Williams Gynecology
by John Schorge, et al.

[2008. New York: McGraw Hill, 1216 pages, hardcover.]

[Review first published in Midwifery Today Issue 89, Spring 2009, © 2009, Midwifery Today, Inc. Review by Marion Toepke McLean.]

Following a long line of editions of the classic text Williams Obstetrics, this inaugural edition of Williams Gynecology is a useful reference book. The book is comprehensive and, while thoroughly based in contemporary, academic gynecological theory, the authors attempt to create a baseline of normalcy in their approach to women’s health care.

For example, the chapter on gynecological infection begins with a discussion of “normal vaginal flora.” Illustrations are clear and helpful. The photograph of clue cells in a saline wet prep under magnification clearly identifies this finding for the practitioner who is learning microscopy. The discussion of bacterial vaginosis is informative but does not broach the current viewpoint that bacterial vaginosis is a variation of normal which may not require treatment in asymptomatic women.

The chapter on contraception goes into most available methods in detail, with good, basic discussions of the advantages and risks of each. There is a page on fertility awareness methods, which the authors acknowledge can be up to 98% effective. However, like most texts, no mention is made of “coitus interruptus,” or withdrawal, which according to Contraceptive Technology is 94% effective—equal to a spermicide or diaphragm, with “perfect use.”

A doctor who volunteered at the Planned Parenthood clinic where I work commented, when told that a client had been using withdrawal for contraception, “why bother with that; it doesn’t work.” He was surprised when I took my copy of Contraceptive Technology from the shelf and pointed out what the studies show. Why do professionals need to have that information? I am not saying that we should recommend withdrawal over more reliable methods of birth control, however, people need to know that it is much better than nothing.

What does that 94% statistic mean? Simply put, if you take 100 fertile couples having sex regularly for a year with no contraception, 85–90 pregnancies will occur. If the same couples use withdrawal—every time—and the male partner (since withdrawal is a male-dependent contraceptive method) is committed to preventing pregnancy and is able to withdraw before ejaculation, on average, six pregnancies will occur. Not a perfect method, but readily available when supplies for other contraceptive methods may be lacking.

About 1/6 of the book is an atlas of gynecological surgery. While not of direct interest to most midwives, it may be helpful in explaining procedures to women who may be in need of surgery, or who have had surgery and want to know what was done.

All in all, this is a useful book, when used as a reference along with other texts that can enlarge on the less technological of women’s reproductive health care. The detailed discussions of diseases and abnormalities and their gynecological treatments are especially valuable.

Marion Toepke McLean has a long career as a midwife in home, hospital, and birth center; as a woman’s health practitioner; and has taught extensively in the US, Mexico and, most recently, Afghanistan. She is an anti-war activist, wife, step-mom and grandmother. She enjoys gardening, and cooking and eating the produce of her land.

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