Reviewer: Tia Andrighetti, DNP, CNM (Frontier Nursing University)
Description: This is the second edition of a book that was first published in 2008. A new edition was needed as the evidence base for maternity care has grown since that time. This book is a guide for labor and delivery nurses to the maternity specialty, an area that is often not covered as thoroughly as possible during education due to the limited number of placements on units for nursing students to gain experience. However, labor and delivery nursing is a specialty with a steep learning curve for anyone entering the profession.
Purpose: The book's objective is to provide guidance for those nurses who wish to enter, or who are entering, a career in labor and delivery. It acts as a reference tool to a specialty area of nursing. This is a worthy objective and much needed. However, the book perpetuates the stereotypes and myths of team members who work in labor and delivery. Therefore, it does not help to increase the teamwork or change the culture, but perpetuate it. While this may help in some instances to deal with team members, it also indoctrinates the new nurse to a less-than-ideal culture, which is not helpful. The book purports to cover the elements that would be helpful to someone new to labor and delivery, but does so in a negative manner. Evidence-based practice (EBP) is also part of the title and, yet, is only minimally covered in the chapters that were reviewed, one of which was the EBP chapter.
Audience: This book is intended for nurses new to labor and delivery. It does not meet the needs of the intended audience as it is biased and reflects an adversarial culture instead of a team-based one. The information provided is also presented in such a way that perpetuates the negative connotations, instead of starting with the positive and also mentioning the negative. For example, L&D nurses want to encourage laboring women to be upright and active and change positions frequently. However, in the chapter on the various birthing positions, the book only mentions that there is no harm in patients being in those positions. If this was presented in a positive light, then the benefits, if any are known, would be highlighted with a note that there have not been any deleterious effects. This reframes it from being something that will not harm a patient to being something we would encourage. The book notes that the authors have more than 50 years of experience. However, it does not note where they have worked, especially with students, and in which areas of the country. Labor and delivery may look very different in different places, and this book is not a representation of labor and delivery nursing in various locations.
Features: The chapters in this book cover the main topics a new nurse would need to know to work in labor and delivery. The orientation checklist at the back is also helpful but should have a note that some aspects are site-dependent, i.e., what a c-section code name may be called. The abbreviations and glossary are also very helpful, as there is much that will be new in this specialty. The book has some positive aspects: for example, it differentiates between physicians and nurse midwives, which is appreciated given the variety of providers who do births. There are also many good examples that are given to highlight what is noted in the text, but some are less than ideal. It would also be helpful to demonstrate a positive chain-of-command situation, not just one with such a negative outcome. Examples of good notes should also be reviewed as they still contain a note of blame, which could be phrased differently to be more inclusive of the team functioning rather than us versus them mentality. Overall, there is missing content in both chapters that were reviewed. In the chapter on positions, there is little to no mention of patients being on birth balls or using peanuts. These are viable options that should be mentioned. Chapter 1 had brief references to TeamSTEPPS concepts, but this is an evidence-based strategy to help combat much of what the authors are addressing in this chapter and there is only superficial mention of it. In Chapter 1, the section on advocacy does not mention the nurse advocating for patient desires. This is especially needed when there are a variety of things that could happen at a given juncture, but this is not addressed at all. The chapters are also lacking in organizational structure and hard to follow as many individual paragraphs do not have opening sentences noting what is to be covered in that paragraph. There is also lots of repetition of material and it almost seems as if the new content has been added for the revision without integrating that content into previous content. The discussion of the nurse-midwifery scope of practice is different depending on what state you are in. Many midwives work with residents as attendings and are not noted as lower than first-year residents, as noted on the chart. Many midwives can care for pre-eclamptic women, so noting specific scopes of practice is not generalizable to various parts of the country or even various birth settings within the same state. This is also true of family practice doctors. The names given to doctors, nurses, and team members are degrading. "Dr. Knowitall" is not a helpful way to refer to a colleague. There are many typos, terminology is outdated, and there is information that conflicts with itself in various parts. Figure 1 mentions the nurse going to the provider, but the written text mentions the nurse going to the charge nurse for abnormal vital signs and not approaching the provider. In figures 1.1 and 1.2, shouldn't the -4 and +4 stations be opposite of what is noted? There is also conflicting information about the effect that squatting has on perineal tears. This text is supposed to highlight the evidence base for maternity care. While there may not be evidence for some things, where there is evidence should be noted. The idea of rigid labor curves is a dated concept that is no longer supported in current evidence. This is not addressed. The information on the rebozo may not have included randomized controlled trials, but there is evidence that a baby in an occiput anterior position is more optimal for labor and birth than malpositioned and the rebozo has been found to help that. The book is also written in the voice that all people who are laboring identify as women and most pictures and mention of partners refer to them as husbands. This is not inclusive language. The views expressed of organizational culture are extremely negative. This will do nothing to help the readers know what a positive culture looks like or how to create a positive culture. That should be the focus, followed by how to work within a structure that might not be as ideal.
Assessment: I have grave concerns that the biases, negativity, and defensiveness noted in this book be passed on to a new generation of nurses going into labor and delivery. This is not the culture that helps laboring patients, nor helps to keep them safe. Until we can all work as a team and value all members of that team, we cannot truly help to keep patients safe. Therefore, I do not recommend this book. While it may help update the information that was in the previous version, it is not well integrated to remove most of that old information, nor has it been placed in such a way to help the flow of the sections. This leads to conflicting information. There are several examples of books that are more thorough, evidence based, and less biased; Maternal Child Nursing Care, 6th edition, Perry et al. (Elsevier, 2018), Maternity and Pediatric Nursing, 4th edition, Ricci et al. (Wolters Kluwer, 2021), and Maternity and Women's Health Care, 12th edition, Lowdermilk et al. (Elsevier, 2020).
