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Ina May Gaskin Talks About Fear, Feminism And "Birth Matters"

By ceridwen |

Christiane Northrup, MD calls Ina May Gaskin’s newest book, Birth Matters, “a must-read for anyone and everyone who cares about humanity.” I completely agree. In this “manifesta,”  the mother of modern midwifery explains why birth matters not just to women and babies but our society as a whole. We all need to listen to Ina May. One day this woman will be on a postage stamp. But for now, enjoy this internet interview.

In Birth Matters you write quite a bit about fear and childbirth. Can you talk about how fear in labor works on a physiological level? Where is this fear coming from?

When we mammals become afraid, the brain causes a dump of adrenaline into our bloodstream that quickens our heart rate, makes us stronger and faster, and hyper-alert. This is called the “fight or flight” reaction. It’s not the ideal state for giving birth. In fact, it’s the ideal state for stopping labor once it has started. Since our skeletal muscles are in a state of hardness and rigidity when we are full of adrenaline, it should be obvious that it would be difficult for a baby to push its way through such rigidity into the outer world. We humans suffer from the fact that we are the only species that has figured out how to scare each other about birth.

Fear of childbirth is a cultural phenomenon that has been pushed to an extreme degree in the US and other countries that have been influenced by our weird birth culture. I’m speaking of the very mainstream view that women’s bodies are some kind of accident of nature, that are unable to give birth without technological assistance at each and every birth. Part of what makes our birth culture weird is that it so emphatically tries to convince us that we are different from all other mammals. That’s kind of trap, especially when it comes to birth, since according to this superstition, they are built better for birth than we are.

Of course, we’re the only species in which the male had any influence on the position taken by the female in labor. The male of other species limits his behavior to providing any protection against predators that might be needed and otherwise, letting the female get into whatever position she wishes to take to facilitate the process of labor and birth.

It’s very easy to scare pregnant women. It’s also easy to bother women in labor enough to interfere with the comfort and efficiency of the biological process taking place. Sometimes it stops altogether. Keeping high levels of adrenaline the norm in many hospital maternity wards has become the norm. Birth is often portrayed in the same way that emergency room medicine is shown on television dramas. The emphasis is on adrenaline and “what if” scenarios. Rarely do we see any example of birth in a relaxed female, and if we do, she is not likely to be a human.

While adrenaline is the hormone that says “Stop” to labor, oxytocin is the one that says “Go”. Oxytocin flows when we aren’t afraid. It suppresses adrenaline. We feel oxytocin when we feel nurtured or help someone else feel that way. Oxytocin helps the relevant parts of the woman’s body to open enough to allow passage of the baby outwards. Good flow of oxytocin requires protected environments surrounding laboring women. The behavior of all of the other 5,000 species of mammals reflects this need for calm during labor. When we humans finally realize how important it is to create environments which favor the flow of natural oxytocin during pregnancy and labor, we’ll all be a lot happier.

When you were invited to speak to students at Yale in the 1970s, your slides of mothers with their newborns were greeted with a “vehement chorus of boos and hisses” from the “young women present.” Why were these liberated women so put off by images of birth and motherhood? And are we still dealing with that legacy today?

I think that those women had been reading feminist writers such as Simone de Beauvoir and Shulamith Firestone, whose writings expressed a strong disgust and loathing of the female body. According to this view, pregnancy was a trap for women, and those who fell into this trap were viewed as traitors to the cause of women’s liberation. Firestone’s strategy for women’s liberation depended upon “extrauterine gestation” in test tubes (she was confident that men could soon create artificial placentas). Most feminist writers of the 70s, 80s and even 90s stayed far away from the subjects of childbirth and lactation. Mary O’Brien is an important exception (except she is less well known than she ought to be). She wrote, “It is from an adequate understanding of the process of reproduction, nature’s traditional and bitter trap for the suppression of women, that women can begin to understand their possibilities and their freedom.” (O’Brien, Mary. 1983. The Politics of Reproduction. Boston: Routledge and Kegan Paul). Whatever they were reading, the dominant view about pregnancy was that it represented a loss of control over their bodies.

