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Ina May on UC?

post #1 of 52
Thread Starter 
After reading Laura Shanley's book, I'd like to read Ina May Gaskin's comments on UC for myself. Does anyone have a link to something along those lines? Or can you tell me more about it, if you've read it yourself. Thanks!
post #2 of 52
She wrote an article on unassisted birth for Midwifery Today, in the Summer 2003 issue, in which she basically says that UC is too dangerous to support. I do not have the text of it in digital format and am not aware of it being anywhere online, but I bet you'd be able to find it through your local library.

I can, though, show you the letter I wrote in reponse to that article:

Quote:
July 8, 2003

To the editor:

Ina May Gaskin speculates (“Some Thoughts on Unassisted Childbirth”, Midwifery Today, Issue 66) that the “extremism” of the choice to give birth without a medically-trained attendant has perhaps arisen in response to the extreme medicalizing of childbirth in the past decade. It may be tempting to draw a correlation between two events that occur within the same timeframe and have subject matter in common, but it turns out to be far too simplistic an analysis, as is Gail Hart’s theory (“What the Unassisted Birth Movement Teaches Midwives”) that women are turning to unassisted birth because midwives have scared women away and failed to give them what they need. Apparently it bears repeating that birth is by its very nature sacred and sexual, and that such states cannot be fully realized and entered into when one is aware of or interacting with a person with whom she is not able to express her deepest self. Sarah Buckley writes in the same issue of Midwifery Today that with her unassisted birth (after three attended homebirths) she has “felt the awakening power of birth -- more potent for me than any spiritual or shamanic practice” and that it “has taught me, on a cellular level, that birth is about love and ecstasy.” Modern midwives cannot help but interfere with the experience of this to some degree.

It cannot be disputed that we are wired to give birth in privacy; our bodies function most normally in labor and birth when not observed. Michel Odent writes that “during the birth process and any kind of sexual experience, any stimulation of the neocortex tends to have an inhibitory effect: logical words, feeling observed, bright lights, etc.” He also writes that certain instinctive, normal birthing behaviors do not take place “if another person takes on the role of “coach,” “guide,” “helper,” “support person,” or “observer”.” Sarah Buckley writes that “Undisturbed birth is exceedingly rare in our culture, even in birth centers and homebirths. Two factors that disturb birth in all mammals are firstly being in an unfamiliar place and secondly the presence of an observer. Feelings of safety and privacy thus seem to be fundamental. […] Some writers have observed that, for a woman, having a baby has a lot of parallels with making a baby: same hormones, same parts of the body, same sounds, and the same needs for feelings of safety and privacy. How would it be to attempt to make love in the conditions under which we expect women to give birth?”

For women whose bodies are naturally able to give birth normally and without incident, lack of privacy may be the last thing standing in the way of that happening. Note that there is no claim here that nature itself is always benign. Quite the opposite; its sometimes hostility (in the form of natural selection) to our agenda (that of every baby being a live baby) may sometimes warrant special treatment of birth. This does not, however, in any way nullify the fact that intervention and lack of privacy in birth cause the body to function far less than optimally. There is no getting around that birth may involve dysfunction; but neither does one approach to avoiding it apply equally well to all births. The woman whose birth might have ended in trauma or tragedy had it not been for medical intervention knows this very well; the woman whose birth ends in trauma or tragedy because of outside interference also knows this very well.

As a homebirth midwife, Gaskin of course seeks to balance these two considerations, but is clearly uncomfortable going so far as to allow that it is appropriate to forego observation even when it is the observation itself that makes the birth dysfunctional. In this way she keeps good company with traditional medicine, which asserts that managed/observed birth is, despite its particular risks, generally safer than unmanaged, unobserved birth, i.e., unassisted birth.

However, instead of presenting actual evidence for this belief, she resorts to the time-honored obstetrical tradition of attempting to influence with anecdotal horror stories that are meant to instill fear. Homebirth advocates are familiar enough with this tactic: the hospital worker claims that “I cannot support homebirth as a choice because I’ve seen what can happen,” and then proceeds to tell us all about this woman or that baby who would have died if they had not been in the hospital. The reason homebirth advocates reject this tactic is that they know that hospital workers have a limited type of training and experience that colors their perception and biases them in favor of one interpretation of events over another. But it does not mean that homebirth advocates are themselves immune from behaving as if their own limited perspectives are especially valid, as Gaskin demonstrates so well.

