Ina May’s Guide to Childbirth

by Ina May Gaskin, 2003, 2019

Recommended by Adam. This one was not as organized as the Susan McCutcheon book, Natural Childbirth the Bradley Way. Ina May is a midwife. She has been for decades. Her book, Spiritual Midwifery, was first written in 1975 and has been updated 7 times. She started a birthing center in Tennessee called The Farm. Pregnant women were welcomed there to live and work and have their babies naturally. They had very successful outcomes, story after story, even with breech babies and other complications. The book starts with many (49) personal birth stories. There are all types; young, old, easy labor, hard labor, single mothers, married, breech, etc.! I didn’t read them all.

The second part is all of the information and evidence for natural childbirth, given in a very conversational style, but not as organized, nor as forceful or convincing as the Bradley book. The same conclusions are made, though, and that is that our modern medical establishment has botched childbirth, and most of the interventions we do are not necessary and actually do harm. We make women think their bodies are faulty, when in actuality, a women’s body and mind, left to themselves and with the loving care of a knowledgeable midwife or Doula, is more than capable of having a completely natural birth experience. Natural childbirth is immensely safer and better for everyone involved.

Several tidbits:

The mind-body connection – a woman in labor can actually stop labor, reverse it, if she is tense or anxious. Doctors in the labor room can cause this. Then, the doctor thinks there is something wrong that needs intervention – induce, etc., etc. Actually, what is needed is for the stress to be lessened, let the woman get up, walk around, eat, have privacy, etc. Then labor re-starts and babies are born naturally.

“Remember this, for it is as true as true gets: Your body is not a badly designed machine. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceroses, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.”

Breaking the water bag intentionally can cause problems – the rush of water can cause the umbilical cord to be swept out and then the baby pinches off the oxygen-rich blood as he moves into the cervix. This almost always results in a necessary, emergency C-section.

Labor for first-time mothers can last anywhere from an hour to 20 hours or more.

Hormone levels change throughout the birthing process. Fear can cause hormones that halt labor, as may have been necessary in ages past, but now our fears are largely emotional, internalized, and only disrupt labor unnecessarily. She gives Viktor E.Frankl’s quote, “The last of human freedoms–the ability to choose one’s attitude especially in a given set of circumstances, especially in difficult circumstances.”

Natural oxytocin is released during labor and is a natural pain-reliever. “The act of saying, “I love you” releases oxytocin.”

“Your thoughts may be positive and enjoyable or some may be difficult or unpleasant. Let them pass without judging them. Don’t identify with them, but do notice them…

“You may notice after you have done this a time or two that you cannot control the thoughts that pass through your mind. What you can control is the pace, the depth, and the rhythm of your breathing. You can take a deeper breath than usual, and you can exhale much more slowly and completely than usual. Notice your body after you do this. Lower your shoulders if they are hunched forward. Relax your jaw and your forehead. Relax your hands and your feet.

“A good time to do this exercise is when you lie down to take a nap or go to sleep at night. Let yourself feel heavy. Sink low. You can practice this technique any time you find yourself worrying or anxious about giving birth. The main thing to remember is that your breathing is the key to your feelings…

“Do not judge yourself for being afraid. As I’ve said before, it’s quite natural to have some fear of the unknown. Anything you fear is teaching you courage to overcome fear…”

These words she uses have helped many fearful women in labor: “Don’t worry. I’ve never seen anyone explode or tear in half.” “Only the baby will come out. Your body is very wise. It only pushes out what needs to come out.” These words cause a flood of relief and gratitude, which release nature’s endorphins, pain diminishes, causing more endorphins to be released, more gratitude, and labor moves along more efficiently.

She writes about Dr. Grantly Dick-Read and his book, Childbirth Without Fear. That book changed her life. In the 1960s, it was not possible to have an unmedicated labor and birth without episiotomy, forceps, or vacuum extractor. Dr. Dick-Read had witnessed natural childbirth among Flemish women in WWI, and knew it could be a joyful (in the midst of war), almost pain-free experience.

