October 6, 2011
Check out Ina May Gaskin, author of Birth Matters and winner of the Right Livelihood Award, on workingmums.com.
Midwifery campaigner Ina May Gaskin says UK women should not look to emulate the US maternity system or they could end up with higher numbers of maternal deaths. “You are headed in our direction, but you can still change course,” she says.
Her warning comes after concerns over maternal deaths at an Essex hospital. Gaskin has just been awarded the Right Livelihood Award, dubbed the Alternative Nobel, for her campaigning work in the US.
She became involved in midwifery after the birth of the first of her five children, two of whom subsequently died. Her first daughter was delivered by a mandatory forceps procedure. “I was horrified because I was not given the chance to say no,” she says, adding that forceps was so common in the 1970s when she gave birth that two thirds of women had a forceps delivery.
“I enjoyed the labour process,” she adds. “It was only when I was tied down and it became like some sort of medieval torture chamber that it became a negative experience. Then the baby was kept from me for the first day and when I was given her I did not feel the instincts I should have felt.”
After that experience, she became interested in the whole birth process and soon after had the opportunity to become a midwife. She was in a travelling community at the time and the hundreds of caravanners she was with eventually settled in Tennessee where their community became known as the Farm. She began delivering community members’ babies at home and opened up one of the US’ first non-hospital birthing centres before writing a book Spiritual Midwifery, which became a rallying cry for the midwifery movement in the country. Since then she has travelled widely to campaign for women-centred births and has won widespread respect. An obstetric manoeuvre is even named after her. She is also credited with helping found the Midwives’ Alliance of North America and has worked to set standards in midwifery care. Despite being 71, she is continuing to campaign.
Her new book, “Birth Matters: A Midwife’s Manifesta”, argues that the US needs midwives more than ever. Gaskin hopes that her Right Livelihood Award will raise awareness about the work she has been doing on maternal health. She says there is so much reliance in the US on technology that the skills and profession of midwives are under threat. “Midwifery and our knowledge of how the body works is pretty much being wiped out,” she says.
“Women who opt not to have medical intervention and who want to experience natural childbirth are accused of being martyrs and show offs,” she says. “A lot of women experience childbirth as very empowering and feel it makes them a more capable, competent mother. It helps them to bond. But hospitals in the US go though a series of what I call separating rituals. Women are separated from their family members when they come in. Their partner is sent to the business office to pay for their care as soon as they arrive. A needle is stuck in their arm and they are then pinned to the bed. They lie there like Gulliver because it has become so important to have every beat of their babies’ heart recorded. This is not about what’s good for the baby, though. It’s about protecting the hospitals against being sued. They are then given drugs which slow down labour, but they also have to fit into hospital schedules so a time limit is imposed for labour and they are given drugs that induce labour.”
Gaskin has been campaigning against one drug in particular that is used to induce labour – misoprostol – which she says can increase the risk of maternal deaths. Her 2000 article on the drug has been credited with prompting the drug’s manufacturer, G.D. Searle, to issue a letter to all US maternity care providers warning against its use in pregnant women. She has been trying to compile statistics about the causes of maternal deaths in the US which she feels are very poorly reported, whether this is the result of side effects to drugs, poor hospital care which she says is often covered up or because women in the US are sent home with no community midwifery or health visitor system in place to monitor their health.
“There are no home visits after the birth in the US and women are not even properly advised of the symptoms to look out for things like deep vein thrombosis,” she says. “There have been cases of single women being discovered dead with a starving baby by their side. It is disturbing to me that there appears not to be more curiosity in the US media to investigate this more.” In April 2011, the Maternal Accountability Act was introduced into Congress, which would make mandatory the use of a standard Death Certificate across all the US states, allowing the extent of birth-related deaths to be recorded.
Gaskin has also campaigned on issues like breastfeeding. She says it’s a complex one in the US. For instance, poor or non-existent maternity leave policies mean women have to rush back into the workplace and give up breastfeeding early; and Puritanical attitudes to women mean there is little tolerance of breastfeeding in some places.
“People speak about their right not to be offended by breastfeeding women,” she says. She is not in favour, however, of criticising women who do not breastfeed. “I prefer to lavish praise on those who do and withhold the criticism since you never know what has led to that decision,” she says.
Gaskin herself says she managed her work life balance through living in a communal environment. That meant she could work and leave her children with other women who lived with her and knew them well. “They were pioneering days,” she says. “I didn’t have to transport my children elsewhere for care. There were many families under the same roof. I think there are lots of things to learn from that kind of experience which is similar to native American customs.
“Women don’t want to be alone when they become a mum. They need role models, confident mums who they can imitate. We don’t have that so much now. Modern life needs to get back some sense of community. Home births are an important part of this and it is good to see the move in the UK to strengthen this. It encourages women-centredness. There are so many huge entities that profit from women being afraid of their own bodies.”