I had the great pleasure of interviewing Ina May Gaskin last month upon the launch of her new book Birth Matters. This is the second part of that interview. I thought it would be nice to post it today, the International Day Of The Midwife.
Birth Matters is a “manifesta,” a response to the crisis in maternity care we face today. Just this week America was given the lowest ranking in the developed world when it comes to maternal mortality. There’s no question that things need to change. One way we can improve outcomes is to reduce the number of unnecessary interventions in birth. There’s so much the midwifery model of care can do to help in this respect. But, unfortunately, unlike other places in the world, midwifery is not considered a mainstream option here.
It can be hard to get used to the idea of a midwife when you’ve grown up assuming that doctors are the only ones qualified to care for a woman in labor. Many people in America don’t know exactly what a midwife is. I wasn’t aware of the midwifery model of care when I first became pregnant. And I definitely wasn’t aware that I had the option of giving birth with a midwife, in a hospital, or at home, and have it be entirely paid for by my insurance.
So often the conversation turns at this point to us vs them. Doctor vs. midwife. And though those conversations/debates can be incredibly productive and important, the truth is pregnant and laboring women really should have it all. We should have midwives, doctors and specialists (in case they are needed), doulas, nurses, the freedom to labor at home and/or a birthing center and/or a hospital. We should not have to pick a side. We should not be made to feel afraid of “what the hospital will do” or told that birth is “inherently risky.” We should feel supported all the way through by both the vast, artisanal skills of midwives and the honed abilities of well-trained specialists, should they become necessary. Right now the scales are tipped too far towards technology. With the help of Ina May and other midwives, maybe we can tip them back a little. Call me middle-of-the-road, but I am a fan of equilibrium.
And on that note, a few words from the conclusion of Birth Matters:
“It’s time to stop the witch hunt and save both midwifery and obstetrics by educating women, future midwives, and future doctors in the wisdom of nature’s design for birth. All the woman and men–midwives, nurses, obstetricians, and doulas– who preserve the midwifery model of care, and honor the medical oath to first do no harm, deserve our admiration and our support… ”
You’ve been dubbed the “mother of modern midwifery,” but some may be surprised to learn how you’ve been influenced by, and, indeed, influenced, many obstetricians over the years. Though conversations about birth these days can quickly become polarized (hospital vs. home, natural vs. medical), a mutual respect between doctors and midwives can be incredibly beneficial to women. What have been the more positive collaborations between midwifery and medicine in your personal experience?
I was very lucky to have met quite a few humane, compassionate, experienced obstetricians or family physicians during the 70s. The seminar in emergency birth techniques that Dr. Louis La Pere provided me and my assistants just before birth #4 enabled us to safely deal with a tightly wrapped umbilical cord, a resuscitation, and a postpartum hemorrhage, without needing a hospital transport. In similar fashion, the help we got from a family physician with years of experience working with Amish for whom home birth was the norm, enabled us to form a good working relationship with hospital staff in our area during the time when we were new in the area and perceived as outsiders with strange ideas. He bragged about us endlessly. He knew full well that the women and babies from home births were much less likely than women who had hospital births to have post-childbirth infections. As part of a generation of US physicians who trained to consider the skills associated with breech birth as essential, he was happy to demonstrate what he knew about it to us. Thus we learned not to fear the footling breech and how to perform an internal podalic version in case of extreme emergency.
Maybe because I had an older brother who taught me a lot of neat things, I have not had a problem learning from doctors of my father’s generation (there were very few women doctors during the 70s).
You’re a big fan of Japanese obstetrician Takao Kobayashi. Why do you think he should be considered a “national treasure”?
I don’t want to take anything away from Takao Kobayashi, but I was actually writing about Dr. Tadashi Yoshimura when I brought up “national treasure.” He impressed me because through conscientious observation of women in labor, he was about to get it that what he had been taught in medical school was actually harmful to women’s ability to give birth. Gradually, he learned how to back off and keep his hands off of and out of women—not to mention off of instruments. What he picked up instead was a camera, and he has captured some of the most beautiful photos I’ve seen during the ecstatic moments just after birth, as parents and baby experience together wonder and joy of birth.
As laypeople trying to understand the implications of our choices, can you give any advice about navigating the tangles of conflicting studies about safety in birth?
Read Birth Matters. I deal with this issue extensively, in a way that I hope is easy to understand.
In one of the birth stories in Birth Matters, Charlotte Hamilton writes that at the very hardest part of her labor, “it was almost impossible to talk even though my mind was very lucid and thoughts were crystal clear.” From outward appearances laboring women can seem ‘out of it’ or in a ‘trance,’ but mentally they are in a state of heightened awareness. I find it encouraging to think about being at once more animal and more mentally astute during childbirth– can you speak about that seeming contradiction?
Our culture teaches that a trance state means that we are oblivious to what is going on around us, when it actually means that we are in a state of heightened awareness. However, this awareness is one in which feelings of the body are not suppressed by the thinking mind (the part of us that makes it possible for us to scare ourselves). That part of the brain is the part that’s active when we are expressing ourselves in words. In the trance state that one enters while deep in labor, it may good to make low, deep sounds that aid relaxation, but only some women (obstetricians, for example) will benefit much by chanting comforting words (I know one who chanted, “I will too open another centimeter,” etc.)
The words “privacy” and “kindness” come up again and again in Birth Matters. What do these words mean to you?
Privacy and kindness are essential, non-negotiable requirements for environments which favor birth-giving. They’re human needs.
In a chapter titled, “What’s a Father-To-Be To Do” you tell the male partners that in labor, “she leads, you follow.” I think this is great advice. Are there any examples that come to mind?
I think of my friend, Naoli, who, in labor with her daughter, favored the progress of labor by holding her husband by the arms and walking as her uterus did its amazing work. If she went backward, she felt more pain, but if she walked forward and he walked backward, she had deep feelings of love and energy and opening. Guess which way they walked?
Though you outline in great detail the ways maternity care in the US is in crisis, I’m not alone in thinking that your books have done more to inspire and encourage women that send us into spirals of gloom. How can we use this inspiration to make positive changes?
We teach other women that it is a fine thing to have a female body and how not to fear it. We need to teach our sisters the real dangers that are out there, because there are plenty of powerful entities in our society that seek to profit from the fears that are so easy to exploit in young women who believe most of the negative stuff that is pumped in our mainstream culture. I recently read an essay by a woman of 28, who was about to have her ovaries hyper-stimulated so she can have some of her eggs harvested and frozen. Why? She doesn’t see herself being mature enough to raise a baby now or, perhaps more important, even find an acceptable male partner, and she’s pretty sure that when she finally does approach that point of maturity, her eggs will all be spoiled with age.
I think the cautionary tales about the medical experiments that have taken place in the past (and didn’t turn out well) are just as necessary as the inspiring stories of how well birth seems to work in cars in traffic, hospital parking lots and even women’s homes when labor strikes super fast. Let’s get over the silly superstitions that say our bodies are more screwed up than any other mammals’. They’re not—if we free ourselves from the rules and restraints that have been imposed on human females. When women get wild in hospitals, we’ll be experiencing much less fear about birth in our society in general. I’m pretty sure that we could dispense with a lot of the furniture that is commonly there in birth rooms if we set our minds to it.
The first part of the interview can be read here.