booknotes: birth matters

I must have hallucinated starting the review of this book, because I have a clear memory of doing so but now cannot find the draft anywhere. Och, well. We'll just have to begin again.

I need to admit upfront that I'm an entirely biased reviewer of anything Ina May Gaskin writes. My mother's copy of Spiritual Midwifery was, along with Our Bodies, Ourselves, one of my adolescent introductions to feminism, as well as to female bodies and the amazing things they're capable of. I think what Gaskin and the other midwives at The Farm have been doing for the past forty years is hands-down one of the most awesome things to come out of the 1960s, the women's health movement, and feminist activism. So when my friend Molly offered up Ina May Gaskin's Birth Matters: A Midwife's Manifesta (New York: Seven Stories Press, 2011) as one of the reading options for her GoodReads reading group on feminist pregnancy, birth, and parenting, I jumped at the chance.

UPDATE: You can read Molly's review over at first the egg.

That having been said, I also approached the Gaskin's memoir with some trepidation: how would her work and her writing come across in a new book, one that would be impossible to read through the filter of "that's just how they talked about things back in the 70s..."? I was a little bit worried about being let down, much in the same way one's favorite books from childhood often feel a bit tarnished upon re-reading.

My fears, however, were (mostly) all for naught. Birth Matters is highly readable, compelling, contemporary, and unapologetically feminist in its approach to the political and cultural barriers to high-quality pregnancy, birth, and parent-and-child care in our society. "The way a culture treats women in birth is a good indicator of how well women and their contributions to society are valued and honored," Gaskin argues in chapter one, "The Importance of Birth and Birth Stories":

My intention in this book is not to persuade those women who want to avoid pregnancy to change their minds -- far from it. But I do want to convince even women with no interest in motherhood that the right to a positive and safe birth is just as important as the right to choose whether or not to have a child (7).

She gently points out that the often bitter divisions between parents and non-parents is an unhelpful model for making our world a better place for all humanity: "It is time for feminists to realize that pitting the needs of nonmothers against those of mothers is a way of weakening -- not strengthening -- women. Women should not lose their human rights when they become mothers" (41). Beyond looking at women and mothers, she articulates what I think should be shouted from the rooftops by us all: that the way we welcome children into the world speaks volumes about how we value humanity -- and as such, birth matters to all of us simply because we are part of that human community. The way we were welcomed into the world and cared for as infants and children is part of that story, even if we don't ever plan on becoming parents ourselves.

Gaskin has been in the enviable (for most midwives) position of enjoying strong, positive working relationships with practicing OB/GYN physicians throughout her tenure as a midwife at The Farm, and her belief in the ability of medical doctors and lay or nurse-midwives to work together to foster positive birth experiences for families is evident throughout the book. I really appreciated the way she highlighted the work of medical doctors who trust birthing parents' bodies and offer their expertise without trying to direct the process or fueling fear of the body's work during pregnancy. Yes, sometimes life-threatening complications develop during pregnancy and birth -- but too often in our culture we attempt medical interventions in childbirth that end up being detrimental to the health and well-being of both infants and their birth parents. Gaskin offers an alternative vision of how birth practices can be (and have for the nearly three thousand births Gaskin and her team have overseen in the forty years between 1970-2010). Indeed, it is the outcomes of Gaskin's practice that will likely be most compelling for skeptics of out-of-hospital childbirth: of the 2,844 births attended at the Farm 94.7% were completed at home with a maternal death rate of 0% and a neonatal death rate of 1.7 deaths per 1,000 births. The Farm's rate for c-sections stands at 1.7% which nation-wide hovers between 30-50% (far exceeding the World Health Organization's recommendation of 5-10% of all births*).

Most of what Ina May Gaskin has to say will sound familiar to anyone who has read recent books on pregnancy and birth, particularly Born in the USA by Marsden Wagner and Pushed by Jennifer Block (I highly recommend them both). However, there is some valuable material here that even those familiar with the arguments for the midwifery model of care will likely be interested in. Interspersed throughout are birth narratives written by women who have given birth at The Farm. From my point of view, there can never be too many birth narratives out there for us to draw upon. It's particularly useful to read how different each person's story is, even though they have made some of the same basic choices about the type of care they want to receive. I was also glad to see a chapter on sexuality and childbirth -- something I wish Gaskin had done more with. The midwives at the farm have long advocated for sexual interaction between a laboring woman and her partner(s) as a way of facilitating a less painful, more effective labor. The idea of "orgasmic childbirth" might seem obscene to some, idealistic to others, but even if you don't want to think about childbirth itself as a sexual experience, I think Gaskin has some important points to make about the way medicalizing childbirth (treating it as an illness) has removed women's bodies and their physical presence -- sexual and otherwise -- from the active birth process.

My one frustration with Birth Matters is the consistency with which Gaskin's language choices and examples reinforce the assumption that all birthing takes place within the context of heterosexual, gender-normative lives. The birth parent is consistently a woman/mother and is never identifiably partnered with a woman, although in several stories it is unclear whether the birth parent is single or has a partner. This seemed like an odd oversight for someone who is otherwise so clearly open to the possibility that families come in many shapes and sizes. At times, Gaskin also over-simplifies the history of midwifery and falls into the trap of romanticizing the sacred feminine and female bodies -- something that makes me slightly uncomfortable since I try to avoid essentializing femininity/femaleness. I'd recommend, as a supplement to reading this, the wonderful essay "The Manly Art of Pregnancy," by j wallace (found in Gender Outlaws: The Next Generation, edited by S. Bear Bergman and Kate Bornstein, 2010) which just might be my favorite thing written about pregnancy ever. And I would hope that future editions of this work acknowledge more overtly that people with many different sex and gender identities and family contexts become pregnant and wish to give birth in supportive, low-intervention settings such as The Farm.

The final verdict: Read this book if you care about the cultural and political contexts in which we come into the world, and if you question -- even a little bit -- the medicalization of pregnancy and childbirth that has become the norm in our country at this point in history. Gaskin's memoir-manifesta is a beautiful testament to how there is a different way -- not just in the future, but here and now.

*See the WHO report The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage [PDF]