Ina May Gaskin


She has been called the “midwife of modern midwifery” and lectures around the world on safe motherhood and “sphincter law.” The midwifery center she founded on The Farm, a commune in Tennessee, has become world famous for hosting thousands of births, including vaginal twins, breech and VBAC, and for its unparalleled statistics – in thirty years, just 1.4% of women who gave birth on The Farm needed a cesarean. Ina May Gaskin even has an obstetric maneuver named after her. Now, her best-selling Ina May’s Guide to Childbirth has a new follow-on, Ina May’s Guide to Breastfeeding (Bantam), out this month. Babble asked how she makes it looks so easy. – Jennifer Block

How have you achieved such amazing outcomes on the Farm? Do hippies have easier births?

Women who are healthy and who give birth in a supportive, relaxing atmosphere have easier births. In the beginning years, the women at The Farm were strongly motivated to give birth with as little medical intervention as possible. (There were some nasty interventions that were routine in the 1960s that we wanted to escape.) Our guiding philosophy was appropriate use of technology. We midwives had become experts in helping parents-to-be relax as much as possible during labor and birth, and the fact that we allowed – even encouraged – eating and drinking during labor has surely contributed to our low rates of interventions. Also important: every woman knew that her baby’s and her safety were our top priorities and that we would get them to a hospital if necessary or helpful.

Because we were isolated by lack of cars and telephones, we were able to form our own birth culture, free from outside pressures and fears. Each of us had the major advantage of knowing several hundred other women who had been able to give birth at home without medication, so childbirth education on The Farm was something you’d get every time you listened to a friend’s birth story. We weren’t exposed to television dramas and movies depicting birth as a frightening process.

I think it’s possible to point out the advantages of breastfeeding without being judgmental about women who choose, or must choose, another form of feeding their babies.

Women do hear lots of frightening birth stories . . . Would it help if they didn’t?

Don’t listen to people’s frightening birth stories while you’re pregnant. The pathological levels of fear of labor pain have definitely helped to drive up national cesarean rates in most countries. Now we have the ridiculous situation in which an entire generation of women of childbearing age have been trained to believe that major surgery (the cesarean) isn’t painful or potentially harmful. Too often, women aren’t shown that the pain of cesarean is felt after the surgery, so this aspect of the operation often comes as a big surprise. On the other hand, until fairly recently, there was little or no general knowledge of the fact that some women experience labor and birth as pleasurable – even orgasmic – experiences.

But does emphasizing this idea of the “perfect birth” set women up for feelings of failure or guilt?

The view that women who have had positive experiences giving birth vaginally should be quiet about them, lest they make a woman who had (or chooses) a cesarean feel bad or guilty, this doesn’t seem a good idea. If we make ourselves mute in order to make sure that no one ever feels bad, we are likely contributing to ever higher levels of cesarean section and lower rates of initiation of breastfeeding.

This argument seems to come up a lot with breastfeeding. In your new book you write: “What other human activity would permit you to give your baby the best possible nurturing and health protection at the same time that you enhance your own long-term health, provide the most economical infant food possible, and protect the natural environment?” There are people who would say this makes women who aren’t breastfeeding feel guilty.

I think it’s possible to point out the advantages of breastfeeding without being judgmental about women who choose, or must choose, another form of feeding their babies. I tried hard to maintain a nonjudgmental tone throughout my book, because I recognize that not every mother will be able to exclusively breastfeed her child, given the many obstacles to initiating and maintaining breastfeeding that exist in our society. I want mothers and fathers to understand that their bottle-fed babies will benefit greatly from being cuddled as they are being fed – the same physical closeness that is part and parcel of breastfeeding.

Whether we like it or not, breastfeeding needs to be promoted in our society, and facts about it need to be known.

You write about how stress levels can actually stop breastmilk from flowing, because stress interferes with the release of oxytocin. How significant is this in terms of childbearing in general?

There’s a big difference between exogenous oxytocin (the kind that is put into intravenous lines or syringes for injection) and endogenous oxytocin (the kind that is produced by our own bodies). What happens too often in our maternity wards in this country is that women are so stressed and frightened in labor that they have high adrenaline levels. These same women, if they had had proper preparation for labor and birth and if they had doulas or midwives with them throughout labor, would have adrenaline levels so low as to permit their own oxytocin to flow freely, thus helping them to progress well in labor and to give birth vaginally.

One of the reasons that we in the US have such high rates of cesarean section is that we fail to make it possible for women to have high levels of their own oxytocin during labor, because we don’t understand why and how we should create relaxing atmospheres in which women can give birth.

You call breastfeeding a “lost art.” This seems to be frustrating to many women: i.e., if it’s so normal and natural and healthy, why does it seem to be so difficult?

Mammals – whatever the species – have trouble lactating or getting their milk into their young when they are forced to be in stressful environments. Milk doesn’t flow from mother to infant unless the mother and her newborn are able to spend uninterrupted time with each other. The human is the only mammalian species that routinely separates its newborns from their mothers during the first few hours following birth.

Nature never meant us to live at the fast pace that young parents are almost forced to consider normal at the present day. Babies’ cords are cut immediately after birth, and they’re carried away to be examined, washed with soap, weighed, measured, and given antibiotic eye ointments. Anyone who is serious about giving babies the best possible chance to breastfeed doesn’t separate babies and mothers for reasons like these. Nature never meant us to live at the fast pace that young parents are almost forced to consider normal at the present day.

And labor interventions can impact breastfeeding.

We tend to blame the problems on women’s bodies, or even on “nature’s design.” In fact, there’s nothing wrong with nature’s design; it still works perfectly fine, but nature never meant us to live at the fast pace that young parents are almost forced to consider normal at the present day.

It’s much easier for any woman to breastfeed if she has had the gift of watching many other mothers breastfeed. We are social creatures, and we learn from watching others. Primatologists have learned that primates in captivity have trouble nurturing their young unless they are permitted to live in social groups. We humans have yet to learn this about ourselves. A lot of our young mothers live in great isolation from each other.

Which is why you call for a “breastfeeding culture.” Is it possible in modern society?

Norway is a highly industrialized country that deliberately put together a breastfeeding culture in the 1970s in order to turn away from its previous habit of formula-feeding all but 20% of its newborn babies. They changed hospital policies, medical education, and social behavior. No longer were infant formula manufacturers able to use hospitals as places where breastfeeding could be sabotaged at the get-go. Norwegians weren’t used to seeing mothers breastfeeding in public. They learned to make accommodations for them, instead of demanding that these mothers make themselves invisible. Now Norway leads the world in breastfeeding.

Until that happens in the United States, what’s your advice to new mothers?

I hope that over the next couple of decades we in the U.S. will have learned to create places in which women will be able to feed their babies in public, however and wherever they have chosen to do this. No one ought to be rude or judgmental about a woman feeding her baby. My advice to mothers is: do what you need to do, and don’t assume that people will be judgmental or rude to you. You are doing everyone a favor by feeding your baby instead of forcing him or her to cry until you manage to go into hiding.

It’s actually healthy and good for all children to see babies being breastfed. It helps to create sanity.