The midwifery model of childbirth views pregnancy and childbirth as normal life events. The techno-medical model of maternity care sees pregnancy and childbirth as diseases that require medical interventions in almost every birth. Since the 1920s, the techno-medical model has become dominant in the U.S. and Canada, and now only 10% of births are accompanied by a midwife. It is different in western Europe, where midwives are involved in 70% of births. These countries also have the lowest rates of maternal and infant death. It may be hard to distinguish between the midwifery model and the techno-medical model in some hospitals because they employ midwives. However, often these midwives are overcome by paperwork and by pressure to conform to the techno-medical model.

She has a section on ultrasound. Ultrasounds came into being in the 1970s after it was discovered the x-rays they were doing in-utero were causing an increase in cancer among children. “The use of ultrasound is especially unregulated and popular in the United States. The Food and Drug Administration (FDA) bowed to pressure from industry and organized medicine to relinquish control over the amount of sonic energy that can be emitted by the new ultrasound devices used in Obstetrics. Currently, there are no federal or state regulations requiring periodic calibration of obstetric ultrasound machines, written consent of the pregnant woman, indications for the procedure, the type of equipment used, the amount of exposure, or the identification and qualification of the sonographer…

“Research about the safety of ultrasound has been limited, considering the extent of its casual use. No problems have been detected in the short term for children exposed during pregnancy and labor, but ultrasound has not been used long enough to identify any long-term hazards. We truly have no idea what long-term effects there may be from exposing unborn babies to ultrasound.

“The notion that ultrasound makes pregnancy or birth safer for all women is a misconception….Ultrasound can be useful to diagnose if a baby is alive, the age of a baby (only in early pregnancy), how many there are, the location of the placenta, the position of the baby, and, when two scans are done two weeks apart, how the baby is growing…”

She also has a section on Gestational Diabetes. “Gestational diabetes (GD) is not really a disease. Rather, it is a higher level of blood sugar (glucose) than average during pregnancy, as determined by a glucose tolerance test (GTT). It differs from diabetes mellitus in that GD goes away after the baby is born….

“…The test, unfortunately, is not very reliable. Between 50 and 70 percent of women, if retested, will have a different result than they got from the first test. The best evidence we have says there is no treatment for GD, either with diet or with insulin, that improves the outcome for mothers or their babies. In short, the anxiety that is often produced by this test simply isn’t worth the information gained from it…”

Like Susan McCutcheon, she cautions against going to the hospital too early. “The trend of the last several decades in North America has been to induce labor when a mother comes to a hospital in latent (sometimes also called “false” labor), rather than to send her home to wait for active labor to begin.” Things she recommends doing, rather than going to the hospital, are taking a hot bath, drinking a glass of wine (NO!!!!), and going to bed for a while.

The section on induction is excellent. Inductions have increased dramatically in the U.S. and vary widely from hospital to hospital. Some have a 70% induction rate. The medical reasons for inducing are cancer, hypertension, diabetes, kidney disease, preeclampsia, a small-for-dates baby, a decrease in the amount of amniotic fluid, or an intrauterine death followed by a long wait for labor to begin…”

“Most U.S. women with jobs outside their homes, many with only six weeks of maternity leave to look forward to, if that, are understandably ready to start labor if there are no risks associated with induction. They assume–often wrongly–that their caregiver will inform them of any risks induction might carry.”

The disadvantages she writes about include messing with the natural hormones of labor that only causes more problems. The labors after inducing are “harsher, stronger, significantly more painful…”

“One important thing to realize about induction is that there is no huge hurry to do it. If there were, you would already be on your way to the operating room. There is usually time to negotiate putting off induction some hours or, possibly, days.”

The disadvantages of induction to the baby are that many babies are actually premature. They induce thinking the baby is overdue, and find out the baby is actually premature.

“We know that when induction is purely elective, there is a higher incidence of fetal distress than in labors that begin spontaneously. Oxytocin and prostaglandin inductions, the most common methods in use, are well known to cause longer, more intense uterine contractions, sometimes to the point of interfering with the flow of oxygen-rich blood from the placenta to the baby.” So a fetal monitor is installed – the mother must lie still, the internal scalp electrode is poked into the baby’s scalp, the water bag must be broken, and that can cause infection for mother and child.

