Book
Critique For
“Ina
May's Guide to Childbirth”
Overall I
would recommend this book to all pregnant women. As far as methods of
practice go I don't have many disagreements. Some of her ideology,
including evolutionary theories and weird spiritualism, do not sit
well with me, and I would preface any recommendation with that
disclaimer.
Basic
Foundations
I agree with the underlying principle that birth is
natural, and that we as humans are designed to give birth without a
problem. The psalmist refers to being made by God, “...thou
hast covered me in my mother's womb. 14 I will praise thee; for I am
fearfully and wonderfully made:..”, and Mrs. Gaskin writes that “
Your body is not a lemon. You are not a machine. The creator
is not a careless mechanic.”. Women need to know that their bodies
are not only capable of delivering children, but were created to
deliver children. Too often in today's society women are scared of
birth because doctors treat pregnancy and childbirth as a nine month
long disease to be cured by interventions. Mrs. Gaskin points out
that too many women today fear the pain of childbirth because they
don't view it in the correct perspective. In our society today pain
is bad, and we do everything in our power to alleviate, and mask,
pain to the point that we forget that labor pain has a use. If you
have a bad headache you take a pain reliever, if you are having a
baby you need drugs to kill the pain. Women don't realize that if
they worked with their bodies, rather than fought them, birth would
be easier.
Something that I found
very interesting was a study done to compare a group of Dutch women's
expectations of labor with those of a group of U.S. women. Both
groups were informed of the potential negative effects of the
pain-relieving medication, and nearly two-thirds of the Dutch group
labored and delivered without narcotics, as compared to only
one-sixth of the U.S. group. Interestingly in both groups, the
proportion of women expecting pain and those getting medication, were
nearly identical. I like that she mentions that too often in the
United States natural birth is viewed as an extreme sport, rather
than the normal way to have a baby. Right now, in the words of Mrs.
Gaskin's mother-in-law, we are “too well bred to breed well”.We
need to make women more aware of the fact that pain medication is not
harmless, as we are led to believe by most doctors, and that if you
approach labor with the expectation of working with the pain, rather
than fighting the pain, your labor will go more smoothly.
We need women to realize
that when avoidance of pain becomes the major emphasis of childbirth
care, the paradoxical effect is that more women experience a great
amount of pain after the birth. Frequent use of epidural anesthesia
drives up the rate of c-sections, episiotomies, and forceps use. If
you labor without pain medication you will have pain during the labor
and birth, but it will be over as soon as the baby is born. If you
have pain medication during labor your chances of needing an
intervention to help deliver the baby go up, and when you have
interventions you will most likely need even stronger pain medication
after the birth to relieve the discomfort and pain caused by the
c-section, episiotomy, or forceps.
The next thing Mrs. Gaskin
has figured out is something a lot of people would laugh at, but that
I agree with, is the connection of mind and body. Now I don't believe
in some of the mysticism mind/body stuff that she does, but there is
a connection there. If there wasn't why would placebo pills work? I
have personally seen one case of this, and have heard of another. In
the case I saw, the midwife checked the dilation and found her to be
eight cm dilated. The mother then decided she was done, and informed
the midwife that she was ready to push. The midwife told her to wait
until she was fully dilated to push, but checked again any way, only
to find that the mother WAS fully dilated. She had dilated from eight
cm to ten cm in less than two minutes, simply by putting her mind to
it. In the second case, a friend of mine's sister was induced early
in the morning, and, as is usual with inductions, by about six
o'clock that night was only at about seven cm. She was then informed
that if she didn't have the baby by six thirty she was going to be
taken back for a c-section. Her baby was born at six twenty-seven.
Our minds are powerful, and we need to remember that when it comes to
birth they can help, or hinder, the process.
