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

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

  1. There’s a fine line between the message that natural birth is the ideal birth that we should strive for when feasible (which I do believe is true), and the message that you are a failure if you do not achieve a natural birth (which we all know is not true). It is hard to walk this line if you’re a birth coach or midwife who knows that interventions come with risks. They don’t want their patients to go for interventions when they’re not necessary. In delivering that message, they have to be very careful not to make women feel that when they do need interventions, or even when they want interventions, that this makes them a failure at childbirth.

    I had an almost natural birth, and it was pretty tough. I credit having practiced hypnobirthing and the help of my support team for not having drugs. I did get a little pitocin. My baby’s head was slightly tilted to the side, which made vaginal delivery not impossible, but more difficult and with a much longer labor than it would have been. Afterward, I somewhat guiltily told my hypnobirthing teacher / doula that if it had taken any longer to reach the pushing phase, I would have asked for drugs. She immediately said, “Oh I don’t blame you! Anyone would!” So although I didn’t end up with that experience of feeling guilty over what happened, I can empathize with those who did. Like some of the other commenters, I’m athletic and felt sure I would kick butt at childbirth. But some things are beyond our control in childbirth. We really need to figure out a way to help women have more control over the controllable parts, while accepting that we can’t control the entire process and not feeling guilty about that.

  2. I have been catching up on older episodes of the Longest Shortest Time and I had breezed past this one a few times. I guess I thought, eh, my daughter is almost four, I’ve had a long time to get past the experience of child birth, I don’t know how relevant this will be to me right now.

    I was surprised as I listened to it that it brought back a lot of the feelings that I had around my daughter’s birth in 2011. Like Hillary, I hoped for a child birth without interventions. Actually though, I was never adamant about not having any interventions except that I really wanted to avoid a c-section if at all possible. I was mentally prepared for the fact that I could not anticipate what child birth would be like and that I might need to make decisions on the spot. Still, I chose a local hospital with a nurse-midwife unit thinking that it would give me the best care and the best chance for the birth experience that I hoped to have. I felt lucky because they had a lot of the things to try to make labor a good experience–birthing tubs, balls, procedures for letting mamas walk around and labor in their preferred positions.

    At 38 weeks, 2 days, on a lovely early fall day, I was laying on my couch early in the afternoon and I noticed that I had some discharge. Actually, as I became aware of it, it crossed my mind that I might have noticed fluid earlier, but in pregnancy it felt like my body was always doing some weird new thing. And as a person who does not like unnecessary attention I was always trying not to rush to assumptions. So I had ignored it. Laying on that couch though, I remembered that some women experienced water breaking as a trickle. So I called the Nurse Midwife unit and after asking some questions they recommended that I go to get checked out in the hospital.

    I called my (then) partner (who was skeptical and a bit annoyed that I was calling him home from work) and he came back and drove me to the hospital. It turned out that my water had broken; and it was concerning to the medical staff that I could not say when it had happened. So they admitted me and gave me a timeline of about five hours to wait for labor to kick in before they said they would start pitocin (I really can’t remember if they offered me any options, though I do remember that they were calm with an edge of urgency).

    At 8:00pm they started pitocin. My dream of a water birth went out the window, but I was okay and my baby seemed to be doing okay, so I wasn’t heartbroken. Actually, for a few hours after they started pitocin I wondered what all the fuss was about. Sure, I was having contractions, but between them I was laughing and talking, and really just waiting.

    At about 11:00 I talked to my mom who was racing from Kansas to Minnesota to be by my side. And at 11:30 things still seemed to be progressing slowly so I laid down to try to rest. But by midnight, labor was in full force. Yes, it went that fast. By 12:30am I gave in and asked (pleaded) for an epidural. Although it is not clear to me how this happened for everyone else, in my mind, the nurse-midwife in my room spent as long as she could reading the list of risks to me before going to summon the anesthesiologist; and after a grueling wait the anesthesiologist came and read the risks in excruciating detail again. Which was ridiculous, because at that point it wasn’t like I could hear them anyway.

    By the time the anesthesiologist was set up I started to feel intense pressure and when I mentioned that, the nurse-midwife stopped the action in the room and said that it was too late for the epidural because it was time to push.

    The hour and a half that followed felt like one long contraction. Actually what it felt like was my body being torn in half from the inside. I literally thought (for as much as I could process thoughts) that I was right on the edge of death–how could anyone experience anything like that and survive? And after having been very clear about what I did and didn’t want people to do or say while I was in labor, I felt utterly inside of myself, completely unaware of anything that was happening around me. I’ve said since that there could have been a circus in the room and I would have had no ability to notice it.

