Conscious Close Up with Ina May Gaskin

by Anni Daulter

 

Why did you want to become a midwife?

The birth of my first child in 1966 taught me how crazily unscientific obstetric practice in the US had become. I was forced to have a forceps delivery simply because this was my first baby. Later research taught me that the forceps rate in the US was a shocking 65 percent then—a fact that was unknown to US women at the time. Dr. Joseph B. DeLee, one of the two most influential obstetricians of the early 20th century, called for every first baby to be delivered by forceps in 1920 (an idea which was considered extremely radical at the time, but because he wrote many textbooks, his recommendation became standard policy before many years had passed). I was struck by the fact that he still had more power while he was lying in his grave than I did as a healthy, living, breathing woman expecting a baby. It's fair to say that I was pretty angry about that.

After the birth of my baby (I had a great labor, by the way, as long as everyone was leaving me alone), I wanted to understand why a profession that was regarded as scientific could have made a normal physiological event seem like torture (the delivery room even looked like a medieval torture chamber).

About two years later, I heard a couple talk about the planned home birth of their third child. I was too shocked to remember it until I was prompted 25 years later, but I did remember the second, third, and fourth home birth stories that women told me. Every one of these women talked about the ecstatic experiences they had. Hearing those stories made me know that not only would I have any future children at home but that I wanted to be a midwife.

A favorite birthing story?

My next door neighbor was very small, and her husband was enormous. So was her belly by the end of her first pregnancy, and I had to wonder how she was going to be able to accomplish such an impossible-seeming task. Off she went to what turned out to be her last prenatal visit. She came home with her baby in her arms. "What happened?" I asked her, incredulous that her baby's birth had already happened.

"Well," she said with a big smile of accomplishment, "the doctor decided that it would be good for him to examine me internally, and that exam started my labor right then and there. My baby was born right there on the examining table twenty minutes later. I couldn't even get my socks off!"

What is “The Farm” and how long has it existed?

The Farm is a community of about 200 people (our peak population during the 1970s was about 1200) that is located in mostly wooded land in central Tennessee. It was founded by my husband, Stephen, and almost 300 young people who had accompanied him on a 5-month lecture tour during the fall and winter of 1970-1971. We were part of the "back to the land" movement that was very widespread during that time, and we, unlike some thousands of other communities started during that time, survived to tell the tale.

Regarding technology, we were not Luddites, but we did stand for appropriate use of technology. We noticed that overuse of technology had already caused a lot of problems for the environment and for other species. We thought that living in an appropriate way in the 1970s would give us an opportunity to enjoy the best of both worlds: we could recover the wisdom of the past in birthing (for instance) at the same time that we could enjoy the benefits afforded by modern communication and transportation and the ability to get women to hospital quickly whenever complications developed. We were able to learn that most complications could be prevented; we had reason to transport less than 5% of the women in labor, and less than 2% actually needed cesareans. Education, a good amount of exercise, and good nutrition did the rest.

How many midwives do you train every year at the farm / is there a shortage of midwives in the US?

There is a great shortage of midwives in the US. This is because this essential profession was virtually eliminated during the first quarter of the 20th century—a social experiment that was a first in recorded human history. Even today, about 60 years into the revival of the midwifery profession in our country, we only have about 8,000 working midwives to serve the maternity care needs of a country of 310 million people.

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What challenges do women face today with birthing in hospitals?

Despite the fact that giving birth in the US is more expensive than anywhere else in the world, our maternity care outcomes do not compare well with those in many other countries. Maternity care here has come to prioritize ways of profiting from birth rather than doing the best job possible of creating and maintaining a maternity care system that is women-centered and produces good outcomes. Yes, neonatal mortality is an important measure, but maternal mortality and morbidity cannot be ignored. We shouldn't have high rates of "near-misses" (women who narrowly missed dying), cases of long-term injury or illness, and we should have high rates of breastfeeding. We have a long way to go to remedy these horrific shortcomings in maternity care.

Today's high cesarean rates speak to some of the challenges that face women giving birth in US hospitals today. As strange as this may sound, relatively few maternity staff members have had the chance to witness a healthy woman's labor from beginning until end. Lack of chance to witness this biological event from its beginnings until its conclusion—whether during training or everyday experience on the job—means that too few doctors, nurses (and sometimes midwives) have developed the skills necessary to help women during labor. Fear of malpractice litigation has led most hospitals require continuous electronic fetal monitoring, a technology that has not proved up on its early promises to greatly reduce neonatal death but has instead been shown to increase the cesarean rate. The difficulty with this is that for EFM to function up to par, the laboring woman usually must remain on her back. This position creates a more painful and less efficient labor than that which a woman can experience when she is able to move about freely during labor.

Women who have a good understanding of how their bodies work, who are healthy and well informed, and who have a doula beside them have the best chance of overcoming the challenges that I have outlined above.

Get to know Ina personally…

My favorite place to re-juvinate myself is…

My garden.

My favorite comfort foods are…

Japanese rice balls and a dish I make with shitake mushroom, goat and ricotta cheeses, and spinach.

My passion is…

teaching women to respect their bodies and teaching men of the ways in which women really do need protection, and teaching medical professionals about sphincter law and certain ingenious ideas and techniques that they could learn from indigenous peoples around the world.

My all time favorite book is…

Huckleberry Finn.

My hero / heroine is…

Mrs. Margaret Charles Smith, author of Listen to Me Good: The Story of an Alabama Midwife, Dr. Tadashi Yoshimura of Okazaki City, Japan, and Dr. Alfred Rockenschaub of Vienna, Austria.

My own life quote would be….

Never stop learning and never give up.