possible interventions with rationale to improve the fetus' status. There are also numerous examples of monitor strips to help the reader identify varying heart rate patterns and their implications. The wide range of patterns used is unofficial to the learner trying to synthesize the material. Unfortunately, a few of the monitor strips are somewhat difficult to read due to reproduction techniques. This difficulty, however, is not enough to hinder the reader's learning.

A significant portion of the book allows for self-assessment by the reader of her or his knowledge, understanding, and interpretive skills of fetal well-being. This too is a strength of the book, because it offers immediate feedback to the reader who is trying to improve and verify her or his knowledge base. It is beneficial to be able to review several monitor strips and then compare one's own interpretation with that of the expert, the author. Although the author makes reference to reassuring monitor strips that can then allow for intermittent monitoring, it is not the intent of the author to discuss the pros and cons of continuous versus intermittent monitoring. Instead, the author's intent is to provide a resource for clinicians to help them to understand and manage a variety of findings when using fetal monitoring. It is important for the reader to recognize this difference.

The author combines information throughout Electronic Fetal Monitoring for every level of learner. Early in the text, the author includes a detailed section that explains the types of monitoring equipment currently available and cites their advantages and disadvantages. However, when discussing uterine contraction monitoring, the author neglects to mention the Intran intrauterine pressure catheter with a pressure gauge self-contained in the single unit. It now replaces older systems that depend on water pressure and are often difficult to operate accurately.

The specific sections on fetal heart rate changes and pattern interpretation will offer many readers a comprehensive discussion of the scope and physiologic basis of fetal monitoring. For others, the text will be a supplemen[Text missing] clarify and enhance basic knowledge. In addition, for many readers, the self-assessment section will serve as an excellent review and assessment of one's skills in interpreting fetal monitors. This section could be further enhanced by the addition of scalp or cord pH results with illustrations of ominous patterns and tracings that show improvement after intervention.

In summary, Electronic Fetal Monitoring is not only an excellent reference book for the beginning and intermediate practitioner to use in understanding fetal heart rate patterns but also for the advanced practitioner who is interested in a review of skills and knowledge.

BirthSong. 59 minutes. Produced and written by Claudia Valeri, 1989. Available as audio cassette from C. Valeri, Prop., 382-21-10405 Jasper Ave., Edmonton, Alberta, Canada, T5J 3S2. (403) 451-5140. Purchase price: $10.50, plus $3.00 shipping.

Reviewed by: Ronald K. McCraw, PhD, DO, Fort Worth, Texas.

Ms. Valeri has been a writer and broadcaster for 20 years and has a Canadian television program devoted to parenting. Because of a pelvic infection, which she attributed to a Dalkon Shield IUD, she experienced the loss of an ovary and tube. She reports that her other tube is blocked. Consequently, she has experienced two ectopic pregnancies and one failed in-vitro fertilization attempt. Ms. Valeri thus characterizes this audio cassette as the “partial fulfillment of a dream” because its creation provided her with her “closest experience so far of what it's like to create and give life.” Judy Cochrane, a nurse, writer, and childbirth educator for 14 years, served as project consultant for this tape.

The program is divided into three sections. The section, “Night Meditation,” is 27 minutes long and is recommended for bedtime as one is falling asleep, when one's subconscious is most suggestible. “Bonding with Baby,” a 17-minute segment, provides a briefer relaxation experience for use during the day. “Create Your Labour,” is 15 minutes in length and is recommended for use in the last six weeks of pregnancy.

In all three segments a soothing female voice over a background of relaxing music takes the listener through a relaxation procedure, followed by visual imagery, and positive affirmations concerning the listener's pregnancy and upcoming childbirth. The tape encourages eating well and getting plenty of rest. It stresses that there is no right or wrong way to have a baby, that the woman will be able to handle whatever happens, and that the birth experience—whatever it is—will be right and perfect for her. The listener is not set up for possible disappointment by being told her labor will be quick or painless. A nice touch in the tape is the inclusion of positive affirmations that the woman will be able to forgive the baby's father, her own mother, and herself for any past misdeeds that may have occurred.

The purchaser of the cassette is correctly cautioned that the tape is no substitute for either her physician or her childbirth educator. This reviewer is quite impressed with this tape. It is obvious that this project was indeed a “labor of love” for Ms. Valeri. This cassette can be used with pregnant women to help them replace negative emotions (e.g., anxiety, anger, frustration, self-doubt) with positive emotions (e.g., confidence, love, relaxation, acceptance). In so doing, their chances of having an easier, more emotionally satisfying pregnancy and childbirth experience should be enhanced.

