rm Lhorhca
M. Lung.
C N M. M?
.H
I
ously, sional country viders needs
he patterns for providing health care differ from country to country. Simultanethe composition team members
of profesdiffers from
to country. The health proin everv settins must fit the of the setting 1 more speclfimeet the cultural they must
tally, health needs of the people in the neighborhood, the town, the region. the country. The educational oreoaration of the professional team mernbers also shows slight variation. Each country must adiust its educational patterns and edurational standards to meet its own manpcwer needs. There is, however, a unhars4 definition of the Professiona! Midwife which provides interndtionai recognition of the Midwife. The detinition was formulated bv the Internatonal Conference of Midwives (KM) In coliaboration with the Federation of International Gynecologists and Obstetrkian~s OWO) and revtsed in
. .
‘This papar was presenteid by Ms. Lang at theW World Cmgress of Gynecdryiy and 0bstetk.s which was held in Mex’ko Cii, Mexico October l;Q3, 1976.
fullv recogn&d in the co&& ir. wh.-h it is located, has successfully compieted the prescribed course of studies ir; mid-tifery and has ac auired !he reauisitti aualifkations ta de regtstered and/or legally licensed to practice midwifery. (See Ap The
midwife’s JOURNAL
functions
are
well
OF NURSE-MIDWIFERY
known world.
to most Statistical
of the families in the reports inform us
that 80% of the world’s babies delivered by non.physicians livery by a midwife is the norm
a:e de-
The Mtdwrfe has been known to the health field for centuries; how ever, new roles are now developing as the Midwife is rapidly being recog nized as a key member in perlnatal care, a key member on the modem perhatal team. What is Perinaial Care? I believe it is today’s most important responsibility to the present and future generations . . it must assure quality in the beginnings of a life! What is the Midwife’s Function in Perinatal Care? From the professional’s point of view: As a perinatal team member, the midwife functions as an integrated professional providing direct patient care not only in the delivery room, but also prov.ding prenatal care, neonatal care, post. natal and infant care within the hospital and the community of a designated geographic region. From the family’s point of view: As a family care provider, the midwife provides personalized health care for healthy women in all phases of the cycle of reproduction, including all aspects of childbieh, baby care, parenting, and family planning. What then needs further emphasis regarding the midwife’s unique contribution and special misston l
Vol.
respons!bIlity on the perlndal
XXII,
No. 1. Spring
is her team. 1977
(I) The System” Region
I
Midwife of the
is the P&natal
“Circulatory Team ;n (I
n basic anatomy, we all learned that the body needs a circulatory system so that
all parts of the body will be provided with continuous sustenance. Likewise, each perinatal team needs a “circulatory system” so that all parts/ members of the team are provided with valuable sustenance - patient health status information. That circulating factor the midwife Increasing
uf the
perinatal
numbers
teanx
is
of professional
midwives have become expert providers of hospital-based and community-based health care. In many areas. the domiciliary midwife has now been offered hospital privileges and the hospital-based midwife now takes her prenatal and post partum responsibilities to her patients In the Community. The uniqueness is that the midwife circulates (rotates) between the two major areas, the corn. muni’y and the hospital. As she provides direct patient care In all areas. she sathers valuable sustaining pa tient-related informaton which en hances the functions of the total pennatal team. Furthermore, on behalf of the pa!ient, she acts as a continuous link providing emotional support and individualized attention and health care management, thereby meeting the patient’s needs as expressed in the home and as expressed in the delivery room. (2) The MidLuife IS on “Expert rn the Managemen! of Pennatal Care of the Healthy”
M
idwifery on the
education preventive
is basec compo
nents of heel&h care. Like wise, the practice of midwifery en compasses preventive medicine as i is based on preserwng the health! and preuenting illness and complica tions. In short, the midwife is i “Health Preservation Advocate.” tier skills of management of tha labor and delivery of a healthy mo
JOURNAL OF NURSE-MIDWIFERY. Vol. XXII, No. 1, Spring 1977
It is important that all perinatal team members are clearly aware that any ’ ru 3 which artificially changes the Bother’s blood chemistry, iniiiates lbor or shortens the intervals be veen uterine contractions can dizctly or indirectly adversely affect le fetus. Despite sit studies no one news the degree of drug toxicity. Nxygen depletion, fundal pressure or lead compression o: traction by foreps that an unborn infant can to&Ite before he sustains some degree )f permanent brain damage. The team members must remem,er that minimal permanent brain famage may not appear on the inant mortality scale. nor is it easily ietectabte :heckup ler’s clinic 3n within
during the newborn in the perinatal team memor office; the family
however. for rhe
it lives rest of
hat Life! The midwife in the comnunity will probab4y be faced with the sad outcome. It is important that each professional perinatal team member search and research to see if any of the obstetrical/perinataI practices could be the basis for complications and unusual findings Could it be that medication “A” or procedure 73” has produced outcome “E” or “F” for which we now try to find heroic diagnostic and curative procedures?
