I had the incredible opportunity to interview Ina May Gaskin about her new book Birth Matters: a Midwife’s Manifesta. I had a few questions of my own, but also asked many of the questions that My Best Birth members had for America’s leading midwife. Please read on!
What was the hardest part of writing Birth Matters?
Getting it done on time! The editor kept adding ideas. She’d say, “Why don’t you say something about breast implants?” and that would open up a whole can of worms. Well, cans of worms sometimes need to be opened, so I got a can opener. Then it was hard to stop because I had things to say about a lot of things.
Did you learn anything new from writing Birth Matters?
Yes, I learned a bunch about breast implants. Of course, I always knew it’s not good to put foreign elements in the body. If nature wanted us to be full of silica, we would be. I also got to read some archival books that have mostly been forgotten. I wanted to write something for the younger generation that may not know some of the information in these books.
I especially loved some of the historical bits, like the part about Elizabeth Cady Stanton on her birth experiences.
Elizabeth Cady Stanton was passionate and loved the way she gave birth. She thought it was a feminist thing to be strong in birth.
To what specifically do you attribute The Farm’s great outcomes of low transfer and low morbidity and mortality?
We had a community that was too populous for them to absorb us into the mainstream culture. We deliberately set out to change the culture surrounding birth. Almost all new members of the Farm were of childbearing age. We had a big piece of land, not the greatest roads, which was a major disincentive to go to the hospital just for pain relief, because a laboring mom knew she’d have to endure fifteen minutes or so of a bumpy car ride! We learned quite a few ways to make pain bearable or even absent. We developed the ability to give birth as women do in indigenous communities around the world. There were skills involved, not just by the midwives, but also by the women. For example, we learned that it helps in late labor to moan. Moaning can alleviate pain, whereas whining will accentuate it.
What do you think about the Big Push for Midwives campaign?
I am very much behind Big Push for Midwives. I started out as an unregulated midwife; there was no way to be regulated back then. I think that some regulation is ok. I understand the fear because we stood aside at first in Tennessee from the passing of a CPM bill, simply because it would have greatly restricted our practice. We wanted to maintain the possibility of attending VBACs, twin births, etc… Ideally there would be some regulation without unfair restrictions.
One member asks: Do you think that obstetricians, especially male obstetricians, have contributed to the maternity crisis today, based on the fact that they will never physically experience pregnancy, labor or childbirth, or even a c-section as a woman would?
No. I believe some men are actually more compassionate with women than other women are. I don’t attribute much to gender differences. You don’t always get what you expect you are going to get. There were a few men who really didn’t know anything, like Hugh L. Hodge, who wrote that we just have to scare women so they will place their births in doctors’ hands. When we scare our incoming medical students, when all they see is horrible birth, they won’t be good obstetricians. They won’t know that they are carrying in a real fear. Their training does not emphasize self-calming techniques. It was the fact that we wiped out midwifery that was the big factor in giving us this brutal form of obstetrics that is peculiar to the US. As a culture, our obstetrics is much more interventional than other countries.
What about the 93% c-section rate in Brazil?
Brazil did that by imitating us. They just hurried there a little faster and we should take heed from them because their mortality rates are higher. They didn’t value midwifery. They destroyed the profession, and it is much easier to destroy than to recover. The high cesarean rate is in private hospitals, and efforts are being made to lower the c-section rate in public hospitals.
This is why I have the Safe Motherhood Quilt. Read the stories of the kinds of death that c-section has caused. It is major abdominal surgery. It should not be done lightly; it should be done only if there is a bigger danger.
Another member asks: How do you keep up hope in the face of all of the devastating information you encounter? C-section rates are rising, our maternal mortality rates are rising, etc. Doesn't it seem sometimes like in the big scheme of things, we are fighting a losing battle?
I’ve been putting out a message for a long time and it seems like more people are paying attention now. I remember in the early 90s when women themselves started wanting elective c-sections. That was when it was toughest. I didn’t know if I could put in a book the stories and science that would make women less afraid, but Ina May’s Guide to Childbirth was released in 2003 and I have seen positive change in the feedback since then.
