Birth Matters: A Midwife’s Manifesta by Ina May Gaskin

Ina May Gaskin, America’s Leading Midwife, has a new book out this month titled Birth Matters: A Midwife’s Manifesta. And I am in tears from just finishing it.

I am sure many of my reader’s are familiar with Ina May and her life’s work of not only providing phenomal midwifery services to women at The Farm, her community in rural Tennessee, but also her dedication to promoting the midwifery model of care to improve women’s birth experiences.

Ina May’s Guide to Childbirth truly made me believe in my ability to birth my son at home.  It made me realize that I needed to “let my monkey out” while laboring, as Ina May so famously suggested.  I needed to tap into my primal self, the self that instinctively knows how to birth a baby.  The self who, if she didn’t realize she was pregnant and suddenly doubled over in pain and thought she had to make a gigantic bowel movement, would assume the position and birth a baby.

And I did. I moaned, I swayed, I paced, and knelt, and reached, and I grabbed that baby -at home- with the care of 2 great midwives, a doula, and my husband by my side.  So thank you, Ina May.

Birth Matters is different from her other books because it is a history of birth, an exploration of why birth changed from midwife driven to obstetrics and surgery, and how we can get it back to being about women, not profit.  Birth is not only a feminist issue, it is person issue.  Birth shapes mothers and fathers; and how babies are born can shape them as well.  Birth should be respected and honored, not treated as a medical issue in need of solving.

The US has a serious problem.  Our Motherhood Morbidity rates far exceed other nations with comparable technology and wealth.  As it stands, we are at 15.1 maternal deaths per 100,000 births in 2005, up from 7.5 per 100,000 in 1982.   Even sadder, the rates are likely higher than even we know since the CDC reports that two thirds of maternal deaths are not represented because the method of reporting deaths has no standard and is not being done properly.  We are behind 40 other countries.

To understand where we are, where we have been, and where we need to go Ina May documents her own journey to midwifery, the witch hunt and near total eradication of the midwife culture in the US, the resurgence of midwifery care thanks to the Natural Birth Movement, and how we still have a long way to go to get midwifery care to all mothers who desire it.

I myself had to travel 1.5 hours away to receive care in order to have a homebirth. Was it worth it?  Yes!  Would I do it again?  Absolutely.  Should I have to?  No. And NY isn’t the worst in terms of laws regarding midwifery care.  At least here midwives are now legal to practice and Certified Nurse Midwives can be covered by insurance.  Others have it far worse than I did.

So much of this book took me back to my own hospital birth.  In a way I am grateful for it because now I see why hospitals aren’t the best place to have a baby.  The OB/GYN model of care treats women as “ill” who need to be monitored, tested, and have their birth’s practically mapped out if the baby won’t come on their “estimated due date.”  Even the EDD’s are changing.  When once the expectation was that a mother would have her baby around 40-42 weeks, we have shortchanged mother’s by 2 weeks and say 40 is the max!  Just in my own life, the mothers I know who chose an OB and delivered in a hospital usually ended up delivering in the 37-40 week timeframe.  Many ended up with inductions.  Of the women I know who chose a midwife and/or a homebirth, most delivered in the 38-41 week time frame, or later.

I appreciate technological advances but where do we draw the line?  Ina May relates many of the “advances” in medicine and technology that have in fact done great harm to mothers and babies.  She even discusses the new phenomenon of stopping periods with birth control.  It seems the research on many drugs and procedures prescribed to women are lacking the long term studies they deserve.  Examples include DES (the hormone pill given to women to prevent miscarriages which has given two generations, maybe more, a rare cancer), X-Ray’s on pregnant women that were once all the rage, forcep deliveries for nearly every birth at one time, twilight sleep (women were drugged and given amnesiacs, tied down, and went totally crazy.  They gave birth tied down but never remembered it, thus thinking it went well and was painless, when in fact it was not).  Then there is the technical advance of Electronic Fetal Monitoring and the pain relief drug, the Epidural.

The last two can be useful, but with overuse they cause more harm than good.  EFM in particular seems wonderful, but it has replaced nurses and doctors with a beeping machine.

And what about the Cesarean? I don’t think even the most staunch natural birth adovocate will deny that the C-Section has a place in this world. It can and has saved countless mothers and babies.

It has also become commonplace, accepted, and normal.  It is no longer just a life saving measure.  It is prescribed for virtually all breach babies, multiples, and of course, for any women who has had a previous C-Section.

The World Health Organization says C-Section births should be no higher than 10-15%.  The US stands at 32%, nearly one in three women! Some hospitals have rates in the 60-75% range.  When the C-Section rate reaches its highest point at 5:00-6:00 PM we know something is wrong.

Ina May and others are proposing we change the broken maternal healthcare system.  Easier said than done, right?

There is a new Mother-Friendly Childbirth Initiative, and this is laid out in the book.  Among other things, to be classified as a CIMS hospital, free standing birth center, or homebirth practice, C-Section rates cannot exceed 15%, but the goal is 5%.  Inductions (a topic close to my heart) should not exceed the rate of 10%, episiotomies should not exceed 20% but the goal is 5%, and VBAC (vaginal births after Cesarean) should be at least 60% but the goal is 75%.  The VBAC rate finally has a chance to increase thanks to the recent ruling by ACOG saying every woman has the right to a trial of labor to achieve a vaginal birth after cesarean.

Other goals are to treat women with the respect their deserve, to give more women access to midwives who want it, to let women labor and move about freely, to let women eat or drink, and so on.  Things that you would think are common sense, yet they don’t happen in many hospitals.

The CIMS hospital would also discourage non religious circumcisions, follow the WHO-UNICEF’s “10 Steps of the Baby Friendly Hospital Initiative”  for successsful breastfeeding, and mothers would receive adequate post-partum care including homevisits.

I am almost in tears again reliving the story told in this book (and many other places) of a woman who died of a post-partum hemorrhage a few years ago in NY.  Her mother was concerned about her, and last time they spoke the woman complained of a head ache.  When police finally broke down her door many days alter (after being asked to many times) they found the mother had bled out and her newborn had died of dehydration and starvation.

Had there been a postpartum homevisit her condition would have likely been discovered.  And at the very least, the baby would have been discovered in time.  In the book the number of babies born to single mothers is reported to be nearly 50%.  Many probably don’t have family to check on them.

The US has a problem. There is a solution.  God-willing one day this broken system will be fixed and the needless deaths of mothers (and babies) due to inadequate care, botched C-Sections, and post-partum complications left undiscovered will cease.

That is why I will be joining the Rally at the U.S. Capital with Ina May Gaskin and The Safe Motherhood Quilt.

Find out more information on The Motherhood Quilt and its mission.

You are damn right Birth Matters.  So let’s fix it.

You can find a copy of Birth Matters from my affiliate  If you buy from my link you can help fund my trip to DC!  I am also hoping to attend her speech which has a hefty ticket price and would involve an extra hotel night.

I received a copy of this book in advance from the publisher for review. I also devoured it in 3 days.  Clearly, I enjoyed it and I think you will too.

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