Gaskin continues to disappoint throughout the rest of her article; rather than address the issues surrounding unassisted birth itself, she devotes her energy to attacking the professional and personal integrity of a well-known unassisted birth author, Laura Shanley. For example, Gaskin muses, “I find myself wondering whether Shanley has received any letters from readers who followed her advice but had a bad outcome. If she did, would she tell her readers?” The insinuation is that Shanley is deliberately misleading people. Aside from the libelous nature of that statement, I find myself wondering where it is that Gaskin (or any other midwife or doctor) details the complaints that her past clients have against her for advice or guidance that she has given.

She attempts to call into question Shanley’s credibility several other times; at one point misquoting her as saying that “it is safe to say that midwives must time contractions and measure dilation,” critically noting that Shanley does so “without providing any evidence for this assertion.” What Shanley actually wrote was: “Although the law varies from state to state and country to country, generally it is safe to say that midwives must time contractions and measure dilation.” A different statement. In any case, whether it is technically true or not is really beside the point, which is that the care that midwives give their clients is often influenced by state law. Gaskin must surely know that the political climate is such that midwives are either pressured or required to follow a certain protocol of management of labor, under threat of losing licensure or facing imprisonment if they do not. It is disingenuous to imply otherwise.

Gaskin wraps up neatly with a few more anecdotal horror stories, and the claim that “It is a fact that approximately 10-15 percent of all births will require skilled assistance to reach a healthy outcome for mother and baby” (without providing any evidence for this assertion.)

I do not doubt that Gaskin’s concerns about the safety of unassisted birth are real and that they do deserve to be examined; and her exhortation to “exercise your critical faculties” is absolutely what any responsible, conscientious person must do. But she undermines this message by speaking as if she expects us to suspend those critical faculties and judge the unassisted childbirth movement by subjective accounts of UCs gone wrong and flimsy critiques of individuals involved with the movement, as if the validity of unassisted birth is dependant on either. She also undermines her status as a protector of women and babies in birth by completely failing to address what many in the unassisted camp consider the key issues: that the sacred and sexual aspects of birth are not likely to surface and may even be dishonored with the presence of someone with whom the birthing woman is not naturally intimate, and that management and observation can and does interfere with the normal (and therefore safe) progress of labor and birth, as well as with the process of bonding between mother and baby.
post #3 of 52
You GO!
post #4 of 52

I only remembered this as it was recently republished in the latest New Nativity II newsletter I got in the mail last month:

http://www.unassistedchildbirth.com/uc/midwives.html

Quote:
My first indication that I was not going to be welcomed into "The Sister-hood" came in 1993. My book, Unassisted Childbirth, was about to be published and I decided to call a midwife whose book I had found particularly inspiring. As I gushed to her about how much I had learned from her book - to the point that I felt confident enough to give birth alone - I began to realize she didn't share my enthusiasm for unassisted birth. In fact, she sounded outright hostile.

Edited by JesseMomme - 12/24/13 at 1:27pm
post #5 of 52
FLB.. Can I copy your letter for my files?? You rock.
post #6 of 52
Quote:
Originally Posted by fourlittlebirds View Post
She wrote an article on unassisted birth for Midwifery Today, in the Summer 2003 issue, in which she basically says that UC is too dangerous to support. I do not have the text of it in digital format and am not aware of it being anywhere online, but I bet you'd be able to find it through your local library.

I can, though, show you the letter I wrote in reponse to that article:
That letter is AWESOME!
I have personally spoken with her on the same subject(someone brought it up at one of the Midwife Assistant workshops I attended) and she is very definitely not in favor of UC. I am very definitely in favor for. But who am I? I am just a midwifery student, who has decided that UC was the only sensible and safe option for me in 1989, when our local hospitals would still knock a woman out if she asked for it(and this did happen to our assistant pastor's wife- I did teach her enough that she didn't have any medication at all til she was pushing the baby out, then afterwards asked herself, why did I even do that(get knocked out). She was only out for about 10 minutes, but missed the entire birth..she really regretted it...I thought she would and told her ahead of time- oh well....). So Ina May and I agreed to disagree...
post #7 of 52
FLB that was a wonderful response.
I am not having any luck through google locating what Gaskin says about UC.
post #8 of 52
I saw her speak at a conference in 2003 (I think--trying to remember which baby I was slinging at the time ), and she was showing a portion of her mother quilt project. She said that some of the women represented on the quilt were there b/c they chose to go w/o midwifery care and that every woman deserves a midwife. (I agree in part, every woman deserves to have the choice of utilizing a midwife if she wants/needs one, IMO) I remember finding her words and attitude to be condescending.

