March 19, 2012 < Previous Entry | Next Entry >

Ina May Gaskin and the Safe Motherhood Quilt Project Focus on High U.S. Maternal Mortality Rates

In part two of our interview with pioneering midwife Ina May Gaskin, she describes the women who died of pregnancy-related causes and are commemorated in squares of the Safe Motherhood Quilt Project. Gaskin argues midwifery is about helping the woman and her child, but is also key to shaping how society as a whole views the birthing process. Gaskin is the author of Ina May’s Guide to Childbirth and, most recently, Birth Matters: A Midwife’s Manifesta.

AMY GOODMAN: Our guest is Ina May Gaskin. She’s the founder and director of the Farm Midwifery Center in Tennessee, winner of the 2011 Right Livelihood Award, author of Ina May’s Guide to Childbirth and, most recently, Birth Matters: A Midwife’s Manifesta. She’s also the founder of the Safe Motherhood Quilt Project, which draws attention to the high maternal mortality rate in the United States.

Can you tell us about the quilt that you’re holding here?

INA MAY GASKIN: Well, volunteers help me. I didn’t do all this needlework, OK? And there’s some wonderful artists that have been working on it with me. And these stories come to me, and they’ve educated me about the weaknesses in our system.

Here’s Virginia Njoroge, who was a Kenyan immigrant. Her husband remained in Kenya, and she came here to Olathe, Kansas, where she gave birth to twins. I’m assuming she probably had a Caesarean, because of the twins. That’s normally what’s done. She went home to this—I saw a picture on television in the news report of her little apartment. But apparently, nobody looked in on her. She didn’t have family there. She hadn’t yet become part of the immigrant community. And so, basically, she was ignored to death. A disturbing smell came. They went and checked three weeks after these babies had been born and found her long dead. And they didn’t know it, but—that she had even had babies, because these babies had scooched off the bed, were caught between the wall and—I mean, it’s appalling.

I don’t know of this happening in any other country. And she’s not the only such death of women, postpartum, released from the hospital, and because of insurance policy that began in the 1990s, they decided not to pay anybody to come and visit you. But this is what happens after early hospital discharge in countries that care about women and keeping them alive after they’ve given birth. You have—you can’t do this over the phone. You actually have to have a trained midwife or nurse visit the home, look around, smell things, examine—not require a sick mother to get herself and her children to a doctor’s office or emergency room.

AMY GOODMAN: This quilt is like a book for you.

INA MAY GASKIN: It is.

AMY GOODMAN: You just turn the pages.

INA MAY GASKIN: I can turn the pages. The two women here were teachers at the same small school in Woodbury, New Jersey. They knew each other, each one having her first baby. She died of—

AMY GOODMAN: Melissa Susan Farah.

INA MAY GASKIN: Melissa Susan Farah died—no, I’m sorry. Valerie Scythes died first. And she probably was—the nurses had too much to do, so when she needed help after her Caesarean—you’re supposed to get up and move around after you’ve had abdominal surgery, so that you don’t die from a pulmonary embolism, which it was the cause of her death 30 hours after she gave birth. But she didn’t have adequate postpartum care even in the hospital. And she, too, had a Caesarean.

AMY GOODMAN: Melissa Susan Farah.

INA MAY GASKIN: And it frightened her that she had died.

AMY GOODMAN: Because she was her friend.

INA MAY GASKIN: Exactly.

AMY GOODMAN: She’s just age 28.

INA MAY GASKIN: And apparently she said to her co-workers, "I wonder if that will happen to me." And I don’t know the specific cause. I believe it was heavy bleeding. And so, I can’t specify, but—and then we have—it’s not just—of course, poor women are quite represented here. But so, this woman was the head of the cheerleading squad for the—

AMY GOODMAN: This is Caroline Wiren.

