By Erika-Marie S. Geiss

Ina May Gaskin
According to the December 2007 report "Births, Preliminary Data for 2006" issued by the National Vital Statistics System at the Centers for Disease Control: "The cesarean delivery rate in the United States increased in 2006 to over 31 percent, a new record high and further evidence pointing towards a nationwide change in obstetric practices. The cesarean rate has increased more than 50 percent over the past decade." Among the mitigating factors for planned or scheduled caesarean deliveries are multiple births, obesity, and other health considerations as well as maternal choice for a variety of reasons. Sometimes voluntarily opting for a scheduled cesarean delivery is related to a lack of preparedness and fear about the natural childbirth process (as opposed to taking control of it as a recent article by Alice Park in the April 28 edition of Time magazine asserts is the evolution of childbirth).

Among the preparedness tips and suggestions for mothers who want to deliver naturally, Ina May Gaskin's Sphincter Law is rarely cited in mainstream publications geared to pregnant women or those trying to conceive. Teaching pregnant women to understand the cervix as a sphincter is an unfortunate omission in the literature and discussion for labor and delivery. Becoming equipped with the knowledge of Sphincter Law could not only change women's attitudes towards natural, vaginal delivery, but could also give pregnant women more control over their experience in the third trimester and during labor and delivery itself.

The mother of one child, and labeled elderly prima gravida when pregnant, I had an unmedicated vaginal delivery without any complications, to which I owe Sphincter Law a lot of credit. While trying to conceive and during pregnancy, among the many texts I read were Ina May Gaskin's Spiritual Midwifery (1977) and Ina May's Guide to Childbirth (2003), which is where I first learned about Sphincter Law. There was something about Sphincter Law that made sense, especially during my third trimester when my son seemed to live perched on my intestines and bladder, making waste elimination beyond uncomfortable. Employing Sphincter Law during my third trimester not only eased the difficulty of going to the bathroom, but afforded the opportunity to practice it, thus preparing myself physically and mentally for a natural delivery.

Several months after my son was born, I had the opportunity to speak with Ina May Gaskin about the genesis of Sphincter Law and how and why it works. Gaskin is the first to have discussed the cervix as a sphincter, tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. In effect, the sphincters include any of the bodily openings from which an organ expels an object whether it is air, waste, or a child. Human socialization has taught us keep our sphincters in check?asserting control over them so as not to be inappropriate or impolite. This same control, however, can serve to hinder the natural childbirth process, but understanding and using Gaskin's Sphincter Law can instead help and ease both the tension and fear associated with natural childbirth.

Erika-Marie S. Geiss: How did you discover Sphincter Law?

Ina May Gaskin: I discovered it through observation, particularly with one of my patients who was also a singer. During a difficult stage in her labor, I knew that she could not bear to hear or sing a wrong note, so I had her sing. It was purely instinctive on my part, to have her sing, because I realized that if you want the bottom end to do something, yet you can't control it, then [you have to] work on the top end. By breathing deeply so that the middle expands, and you open your upper openings (the mouth and larynx), then the other openings will follow and also open. It's the principle of "as above, so below."

Geiss: For those readers who are not familiar with your work, what are the basics of Sphincter Law?

Gaskin: When the voluntary muscles get tired, the sphincters don't get tired. Those are connected to the organs that fill up with something?the bladder, uterus, intestines. They expand and contract, and when they yawn open, whatever is inside comes out, and then they close again. But, they work better in privacy?they're shy?and this is true of humans and most animals. We seek privacy to allow our sphincters to do their jobs, jobs that at the most basic level, have to do with hormone levels in the body. For example, oxytocin levels in blood rise when something big comes out (whether it's a baby or a bowel movement). Laughter is one thing that can help open the sphincters. I ask women to laugh when they're having a baby because it helps the process along; it also adds to oxytocin and endorphin levels. But on the converse, if someone is afraid or feels violated, for example, the sphincter can slam shut [what is sometimes called cervical reversal].

Geiss: How did you come up with the term?

Gaskin: Sphincter is a powerful word, and attracts attention, so it made sense to call it what it is.

Geiss: Is Sphincter Law a technique that many midwives use?