Out of the nearly 3000 births that have taken place with your midwifery practice at The Farm, only 1.7% were c-sections. Why is the national c-section average– now  over 30%, and over 40% in some hospitals where I live in New York City– so much higher than this? And what does this mean for women?

About a hundred years ago, the midwifery profession (which greatly predates the profession of medicine) was on its way to complete extinction in our country. This radical experiment in human behavior created a climate of fear surrounding pregnancy and birth that has grown stronger as ever more technology has been invented to solve the “problem of birth”. When midwifery is suppressed, the people who best understand birth are not permitted to have much to do with it—especially when it comes to creating norms of behavior. Half a century ago, this resulted in the very strange habit of pulling 2/3 of US babies into the world with forceps gripping their heads. Today, there is just as little faith held by the obstetrics profession that women’s bodies can give birth without medical intervention as there was half a century ago. The difference is that today’s preferred solution is the c-section in place of the forceps “delivery.” Removing any restraints and subjecting more and more women to c-sections for no good reason increases the perception that such treatment is safe and acceptable. However, there is no question about how pushing up the c-section rate makes sense in a for-profit maternity care industry. In such an industry, there is little or no incentive to keep costs down, and there is much reason to schedule birth for the comfort of the caregivers. This is a big reason why more US babies are born between 9 and 5 on Mondays through Friday, avoiding all holidays if possible.

Read an excerpt of Birth Matters — Ina May Gaskin’s “Vision for the Future” on Babble.


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About ceridwen



Ceridwen Morris is a writer, mother, and certified childbirth educator. She is the author of several books and screenplays, including (Three Rivers; 2007). She serves on the board of The Childbirth Education Association of Metropolitan New York and teaches at Tribeca Parenting in New York City. Read bio and latest posts → Read Ceridwen's latest posts →

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20 thoughts on “Ina May Gaskin Talks About Fear, Feminism And "Birth Matters"

  1. Shandra says:

    You can risk out of the Farm.

    I also think it is a little crazy to believe women did not fear childbirth before medically monitored labour. The historical record is full of women fearing labour – quite rightly since mortality rates were high.

    I think at one point gaskin’s thoughts were insightful. But now I think the natural childbirth movement has gone off the rails, moving from woman-centered CARE to blaming and shaming, a de-emphasis on real education, and a culture of determinism and incompetence. It really is too bad.

  2. Bunnytwenty says:

    Yeah, what Shaundra said. I love Ina May, but for her to claim that women only fear childbirth because of male influence? Prior to modern medicine, childbirth was not terribly unlikely to kill you. Any sane person would find it frightening. These days, there’s no reason why birth should be scary at all, since maternal death is pretty rare in the US, and she’s correct to say that the atmosphere of fear around childbirth these days is unreasonable and harmful to women, and that it’s something that needs to be tamped down on, but let’s not be ahistorical here.

  3. JayneF says:

    Since “fear of childbirth” came up in the previous comments I thought it was interesting to consider what that really means. Dying during birth is so rare and extreme that I don’t really think it’s the primary fear that women speak of when they express trepidations about giving birth. I think it’s more the UNKNOWN and the notion that “there will be pain” that drives up anxiety for many women. Ina May is saying that the hospital environment contributes to that perception, whereas birthing in a calmer, more “homey” setting alleviates fear. My feeling is that “fear” is very subjective; and while one woman may be repelled by a hospital setting another may be just as repelled by a birthing tub in her living room with no access to pain medication. Technology and intervention have their place, but I think few would disagree that they are both overused in your average delivery room. The medical community has to see this too, as witnessed by the decline of routine episiotomies, for example.

