Ina May on UC? - Page 2

[Ruthla]

Originally Posted by fourlittlebirds

Well, there's catastrophic rupture, and placental abruption to name a couple.

But how would a midwife handle those situations outside of a hospital setting? Wouldn't catastrophic rupture (is that the same thing as uterine rupture?) and placental abruption both be handled via c/s in a hospital setting? Shoulder dystocia is the only complication I'm aware of where a midwife's skilled hands can make a difference at home.

[babycatcher01]

It is sad to hear that she dosnt promote birthing freedom, she was involved in a big movment and she changed alot of lives. She just seemed to fall away from the true way of birthing. It is very very sad.

[mwherbs]

I think her opinion has been colored by the losses she and others experienced- it wasn't just that a "friendly" doc came to save them- they sought out help because of their losses-
and they modified the farm to also accomidate/prevent additional losses including making what people would consider a neonatal nursery - at the farm

I also think that to her it is like stepping back into that area where they started out- and she and the community have learned so much and changed over time- now we may be critical of how they manage or have managed births but most of us would not be having much discussion at all if it weren't for her and her widely published book-- there is the farm book, Heart and Hands and now Ann Frye's tombs... and really no one tried to open up exact practice and simplify obstetrics in the way they did. i do not worship her but I do have respect for what living history she represents-- I have not experienced the losses she has and I have no idea how I would end up responding to them if I did.
I was recently at a conference where she was the luncheon speaker- and her absolute focus was on unnecessary deaths of mothers and sometimes babies- ( not something I could actually eat lunch over and listen to) But I get her I understand that this is now her work- and we can all agree that many obstetric practices need to be changed.

[Snowdrift]

Originally Posted by zoebird

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 disagree with this. Yes, if only those with a physical problem requiring outside care sought it out, then it owul dput midwives and OBs out of business, but I don't think only women requiring outside care would seek it.

Many of us regard birth as something other than a sexual act. I regard it as a female ritual of sorts. I've considered UC time and again and I think I've finally realized that I was leaning towards UC mostly bc of my fear of medical professionals not bc I felt I want complete privacy when I birth. I don't especially wany my DH around. What I want are women to be with me, to understand, and to support and to provide assistance if needed or desired.

Certainly for my next birth I will have a midwife, although I understand that that is a costly luxury. Perhaps in the future, after a few more births, I'll revisit the idea of UC, but I think that that would be largely a financial decision.

Really, for many of us, birth is not a sex act, it is a female act. I think midwives are safe.

Their cautions about the need for attended birth may be wrongheaded in many ways (especially Ina May's, which are pretty archaic), I don't think it is as selfish as being about preserving clientele.

People still hire massage therapists even though they are unnecessary and they can get a partner to help them to it for themselves.

[lizzie]

Originally Posted by fourlittlebirds

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.

Thanks, Linda! I absolutely will!

Yk, kind of OT, but I was taken aback by how sexual my births were.. and I didn't even realize it until after the fact, particularly with the first one. The second I had a better idea of it. And my dh, the crazy man, was the really the one who seemed to get that on some instinctive level.. I was all ready to have a passel of women, from my mom to my sketchy SIL in there with me, and he just said NO. NO way!! This birth is about US.... And sure enough, when I was in labor, I was so grateful for that.. if my parents had been in there, it would have been so much like they were watching dh and I make love. I was so glad it was mostly just us, with the odd nurse rambling through, but I guess it's easier for me to make love in front of strangers, rather than my parents? Either way, for me, absolutely sexual... not really a girl thing at all, and I think other women would seriously annoy me during birthing. Just my personal feeling...


lizzie

[cottonwood]

Originally Posted by Ruthla

But how would a midwife handle those situations outside of a hospital setting? Wouldn't catastrophic rupture (is that the same thing as uterine rupture?) and placental abruption both be handled via c/s in a hospital setting? Shoulder dystocia is the only complication I'm aware of where a midwife's skilled hands can make a difference at home.

Right, sorry, I wasn't reading you right.