    My labor was “short”, which the people around me seemed to equate with being easy.They told me how strong and awesome I was. But if anything, comments like that made me feel angry. I was in so much pain–my body hurt everywhere. I felt like I had been hit by a bus. And I kept wishing that rather than delay the epidural when I had pitocin, that someone (anyone!) had said, hey, this is going to be rough–you really should consider pain medication. Instead I felt like everyone was cheering me on to this victory that I didn’t want to be a victory. I didn’t feel strong, I felt duped.

    My daughter was born well, which was tremendous, but she was a bit early and quite small (6 lbs 6 oz). And because of that she (we) had some issues with breastfeeding, jaundice, weight gain, and intense sleepiness right out of the gate. Where I had been prepared for childbirth to be an adaptive challenge, I did not at all feel prepared for dealing with my own very real trauma from birth as well as a healthy but high-needs newborn.

    One thing that was in the back of my mind as I prepared and went into the birth experience was that I wanted to be tough. I wanted to be able to say that I had done it all myself. I wanted to experience the ecstasy that (apparently) kicks in after childbirth. And I wanted the glory of it–to feel like a badass, for other people to think that I was a badass.

    After it was over I really just wanted to forget all about the experience and the pain so that I could take care of my baby. I found myself angry that I had put so much pressure on myself to not have pain medications when they could have made the experience of childbirth so much less traumatic.

    Aside from my healthy, wonderful daughter, the one great thing that came from the experience is that I have deep empathy for mamas no matter what their child birth plan or experience. I have stopped judging any birth experience. When it comes to having our kids, I think we are all trying to make the best choices, and we never really know what they are until it’s over.

  3. I think its impossible to remove the fear around childbirth. Just like as a child you are terrified to have the training wheels removed and ride your bike for the first time unassisted, I think in order to not fear birth, you must experience it. Understand it. And that can only come from going through it. We are asked to give up complete control of our body and mind and let it do its own work. Its impossible to practice or prepare for.
    With my first pregnancy I was resolute that I was not going to have any interventions. I could do it. I read Ina’s books and felt confident. Once contractions hit, all of that confidence disappeared and I was so caught up in the intensity of the pain I was overwhelmed. I asked for an epidural as soon as I got to the hospital. I can remember lying in the bed and getting to the point that my body was going numb from the pain as another contraction slammed me. It was an out of body experience and I didn’t like it. It was horrible. As best as my husband tried, he couldn’t coach me out of that. After the epidural and my bag of waters breaking they augmented my labor, so that the labor wouldn’t slow down which can happen after an epidural. Not long after I had to get oxygen as well because the cord was wrapped around my daughter’s neck and the pitocin contractions were too hard on her little body. With each contraction the cord was getting pulled tighter and tighter. Her heart rate was dipping dangerously low. The doctors and nurses handled it well, and kept me unaware of how serious it was but I began pushing at 9cm dilation because she needed to get out. I can vividly remember the doctor saying “You can do this. We need to get the baby out. If we don’t get this done in a few pushes, we will have to have a c-section.” I remember thinking, but I need that last cm! I can’t push at 9!!! But I did. It was so rushed and hurried, in fact, that there was a maintenance man in my room during the first few pushes; the curtain was broken and he was fixing it. The doctor yelled for him to get out. But I didn’t care. I was just focused on getting the baby out safely.
    I pushed for around 30 minutes and our daughter was born. Purple as a grape. No crying. I was terrified. My husband was blissful, he had a daughter. But I’m a biomedical scientist and I knew…it wasn’t good. She finally let out the tiniest, weakest mew and was thrown out the room to neonatal specialist. I prayed on repeat, “Please God, let her be ok.” until she came back in pink as a pig and howling with anger. She was healthy and ok. I am resolute that I will never get induced or augmented again. It isn’t for me.
    With my second pregnancy, the fear was erased and while the contractions were painful, they were manageable in a strange, magical way that I don’t think would have been possible with my first. I was confident I could do this, and I knew what was coming. The veil was lifted and the mystery that shrouded birth was gone. While I know that the second being easier was had somewhat to do with my body already having done it once, doing it again faster (second labor was 3.5hrs) I do think that the lack of fear, confidence, and the trust I felt in my body was what made it a different experience. I still had an epidural. I somewhat regret it. But if I hadn’t my mother wouldn’t have been there so I am at peace with my decision. Next labor, if I am lucky enough to have one, will likely be completely free from intervention.
    What I would love to see is some type of book or information that can be given to husbands or partners on how to be better coaches. Hospitals are making attempts to be more mother centered at birth, but they still have a long way to go from birthing centers. A book that labor and delivery nurses could read and use to help calm that fear and help us to embrace the unknown and bolster our confidence when it is shaken or gone, instead of the more sterile, unattached job they typically perform. (L&D nurses are special people. I’m in no means saying they don’t do their jobs effectually. I know they often juggle more than one patient and cannot provide intensely personalized coaching. But I think that labor bedside manner should be more encouraging and supportive and empowering than I’ve experienced. I had good L&D nurses who helped me through both labors, but the difference between good and great for me would be more support and empowerment). I did not use a midwife or doula for either births. I know they provide those services that I wish I would have had, but they also come at an expense that at the time wasn’t feasible for our family. But for all of my husband’s many endearing and wonderful qualities, he was a terrible birth coach. He was terrified. He didn’t like to see me in pain and didn’t know how to help. Even in the second labor he was unsure of what to do. I think it would benefit so many to read a book on how to support someone in labor. Make it a mandatory part of the labor and delivery nurse curriculum. Its hard to advocate for yourself when you feel that you have no control. You look to your support team to help you. But if they are scared and overwhelmed and unaware of what needs to be done they can’t help you.
    Thanks so much for this awesome podcast! I’m thoroughly enjoying it!

