Home births best

“LET’S say you want some advice that might help you give birth, whatever that might be. My shortest answer is: let your monkey do it.”

So says the world’s most famous midwife, Ina May Gaskin. These simple words of wisdom — which remind women that birth requires we get our thinking brains out of the way and let our mammalian instincts take over — had a huge impact on me as I prepared for my first birth at home.

Like hundreds of thousands of women around the world her two best-selling books Spiritual Midwifery and Ina May’s Guide to Childbirth were my birth bibles.

Ina May learnt to deliver babies by necessity in the back of buses in 1970, on an epic voyage across the United States with her husband Steven, a philosophy professor. They had set off from San Francisco in a convoy of 60 yellow school buses, picking up followers as they went, eventually buying land and creating an alternative community, The Farm, in Tennessee. She later trained formally as a midwife. In 2011 she was awarded the Right Livelihood Award (the “Alternative Nobel prize”) in Sweden, for her lifetime’s achievement.

Forty years on, she is still delivering babies, and reviving techniques which have died out with the virtual eradication of midwifery in the US in the 20th century. At the time of our interview she had just returned from delivering a footling breech home birth, a manoeuvre which usually means an automatic caesarean section in most hospitals.

Her safety statistics are impressive — with a C-section rate at a low 2% — and she is a staunch defender of woman-centred care and the right for natural birth.

“Modern industrialised societies are quite disconnected from nature. Not many of us were reared on farms, where we could have a chance to know how well birth works in various species and the conditions under which it works best. We are the only species of mammal that has the capacity to frighten our female members about their ability to give birth, and we see a lot of fear-mongering these days.”

She sees the rise of popular real-life birth programmes on television, such as One Born Every Minute, as a mixed blessing. “Prudery keeps some of the best, most effective midwifery care from being seen on television, because most woman-centred care does not require that a woman keep her body covered as she labours and gives birth. Modern television standards in most parts of the world would not permit a camera shot of normal labour if her breasts were exposed or of a birth, because the woman’s vulva must not be seen. At the same time, there is no such taboo keeping people from watching the abdominal and uterine incisions during a caesarean.

“When young women can’t see the bodily changes that permit birth to happen, they can’t even imagine that it could be possible, and many develop a pathological fear of their own bodies. The same goes for doctors.”

Ina May is first and foremost a home-birth midwife with levels of mortality much lower than hospitals. Yet the home birth movement is often considered to be irresponsible — with critics highlighting any death at home, while overlooking those which occur in hospitals — which in the US are not required to be reported.

“There is a great deal of ignorance surrounding home birth, much of it generated by the amount of propaganda that promotes the idea that the babies of healthy mothers are in greater danger of dying soon after birth if their mothers planned a home birth instead of a hospital birth. No credible studies have demonstrated this so far.

“The plain truth is that when countries make it impossible for healthy women to plan a home birth, the old pattern of obstetricians dominating midwives is heavily reinforced. This means that obstetrical knowledge begins to disappear.”

Natural birth, says Ina May, is controlled by a naturally produced cocktail of hormones and brain chemicals, it costs less, has a lower complication rate and is the optimal biological experience for mother and child. However, she recommends hospital birth as the safest option for women with medical conditions that threaten their health or that of the baby, including: heart conditions, hypertension, pre-eclampsia and related conditions, placental abnormalities and women who go into premature labour (pre-37 weeks).

Ina May is deeply concerned about what she refers to as the “witch hunt” against home birth midwives around the world — in particular the professor of midwifery in Hungary who is under house arrest. Home birth in Ireland seems under constant threat too, according to Krysia Lynch, Co-ordinator Home Birth Association (HBA). “Women in Ireland (as in the rest of Europe) are theoretically entitled to choose where they want to birth their babies,” she says. “Yet newly introduced legislation around how to categorise “low risk” mothers appears to make this an impossibility for many.

“At what appears to be the darkest time in the history of home birth in Ireland, the HBA have invited Ina May Gaskin speak at our conference to bring back hope to women and midwives alike.”

When asked how much influence Gaskin might have on birth in Ireland, Colm O’Boyle, midwife lecturer at Trinity College Dublin responded: “Maternity services in Ireland are very hospital-based and so vulnerable to hierarchical and institutional forces that can be restrictive and undermine women’s birth autonomy and choices.

“Midwives espouse a philosophy of care that is woman centred but which is difficult to fully implement in contemporary Irish maternity hospital settings.

“Ina May’s and the HBA’s focus on positive birthing experiences is not lost on hospital midwives, but perhaps does not recognise or directly address the particular challenge of providing good quality midwifery and maternity services in increasingly financially constrained and under-resourced circumstances.”

Home birth conference

Celebrating 30 years of supporting home birth in Ireland.

Keynote speaker: Ina May Gaskin. Stalls include: slings; birth preparation; books; clothes and toys. When: Sunday, Apr 29, 10am-5pm (registration from 9am) Where: Louis Fitzgerald Hotel, Naas Rd, Dublin 22 (Just off the M50) Cost: €60 non-members €50 members — tickets online or on door.

Further information: http://www.homebirth.ie


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