I was going to think some more on what could be said about this (about what having a midwife is necessary for,) but the thing is, with just about any complication there can be different opinions as to whether it's natural or created in some way, and what that means for each woman. Given my special circumstances, I don't believe shoulder dystocia is a possibility for me AT ALL. Given someone else's special circumstances, it might be.

Originally Posted by mwherbs

I also think that to her it is like stepping back into that area where they started out- and she and the community have learned so much and changed over time- now we may be critical of how they manage or have managed births but most of us would not be having much discussion at all if it weren't for her and her widely published book-- there is the farm book, Heart and Hands and now Ann Frye's tombs... and really no one tried to open up exact practice and simplify obstetrics in the way they did. i do not worship her but I do have respect for what living history she represents-- I have not experienced the losses she has and I have no idea how I would end up responding to them if I did.

Just about any time I've ever talked about Ina May here on at MDC I've offered the disclaimer that yes, she has done a lot for the homebirth movement and I respect her for that yadda yadda yadda. Having to make that disclaimer gets a little tiring, but I want people to understand that when I criticize her practices or views, it isn't about demonizing her or disregarding her accomplishments and the context in which her practices and views came to be. There are things she is about that I disagree with. That doesn't mean that I think she's a bad person or has never done anything of value.

But here, on the UC forum, with the topic being specifically about her view on one thing, UC, and her method of supporting that view, I really don't understand why someone would feel it necessary or appropriate to interject, off-topic, to remind us that she has done important things and that for her to be opposed to UC is understandable. Because those things are not even being debated and are not relevant to the OP, it feels disrespectful. I can't imagine going onto the homebirth forum, criticizing the views or practices of the doctor who delivered me and how that affected my mother and me, and another doctor coming on there and making excuses for him (even if they were valid) and pointing out that he had also done good work. That might be so, but it's not the point. And it's not the point here, either.

[accountclosed3]

tie-dyed:

i don't know really what judgement your tossing onto me. I have no qualms with a woman choosing an OB, a midwife, or her grandmother's best friend if that's what she wants. And, i never said that there was only one way to consider or think about birth. Just because i see it as a sex act (in part) doesn't mean that i think everyone does or should.

if you're judging yoruself for your choice, then look at yourself. I've never judged anyone for choosing differently from me. I support free choice--and UC as a part of that. I do not prize UC over other forms of birth, nor my perspective of birth for myself over what others may choose for themselves.

Finally, to my quote, the construct that i was asserting was in reflection of Ina May's assertion, as quoted by FLB, that only 10-15% need, that is require, medical attention of some sort (midwife or OB attention). This means that 85-90% of the population *can* have safe UCs because they don't require attention. It doesn't mean that i think that they *should* or they're wrong for choosing otherwise.

truth be told, if 100% of the women believed that they didn't need medical attention and could do it on their own, then fewer would be choosing hospitals and midwives as the "safest" way to birth. Instead, they would be choosing it for other reasons (such as those you mentioned for wanting a midwife) or for actual medical need (that 10-15%). It would be a free choice. And there would be less demand for midwives and OBs. Thus, fewer jobs.

[rajahkat]

tie-dyed--

I think you have a very valid point. I tend to think exactly the same thing that I think you were trying to get across-

the idea of a midwife as a counselor, someone who has been through it before, a spiritual guide, per se (maybe more along the lines of a doula?) I tend to correlate midwives to massage therapists as well, LOL. Totally uneccessary, but for some a welcome luxury.

After having had 3 UC's I still don't really see my labors and births as "sexual". Not in the way that I would be uncomfortable to have people other than my dh there...... I've not personally met any other people that I feel a spiritual bond with to the extent that I would want them at my births.

But for me, I see birth as a spiritual experience (in the same way that sex can be) and as a pagan, I totally get the desire to give birth surrounded by a like-minded group of women.....

Kat

[cottonwood]

Originally Posted by tie-dyed

I don't think it is as selfish as being about preserving clientele.

