Thursday, August 7, 2008

a really long but excited report about a rad book / WARNING: tread no further if you’re squeamish about birthing words like sphincter and episiotomy

(I will post a picture of something nice every now and again to offset such long-winded text.)

I have been reading and loving “Ina May’s Guide to Childbirth” and getting so excited for the beautiful event of childbirth. I want it all! The pain! The joy! The waves! I can’t wait to watch my body go through the process of plunking out onto the earth another human being. What an incredible and weird thing. To be fair, I have read a couple of conventional birthing books too that stress the medical model, but they haven't jazzed me up nearly as much.

Ina May’s Guide to Childbirth (by Ina May Gaskin) has done so much to prepare me mentally for this event. She is one of the U.S.’s premiere midwives, published in all kinds of professional journals, and asked to speak the world over. She has also traveled worldwide to learn from both indigenous and civilized peoples who don’t have an invasive medical model for birth and yet give birth better. Sure, some of those people don’t have a lot of hygiene and nutrition know-how, so their life expectancies might not be stellar, but the act of childbirth itself is seen as normal, not as an emergency from the get-go. What’s nice is that she acknowledges the use of medical intervention when necessary, and appreciate that we have surgery as an option for saving lives. But she believes there are better ways to deal with the majority of births.

Let me give you a small example. She talks about “shoulder dystocia,” in which the baby’s head makes it out of the mom but his shoulders get stuck. This occurs in 1–2 % of births, and in medical circles, it almost always results in using forceps, giving the woman an episiotomy (cutting her from the vagina to the anus), or other injury to mom or baby. Well, Ina May and her partners were once studying with indigenous Guatemalan midwives and noticed that in such a case, these midwives have the woman turn onto her hands and knees, in a dog position. Guess what? Out pops that baby almost every time. Why? The pelvis (and the baby) are made of movable bones, so a position change can affect body shape. These illiterate midwives had been passing down for who knows how many generations a good position for remedying stuck shoulders. From then on, Ina May and her partners used that trick, and after enough experience to see that it worked, Ina published her finds in Journal of Family Practice and Journal of Reproductive Medicine. The maneuver was later named after her as The Gaskin Maneuver, but when she asked the Guatemalan midwives where they had learned it, they said, “Dios. We learned it from God.” (This story is on page 99 of the book.)

Ina May also emphasizes a woman being able to choose her birthing positions according to what feels good – squatting, standing, kneeling, etc. – rather than on the “stranded beetle” position used in hospitals. A lying-on-back position was first recorded as used by a mistress of the French King in the 1600’s. Shortly thereafter, forceps for grabbing the baby and chloroform as an anesthesia came into use by the “civilized, fashionable” ladies, necessitating their lying down. Squatting began being viewed as low-class. So, for the sake of fashion, we abandoned good birthing positions that allowed us to work with gravity, our best muscle function, and best blood flow between mom and baby.

Lest you think this woman a quack, let me say that on the contrary, she and her midwife partners have run a birthing center in Tennessee for the last few decades with amazing statistics. They see less than 4% medical intervention, including the use of forceps or a vacuum. The c-section rate for their patients has been consistently less than 2%! Compare that to the U.S. average right now of 29.5%. She is so encouraging and down to earth about birth, purporting that a woman’s body is made to do this and is quite capable of it when the woman is physically comfortable, surrounded by loving support, and most importantly of all, mentally and emotionally at ease. You wanna eat while in labor? Eat! This is the hardest job you’ve ever done, so why would we deprive you of food?! And yet, food deprivation is standard hospital procedure, just in case you have to be wheeled into surgery. And we think we’re advanced and that less technologically saavy cultures are barbaric. Hm.

Check out this water bug's shadow on the river rocks below!

Ina May talks lots about the mind-body connection. What struck me was the part about sphincters. We all know that it’s difficult to poo if you’re in an uncomfortable environment or don’t have privacy. Some people on vacations will actually hold in their poo for a week or more because they’re not comfortable. Same idea with sex; a vagina doesn’t open well if its owner doesn’t want sex. Well, my friends, these acts involve sphincters, as does childbirth. Biologically, what closes sphincters in humans and animals is adrenaline coursing through the body. This is a good and helpful response if a person or critter is out in the wild pottying, sexing, or birthing, and they need to end it quickly and run from something. But it’s not good when a woman is actually safe, yet her body is freaked out and producing adrenaline because of loud noises and commotion, bright lights, unfamiliar equipment and people, etc.

Oooh! Don’t you want to give birth right now? I do! But I want to do it well. I’m under no Pollyanna perception that it’ll be downright orgasmic, although many women do have orgasmic type sensations under pleasant, natural birthing conditions. That’s not something you’ll hear much talk of in our polite society. In short, Ina May doesn’t say birth will be pain-free, but that your best chances of a good birth rest in being fear-free.

Okay, I’m out to do Kegels exercises.


melissa said...

dude! great post! i was as taken with ina may as you are. i second that review, every word! i learned tons from her!

tamie said...

I love this post. It's beautiful. I don't know if I will ever have children but reading this post certainly makes me want that experience of pregnancy and child-birth.