Many women want to know the best path to becoming a midwife. What do you suggest?
There is no one right answer to that question. Really it has to do with an individual’s previous background and how they intend to practice. If you have your sights set on Home Birth, Shenandoah University offers guaranteed home birth experience in their nurse-midwifery program, but most nurse-midwifery tracks are purely hospital-based training. Experience with women is not as easy to get in nurse-midwifery programs as it is in the apprenticeship model. This is where doula training has relevance and value. I wish that every potential obstetrical nurse would have to complete doula training.
What is your vision of the future of midwifery?
I would love to see CPMs in every state, 150-200K midwives in the US. My hope is that the profession survives. Ideally, midwives would help train future obstetricians, so that the skills that were once required for obstetricians to learn would be brought back (like breech skills). The lack of these types of skills are driving up our mortality rate. We do not have to accept that.
Please tell us about a birth that stands out in your mind.
Ira, the anencephaly baby whose birth I assisted at in 1974. I had only seen photos of anencephaly babies before this birth. An anencephaly baby has no forebrain and has the proportions of an adult, only baby sized: long arms and legs, smallish head, no skull. Ira came lips first, and he sucked my thumb awhile before he was born, which is probably why I formulated a bit of an attachment. He was very strong. Because we didn’t quite know what to do with a baby with no skull, we brought him to the hospital, where he was kept for five days. We found out that for the entire five days he spent in the hospital, he had not been fed a drop. They just figured he’d die. When the mother discovered this, we checked him out of the hospital against their protocol and he spent his remaining six days of life in his parent’s arms. There were lessons this child brought. He had a unique and short life, but was nothing we should be protected against. I often wondered how long he would have lived if we had not taken him to the hospital. He was responsive; he would look at you and react. Medical textbooks used to refer to these babies as monsters. After I published the story in Spiritual Midwifery in 1976, that word finally dropped out of the textbooks.
Can you impart the most important way to change the culture of birth and get women, government and other health care professionals on board?
Change comes by changing a bunch of different things. Midwifery in the US understands that we occasionally need medicine and interventions. What needs to change is that obstetrics needs to understand that it too needs midwifery. If we don’t get midwifery back into birth in a big way, a partnership way, then obstetrics itself is doomed. We will head toward an all c-section culture with no more possibilities.
The thing is, there is safety in numbers. There are obstetricians who understand the need for midwifery, but to be the first one to stick your neck out is challenging.
We have to help these right-thinking obstetricians to know that they are not alone. We are not going to see changes in the mortality and morbidity numbers until we see authentic midwifery really back in the birth model. No more time limits on birth, no more limits on eating and drinking, on mobility. We need to get back to the mother-baby friendly childbirth initiative. We need to get the Coalition for Improving Maternity Services (CIMS) Ten Steps of Mother-Friendly Care implemented across the country.
Do you have anything specific that you want to say to your readers?
This is a book that I hope that men will read. When you put birth in the title, most men will turn the other way, but it is really important that men will come to understand that women’s bodies need respect and it is common sense to give women’s bodies respect. Women are not an evolutionary fluke. We need to break free from the superstition that technology in greater amounts is for the greater good. Sphincter Law gives men some understanding as to how women’s feelings are important. Reading books that frighten us is not the way to go. Go on YouTube and check out some animal birth videos. We can learn a lot from animal births.
Did you see the YouTube video of the elephant giving birth? How amazing.
Yes! Look at how that mama elephant gave birth so confidently without having taken a course or holding a credential. She knew instinctively what to do to get her baby to breathe.
Birth Matters: a Midwife’s Manifesta is definitely a must-read for all who care about the future of maternity care. The forward by Ani DiFranco sets the tone for this captivating new book, filled cover to cover with facts, stories and practical, concrete solutions for improving the state of maternity care. Please click here to order your copy! Thank you Ina May for taking the time to talk to me!
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