Birth Matters

Birth Matters by Ina May Gaskin

Full Title: Birth Matters: A Midwife’s Manifesta
Ina May Gaskin
Publisher: Seven Stories Press (2011)
Number of Pages: 272
How long it took me to read: 4 days
Where I got this book: On loan from my fantastic midwife.
ISBN: 978-1-58322-927-9

Like a Moth to a Flame

I was a little familiar with Ina May Gaskin and what she stands for by the time I picked up her book. Not only has she been mentioned in nearly every work on midwifery I’ve come across, identified as a pioneer in America’s homebirth renaissance, but my dear friend Morgan, a fellow home-birth warrior woman, raves about her frequently. It was Morgan who excitedly insisted I find something, anything, to read by Ina May. And it was Morgan who giddily shared Ina May’s straightforward wisdom; for instance, that a woman’s body isn’t a lemon (as in a junky car), and that we women are not inferior to hamsters (who give birth unassisted). It was also Morgan who gave me a copy of the important documentary The Business of Being Born, which features a very eccentric-looking Ina May, a woman who my dad might look at and refer to as a “leftover hippie.” Despite being absolutely sold on Ina May’s insight by the time this book was in my hands, and as much as I knew I should read her, I was worried her writing would be dry, and was unconvinced her book would captivate me. Retrospectively, having read this and not had a chance to write about it until my babies timed their naps together, I can tell you how remarkably readable this woman is, and brilliant and insightful—not to mention surprisingly funny!

Favorite Five

I propose that the top 5 quotes from this book are:

5. “Uteri and vaginas are not like ill-functioning hearts, which, when they become sick, can have their clogged valves or arteries surgically reopened, at least temporarily, or eyes whose vision can sometimes be greatly improved by cataract or laser surgery. There’s no tinkering with the uterus in this way. We should make every effort possible not to damage it. We need to recognize that technology is humbled in some very important ways by pregnancy and birth. Many of our current problems in US maternity care stem from the fact that we leave no room for recognizing when nature is smarter than we are.” (pp.107-8)

4. “Women who have been taught to be afraid of their bodies are easy to manipulate into making reproductive choices that they may later regret.” (p.54)

3. “Spontaneously, we became a childbirth education group by sharing stories of pregnancy and birth. Together we learned how the wide variety of body types and genetic combinations represented in our community all seemed well fitted for survival, at least as concerned the ability to go into labor at the most appropriate time, to labor, to give birth, and to breastfeed. This shared experience gave us great respect for our bodies. Hundreds of us learned that women don’t have to carry the kind of fear of birth and of the supposedly ill-designed human female body that has become so widespread in mainstream US culture. We could tell from looking around at each other and knowing each other’s birth stories that our bodies were up to the task of giving birth.” (p.144)

2. “Because I had got through most of my first labor without any medication quite well (despite being forced to stay in bed) by pretending that I was a mountain lion, it made sense to me to help women think of themselves as competent animals, instead of insisting upon a notion of human exceptionalism. It seemed crazy to me to take on the belief that the human female is the only mammal on earth that is a mistake of nature. Whatever you might have heard to the contrary, we women are just as well made for giving birth as any other mammal. The fact that we walk on two legs instead of four does not hamper this ability. If we need to, it’s quite possible for us to take a hands-and-knees position, which is much like being a four-legged mammal. And special interventions in the birth process should be no more necessary among human females than they are among other female mammals, as long as we humans are well nourished, fit, aware of how our bodies and minds work, and healthy. I repeat: we humans are not inferior to hamsters, rhinoceri, squirrels, or aardvarks in our reproductive design. It’s our minds that sometimes complicate matters for us.” (p.23)

…and my pick for the No.1 quote is…

1. “There is a sacred power in the innately feminine capacity of giving birth. It is one of the elemental, continuing processes of nature that women have the chance to experience, and it is the one act of human creation that is not shared by men. Why would we not want to explore this territory?” (pp.1-2)

Conversation with the Reader

While I read, I write, and as I write, I read. Here’s some of what I wrote while I read this book:

