Spiritual Midwifery. Ina May Gaskin. The original Spiritual Midwifery, published in , introduced an entire generation of young women to the possibility of home birth and breast feeding. It also breathed new life into the all-but-vanished field of midwifery.
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One Monday morning last spring, Ina May Gaskin got into her golf cart and drove it down the dirt road away from her home on the Farm, a community of residents on a former commune in rural Tennessee that her husband started in the s.
She pulled up to the community center, where she would be teaching a class on delivering breech babies. The class was part of a weeklong seminar Gaskin and her fellow midwives were offering to an eclectic group: nurse-midwifery students attending for college credit; a Boston-area family-practice doctor; midwives from around the country; and one, from Australia, who went by the one-word moniker Macca.
They had traveled to this corner of southern Tennessee to learn from the founding mother of the natural-birth movement. Gaskin began her presentation. Footling breeches, which are thought to be the most difficult, in our experience, they often just slid right out.
Her gray hair, trimmed since the days when she wore it in thigh-length braids, was loose and a bit wild, and she wore jeans, gardening shoes and a homemade jacket. Gaskin, a longtime critic of American maternity care, is perhaps the most prominent figure in the crusade to expand access to, and to legalize, midwife-assisted homebirth.
Although she practices without a medical license, she is invited to speak at major teaching hospitals and conferences around the world and has been awarded an honorary doctorate from Thames Valley University in England. She is the only midwife to have an obstetric procedure named for her.
Gaskin cued up a video of a birth that took place in the s. Although ACOG modified that view in , more than 90 percent of breech babies are now born by Caesarean, and the Farm is one of a dwindling number of places in the United States where practitioners still know how to perform vaginal breech delivery.
Judy made increasingly urgent sounds — something between a Tuvan throat singer and a squawking chicken — as the buttocks inched out. Gaskin paused the video. She restarted the video to show how that situation could unfold. On the DVD, a younger Gaskin, wearing a sleeveless dress, moved without a hint of nervousness. The Tuvan throat sounds escalated. Gaskin let the baby, half-born, hang out of his mother and dangle off the side of the bed. Using the weight of his body to traction his head into a better position, she pulled him out with a rush of bloody fluid.
The boy looked a little limp, but after a vigorous rubdown and some gulps from an oxygen tank, he gave a cry. I first learned about Gaskin when I became pregnant last year. It tells of how Gaskin and other women discovered that birth could be a euphoric experience, a way of accessing a uniquely female power.
It has been translated into six languages and sold well over half a million copies. I viewed the book with equal parts fascination and trepidation. Unmedicated home birth is being chosen by a growing minority of women.
Between and , giving birth at home increased 29 percent. Most of this rise is among white women. Currently about one-third of all American babies are delivered surgically. Most U. There are also often deadlines for the length of time a woman may be in labor before surgery is required, and many doctors will not perform a vaginal delivery after a previous Caesarean. Gaskin says the American approach to birth is not serving women and babies. The United States spends more on health care than any other country and more on maternal health than any other type of hospital care but is ranked 50th in maternal mortality and 41st in neonatal mortality.
Gaskin and many of her fellow midwives have no formal medical training, and the fact that they have good outcomes even with births that obstetricians consider high-risk — breeches, big babies and vaginal births after C-section or VBACs — is evidence, she says, that for most women less interventionist care is better.
Of course, comparing the Farm to hospitals is of limited value. Many hospitals deliver at least as many babies in a year as the Farm midwives have delivered in three decades. Women who give birth at the Farm are self-selected, and midwives screen them further, eliminating, for instance, women with complicated medical histories. Hospitals would undoubtedly have better outcomes if all pregnant women arrived in excellent health. Is it actually safer for a low-risk woman to give birth outside of the medical establishment, as Gaskin claims?
Natural-birth advocates point to studies in countries where home birth and midwifery are part of mainstream medical care — in the Netherlands, 30 percent of births take place at home — which show home birth to be equally safe for the baby. I went to Tennessee to meet Gaskin when I was five months pregnant.
The Farm has the sleepy feel of a utopian community post-fervor, a slightly ruined idyll on 1, acres of forest. One paved road connects a network of dirt roads where trailers, solar-powered permaculture huts, a geodesic dome and regular suburban houses coexist. In , having returned from the Peace Corps, she was living in San Francisco with her husband and young daughter and teaching English.
Ina May and her husband went to hear Stephen Gaskin, a professor at San Francisco State College who held a weekly session called Monday Night Class, where young people processed their acid trips. Reed thin and over six feet tall, with long stringy brown hair and a beard, Stephen Gaskin opened class with a lecture, delivered cross-legged, drawing on geometry, Taoism or the New Testament, and then took questions. Around of his followers decided to join him in a bus caravan.
Ina May, then 29, and nine other women on the trip were pregnant. She was strapped down and given an episiotomy and a forceps delivery, standard hospital protocol at the time.
Other women also had bad birth experiences and wanted to avoid hospitals. They passed around a Mexican midwifery manual and agreed to support one another in labor. Gaskin attended her first birth in a bus parked at Northwestern University, where Stephen Gaskin was speaking. The participants in the caravan settled in Summertown, Tenn. They took a vow of poverty and veganism and lived communally. Members built latrines, acquired horses and tractors and plowed meadows. The progenitor of the modern natural birth movement was a British obstetrician named Grantly Dick-Read.