L---I LOVE that letter. I hope you find a way to work it into the book in some way!
post #9 of 52
Wow, that letter was incredibly well written. Beautiful, mama!
post #10 of 52
FLB :
post #11 of 52
FLB, Your letter is wonderful and articulates so clearly what I feel intuitively about birth. Haven't done it yet (due w/ our 1st in June!) but words like yours are such tremendous support. We have chosen to work with a midwife, but feel very fortunate that she respects the sacred and intimate nature of birth and our desires for the birth of our baby. If we hadn't been able to find her, DH and I would seriously consider UC. Thanks again!!!
post #12 of 52
yes, i was also inspired by the letter.

UCs, btw, would put midwives out of business. if only 10-15% of pregnancies need some sort of assistance, then the other 85-90% of us can UC! if only 10-15% of the pregnant population is getting care, then a lot of doctors and midwives would be out of work.
post #13 of 52
Thread Starter 
Thanks for sharing your letter, Fourlittlebirds. That gives me enough of an idea about Ina May's opinions to satisfy my curiosity for now. Your letter is excellent! Did they publish it in its entirety?
post #14 of 52
Quote:
Originally Posted by zoebird View Post
UCs, btw, would put midwives out of business. if only 10-15% of pregnancies need some sort of assistance, then the other 85-90% of us can UC! if only 10-15% of the pregnant population is getting care, then a lot of doctors and midwives would be out of work.
I'm willing to go one step furthur and say that most births that DO require some sort of intervention probably belong in a hospital- c/s, or intensive care for the newborn, or some sort of medical treatment for the mother (for something unrelated to childbirth.)

Only in the case of shoulder dystocia, (and perhaps a few other situations I'm not personally aware of) would a midwife's presence at a home birth make a difference, medically. How common are those situations anyway?

I wonder if Ms. Gaskin is aware that not everywhere is like The Farm, and the choice is often between a highly medicalized hospital birth or a UC. Even if she thinks a good midwife would be ideal, does she recognize that UC can be far safer than a hospital birth under those circumstances? I wonder if she's deluded by her own importance at births or simply unaware of reality outside The Farm.
post #15 of 52
From what I have read (admittedly I have avoided reading quite a bit by her), Gaskin (and The Farm) has become pretty medically minded and controlling over the years. Yet, many almost WORSHIP her.
post #16 of 52
Thanks, everyone. I was definitely fired up with that one.

Lizzie, feel free to use it however you like. You can credit it to Linda Hessel.
post #17 of 52
Tell me if I'm wrong here (I read Spiritual Midwifery awhile ago) but seems I remember that when Ina May and friends began they were UC-ing! That is, birthing without medical assitance.
post #18 of 52
Quote:
Originally Posted by boheime View Post
Yet, many almost WORSHIP her.
Right there is the problem. It sounds like she's succumbed to the "Dr. G-d" syndrome that plagues many physicians.

I read Spiritual Midwifery and was inspired by her. I have no doubt that she was a wonderful, low-interventionist, spiritual midwife when she first started out. As per the above mentioned book, the first few births she attended were basically UCs with a clueless MW wannabe (Ms Gasken) observing!
post #19 of 52
Shawnee, no they didn't. I know that MT is sympathetic to UC issues, so I assume that it was just because of space constraints or else they felt I could have been more succinct. I was disappointed, though.

Regarding the "fact" that 10-15% of births require assistance, well, that's ridiculous. It's only a fact conditionally speaking. Conditional on the type of environment and mother's health and approach to birth and degree of medicalization and a host of other factors. I find it hard to believe that Gaskin really believes that results culled mostly from hospital birth stats apply equally well to (truly) natural and undisturbed birth. I just cannot wrap my mind around why she felt it appropriate and logical to use that as part of her argument against UC. The real fact of the matter is that we don't know what the stats look like for birth under ideal conditions, but that we can at the very least assume that they are far better than for birth under unideal conditions.

