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Ina May Gaskin finds that midwife care makes sense for women — and for the economy.

Birth of a Movement

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Ana May Gaskin is credited with rekindling interest in midwifery and almost single-handedly starting the modern home-birth movement in this country. Founder of The Farm Midwifery Center in Summertown, Tenn., Gaskin has helped deliver as many as 24 babies a month.

Currently, she stays busy campaigning for a national certification program for direct-entry or lay midwives, like herself, who are trained through midwifery schools, workshops and experience, and are not required to attend medical school. She also lectures internationally on midwifery, writes articles for medical and birth-related publications and edits a quarterly journal, "The Birth Gazette." Gaskin is the author of "Spiritual Midwifery" (1976) and has recently completed "Ina May's Birth Book," to be released soon.

Gaskin visited Richmond in early February to speak to the state House of Delegates in support of direct-entry midwives as well as a bill requiring physicians and pharmacists to disclose warning information about Cytotec (misoprostol), a controversial drug used to induce labor.

Style: You've been delivering babies for 30 years. How many babies have you helped into the world? Does it ever get old?

Gaskin: I've been present for about a thousand births. Indirectly, I've assisted with 2,200. [The others were attended by her partners, whom she trained.] No, it never gets old, absolutely not. I was at a birth last week, and it was just as exciting to me as ever.

Nearly all the women you've assisted have given birth in your birth center, not in a hospital. [Hospital transfer is available to those who need it.] Giving birth out of hospital might be considered risky by medical professionals. Yet your figures reveal a much lower rate of surgical delivery than the figures of typical obstetricians. What is your rate, and what is the national rate? How do you explain the difference?

Our C-section rate is well under 2 percent — 1.5 or 1.4 percent in 30 years. The rate in the U.S. is climbing again. It's pretty close to one woman in four having C-sections now.

How do I explain it? This has been fascinating to me and I can't pin it down to one thing, but I believe my partners and I are working with women who are far more relaxed than most women can be in the hospital. The truth is that many of the routines that go on in hospitals run counter to helping women relax while giving birth, such as time restrictions placed on labor, restrictions against having a drink or eating food. Or the continuous monitoring of the baby's heartbeat that is done so often … [that] ties the woman to the bed and keeps her from being in a position where gravity would help her. We would be encouraging women to be up and moving freely. We monitor, but not through every contraction. We also don't give the drugs to strengthen labor, because we find the woman's own hormonal system supplies this very nicely.

Of course we fully recognize that in some percentage of births, a cesarean is a lifesaving operation. But when it's used too often, it can cause great problems to mother and baby, and that's not generally recognized.

What percentage of women do you estimate are actually suited to give birth without medical assistance?

Are you separating medical assistance from midwifery assistance? In the countries that do best, in terms of birth-related infant and maternal death rates, three-fourths of births are attended only by midwives. … In most countries, the midwives far outnumber the obstetricians. In England, they have about 30,000 midwives and 800 obstetricians. And that's true of every western European country — midwives are numbered in the thousands and obstetricians in the hundreds. But in [the United States], midwifery was pretty much done in by obstetrics, and we're still trying to recover. So we don't have enough midwives for everyone to have one at this point.

Most countries don't find it economical at all for prenatal care to be given by board-certified surgeons, which is what obstetricians are. When you're talking about healthy women, you're talking about something that's been going on for millions of years. It works pretty well, or none of us would be here.

[At her birth center], everybody is willing and happy to save medical assistance for those instances when it's actually needed. About 3 percent of the time, we've found that we needed the doctor's attention for some reason, though not always for surgery.

Now, maybe we were a little healthier than average — fit, nonsmokers, no alcoholics. In the general population, maybe 15 or 20 percent might require an OB's attention at times, but the remaining 80 or 85 percent could do very well with midwives only.

You've said that midwifery can help relieve some of our national problems, including unwanted teen pregnancies and infant-mortality rates. How?

I'm talking about midwifery in the context of a community, like I've had. I've watched those children grow; they know they can come to me. Those girls learn that as midwives, we have a lot of information about birth, having babies, breastfeeding — and about sex. Because we can talk about this easily, and we have the trust of the parents, we can warn them away from unwanted sexual activity that might get them pregnant when they don't want to be.

I think if you want a lower abortion rate, you have to give sex education. Uh oh, there, I've said it. But that's how it's worked out in my village. Rather than take the punitive approach, you give information so it isn't all a big, big mystery.

In your writing, you have referred to the possibility of having an orgasm during labor. Are you kidding me?

No I'm not kidding you. It's happened to women who never even knew it was possible. … To understand that, I'll point to the idea that the sexual act can be painful if it's rape, and it can be pleasurable if it's lovemaking. Labor and childbirth work in a similar way. It's not a promise, but it's one of the possibilities of a woman's

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