Dick-Read was in part hoping to persuade working women to come back to the home and have more babies. He said that non-Western women, free from negative ideas about labor, gave birth more easily, and he recommended using fewer medical interventions. But for much of history many feminists have come out on the side of fleeing from nature, not embracing it.
In the early s, feminists played a significant role in moving birth out of the domain of midwives and the home and into the hospital. In , a group of suffragists, professionals and housewives formed the National Twilight Sleep Association to lobby for access to scopolamine, an amnesiac that when paired with morphine allowed women to go into labor and forget the experience afterward.
In retrospect, twilight sleep looks barbaric; women on the drugs thrashed violently and were often hooded or placed in cage-beds while they labored. But many women demanded it, staging meetings where they testified about the benefits of twilight-sleep birth: shorter, less painful labors, better breast feeding, fewer forceps deliveries and an easier recovery.
In the s when Gaskin began advocating for natural-birth options, she found herself at odds with feminists who were focused on getting women into the workplace and out from under the constraints of family. She was even booed off the stage in by a Yale feminist group. Some feminists, like the theorist Shulamith Firestone, hoped ardently for the day when human reproduction would be handled completely by machines.
The idea then was that biology was not destiny, and we should transcend it. For Gaskin, choice in birth remains a realm of reproductive freedom that mainstream feminism, until recently, has foolishly ignored. She thinks that women should seek not just the freedom to decide whether or not to have a baby, but how to have it. At the end of the breech-birth presentation, Gaskin got a call from another Farm midwife, Pamela Hunt, who had just delivered the baby of a woman who was staying at the Farm.
Gaskin headed to her birthing cabin. Inside, she found Hagino Hargis, who was 28, naked on a wicker bed with her tiny daughter at her breast under a heating blanket. Tiny veins were visible through translucent aquatic eyelids. Her cord, twisted like a fiber-optic cable, was still attached to the placenta, which bubbled lightly in a bloodied salad bowl next to Hargis.
Hargis had driven from Kentucky with her husband, 3-year-old son and mother the previous week as she neared term. Her primary midwife was Hunt, and Gaskin planned on attending the birth. But after a week of going for walks, baking cakes and painting a labyrinth to meditate on during labor, Hargis had given birth very quickly. Hunt barely had time to get her gloves on when she arrived and found Hargis on her hands and knees, about to deliver. Hargis looked uncertain. In most states, the procedure is required by law.
Farm midwives also recommend using the ointment — they know that some infections can be asymptomatic and they think the ointment is harmless. The midwives then advise of the risks and let the woman decide. Hargis had tested positive for bacterial vaginosis. Hargis looked to her husband. OB-GYNs are very vulnerable to lawsuits. According to the Physician Insurers Association of America , they pay the most in damages of any medical specialty.
The charge frequently leveled against practitioners is that they did not offer a medical intervention or did not offer it early enough. Her midwifery clinic has never purchased malpractice insurance or been sued. For years, when the commune was a true collective, she did not even accept payment for attending births. Farm midwives give intimate intensive prenatal care and have a high degree of trust with their patients.
Midwifery was outlawed in some states as an independent profession at the turn of the century. Soon after, it was reinvented as an extension of a nursing degree, under the management of obstetrics. Today certified nurse midwives largely practice in hospitals and generally rely on obstetricians to grant them privileges.
The registry, whose accreditation office is in a trailer on the Farm, grants an alternative certification and title — certified professional midwife C.
When I visited the Farm, Gaskin was planning to travel to testify at the trial of a C. She pleaded guilty to lesser charges. I pressed Gaskin about the case. She conceded that his life would have been saved but said that hospital birth comes with its own risks. So midway through my pregnancy I switched from my obstetrician to a certified nurse midwife in a well-regarded New York hospital.
When I reached my due date, an ultrasound estimated that my baby weighed 9.
Ina May Gaskin's 'Spiritual Midwifery': All About Home Births
There's a growing national interest in the subjects of home birth and midwifery as couples who are about to have children feel an urge to return to more natural and appropriate birthing practices. The idea of an aware, drug-less childbirth in the comfort and security of one's own home attended by an experienced midwife with one's husband and any previous children in the family close by to greet the new infant is one that just 'feels right" to an ever increasing number of mothers-to-be. In Europe, as in most other parts of the world, the majority of births still take place in the home. Only in America do the greater number now occur in hospitals.
Mommy Wars: The Prequel
One Monday morning last spring, Ina May Gaskin got into her golf cart and drove it down the dirt road away from her home on the Farm, a community of residents on a former commune in rural Tennessee that her husband started in the s. She pulled up to the community center, where she would be teaching a class on delivering breech babies. The class was part of a weeklong seminar Gaskin and her fellow midwives were offering to an eclectic group: nurse-midwifery students attending for college credit; a Boston-area family-practice doctor; midwives from around the country; and one, from Australia, who went by the one-word moniker Macca. They had traveled to this corner of southern Tennessee to learn from the founding mother of the natural-birth movement. Gaskin began her presentation. Footling breeches, which are thought to be the most difficult, in our experience, they often just slid right out.
Ina May Gaskin
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