The Stork Didn't Bring Me. By Marie-Francine Hebert. Illustrations by Darcia Labrosse, Deephaven, MN: Meadowbrook Press, 1988. A Read & Play Learning Set, $12.95.

Reviewed by: Nancy Kraus, CNM, MSN, Associate Editor, Journal of Nurse-Midwifery.

This Read & Play Learning Set is designed for children aged 5 to 12. The set includes a soft-cover book, a board game, and a parents' guide.

The 24-page book is illustrated with pastel cartoons and written in a cute, irreverant style reminiscent of the 1973 classic Where Did I Come From? by Peter Mayle. Like Mayle's book, the primary topic is conception, but with less depth than Mayle's—enough information for younger children, but probably not enough for the 9- to 12-year-olds.

The board game, on heavy cardboard stock, folds to fit inside the box that also holds the book, parents' guide, dice and four game pieces. The game, whose topic is fetal development, is a simple race from conception to the finish at birth and conveys very simplistic information about fetal development, I didn't think it was particularly fun or educational, but my 6½-year-old son wanted to play it twice in a row.

The seven-page parents' guide adds ideas about what questions children might ask after reading the book and explains to adults why the authors included certain things. The authors make a conscious effort to be nonsexist in text and illustrations.

The set would be valuable in a lending library for sibling preparation of children aged 5 to 8.

Show Me Yours! Understanding Children's Sexuality. By Ronald and Juliette Goldman. New York: Viking-Penguin, 1988. 269 pages. $7.95, softcover.

Reviewed by: Ronald K. McCraw, PhD, DO, Fort Worth, Texas.

Both of the authors, psychologist Ronald Goldman and sociologist Juliette Goldman, have backgrounds in education. This book describes the results of their personal interviews with almost 1,000 children aged 5 to 15 in the United States, Canada, England, Sweden, and Australia and the results of questionnaires they administered to more than 1,000 Australian college students. Their intention is to provide readers with information about normal sexual beliefs, attitudes, and experiences of children. They note that until recently more was known about sexual pathology in children than normal sexual attitudes and experiences.

The introduction summarizes what experts have found or hypothesized about gender identity, sexuality, and sexual behavior of children. Part I covers the Goldmans' findings about what children at various ages and in different countries know (or believe) about sexual differences, conception, pregnancy, childbirth, contraception, nudity, and intercourse. The authors found considerable ignorance regarding sex, even among sexually-active teens. Part II deals with the results of the questionnaires administered to Australian college students concerning their childhood sexual experiences and beliefs. Included are the students' perceptions of their parents' attitudes toward dirty jokes, masturbation, nudity, sex play, etc. Information is also provided about the frequency and types of sex play among children and of sexual abuse by adults.

Part III discusses implications of the findings and makes recommendations as to how adults can help children develop healthier sexual attitudes by being more honest, sensitive, and accepting. The final chapter explores some difficult and unresolved issues, such as AIDS and herpes, morals and values, early maturation, and sex education for homosexuals. The authors argue that a new and more satisfactory theory of human sexuality is needed to replace Freudian theory.

This is an interesting and often amusing book that contains some good suggestions. However, it is primarily written for a lay audience and does not offer much that is new or of immediate practical importance to health-care providers.

Community Midwifery: A Practical Guide. By Mary Crank and Caroline Flint London, England: Heineman Medical Books, 1989. 262 pages. $34.95, softcover

Reviewed by: Edna B. Quinn, PhD, CNM, Visiting Fulbright Professor, Jordan University of Science and Technology, Irbid, Jordan.

Appreciation of this book seems directly related to the reader's respect for the individuality of women, belief in the importance of continuity of care, and acceptance of birth as a normal physiological process (unfortunately “medicalized” in modem society). The authors, two British midwives, have 2 refreshing ability to communicate the “wonder, delight, and energy” they find in community practice. They advocate discarding “many of the ‘hospital' attitudes that have dominated care for the past 20 years or so” and returning to community midwifery and home births. Convincing research is cited that supports the safety of home births for many women in Britain. For high-risk women the authors recommend on-going care by a small group of midwives working with an obstetrician, and eventual hospital delivery.

As the title implies, this is not a midwifery text but a practical guide, replete with fresh insights and advice. It would instill confidence in students and those doing a delivery for the first time, and is recommended for all midwives and maternity nurses. Obstetricians could profit from reading it. One of the best things about the book is the authors' engaging style. This reviewer had an ongoing dialogue with them. Their anecdotes and examples are interesting and relevant and the text is enriched by numerous free-hand drawings, not sterile photographs.

