Reflections on My Interactions with Ina May Gaskin

So we are moving from the major metropolis of Dallas/Fort Worth to the beautiful farmland of the Shenandoah Valley in about 6 weeks. I can’t wait to get back to Virginia–I really can’t; but there are times when I have access to some AMAZING things in DFW, and I wonder if i will have any similar opportunities when we move. Meeting Ina May Gaskin was one of those amazing things.

Some of you may be wondering–who is this Ina May Gaskin woman she’s talking about? She’s a Certified Professional Midwife (CPM) that has transformed the way that many people think about midwifery in the United States. Her biography says that she has helped around 1200 babies come into the world in the last 40 years. Sounds like a lot of babies, right? Don’t worry, I did the math for you: that’s 30 births a year, or 2.5 births a month. I think you’d be hard-pressed to find a well-respected OB that has assisted in only 2-3 births a month over the last four decades. Yes, she travels a lot; yes, she’s written several books; yes, she’s done a bazillion speeches–she’s busy! But after listening to her talk this last weekend, 2-3 births a month is about all she would ever take on.

During my pregnancy I read Ina May’s Guide to Childbirth, and admittedly, there were parts that I loved and parts that were just a little too “hippie” for me. But hey, each woman’s birth story is her own, so I just kinda went with it! There were a ton of helpful insights in the book, and I highly recommend it to any woman who is preparing to give birth. So there’s my Ina May shpeal–what is about to follow is a collection of thoughts. They may or may not all work together. I’m just jotting things as I remember them so I can look back and reminisce about what went on this weekend!

Friday Night–Dinner at the Reata

Just a few days before the event, I was invited by a “birthy” friend 😉 to go to dinner with Ina May at the Reata in downtown Fort Worth. The room sat about 40 people. We thought we would be late, but we actually got there a few minutes early, and I had a moment to introduce myself (like Ina My wanted to know who I was–ha!). I actually had a couple of opportunities, but I chickened out on the first two because I hadn’t come up with what to say yet (**lame**). When I saw a dear midwife friend introducing herself, I realized I could sort of piggy-back off of her conversation, so as soon as she stepped away, I got the courage to “step up to the plate.”

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Meeting Ina May Gaskin

I think I said something along the lines of, “Hi, I’m Nicole! I had a baby in September at a birth center, and I work there now! And my husband is a chiropractor, and he specializes prenatal and postnatal care for mom and baby!” At which point she interrupted me: “Oh that is fantastic! We appreciate the work that our chiropractors do!” And then I jumped back in (did I just cut Ina May Gaskin off??), “And I really just appreciate everything you’ve done to spread the word about care for expectant mothers, and especially midwifery care! And it is just really a pleasure to meet you! And thank you for being here! And I hope you enjoy your stay in Texas!” And then I very awkwardly walked away, realizing I couldn’t figure out how to end that conversation. Getting back to my table I realized that I had been a little bit of a blubbering idiot and the only part of the conversation that she commented on was directed toward The Chiropractor (really?? I should have given you more stats about my birth! I promise you would have been impressed! Ok, maybe not impressed…satisfied. Maybe that is what you would have been…).

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Dinner with my midwife Christy and my “birthy” friend Jeanine!

The dinner was delicious. I was able to sit with my midwife (which is always fun!), my lovely “birthy” friend, and I made a couple of new friends along the way! After dinner, I knew I had been away from my “I don’t like bottles or solid foods” baby for long enough and he was probably starving, but I really wanted a photo with Ina May, so I awkwardly walked over to her table, and she graciously agreed!

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After dinner with Ina May

And here’s the part where I was so worried about “I don’t like bottles or solid foods” baby that I rushed out without paying for my drinks (sorry, Jeanine!). No worries, I paid her back 😉

Saturday, Book Signing

So one of the perks to paying to go to the dinner with Ina May was that we got to “cut the line” for the book signing the next day. This was awesome because we didn’t have to rush to get into the line, but I felt like the world’s biggest jerk walking by all of the ladies who were so patiently waiting to get their books signed (if any of you are reading this, I apologize! My wristband said I could do it!). The Chiropractor and “I don’t like bottles or solid foods” baby came along with me to this event because really my journey through birth was OUR journey through birth, and I felt like it just wouldn’t be right to not have them there.

