generalizing about ”futility” issues that are resolved, ulti-mately, at the level of the individual patient. The volumeconvincingly makes the point that end-of-life issues requirefar more study. In this reviewer’s opinion, even if there iscontinued study and debate, at the public and professionallevels, of the myriad pungent issues raised by end-of-lifecare, it is not a certainty that such effort will effectuallyremove medical futility from its current domain of nebu-lousness, confusion, and sharp division of views.

This text has an abundance of scholarly value forclinicians as well as theorists. The number of up-to-datereferences is considerable. The overall didactic nature ofthe book, however, will likely diminish its potentialappeal to lay readers.

The various contributors to this fine volume, individuallyand collectively, have bequeathed fertile soil of scholarlydiscussion about medical futility. In this soil, further profes-sional and societal discussion will likely take root.

Miscarriage: Your Questions Answered. By UrsulaMarkham. Boston (MA): Element Books, 1998. 110pages. $9.95, softcover.

Reviewed by: M. Patricia Kuhn CNM, MSN. Private Prac-tice, Millburn, New Jersey.

British hypnotherapist Ursula Markham, author of pre-vious work on bereavement and childhood trauma, hasproduced a slim guide on coping with miscarriage.Principally intended for women facing the loss of theirunborn children, the focus of this self-help book ispsychological. It is an effort aimed at regaining equilib-rium for the aggrieved.

Markham draws experience as a psychotherapist topresent conversation and anecdotes illustrating the com-plexity of the loss that accompanies miscarriage. Wom-en’s voices describe the pain and confusion that is oftenfelt as they listen to healthcare providers refer to their“abortions.” She explores six stages of grief using thismethod. The author provides scripted relaxation tech-niques and encourages the use of visualization in bothrecovery from miscarriage and preparation for a futurepregnancy. She includes a brief summary of comple-mentary therapies. Markham stresses that the use ofthese more commonly termed alternative therapies isadjunctive and does not preclude midwifery or medicalcare. A section of the book explores the difficult step ofmoving past the miscarriage to the contemplation offuture children. Other discussion regards women at riskfor pregnancy loss and some early signs of impendingabortion. She completes the guide with suggested read-ings and lists practitioners of alternative therapies.

Miscarriage: Your Questions Answered succeeds intouching upon facets of the emotional experience par-ticular to the woman who has lost one or more pregnan-cies. Revealing the shock of unexpected loss and the

abruptness that often characterizes a miscarriage,women voice their sorrow and sense of isolation in thisremarkably common event. Unfortunately, despite thefrequency with which conception leads to death, there islittle public acknowledgment of the pain caused bymiscarriage in our culture. This publication adds to thescant literature addressing that void. This literature be-gins to counter forces that seek quick resolution to theevent and attempts to share women’s varied experi-ences, emotional and physical.

Markham describes the anxiety and doubt associatedwith initially confronting bleeding or cramping. Shedetails some women’s fear regarding the amount ofblood loss and touches on the betrayal others feel thattheir bodies did not signal the impending loss. How dothey trust misplaced signs of well-being again? Theuncertainty that follows miscarriage is noted. Ratherthan tamp down feelings associated with miscarriage,Markham counsels reworking the loss for eventual re-covery. This book advises defying the explanation thatthe miscarriage may be “all for the best.” It guideswomen to seek to honor their loss and help remembertheir unborn child(ren). Also targeted is the significanceof anniversary phenomena in reviving the pain of theirloss, particularly the importance the estimated date ofdelivery may have.

Markham’s work is a recent addition to “The ElementGuide” series, a collection focusing on psychological andemotional issues published in Britain, Australia, and theUnited States. The strength of Miscarriage: Your Ques-tions Answered is in this realm. Although the emotionalexperience is universal, other aspects of the book do nottranslate as well. The medical terminology and somedescriptions of care are distinctly British, but may beeasily interpreted; however, the medical information andexplanation provided is frequently vague, incomplete, ornot exemplary of practice in this country. For instance, aprotocol of intravenous progesterone is mentioned as atocolytic. Although the clinician can easily skirt theirrelevant material, the mourning woman, for whom thisbook is intended, may experience confusion or disso-nance with her own experience. The brief chapter,“Help at Every Stage,” is incomplete and weak in itsdescription of who is at risk and early signs of miscar-riage. Similarly, the chapter on alternative therapies isundeveloped beyond creating a list of each approachwith a one to two paragraph description.

Markham offers appropriate emotional support anddirection for healing. She clearly is well versed in thecomplicated issues surrounding miscarriage; however, inthis reviewer’s opinion the most comprehensive sourcefor grief work and psychological insight for womencoping with pregnancy loss remains Allen and Marks’superior Miscarriage: Women Sharing from the Heart.

Journal of Nurse-Midwifery • Vol. 44, No. 5, September/October 1999 527