Prized advocate of natural birth

Author and midwife Ina May Gaskin is an international figure in the world of midwifery

THE STORY of how Ina May Gaskin came to found a birthing centre in rural Tennessee is one of the great enduring tales of the hippy era.

Gaskin was an idealistic post-graduate when she met her husband, the philosopher and university lecturer Stephen Gaskin, who was one of the pioneers of the movement that made San Francisco a refuge for counter-culture beatniks everywhere.

In October 1970 the Gaskins led a convoy of 60 vehicles on a speaking tour of the United States spreading their “far-out” philosophy across the US while looking for a place with cheap land to settle and become a self-sustaining community.

It was on the bus ride that Ina May Gaskin witnessed her first birth. She had a baby herself in 1966 in hospital and it was a brutal experience – the obstetrician insisted on a forceps delivery as was the norm at the time.

“I was strapped to a medieval torture chair with leather straps around my wrist,” she recalls, “my baby got pulled into the world. The baby and I were not injured, but I remember the physical insult of it, the indignity, the psychological effects of being separated from the baby. I knew this was madness.”

The birth she witnessed on the bus was an altogether different experience. “What I saw with that woman was a woman who gave birth without pain and without a drop of blood being spilled,” she says. “I knew it could be that way.”

When Gaskin and the rest of the wandering entourage settled on what became known as The Farm in rural Tennessee, she resolved to become a midwife. Having a masters in English literature may be no training for such an exacting profession, but she was familiar with the controversy over midwifery-led care having read Laurence Sterne’s Tristram Shandy where a midwife finds her role usurped by a doctor flourishing the latest medical gadget – a forceps.

The Farm endures to this day. In its 41 years more than 3,000 babies have been born there through natural methods. Women are encouraged to give birth without artificial pain relief, in their own time and with a minimum of interventions.

The Caesarean section rate is 1.8 per cent, 20 times less than the US average, the average transfer rate to hospital is 4 per cent and not a single mother’s life has been lost in that time.

Ina May Gaskin gained a professional qualification as a midwife and, now 72, has become an international figure in the world of midwifery. She has disseminated her message of natural childbirth through her books, most notably Spiritual Midwifery which still has a cult following, and its three follow-ups.

She travels the world and has a number of celebrity champions especially the television presenter Ricki Lake who herself was a guest at the Home Birth Association (HBA) conference three years ago.

Gaskin is a redoubtable advocate of natural birth without interventions or Caesarean sections unless absolutely necessary. She maintains that so much of what passes for conventional wisdom and practice in terms of birth is “culture not nature”, pregnancy is not a disease, but a healthy state and women are treated like machines.

“I’ve seen habits that were set decades ago, that have been accepted for science, which deliberately injure the woman to make it a more controllable delivery than if she gave birth on her own,” she says. “Medical students are being taught the wrong idea because a living being is quite different from a machine which has no feelings. Women are now terrified of their own bodies.”

She maintains practices first developed in Ireland have a lot to answer for in that regard, especially the process known as active management of labour (AML). It was first practised at the National Maternity Hospital Holles Street in the 1970s and is now the norm in the developed world. The active management of labour involves ensuring that women do not go into protracted labour. It was a technique that found its way around the world making it easier for busy maternity hospitals to “manage” labour by inducing or speeding up births.

Gaskin associates AML with the escalating rates of Caesarean birth around the world which has spread from developed to developing countries. It is, she says, “bad news for women and babies” because it replaces a natural process with an unnatural process which often involves drugs to speed up the labour. The more the interventions, the more the likelihood of a Caesarean section.

In Ireland the Caesarean rate is about 30 per cent, twice the average recommended by the WHO.

She has been visiting Ireland since the early 1980s when homebirth was simply not an option for the vast majority of Irish mothers. The situation is better nowadays, but the circumstances in which mothers are eligible for a homebirth has been severely circumscribed by the Health Service Executive.

Gaskin will speak on the birthing in our society from both a mother and midwife’s perspective at the Home Birth Association conference this weekend. One of the issues she will cover is the autonomy of midwives and their ability to use their own judgment as to whether a woman is eligible for a homebirth or not. Gaskin maintains it is not the rate of homebirths that matters, as it is not for everyone, but it is a “reasonable choice” for those women who can safely have them and that choice is a “human right”.

“What happens is that when it gets to be seen as the bad thing to do, you are messing up your knowledge base,” she says. “It is the only place where some women can behave in a way that they are going to give birth naturally. It allows midwives to keep their connection with nature alive,” she says.

Gaskin is famous for having a method of giving birth named after her. She learned the Gaskin Manoeuvre, which aids a baby whose shoulder is out of place to be delivered safely, from midwives in Guatemala. Her work was recognised last year when she received the Right Livelihood award, the alternative Nobel Prize. Her husband had won the same award in 1980 for his charity Plenty International. Theirs is a story of where idealism has triumphed against the odds.

The HBA conference is on at the Louis Fitzgerald Hotel, Naas Road, Dublin 22, on April 29th. Admissionis €45 for HBA members and €65 for non-members. Registration at homebirth.ie