Ina May Gaskin Reviews Groundbreaking Book, The Heart in the Womb

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About The Heart in the Womb: An Exploration into the Roots of Human Love and Social Cohesion

Modern-day life and our highly stressed, “risk-averse” society has led to a medicalised, fearful model of childbirth, one that has stripped the process of its wondrous magic. In this groundbreaking book, consultant obstetrician Dr Amali Lokugamage discusses ways in which every woman can aim to give birth in the most natural, supportive way possible, and looks at the wider implications for society at large. 
This book includes a foreword by Dr Luke Zander, founder of the multidisciplinary Forum on Maternity and the Newborn at the Royal Society of Medicine, and advisor to the Parliamentary Select Committee on Health, for its report on maternity services.
Ina May Gaskin’s Review of the The Heart in the Womb
This wonderful book springs from the life experience of a Sri Lankan-born, U.K.-educated obstetrician-gynecologist, Dr. Amali Lokugamage, who little suspected how much a pregnancy could transform a woman until it happened to her at the age of 42. The story of her awakening to the wisdom transmitted by the new life within her is as compelling as great fiction — and what makes it even more riveting is that it is not fiction. This is a very scientific book, as well as a powerful case report.
Dr. Lokugamage’s credentials are as impeccable as they come: she’s not only an obstetrician-gynecologist with two decades of practice in a busy London hospital under her belt, but an epidemiologist, a medical researcher, an acupuncturist and homeopath as well. Note to the U. S. reader: it’s more usual in the U. K. than it is here for an obstetrician to have training in alternative or complementary health care modalities.
Prior to her pregnancy, Dr. Lokugamage writes that her knowledge concerning pregnancy and birth was basically confined to what could be gleaned from academic tomes on obstetrics, epidemiological studies, statistics of childbirth and the “traditional” beliefs of obstetrics common in the U. K. of the last two decades. Within this framework, she and her colleagues would tend to be preoccupied with material ways of preventing illness or death in mothers and babies. Like nearly every doctor of a similar background, she remarks that she could not have even considered having a home birth before her pregnancy began to work unexpected changes in her way of perceiving her body and birth.
Early in her marriage, Dr. Lokugamage had become ill while doing tsunami relief work in India in intense heat. She writes that she suffered non-specific fatigue syndrome after that illness and became concerned that her chances of conceiving a pregnancy were becoming increasingly low. These worries were heightened when medical fertility tests indicated that she was nearing menopause. However, instead of resorting to in-vitro fertilization as a first option as most of her colleagues would have, she followed a course of acupuncture and traditional herbs along with continuing her daily practice of meditation, relaxation, and visualizations. It wasn’t long before she was once again ovulating, and after three months, she was pregnant — an undeniably strong validation of the promise of such practices and therapies in her case.
“As soon as I conceived my son, I lost autonomy over my body,” writes Dr. Lokugamage. “The baby just took over all my systems.” The list of the pregnancy complications she experienced is long, but wouldn’t surprise any doctor providing care for women over forty: hyperemesis gravidarum, frozen left shoulder severe enough to stop her from carrying out the manual part of her job, gestational diabetes, episodes of breathlessness, and symphysis pubic dysfunction, to name the most significant. Many Western-trained physicians may be surprised by the treatments and realizations that helped Dr. Lokugamage navigate her various pregnancy problems. But many may find her account of how her pubic symphysis dysfunction made it impossible to walk without extreme pain but that she could do basic Samba dance moves “quite swiftly and beautifully” as fascinating as I did.
Yoga-breathing, massage, reflexology, some changes in her diet, a growing sense of communication with her unborn baby, and a general slowing down of her life pace all helped to ameliorate or even obliterate the various pregnancy symptoms that she experienced. While still pregnant, she mentions watching an online video of neuroanatomist Dr. Jill Bolte Taylor, “who talked about her insights into the working of consciousness whilst she experienced a brain haemorrhage.” Dr. Lokugamage found “strange parallels” between a neuroanatomist having a stroke and an obstetrician having a baby — the fascination of the scientist undergoing a peak experience involving consciousness changes during a condition that she had studied for many years from a theoretical perspective. Reading Dr. Taylor’s book, My Stroke of Insight, led Dr. Lokugamage to a realization that her brain during pregnancy had experienced a similar transformation, but from a different angle.
I highly recommend this book. The Heart in the Womb is one of the best antidotes to extreme fear of birth that I can think of. Every pregnant couple who can read should read it.
“If we go too far in trying to eliminate hazards for a smaller number of people, we can interfere with the health of a large number of people.” — Dr. Amali Lokugamage
Ina May Gaskin, MA, CPM, PhD(Hon.) is founder and director of the Farm Midwifery Center, located near Summertown, Tennessee. Founded in 1971, by 2011, the Farm Midwifery Center had handled approximately 3000 births, with remarkably good outcomes. Ms. Gaskin herself has attended more than 1200 births. She is author of Spiritual Midwifery, now in its fourth edition. For twenty-two years she published Birth Gazette , a quarterly covering health care, childbirth and midwifery issues. Ina May’s Guide to Childbirth was released in 2003 by Bantam/Dell, a division of Random House and has been translated into Italian, Slovenian, German, and French. Ina May’s Guide to Breastfeeding was published in 2009 by Bantam/Dell, and her newest book, Birth Matters: A Midwife’s Manifesta, was published in 2011.
Special Excerpt of The Heart in the Womb
My own pregnancy transformed my views of childbirth. Until then, my knowledge had been derived from academic tomes on obstetrics, epidemiological studies, statistics of childbirth, and the “traditional” beliefs of obstetricians derived from twenty years of obstetric practice in the United Kingdom. But these views were radically revised following my own experiences. However, this knowledge can only truly have been accessed during pregnancy because it is based on the non-material, immeasurable inner wisdom that pregnancy hormones unlock in a woman’s consciousness. These changes slow down left-brain-orientated rational thoughts and open a portal into greater right-brain activity, which offers women amazing gifts of consciousness that are normally suppressed in everyday modern life. The forgetful pregnant brain is an asset to birthing well, as it naturally dissipates the anxieties that accompany strategising and “over-thinking”, because it is geared towards allowing awareness to rest in the present moment. Contemporary women often rebel against this state of mind, as it is particularly difficult to succumb to it whilst working and it is not well supported by modern society. However, in the field of mindfulness psychotherapy there is growing support for the idea that this state of mind reduces stress and related physical diseases. There are cognitive therapies aimed at facilitating this consciousness through practise and conscious effort; however, nature itself endows this state to pregnant women – if only they are able to surrender to it.
Before and during my pregnancy, I was lucky enough to hear and meet some of the most experienced and knowledgeable non-medical birthing gurus. These are internationally renowned natural childbirth experts or birth activists whom I later mention in chapter 6. My colleagues in clinical medicine and medical research have, for the most part, been completely unaware of the existence of these other experienced birthing experts, but, for me, their input into my pregnancy was invaluable. My standard medical antenatal care was supportive, but the experience of these alternative pregnancy-care gurus was empowering, as their knowledge-base helped me to access my own inner wisdom and inner confidence to birth well.
The words “consciousness” and “inner wisdom” may mean nothing to my fellow obstetric colleagues because they are more preoccupied with material ways of preventing illness and death in mothers. But birthing well is undeniably linked to mind and body health, as shown by studies demonstrating that the presence of an older “wise” woman providing support to the mother during childbirth has a greater effect on helping the woman to achieve a normal, safe birth than many standard medical interventions. This suggests that improving a woman’s emotional status and confidence in her body to undergo childbirth is as important as having a medical infrastructure. The French for midwife, “sage femme”, literally means “wise woman”, a term that acknowledges the role of this supportive figure. Fear of childbirth and lack of confidence in the body’s ability to face the process are factors that have been linked to the increase in requests for caesarean sections. Similarly, lack of privacy and birthing environments that produce fear have been linked to inefficient womb contractions, leading to the need for medical deliveries. These are not the only factors contributing to such outcomes, but they are currently deeply underestimated in contemporary hospital-based maternity systems.
This book is a commentary of my observations and experiences, both as an obstetrician and a pregnant woman. For an obstetrician to have a homebirth is a rarity, and it is because of this that I feel I can provide a unique commentary on my own experience, from both a professional and a personal viewpoint. I stress, however, that this is not a scientific book; it is more about the art of birthing and I have approached the book through my experience of living. I was prompted to write about this very personal experience because, prior to my pregnancy, I was never fully able to understand why a woman would actively choose to give birth at home, outside of a hospital safety-net. However, during my own pregnancy I became increasingly aware of the fact that once a woman taps into her innate birthing wisdom, decision-making no longer takes place only through logical risk-analysis, but instead though an internal – call it perhaps an instinctual – knowledge of what is right for herself and her baby. If this voice from within is very strong – and during pregnancy it can become very strong indeed – then it overrides any logical argument. The expectant mother develops a courage and confidence towards childbirth and an awareness that, if she is in a comfortable setting, her body will know how to let the natural process unfold.
Robbie Davis-Floyd, childbirth medical anthropologist, says “women giving birth undergo a quite powerful and psychologically compelling physiological and cognitive transformation.” 1 This is because pregnancy is a time of great change for a woman’s body and mind, which creates opportunity for personal growth.
Reference List
(1) Floyd R. Birth as an American rite of passage. 2nd ed. Berkeley, Calif: University of California Press; 2003.
About Dr. Amali Lokugamage

