The Missing Chapter to Ina May's Guide


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

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

  1. I am the mother of two boys. Each came into this world very differently. I had wanted a natural birth with my first — did all the things I was supposed to. Checked all the boxes, picked the best midwife for the hospital that was less than a mile away from our house, went through the motions of planning for something that I really had no idea how to plan for — how was I supposed to know what to expect? I’d run a marathons, I could birth a baby. I was going to go with it .. face it as it came — with the support of an army of people. I had Ina May’s guide, but I never finished it — in fact I barely cracked it open. In the end, I labored from Saturday until Monday night, going to the hospital 3 different times, finally being admitted with an epideral on Monday morning when I was only dilated to 4cm. No progress led to Pitosin which got me to 10cm but no sensations to push. I’m convinced the epideral dropped to my legs when my midwife had me get out of the bed and then all hell broke loose and I could feel the contractions going into the hardest part of the labor. I had visions of climbing out of my body. My entire body was tense, scared and in utter pain. No wonder I tore pushing out a little 6lb 6oz. baby. But, I did .. push it out. I got my immediate contact and bonding during the golden hour. I experienced the intense hormone swing in the days following and with every thing, my baby was good. He was healthy, thriving, he was perfect.

    Needless to say, and despite everything I had to be thankful for, I felt every single morsel of failure that you talk about. Failure for sure, but also confused, embarrassed, unsettled … and worst of all — still scared to death by child birth. Unlike other friends who had had hard labors and ended with a C-section, who then simply scheduled another C-section for their second child, I pushed my baby out and that meant I would have to face it again if I wanted another baby. I waited nearly 5 years.

    I had a couple friends who had birthed their babies at home and I admired them, but even after I got pregnant again it wasn’t really an option I had considered for myself until my doula simply asked me about it. I told my hospital midwife that I was considering a home birth (which meant she wouldn’t attend it) and she encouraged me to take a tour of the hospital again to get a new, fresh lay of the land. I never took the tour. The thought of walking into that space again, while pregnant, was too much for me.

    I hired a rural home birth midwife, a woman who predominantly serves farm wives who life far enough away from a hospital that they birth at home. She had attended the birth of my close friend’s first baby and came highly recommended. She believes in natural child birth and takes a “hands off” approach. I admit, at first, the details of her hands-off approach scared me .… and then it hit me: I was going to have to flip my brain upside down in order to do this. Safety is perceived through certain things and I knew I was going to have to work to rid my brain of fear so that I could get out of my body’s way. I worked for months, actively and subconsciously, to prepare my mind, which was so closely linked to my heart and my body.

    I finally read Ina May’s Guide — paired with my first-hand knowledge of how fear took hold of my first birth experience, her book laid out the path I needed to follow to write a new story. I don’ t think that I could have heard what I needed to hear, had I not had a birth experience to reference, even if it was a traumatic one. I could pick out one “mistake” after another that I had made and slowly I began to chip away at that experience … understanding what had happened in a different way, a way that allowed me to at least grasp how I had slipped into such a trying situation. It wasn’t until I reach the day in my second pregnancy (week 38-day1) when I had given birth to my first born that I literally and consciously forgave myself … for being scared, for not knowing, for … failing. Only I didn’t view it as failing anymore.

    My second son was born a few days later. My labor started early in the morning on December 26th and I progressed for a couple hours in bed, then a couple more hours in the bathroom, then a couple more in the basement where my husband had busily prepared the birthing tub and a bed next to a roaring fire (no fir rug, though!) — The one thing I had told myself throughout the pregnancy was that I needed to birth this baby alone — no-one else could do it for me. I labored alone nearly the entire time. My husband almost didn’t listen to me when I told him to call the midwife only 2 hours into labor, but if he hadn’t she wouldn’t have made it in time. As it was, she arrived 15 minutes before he was born. I had labored through transition on my own, like a woman forging into a dark forest. I didn’t know what contractions after 4cm felt like. I had no road map. And so, when my body started pushing and I couldn’t stop it, my mind couldn’t grasp right away what was happening. After the second pushing contraction, my midwife asked if I could feel anything and I could … his head was right there. My hand guided my son into the world through the next two contractions. I must have closed my eyes, because I only have the memories of what my hand felt. I didn’t see that he was born in the caul … still in his water sack. 6 hours, no meds, nearly alone, I birthed my baby. It was hard, it had intensity, there was some pain, (it was not orgasmic!) .… but all in all, it was amazing — AH-MAZING. I was fully healed — I had healed myself and my old wounds.