We walked up to her table, and I turned into a blabbering idiot again: “Hi, I don’t know if you remember me, but I was at the dinner last night! My husband, oh this is my husband (pulling him closer), is the chiropractor that works with expectant moms…” She interjected, “Oh of course! Yes, I remember you! So glad you could bring the whole family!” At which point she signed my copy of Ina May’s Guide to Child Birth and we gathered around her for a picture. I remember someone saying, “Hold the book up so you remember which one she signed,” and since we were in front of the camera, I just did what people told me to do. As soon as the shutter went off, my own mind reappeared and I thought, “So I can remember which one she signed? How am I going to forget when I put this thing in a frame!” 😉 And then I remembered my thoughts from the night before–tell her something awesome about your birth!! “And this is my baby…well, my BIG baby…he was 9lbs 6oz when he was born and I had an 8 hour labor and no tearing!” “That’s great!” she said. Had she heard me? “No tearing! Some people think that it can’t be done, but it can!” (Did I really just say that to Ina May Gaskin?! Of course SHE knew it could be done! She trusts the birth process more than anyone on the planet! I didn’t have to tell HER that it could be done…and this is the part where I awkwardly walked away again!)

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Ina May Gaskin signs thechiropracticfamily’s copy of Ina May’s Guide to Child Birth!

Saturday, Ina May Talks on Maternal Mortality

I was really excited to listen to this talk. Truthfully, she could have talked about how to flip hamburgers, and I would have been excited (which she would never do…she’s vegan!). Another one of my perks for going to dinner was that I got to sit in the front row–yes, the FRONT ROW–I was ecstatic!

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That’s me! Second face in–on the front row!

What I loved most about this talk is that it wasn’t all that structured. She told the story of her first birth, of how she was getting ready to push and everything was going beautifully, and because of that hospital’s procedures, she was given medicine. The next thing she remembers, she woke up, not pregnant anymore. When they brought her baby to her room, she felt a total disconnect–wasn’t sure if the baby was hers because she felt no connection. She realized this wasn’t right. And thus began her journey.

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Tellings us her birth story.

She had a few hippie thoughts, but for me, I was surprised at how hysterical she was!

A few highlights:

  • When talking about sphincters, she talked about the importance of a woman’s body being relaxed and open. Women should be allowed to do what they feel is natural. She said, “It is hard for men to understand. They have a sphincter too, you know. It would be like going to the bathroom with them and yelling at them and telling them HOW they should poop–I bet it would be a lot harder for them and it would take a lot longer, too!”
  • Ina May was asked how to protect the perineum. And whether perineal massage works. Her answer: “Massage does nothing. I mean, unless it does something for you–I don’t want to get in the way of anyone’s fun! But a healthy diet, and movement–women need to move, to walk. And lots of water. And squatting. People in Asian cultures squat all the time: to clean the floors, to cook, to garden, to use the bathroom. Women should practice squatting. Here, I’ll show you:”
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Yes, this happened!

She also had some very amazing statistics:

  • When she became a midwife 40 years ago, forceps were used in 75% of all births (do what?!)
  • The c-section rate was less than 5% (the national rate is over 30% today; I know of a few DFW hospitals that have rates at almost 70%!)

She told stories of birth from around the world where doctors literally stand above the mother and PUSH the baby out of mom’s belly (ouch!) and in other places (like the Scottish Isles) where midwives travel all over to make sure a mother is given the best care possible (and OBs are not legally allowed to refuse to help midwives when asked).

She talked about the complications that mothers experience from unnecessary c-sections and inductions. She brought along her quilt that has one square for each mother who has died unnecessarily from MEDICAL childbirth complications (we are not living in Little House on the Prairie here, folks; it was amazing to hear how these women died simply because doctors are taught to rely on technology, rather than skilled training, and how they are taught to fear things like breech vaginal birth). By the way, she does not fault the doctors for this–they are learning what they are taught. She faults the system in which they are taught.

What amazed me most about the entire talk was her openness and lack of rebellion. I pictured her to be this renegade hippie who was going to say that hospital births were unnecessary, but she didn’t–not at all, in fact. She feels that maternal CARE is what is most important. Be it at home, in a birth center, or in a hospital. Every woman DESERVES that personalized attention (one-on-one, from someone who has become a friend and a support…not a professional running between 10 rooms to check on everyone), DESERVES to know that they are SO capable of birthing their baby (your body is not broken, your baby is not too big, breech birth is safe with someone who is trained to know what to do and who is not fearful of it), and DESERVES to be supported in her decisions. It is up to women to take responsibility for their birth, and to find the person to provide care that brings the sacredness back to birth and to the family.