(4) As Fart of the Ferrnntal Team. Midu ~fe IS o “Patient Aduocate”
the
n advocate must be someone who knows :he patient thoroughly, over a period of months - preferably years -. not lust by a single interview from across the table. Those who take an advccate role must know the patlent as a person. a whole person. as a member of the family from which she’hc came. to which she/he or the babv
A
wlii return The advocate must kn0.d the patient in at least five ways WIthIn the realm and context of the physlcal. psychotogicat. educational. economi cal. and spiritual religious h-ome of their existence
in perinatal also relate to
care, advocacy the baby. In
stance, the parent and baby must be considered in the “complete patient package” before and after birth. As there must te a good understanding of the medical diagnosis of a pregnancy, there Ltou!d also be a diagnosis of ihe fact Cal and emotional understanding of the pregnancy and the meaning it has for the mother, father and family. As midwives or other perinatal team members act as advocates of a baby/mother combination, the professional can only be effective if she/ he becomes aware of the specific deep.rooted needs and slrcngths of that particular mother’s existence as ,1n individual. as a fam’ly member, or BS pal: of the cuitural esjironment to whkh the mother/bao!l must return. (5) The Mid&j; . . an “i:ducator” to Prepare !ha Patient-Put& jor a Fauorctb 4: F’erinotal ExperLnce 1 idwifery
practice
C :eptlon. Individual r nidurife appears t his age group.
must this In-
encompas-
ses the phiiosophy that each wornin has the tight to preventkxe znd personal&d health care. and tha right to acquire f arnily health
attention from less threatening
a to
Pregnant Women: A missed menperiod causes a woman to seek c ut professional assistance to check ot oregnancy via a cjut her suspicions test or physical examina?,regnan;y t ion. This is an obvious key opport unity fcr the midwife to offer preblentive medicine and health educacount ton and “hea!th-preservation” s,eling, all of which the midwife is t rained to provide. Care of Mother During .‘regnancy md Delivery: Comprehe;lsive prenatal care is a vital base for quality jerinatd care. As the m!dwrfe prorides direct prenatal m:magement, S trual
f
;he also encourages emotional and lhysical preparation for childbirth to lelp prepare the mother for 3 satisfyng perinatal experience. Ihe proIides educational sessions S. the paient’s request. The mrdwife’s knowlvledge of each mother/family’s special needs is integrated into the ini+vife’s Individualized management of each
healthy patient’s labor and delivery. She also provides important supportive care for those mothers whQ are at perinatai risk who will bl: m-snaged education which will help her underby the obstetrician .perina olog st. On aand her own psy~ltophysiological behalf uf the patient, all lnforrnation fundian!; as a woman, mate, and is appropriately shared with the total mother. This means that aloag with perinatal team to enhance quality quality phbsicaf c&e, the midwife pertnatal team management and also provides opport,miti< s for family team education in the delivery room. fife education which will guide the Care of Infant: While leaming to womar,, and her family tc ward ‘selfnurture the infant, a mother usually preservation 0; health.” seeks guidance for successful breasl For perine;:! health services to be feeding and otl-er mothe-irlg tech succea,f~?l the goals must be realistic niqucs. The midwife proui 3es this in tr,n s of the patient’s ability and guidance and also utilizes this oppor wish (a comply. People learn best tunity to integrate otter infanl what the’) r;eod to know and at a “health-preservation” education. time whely they want to know. Mid Interconceptiond-family plannin:, wives colne in cont?zt with the pa patient: immediately post-parturr tient-public at ihe 7 >st impression and shortly thereafter, a mother i! able and educable points of life: usually cbqcerned with her body ad The justment to the non-pregnant state I’re.AdoltarentjTe‘eenager: body and emotional changes of the a Simultaneously, she is usually mos pre-adolescent/teenager are trigger . I motivated toward seeking famll! 1 ing a natural curiosity and a searcl alarming measures. A mother intttall! f@! answers to difficult question S requests these servkes from the fa regarding the organs of reproductlor miliar midwife who also delivered he 1, emotkms, hygiene, sex, and contrz k I baby. Child spacing Is a key factor tc
M
14
assure a successful perlnatal outcome. Guidance In Parenting for couples New parents, or indtvtduals who are anticipating a rapidly aP proaching new adult role as parent. frequently seek out a professional who can help guide them toward fulfilling that role. The midwife helps provtcle them with educational sessions on “parenting.” The importance of good parenting is well documented to assure optimal growth and development of a newborn, the infant. (6) The Midwife is an “Educator Professional Team Members”
S
tudents
in the
health
of
profes-
sions are eager to learn. Before management of risk factors can be learned, all perinatal team members must know the important aspects of management of mothers with an essentially healthy/uncomplicated course of pregnancy and childbirth. The midwife, as the acknowledged expert in the management of the healthy, is the choke educator and clinical instructor for midwifery students and medical students. Many leading medical centers around the world have employed professional midwives as professors and assistant professors in the education for perinatal care of the healthy.