    So, I know the frustration that you brought to this interview because I’ve felt it first hand. I also know the amazing potential that Ina May writes about .. because I’ve felt it first hand. It is all so big and so deep and so powerful. Every last bit of all of it.

  2. Is Ina May really reading these comments?! I love this podcast and this thread and all the comments here (well, all the ones I’ve been able to read so far!). I want to reiterate what Sarah Nichols — and probably others — have emphasized: women who DO have a natural birth at home can also feel traumatized and feel like a failure. I am one of them. I DID have the natural homebirth I wanted and I’m grateful now that I did because everything turned out ok in the end. I’m convinced I would have had a c-section if I were in the hospital for failure to progress — and I’m glad I didn’t end up with a c/s but I also wonder if some of the complications we ended up having postpartum would have been avoided if I DID have a c/s. I think this is a hugely important topic, given the number and depth of the comments. I’m thrilled this conversation is happening and I do hope Ina May writes more about this in the next edition. I could go on and on, but here’s my story:

    I had an agonizingly long and complicated labor, birth and postpartum. Now, almost three years later, I am still struggling to reconcile and resolve the difficult emotions and experiences I had. I felt betrayed by my body. Why was my labor so long? What was wrong? Why couldn’t it have been quicker, easier? I didn’t necessarily feel like I “deserved” or “expected” a short or easy labor, but somehow I felt angry and betrayed by my body for taking so long to give birth (30 hours and various complications including malposition, which is why dilation and descent took so long, and a short cord resulting in early detachment of the placenta and hemorrhage). And a long hard postpartum: I bled a lot so my recovery was super slow; the baby was tachypneic for the first day which can be normal, or can be a sign of respiratory distress or infection, and since I had my baby at home we were debating whether to take him to the hospital or not; my beloved grandmother died when he was 11 days old; we ended up in the hospital after all at 3 weeks for a high temperature, requiring IV fluids, antibiotics, multiple lumbar punctures; and then after all this emotional upheaval and trauma (and therefore not sleeping), I ended up with a low milk supply (not surprisingly). That was one of the most devastating experiences of my life: not having enough milk to feed my child. I can’t even go into all the things I did over the proceeding months to try to boost my supply. I can’t even begin to convey how deeply I grieved that loss, how deeply I felt it every single day for months.
    I felt betrayed by my body, again. Why couldn’t I produce enough milk? What was wrong WITH ME? It felt primal, and yet still so personal. I have medium sized breasts, but large enough to have stretch marks! I have always felt self-conscious about my stretch marks, I have never learned to love them or feel completely comfortable about my breasts. But I always felt like it was ok, because at least I would be able to breastfeed and that was the whole point of breasts anyway, so who cares what they look like? And then when I couldn’t breastfeed exclusively, and we gave the baby bottles of formula and donated breastmilk from goddess-angel-friends, I felt like such a failure. It didn’t matter that I had had the natural homebirth I wanted, because I was failing at exclusive breastfeeding.

  3. I had planned as natural childbirth as possible, shifting between wanting a home birth and wanting a midwife attended as low as possible intervention hospital birth (really what I wanted was a home birth experience in a hospital just in case there were complications:-).

    I took a 24-hour Bradley-based but a little more flexible than Bradley birthing class, read all of Ina May’s books, read the Natural Hospital birth book, read pretty much any other book I could get my hands on, plus blogs, birth stories, and talked to people about their experiences. I wrote a brief, clear birth plan and included situations like epi/pit and c-section because although I wanted to do everything possible to avoid those, if I was in a situation where those were needed I wanted to make it as positive experience as possible. I would highly recommend doing this! I was certain I would have a drug-free labor and spend most of it at home and in a shower/tub. That is not at all what happened.

