05/14/2012 11:40 am ET Updated Dec 06, 2017

Where Do Babies Comes From? Reviewing Ina May Gaskin's Birth Matters

2012-05-12-birth2.gifIna May Gaskin has been delivering babies for nearly 40 years and her latest book, Birth Matters, A Midwife's Manifesta (Seven Stories) shows you how. Not that you wanted to know. Or maybe like me, you do want to know. Finally, after all this time doing other things, I'm ready to consider, where do babies comes from? Well that's not entirely true: I'm really interested in how women do this thing.

Apparently I am not alone. It was just announced this week that Gaskin will be in an upcoming film, Birth Story: Ina May Gaskin and The Farm Midwives, premiering at The 2012 Los Angeles Film Festival. Her perspective, while not new, continues to be current and a challenge to what some may consider conventional wisdom.

I watched The Business of Being Born, a doc also featuring Gaskin prominently, with great curiosity. The film by talk-show host Ricki Lake is all about the merits of natural birth. But honesty, the direction of my interest was more along the lines of Lake of Fire, a film about the abortion debate: You know, how people avoid having babies... and why other people get upset about it. Motherhood was for me a stimulating topic I'd get to at some later date.

And look at me, here reading this book for Mother's Day. A distraction, maybe. This is a weekend that in recent years, has been stressful. My mother and I for various reasons, have been in conflict. I was a very compliant child, but as I've grown older, it's like a late-term adolescence sprung up from nowhere -- well everything comes from something -- but it did appear, this not-getting-along.

We are cordial of course. But --

So I'm reading Gaskin's book because I'm thinking about motherhood because I'm ready now, and I can't help but think about my own mother and how estranged we have been. And if anything, Birth Matters is really about how, while labor is not without risk (and what isn't?), it is a process by which a woman does an extraordinary yet quite natural thing.

Unfortunately, the technologies -- principally the drive to profit and perhaps a touch of woman-envy -- have women having C-sections (when an incision is made in the mother's abdomen to deliver the baby) and medicating their pain -- and have pushed women away from the (relative) simplicity of this process. We now live in a world where in many countries the rate of Cesarean sections is off the charts:

This kind of extremely medicalized maternity care has become common in urban areas of Mexico, Brazil, China, Venezuela, and Thailand, for example, where rates of C-sections have risen to four or five times more than the rates considered safe by the World Health Organization (WHO). In 1985 and again in 2007, the WHO... made a series of recommendations, including that the rate of C-sections should never be more than 10 to 15 percent of all births. Many private hospitals in the countries mentioned above have cesarean rates of 90 to 95 percent.

- Birth Matters

Just think of how many women you know who've had one. My guess is a lot.

So people like C-sections. That would all be well and good but according to Gaskin, in the U.S., the "maternal mortality rate has risen sharply in some states at the same time as maternity care costs per capita have escalated to levels two to three times as high as those in nations of comparable wealth."

So we're paying more for less.

Even more bothersome, in the United States maternal mortality is not uniformly tracked, if at all, so we can't at this moment even ascertain how often American women die giving birth. So we don't truly know how we are doing:

Since we find ourselves with a rising maternal death rate despite our spending more per capita on maternity care than any other nation in the world, it is clear that we are doing something wrong. Most likely we are doing a lot of things wrong. How do we identify and prioritize these things?...

Let's face it. We're not going to know exactly what to do about our predicament unless we start by creating the infrastructure that most of us probably think we already have in place... Unless we take the trouble to collect good data, we won't know for a fact what is causing the rising maternal mortality rate.
- Birth Matters

What's more, when there is a gap in hospital accountability -- except to the insurance companies and peer reviews -- well, you know how that goes.

What Gaskin is calling for is, at a minimum, that birthing places track mortality so we at least know what the baseline is so that we can ultimately figure out how to better deliver babies and care for mothers.

Behind this assertion, I think is the knowledge that there is a more elegant way of doing things, and that once people are held accountable for their medicine they will change.

Let's hope so.

My African grandmothers (yes, gramps had like five wives) all delivered babies at home. And yet of course, Africa has its rules -- survival of the fittest, so many died of preventable diseases and not-so-preventable ones. But it is still true that they did deliver healthy children and these women survived and lived good lives. So in some part of my brain, I know that this is possible, that women, my relatives, have become mothers for as long as we have -- been in Africa. Haha.

That said, I don't want to paint some Pollyannaish picture of giving birth in the savannah. I volunteer on a board that helps women get to the hospital if they are in danger of suffering from obstetric fistula, which is when a woman suffers injury from giving birth vaginally and is literally leaking from her bowels.

I would say in addition that Gaskin's approach is really one that fully embraces the full, dare I say it, sexuality of birth. It can be something devoid of fear -- still painful, but not unbearable pain.

Sexuality of birth...

Leaking from her bowels...

Are you insane?

I know. My grandmothers would've laughed at putting those two ideas together. Some things don't translate. That said, part of Gaskin's thesis is that pain and fear are directly connected in labor. And that the current technologies amplify our pain because they make us afraid and uncomfortable. This, my grandmothers would have understood -- make the woman comfortable, do not make her afraid.


Americans however are much more open in their sexuality than they give themselves credit for. I think this is a good thing.

And I think this is the hope -- the subtext -- of Gaskin's book. That we can let go of our hang-ups -- HOW DO I LOOK PUSHING THIS FOOTBALL OUT OF MY... -- and just let it be.

Just let women be and do what they think best.

If they want to give birth in a hospital with an IV, sure fine.

If they want a doula, a midwife and a pool with soft music playing in the background, sure fine.
But we should be tracking all of this and insurance had better cover it.

Women need to be supported and educated about their options and this comes from within -- from doing the research on their own, to educating their partners and families, to finding healthcare that works for them, to building a support network to help them after the delivery.

Even if the structure will not allow for it, women themselves will make this happen. They must simply demand it. The market will adjust to the demand. And they must just do what is best for themselves and the baby. They have to listen to their own sense.

(Maybe that's where the Manifesta part of the title comes in, there is something radical about this project to begin with -- the changing of (masculine) manifesto to (feminine) manifesta, gives you the hint. Perhaps I am being a little heavy on the up-with-women sentiment here; don't be fooled by the title, Gaskin is measured in her tone.)

Even though I have a complicated relationship with my mother (who doesn't?) reading Birth Matters was humbling, inspiring. Humbling because I was reminded that my mother did not have an optimal setting when she was having me, she was under stress and I feel gratitude for her strength to propel me into this world despite it.

Inspiring because Gaskin is putting us -- the reader to task. It's a challenge. A call to be brave, like having the faith that you can hold conflicted feelings for a person so equally. But there it is. I have done it. I could do that. I can do so much more now, as can so many women.

You know, there is a cliché -- think of the sports player who looks earnestly into the camera and says, "I love you, ma!" I was never emotionally effusive like that. And yet, I do feel that way about my mom.

Where do babies come from?


Love is what my mother gave me. Love is what binds us still. That is a very good thing.

And as for Mother's Day, just let it be. And by that I mean, perhaps it's finally time to be in the present, to have no expectations. For me, it's about trusting in my own womanhood and a little less searching for the womb that got me here.