Sphincter
Law
Mrs. Gaskin
and her partner midwives operate according to a basic set of
principles that they have termed sphincter law. Most U.S. women and
virtually all obstetricians believe in a set of assumptions that OB's
call the Law of the three P's. The three P's are Passenger (the baby)
the Passage (the pelvis and vagina) and the Powers (the strength of
the uterine contractions), under the law of the three P's if there is
a problem with one of the P's it can hinder a successful vaginal
birth. “The major philosophical difference between Sphincter Law
and the Law of the Three P's is that the latter blames woman for what
medicine calls “dysfunctional labors”.” According to the Three
P's if a woman doesn't birth the baby in the time allotted it is her
fault: She grew too big a baby, she has too weak a uterus, or her
vagina and pelvis are too small. According to Sphincter Law if a
woman doesn't have a normal birth in a “reasonable” it is because
of a lack of privacy, fear, or stimulation of the wrong part of the
woman's brain.
Basics of
sphincter law: Sphincters do not obey commands, Sphincters function
best in an atmosphere of familiarity and privacy, Laughter helps
sphincters open, Sphincters may slam shut if their owner is startled
or frightened.
Ina May is
correct in her assessment that stimulating the wrong part of the
brain will slow labor, however she refers to a “new” brain and an
“old” brain but I believe that we have had a whole brain since
God first created us. We do have different parts of our brain that
control different functions, but the parts are all the same age. It
is true that stimulating the neocortex (responsible for abstract
thought) can hinder labor, and that the brain stem controls the
hormones that help labor, the brain stem is not “primitive”
brain. I also disagree with her statement that we have evolved to the
point that we forgot the Sphincter law. I think that we have
continually tried to “play god” and control a created process to
the point that we have forgotten that it is natural. Also she states
at one point that “you need to let your monkey do it” assuming
that we have evolved from, and are related to apes. I disagree with
this statement completely. She also encourages women to imagine
themselves as a strong mammal during labor to help them remember that
they are capable of giving birth. I don't think it is right for a
human that is created in the image of God to imagine that they are
an animal, though realizing that God causes animals to give birth
without a problem most of the times is helpful, I would recommend
memorizing Isaiah 66:9 ”Shall
I bring to the birth, and not cause to bring forth? saith the Lord:
shall I cause to bring forth, and shut the womb? saith thy God.”
We can let our bodies work the why God designed them to work without
imaging that we are just animals.
The Influence
of TV
I agree with
Mrs. Gaskin that TV is giving woman the wrong impressions about birth
because drama sells, but I don't think that the answer to that
problem is to explicitly show natural birth on public TV. I also
agree with her opinion that TV producers are hypocritical to say that
natural un-medicated birth is too graphic, but that they will show
many other things that are actually more graphic. I would propose
that birth videos were more accessible to expectant mothers, that the
TV shows cut back on the emergency births, and intersperse some
normal births. Also I think that who ever the mothers care provider
is should make sure that she doesn't have and irrational fears based
off of TV, and encourage her to educate herself on normal birth so
that she doesn't go into labor with all of the fake scenarios in her
head. I think that would help alleviate some of the fear that
surrounds birth, and wouldn't make a spectacle of something that is
usually a very private experience.
Miscellaneous
I would
recommend a balanced omnivorous diet to all pregnant women instead of
vegetarian,
though if a
client was a vegetarian I would just monitor to make sure that they
were getting all of the needed vitamins, minerals, and fats, and
recommend supplements when required.
Ina May says
that puns and witticisms will not work when a mother is in labor and
recommends telling off colour jokes to encourage mothers to laugh,
which helps open the sphincters, but I think you can come up with
something just as funny that isn't crude to help a mother laugh
during labor.
Conclusion
I would
strongly recommend this book expectant mothers and anyone else
interested in natural childbirth. The birth stories in the first
section of the book are very helpful, and Ina May does a wonderful
job describing why the way they practice works so well in the second
half of the book. When recommending this book I would just clarify
with the person that I do not agree with all of Mrs. Gaskin's
“theology”. Over all this book is a great resource, and a
valuable addition to any midwife's library.