It's hard for me to believe that any would consider it a genuine concern anyway. It's unlikely that we'll ever get to the point where we all believe that medically-trained birth attendants are unnecessary for any but those with health issues, at least not in this lifetime. Something always pops up in my mind when this question comes up, though, which is something that Pamamidwife said once. She said that she had told a fellow midwife that she thinks it a positive thing that women are empowering themselves to give birth unassisted. The other midwife said, quite seriously, "but if all women did that, we'd be out of a job!" I think for most, though, it is more about ego than money. The ego wants to be special, to be needed. That's a powerful reason to perpetuate the idea that midwives are needed and that they are an integral part of the sisterhood.

People still hire massage therapists even though they are unnecessary and they can get a partner to help them to it for themselves.

Even if some unimaginably huge paradigm shift were to occur, I agree with you that people would still have reasons to have attendants around them.

Many of us regard birth as something other than a sexual act. I regard it as a female ritual of sorts. [...] Really, for many of us, birth is not a sex act, it is a female act.

It's no secret that most people don't regard birth as a sexual act. Does that mean that it is inherently not so, or has that knowledge been suppressed in them for one reason or another? Even midwives -- who we can assume do regard birth as a female ritual of sorts -- will say, "what gets the baby in, gets the baby out." Meaning that for a normal birth a hormonal process needs to be initiated, and that is the same hormonal process that is the basis for sexual arousal. Can these things co-exist? Maybe they can, if we re-formulate our perceptions of what constitutes a sexual act and a female ritual.

One problem is in the terminology. People who call birth sexual are usually (but not always) defining that in a very much more basic way (i.e. pleasure, primality, and a host of hormone-driven physiological events such as blood flowing to the vagina) than people who don't, who associate it with things that are felt to be taboo in most contexts, including birth.

It's a shame that we don't have an analogous word for "sexual arousal" that applies to the birth act, because language affects perception so strongly. If you can't name it, it's hard for it to exist in the head.

For me, birth was a very intimate and personal process in which I had to allow myself to enter an altered state of consciousness and exhibit deeply primal behavior. It was the ultimate expression of the goddess archetype in my self. For the process to happen optimally, the body must be flooded with hormones that soften the body, open it up, make it sensitive. I don't think that can't happen in a circle of women. I'm skeptical as to whether it can ever be fully realized in the presence of people who have been hired, who are more acquaintances than deeply connected companions, who are there to do clinical tasks. I do regard it as happening optimally in privacy or in the presence of those with whom the mother is normally and deeply intimate and who is inside it with her. Otherwise self-consciousness and a pull of awareness toward the outside is going to be present on some level.

[attachedmamaof3]

Originally Posted by fourlittlebirds

Otherwise self-consciousness and a pull of awareness toward the outside is going to be present on some level.

Absolutely. Absolutely. :

I absolutely cannot imagine having someone other than DH present for my laboring once we've experienced it alone. The intimacy of birth is (for me) EXACTLY the same as the intimacy with a lover. Intensely personal, private, loving and bonding. It would seem like 'cheapening it' (for lack of better words) to allow someone (outside) to intrude on those moments, and would SEVERELY diminish my ability to function as I need to because of self-conciousness/awareness/vulnerability, etc.

[mwherbs]

well I was not intending to be offensive I was attempting to say how I understand or view her perspective-- that she and the women around her basically did UC- birthed together or alone without any training or even the benefit of what we take for granted as information now- and that at some point they decided to seek out some help, get more information- this was before there was the internet to go to. So my guess is that if she thinks of women who UC as being like her and her friends/family when they started the farm- this is how she comes down on the side against it-- more having to do with re-tracing the life path she has already been down... Now that is not exactly what we are doing and our experiences are very different from hers just by the very nature of information available to us today.
in some ways it is like trying to talk to my grandparents about vaccines we might agree on some things but there are just things that they are not going to get and I am not going to completely understand about them either- we share similar values but our experiences are in passing-

------------------------
Ina May on UC?
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!--
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[kimiij]

Originally Posted by fourlittlebirds

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.)