She also gave some great resources for us to Google (which I have done for you):

  • She spoke on instinct, and how we are all mammals, but because of all of the interventions that have taken place over the last 40+ years, we are losing our instincts. We were instructed to check out the dramatic struggle for life on YouTube (**video contains live birth**)
  • As women, we’ve been taught to be afraid of some strange, natural things during birth–like pooping. She suggested reading the very funny article “How I Learned to Stop Worrying and Love Pooping During Childbirth” by Tracy Moore
  • There is also much talk nowadays about women’s hips being too narrow or baby’s head being too large to “facilitate” birth, when in actuality, we were all designed this way. She suggested Googling “Human Bipedalism and Birth” for an explanation. Many of the scholarly articles are unavailable via the web, but here is a nice condensed article written for college students that I found.
  • She often referenced mammal birth, and said several times that birth is misunderstood because people don’t know what is normal. She asked us to check out “Chimp Birth Attica Zoo” to see a chimp mom finding her comfortable labor positions. (**video contains live birth**)
  • When Ina May spoke on maternal and infant mortality, she referenced the CDC Wonder Site.

Thoughts on Labor Pain from a Mom Who Birthed Naturally

My beautiful, big baby boy!
Photo courtesy Evie Marie (www.eviemarie.com)

For those of you who don’t know me, I had a beautiful, big baby boy last September. Not in a hospital, but in a birth center with a fantastic midwife, her student, an assistant, my husband, my doula, and my birth photographer there to cheer me on. You may very well think that I sound a little crazy, but birthing outside of a hospital with midwife was hands-down a choice I would make over and over again! Birthing outside of a hospital means doing it naturally–vaginally and without an epidural–which is something I have been asked about a lot in personal conversation and via email. I’ve written a similar email to several women who have birthed in both hospitals and birth centers that have asked for my opinion around a natural birth, so I thought I would blog the email, as it may come in handy for other mamas who are curious about what birth might look like without an epidural and what other options you may want to consider. And I’m not your doctor or your midwife, so obviously this is not me giving you medical advice! Rather, these are some of my thoughts from my pregnancy and labor that may give you ideas to help ask additional questions! So here it goes:

I’m really excited that you are taking some time to explore your options, rather than just doing what is “normal” across the US! We decided that a hospital birth was not a good fit for our family, so I knew early-on that I would not have the option of any pain medication, and I was originally very nervous about it. I ended up doing a TON of research when we were looking at an out of hospital birth, so I apologize ahead of time if this is more than you were hoping for! Bottom line (in case you get bored half way through this and decide to stop reading!) is that contractions were not NEARLY what I thought they would be (they felt like strong period cramps), and you can ABSOLUTELY do it without an epidural (and if anyone tells you otherwise, then they have no idea what they are talking about!). Ok, so here’s the long-winded version:

First, I wanted to tell you how flattered I am that you are even asking for my opinion! I absolutely love love LOVED my birth experience (every minute of it), so I am so grateful to get to share it with others. Also, please know that my experience was just that: MINE–that means that I made the decisions that I felt were best for me and my family, and your birth will belong to YOU and YOUR family, so no matter what you decide after reading this long essay that is about to follow 😉 I will be excited for your decision because I know it will be what you and your husband feel is right for you guys! And in the end, the most important thing is that your baby arrives on this earth healthy!

Second, I am very pro-natural birth and I feel that all women should be encouraged in their decision to go that route, so WARNING: you’re not going to read a lot of positives below about epidurals from me! In order to give you my opinion, I’m going to have to start from the beginning:

I have always had very painful menstrual cramps, and growing up, people used to tell me that meant that I would have a much harder labor (which I now know to be false), so my feelings on epidurals have always been “Sign me up! I don’t like pain, and if you have a way to get a baby out of me without pain, then please proceed!” As per the usual, enter The Chiropractor–My husband has a very holistic approach to health because of his chiropractic background, and he didn’t want me to have any drugs. Before we got pregnant, I told him I would consider it, but ultimately it was my body and my decision (which I now see was very selfish of me because Luke is his baby too; not to mention that my decisions were going to affect Luke, who wasn’t big enough to make decisions on his own!). So, when we got pregnant, I started looking for the right doctor or midwife to deliver my baby in a hospital. We went to several interview appointments, and every hospital we visited had a very cold feeling to them, and I was having a hard time finding anyone that I wanted to help deliver my baby because I felt like “just another patient.” That was when we started looking outside of a hospital. I knew that if I chose to birth outside of a hospital that drugs wouldn’t be an option, so I had to decide what was more important to me: personalized care for 40+ weeks, or pain relief on a single day. To me, the long-term care was more important, so we went with a birth center and a midwife that I LOVED.