INA MAY GASKIN: Wiren, wife of the linebacker Nyle Wiren, the Tampa Bay team. And she was a healthy woman, and I don’t know specifically what was the cause of her death, but this woman, I know friends of hers. She was a—her husband is still really upset about her death, and—

AMY GOODMAN: Heather Egan Hayes.

INA MAY GASKIN: Against the hospital sometimes.

AMY GOODMAN: Well, let me ask you. You have a chapter in your book, Birth Matters, called "A Brief Look at the History of Midwives and Medical Men."

INA MAY GASKIN: Right.

AMY GOODMAN: Explain.

INA MAY GASKIN: Well, for 500 years, actually, we’ve had a tension between the newly forming medical profession and midwifery, which had always been here. And that resulted in the idea that you have to be literate to know something about childbirth that’s worth knowing and what would allow you then to be a caregiver. So, of course, the first books were written by men. What most people don’t understand is they were written by men that had never seen a birth. Never. And they became the authorities, and they started writing about how horrible the midwives were. Well, this is at the same time in Europe when midwives were already identified by—in one of the evil books that was written about, you know, demonology and so forth. "Get the midwives." So they were being burned at the stake here and there, or hanged, depending on what country it happened in. And then, you had a few of them in Europe that actually managed to write a book that was significant and quite amazing, but none of these books made it over here, OK?

And so, we then—in the United States, early America, we took it to the huge extreme of obliterating midwifery as a profession entirely. And then it began to be resurrected in the second half of the 20th century. So, now we’ve gotten this far. We’ve got about 10,000 midwives, but they are marginalized by all of these forces that have grown up in the meantime, so that would be the insurance industry, the hospital industry, and then medicine, which has sort been able to push midwifery aside to the point that they don’t know what—they’re not equipped anymore to know what a physiological birth would be like. And so, then you have farming—in the same way that real farming is sort of gone, so people don’t know what that even looked like, we have a nature-fearing. And then the profit motive comes in, because then there’s this tremendous pressure to maintain the status quo. So we’re heading actually now in the direction that Brazil has already taken, and some other countries, where in the private hospitals the Caesarean rate is 95 percent. OK? Now, when you get up to 95 percent, even the women are clamoring for Caesareans, because they think it’s less horrible than—

AMY GOODMAN: Explain what—

INA MAY GASKIN: —than going through the process of labor. And yet, you have, you know, the Occupy family who couldn’t—you know, with the first baby, and I believe she was 37 years old, and boom!

AMY GOODMAN: Beka Economopoulos.

INA MAY GASKIN: Exactly.

AMY GOODMAN: Puts out "Occupy Baby," which we broadcast on Democracy Now!

INA MAY GASKIN: And, you know, in South Dakota—you see, we might think that was the only fast baby born—they probably have 70 births a year in cars, because midwives are so few and far between, and hospitals barely exist in South Dakota. So when we artificially restrict midwives and make them be marginalized and hard to get insurance to pay for them, even Medicaid to pay for midwife births—we should have so many more—but then you get these absurd situations, where babies shouldn’t have to be born in cars because women can’t get midwives in all these other states.

AMY GOODMAN: Ina May Gaskin, why is it in the medical establishment’s interest to do Caesarean section?

INA MAY GASKIN: Oh, well, it’s easy to go home. You know? That’s why more babies are born between 9:00 and 5:00, Monday through Friday, and not to many babies are born on Christmas, New Year’s or Super Bowl Sunday. Sad, but true.

AMY GOODMAN: Talk about the continuum from the contraceptive insurance controversy to giving birth, because some might be listening who are opposed to—who want—who are opposed to women getting insurance coverage for contraceptives, say, "No, this is the woman that we would support, Ina May Gaskin, because she’s all about childbirth." But you see it as a continuum. If you’re not giving insurance for contraception, why do you see that fitting into the picture of healthcare that you want to provide?

