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.