Birthing at a birth center seemed right to me, but I had two major fears: pain during labor and birth & the fear of something being wrong with the baby. The birth center we chose was just a few minutes from a hospital with a well-respected maternity doctor & NICU, so that cleared up fear #2 for me (and, as I learned throughout my pregnancy, child birth is not an “emergency” situation; it is very natural–after all, women in Africa have been giving birth to healthy babies in fields for years! I know that is the extreme, but it still made me feel better!). All I had left to do was tackle fear #1, which proved to be a long road for me. So the first thing I thought I should do was to understand what I was “missing out on” with an epidural, and what I found shocked me. Every doctor and midwife in a hospital setting that I had talked to had reassured me that epidurals were extremely safe and would not affect my baby. That didn’t really make sense to me because I knew that I was spending so much time watching what I was eating and drinking for 40 weeks because the baby was getting all of its nutrients from me…how could the drugs not affect the baby in some way? Of what I read, here are a few things that stood out to me the most:

1. Epidurals can cause longer labors with slower progress: this makes sense because you can’t feel what you’re doing. If you can’t feel when to push and rely on machines to tell you when to do so, you sometimes aren’t able to give extremely effective pushes (which can lead to further complications like fetal distress). I don’t know about you, but I wanted labor to be over as quickly as possible (before I was in it!), and I trust my body more than a machine anyway 🙂 It is really amazing how you just “know” how hard and long to push (I would also advise to ask if you can push as you feel it necessary, rather than pushing for counts of 10 like you often see on TV or in the movies)
2. When you have an epidural, you can no longer walk around: for me, movement during labor was a key way to reducing my pain (more about that later)
3. Epidurals can cause initial latching problems when breastfeeding: The drugs absolutely get to your baby, and it can make babies kind of lethargic. Check out the video showing the “breast crawl“–babies actually have the ability to crawl toward their food source shortly after birth (it is pretty crazy and really cool!). When babies are put on momma’s tummy after birth and allowed to crawl, it also help to expel the placenta faster, as well. There is another video out there called Delivery Self Attachment by Lennart Righard, M.D. It shows epidural and non-epidural babies, and the non-epidural babies perform the crawl beautifully, while the epidural babies kind of just lay there like beached whales…it made me sad 😦

Ok, so I decided that maybe I wasn’t missing out on much with an epidural–EXCEPT THE PAIN RELIEF! I was still not looking forward to being in pain, so now what was I going to do? My midwife explained to me the benefits of laboring in water, which was a great relief for me! Also, being allowed to labor in whatever position I wanted to (standing, kneeling, walking, on all fours, etc) made a HUGE difference for me. I don’t know if I would be having the same conversation with you if I “had” to lay on my back. You may want to check with your doctor/midwife to see what restrictions the hospital has as far as movement goes so you know ahead of time. I put “had” in quotation marks because I want you to understand that this is very much YOUR birth…the hospital may try to put restrictions on you, so you may want to write a birth plan ahead of time about what you do/don’t want, and if you (or your husband) need to raise a little hell to get what you want while you are in labor–DO IT! You won’t regret it! I would also encourage you to hire a doula, who is there to offer you support during labor and make sure your wishes are carried out. She in no way replaces your husband’s important role, but she acts as a support and allows him to not have to worry about “in the moment” decision-making. Andrew was so thankful for our doula after our labor because she took some of the pressure off of him, and he was really just able to focus on me and the baby! She can also come to your house before you go to the hospital to help you decide when it is time to go so you don’t get sent home for not being far enough along, and she can show you different positions to labor in as well as pain-relief techniques. Another thing that I really encourage you to do ahead of time is decide whether or not you want the epidural…it is a lot harder to say “no” when someone offers you pain relief when you are IN pain. I didn’t have the option of that extreme of a pain reliever, but I believe it would have been more difficult to refuse it had I been asked while I was in labor. (I read one time about a mom who put a sign on her hospital door that said “Labor in progress: please do not offer pain medication, but love and encouragement are welcome!”–I love that!)

Complete relaxation is a great way to relieve pain, as well. Here is an exercise that I learned while I was pregnant: spend 5 or so minutes laying on your bed, floor, wherever is comfortable and COMPLETELY relaxing. Have him slowly squeeze your thigh just above your knee starting lightly and ending as hard as he can over the course of about 30-40 seconds and just breathe through it (simulating feeling pain for the duration of a contraction). Then, sit up and have him do it a second time. What you should find is that the second time, it will hurt more because you are more aware of your surroundings and not completely relaxed. If you have trouble areas that you hold tension in, have your husband remind you to relax those points during labor, as well.