    I went into labor 3 weeks before my due date, about 8 hours after I had “broken up” with my OB, and 2 days before my first prenatal visit with my new midwife. I was group B strep positive and my labor started with spontaneous rupture of membranes. On top of that, my contractions were very intense from the beginning (1 min long and 2 min apart and I was unable to talk or move through them). I went to the hospital a few hours after labor started so that I could get the antibiotics and b/c my contractions were very intense. After 12 hours though my labor stalled. I was 4 cm dilated, my contractions were still very intense, but were now 5–7 min apart. I was exhausted. I had had hyperemisis during my pregnancy and I vomited all throughout labor, so even though I was “allowed” to eat I was vomiting blood, there was no way I was going to eat anything:-(

    My midwife suggested an epi and pit or discussing a c-section, or even me getting in the tub (although normally she does not suggest that for less than 7cm). I hated the tub (who knew!), was exhausted and needed a break, had already had 6 rounds of iv antibiotics, and knew that I was pushing the limits of what the hospital would allow re group b strep and ruptured membranes. I opted for the epi and pit. My midwife had the epi started first to see if that would start labor and then an hour or so later when it hadn’t added the pit. My son reacted very badly to the pit and they had to stop it but my body kept laboring very slowly. They started the pit again a few hours later at the lowest dose and we had continual conversations about how a c-section might be necessary. Then there was meconium. Then my temp started to elevate. We had constant monitoring and although my son’s heartrate kept dipping it was now coming back up between contractions. In the end, the midwife came in to check me around hour 37 basically thinking I was going to get a c-section and we were all surprised to find out that I was 9.5cm! My epi ran out/was turned off (I guess I had some that would have come if I pushed a button, but I didn’t understand that:-), she had me slowly labor down for 2 more hours instead of pushing, and in the end I pushed for 15 minutes, had a tiny episiotomy b/c my skin was not stretching and we all just wanted my son born at that point, and he came out lustily sucking on his hand with apgars of 9/9.

    My son was OP, acynclitic, had a fist in his mouth, and the other fist by his head. I was in labor for 40 hours. The first 24 with no meds other than the saline and antibiotics required for group B strep. The last 16 with an epi and pitocin and constant external fetal monitoring.

    I wrote this excerpt below in an online mommy group when I recounted my birth story (and my recovery was very, very easy and he was an excellent nurser from the get-go):
    My birth was very different than the intervention-free natural childbirth I had planned (once I had the epidural, I had a fetal monitor, a contraction monitor, a pulse ox, a BP cuff, the epidural line, a full IV port that was administering–pitocin, saline (I had 6 bags in the course of the labor), zofran, and ampicillan, as well as a host of needle sticks from blood work and attempted IV lines that did not find my tiny veins) but I was thrilled with how it ended up. At each stage of the decision-making I felt that the best decisions were made for the health and safety of me and my child; that I was with a provider I trusted and who understood my perspective; and that the baby and I were being constantly monitored and decisions were being made in our best interest based on our circumstances. It was a long, hard labor that would have been possible with very few providers in NY-NJ (maybe 1–2 others). With the vast majority of providers and facilities I would have definitely had a c-section within the first 12 hours. I am so grateful that I was able to have the vaginal delivery I wanted, that my son was monitored so well throughout the birth and that we were all prepared to make the best decision for him and his health, and that I will hopefully have a much faster recovery time than if I had had a c-section:-)
    I think that the three most important things I did to ensure a positive birth experience where I felt empowered and able to make informed decisions was:
    1. take an in-depth birth class and proactively educate myself about a variety possible birth scenarios
    2. use this education to choose a provider who I trust who has a similar philosophy
    3. consider less than optimal birth scenarios in my birth plan so that I knew how I would want your provider to respond