What book is this? I would be interested in reading it...

[georgia]

Spiritual Midwifery

[ccohenou]

Originally Posted by Ruthla

But how would a midwife handle those situations outside of a hospital setting? Wouldn't catastrophic rupture (is that the same thing as uterine rupture?) and placental abruption both be handled via c/s in a hospital setting? Shoulder dystocia is the only complication I'm aware of where a midwife's skilled hands can make a difference at home.

A severe hemorrhage requiring medication also comes to mind. I think there are probably also situations where a skilled midwife may be able to detect a problem through experience with lots of normal and abnormal labors, through observation, checking heartrates, etc., leading to timely transfer even if she can't solve the problem at home (and conversely, may be able to tell that something iffy is not a problem needing transfer).

[Snowdrift]

Originally Posted by zoebird

tie-dyed:
i don't know really what judgement your tossing onto me. I have no qualms with a woman choosing an OB, a midwife, or her grandmother's best friend if that's what she wants. And, i never said that there was only one way to consider or think about birth. Just because i see it as a sex act (in part) doesn't mean that i think everyone does or should.

Wow. Can I point you to your own sig line? I was taking exception to the idea that midwives in general suppress UC because it would cost them clientele.

I think you got that point, because:

Finally, to my quote, the construct that i was asserting was in reflection of Ina May's assertion, as quoted by FLB, that only 10-15% need, that is require, medical attention of some sort (midwife or OB attention). This means that 85-90% of the population *can* have safe UCs because they don't require attention. It doesn't mean that i think that they *should* or they're wrong for choosing otherwise.

You agree with it.

truth be told, if 100% of the women believed that they didn't need medical attention and could do it on their own, then fewer would be choosing hospitals and midwives as the "safest" way to birth. Instead, they would be choosing it for other reasons (such as those you mentioned for wanting a midwife) or for actual medical need (that 10-15%). It would be a free choice. And there would be less demand for midwives and OBs. Thus, fewer jobs.

Yep. Except that OB's, not midwives would be the first to go. Their attrition rate is already pretty high bc of insurance premiums. Now they handle a vast majority of births, but if women were aware of the safety of birth many would choose UC and many would choose CPMs/DEMs. Midwives' clientele would likely rise.

In any case, all of this involves social changes that would take many years, likely several generations to change.

The only thing I took exception to was the assertion that midwives are working to prevent UC for economic motivations above all else. And I stand my that assertion.

I'm not sure why you think I'm judging you or me or um, anyone.
But thanks for the whole condescending about "judging myself." That wasn't *at all* unnecessarily rude or unfairly judging : /sarcasm

[Snowdrift]

Originally Posted by fourlittlebirds

One problem is in the terminology. People who call birth sexual are usually (but not always) defining that in a very much more basic way (i.e. pleasure, primality, and a host of hormone-driven physiological events such as blood flowing to the vagina) than people who don't, who associate it with things that are felt to be taboo in most contexts, including birth.

This is an interesting comment. See, I don't necessarily consider extreme pleasure, primality, and physiologic responses to events to be necessarily sexual. I consider them ecstatic, sometimes mystical. If a full-body state of pleasure and primality is a sex act, then I've had sex in church. And synogogue. And lots of places where I was alone and not engaged in sexual thought or act.

It's a shame that we don't have an analogous word for "sexual arousal" that applies to the birth act, because language affects perception so strongly. If you can't name it, it's hard for it to exist in the head.

How about ecstasy? Actual I've learned a bit about this word recently in a scriptural context (tried to start a thread on it in religious studies but it died a quick death). Religious ecstasy, birth ecstasty, prophetic ecstast, sexual ecstasy: the state of otherness, of connection with that which is greater than the ordinary self is present in them all, only the context changes.

[cottonwood]

Originally Posted by tie-dyed

This is an interesting comment. See, I don't necessarily consider extreme pleasure, primality, and physiologic responses to events to be necessarily sexual. I consider them ecstatic, sometimes mystical.

