The Missing Chapter to Ina May's Guide

When I was pregnant, I was terrified of childbirth. I told that to my midwife, and she suggested that I read Ina May Gaskin’s manifestoes on natural birth: Spiritual Midwifery and Ina May’s Guide to Childbirth.

I loved Ina May’s story—a hippie living on a caravan of school buses, who learned to be a midwife by delivering other hippies’ babies on those school buses. I loved her message—that we do not have to be fearful of childbirth, and that laughter and kissing and politeness can help reduce pain. And I loved her statistics—there is an incredibly low rate of medical interventions for births at the Farm Midwifery Center, which Ina May founded on the Tennessee commune, where the aforementioned caravan of school buses landed. After a good dose of Ina May, I was confident that I could give birth naturally. It was going to be a challenge, but I was prepared.

Ina May led the midwives at the Farm

Ina May led the midwives at the Farm

Her husband, Stephen Gaskin, was the commune's spiritual leader

Her husband, Stephen Gaskin, was the commune’s spiritual leader

And then I actually gave birth. And it was nothing like what Ina May said it would be. I felt like I had failed. But I also felt mad at Ina May. And the whole natural birth industry, actually. For making me believe that natural birth was not only possible, but that it had the potential to be an ecstatic experience. And for not telling me what you were supposed to think if you didn’t get to have it.

Ina May with a fetuscope in the 70s

Ina May with a fetuscope in the 70s

Ina May with a fetuscope now

Ina May with a fetuscope now

In this episode, I tell Ina May how I felt betrayed by her. And her answer is truly stunning. I’ll let you listen to what she says, but once you’ve heard the episode, please come back to this page. If you wound up feeling like I did after having a baby, Ina May wants to hear from you. Tell your story in the comments below, or just let her know what you think is missing from her book. She will be watching!


More on Ina May Gaskin

Here is Ina May’s TEDx Talk, which I excerpt in the story:

And this movie about Ina May’s life has great footage of the Farm, past and present, including a scene of a 10-pound baby being born to an unmedicated mother. I could see my own reflection in my computer screen as I watched this, and my jaw was literally dropped. The film also shows in action an example of the Gaskin Maneuver, an obstetrical procedure named after Ina May.


All photos except blue/green portrait: David Frohman; Blue/green portrait: Sara Lamm

313 thoughts on “PODCAST #28: The Missing Chapter to Ina May’s Guide

  1. While I absolutely empathize with any woman who wants recognition that their birth experience is OK regardless of if they birthed at home, at hospital, c-section, epidural e.t.c e.t.c. I can’t help wondering, why go after Gaskin? I’ve read all her books. It’s the most inclusive birth literature out there. Gaskin consistently recognizes that hospital, doctors, and C-sections are sometimes necessary. The message she sends is not, “If you don’t have natural birth you failed”, it’s “Hey, this is what’s possible. There are options out there.”

    I really feel that the interviewer never read Gaskin’s books, or watched her video, and was likely just taking other people’s words and opinions as Gaskin’s which is a real shame. I also can’t help but wonder if the midwife should maybe join the discussion. While midwives will often recognize Ina May as a good read, they will also caution that it’s important to steel yourself against any possibility. It’s their role to explore every option with their clients, and that can include what happens if things go sideways.

    I really wouldn’t want Gaskin to change her books. She writes from her experience, and that’s what makes her stories so heartfelt. Obviously her stories aren’t going to be every mama’s story. Doesn’t that go without saying?

    1. Kathleen, I can assure you that I read Gaskin’s books in depth and watched the video. I believe I explained pretty clearly to Ina May what my issue was with her writing. And I also think it was clear that she took the critique to heart. I agree that what she’s saying is, “This is what’s possible,” but I feel that she could go one step further and reassure those of us who don’t achieve what’s “possible” that we are strong women too.

  2. This podcast was a healing gift I’ve needed for two years. Thank you Hilary and Ina May, for your two-way courage, honesty, and vulnerability. I hope you will read this.

    I try not to be too dogmatic, but in my first pregnancy I became a bit of a self-righteous natural birth ideologue, inspired by Ina May’s books. I found it difficult to sit with pregnant women who hadn’t read them and were vulnerable to being disenfranchised by the medical world and ubiquitous chain reaction of hospital routine/interventions. I hired a homebirth midwife who had herself been delivered by one of Ina May’s disciples almost 40 years ago and spent time on the Farm. I made lists of wise counsel from Ina May’s stories: make low-pitched moans, moo like a cow, rub olive oil on perineum, horse lips/raspberries, unwrinkle forehead, kiss, visualize yoni as a cave with waves surging in and out. I delineated what positions to get into in case of shoulder dystocia or baby’s head getting stuck. My birth plan, should I require hospital transfer, requested the hospital allow me to refuse routine IV, refrain from all references to pain (so as not to stimulate the wrong part of my brain), and “allow labor to take its natural course” and “natural birthing instincts to facilitate descent” (w/o pitocin, etc.).