T
he practice of modern wifery encourages a philosophic odentatton
midbask to in-
divlduallzed/famlly centered community-based and hospital-based perinatal care. This is a vital and unique contribution that midwives add to “Team work b the Delivery Room.” If the current trend continues that 80% of the world’s babies are delivered by non-physicians - mostly midwives, then it’s obvious that all perinatal teams should actively integrate the full contribution of the midwives. Some time ago Dr. Allan Guttmacher stated that “. . .if it were not
JOURNAL OF NURSE-MIDWIFERY
l
Vol. XXII, No. 1, SPrhi 1977
Nutrient Requirements in AdolrscrJnco Edited by John 1. McKigney and Hamish N. Munro. Cambridge, Massachuset:s: The MIT Press. 1976. Pries: $15.00. Reviewed by Daisy Salonf, R.D.. Nutrition fnslructor, Msericordia Hospital Medical Center, School of Health Sciences.
planning, and child care. She may practice in ilospitals, its, health units, domiciliary tions or any other service.
clincondi-
As accepted by the ICM Membership and Joint Study Group on MoternftY Core, FIGO, WHO, etc.
JOURNAL OF NURSE-MIDWIFERY .Vd.
In 1973 a conference, sponsored by the National Institute of Child Health and Human Development, National InsMute of Health, was seen by experts in the related fields of health and nutr’tion as a starting point for future and innovative research in the area of nutrient r*-quiremeFts of adolescents. One of the many results of this conference was a compilation of the proceedings, presentations and observations. These have been organized in a book form and divided into five sections dealing with the biologic implications of the adolescent growth process, adolescent nutrient requirements and recommended dietary allowances, factors influencing different nutrient requirements of the volatile adolescent body, innovative directions m evaluating adolescent nutrition, and establishment of new reference points for future study of adolescent nutrient requirements. Following each presentation is a “questkm and answer” type of discussion among conference participants. The discussions are as informative as the Presentations, even though they may be a bit distracting to the reader who is forced to keep an account of
XXII, No. 1, SprfnS 1977
which speaker is which. The reference lilts alter each topic form a fabulous bibliography for those interested in further information on the topic. Topics dealt with ere adolescent obesity, and its relationship to fat cefl size and number, body compoaiticn. the adolescent growth spurt (me dffferences between males and females), the influence of stress upon infection. injury and the catabolic and anabofic responses of the body during such stress, theinffuenceofwiousdrugsuponnutriint requirements of the adofeecenf, and in the final section of me book, specific advice on the use of anthropometric measurements. body composition and lean body mass measurements. maturabon and development indices, and biochemical and clinical measurements. Unfortunately, informat& on the nutritional needs of the pregnant adofescent is not included in the bode. Since there is much nutritional information which needs to be compiled concerning the pregnant teenager, this is a serious om&sion. The book informs the reader of some newer tools for nutrttional assessment, including the technique of neutron activation for measuring nitrogen and calcium metabolism and the study of hair changes, which works on the premise that by studying strands of human hefr one can study energy metaboIism. protein synthesis. endocrine response. microcirculation, chromosomal pattern. trace minerals, histo!agy end histo chemistry. This book is a good reference for dietitlans, nutritionists, nurse-midwives, and others in the health field who work with adolescents.
Spiritual Midwtfmy By Ina May and The Farm Midwives. The Book Publishing Company. The Farm. $ummertosn. Term. 1975. Price: 55.95. Reviewed
by Janet
l&rick,
R.N.
