The Missing Chapter to Ina May's Guide

This is Part 2 of a three-part series on Natural Birth. Click here for Part 1 and Part 3.

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

355 thoughts on “EPISODE #28: The Missing Chapter to Ina May’s Guide

  1. Before I was pregnant, I knew I wanted a natural birth. I wanted to give birth at home, but my family of doctors and nurses drilled it into my head that it only takes a few seconds for a birth story to turn tragic. To ease any potential for guilt, I opted for a hospital birth with midwives.

    The midwives were low-intervention and after my 20 week ultrasound, they measured and checked the baby’s position with their hands. Everything was great and on track, so they said. At 39 weeks, my water started to leak and because I was GBS positive, I went to the hospital early for antibiotics. I was unhappy already: “Great, here’s the first intervention of the day…”

    When we got to the hospital, the medical resident did a standard ultrasound and found that my baby was frank breech. When I asked what options I had for delivery, the midwives and surgical team looked at me like I was crazy. I started sobbing immediately and was angry that any attempt for a vaginal birth was disregarded because of liability concerns and a lack of education about breech deliveries. Recovering from the c-section was awful, and I struggled to understand how women could choose this option. I had a strong case of postpartum depression and cried (sobbed) most of the first few months. Breastfeeding was an incredible challenge in the beginning and I so desperately needed to retain a sense of being a “natural mama” so I persisted. It wasn’t my baby was 11 weeks old that I nursed her pain-free (despite three lactation consultants and numerous breastfeeding support resources).

    Being pregnant was such a beautiful time for me. I loved how my body felt and grew and I felt free from body image issues and self-criticism for the first time in my life. Having a c-section, I felt weak as if I failed my first goal of motherhood. I know that’s not really the case, but that’s how I felt. I was convinced that this postpartum depression was related to not having a natural birth, but the stories shared here make me think differently. So, thank you to this forum.

  2. I’m coming late to this party because I’m catching up on all the podcasts from the beginning (and loving them!).

    I’ve read all 344 comments to date and have not read a single mention of NITROUS OXIDE. I used it for pain relief during labor and it was amazing. It turned me instantly from a shrieking witch to one of Ina May’s blissed out zen mamas. I was lucky enough to deliver in one of two hospitals in the US that uses nitrous oxide. And that is going to continue to be the case as long as no one knows about it and advocates for it as an option. The natural birth movement should be aware of this option because it offers a great middle ground between zero pain relief and the giant needle of an epidural.

    I went into my birth hoping not to get an epidural, but somewhat open to the possibility because I was aware of my ignorance–I had no idea what birth, normal or not, felt like. I didn’t want an epidural for many of the same reasons other women prefer not to have them: 1) big needle in your spine, 2) cascade of interventions, 3) being stuck flat on your back, 4) baby born lethargic and drugged, 5) slower recovery. Nitrous oxide has none of these downsides. You breathe it in through a gas mask, and as soon as you stop breathing it, the effects wear off. As soon as I took my first breaths of the gas, I felt calm and peace descend on me. My anxiety disappeared. I feel like I got the experience Ina May writes about, and nitrous oxide was what made it possible. Since then, I’ve joked frequently that I wish I could use it recreationally.

    In most aspects of my birth experience, I consider that I was lucky. My pregnancy was easy and healthy, I went into labor on my own, my labor was relatively short, nitrous oxide was available to me, my baby was fine. I don’t think I did anything to deserve or earn this easy labor. I just got lucky. When I hear about another woman who had a more difficult experience than mine, I don’t jump to judge her. I don’t think to myself that she must have been weak, or uninformed, or unempowered, or anything like that, and I certainly don’t say anything so rude or ask pointed questions that come off as judgemental, no matter how curious I might be. My first assumption is simply that she was unlucky, while I was lucky. I think that is an attitude that could stand to be incorporated in the natural birth movement as well. An acceptance of the randomness inherent in childbirth. So much of this is just a crapshoot.

    Other women have posted about how the doctors, nurses, midwives, were either supportive or not. I didn’t have any experiences with professionals who were rude or insensitive or anything like that. The worst moments of my interactions with midwives and nurses were when they were just TOO BUSY. And I don’t blame them personally for this, I blame the hospital system that kept the beds overcrowded and assigned too many patients to each doctor and nurse. Why? $$$ Duh. Here are some examples, from trivial to non:
    –when I arrived, there were no available beds, so I was given a tiny room in triage and told to walk the halls. I did for a while, until I felt overexposed, in a robe and slippers, moaning through my transition while family members of other patients watched from their seats in a waiting area. I didn’t know I could get my nitrous oxide in the triage room if I requested it. I didn’t know I didn’t have to walk the halls or that there were smaller, more private areas I might have paced instead.
    –my anesthesiologist came to administer my nitrous oxide, but forgot a form I needed to sign. She left to get it, got involved with another patient and forgot about me for over a half hour of my most intense labor. She apologized when she finally returned, and I snapped, “It’s NOT ok,” since I hadn’t yet had my magic happy gas and was still in my Mr Hyde labor form.
    –my sister’s doctor didn’t come to help her deliver for over 5 hours while she was at the point of being ready to push. He was delivering a baby in another hospital, and she had an epidural, so they figured it wasn’t urgent. WTF

