which makes the reading tortuous and the reader frustrated.

This book is recommended for its pre- sentation of all sides of the question of gender identity/role and the effects of prenatal, postnatal, and sociological in- fluences on it. Money also delves into pair-bonding, and answers the question, “Is the way we do it now the only and/or correct way?’ Money connects diverse pieces of the whole in surprising and controversial ways. The reading is tedious due to the author’s esoteric writing style; but the subject matter although not di- rectly applicable to practice is thought provoking.

Menopause in Modem Perspective: A Guide to Clinical Practice. By Wulf H. Utian, M.B.B.Ch., Ph.D., M.R.C.O.G., F.A.C.O.G. New York: Appleton- Century-Crofts, 1980. 191 pages, $16 50 hardcover.

Reviewed by: Charlene Pope, C.N.M., M. P. H., Baltimore, Maryland

This slim monograph is a thorough re- view of the medical literature regarding menopause by a physician who has been actively involved in the research he sur-

veys for several years. Forty-two of the references cited are drawn from his own work, much of which has been in the midst of the controversy concerning estrogen-replacement therapy. His pur- pose is not only a single overview of an area ripe with conflicting perspectives and findings, but also to provide a clinical manual for use “for the physician, resi- dent, and interested medical student.”

The book is divided into eleven chap- ters, only two of which provide recom- mendations for practitioners. A large por- tion of Utian’s survey is, by necessity, a summary of the known causes of meno- pause as a state of ovarian failure, the principles of female endocrinology, and the response of pelvic and extrapelvic end-organs to hormone deficiency. His discussion of postmenopausal osteo- porosis and the cardiovascular and blood lipid changes related to meno- pause is certainly cautious. For instance, while studies may maintain that estrogen postmenopausally may decrease os- teoporosis, he maintains that evidence that osteoporosis can be prevented by long-term hormone replacement or that there will be any lowering of disabling orthopedic effects, such as fractures and backache, is based on deficient studies.

52

He is careful to point out the multiple- factor etiology of osteoporosis and explores the alternative avenues of ther- apy still open to research.

Perhaps one of the more troubling as- pects of this book are the many questions the author repeatedly raises as still unan- swered. In a work directed at those in clinical practice, I am concerned that busy clinicians will selectively browse out pos- sible therapies that Utian admits are “. not proven safe, practical or effective . . . on a relatively empirical basis.”

Further, though Utian refers to the First International Congress on Menopause’s definition and description of symptoms as having three components (decreased ovarian function, sociocultural, and psychologic, there is little practical advice given to dealing with the latter two com- ponents. His chapter on “Selective Pharmacotherapy after Menopause” lists sedatives, tranquilizers and antidepres- sants as the bulk of nonhormonal drugs with a role in therapy. Though a passing reference is made to possible drug abuse, there are no firm recommendations made to practitioners for the limited use of such adjuncts and necessay counseling and therapy which must accompany their use.

The chapter “Risks Versus Benefits of Replacement Hormones” is an interest- ing review, reminding the reader of the useful role of estrogen for hot flashes, one of the few symptoms for which it is spe- cific, and its many unproven benefits. He cites postmenopausal bleeding and the attendant incidence of unnecessary surgery it brings as ‘<. . . a real disadvan- tage of postmenopausal estrogen ther- apy.” Endometrial hyperplasia and endometrial cancer are explored as areas that must be considered in relation to such factors as unopposed estrogen use, the type of estrogen involved, the dose, the duration of therapy and the individual client’s risk factors. I find it difficult to be- lieve that physicians dealing with the daily counseling of women in office practice will find the pages detailing formulas on cost-benefit and cost-effectiveness analysis of immediate use.

The chapter on “Practical Aspects of Clinical Care” adds little new material ex- cept detailed minimal requirements for prehormone therapy workup and follow-up requirements which may be useful for physicians. Utian’s most aggressive advice is for the formation of a Menopause Clinic which would draw to- gether middle-aged and older women,

screening programs, extra-medical ex- pertise, menopause experience, and op- portunities for research. I think this is an added opportunity to fractionalize health care.

The major use of this book is that ex- pressed in its short closing chapter, The Future, where Utian describes the areas still in need of scientific investigation. Al- though, this resource is recommended for those studying the field for an overview, it will likely be of more use to the hospital’s medical library than the clinician’s book- shelf.

Pregnancy and Childbirth: The Com- plete Guide for a New Life. By Tracy Hotchner. New York: Avon Books, 1979. 689 pp. $6.95, paperback.

Reviewed by: Shirley Fischer, C.N.M., M.S., San Francisco General Hospital Midwifery Service, San Francisco, California.

Pregnancy and Childbirth: The Complete

Guide for a New Life is, in the author’s words, “a consumer guide on pregnancy and birth.” Ms. Hotchner states that she set out “. . . to gather evey possible scrap of information about childbearing

. to help people . . be able to make intelligent decisions at every step for safe and joyful childbirth.” This is a com- mendable goal and this 689-page encyclopedia-style volume is long enough and comprehensive enough (covering over 100 topics) to attempt reaching it. Ms. Hotchner’s attitude is clearly that of a consumer advocate. “There is no ‘right way’ to give birth . . Women can change existing choices in childbirth and encourage more options but they have to climb over that wall and ask for more. ” Her advice on how to deal with an antagonistic medical or hospital environment (Chapters 6 and 7) is quite good. A nice summary of the availability of CNM and lay-midwife practice in vari- ous states is included in the information on choices in childbirth (although the source of this material, the Journal of

Nurse-Midwifery, is not cited.). Unfortunately, many of the “scraps”

Ms. Hotchner has gathered are inaccu- rate, contradictoy, or misleading, partic- ularly in the context of significant infor- mation juxtaposed with trivia in an al- phabetical listing. Some of the advice that disturbs me most appears in the sections on home birth. “If the baby is not breath- ing . . . artificial respiration (mouth-

Journal of Nurse-Midwifery l Vol. 26. No. 4. July/August 1981