Wednesday, January 27, 2010

Ina May Gaskin and Holistic Maternity Care

I just finished Ina May Gaskin's Guide to Childbirth.  This is such a wonderful book and definitely my favorite out of all the books I've read so far for my doula training.  The first section of the book is full of empowering birth stories, the kind of stories you don't usually get to hear about birth. If you pick up a pregnancy and childbirth book while you're preparing to have your baby, it may be full of a lot of things that can frighten you about birth. These stories are meant to let you know that birth can be good.
The second part of the book is really her "guide." It is her perspective on every aspect of birth - her belief that there is a mind/body connection, the "Sphincter Law," the positive and negative about every prenatal and labor procedure, forgotten vaginal powers! and more.

Ina May happens to be the country's most famous midwife. I'm hoping I'll be able to catch her speaking at a conference someday. She is a little bit "hippie" or "crunchy" or "natural," whatever you want to call it, but I love her methods and am wholly impressed at the results her births and studies produce based on her methods and firm belief in the abilities of women's bodies.

What I love most about her is how holistic her methods are. I want to define holistic here because I feel like many, like myself, read holistic and don't really know what it means.  The Merriam-Webster definition is:  
Relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment of, or dissection into parts.
Holistic medicine attempts to treat both the mind and the body.
 The mind/body connection is very strong and very very important in birth. She gives several examples of how the mind caused women's bodies to behave a certain way, and how she treated the mental symptom and the body responded. For instance:

- a woman, whose labor had stalled, who hadn't mentioned that she feared dying in childbirth because of a relative who had. By simply and finally voicing the fear allowed her body to relax and her cervix to open to full dilation.
- a woman who was in early labor being held by her husband, who whispered "you're marvelous!" into her ear. she asked him to repeat it over and over because she could feel her body responding each time he said it. everyone in the room repeated it until she quickly became fully dilated.
- a woman whose labor reversed (went from 8cm, down to 4) because she was afraid of the intensifying contractions that would come just at the end, but by using laughter she lightened up and managed to fully dilate.

When something occurs during labor that makes us nervous, there is a "fight or flight" reaction which releases adrenaline.  If an animal in labor senses a predator near the labor will stall until the animal can move to safety. If a woman is interrupted or observed or pressured during labor she may have a similar adrenaline reaction that will slow her progress. In this case, a doctor will give pitocin, but the problem could be resolved by taking away the stressor and allowing the woman to relax.  Adrenaline can also speed labor up. I have heard of women, who, when told that their baby would have to be delivered by Cesarean section if they didn't hurry up and give birth already, quickly pushed that baby right out!

Ina May does not look at things from one single perspective... as the body as one system and the mind a totally different one. Its not "your body is taking a long time to birth your baby so there's something wrong with your body and we have to treat your body with some induction meds." It is "something is happening to your body that may be affected by your mind, so lets see if we can address your emotions about your body and see how that works on it first."

This also directly has to do with her ideas about Sphincter Law, which is fascinating to read about, so I encourage you to go and directly read how she explains the thoughts behind it, but here is a summary:
According to Sphincter Law, labors that don't result in a normal birth after a "reasonable" amount of time are often slowed or stalled because of a lack of privacy, fear, and stimulation of the wrong part of the laboring woman's brain.
The Basics of Sphincter Law:
1. Excretory, cervical, and vaginal sphincters function best in an atmosphere of intimacy and privacy -- for example, a bathroom with a locking door or a bedroom, where interruption is unlikely or impossible.
2. These sphincters cannot be opened at will and do no respond well to commands (such as "push!" or "relax!")
3. When a person's sphincter is in the process of opening it may suddenly close down if that person becomes upset, frightened, humiliated, or self-conscious.
4. The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, vagina, and the anus to open to full capacity.

Some more background on Ina May Gaskin:
She and her group of midwives founded The Farm Midwife Center in 1971, which is a weird name for what is now a whole village located in rural Tennessee. The village also contains a school, a clinic, a water system, a soy foods production plant, and several businesses. People live there but many people also come and go as they are pregnant and give birth. Many of the children born on the farm return from wherever they are to have their own children on The Farm. And people come from all over the world to birth here as well.

The Farm's birth results and numbers are astounding when compared to the rates in hospitals. Very few cesarean (1.4%) and instrumental deliveries, extremely low rates of induction, high percentage of women with an intact perineum, high rates of breech babies able to be born vaginally, extremely low postpartum hemorrhage, etc etc. And these are normal women from across America and some from other parts of the world as well.

In US hospitals the lowest cesarean rate in 2006 was 18%!
The World Health Organization recommends an optimal C-section rate: "The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006)."


Anyway, if you have made it this far into this post, and are as impressed as I am, I highly recommend reading anything by Ina May Gaskin!

3 comments:

  1. Ina May is truly amazing..

    The explanation of Sphinctor law revolutionized my view on natural birth!

    I am so glad I read her book before having my son; and I'm also glad it's a required read for Doulas!

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  2. Wow! All things I've suspected and just seem intuitively true. How could you even argue with that?! The more I read, the less I want to ever step into a hospital for childbirth.....

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