Ecstatic is a good word. It's something that needs to be explored more. This is new territory (well, at least as far as having been suppressed for so long,) and I think people are really just trying to latch on to something that helps them explain what it is about birth that makes it more than just a mechanical or just a spiritual act. For most people, maybe, who don't have ecstatic experience in church (or whatever non-sexual ecstatic experience,) sex is the closest they are able to come to explaining what is like to not be able to enter this thing fully because of inhibition or a sense of being watched, and it feels especially applicable because (unlike with the ecstasy one might feel in church) this pleasure and primality involves the genitals and sexual hormones and is connected to the act of conception.

[accountclosed3]

tye dyed:

most of the statements in your initial post had nothing to do with your "assertion" that you stand by--I was taking exception to the idea that midwives in general suppress UC because it would cost them clientele--but instead are a series of bizarre statements about birth not being a sex act for you and about wanting a midwife because you see birth as a female act. and, your thoughts that midwives are safe. I have no idea what these had to do with the construct of your assertion. I still have no idea, unless you're implying that i'm judging women (midwives or those who would utilize them) for their choice.

and if you are implying that, it would mean that you "feel judged" and then i asserted a simple "if-then" statement which syntaticly implies that you can dismiss the satement, instead of it being "condescending or judgemental" toward you to assert that it may be the case.

second, i never asserted that midwives are working to prevent UC for economic motivations above all else. rather, i was reflecting that this midwife, and those who agree with her, likely are so vehemently against UC in part for economic reasons. I do not think that it is the primary reason, or even the secondary. I also know that it's not the case of all midwives, as i know many who do support UC.

So, i'm not sure how from my quick statement, you gathered that i was stating that midwives are working to prevent UC for economic motivations above all else.

[accountclosed3]

also, isn't it possible for a woman to see birth as a 'female act' and a 'sexual act' and a 'spiritual act' and a 'family act' and a 'primal act' and a myriad of other types and kinds of 'acts' all at once?

[cottonwood]

For those of you without access to the article, here's some excerpts from it. She starts off: "In this article, I will discuss the meaning behind the choice to be one's own midwife." She gives a short history of modern unassisted birth (as she sees it) then launches straight into a story about a birth that she believes would have ended badly if not for her involvement.

The mother desired a UC, but had gone to 42 weeks without going into labor. Her mother "was well aware of the possible risks involved to the baby" and pressured her to go to the hospital, which the daughter refused, but she was able to at least talk her into having Ina May do an induction, who was aware of the situation and relieved to have the woman now in her care.

During the painful exam she told Ina May "she wasn't sure why she had been so opposed to the idea of having a vaginal exam throughout her pregnancy." Implication being (in context, otherwise I don't know why she would have included the comment): why, how silly of her to not have wanted a vaginal exam, and even she realizes it now. At this point I'm putting myself into this woman's situation and thinking: If I was tired and beaten down by lack of support and fear and had Ina May's hand up my vagina and she asked me, "So how come you didn't want any vaginal exams done during your pregnancy?", I doubt I would have had the emotional energy or assertiveness to explain it to her. I probably would have just given her a weak smile and shrugged just to get it over with. This is the sort of thing I see over and over in the stories in Spiritual Midwifery -- assessments made about what is going on that to me seem very unperceptive and presumptive.

Anyway, on with the story. When Ina May did the cervical exam she found the mother's cervix very high and posterior, but because she was overdue, they induced (she doesn't say by what method.) "For the first six hours the baby tolerated labor well. Still, the mother's cervix opened very slowly and the baby's head remained at a very high station, considering the strength of her rushes." So you've got strong contractions pushing a baby against a cervix that isn't ready to open. Well, the mother and baby began to show signs of not tolerating the labor (or the induction, depending on how you look at it,) and they transferred to the hospital where a cesarean section was done. There was thick meconium staining and the baby was "visibly dehydrated".