  4. Thanks for this podcast. It really resonated with me. I was profoundly disappointed with my birth experience and burst into tears upon thinking about it for a month afterwards. My son is now eight weeks old and I’m finally coming to terms with it. I was in labor for over 50 hours and despite all my planning and self-confidence, my son was born via C-section. I had planned for a natural birth with a midwife at a birthing center. I had read all the books, taken childbirth class, and had even assisted two friends through their wonderful, unmedicated births as a doula-in-training. I had seen firsthand how it’s supposed to happen and, well, maybe that gave me a false sense of security. I felt great throughout my pregnancy and thought this was an indication that things would go as I hoped. The wonderful thing about my birth was that my midwife stayed with me throughout this arduous experience and every intervention was my decision. My baby’s head was malpositioned and I tried laboring (and pushing) in every position to get him to turn and descend. My labor slowed down a few times and after about 36 hours and only 5.5 cm dilation, I chose to go to the hospital to get a Pitocin drip. After 5 hours on Pitocin, I decided to get an epidural. And 6 or 7 hours after that, it was time to push. I pushed for two hours with little result and the midwife brought in the OB, who observed and then recommended a C-section. However, she said I could try pushing for another hour to try to prove her wrong. One hour later, feeling totally defeated, I gave in to the C-section.

    I, too, was intoxicated by Ina May’s rhetoric and was totally unprepared for anything to go wrong though of course, deep down, I knew it was a possibility. I just never thought it would happen to me, a champion of natural birth. I wouldn’t say that I feel like a failure but more that my body failed me. I try to focus on the positives: the support I received, the fact that my baby never showed signs of distress and was born healthy, my empowerment in decision making, the fact that they allowed me to labor for over 24 hours after my water broke (no signs of infection), and that I’m a candidate for VBAC. And perhaps if I had been in a developing country with substandard care, I would have died. However, I can’t help but feel devastated by the experience, something that I can’t express to most people because they respond by saying, “all that matters is that you and the baby are healthy”. Not so. I had to mourn the birth I will probably never get to experience. I can’t give birth at the birthing center until I’ve had a successful VBAC (in hospital) and I don’t think a third child is in the cards for us.

    How do you tell women to trust their bodies and yet, be prepared for the possibility that things may go wrong without instilling fear? I was not psychologically prepared for this and it was devastating.

  5. We have loved this series on “natural” child birth. We had our three babies at home and our births were amazing, disappointing, difficult, beautiful, haunting and confusing. We were lucky, prepared, and humble. There are many who are outspoken in the “homebirth community,” and many more of us who had our own fears and expectations and who want to be able to celebrate our experiences. Don’t we want all families to be able to celebrate the arrival/s of their children? Don’t we want every family who needs to to be able to be disappointed? Don’t we really just want all families to get plenty of support in this time in their lives?
    It is refreshing to hear your honesty with your disappointment not just in your birth but in the messages you got from the “natural birth movement” and makes me think not of who is to blame when it comes to caring for and informing pregnant women but of how competitive our culture is, how hard women are on themselves, and on how many levels women “can’t have it all.” Ina May Gaskin may be the only one who is willing to take on the relationship of birth and self-esteem and support, though certainly she is not the one most responsible. When she does write it, I will be first in line for a copy.

  6. I’m a bit late in leaving this comment, but I just heard the podcast and LOVED it. What a great conversation!

    I am one of those who had a “natural” birth, although I hate that term because I think all births are natural. I prepared the best I could to have my baby at a birth center, and I had a lovely, six hour labor. Great right?

    Except my son had a huuuuuuge head. Needless to say, I had intense pain and phyiscal problems up until nine months to a year afterward. I also had not-too-bad pelvic organ prolapse that I have thankfully learned to correct through exercise.

    But the pain and physical trauma (disfiguration?) combined with caring for a baby with some minor health issues combined with marital problems left me completely broken. Now, I’m a single mom with some serious baggage.

    My question is what do we do after birth? I spent so much time preparing for something that lasted six hours. I prepared for breastfeeding, diapering, teaching my baby to sleep, holding my baby as much as possible, etc. But I didn’t and don’t know how I could have prepared for the changes to my body, my sense of self, and my sexuality. How could I have prepared for the intense self-care I needed to do after birth? And how can I support other mothers of infants to just take some time not only for sleep and showers but for doing things that make them feel human, and even vivacious and desirable? Perhaps it’s something you can’t prepare for, but I think more women need to speak to their friends about the varying outcomes for the woman having the baby. But on a larger scale, I would love it if we had more of a conversation about real life for women who have babies.