    At 27 weeks my water broke prematurely, and by the time I got to the hospital I was contracting every 2 min. Against all odds, our baby stayed inside — that night and for 5 weeks thereafter. I lived in the hospital with regular baby monitoring and round-the-clock medical interventions for 5 weeks.

    Perhaps the universe had a different lesson to teach me than tackling fear. I had, rather, to move past control– both of what happened and how it happened. That, surely, has been the deeper, ongoing lesson of both birthing and mothering.

    At 32 weeks, our baby’s heart rate began to plummet to dangerous levels. I was rushed to the OR for an emergency c-section every 2–3 hours for 48 hours, lights flashing and medical team running madly with alarm in their eyes. Each time our son would bounce back just before they put me under, and I’d beg for another chance to birth naturally. Finally, after more than 2 days without food, drink or sleep, my midwife — as fierce a natural birth advocate as they make them — squeezed mine and my husband’s hands, looked squarely into our eyes and said, “This baby is not going to be able to come vaginally.” We finally consented to a c-section, and two hours later my son gave me a burst of true “birth ecstasy” as he was laid beside my head – healthy for 32 weeks – while they stitched me back together. It turns out my beautiful boy – now a frolicking, thriving toddler — has some medical issues that contributed to his distress in birth. If not for medical intervention, he likely wouldn’t be here. 50 years ago, he likely wouldn’t be here.

    Though profoundly grateful for this outcome, my birth recovery and trauma was just beginning. I cried listening to Hilary’s words because I felt deeply that the natural birth sensibility I had imbibed set me up for unrealistic expectations, self-directed feelings of inadequacy, failure and shame, and externalized feelings of betrayal and rage.

    I didn’t realize just how unresolved all of this was for me until I got pregnant again. Several months ago, while breathing in child’s pose, a buried fuse snapped in me when my prenatal yoga teacher – also a homebirth midwife – told the class to remember “we could trust our bodies, because they know what to do.” After the class I told her my story. I said, “I believe that fear, on the one hand, can be self-fulfilling, and set us up for negative outcomes. And we need to cultivate expansiveness, faith, calm, and surrender to maximize positive outcomes. But when you say things like ‘your body knows what to do’ you set women who have experiences like mine up for tremendous feelings of failure. Surely there must be some way to counteract our culture of anxiety and fear while also conveying to women that birth is often a terrifying mess that may not go as we want it to, and just may require the best of medical interventions, knowledge and support alongside natural birth interventions, wisdom and support. That taking advantage of both of these worlds and everything it takes to bring healthy babies into the world makes us strong, courageous heroines, not failures.” She said in response, “I hear you. I’m so glad you shared your story with me. But I’ve done 400 births, and only seen one other one like yours. Fear is just so damaging; I’d rather set up the other 399 who can have a natural birth to not be afraid.”

    I am now 38 weeks pregnant, and in less than 2 weeks, I will have my second c-section. Baby #2 is breech, and comes with additional risks and complications.

    What would the unwritten chapter of Ina May’s Guide say?

    First of all, you’ve already written part of it with this podcast. It would say, you needed intervention? You are not alone. You are not judged. You are a warrior for your child like every woman who endured labor without medication.

    Two: It’s time to end natural birth/medical polarization including mutual dismissal of the others’ respective knowledge and insight. Even in places with long history, where homebirth midwives have been stigmatized if not illegalized, and are understandably on the defensive. It’s time to bring the best of the medical and natural birth worlds into more productive interface and collaboration. It’s past time.

    Third: listening to this podcast reminded me that there are pieces of natural birth wisdom I and all women can bring to c-sections. I had left that part of me closed in preparing for this birth. This time, I have no written birth plan. I needed to be reminded that though I will have a c-section that doesn’t mean I shouldn’t be empowered to request things like delayed cord clamping and other newborn procedures in the hour following birth.

    The fourth and final piece would go something like this. In Northeastern Thailand, there is a beautiful Buddhist monastery built into a small mountain to represent the 7 stages of enlightenment. Seekers and monks choose among a myriad of paths to ascend through several levels, each more beautiful than the next in terms of both vista and meditation space. Until one leaves the 6th level. Then the path suddenly becomes difficult to discern. The first time I was there, once past the 6th level, I found myself lost, leaving the beautiful, polished order I’d been in to enter a tangle of twisting paths that led to a narrow ledge. I thought it was just me: I had lost the path to “the top.” It was only on my second visit years later – determined this time to stick to the clear path and make it to the glorious Temple I fantasized corresponded to Enlightenment, and finding myself instead again crawling through mud and tangled vines – that I realized that this mess WAS the 7th stage. All the beauty and techniques of the levels below had been built to help comers with THIS: how to bring openness and calm to the Great Big Mess of Lived Experience. I wish I had brought this expectation to my birth experience. I wish Ina May’s books and the culture she helped spawn had better helped prepare me for the Mess, and embrace and honor myself in and through it.

Say Something

Commenting Guidelines Curiosity and spirited discussion are welcome; personal attacks are not. We reserve the right to reject comments that do not follow our guidelines.

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>