  3. Being pregnant was perfection. Not one little concern. Went the hypnobabies route at a birth center. Went into labor with a “high leak” on a Sunday and went into the center early Tuesday morning. Because my water had been leaking over their 18 hour limit, they tranferred me to a hospital. Even though both myself and baby were showing zero signs of stress. I went from moving freely through labor to being strapped to a bed with 8 tubes coming from various parts of my body. Enter pitocin, which I am convinced was hand crafted by the devil, and I felt like I couldn’t breathe, let alone birth a baby. After an epidural and a 2 hour nap, I spent 2 hours pushing out my son. I was incredibly grateful I was able to birth vaginally. Especially as whispers of c section floated through the room. But compared to my intervention free, go home with 8 hours, blissful birth I had planned, this birth was a nightmare. I spent months feeling like I had lost a tremendous battle. I struggled through my first year of motherhood with my feelings of inadequacy and feeling constantly overwhelmed by life. A variety of factors contributed to my negative thoughts, but undoubtedly my birth experience was the beginning of the challenge.

  4. Here’s my birth story that I wrote up a few months after my son was born. I definitely felt like I failed because I didn’t have the natural birth I planned.

    I’d been in labor 18 hours and I was on the phone with my mom. She told me about the Indian women she saw walking up and down the hospital corridor. With each contraction, they would squat and scream. I was pacing the hotel hallway, leaning against the wall to moan through each contraction, trying to be quiet so people in their rooms wouldn’t hear me. Melanie, the midwife, said that if my contractions didn’t pick up in two hours, she recommended I get an epidural and Pitocin, so that I could rest and have the strength to push out the baby.

    The baby wasn’t coming out and it was my fault. I wasn’t ready for him; I wasn’t ready for the next stage of labor where there would be no breaks, no going back. I would have a baby afterwards who I’d never met and had no idea how to take care of. Jonathan and I started repeating “Baby, I’m so excited to meet you, baby, I’m so scared to meet you.” We took a cab to the hospital and Melanie confirmed I was still at 4 centimeters. Jonathan took a nap on the bed in triage since I couldn’t lie down through a contraction. We’d been up for 36 hours. I surrendered to the process and let myself be taken care of.

    I got to the hospital at 8pm and the anesthesiologist arrived after midnight. “This can be easy or it can be difficult,” he said “and what’s going to make the difference is you.” I was shaking and it was difficult. The nurse woke me up throughout the night to turn me from side to side. The monitor said baby’s heartbeat was too regular; it should go up and down. Melanie reached up and tickled the baby’s head to get him to respond throughout the night. She accidentally broke my water when I was six centimeters. I drifted in and out of sleep until I was 10 centimeters.

    A new midwife, Amanda, arrived at shift change to coach me through pushing. I could feel the contractions again along with my legs. I stood up on the bed to squat and felt the baby clear my pubic bone. Jonathan and I were still repeating, “Baby, I’m so excited to meet you, baby, I’m so scared to meet you”. I panted through a few contractions, slowing down. I felt his head come through and pushed a few more times for his shoulders. His whole body slide out. There was a baby on my chest and they cleaned him off. Jonathan held him while Amanda stitched me up. We agreed to name him Jupiter when we saw his strawberry blond hair.

  5. Wow. This is so good for me to read. Before my daughter was born 8 months ago, I practically memorized Ina May’s book. Because I was athletic and had climbed mountains and run marathons and taken a lot of physical risks, I was confident that my body was tough and that I could handle birth without medication. Instead I ended up feeling like a complete failure; I am still struggling with that feeling today. I didn’t even have any real complications; I just had a really long, slow labor and I was vomiting and dry heaving throughout–maybe because of my persistent morning sickness–but it meant instead of resting between contractions I was heaving. But I didn’t get pitocin or have a weird presentation or anything. After about 20 hours of consistent, strong contractions I found out I was still only at 5 cm; I broke down crying and asked for an epidural. I hated it; it only fully took on one side so I could still feel contractions on the left, but I wouldn’t let them try to fix it because I was so ashamed of getting the epidural to begin with. When it finally came time to push, I thought the nurses and midwives were just humoring me, that they knew I wouldn’t be able to do it because I was a wimp who got an epidural. So the whole time I was pushing I was waiting for them to take me to the OR. I ended up pushing my baby out, tore badly and lost a lot of blood. But the biggest wound was the terrible shame I felt at what should have been a completely joyous time. I still wonder why I couldn’t handle the pain when so many other women can…it’s changed my whole perception of myself. I no longer think of myself as strong and resilient; I feel like even my perception of emotional pain is off now…that I’m just a wimp. Even reading these comments, I find myself thinking, well, yeah, but she had pitocin, or some other excuse for getting the epidural, and I had none. I feel like if I hadn’t read Ina May and immersed myself in the natural birth culture, I wouldn’t have had such rigid expectations–Right now I probably would feel like a badass mofo for just birthing a 8.5 pound human. The epidural shame was the biggest trauma of all.