  4. moshermama says:

    My second son’s birth story is a case study in how intimidation can inhibit labor. Bully tactics included combing through the printup of a fetal monitor looking for evidence of fetal distress because the doctor swore she must have heard some distress in there somewhere with which to justify the pitocin she was pushing on me. After 9 hours under her watch along with a nurse who was terrified that I’d have an emergency situation under which she would not be able to place the IV I’d refused, I had barely made it to 4 cm. (I’d come in at 3.) I refused Pitocin 4 times and seriously felt like I wanted to wait until my chosen midwife was there to deliver.

    At the shift change at 7 pm, a new nurse came on who was much more supportive. I went from 4 to 10 in less than three hours.

  5. Jenn says:

    Well if we’re talking anecdata here I had three deliveries:

    1) My daughter, in hospital. Monitoring was mismanaged and so a 2x nuchal cord was missed, and there was no ob available at the critical point to do a c-section; she died 4 days later from her injuries.

    2) Scared out of my pants (see #1, above) and freaking out the whole time; my son was born after only a few hours of entirely pain-free early labour (so pain free I’m not sure when it started), about 20 min to go from 7 cm dilated to 10, and maybe 5 minutes of pushing if that. (“stop pushing” – good luck with that.)

    3) Heartened by #2, had a very cheerful 14 hours of early labour to get to 6 cm. Struggled immensely with contractions to get to 10 cm. It took an hour of pushing to get baby out due to a sunny side up (posterior) presentation and it hurt like all get out. No fear at all like #2.

    Funny how the position was more important than the fear in that last one. Poor babe came out totally bruised.

    It’s fine to say fear can be a factor but it’s hardly the deciding one.

  6. angelica mother of 3 ,1 is in heaven. says:

    I think that fear an also be tamed with educating your self about pregnancy , birth (what to expect), and even what can go wrong , because the more you know, the better you will feel about what can happen, no matter where you are or how you choose to do things.

  7. Danielle says:

    I have to agree that educating yourself gives you some power over your birth. I am not saying that you have to have freakish control over a situation that can very quickly become out of control, but educate yourself on what could be used, what you can actually see yourself doing. I think there are extremists on both sides of the pregnancy coin and either side can scare you into believing that you are not making the right choice. The only thing I can say is have support and educate yourself. Don’t wait until your already in labor to understand how your body is working and what can happen in a hospital. I have heard one too many of my friends not give themselves time to learn about laboring,spending a wee bit too much time shopping for baby items, and get to the hospital to be totally freaked out.

  8. Emily says:

    There seems to be a misunderstanding about the fear she was talking about. I don’t see anything that says women did not fear birth until men got involved. More about how that fear is affected by birthing practices…A calm, relaxed environment will help alleviate fear and therefore tension, whereas the environment often seen in modern birth is more fear inducing than alleviating.

  9. Nadine says:

    I understand that the US has the second highest infant mortality rate of all the developed countries. I’d say that should make us question obstetrics.

  10. Shelley Dobbin says:

    Ina May, I love you!
    Everyone should read “Ina May’s Guide to Childbirth”! I wish I had’ve read it before my first birth. I would have been more confident!
    Birth 2 and 3 were awesome! Baby 2 was a planned natural vaginal breech. It was so beautiful!
    I love giving birth! Ina May… you give so many women and men so much inspiration! Love you! xxx

  11. Amara says:

    Ina May Gaskin’s book gave me the insight to trust myself for my VBAC, this was in 2003 when all the controversy was coming out around VBACS being a risk to the hospital and doctors for ruptures. I obtained a doula (in training for free).. read and cared for my toddler.. and felt i could try to this time, feel I was experiencing birth my way. My prior c-section was unavoidable after 15 hours of labor with Toxemia. It was still something I felt good about, but I felt very managed and wanted the experienced of me managing the birth, this time around. This was for me and my baby alone and no one else.. a personal journey.

    Her book.. set the mental and emotional groundwork I needed to get past my C-section and that I too had a voice and my own personal way for giving birth that I was allowed to discover this time around, or at least given the chance.