INA MAY GASKIN: I can tell you, from being the point—you know, the point of view of somebody taking care of women, I want to take care of people who want to have the baby. When you are not—when the woman had that pregnancy forced upon her, and—that’s hard. It’s hard to bring a good result out of that, you know? So we need—we need sex education in the worst way. And it needs to—we need to let our kids know what’s going on here, because it’s absolutely dangerous to their lives. You can have a whole life thrown off course by ignorance on this subject.

And it’s all about who has control. And I think the control belongs with the people. And midwifery is about, you know, helping the woman and the child through, but you realize it starts—you know, it’s the whole society, how we view birth. And if we think of our women as throwaway items, you know, these inconvenient people that have all these wishes, well, my goodness, I mean, it’s about Mother Earth. Women, in our culture, we don’t even know that we are nature, OK? But we are. And so, we have to have choice all the way through.

AMY GOODMAN: Do you see midwifery as the Occupy movement of medicine?

INA MAY GASKIN: Absolutely, absolutely. It’s about human rights, you see, because midwives even in Europe are finding themselves restricted out of being anything more than just, "Oh, we have to do what the managers say. We have to do what the economic forces are pushing us to." And that’s acting like a woman is a machine, a production item of this product, the baby.

AMY GOODMAN: Where does the drug company fit into this story?

INA MAY GASKIN: Think about it. If you give birth, you know, you can’t find choices here in New York City, and you fly yourself to Tennessee to—this happens. And you give birth where we are, you—

AMY GOODMAN: On a farm in Tennessee.

INA MAY GASKIN: Yeah, you’re going to—it’s going to cost you less than $5,000. And the amount of products that are supported by this are really minimal, because a few gloves, you know—you know, we’re not having the IV lines. We’re not using the operating room very much. You know, a few sterile gloves. It doesn’t take a whole lot.

AMY GOODMAN: And yet, what happens if there’s a problem on the farm when a woman is giving birth?

INA MAY GASKIN: Oh, we have all the stuff we need. And maybe in, you know, less than 5 percent of the cases, we could—we’d take you to the hospital, if you needed. And there’s time to get there, because, you know, you can find complications quite early. So you don’t have all this product. You don’t have all these medications. You don’t have all of these antidepressants later on. You don’t have later hospital admission because we’ve got all these problems.

AMY GOODMAN: In your book, Ina May’s Guide to Childbirth, where you talk about the whole pregnancy, as well, what do you think women in this country need to know that they don’t know?

INA MAY GASKIN: Women need to know that we are just as well made as, you know, the other 5,000 mammals. I mean, our bodies are not flawed. We’re not badly designed machines. We’re not machines at all. And nature didn’t make a design flaw in a human the way people are actually taught, you know? But you have to have people—you’ve got to have some tenderness in the care you get. And that is not, unfortunately, taught. And it makes total difference.

I think that women need to know that we produce hormones in our bodies that make everything go well, but we have needs similar to, you know, race horses giving birth. We don’t need anybody harassing us while we’re doing it. And when I say "harassing," that’s like the standard "viewed as safety" routine for me if I was to go in the hospital and have a baby. OK, I’ve got to get—I’m going to get an IV as soon as I get in there. And then all of these things, if you did them to any other mammal, their body would just go "kkkk!"

AMY GOODMAN: Shut down.

INA MAY GASKIN: Guess what? That’s what happens. I call this "sphincter law," you know? And I’m going to—I’m writing it up for a medical journal now. We’re probably going to pretty up the title and call it Gaskin’s law, but that one—when men—that makes men understand birth. They go, "Oh, if we want something big to come out the bottom, we actually have to be nice to the person?" Mm-hmm, yeah.

AMY GOODMAN: And the whole medicalization of childbirth? And many might be listening and saying, "Wait a second. I mean, there is so much at stake here. The hospitals have to be very, very careful, and that’s why they do what they do."

INA MAY GASKIN: They are being careful for—to preserve themselves. They are not being—they’re protecting the system. It’s a system protecting itself, at the expense, too often, of mother and child. If it was actually true that all this high-tech stuff saves us, we would be in the top 10 for, you know, safety of mothers, not, you know, in the bottom—you know, in the second half of the 100, or who knows?

