Ina May Gaskin: There From The Start

A Pathways exclusive interview with the godmother of modern midwifery

In the midst of the baby boom’s promises of Twilight Sleep to conceal the routine use of episiotomies, forceps and brute force in overflowing maternity wards, Ina May Gaskin found herself surrendering to a traumatic medical birth and being separated from her infant, whom she “doubted was mine when they brought her to me.” She, like many women of her era, began to question what was going on behind the hospital screen and fear-based medical propaganda. This collective questioning, chronicled in proper public spaces like The Ladies’ Home Journal, grew into a national natural birth movement whose mission was to find and share the truth about birth and its promise of empowerment and connection, instead of trauma and separation.

In 1970, inspired by women’s stories of homebirth, Ina May decided to become a midwife and started delivering babies while on a historic cross-country “caravan” with her visionary husband, Stephen, and 300 self-described “hippies” who founded the back-to-nature community known as The Farm in Tennessee. With other midwives on The Farm, Ina May opened one of the first birthing centers in the country. Since then, more than 3,000 women have given birth there, and the C-section rates are an astonishing 2 percent, while the national average hovers at 32 percent and countries like Brazil are at 95 percent. (The World Health Organization recommends a C-section rate of less than 15 percent.) 

In 1975, Ina May published Spiritual Midwifery to share her insights into “normal” birth processes, a now-seminal work credited with saving the midwifery profession from the century-long attack of the founding fathers of obstetrics. Her latest book, Birth Matters: A Midwife’s Manifesta (Seven Stories, April 2011), details the history of birth in America, and other countries, as a route to understanding how the shockingly high rates of maternal and infant mortality in the medical model came to be, despite equally skyrocketing maternity care costs; why America fell into a backward trend with regard to birthing (the U.S. ranks behind 28 other countries); and why the Midwives Model of Care is the wellness paradigm for empowering, healthy births. In Birth Matters, Ina May calls for the right to birth without medical intervention, as facilitated by midwives inside the wellness paradigm, to be formally recognized as a human right.

Pathways: What stage of labor is the natural birth movement in the U.S. right now?

Ina May: Oh, well, we’re still dilating! We’re nowhere near ready to push!

Pathways: The Centers for Disease Control (CDC) said in May 2011 that homebirths in the United States are up 20 percent. Is this good news?

Ina May: It sounds impressive, doesn’t it? But really that puts us at about 1 percent, which is where we were in 1989 before the dip of the 1990s, so now we’ve recovered the dip. So, 1 percent, yeah!

Pathways: On the heels of the CDC announcement, the United Nations released the results of its first systemic survey and Global Midwifery Report since 1976—one year after Spiritual Midwifery was published. The U.N. report declares a global investment in midwifery would save millions of mothers’ and babies’ lives. In the U.S., the trend is toward hospitals shutting down midwives and birth centers. It appears the rest of the world has a different view of midwifery than the United States?

Ina May: The United States took a unique turn from where the rest of the world went in the early 20th century, when the fathers of obstetrics decided to wipe the profession of midwifery off the map. They were successful in doing it; it only took about 20 to 30 years to make it illegal in some states and disreputable with a big propaganda campaign. They depicted midwives as ignorant, unfashionable, dirty old women that might serve you rat pie when they came to take care of you. That was an actual phrase that was used. And they lied and said the European countries were following the same course, which they decidedly were not. So we live with the history of the early 20th century, when birth first started moving into hospitals.

Pathways: What was the impact of this transition of moving away from a woman- and child-centered midwifery model of care toward birth in hospitals?

Ina May: This is when medical students started getting training in hospital wards in large numbers. While in Europe there was a move to hospital births, the midwives still attended the births there. That made for a very different experience for those student doctors in European countries, who were not as apt to pick up forceps— or scissors for an episiotomy—because the midwives (who knew what a normal birth looked like) would say no, and advocate for the woman to birth without interference. European women, who are aghast at our medical births, have asked me since the 80s why American women would allow themselves to be cut, especially because they thought American women were strong. I told them U.S. women didn’t know it was being done to them, and you just found out about it afterward when the anesthesia wore off.

When you replace midwives with obstetric nurses, who are not prepared or trained by midwives, they saw brutal births—pushing and pulling and routine episiotomies and lots of blood. They were not permitted to let the baby be born if the doctor wasn’t there, so they did a lot of preventing birth by holding women’s legs together. So we developed a culture of some pretty brutal practices that were taken for granted as the best that could be done for women, and women themselves had to accept this because they had no other reality.

Pathways: In your new book, Birth Matters: A Midwife’s Manifesta, you write about the letter to the editor of The Ladies’ Home Journal in 1958 that an obstetrics nurse sent in anonymously out of fear of reprimand, confessing “this is what I have seen, and it is brutal.” The magazine was then flooded with letters saying, “yes, this happened to me and it was horrible.” This obstetric nurse’s whistle-blowing seems to be a key moment in the vitalization of the natural birth movement.

Ina May: That definitely fed the movement. There were also lecture tours by Grantly Dick-Read, the author of the classic Childbirth Without Fear; that and probably some university professor’s wives went to Europe and found out about Lamaze and midwives, and there started to be a little bit of awareness that birth could be something different. So it began to be known among a mostly educated group of white women. The Ladies’ Home Journal found itself in the middle of this controversy and kept on printing these letters because they poured in from all over the country. This was in the middle of the baby boom, when maternity wards were bursting around the country and women were giving birth on gurneys in hallways. So, it seemed like a good idea to have midwives around again, but when the first nurse midwives from the American College of Nurse Midwives graduated they became a part of the teaching corps, and it was rare for them to attend births or for women to have a midwife-attended birth.