    2 weeks late and with impending c-section in 2 days and a slight fever.. I had my second child in 3 hours and 20 min.. naturally and she was almost 9 pounds. My blessingway was a henna tattoo with a “do not cute here” written on my c-section scar :) I think it helped the nurses who were getting anxious :)

  12. Kris McKeown says:

    The reason many, many women (and infants) died in childbirth was through the habits of the Drs attending them once labour moved in to hospitals. Students would be dissecting corpses then go straight to the maternity wards and do internal exams. Pueperal fever (childbed fever) was spread by Drs moving from woman to woman without washing their hands and spreading the infection.

    Religion also had a bit part to play in our cultural fear of labour. The King James version of the bible referring to the ‘curse of Eve’ that she should always suffer to give birth, was actually a mis-translation from the original Hebrew. The suffering of labour was more a reflection on European culture of childbirth and suppression of women than any physiological fact.

    There absolutely are times when modern obstetrics is lifesaving. But the routine use of interventions is harmful for the mother and the baby and has far-reaching health implications, not just at the moment of birth.

  13. Anja says:

    I think it’s natural for women to approach labor with some fear, in the same way one might be fearful of a long journey upon which one is about to embark. The fear (of the unknown, of something going wrong) is tempered by excitement, and love, and happiness. The wrongdoing in modern obstetrics is not acknowledging that women are at times fearful of birth, it is in using that fear to convince women that medical procedures are necessary. It is wrong to pull the fear out of the woman’s emotional soup and make it bigger than it really is, or rightly needs to be. I don’t think any one in the natural birth movement denies that sometimes birth is scary, and bad things happen. We just know that mostly bad things don’t happen. And midwives are not (or at least shouldn’t be) in the business of controlling events for their convenience.

  14. NorCalRN says:

    I think it is ridiculous that the first few posters here have stated that women today should not fear death from labor and birth, since maternal death is so rare… The actual numbers tell a different story!!
    The U.S. in all our over-medicated glory is NEAR THE BOTTOM of the list when considering Maternal-Child DEATH in developed countries!! That is when we are compared to countries who RELY on Midwifery and TRUST in a woman’s body and the process of birth. That means, the incidence of Maternal-Child MORTALITY is HIGHER in the U.S. than almost all other developed countries in the World. That is nothing to scoff at, ladies. It is scary how much of our own autonomy, authority and power over our own bodies we are willing to simply hand over to a doctor and a hospital- the majority of which are simply in the BUSINESS of MAKING MONEY. THAT, is scary.

  15. Gwennie says:

    As earlier as 4 or 5 years old, when I had the capacity to consider it, I thought that childbirth was a terrifying prospect. I never discussed it with anyone, but I equated it by saying to myself, well, boys have to grow up and be soldiers…Who knows. Anyhow- I was 23, I think, when I first found a copy of Spiritual Midwifery. I read it over and over again, and it allowed me for the first time to consider childbirth to be something else than painful and scary. It turned around my whole thought process and I am forever grateful for her efforts to get that information out here.

    Thank you Ina May!


  16. b says:

    The greed and callousness of this so-called midwifery movement is astounding.

    Women and their babies died or were maimed at high rates before medical safeguards became the norm. Extreme pain was also the norm.

    Midwives today continue to have high death rates after standardizing for the type of patients they have. Almost all midwifery deaths would be preventable if in a hospital. In fact, the most common reason for midwifery deaths is the inability (due to inadequate training) to recognize lack of oxygenation or fetal distress during labor, a common problem, regardless of the risk level of the pregnancy.

    The farther midwives are from practicing within medical norms the worse the preventable death rate gets. Even Nurse-midwives or Medwives in hospitals have unusually high rates of malpractice involving surprise births asphyxiated babies. In other words, they have no idea the baby is in distress until he or she emerges blue and flopppy. Then, typically they compound the problem by delaying the summoning help of a resuscitation team. Nurse-midwfery training purports to provide them with these skills, but like many claimed skills in nurse-midwifery, the training is too minimal and superficial to allow them to help anyone in a real life situation.