“The forward, written by Ani Difranco, has me pondering what she refers to as the ‘great pharmaceutical empires’ built with the purpose of wiping out all pain, physical and emotional. These empires, she says, teach us that pain is an enemy rather than a teacher. Looking at it from her angle, viewing pain as a catalyst for great triumphs throughout human history, she raises an interesting question: why are we dodging pain? From an evolutionary standpoint, I guess that question sounds stupid. We don’t go out of our way to inflict pain on ourselves or others, and we have entire hospitals and drug companies founded on the desire to keep pain from happening and to stop it if it does happen. And that makes sense if you are sick, or if you get hit by a car, but even so, once you survive something, don’t you share your scars? I have a scar on my left heel that I’m very proud of. I love telling people about the stitches, my first ride in the ambulance when I was only six or seven years old, the way I was afraid I would bleed to death after my foot got caught in the spokes of my sister’s bicycle. I got through it, and I think that’s what people like to hear and talk about: survival, meeting face to face with fear and conquering it, learning something about yourself and the people around you. ‘Getting through it’ makes us proud to have lived. Great accomplishments are accompanied by struggle, and our aches and bruises and calloused hands prove our hard work. I’m not saying we need to chase danger or seek out pain, but when it does attack, we should get through it, live out our emotions honestly, stare down the fear and overcome the pain.

“So in the context of childbirth, I have to wonder why we women, in a time of so much empowerment, feel like we need to be saved from what our bodies do naturally. Are we nothing more than powerless princesses locked in a tower by the dragon of childbirth? Don’t be ridiculous. We fight for so many other things—why not control over the most intimate moments of our lives?”

“Gaskin shares her experiences with second-wave feminists in the sixties and seventies. These were women who referred to babies as ‘parasites’ and felt that advocates for natural birth were traitors to their gender. When speaking to female students at Yale on the beauty of natural childbirth, showing slides of glowing mothers holding their newborns, she was met with boos and hisses. She realized that their version of feminism rejected the innate empowerment of pregnancy and birth.

“One of my good friends has railed fiercely against the idea of having children for as long as I’ve known her, launching at random into vicious tirades outlining how it doesn’t make sense to her why a woman would ‘do that’ to her body. As someone who has always instinctively wanted to raise children, her comments have definitely been hurtful. One day, on a rant against motherhood and pregnancy, she said, ‘What is wrong with these women that they want to do that to themselves?’ Tired and annoyed, I snapped, ‘You know, most women want children; maybe there’s something wrong with you.’ She dropped the topic, at least around me, for another few years.

“I can’t defend my statement that there may be something wrong with her, as it was made in a mean effort to shut her up. At this point, I would say that the only thing really wrong with her was that she was being rude, and regrettably, the only way I could think to stop her hurtful comments was to be rude in return. The truth is, not every woman is maternal by nature, and that’s okay! If a woman doesn’t want to have children, she shouldn’t feel pressured by society to make such a huge, life-altering commitment. Similarly, women like me who do want to stay at home and raise a family shouldn’t feel pressured by society to sacrifice that desire for a career. I feel very blessed that my husband would support me in either direction, and that my personal decision to stay at home with our babies has been a good thing for all of us.”

“As births moved from homes into hospitals, the phenomenon of a cervix closing and labor slowing, sometimes to the point of actually stopping, became commonplace, which was understood by midwives but not necessarily by doctors. Often, discomfort, fear, and pain—all things caused by an unusual setting or the presence of an unwelcome person—will halt a labor in its tracks. As you may know, Pitocin, a synthetic form of oxytocin, can turn that around.

“While Pitocin does a fair job covering one or two of oxytocin’s tasks, there are so many things it can’t do that I wonder if we really should be casually comparing it to oxytocin. Yes, Pitocin does speed up the labor process, and can slow down bleeding, but the oxytocin that is naturally secreted by a laboring woman does so much more. As long as it’s not pushed out of the game by synthetics and drugs, a woman’s natural oxytocin will also bring about feelings of love, which most people know, but also trust, gratitude, and curiosity, which I did not know. It makes sense now as I consider the way I felt so connected to my midwife, Bettie, after having my baby, and how interested I was in getting to know my son immediately after he was born, without feeling tired or hungry or anything. To be honest, the amazing happiness and health I felt at home was so different from the anxiety and pain I felt after the hospital birth. After my home birth, the only medicine I took was an Ibuprofen to stop a headache brought on by pulling an all-nighter. This was a pleasant surprise; after my hospital birth, I was taking pain medication for weeks, as I felt I had taken a stern pummeling between my legs. I remember that pain as being far worse than the pain that came with pushing a baby out.”