  7. I loved this! Ina May is my hero. Her book helped me get over my very traumatic first birth which was actually a home birth. I had complications, the midwife was unsupportive and did not handle them well and my baby and I both nearly died. Had my family of RNs not been there, we probably would have. My midwife treated me as if nothing had happened even while my son was still struggling to breathe, bubbling at the mouth and turning white. By friends and peers of the natural birthing community, I was treated as if I hadn’t thought positively enough about my birth. Often the conversation would turn to “well you didn’t have a doula.” As if that excused my midwife’s atrocious behavior. I googled my midwife’s name (which I should have done prior to birth) and found similar horror stories and the fact that she was on probation with our state during the time of my son’s birth and we were never informed of this…yet it was still all my fault. I had religiously watched The Business of Being Born during my pregnancy and was so excited to be having a midwife! I went to the hospital for baby #2 and #3 and had wonderful midwives that delivered each one. I was looked down on by my home birthing peers. There does seem to be a lot of snobbery within the natural community. If you don’t go all out crunchy, you didn’t do good enough. My hospital experiences were fantastic and really what made the difference was the support I received and how loose hospital policies were. I had zero interventions at the hospital. I had more interventions at my home birth (breaking of waters and constant constant checks, during delivery she had me flat on my back with her hand up my whowho the whole time). I know this isn’t normal but she is actually a very popular midwife in my area. I felt like a failure because of who we chose to be at our birth. I wish that choosing the right midwife would be talked about more, not just choose a midwife instead of an OB. Not all midwives are equally awesome.

  8. I hope that I am not too late in leaving this comment as I only discovered the podcast a few days ago. Thank you very much Hillary for your most helpful, insightful and intelligent podcast series. I was thrilled to find it and am working my way through all of the podcasts. Thank you also for giving your listeners a place to share their comments.
    Podcast #28 “The Missing Chapter in Ina May’s guide” was of particular interest to me. If I could have listened to this podcast immediately following the birth of my daughter in August 2012, it would have helped me immensely. I will spare you the details of my entire birth story but will add that I also had prepared and deeply wished for a natural child birth. I read all of Ina May Gaskin’s books which completely changed my feelings and outlook on child birth.
    Unfortunately I had to have an emergency c-section due to what the hospital referred to as “failure to progress” after 12 hours of labor. To say the least, I was very disappointed to have to have a c-section. My recovery was very rough which I think was partially due to the fact that I hadn’t read anything about what to expect during and after a c-section. Also I struggled from the first minute with getting my daughter to latch on and breastfeed which continued on for weeks after the birth.
    As I write this, I am pregnant with my 2nd baby and am due in a few short weeks. My hope is to have a VBAC but I am aware that this may not happen for me. Despite how my first child birth ended, I was/am very thankful for having read all of Ina May Gaskin’s books on childbirth and did/do not feel angry or disappointed with her directly for my own feelings of failure. Unfortunately, I think it is difficult to have a baby naturally in a hospital these days and not be forced down the medical intervention road leading to a c-section. It greatly depends on where you give birth and the medical professionals who are present. (For my birth, I even chose a UNICEF certified baby/mother friendly hospital where natural childbirth was encouraged.)
    In the case that Ina May does read these comments, I would like to personally thank her for her writing and work on childbirth, midwifery and maternity care. I am not a confident person by nature yet I was able to gain confidence through reading her books about my body and abilities as a woman. During the long hours of my labor, without an epidural and up to full dilation, I did not cry or scream or carry on but worked through the contractions in my own way. Although I was scared during labor at times, I constantly reminded myself that I did not need to fear childbirth. Had I not read Ina May’s books, I am certain that my experience would have been much worse, more fearful and traumatic as I would have completely lacked confidence in myself and not known how to focus and work through labor. I believe I would have needed more support from others rather than relying on myself and my own abilities.

    How I wish that Ina May could be my midwife for the upcoming birth of my son. Instead I will again apply all the knowledge that she has shared in her writing and give it my best to try to have a natural birth.
    (To be clear, I do not see natural child birth as something I must achieve for myself. I simply look forward to enjoying my baby immediately following his birth, being able to get up and walk around afterwards, hopefully a smooth start with breastfeeding and to getting back to my life with my husband and daughter who will be waiting for us.)

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