Recently I had the great pleasure of interviewing the legendary midwife, Ina May Gaskin after she wrote the new and very well-received, Birth Matters: A Midwife’s Manifesta. The book is published by Seven Stories Press and is available here.
I have given birth twice in my life and I will come clean and admit that I am not one of nature’s ‘birth lovers’. My first baby was born in a birth centre and my second was born in a mainstream hospital. Both babies were vaginal births, the first a ‘no intervention style birth’ (but a long, painful, posterior labour) and the second birth an epidural birth. They were pretty successful births, all things considered – my babies were alive and well and I recovered quite quickly, but in both cases I had a lot of fear to overcome and I did not quite make it in my quest to put that fear aside. However, to this day I remain awestruck by the process of birth and my own incredible encounters with that.
Birth Matters is a profoundly encouraging book arguing a way forward for reconciling our modern lives with the act of birth. At its core, Birth Matters recognises that birthing is a feminist issue. In interviewing Ina May Gaskin I asked her all the difficult questions that had been bubbling around in my head since my own birth experiences and I am delighted to say that she was very generous, and not unexpectedly, quite fearless in taking my questions on…
blue milk: I saw your interview on a big feminist site recently and the discussion was quickly bogged down in the comments section by a very heated discussion along old lines around the debate about the obstetrics versus midwifery models of birth. Although many of us, as feminists, are natural allies to you, do you feel like feminism still doesn’t understand what you’re trying to do in some ways?
Ina May Gaskin: I feel this very strongly and have since the mid-1970s, when it became clear to me that becoming a mother was viewed by most prominent feminists as an “anti-feminist” course to take. Those who did become mothers were told that they could do it all, but their true needs were seen as detrimental to the branch of the women’s movement that was emphasizing the need for women to get out of the house and into the workplace.
I found it odd that the one creative act that no man could ever do, was put down and written about in disgusting terms by feminist writers such as Simone de Beauvoir and Shulamith Firestone (who gained far more attention from other feminists than those writers such as Barbara Katz Rothman and Gena Corea, who wrote cogently and intelligently about birth issues). I think this led de Beauvoir and Firestone, among others, into philosophical nonsense that led to a great deal of confusion and poor policy. This is probably one big reason that we have ‘one-size-fits-all’ birth care policy and virtually no regulation of assisted reproductive technologies in the US (no laws, no rules against the implantation of multiple embryos even though these involve great risks to the health of the mother).
blue milk: A big part of the modern birth experience for women is fear, it is the way we portray birth in film and on TV, it is the way we pitch public health messages to women about pregnancy, and it was certainly a big part of my experience of birth (both times) in spite of efforts on my part to overcome that by going to a birth centre instead of a mainstream hospital. Your philosophy, in many ways, is trying to redress that isn’t it? To overcome ‘fear’ as the dominant message for women about birth?
Ina May Gaskin: You’re right. The women I selected to be work as midwives with me and I were able to establish a birth culture in our small community that minimized fear and was, for at least a decade, isolated from the fear that could have been imported via television, films, and the worries coming from anxious relatives. We were successful enough in the beginning years of our practice that the evidence then spoke for itself.
This is why I like to send women to watch other mammals give birth—to see what it’s like when a female moves freely and feels what is happening, without being afraid. YouTube is good for this, especially for: “the dramatic struggle for life” (an elephant giving birth and reviving her baby who isn’t breathing in an animal park) and “chimp birth Attica zoo” for a creative way to save the perineum during crowning and birth.
blue milk: Many women my age are sceptical of anything seen as ‘spiritual’ – I think I was among them, and we were shocked to discover that we were capable of strong feelings about low intervention birth once we became pregnant because we were so certain that we were not hippies and that low intervention births are ‘hippy stuff’. Is the birth movement doing enough to reach women like me – Birth Matters is certainly impressively broad in its pitch – or should women like me ‘get over’ this aversion to spirituality (an aversion, which at its core is surely a little misogynist)?
Ina May Gaskin: I’ve long been aware of your generation’s aversion to ‘hippy stuff’, which is why I chose the bland-looking cover of Ina May’s Guide to Childbirth. That was one of my ways of reaching out, and I tried to do that with language, too. I agree with you that a reflexive aversion to spirituality is misogynist. I was amazed that women who wanted to be strong were willing to so blindly trust a medical profession that had so thoroughly destroyed, discredited or marginalized midwives for no reason (in the US) other than to claim that field of activity for itself. US obstetricians in the early 20th century realized that they didn’t know much, because women preferred midwives. Because they wanted to know what midwives knew, they decided to discredit midwives and make them illegal so they could use poor women as teaching material.
We should also recognize the reality of how mysterious birth is and how many different ways it may be perceived. We need to understand the main historical developments of midwifery and medicine if we want to grasp how important it is to find some balance between midwifery and medicine as we go forward.
blue milk: It is difficult for any movement to be both the activists and the advocates – sometimes these goals will be in conflict. For instance, I think it is a problem for the pro-choice movement in feminism to properly acknowledge the feelings of the small minority of women for whom abortion is a traumatic or regretful decision, and I wonder if you think there has been a similar problem for midwives, as well?
Ina May Gaskin: I agree with your take on how the pro-choice movement carried on in a way that allowed a backlash to develop, and I have to say that I saw that coming. When it comes to midwives, though, I think our problems in understanding what has destroyed or weakened women’s confidence in their ability to give birth go much deeper than the pro-choice movement’s lack of acknowledgement that some women regret abortions they’ve had.
Dutch obstetrics from 18th century forward found a way to exist in balance with Dutch midwifery through the 20th century in a way that was an example to the world. It’s a shame that the US model of maternity care was the one that the rest of the industrialized world imitated instead of the Dutch model.