“An interesting study on expectations of labor compared Dutch women to American women and found that the Dutch women didn’t fear pain nearly as much, and the women who didn’t fear or expect pain were less likely to experience it, and in turn, less likely to ask for medication. Far more American women expected pain and medication, and received both. In other words, we have the power to create these self-fulfilling prophecies. I sometimes wonder if I would’ve asked for medication if I hadn’t been told for years how bad Pitocin contractions were. I found out later my mother hadn’t lasted as long as me with her Pitocin-induced labor before asking for medication. Could I have made it all the way to the end? This is the kind of thing I keep thinking about even though it fills me with guilt.”

“Around the 1800s, doctors began to teach that birth was dangerous, because that was the only way to convince a woman and her husband to allow a male obstetrician to administer vaginal exams and to take control of the birth. If a woman didn’t think she was in danger, there was no way she would sacrifice her modesty; if a husband didn’t believe the lives of his wife and child may be at stake, he wouldn’t allow another man to touch his wife. It was an easy enough myth to spread, evidently. In time, men were barred from delivery rooms and had no idea what was happening to their wives. This was the new normal: fearing for your life so that you could concentrate on that rather than the feeling of being violated.

“I work so hard to try to carry on a light-hearted conversation through the oddity of a vaginal exam. I stare at a fixed point on the wall and attempt to babble my way out of my discomfort. I remind myself I’m being examined by professionals, and I’m nothing special when they see this all day, but then I feel bad about myself at the thought of not being special. And then I have to shut off my brain because there is no right answer and nothing is going to make me feel better when those are my options: being special and feeling tainted, or not being important at all.

“When I was entering the hospital to have my first baby, I was afraid of experiencing that loss of value, and the only way I had to even attempt to calm myself was to say that this was normal, all women go through this, I could turn off my emotions and just have a baby. But I couldn’t. I really couldn’t. It isn’t normal or good to shut off your feelings. You wouldn’t shut off your emotions during sex or even during eating dinner and expect it to add to or help the experience, to make it go faster or easier. You need your emotions during the most basic human events of your life. Your emotions make you human. Your instincts for pleasure and against pain, the ability to listen to your body, those create moments worth experiencing.

“Even animals, who don’t feel humility or humbleness or the desire for privacy and modesty the way we do, want to be alone at birth. A human woman, then, shouldn’t feel like she should have to sacrifice that basic comfort. Why pretend we are less than animals during such a sacred moment as birth? We can’t be forced into a more convenient birth that goes against our instincts and expect not to experience heartbreak when we know we are capable of beauty, power, force, and magnificence. Being able to really feel each emotion and sensation, to know your reactions and respond to your body, are what enable you to physically, mentally, and spiritually add to the experience of birth and deliver you triumphantly to the absolute miracle of bringing forth life.”

“In the early history of obstetrics, the doctor’s go-to for a baby in the wrong position was to reach in with the forceps, even if the mother’s cervix wasn’t dilated. This was risky for both the mother and the child. Gaskin mentions that midwives, having a far longer history of experience as a whole, have a great many more ways to deal with this, belly-dancing to encourage the baby to move properly being one of them. While I didn’t do that, I did go in for a 40-week check-up to find that within a week’s time, my baby had flipped from ready-to-be-born-naturally-at-any-moment to oh-my-gosh-he’s-feet-down-how-did-this-happen? This was an emergency situation. I was term, and my home was two hours away from the nearest delivery ward, meaning that it wasn’t safe for me to attempt a breech birth.

“We discovered this on a Friday. I didn’t comprehend it all at first. I’d been so used to being pregnant that it seemed like it wasn’t ever going to stop, so some part of me felt like I had all the time in the world. Then I realized what it meant for me if the baby didn’t flip. My distance from the hospital meant, at best, a scheduled induction that may end up being a vaginal breech but most likely would end up being a C-section, and some doctors would probably just prefer to schedule the C-section, especially since my last baby had been on the heavy side. I had been feeling so proud of myself, eating healthily, working to keep my iron levels up, getting closer to my dream birth, and I felt it all slipping away from me as I crumbled in a chair, wondering what use my faith was.

