Perinatal Patient Education: A PracticalGuide With Education Handouts for Patients.By Margaret Comerford Freda. Lippincott Williams & Wilkins, 2002.229 pages. $49.95, softcover.

Reviewed by: Sarah R. Cox, CNM, MPH, MSN, St. Luke’s Women’sCenter, San Francisco, CA.

Perinatal Patient Education is meant to be just what thesubtitle states—a practical guide to patient education withhandouts for patients. In this, it succeeds beautifully.

The first part of the book provides the reader with a basicoverview of patient education. This section includes sometheory of patient education, principles of working withadult learners, a primer on behavior change theory, read-ability issues in written materials, cultural competency, anddocumentation. This section of the book is mercifully short,but for the reader who has little or no background in patienteducation, most of the critical pearls of patient educationare clearly covered.

Margaret Comerford Freda is a registered nurse with adoctorate in education. She is an associate professor in theDepartment of Obstetrics and Gynecology and Women’sHealth at Montefiore Medical Center in Bronx, NY. Herexperience working in the field with indigent, pregnantwomen in the Bronx drives the second part of this book.Over 80 handouts are included in this second section,including a wide range of perinatal issues covering thegamut from choosing a health care provider to the right wayto put on a condom.

Each of the handouts is a single page, printed in copyableformat with wide margins and large font. Some particularlynice features of this section are that each handout is also inSpanish (on a separate page), the reading levels are printedat the bottom of the pages, and there is space provided topersonalize the copied handout for one’s patient.

The Spanish translations are well done. This reviewer readthe translations herself and also asked some fellow healtheducators from Mexico and Central and South America toreview the material. The consensus was that the Spanish isvery readable and useful for women from a variety ofSpanish-speaking backgrounds.

A third component of the book is an accompanyingCD-ROM. This CD allows the user to readily print andcustomize the book handouts so the provider can printeducation materials on demand rather than keeping stacksof papers lying about the clinic. In a crowded, but comput-er-equipped clinic, this would definitely be a benefit. Theauthor also makes a point of saying that providers mayapply their own logos to the materials to personalize for usein their clinics, thus freeing the user from copyrightconcerns.

There are a few problems with the book. The author makes

a good point about the need for low level (sixth grade orlower) written materials. Although most of the handouts areat this level, some very important handouts—like the oneon circumcision—are well above the sixth-grade level.Also, some of the information on the handouts is incor-rect—for example, the statement that “herpes simplexvirus . . . is transmitted during sex through direct contactwith a person who has active sores.” (Reviewer’s note: Thevirus can also be transmitted during asymptomatic viralshedding.) There are also a few topics not covered that onemight wish for, such as a handout on group B streptococcustesting.

In a future edition, this reviewer would suggest moreaggressive editing to pick up and correct the typos scatteredthroughout the book and perhaps a spiral binding. Spiralbinding would make the handout pages much easier to copyand would preserve the integrity of the book for theday-to-day user.

Even so, this is an excellent resource. As with all patienteducation materials, users must read the materials carefullyto be sure that they agree with the content and that theadvice included meshes with their protocols of practice. Tothe best of this reviewer’s knowledge, there is no otherresource currently available that provides this combinationof background information and copyable handouts in bothEnglish and Spanish. The book is aimed at nurses in clinicalpractice, but may be used by advanced practice nurses andphysicians as well. It will be a valuable resource incommunity maternity clinics with many bilingual patients.

Giving Birth: A Journey Intothe World of Mothers and Midwives.By Catherine Taylor. New York: Berkley Publishing Group, 2002. 300pages. $14.95, paperback.

Reviewed by: Robyn Churchill, BA, BSN, MSN, CNM, WomenCare,Arlington, MA.

Catherine Taylor, a lay writer with impressive educationalcredentials (she holds degrees from Cornell, Oxford, andDuke), has written a lively account of midwifery practice inthe United States, directed at educated women who mightbe open to the possibility of midwifery care. The book is anengaging account of Taylor’s odyssey shadowing midwivesin the Southwest in a quest to understand the personal,medical, social, and economic forces pushing and con-straining current American midwifery practice. The pro-gression of Taylor’s second pregnancy, from conceptionthrough birth, provides a loose structure for the journey sheundertakes while following midwives in different practicesettings, becoming certified as a professional doula in theprocess, and ultimately giving birth, at home, to her ownchild.

