General principles should not be based on exceptional cases. - Robert J. Sawyer1

Maternity care is weighed down with practices and treatments unproven and sometimes harmful. Nurses, midwives, and physicians strive to provide the best care for mothers, fetuses, and infants but often use the "n of one" principle or rely on intuition rather than analyses and scientific methods.

Anderson and Stone have created an analysis of the available evidence surrounding sometimes controversial areas of obstetrical practice, including the management of prelabor rupture of membranes at term, home birth, and tethering in labor, among others.

Each chapter begins with a description and history of the question, reviews current evidence, and ends with a case study, using the available evidence for best practice. This approach allows the reader to concentrate on the issue and understand how the practices evolved and where the best practice stands currently. Obstetrical and midwifery practice can be regional; what is considered controversial in some locations is accepted standard of care in other settings. This text coordinates an approach that can be useful in changing outdated protocols used on the obstetrical unit. Each chapter is written by acknowledged experts in the field.

For example, Osborne2 describes historical approaches to the management of the second stage of labor. She then reviews the literature looking at spontaneous pushing behaviors as well as the effects of prolonged second stage on mothers and infants. After this review of the evidence, including the evidence regarding women's preferences, she discusses implementation of best practices, with a case study describing an exemplar of best practice.

This text is recommended for anyone providing care to pregnant women, including nurses, midwives, and physicians. The authors provide a grounded explanation of the evolution of practice, the rational for change if change is needed, and a base for those practitioners who want to spearhead transformations of care on their units. For those who care for laboring and birthing women and who are sometimes at a loss for words to support what they understand to be best practice, this book provides the basis for rational change, strategies for implementation, and case studies for review. The title of the book refers to midwifery practice, but this text is appropriate for anyone providing care to pregnant and laboring women. This reviewer hopes that the title will not discourage physicians and nurses from absorbing the information presented.

-Jackie Tillett, ND, CNM, FACNM

Clinical Professor

Department of Obstetrics and Gynecology

University of Wisconsin School of Medicine and Public Health

Madison, Wisconsin

References