“As my midwife Bettie gently explained the situation, I nodded bravely. My hair was in braids that day, and I remember thinking in that moment how stupid I looked, a stupid little girl in pigtails thinking she could do anything she wanted—then slowly, my lips trembled, my wide eyes quit staring and gave way to the blink that spilled tears down my face. My husband brought me a plate of animal crackers and Bettie brought me a drink. We talked about my limited options. She gave me a card for a chiropractor in my area who could do some neat trick that might flip my baby back in place. She scheduled an appointment for me for the coming Monday at a hospital where they could do an ultrasound to see just where the baby was. She told me that the hospital had worked with her before and was much more accepting of her than other hospitals, even asking her opinion on certain cases. She told me that she knew they let mothers do skin-to-skin after C-sections, making it as natural an environment as they could. It was comforting and terrifying. She gave me a booklet with exercises I could try to move the baby into place. She showed me one where you start with your knees on the sofa, put your hands on the floor, crawl forward… I remember thinking how cute her outfit was and how stupid it was to think about how cute she looked as she showed me this one thing that might change my life. She told me to call her that night after seeing the chiropractor to tell her how things went.

“Before I left, I asked her to pray with me. She and Justin and our toddler put their hands on my belly and we prayed quietly. I gathered strength. I managed to be calm as we left and I called my family to tell them what was going on and to ask for their prayers, as well. I thought of this and I thought of feeling so exposed again, but this time, cut open on a slab for masked strangers to yank life from my organs. But I told myself that I could not have come this far for God to leave me. I told myself to keep my faith even when I felt like a stupid little girl. The end hadn’t come yet. Why waste my time in misery?

“The chiropractor was closed.

“Bettie and I texted back and forth—she had a friend at the hospital who recommended an external version procedure. I could go in Monday and more or less be professionally prodded until the baby maybe switched places and maybe didn’t. The risk was that I could go into labor and deliver at the hospital, and that it may be an emergency C-section. Since that was the risk anyway, I decided to take that last chance.

“When I got home, I climbed onto the sofa and crawled off. I arched my back like a cat and shook my hips like a dog wagging her tail. I placed my ironing board at an angle on my sofa and, with Justin’s help, heaved the ridiculous weight of me on it to recline upside down for twenty minutes, blood rushing to my head. All this time, I prayed. I spoke to my baby. I thought of my child moving inside of me, what it must look like in that cramped space, what it must feel like to move. I opened the ‘Spinning Babies’ workbook from Bettie and looked at the illustrations, read how to learn what was an arm, a head, a leg, a bottom, and flattened myself on the sofa, pushing my stomach around to try to guess. I did this all weekend, over and over again. On Sunday, my father called to tell me both the churches he pastors had prayed for me. Bettie was praying for me. My other midwife, Laura, was praying for me. Everyone was praying for me. I wasn’t a scared little girl, alone in her stupidity. I was in the midst of a community and I wasn’t alone.

“Sunday night, Justin’s sister came over. I gave her instructions to care for our son, and packed my bags. Justin and I barely slept before piling ourselves into the car and driving out the two hours to the city, praying and hoping the whole way.

If the baby has moved, Bettie had told us, they’ll think I made a mistake. They’ll think I felt the baby wrong. They won’t believe that anything you did worked. And that’s okay. I’m all right with them calling me stupid.

“Somehow, Justin and I managed to be cheerful and friendly with everyone whose path we crossed at the hospital that day. We joked with the nurse who showed us into our tiny room overcrowded with machinery. We told her how silly I looked pretending to be a bat while trying to move our baby. She told Justin she had only just met me and she already loved me, and that she really, really hoped the baby had already moved.

“The doctor, a girl just barely older than me, came in and introduced herself. We began with an ultrasound, to see where the baby was.

The baby had moved.

“The nurse cheered and hugged me, I high-fived the doctor, and I was ready to go home! The hospital wasn’t ready for me to leave—I hadn’t even been there an hour and my entrance form was incomplete. I answered a few more questions, was introduced to another doctor who put my hand where my baby’s head was, and after I was left alone to dress, I happily snapped pictures of the bed I was barely in and the bucket of mysterious hospital clutter that wasn’t used on me, hoping to illustrate the picture for my child in the future. This was now part of our story.