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Dr. Lokugamage works as a consultant obstetrician & gynaecologist/honorary senior lecturer at the Whittington Hospital, London, UK, as well as the Hospital of St Johns and St Elizabeth, London. Her main clinical interests lie in medical gynaecology and general obstetrics. The long term behavioural and emotional consequences of how we are born and nurtured are of particular interest to her. Dr Lokugamage has set up a maternity acupuncture service within the NHS. She also has a keen interest in improving rates of natural birth and had a homebirth herself in 2008. Her experience of homebirth led to her writing The Heart in the Womb which was published in spring 2011.

She is a strong supporter of integrated medicine, where conventional obstetrics & gynecology is merged with complementary medicine. Integrated medicine views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment. It also involves patients and doctors working to maintain health by paying attention to lifestyle factors such as diet, exercise, quality of rest. She is a registered homeopath and practices acupuncture.
Her undergraduate medical qualifications are from St Andrews and Manchester Universities. An MSc epidemiology was obtained at the London School of Hygiene and Tropical Medicine and an MD was awarded from University College London. Clinical training was undertaken at London teaching hospitals. She was awarded a Fellow of the Royal College and Obstetricians (FRCOG) in 2008.
She has a great interest in medical education and has role in coordinating undergraduate education in women’s health and vertical modules as well as being a student support officer for University College London as well as an active role in postgraduate teaching.
This service option helps to empower women because it seeks to promote self healing mechanisms within the patient. It aspires to reduce women’s feeling of vulnerability when they have pregnancy disorders because they have another tool that may reduce the medicalisation of childbirth or be an adjunct to medical/surgical treatment.