Ok, so we talked about all of this pain relief for contractions, but I didn’t really tell you about my contractions (maybe this part should have been first!). This is where I was thankful for my painful menstrual cramps! My contractions felt like strong menstrual cramps, so I feel like all of those years of having periods MORE than prepared me for labor! The benefit of contractions is that they aren’t constant: they only last for short bursts and then they go away. I found a lot of comfort in focusing only on the contraction that I was having in that moment and not worrying about how many more I would have to endure. And when each one was over, I tried to remind myself (and Andrew helped remind me) that I would never have to have that contraction again and I was one closer to meeting my baby. You know your body best, but my vote is that you can TOTALLY handle the pain! Our bodies were made to do it! There are some great articles out there about the purpose of pain during labor that really helped me.

I told you about epidurals and contractions, but another one of my fears was the pain of crowning. Luckily, my doula reminded me that crowning and stretching can last only 5-10 minutes if you are pushing effectively (which you can do without an epidural blocking your sensations of when to push!), so the good news is that this is the shortest part of labor (yay!). I will tell you that this is where I felt the most discomfort, but again, it was not unbearable. I have heard it described as a “ring of fire,” and I think that is a pretty accurate description. One thing that my midwives did to relieve pain was to apply warm compresses to my perineum as I pushed to help the skin stretch slowly. It never hurts to ask your doctor/midwife if he/she knows about these compresses, as well.

The key to making this as comfortable as possible is having the skin stretch slowly, as fast stretching can cause tearing. Your skin is able to stretch better when you have taken good care of yourself throughout pregnancy. A healthy diet (like 85% fruits and veggies, lean protein, and very little carbs), TONS of water, and exercise can go a LONG way here! Also, I am a big fan of not only prenatals, along with fish oil, but also high-dose vitamin C. I was taking around 8000 mg/day by the end of my pregnancy, but I built up to that over 40 weeks. Taking too much at once can cause diarrhea, but you could start by taking 1000-2000mg/day which will help the integrity of your skin (it also has been shown to shorten labor duration, as well). The skin will also stretch slowly if you can feel yourself pushing…you can control how hard you push and when you need to pause! Slow stretching can minimize tearing, as well.

You may also be wondering about an episiotomy. An episiotomy was explained to me this way: think of trying to tear a piece of fabric into two pieces–it is hard, but you can do it. Now cut a slit at the top of the fabric and then try tearing–it will happen much easier. An episiotomy is the same way: if you are cut, you can tear much easier, as well (which doesn’t sound fun to me!). Also, it is easier for the skin to heal from tearing as jagged skin intertwines back together easier than straight edges made from scissors, so you may want to talk to your doctor about what his/her feelings on episiotomies are (how often he/she performs them; when he/she feels they are necessary; and make sure that he/she knows that it is only ok to cut one if YOU give permission!)

Finally, above everything else, my pregnancy, labor, and delivery were a spiritual journey for me (especially in the 15 days after my “due date”). I was able to offer my pregnancy up to God in thanksgiving for everything he had given to me. I learned so much about humility, trust, and surrender. God is incapable of creating anything that is imperfect (although we, as humans, are VERY capable of creating imperfections!). He created us in His image and likeness, and He created our bodies to be able to bear children. He allowed us to conceive, helped us to carry a child for 40+ weeks, so I cannot imagine how he would create a child that was too large to emerge from our bodies. He has created your baby to be just the right size to come out of your body, and He has given you the strength and grace to birth your baby. God is so amazing and so great! I am a testament of His complete love for us: He gave me extra time to grow my child, helped me through a beautiful 8 hour labor, and met me on the other side to deliver an 9lb 6oz baby boy with absolutely no tearing (and no episiotomy). He has now given me the opportunity to share my story with you, for which I am so thankful. You absolutely can do anything that you set your mind to with God’s grace to guide you.

And know that you are already and AWESOME mommy to your baby because you are working to understand all of your options before making an informed decision. Way to go, momma!

Also wanted to include links to a couple of short, well-researched articles for additional information (also check out the purpose of pain during labor link in the body of the blog):

Epidurals: Facts, Implications, and Alternatives by Kate Englehardt, DC, DACCP

The Epidural Epidemic by Jeanne Ohm, DC, FICPA