M. Lung.
C N M. M?
.H
I
ously, sional country viders needs
he patterns for providing health care differ from country to country. Simultanethe composition team members
of profesdiffers from
to country. The health proin everv settins must fit the of the setting 1 more speclfimeet the cultural they must
tally, health needs of the people in the neighborhood, the town, the region. the country. The educational oreoaration of the professional team mernbers also shows slight variation. Each country must adiust its educational patterns and edurational standards to meet its own manpcwer needs. There is, however, a unhars4 definition of the Professiona! Midwife which provides interndtionai recognition of the Midwife. The detinition was formulated bv the Internatonal Conference of Midwives (KM) In coliaboration with the Federation of International Gynecologists and Obstetrkian~s OWO) and revtsed in
. .
‘This papar was presenteid by Ms. Lang at theW World Cmgress of Gynecdryiy and 0bstetk.s which was held in Mex’ko Cii, Mexico October l;Q3, 1976.
fullv recogn&d in the co&& ir. wh.-h it is located, has successfully compieted the prescribed course of studies ir; mid-tifery and has ac auired !he reauisitti aualifkations ta de regtstered and/or legally licensed to practice midwifery. (See Ap The
midwife’s JOURNAL
functions
are
well
OF NURSE-MIDWIFERY
known world.
to most Statistical
of the families in the reports inform us
that 80% of the world’s babies delivered by non.physicians livery by a midwife is the norm
a:e de-
The Mtdwrfe has been known to the health field for centuries; how ever, new roles are now developing as the Midwife is rapidly being recog nized as a key member in perlnatal care, a key member on the modem perhatal team. What is Perinaial Care? I believe it is today’s most important responsibility to the present and future generations . . it must assure quality in the beginnings of a life! What is the Midwife’s Function in Perinatal Care? From the professional’s point of view: As a perinatal team member, the midwife functions as an integrated professional providing direct patient care not only in the delivery room, but also prov.ding prenatal care, neonatal care, post. natal and infant care within the hospital and the community of a designated geographic region. From the family’s point of view: As a family care provider, the midwife provides personalized health care for healthy women in all phases of the cycle of reproduction, including all aspects of childbieh, baby care, parenting, and family planning. What then needs further emphasis regarding the midwife’s unique contribution and special misston l
Vol.
respons!bIlity on the perlndal
XXII,
No. 1. Spring
is her team. 1977
(I) The System” Region
I
Midwife of the
is the P&natal
“Circulatory Team ;n (I
n basic anatomy, we all learned that the body needs a circulatory system so that
all parts of the body will be provided with continuous sustenance. Likewise, each perinatal team needs a “circulatory system” so that all parts/ members of the team are provided with valuable sustenance - patient health status information. That circulating factor the midwife Increasing
uf the
perinatal
numbers
teanx
is
of professional
midwives have become expert providers of hospital-based and community-based health care. In many areas. the domiciliary midwife has now been offered hospital privileges and the hospital-based midwife now takes her prenatal and post partum responsibilities to her patients In the Community. The uniqueness is that the midwife circulates (rotates) between the two major areas, the corn. muni’y and the hospital. As she provides direct patient care In all areas. she sathers valuable sustaining pa tient-related informaton which en hances the functions of the total pennatal team. Furthermore, on behalf of the pa!ient, she acts as a continuous link providing emotional support and individualized attention and health care management, thereby meeting the patient’s needs as expressed in the home and as expressed in the delivery room. (2) The MidLuife IS on “Expert rn the Managemen! of Pennatal Care of the Healthy”
M
idwifery on the
education preventive
is basec compo
nents of heel&h care. Like wise, the practice of midwifery en compasses preventive medicine as i is based on preserwng the health! and preuenting illness and complica tions. In short, the midwife is i “Health Preservation Advocate.” tier skills of management of tha labor and delivery of a healthy mo
JOURNAL OF NURSE-MIDWIFERY. Vol. XXII, No. 1, Spring 1977
It is important that all perinatal team members are clearly aware that any ’ ru 3 which artificially changes the Bother’s blood chemistry, iniiiates lbor or shortens the intervals be veen uterine contractions can dizctly or indirectly adversely affect le fetus. Despite sit studies no one news the degree of drug toxicity. Nxygen depletion, fundal pressure or lead compression o: traction by foreps that an unborn infant can to&Ite before he sustains some degree )f permanent brain damage. The team members must remem,er that minimal permanent brain famage may not appear on the inant mortality scale. nor is it easily ietectabte :heckup ler’s clinic 3n within
during the newborn in the perinatal team memor office; the family
however. for rhe
it lives rest of
hat Life! The midwife in the comnunity will probab4y be faced with the sad outcome. It is important that each professional perinatal team member search and research to see if any of the obstetrical/perinataI practices could be the basis for complications and unusual findings Could it be that medication “A” or procedure 73” has produced outcome “E” or “F” for which we now try to find heroic diagnostic and curative procedures?