The section on Cytotec (Misoprostol) is scary. The FDA never approved it for labor induction; it is an E1 prostaglandin approved for ulcer prevention. There were some catastrophic side effects: “uterine rupture, uncontrollable maternal bleeding in labor or following birth, amniotic fluid embolism, maternal death, fetal Asphyxia, cerebral palsy, stillbirth, and death of the newborn.” The FDA gave it a “black box” designation. Hundreds of obstetricians protested so after 2 years, the FDA removed the black box designation. There are still warnings in the package insert, but laboring mothers are not given the package inserts. The use continues – the drug is cheap and effective and not harmful to most women and babies. “The FDA does not reveal how many reports of maternal or fetal deaths have been reported to it. Insurance company settlements in the millions tend to keep families who have brought malpractice lawsuits after the death of family member quiet. So it is.”

Medications for pain relief:

Tranquilizers like Valium cross the placenta and interfere with the baby’s ability to breathe, suck, maintain muscle tension. Epidurals are given in 85 percent of the hospital births. It has several side effects: dramatic drop in blood pressure, so an IV has to be put in. One in 5 women will have a fever, which results in tests being done on the baby – separation and needle jabs. They don’t always work. Sometimes the anesthesiologist punctures the lumbar, resulting in a headache that lasts days to weeks. Epidurals are more likely to result in C-sections, forceps deliveries, or vacuum-extractor deliveries. The epidural site can become infected. About 1 in 5000 women die or are permanently paralyzed. “Rates tend to be high in those institutions where obstetric anesthesiologists stroll the halls in the daytime, informing women of their working hours and the need to have an epidural before they go home…”

She writes about how hospitals cut the umbilical cord immediately, but in 2006, Judy Mercer, a U.S. nurse-midwife and professor of nursing, after researching this for 4 decades, released a landmark study that showed allowing a brief delay in premature babies born before 32 weeks prevented– “to a significant degree”–bleeding in the brain and infections.

In the section on “Preparing Yourself for New Motherhood While You’re Still Pregnant,” she talks about the need to prepare – gather as much help as you can – cooking, laundry, housework, caring for older children. “Plan to spend most of your time on your bed with your new baby.”…”Yes, you’ll get up to go to the toilet or to take a shower or sitz bath, but you should feel no obligation to be in a hurry to get back on your feet just because you have had your baby. You have no duty to play hostess to family members or friends who drop by for a visit. You may be waking up every hour or two to feed your baby for a while, if you are breast-feeding. This is perfectly normal during the newborn period.”

“Even when everything goes well in giving birth, the first days and weeks after birth can be more stressful than you might realize. This is especially true if you were a real get-things-done person in your life before children. You have twenty-four-hour-per-day responsibility for a helpless new human being, seven days a week–unless you are living near or with family members with time to mother you and your baby sometimes. You will probably be more tired than ever before in your life. A major accomplishment in an entire day might be brushing your hair or taking a shower….” Ask for help! You are not alone!

“Stay close to home, don’t entertain, and rest.”

Postpartum Depression is characterized by “feelings of guilt, hopelessness, and despair, insomnia, difficulty focusing, feelings of inadequacy, irrational concern about the baby’s well-being, nightmares, and persistent thoughts of hurting oneself or the baby.” Get diagnosed if those are your feelings. “Reach out for help.”

Placenta Previa is when “the placenta implants over the cervical opening, exposing mother and baby to extreme danger when the cervix begins to dilate.” Must have a C-section.

“The Risks of New Technologies and Obstetric Fashions:” She discusses the use of X-rays for 50 years until the 1950s when they were found to cause childhood cancers. She talks about DES, which was given to 2 million women in the 1940s and 1950s to prevent miscarriage, but it caused vaginal cancers and genital abnormalities in the young women and men whose mothers were given the drug. Then, thalidomide was prescribed for many sleeping for pregnant women in the UK and Germany in the 1950s. It caused limbs to be deformed in 24,000 European babies, and 2/3 of them died at birth.

Last two sentences: “If I have convinced you of nothing else in this book, I hope that one message will stay with you. Your body is not a lemon!”