AMY GOODMAN: So, walk us through a delivery, Gaskin-style.

INA MAY GASKIN: OK.

AMY GOODMAN: Ina May-style.

INA MAY GASKIN: Well, let’s say we’re very interested in the pregnancy that you’ve eaten well, you know, and that you don’t—you know, you’re not smoking tobacco and these things that can really impact the health of your baby. So we want good nutrition. We want you exercising a lot, and so walking, using the stairs instead of the escalator is a good idea, doing a lot of squatting. Squat 300 times a day, you’re going to give birth quickly. So, I mean—and including, you could be 42 years old and having your first baby and have your baby in under, you know—

AMY GOODMAN: How—

INA MAY GASKIN: —three hours.

AMY GOODMAN: How soon, up until the delivery, can you squat? Can you squat in your ninth month?

INA MAY GASKIN: Yes, ma’am.

AMY GOODMAN: Three hundred times a day?

INA MAY GASKIN: Well, if you’ve been doing it every day previous to that, because that’s what women—that’s what our ancestors did in their working lives, you know? And they gave birth with ease. I know a Japanese obstetrician, and, you know, in Japanese it’s goro goro, paku paku, biku biku, and that basically means, "Don’t veg out, don’t pig out, and you won’t freak out." And he’s—he’s a genius. You know, he works with midwives, because he knows you have to have midwives. You have to have people who know how to bring a calm atmosphere. And you can do this in a hospital, but you actually have to have a certain rate of home birth, so that people even know this exists, you know, that it’s a possibility to give birth and end up ecstatic and remembering the euphoria in not just your mind, but your entire body and being is changed by this.

AMY GOODMAN: The fact that you’re laid out on a bed to give birth in most American hospitals.

INA MAY GASKIN: Right. It’s the worst posture to get something big out your bottom. I mean, imagine. So, you want to be all other mammals. I mean, can you imagine an elephant on its back being restrained? Or a horse or a camel? Or—no. This is a—this is done for the convenience of the, you know, to put the forceps in. Historically, it derives from that. But you would be up moving around. And you would probably, given your own—you know, responding to your own body messages, you would be on your knees and your hands, and that way you gain a better diameter, the baby comes more easily, shoulders less likely to get stuck, and you go on your way to do that, so that—yeah, that would—lots and lots of labors are made more painful and less productive and take longer simply because of this restrictive positioning.

AMY GOODMAN: Well, they often say you have to do that, because they have to put that belt that monitors the baby’s heart.

INA MAY GASKIN: And, of course, you could have a human being praising you and giving you, you know, good talk, listening, you know, with even an electronic device. That’s cutting down the personnel, you see. And so, that’s not as good, but it produces a written—you know, a piece of paper in court when you get sued later, where you can say, "Well, look, we did everything." It makes it look as if the person is getting intensive care, when in fact they’re getting—they’re sharing a midwife with maybe four other people.

AMY GOODMAN: Do you see any hopeful signs today—

INA MAY GASKIN: Yes.

AMY GOODMAN: —in America?

INA MAY GASKIN: I really do. I think the doula movement is just wonderful.

AMY GOODMAN: And explain what that is.

INA MAY GASKIN: The doula movement—a "doula" is, you know, a grabbed word from Greek that used to mean, you know, "slave" or something, but in the American usage it means a labor companion. And so, if you have a person, whether—usually it’s going to be a woman. It doesn’t matter whether she’s had a baby or not. But she likes being there to help women in birth, and she’s a calm presence. She’s knowledgeable about what would take—places you could be touched and positions that might be working better for you. And the presence of the doula can cut your labor time in half. It can, you know, keep you maybe from having an epidural too early on, which could extend things and more likely take you into the operating room.