(4) As Fart of the Ferrnntal Team. Midu ~fe IS o “Patient Aduocate”
the
n advocate must be someone who knows :he patient thoroughly, over a period of months - preferably years -. not lust by a single interview from across the table. Those who take an advccate role must know the patlent as a person. a whole person. as a member of the family from which she’hc came. to which she/he or the babv
A
wlii return The advocate must kn0.d the patient in at least five ways WIthIn the realm and context of the physlcal. psychotogicat. educational. economi cal. and spiritual religious h-ome of their existence
in perinatal also relate to
care, advocacy the baby. In
stance, the parent and baby must be considered in the “complete patient package” before and after birth. As there must te a good understanding of the medical diagnosis of a pregnancy, there Ltou!d also be a diagnosis of ihe fact Cal and emotional understanding of the pregnancy and the meaning it has for the mother, father and family. As midwives or other perinatal team members act as advocates of a baby/mother combination, the professional can only be effective if she/ he becomes aware of the specific deep.rooted needs and slrcngths of that particular mother’s existence as ,1n individual. as a fam’ly member, or BS pal: of the cuitural esjironment to whkh the mother/bao!l must return. (5) The Mid&j; . . an “i:ducator” to Prepare !ha Patient-Put& jor a Fauorctb 4: F’erinotal ExperLnce 1 idwifery
practice
C :eptlon. Individual r nidurife appears t his age group.
must this In-
encompas-
ses the phiiosophy that each wornin has the tight to preventkxe znd personal&d health care. and tha right to acquire f arnily health
attention from less threatening
a to
Pregnant Women: A missed menperiod causes a woman to seek c ut professional assistance to check ot oregnancy via a cjut her suspicions test or physical examina?,regnan;y t ion. This is an obvious key opport unity fcr the midwife to offer preblentive medicine and health educacount ton and “hea!th-preservation” s,eling, all of which the midwife is t rained to provide. Care of Mother During .‘regnancy md Delivery: Comprehe;lsive prenatal care is a vital base for quality jerinatd care. As the m!dwrfe prorides direct prenatal m:magement, S trual
f
;he also encourages emotional and lhysical preparation for childbirth to lelp prepare the mother for 3 satisfyng perinatal experience. Ihe proIides educational sessions S. the paient’s request. The mrdwife’s knowlvledge of each mother/family’s special needs is integrated into the ini+vife’s Individualized management of each
healthy patient’s labor and delivery. She also provides important supportive care for those mothers whQ are at perinatai risk who will bl: m-snaged education which will help her underby the obstetrician .perina olog st. On aand her own psy~ltophysiological behalf uf the patient, all lnforrnation fundian!; as a woman, mate, and is appropriately shared with the total mother. This means that aloag with perinatal team to enhance quality quality phbsicaf c&e, the midwife pertnatal team management and also provides opport,miti< s for family team education in the delivery room. fife education which will guide the Care of Infant: While leaming to womar,, and her family tc ward ‘selfnurture the infant, a mother usually preservation 0; health.” seeks guidance for successful breasl For perine;:! health services to be feeding and otl-er mothe-irlg tech succea,f~?l the goals must be realistic niqucs. The midwife proui 3es this in tr,n s of the patient’s ability and guidance and also utilizes this oppor wish (a comply. People learn best tunity to integrate otter infanl what the’) r;eod to know and at a “health-preservation” education. time whely they want to know. Mid Interconceptiond-family plannin:, wives colne in cont?zt with the pa patient: immediately post-parturr tient-public at ihe 7 >st impression and shortly thereafter, a mother i! able and educable points of life: usually cbqcerned with her body ad The justment to the non-pregnant state I’re.AdoltarentjTe‘eenager: body and emotional changes of the a Simultaneously, she is usually mos pre-adolescent/teenager are trigger . I motivated toward seeking famll! 1 ing a natural curiosity and a searcl alarming measures. A mother intttall! f@! answers to difficult question S requests these servkes from the fa regarding the organs of reproductlor miliar midwife who also delivered he 1, emotkms, hygiene, sex, and contrz k I baby. Child spacing Is a key factor tc
M
14
assure a successful perlnatal outcome. Guidance In Parenting for couples New parents, or indtvtduals who are anticipating a rapidly aP proaching new adult role as parent. frequently seek out a professional who can help guide them toward fulfilling that role. The midwife helps provtcle them with educational sessions on “parenting.” The importance of good parenting is well documented to assure optimal growth and development of a newborn, the infant. (6) The Midwife is an “Educator Professional Team Members”
S
tudents
in the
health
of
profes-
sions are eager to learn. Before management of risk factors can be learned, all perinatal team members must know the important aspects of management of mothers with an essentially healthy/uncomplicated course of pregnancy and childbirth. The midwife, as the acknowledged expert in the management of the healthy, is the choke educator and clinical instructor for midwifery students and medical students. Many leading medical centers around the world have employed professional midwives as professors and assistant professors in the education for perinatal care of the healthy.