Quote:
Originally Posted by Ruthla
Only in the case of shoulder dystocia, (and perhaps a few other situations I'm not personally aware of) would a midwife's presence at a home birth make a difference, medically. How common are those situations anyway?
Well, there's catastrophic rupture, and placental abruption to name a couple. But, like you say, how common are these situations? Or, more to the point, how common are they when not created by some interference with the natural process? It's impossible to know, because even in UCs there's often some kind of subtle and maybe unperceived interference, from previous c-sections to the husband acting as midwife to the modern difficulty of suppressing the control of the neocortex, etc.

Quote:
Even if she thinks a good midwife would be ideal, does she recognize that UC can be far safer than a hospital birth under those circumstances?
Even Henci Goer, who is also not a fan of UC (at least publicly because there are no studies to show it to be safe,) admits (in her book The Thinking Woman's Guide to a Better Birth) that UC is in generally safer than hospital birth.

Quote:
I wonder if she's deluded by her own importance at births or simply unaware of reality outside The Farm.
Wellll... her style of midwifery (as seen in Spiritual Midwifery) is based on the premise that the midwife is this archetypal guru character that women need to be guided by, psychologically, spiritually, physically. In contrast, here's Laura Shanley:

Quote:
Midwives are not the saviors of birth (as I've heard several of them say). They are not the exclusive holders of the "sacred knowledge." They are not the "Goddesses of Birth" - unless they are the ones giving birth. Every woman is her own birth savior. Every woman has the sacred knowledge. Every woman is wise if she allows herself to be.
So if you're used to being regarded as a savior, for people to claim autonomy has to be a little threatening. Even our dear Pamamidwife here at MDC has talked about struggling with ego issues pertaining to her role as midwife, and the pedestal she's been put on is much shorter than Ina May's. I guess I had half hoped that she'd find a way to gracefully step off that pedestal by continuing to grow and learn, as Pam has. To be above the fear-mongering and lack of critical thinking that those trained in medicine so often display.

FWIW, her response to my letter (and to be fair, I have no idea how much Midwifery Today edited out of her letter) addressed *only* my point that she should know that midwives are legally expected to apply standards that do not necessarily serve the individual. She wrote, "If Linda Hessel is right that there are lots of state laws [not what I said, but whatever] that actually require that midwives time contractions and check dilation, midwives and women together should go back to the legislature to fix them. Tennessee midwives don't work under conditions like this and I don't see why anyone should have such provisions in their laws."

Now, this is pretty amazing to me. She's been president of MANA and travels all over to speak at conferences. She's not isolated. How can she not know that in many places midwives must be licensed to practice legally, and that licensure often requires not just proof of education but also agreement to adhere to a certain protocol? In some places any type of midwifery is illegal and the political climate is so hostile that sometimes midwives are willing to make concessions to be able to practice at all. Even here in Oregon where we have quite a bit of freedom, that's in part due to the thousands of dollars each year paid to a lobbyist. Our situation is not at all secure. And then there's the fact that, like doctors, midwives sometimes practice defensively. The midwife who attended my first birth kept a very careful chart of all vitals because in the event of a poor outcome it would help her to legally protect herself. It is just naive to think that these sorts of things do not affect the birth process, and if the only option a woman has outside of a hospital birth is to hire a midwife who practices this way, how is she going to manage to have an undisturbed (safe) birth? This is a real problem. And here we have Ina May dismissively and simplistically telling us that we just need to go the legislature to fix it, as if it is just that simple. It does make me feel like she is to some degree unaware of the reality outside the Farm, as you put it.
post #20 of 52
Quote:
Originally Posted by torio View Post
Tell me if I'm wrong here (I read Spiritual Midwifery awhile ago) but seems I remember that when Ina May and friends began they were UC-ing! That is, birthing without medical assitance.
The first few. Maybe six or seven, I can't remember, but it was while they were en route to the Farm and none of the women had had medical training yet. Ina May's was one of the babies born during this time, and died due to prematurity. The other babies were fine. Then they got to the Farm and a local doctor came out to show them how to assist in birth and deal with complications (hence the hands-on approach and high episiotomy rate!) So once they had a real choice, it was to combine obstetrics with a personal approach, in a non-clinical setting. This was of course a huge improvement over hospital birth at the time, at least spiritually speaking. They had a mortality rate comparable to the hospital's -- out of 1000 births, there were seven stillbirths and eight more neonatal deaths, some of which occured after transfer to the hospital. (It breaks it down further in the book.)
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