Ina May Gaskin is arguably the most recognized midwife in the United States. Her new book is a clear-eyed look at what birth has become and how we can regain a sense of the wisdom of nature. Ina May has been front-and-center in the movement to humanize and optimize pregnancy, childbirth, and early parenting since before her first book, Spiritual Midwifery, was published in 1975. Along with Birth Book written by Raven Lang (1972) and Immaculate Deception by Suzanne Arms (1975), Gaskin's work was instrumental in awakening a generation to the benefits of embracing the power and inherent nature of childbirth. These visionaries seemed to set us on the path to a transformed system of maternal-infant care.
Sadly, roadblocks on that path have arisen from resurgent practices that disrupt the birth process for the mother and bring trauma to the neonate. Meanwhile, cosmetic changes and flashy, high-tech routines have created the skewed impression within our society that medicalized childbirth is now both humane and lifesaving. In circles of young mothers, medicalization is being welcomed without a critical look at the consequences! It is my fervent hope that Ina May's Guide to Childbirth will be instrumental in bringing a new generation of young women to recognize the dangers extant in routine medicalization during any phase of the process of having a baby. Recent research indicates that under 1% of U.S. women giving birth today complete the process absent medical intervention, and a majority have upwards of five procedures (DeClercq, 2002).
Gaskin begins her book with what she knows can captivate those who are approaching the arrival of an infant-birth stories. She knows that positive birth stories create confidence and soothe fears. So, she presents dozens of short stories of successful, satisfying, ecstatic, delightful births-most of which were attended by her and her colleagues, the midwives of The Farm, in Summertown, Tennessee. Her stories inspire us by showing the endless possibilities available to women for joyous birth. Her vast experience, and her love and respect for women, their bodies, and their abilities, spill from the pages, imbuing wisdom and common sense.
It is clear to care providers of today's young women that many are terrified of childbirth-of its capacity for pain. Ina May addresses these fears in a chapter titled "The Pain/Pleasure Riddle." She counters the picture of labor's pain by describing the pleasure, and even the sexual pleasure, that some women experience-affirming that labor has potential to be delightful. Then, with her trademark irreverence and humor, she gives us a chapter on "Sphincter Law"equating the cervix and vagina to other sphincters of the body. She tells us that just as our bladder and bowel sphincters do not respond well to lack of privacy or commands from others to perform, neither do our cervical or vaginal sphincters take kindly to being heckled. "Sphincters do not obey orders," she tells us, and "Sphincters function best in an atmosphere of familiarity and privacy." In fact, "Sphincters may suddenly close when their owner is startled or frightened." Among her remedies? Familiarity, autonomy, privacy. "Laughter helps open the sphincters," and "Slow, deep breathing aids the opening of sphincters." (pp. 172-176)
Gaskin contrasts the techno-medical model of maternity care with the midwifery or humanistic model. Disproved are fears that out-ofhospital, "alternative" birth practices might endanger mother or baby. A series of chapters offer clear explanations of common problems that can arise and corresponding techno-medical interventions. Then, Gaskin lays out the truly disturbing consequences that can develop from those interventions. Most disturbing is that U.S. maternal mortality rates have risen in recent years after decades of steady decline. Gaskin is the first to bring this hidden problem to the public eye.
Compelling explanations of the humanistic model are presented, Gaskin drawing strong pictures of how midwives incorporate elements of familiarity, autonomy, privacy, sexuality, physiology, and evidencebased practice into the birth day. The midwives' model can reward us with enhanced bonding and its intrinsic benefits, with healthy mothers attuned to healthy newborns.
APPPAH's members are focused on the psychology and health of the fetus and infant. Although Gaskin does not concentrate on the psychology and health of the baby, as we read her Guide to Childbirth, we must keep in mind that mother and baby are a bonded unit. What happens to one happens to the other. Without a mother who is healthy in her mind, body and spirit, there cannot be the best of health in her baby. This book can set us on a path for the best possible health of mamatoto, of motherbaby, of a human bonded pair, whose paramount need is wellness in and with each other. Ina May Gaskin has written a guide that can return us to that road to transformation embarked upon in the 1970s. I urge APPPAH's members to read this book, to recommend it to clients, and to consider giving it to any loved one who is approaching birth. It is an important book and a gift to our new century.
Arms, S. (1975). Immaculate deception. San Francisco: San Francisco Book Company/ Houghton Mifflin.
Declercq, E. R, Sakala, C., Corry, M. P., Applebaum, S., Risher, P. (2002). Listening to mothers: Report of the first national U.S. survey of women's childbearing experiences. Retrieved 11/24/02 from
Lang, R. (1972). Birth book. Palo Alto, CA: Genesis Press.