T
he practice of modern wifery encourages a philosophic odentatton
midbask to in-
divlduallzed/famlly centered community-based and hospital-based perinatal care. This is a vital and unique contribution that midwives add to “Team work b the Delivery Room.” If the current trend continues that 80% of the world’s babies are delivered by non-physicians - mostly midwives, then it’s obvious that all perinatal teams should actively integrate the full contribution of the midwives. Some time ago Dr. Allan Guttmacher stated that “. . .if it were not
JOURNAL OF NURSE-MIDWIFERY
l
Vol. XXII, No. 1, SPrhi 1977
Nutrient Requirements in AdolrscrJnco Edited by John 1. McKigney and Hamish N. Munro. Cambridge, Massachuset:s: The MIT Press. 1976. Pries: $15.00. Reviewed by Daisy Salonf, R.D.. Nutrition fnslructor, Msericordia Hospital Medical Center, School of Health Sciences.
planning, and child care. She may practice in ilospitals, its, health units, domiciliary tions or any other service.
clincondi-
As accepted by the ICM Membership and Joint Study Group on MoternftY Core, FIGO, WHO, etc.
JOURNAL OF NURSE-MIDWIFERY .Vd.
In 1973 a conference, sponsored by the National Institute of Child Health and Human Development, National InsMute of Health, was seen by experts in the related fields of health and nutr’tion as a starting point for future and innovative research in the area of nutrient r*-quiremeFts of adolescents. One of the many results of this conference was a compilation of the proceedings, presentations and observations. These have been organized in a book form and divided into five sections dealing with the biologic implications of the adolescent growth process, adolescent nutrient requirements and recommended dietary allowances, factors influencing different nutrient requirements of the volatile adolescent body, innovative directions m evaluating adolescent nutrition, and establishment of new reference points for future study of adolescent nutrient requirements. Following each presentation is a “questkm and answer” type of discussion among conference participants. The discussions are as informative as the Presentations, even though they may be a bit distracting to the reader who is forced to keep an account of
XXII, No. 1, SprfnS 1977
which speaker is which. The reference lilts alter each topic form a fabulous bibliography for those interested in further information on the topic. Topics dealt with ere adolescent obesity, and its relationship to fat cefl size and number, body compoaiticn. the adolescent growth spurt (me dffferences between males and females), the influence of stress upon infection. injury and the catabolic and anabofic responses of the body during such stress, theinffuenceofwiousdrugsuponnutriint requirements of the adofeecenf, and in the final section of me book, specific advice on the use of anthropometric measurements. body composition and lean body mass measurements. maturabon and development indices, and biochemical and clinical measurements. Unfortunately, informat& on the nutritional needs of the pregnant adofescent is not included in the bode. Since there is much nutritional information which needs to be compiled concerning the pregnant teenager, this is a serious om&sion. The book informs the reader of some newer tools for nutrttional assessment, including the technique of neutron activation for measuring nitrogen and calcium metabolism and the study of hair changes, which works on the premise that by studying strands of human hefr one can study energy metaboIism. protein synthesis. endocrine response. microcirculation, chromosomal pattern. trace minerals, histo!agy end histo chemistry. This book is a good reference for dietitlans, nutritionists, nurse-midwives, and others in the health field who work with adolescents.
Spiritual Midwtfmy By Ina May and The Farm Midwives. The Book Publishing Company. The Farm. $ummertosn. Term. 1975. Price: 55.95. Reviewed
by Janet
l&rick,
R.N.