    Nurse-midwives in the home have twice the death rates of those in the hospital. Presumably, they don’t have twice as many sudden emergencies that can’t make it to the hospital in time. More likely, once outside the scrutiny of others, they insert their less-is-more philosophy and merely stand around and catch as a substitute for actual clinical monitoring. Again part of this is intentional, but it a necessity for midwives as they have almost non-existent training in recognizing and addressing problems in labor.

    In two years, typically one class and a small part of the second clinical year is devoted problems in labor. The bulk of midwifery training is on gyny, prenatal, menopause, running a midwifery practice, social aspects of medicine and anything but, how to watch out for your and your child during labor.

    Of course, to get women to sign up and fork over big bucks, for basicially doing nothing, they misrepresent themselves, and claim they do everything that a hospital would do and their results are the same.

    Then there are lay midwives, CPM, DEM and anyone who wishes to call herself a midwife. They have preventable death rates 3-5 X higher than similar patients in hospitals. These are essentially baby catchers and little else. If you can give birth without harm with one of these, you could freebirth and save yourself lots of money.

    Countries with midwifery as the norm have much higher death rates related to labor, particularly related to birth attendant neglect. Once you standardize the data between countries and count all the death in utero during labor (a sign of extreme incompetence and neglect, one that is very disproporationately found in midwifery attended births) midwifery-based countries have higher birth-related deaths (which is not the same as infant death that counts up to one year and doesn’t count in labor in utero deaths) .

    You see, the reason midwives like to cite infant death statistics is because they are not standardized between countries and they don’t do a good job of focusing in on and counting labor related deaths, especially just before birth, where midwifery kills the most.

    Midwives seek to profiteer off of medicine’s success. They want to swoop in and collect the rates doctor and hospitals have to charge because they have tons of expenses in training and equipement and facilities available 24/7 that keep you and your child from dying. However, they offer nothing but insincere smiles and deception.

    They are selling pain and death a premium price.

  17. Kate says:

    I just finished reading Ina May’s “Birth Matters”, and all I can say is I applaud Ina May for her wonderful ability to educate and empower women, and to offer them the truth that in life we, as women, truly can have the safe, beautiful births we were meant to. After a textbook hospital birth full of terrifying interventions with our first child in 2006- we were in a small rural area where even the choices we had been offered were quickly reneged once we were in the OB’s hands. Our son was in the NICU for five long days after the gamut they put us through. We are now looking forward to a different experience with our child on the way.THANK YOU Ina May, Thank you.

  18. Sara says:

    B-I can’t speak for other countries but, as far as it relates to America, you are terribly mistaken in your citing of Midwifery safety. You should go to the CDC Wonder website and check out the linked infant birth/death records. You can sort by lots of different characteristics…You can eliminate all high risk PG and select only vaginal deliveries. You can run the report to reflect deaths by place of birth and medical provider (CNM, MD, DO, & other). You can also choose age of death and specify only neonatal deaths–including in utero deaths. If you do this you will find that CNMs have the lowest deaths. Then Doctors of Osteopathy. Then MDs.

  19. Angie says:

    B- You just don’t make any sense. On any of your claims, numbers or “anecdotal evidence”. Childbirth is not pain and death, you clearly know very little about it. Or maybe my near painless homebirth attended by my very skilled and experienced, gasp, CPM, doesn’t count in your book. There’s a reason many women are turning toward the “so-called midwifery movement”.

  20. Natters says:

    A great quote I love is “fear often times comes from questions never asked.” I totally agree and see in my own experience that once I did educate myself, become proactive and ask questions, the fear toned down quite a bit.

    This interview with an OB/GYN is super helpful in explaining and dispelling fear. h

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