SUMMERTOWN, Tenn. — Despite living on a commune in rural Tennessee, Ina May Gaskin has had the kind of career success most people only dream about.
A midwife who never formally studied nursing, Gaskin has helped to bring home birth and lay midwifery back from the brink of extinction in the U.S. An obstetrical maneuver she learned from the indigenous Mayans of Guatemala has made it into scientific journals and medical textbooks, and her insistence on the rights of a birthing mother empowered a generation of women to demand changes from doctors and hospitals.
With a lifetime of accomplishment, the 67-year-old Gaskin has earned the right to slow down. But that is the farthest thing from her mind.
“At the time we began, I couldn’t have dreamed that in 25 years’ time women would be actively seeking Caesareans,” she said.
Gaskin largely blames the nation’s rising maternal death rate on the increase in Caesarean section births and the drugs sometimes used to induce labor.
The National Center for Health Statistics reported last month that the maternal death rate for 2005 has risen to about 15 women per 100,000 live births, more than double the 1998 rate of 7.
At least part of that increase is due to better reporting, but researchers say Caesareans also may be a factor.
Promoting natural birth
Gaskin passionately believes natural childbirth is the answer. The number of women giving birth with a midwife has doubled over the last decade and accounts for about 8 percent of births today — the vast majority in hospitals. Still, she says it’s a challenge to promote natural birth to a generation that favors comfort and convenience.
Promoting home births is an even tougher sell. The American College of Obstetricians and Gynecologists has continuously warned against home births as too risky.
Part of Gaskin’s success has been that she combines an analytical mind with an instinctual understanding of birth.
She promoted the idea that a woman’s state of mind will influence how easy her birth is and encouraged unorthodox ways to improve the woman’s experience, like encouraging her to make out with her husband during labor.
At the same time, she kept detailed records of each birth, providing her commune, The Farm, with statistics that would prove important in the debate over the safety of out-of-hospital births.
She has tried to widen the reach of her message by airing natural birth videos from The Farm on television. “The women are so beautiful giving birth,” she said.
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TV stations rarely have run them, calling them too graphic.
“I started to think I should put them on YouTube,” Gaskin said.
High C-section rate
But the high rate of Caesarean sections in the U.S. may help Gaskin’s message gain some traction. Former talk show host Ricki Lake produced and starred in a recent documentary that features Gaskin and is critical of hospital births and their high rate of C-sections.
The U.S. now has a Caesarean section rate of 31 percent, a figure the College of Obstetricians and Gynecologists agrees is troubling.
At the same time, this group of doctors who perform the C-sections also reiterates its “long-standing opposition to home births.” In a recent statement, the organization said childbirth decisions “should not be dictated by what’s fashionable, trendy, or the latest cause celebre.”
Home births are not safe, their statement warns, because “a seemingly normal labor and delivery can quickly become life-threatening.”
Over the years, studies on the safety of home births have conflicted. The doctors’ group says research comparing the safety of home and hospital births has been limited and is not scientifically rigorous.
Their organization approves of the assistance of hospital midwives certified by the American College of Nurse Midwives. These midwives have nursing degrees or comparable training. The college of obstetricians warns against lay midwives like Gaskin, who have no formal medical training and who aid in home births.
Even so, the College of Nurse Midwives says home births can be safe, and they are fans of Gaskin’s. “She’s quite a remarkable woman and an icon of midwifery,” said Mairi Breen Rothman, a nurse midwife and consultant to the midwives college. Rothman herself was inspired by Gaskin’s book.
‘The Orgasmic Birth’
Gaskin began her practice as one of about 250 hippies who pooled their money in 1971 to buy rural land south of Nashville to form a commune. Soon she and a few other women on The Farm were delivering 25 to 30 babies each month.
Not all obstetricians think home births are inherently unsafe. New York obstetrician Heidi Rinehart spent a few weeks at The Farm while a medical student. Although her husband also is an obstetrician, when they were having a baby, they asked Gaskin to be their midwife.
But even doctors who’ve never heard of Gaskin have felt her influence because of patients who have read her books, seen her birth videos or heard her speak.
“They request or demand or vote with their feet to have the kind of birth they want,” Rinehart said.
Now, Gaskin has a film in the works that is in keeping with her anti-establishment, freewheeling nature.
“We’re doing a movie called ‘The Orgasmic Birth,’ ” she said.
That’s not a metaphor. Gaskin says that under the right circumstances women experience a sort of birth ecstasy.
“I mean, it’s not a guarantee,” she said, shrugging her shoulders and smiling, “but it’s a possibility.
“It’s the only way I can think to market it to (this) generation.”
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