Ina May writes: "I pondered this case for weeks after the baby's birth, aware that his grandmother's intervention had almost surely saved his life. [...] The mother's threat to carry her daughter to the hospital, despite her repeated wishes to be left alone, seemed to be the factor that broke through the daughter's reluctance to having skilled care during labor and birth. It also caused this young mother to question her feeling that she alone was the final and best authority on what as transpiring with her body and her baby at this particular time." (Which Ina May clearly feels was a good thing. I find that last bit really egocentric and dismissive of the mind-body connection. Assuming the baby needed to be born that way, who's to say that the mother didn't feel something wasn't right, and that it was why she finally consented to professional involvement?)

So, what can we learn from this? I guess, that babies can die if they go to 42 weeks gestation, so it's best to induce then, and if you're UCing you won't have somebody to tell you that and do it for you. Therefore, UC is inadvisable.

Immediately after this story, Ina May launches into the attacks on Laura Shanley, some of which I mentioned in my letter. Then (and ironically, given the possible questions about the validity of her interventive approach to assisting birth) she writes "What bothers me most about the avid promotion of unassisted childbirth is that these advocates generally neglect to concede that following their advice could possibly bring harm to anyone. Each one writes that her experience with unassisted childbirth was completely positive and asks her readers to believe that their experiences will be equally wonderful." Doesn't that sound a lot like something a doctor would say about homebirth midwifery advocates?

She goes on to mention the Motherhood Remembrance Quilt (www.rememberthemothers.org) she assembled blocks for. "Two of the blocks represent women who died during an unassisted labor and birth. One was a first-time mother who died from postpartum hemmorhage at the age of 19 in a college dormitory and the other, a woman who had given birth nine times previously, had succumbed to eclampsia and a ruptured liver during her unassisted tenth labor." So one was quite possibly uneducated, poor, without support, and/or trying to hide the pregnancy, and the other was gravely ill. And this is relevant to what most of us are doing and how we approach birth, how?

Next, evidence from the early days of The Farm. "Anyone who reads Spiritual Midwifery attentively will also notice that the second and fourth babies whose births I attended could easily have died if their mothers had had unassisted births." The first baby she's speaking of was born five weeks early weighing five pounds. She "gave a small cry and then turned blue." They didn't know what to do but pray. Then Stephen (their sort-of spiritual leader or guru) walked in, picked up the baby, and simply breathed into her and she turned pink. The mother or her own husband couldn't have done that simple thing, of course. The other baby doesn't seem to be identified by number, but I assume she's talking about the one who was born two and a half months premature at under three pounds, and was taken to the hospital to be kept warm in an incubator and tube-fed (amazingly, she was breathing on her own and "her heartbeat was good and strong".)

Ugggggh, OT but looking through some of these stories again, some of the stuff that went on and some of the attitudes, it's just crazy to me that they are upheld as such an amazing beautiful thing, such an ideal to strive for. I half wonder if the mothers were so blissed out not because they were treated so appropriately but because they were stoned. The stories are beautiful in the sense that they aren't clinical and cold like the typical birth story of the time (and well, today for that matter.) But you still have things like, "Diane's labor was fairly smooth, even though the midwives had to encourage her to be good to her husband. She was dilating easily. When the baby's head moved through her cervix, though, it was a different story. Diane started screaming. I told her to shut up and keep herself together, but the baby was moving so fast that she wasn't going to listen." Nice.

Anyway, back to Ina May's article. The last story she tells is of another midwife who "was called to assist a first-time mother who intended to have an unassisted birth but became worried when 20 hours had not yet produced the baby. The midwife arrived to find the mother feverish, with long-ruptured membranes and the baby showing signs of infection. A quick trip to the hospital and an emergency cesarean section saved this baby's life and possibly the mother's fertility."

She sums up with the "10-15%" figure, and "Women need to be aware that these are real complications with real causes for concern." Because, you know, most women don't know this. Especially, I guess, the type of woman who would plan a UC.

So there you go. I hope my inserted comments aren't too distracting.