“I was a happy, beautiful woman surrounded by love on her way to a triumphant natural birth in the comfort of her own home.”

Gaskin mentions Wendy Kline’s book Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave, something I may want to read later. In it, she discusses, among other things, the difference between various feminists’ approaches to our bodies. For instance, the twelve feminists who collaborated on Our Bodies, Ourselves in 1970 promoted the female body as the center of a woman’s identity, whereas women like Simone de Beauvoir and other ‘equality feminists’ sought equality by de-emphasizing a woman’s body. What an anti-woman concept! That idea would have to be based on the thought that men are inherently greater than women. Our bodies are not things we have to overcome. They are what we are blessed to work with, what make us women to begin with. To work against our bodies is to work against our inheritance as women. They are not what make us weak but what make us strong. Femininity is not synonymous with weakness. We should work with our strengths, not against them, and be strong as women, rather than assume masculine traits as though that were the better thing to be. We are different, not unequal.”

“Towards the end of her fascinating and well-researched book, Gaskin touches on the elective C-section fad. After reading about so many fights women have had to avoid C-sections, after the many stories of women denied a VBAC (vaginal birth after cesarean), the devastating stories of women given C-sections when they didn’t want or need them, it floors me that there are healthy women who schedule them as easily as they might schedule a pedicure. One of my good friends has often voiced her desire for an elective C-section, and her reasoning is that she doesn’t want to mess up how she looks ‘down there.’ It isn’t entirely vanity on her part—some of it, certainly, is fear. This is a woman who, like so many others, has been raised to fear her body, a woman who has learned her worth is directly linked to the state of her vagina, that her value is in the quality of sexual intercourse she can provide. That viewpoint assumes that a C-section is better than a vaginal birth because her husband wouldn’t look in disgust at a small scar on her abdomen, so a potentially dangerous surgery is better than a natural birth.

“Society’s peculiar relationship with breasts certainly adds to our collective discomfort with our bodies. I’m sure you’ve heard stories of women frustrated by the negative reaction to public nursing just as I’m sure you’ve heard them express frustration at how flashy Victoria’s Secrets ads are. There is some confusion about when, where, and how breasts are acceptable. Another friend of mine is uncomfortable with the idea of breastfeeding, insisting that breasts are for husbands and not for babies. But we women haven’t been cursed with single-use bodies. I can see where the confusion is: how can our bodies be utilitarian, decorative, and pleasurable? Men’s bodies are perhaps a bit more straightforward.

“I can tell you this: my body wasn’t confused by my labors and isn’t confused when my baby nurses. My instincts tend to override my brain where my children are involved. We can fulfill all of our biological roles without detriment to any of them, like masterful Swiss army knives. There are equal places for maternity and sexuality. We just need to foster better relationships between ourselves and our bodies, and try not to hinder healthy relationships in other women by projecting our own fears onto them.”

“I conclude this book amazed at how little I knew previously about vaccines, drugs, the dangers of C-sections, breast implants, and birth control. Part of me wants to call every woman I know and inform her of these things, and part of me sheepishly wonders whether I was the last one to know! I went through my first pregnancy quite unaware of the detrimental effect of Pitocin, even though I had been given The Business of Being Born and stubbornly, afraid of being afraid, left it unwatched in a stack of DVD’s. The news is there already. We can know all of these things. We can make informed decisions. I guess it’s just a matter of whether we want to go the easy route or the hard route. There is much that is easy about going along with a hospital birth: there is little to think about, and you can choose to trust the professionals, who have delivered so many other babies, rather than trust yourself, whose purpose in life at this point is to birth your child. I can understand not wanting to know what decisions might be dangerous when so many of your friends and family have walked this easy path in front of you.

“It is much harder to go along the unknown path, doing research that will almost certainly end up frightening you, and finding out whether your insurance will cover the costs of a midwife. It is scary not to know whether your friends and family will support this controversial decision, a decision that would fly in the face of their decision to stay on the beaten path. But it was when off the beaten path that I learned what I was capable of, and it was there that I discovered my crazy decision was supported by more people than I had counted on.”

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