From my perspective, it’s pretty easy to see how much the rest of the world has imitated US obstetrics, apparently unaware of the ignorance of women’s bodies upon which this model of obstetric care was constructed. Australia, for instance, imitated the UK during the early 20th century, by keeping midwifery (but a midwifery that accepted the dominance of medicine). Midwives had a certain amount of autonomy until the move came to make every birth take place in hospital. When a few women rebelled during the 1970s against the lack of choice this meant for them and started Australia’s home birth movement, organized medicine’s attack on home birth practitioners was swift and savage, with the de-registration of Dr. John Stevenson, the family physician who stood behind some of those first home birth midwives. According to what I’ve been told by countless Australian moms and midwives is that it has gone pretty much downhill since then.
I don’t know enough about the history of birth in Australia to know if there was anything close to a 67% forceps rate during the 1950s or 1960s, as there was in the US. This was a product of how ignorant US obstetrics got after half a century of there being no midwives. That 67% forceps rate went with a c-section rate of 5%, by the way, but when the late 1970s brought along a new generation of women demanding midwives, and along with that, the electronic fetal monitor and the epidural, forceps were quickly outmoded and replaced by a suddenly increased tolerance for cesarean section.
What further confused the picture was that during this period, the US reported maternal death rates that were not very different from the levels reported by other countries. The trouble was that the US figures were and still are much less accurate, because the US has never had a real health care system with consistent methods of reporting and reviewing maternal deaths—something I wasn’t able to unearth until 1999.
When medicine rules or obliterates midwifery, it becomes difficult for women to understand the power that midwifery could have if it were once again a profession whose power equaled that of the obstetric profession.
blue milk: But in an individual birth experience, sometimes the politics of the birth debate, which is such high stakes now, means that a woman’s desires are potentially in competition with both the obstetrician’s and the midwife’s interests, would you agree or not?
Ina May Gaskin: To begin with, women may easily desire the impossible—that every baby can survive if we apply enough technology and expensive medication. Too many have been seduced into thinking this is true. Women have been infantilized to a great degree, another factor that hasn’t helped. We can’t count how many women fell for the line that their sex lives would be enhanced by having a cesarean instead of a vaginal birth on the grounds that the vagina through which a baby has passed has been stretched out and ruined. I just spoke this morning with an Israeli woman who had a c-section for her full gestation twins 9 years ago and still grieves about the loss of the body she once had. Her figure is beautiful—that’s not the problem. But lovemaking has been painful for her ever since the surgery, and no surgeon can tell her why or fix her. And she knows that her surgery wasn’t an emergency but more a product of her doctor’s discomfort with the possibility that her second twin might be breech.
It would be good if we could get women, midwives, and obstetricians all to agree that it is not good for midwives or obstetricians to lack the knowledge and skills that were once considered essential to both professions. Skills that are being lost already at a rapid rate include: the ability to diagnose a false pregnancy before a cesarean is performed, the ability to safely assist vaginal birth of breech babies or multiple gestation babies, and manual palpitation and pelvimetry. I could go on, but you get the idea.
blue milk: I love that you see fathers as the great untapped resource in the movement towards kinder, gentler births. Can you expand upon your thinking here?
Ina May Gaskin: Fathers really have a strong instinct to protect their partners during pregnancy and especially during labor. Lots of men have told me that my chapter on ‘sphincter law’ in the Guide to Childbirth is what helped them understand what helps and doesn’t help their partners during labor. It also helps them to know that women’s genitals have the spectacular ability to swell and expand temporarily during the birth process and then to go back to their formerly small size without being ruined, in similar fashion to what happens during a male erection. Knowing that it is the blood flow to the appropriate organs that is needed and that this can happen only when the laboring mother is not kept from getting into the good birth trance empowers her partner to help create the conditions that help her get there.
blue milk: For people who don’t understand why birth continues to be such a hot button issue, can you explain to them, in a nutshell, why it is important that women have choice about the way they birth and why so many people want to control that decision?
Ina May Gaskin: It was an enterprising US obstetrician in the early 19th century who got the idea that medical men could entirely take over maternity care from women if they just became fear merchants instead of caring physicians or scientists. Never mind producing any evidence, he said in many more words than I just used in paraphrasing him—just scare them. That’s easier and very effective. That was Dr. Hugh Hodge, and he was right. Now we have to recognize how much harm has come and spread globally from his selfish advice, and we can then start a world-wide movement to dispel this fear and reverse the damage that has been done. I’m excited about what we can do with this now that it has become possible to piece together the long story of how fear came to dominate birth in our species.
Once fear becomes the norm, it becomes possible for a lot of profit to be made from the materials, medicines, delivery systems, advertising, conferences, and so on that pertain to high-tech maternity care as the norm. More profit is made when the number of people involved in care is diminished (especially in the US, where health insurance is so expensive). This means that fear, ignorance, and greed are interwoven and tend to cycle to ever higher levels that have already reached madness in countries where caesarean rates exceed 50% (China, for instance). Midwifery knowledge can disappear in a remarkably short time (10-20 years), to the point that women can no longer imagine what it might be like to have a midwife. (I know this, because I was that woman when I was pregnant and giving birth to my first). This is how you get a mass of infantilized women who may put up with dangerous and uncomfortable practices for a couple of generations before they get enough gumption to put things right. This is what a growing number of us are working on now in the US!
Many thanks for this opportunity.
blue milk: Thank you for the very thought-provoking responses.
I am very much interested in your own response to this interview as a reader, but please, let’s not get overly side-tracked by old arguments that have been more than thrashed out in other forums. I would really like the discussion to move on to some of the more interesting and challenging directions that Ina May Gaskin’s thoughts have taken us.