    1. Kristina — I know that feeling all too well! You sound a lot like me. I too, have done many athletic events and looked forward to having an unmedicated birth with my last baby. You need to forgive yourself! I have given birth 4 times and I can honestly say that the best thing about my first birth was that I had no guilt or shame for getting an epidural because I went into it with little or no expectations. It was after the fact when I read and watched so much stuff about “natural birth” that I began to feel shame about my subsequent births and especially my last birth (I have 4 kids) where I practiced hypnobirth every day. My expectations were set so high and I could barely look my husband in the eye after I asked for the epidural. But guess what, I am over it!!. I take total ownership of the decision I made, and I did what I needed to do at the time and so did you. I am mad and sad for you. I hate that the wound of shame has stolen from your joy! No one is you, they don’t experience pain the way you do, they haven’t experienced an identical labor, and so you need to stop comparing yourself to other people. I ran into a good friend the other day who was about to sign up for his 3rd 100 mile race. He has never finished before. On his last race me made it 87 miles, but I could sense some bitterness. I told him how awesome it was that he had made it that far. He thanked me for acknowledging those 87 miles and said it was so easy to focus on the fact that he didn’t finish instead of how far he’d come. I have no doubt that you are strong lady! There is absolutely not one thing you can do about your birth experience, but you CAN change how you feel about it. Celebrate your awesomeness, avoid things that make the feeling worse (reading blissful birth stories etc.), and kick that feeling to the curb. That is strength in my book!

  6. I did get a natural childbirth, because I was privileged enough to be able to choose home birth. My state allows it. Our insurance covered 80% of the cost, and I could afford the other 20%. I think what’s unrealistic in our country, and maybe is actually the missing chapter to Ina May’s book, is the expectation of being able to have a natural childbirth in a hospital setting. Birth plans in hospitals are bullshit and set up expectations for mothers.

    I think this discourse is very important. But eventually, I hope we can all turn our attention toward our culture and the hospital birth system and change it. I hope we can change laws in states where home birth or any out-of-hospital birth is not allowed. I hope we can get insurance companies to pay 100% of out-of-hospital births. Policies like these will all support women, babies, and health, and they will empower women. Hospitals, in my opinion, are part of a dominant patriarchal culture that fears women, and their power, and thus tries to control them and control birth. In the process, the dominant culture/hospitals are hurting women and children.

  7. I actually did have a natural birth, but please stay with me.

    Following my birth, my daughter was taken from me and to the NICU due to Meconium Aspiration. We missed the magic hour, the magic week, the magic month.… more on that in a minute.

    Also following my birth I suffered massive hemorrhaging and (to make a long very very eventful story shorter), during a postpartum surgery, doctors discovered I had placenta accreta. Accreta is pretty scary, tends to reoccur, often leads to preterm birth, and not infrequently maternal death. I certainly spent the hours and weeks after the birth fighting for my life. After compiling the data and getting multiple high risk OB opinions, we opted not to become pregnant again. But I knew my family was incomplete.

    3 years later, my second daughter was born. I caught her. I was the first bare skin she touched. She went right to my chest, right to my breast, and we had the magic hour, the magic week, the magic year. But I didn’t give birth to her. A surrogate did.

    My first daughter I carried in my womb, but not in my arms until she was 8 weeks old.
    My second daughter I carried in my arms, against my chest, immediately, and did not let go for 4 days (not even to pee or shower), but not in my womb.

    This unconventional journey was for me my “failure”. I hope it’s appropriate to share here despite the natural birth I did have with my first. The birth of my second felt like a crazy science experiment and I experienced such a sense of failure and sadness throughout it. She’s now 13 months and I wonder if she will hate me for not carrying her in my body. Meanwhile my 4 year old is very emotionally sensitive and a bit “clingy”. I worry daily it is because we were both to ill to be together for her first months.

    I think the saddest part of all these stories is simultaneously the beautiful part. How easily we can label ourselves as failures in the journey that is motherhood. AND how far from alone we are.

    1. Meagan, this is really touching. The whole point of this project is to share our wide variety of experiences, so thank you for sharing yours!

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