The book covers the entire maternity cycle. A chapter on pregnancy care includes tips on home remedies for common discomforts. Another chapter describes the role of the community midwife in the hospital, including several case histories to illustrate how care can be adapted to meet the needs of individual clients. An excellent chapter on home births outlines prerequisites to be met (for example, the home should be no more than half an hour away from a maternity unit; there must be a telephone or 24-hour access to a neighbor's telephone). There are lists of the midwife's equipment and supplies the mother must obtain. The chapter also details problems that can arise and indications for transfer to the hospital. Advice on managing problems is explicit. In the authors' opinion, potential problems are a serious concern, but should be put in perspective.

Comfort measures in labor, including the midwife's physical presence, her voice (sometimes her silence), her hands, and her ears (listening to women, “not just to their words but to the noises they make”), are discussed. At home or in the hospital, the midwife must be sensitive to each woman's individual needs—“whether it be for a back rub, a change of position, or an epidural.” Examples of postpartum care responsibilities include increasing the parents' confidence in their ability to care for their child, as well as assessing the mother and newborn. Practical advice on teaching parents is excellent.

Other chapters give tips on ethical and legal issues and the logistics of developing and running a practice. Topics such as caseloads, how to in[Text missing] corporate students in a practice, and group versus independent (solo) practice are dealt with in detail. Everything the midwife needs to know, from organizing prenatal classes to keeping records and maintaining supplies, is discussed.

The only major problem American readers may have with the book is that it is geared to British maternity care. The drugs mentioned have British trade names, the appendix lists British organizations the midwife may need to use, and the legal aspects of midwifery have to do with British law. Furthermore, the authors assume a level of preparation and knowledge that may not be relevant to non-British midwives. For example, the British midwife's equipment for home deliveries includes a laryngoscope with neonatal blade. endotracheal tubes, Spencer–Wells forceps, oxygen, and IV fluids—items not usually included in the American nurse-midwife's homebirth equipment. Nevertheless, American midwives can enjoy and profit from this book. Perhaps, it may inspire an American midwife to write a similar guide, applying her knowledge and experience to the American scene.

Examination of the Pregnant Woman. By Howard Sann, 1988. Color, sound, 19 minutes. Available in ¾-inch U-matic and ½-inch VHS formats only from J. B. Lippincott, Attn. Audio-Visual Department, East Washington Square, Philadelphia, Pennsylvania 19105. 1 (800)-523-2945. In Canada and Pennsylvania, call collect (215) 238-4443. Purchase price is $319.00, with 30-day free return. No rentals are available.

Reviewed by: Ronald K. McCraw, PhD, DO, Fort Worth, Texas.

Examination of the Pregnant Woman is designed to show a professional audience how to properly conduct a physical assessment of the pregnant woman at various stages of her pregnancy. This is done by showing a female examiner assessing three different gravidas, one during each trimester. The examiner and all three patients are white. The examiner's profession is not identified during the video itself, but the ending credits indicate that she is a family nurse-practitioner.

The video begins with an explanation of reasons for physical assessment during pregnancy. Then, factors that make the pregnant woman at high risk and in need of increased monitoring are listed. The signs and symptoms of pregnancy are discussed. The narrator notes that women, especially primigravidas, may have many fears and misconceptions about pregnancy and that these should be addressed.

The first examination shows a complete physical performed during the initial visit of a woman in her first trimester. The examiner is instructed to collect various data. For example, he/she is advised to determine whether the pelvic inlet is “large enough,” whether the sacrum is concave, whether the ischial spines are blunt or concave, whether the obstetrical conjugate is “adequate,” and whether the sidewalls are straight or concave. There is no demonstration or explanation, however, as to how these factors are assessed. During this initial visit the gravida is advised to avoid smoking, alcohol, and drugs and to do some reading about pregnancy.

The video also discusses normal physiological changes associated with pregnancy, such as changes in blood pressure, respiratory rate, and stroke volume. The second and third trimester examinations are shown. Assessment of fundal height, Leopold's maneuvers, and auscultation of fetal heart rate are explained and demonstrated. The indications for pelvic examination during the second and third trimester are covered. Various laboratory tests recommended at different stages of pregnancy, such as the one-hour glucose screen and alpha fetoprotein, are also mentioned. The indications and timing of Rhogam injections are discussed.

The content of this video is accurate, and the technical aspects are very good. In the discussion of recommended blood tests, HIV testing should be included. In addition, it would be useful to explain how to do some basic pelvimetry, especially since the video notes its importance. Otherwise, the content appears thorough. This would be an excellent teaching video for medical, nursing, and nurse-midwifery students. It would also be a useful review for family practice residents just before starting their obstetrics rotation.