Gaskin: I started out with the realization that many midwives didn't consciously know about Sphincter Law and few nurses or nurse-midwives knew about it. There was a common experience, though, among the midwives that I have worked with. A lot of homebirth midwives used it subconsciously, but I didn't know of anyone else who had shaved down the knowledge of the cervix decreasing (or reversing) during labor. Some women, during labor, have reversed dilation without showing the least signs?and this is a story (number 99) described in my Guide to Childbirth. Yet all of these midwives experienced something that supposedly never happened, according to medical texts, and there was no connection to how or why it happens. There is a fundamental ignorance that is taught: believing in false modesty, allowing the mind to censor primal thought. When I wrote the book, I tried to write it for the generation before you and for your generation?women who were completely scared of their bodies. I wanted to change behavior. The concept of "let your monkey do it?, that is, leaving your socialization and high-level reasoning behind, Sphincter Law and [the ability to] orgasm during childbirth are the messages that many really come away from with it.

Geiss: What about obstetricians? Is it employed or discussed by the mainstream medical community?

Gaskin: Not yet. I haven't heard of a single one discussing it today. Thirty to thirty-five years ago, OBs [sic.] were interested in what midwives know, today not so much. But today there are more midwives. The [midwifery] industry was just starting to grow a generation ago. I don't get the same invitations that I used to get from obstetricians, but hopefully that will change.

Geiss: In your estimation, would understanding Sphincter Law improve the chances of easier vaginal deliveries even in a hospital setting?

Gaskin: It would if obstetricians understood. Obstetricians need to have experiences they don't have now, as well as be able to connect birthing to the animal world and not make birthing a procedure. If doctors were asked to lie on their backs, with their feet in stirrups and forced to move their bowels on demand, they might have a different approach.

Geiss: What can a pregnant woman do ahead of time to prepare herself to use Sphincter Law during labor?

Gaskin: Practice when moving the bowels: laugh, take her time, squat, and cultivate a sense of humor and laughing and a connection to the entire bodily process. Sphincter muscles are more likely to open if the woman feels positive about herself where she feels inspired and enjoys the birth process.

Geiss: How is the breathing associated with Sphincter Law different from or similar to other popular breathing techniques and natural childbirth methods?

Gaskin: [The breathing associated with Sphincter Law] is less restrictive and less contrived than some of the other [popular] breathing techniques, which I call "distraction breathing?.

Geiss: If a pregnant woman is also taking other childbirth classes (such as Bradley or Lamaze), can Sphincter Law complement her childbirth education, and how can she incorporate it into her knowledge base? Gaskin: The distraction breathing that's taught in some of these classes is different than the physiological breathing necessary to accomplish birthing. Hyperventilating is not helpful, and women get caught up in breathing the right way, and then when they are delivering, get panicky when they think they are breathing wrong. This creates a self-fulfilling prophecy of a challenging birth. Instead of letting their monkey do it, women can get trapped by the false modesty and in the fear they have been taught. But when women try the kind of deep, yogic abdominal breathing used in Sphincter Law, they find that they relax and can enjoy the process.

Geiss: When is using it most useful during labor and delivery?

Gaskin: Throughout [the entire process] but especially when the woman delivering is starting to feel vulnerable or scared.

Geiss: Is there any other information that you would like to add?

Gaskin: Yes. Women should not listen to the horror stories and instead seek out positive birth stories?ones that share about what worked and what didn't work for the mothers sharing their stories. If you know someone who went the path you intend to go, then it starts to seem more possible. We're so isolated and shy, with a false modesty when it comes to bodily functions including childbirth. There isn't a lot of opportunity to get together and connect about these things in a very frank way. Consider hiring a doula or midwife or consider asking a friend or sister to take a class with a doula with you for that kind of connectedness and experience, even if you are intending to have a hospital birth.

About Ina May Gaskin
Ina May Gaskin is a pioneer in modern midwifery. Gaskin is founder and director of the Farm Midwifery Center, located near Summertown, Tennessee. Founded in 1971, the Farm Midwifery Center had handled more than 2,200 births by 1996 with remarkably good outcomes. Ms. Gaskin herself has attended more than 1,200 births, including the birth of a family friend of the article's author. Gaskin is the first midwife for whom an obstetric technique was named. The Gaskin Maneuver is a low-intervention but extremely effective method for shoulder dystocia, a birth complication where the child's head has been delivered but the shoulders are stuck and cannot be delivered. The Gaskin Maneuver is among the reasons for the near quarter-century decline in automatic cesareans when obstetricians are presented with a breech birth. Gaskin still practices midwifery and most recently was a keynote speaker at the La Leche League International 50th Anniversary conference in June 2007.

Erika-Marie S. Geiss is a work-at-home mom, editor, and freelance writer. Her publication credits include The News Herald, Inkwell Newswatch, Speak2Me, World Energy Monthly Review, theWAHMmagazine, and as a contributing author-blogger at babiesonline and a guest blogger at Family Resource. She and her husband are raising their son in the suburbs of Detroit.