AMY GOODMAN: The epidural is the—

INA MAY GASKIN: It is the pain—

AMY GOODMAN: The anesthetic.

INA MAY GASKIN: The anesthesia that restricts your movement, your lower body, and normally the sensations that you have. But what women don’t know is that we actually produce a hormone in our body that is an opiate. But we—it’s called neural endorphin, and we can only produce it when we are being cared for in this tender way that gets, I think, shoved aside and minimized in its importance.

AMY GOODMAN: If someone is to take one thing away from Birth Matters: A Midwife’s Manifesta, what would it be, Ina May Gaskin?

INA MAY GASKIN: It’s that female power, creating life and giving life, needs to reside in—as women’s business, and that we need to have this power respected. It can’t be made by people who don’t understand it. We need to reverse course and say midwifery—we’ve tried centuries of minimizing and marginalizing midwives, and it hasn’t turned out all that well. We’re not heading in a good direction here. We actually have to reverse course and empower midwives in all countries, because we are the solution to this growing levels of fear that earn the wrong people money and result in bad results you see for mothers and babies and families.

AMY GOODMAN: Are there midwifery schools in the United States?

INA MAY GASKIN: There are very few. There are not enough. Every midwife—every state needs to have actually more midwives than physicians doing births.

AMY GOODMAN: And what’s the difference between a midwife and a nurse-midwife?

INA MAY GASKIN: A midwife—well, I put it together, you see. We had nurse-midwifery came in because the word "midwife" was so disparaged in this country, to bring it back you had to put the "nurse" in front of it to even shoehorn the profession back in. But ideally you wouldn’t have all these distinctions. I think we have to understand that a university training, in and of itself, doesn’t guarantee that you get a great midwife. I know midwives that couldn’t read that taught me things that are absolutely lifesaving that are now in the medical journals, because I’ve been able to bridge that gap to some extent. And so, what I want—we talk about the midwifery model of care, and that is the one that is absolutely centered on the woman and the baby, not on the institution, not on maintaining some sort of system that looks good but actually doesn’t produce great results.

AMY GOODMAN: It sounds like you’re not only talking about a model that would improve the system of birth in this country or the whole practice we have of giving birth in this country in hospitals, but that would improve healthcare in general—

INA MAY GASKIN: Thank you.

AMY GOODMAN: —in the United States.

INA MAY GASKIN: That is exactly true, because it—birth is so powerful, and it’s the water we—you know, it’s almost like, you know, how fish can’t see the water. OK? It’s so powerful how we’re born. And I was just last night at a restaurant with a couple from New York City with their eight-week-old baby in a restaurant, and you get that look when you walk in: "Oh, my god. What’s this going to be like?" And this baby is so happy, because his parents are so happy about how they gave birth. This is a 42-year-old first-time mother shooting the baby out in the bathtub in about an hour and a half. I mean, to hang on. And it’s going so well. It’s just—that is so powerful, to begin life in euphoria, not in distress and having to then go, "Well, what if we had done this?" or, "What if we had known that that would happen?"

I think we’re not curious enough about birth, because we think, "Oh, well, all the high-tech stuff makes it safe." No, you can overuse high-tech stuff in order to make things more efficient for an institution to where you make actually birth less safe. So we need to quit haranguing people because we have a tiny 1 percent who have chosen out-of-hospital birth, and we act like that’s the problem, when we’re ignoring this increasing maternal death rate. And I—you know, it’s taken me a decade to be interviewed about it. So, I’m really happy that you are the one to break the censorship that has existed on this question.

AMY GOODMAN: Well, Ina May, I think you very much for being with us. Ina May Gaskin wrote the book, Ina May’s Guide to Childbirth. And now, most recently, her new book is out; it’s called Birth Matters: A Midwife’s Manifesta. She’s founder of the Safe Motherhood Quilt Project, drawing attention to the high maternal mortality rate in this country. Thank you so much for being here.

INA MAY GASKIN: Thank you.

AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report.

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