Taylor’s journey begins with a busy hospital practice ofmany midwives, who struggle with the myriad forces that

Journal of Midwifery & Women’s Health • www.jmwh.org 295

affect their positions and conflict with their innate trust inbirth as a normal process. Taylor does a laudable jobdescribing their struggles, as they chafe against the hostilityof nurses, cope with managed care’s demand for increasedproductivity, and navigate around the interventionist man-dates of physician backup. This section is rife with themidwives’ frustrations with the unending compromisesforced on them by the institution whose values are so oftenat odds with their belief in birth as a natural process.

The rest of the book focuses on out-of-hospital birth, bothin a birth center and at home. Taylor’s interviews with thenonhospital midwives reveal that, although still facingantagonistic economic and political forces, these midwiveshave more autonomy and job satisfaction than the hospital-based midwives. She describes the birth center in idyllicterms, but it is clear that the forces that control the practiceof the hospital midwives also have their effects on the birthcenter. Its success seems to rely exclusively on the unfailingenergy of Elizabeth Gilmore, the director, leading one tobelieve that without her, this birth center might cease to exist.

The final section is filled with tales of homebirths. Taylorquotes one woman’s description of homebirth as birth“without the math,” displaying her personal bias toward thespirituality of homebirth. But she balances this by discuss-ing the exhausting role of these midwives who daily facethe “challenge of bucking the system by [their] veryexistence.” She even takes on the conflicts between nurse-midwives and direct entry midwives, describing it in termsof the “virgin-whore dichotomy.” She competently de-scribes a hospital transport and uses her own fears as guidesof what women may well be feeling as they make thechoice to birth at home. The author places homebirth in aninternational perspective, and points to the excellent birthoutcomes when women have been appropriately screenedand educated.

Throughout the course of the book, Taylor addresses manypervasive cultural values, including our expectation ofperfect babies, which she suggests may lead to a societalintolerance of children with disabilities. She addressesissues of informed consent, managed care, and obstetrics’impatience with the unpredictability of labor. She presentsthe paternalism of a system that has taken birth away froma woman’s realm and fails to revere women or providesocial or economic safety for their children.

While never failing to provide detailed descriptions of themidwives’ hairstyles and dressing habits, she captures theessence of the midwives she meets and accurately presentsthe forces at play in the world of midwifery. She citesprominent authors, including Judith Rooks, Henci Goer,Barbara Katz Rothman, and Sheila Kitzinger, although she

frequently cites them from secondary sources. Overall, herbibliography is impressive, including Birth, JOGNN,JAMA, and Lancet. She has clearly investigated midwifery,common interventions on normal birth, and internationalmaternal/child health perspectives.

Inevitable shortcomings in writing about clinical manage-ment are to be expected in a book by a nonclinician, butTaylor’s are almost exclusively minor. These oversights arerare, and this reviewer was impressed with the overallaccuracy with which the clinical situations were described.

Her rousing finish may be just a touch overdone, but thepoint is clear. Birth has been removed from the family andhome, the fear of a bad outcome has been instrumental inleading American birth to the hospital, and women havebecome passive participants in birth as we place our trust inthe institution of medicine.

Taylor’s book fills a void in the popular literature. GivingBirth presents a view of birth in which fear is notablyabsent, and the magic is mixed in with the pain in a realisticportrayal of what most women experience. As a resourcefor women considering homebirth or birth centers, there aremany convincing arguments in favor of the safety andpersonal satisfaction of birthing in out-of-hospital settings.For women who choose a hospital birth, the presentation ofdoulas as a welcome, and even necessary, addition to everylabor room is equally well presented. And for readerscurious about what it is like to be a midwife, Taylor hascreated a window into the personal lives of many midwiveswith whom she has shared the joys, frustrations, andsleepless nights inherent in the world of midwifery.

Online Media Reviews for This Issue Available at:www.jmwh.org

Cultural Competence in Health Care:A Practical Guide.

By Anne Rundle, Maria Carvalho, and Mary Robinson

(Editors). San Francisco: Jossey-Bass, 1999. 234

pages. $40.00, paperback. Reviewed by: Susan

Murphy Cohen, BSN, SNM.

Your Pregnancy for the Father-to-Be. EverythingYou Need to Know About Pregnancy, Childbirth,

and Ready for Your New Baby.By Glade B. Curtis and Judith Schuler. Cambridge:

Perseus Publishing, 2003. 264 pages. $13.95,

softcover. Reviewed by: Ira Kantrowitz-Gordon,

CNM, MN.

296 Volume 48, No. 4, July/August 2003