    1. Hello, have you checked this one out?

      It came highly recommended by two friends (and more importantly, their partners) so I bought one for my husband. Of course he only read the “important parts” (according to him) so on the day he didn’t actually know much and I was SO MAD at him because I then had to explain everything to him! I had a vaginal delivery but somehow in the middle of labor my daughter turned sunny-side-up and stayed that way for a while.

    2. When I had my first baby my husband and I did a Bradley method birth class. It was focused on educating the Father’s on how to be good birth coaches. It really helped my husband a lot.

  4. I’m not sure which Ina May book I read the week before I gave birth, but it was extremely helpful to me. The part I remember reading most was that first chapter where she had different women write about their many different births. Some of them had really painless and easy births, many of them had more pain than they expected, some of them had extremely extremely painful births, some of the births didn’t go as planned and there were complications and you can read to see how they were addressed under different circumstances. After reading the book, I remember coming away from it with the idea that there is no telling what kind of birth I will have, and I just hoped that it was going to be one of those easy painless ones. :)

    And during labor, when the painful part became pretty much unbearable, the one part of the book I held on to when I was screaming in pain for hours and felt like I was going to go insane from how much pain I was in was the part of the book where this one woman in labor was screaming that she was going be split open and that she was going to die… Ina May told her that she was in pain but she wasn’t going to die, and that everything is happening naturally and as it should, and that she was going to get through this and it wasn’t going to last forever. That idea that the pain is natural and that it will end really helped me.

    If it were not for this book, I’m not sure I could have gotten through it naturally… My husband and I took Bradley classes and came away from the classes with the idea that if we did everything right, then it wouldn’t hurt too much and that everything will be peaceful and controlled. Ina May’s book was the only thing that really gave us an inkling that this might not be the case even if we did everything Bradley classes taught us. I’m really thankful that this book existed and that I was able to read it before labor.

    And I don’t mean to belittle Bradley classes either. They were also instrumental in helping us have the kind of birth that we were hoping for. It’s just that in the setting expectations for the amount of pain… that was very off… at least for me. :)

  5. Ok, maybe this is because I’m not a mom and don’t intend to ever give birth, but what’s with the shame? How can you feel like a failure when the goal was to bring a child into the world and you did? Why does it matter how you did it? I walked to work today, those people over there drove and some other folks took the bus. We all made it to work – who cares how we got there?

    1. Liz, I know this can be really hard to understand if you have never given birth. I know it would’ve been hard for me to wrap my head around before I went through it. Here’s the thing. *Of course* people who have healthy babies are grateful. But the baby’s health is a totally separate thing from the mom’s health. We don’t stop being people once we have babies. Many of us are severely traumatized. And then there is a school of thought that says that if we were traumatized, it was our own damn fault because we didn’t do it right. That way of thinking does not help. We need moms to be supported no matter what happens. We need them to help them with their metal and physical struggles. Because babies need and deserve healthy moms. Hope this helps you to understand it better.

      1. I may not be speaking for Ina May, but I would never ever hold a woman traumatized by birth accountable for her trauma. That just doesn’t make sense. It’s the care providers’ jobs to do everything possible to reduce the likelihood that a woman will be traumatized by her experience, and if she is, then to not exacerbate it.

        1. Yes, to be clear, Ina May doesn’t blame the mom for her trauma — but there are some natural birth advocated who do, including some who have commented on this story.

  6. Things that would help in the childbirth conversation, especially for first-time mothers:
    — Even though women have been giving birth for centuries and your doctor may have delivered hundreds of babies, there is still A LOT — a lot — about pregnancy and labor and delivery that is unknown. Unknown. I found that very surprising. I thought medicine was a science and that the whole baby making 9month process was only a little bit mysterious when really there are a lot of unknowns.
    — Partly because of all the unknowns and partly for other reasons, every single birth is unique. They are like snowflakes…similarities exist but no two are the same.
    — If this sounds scary for first-time moms, it is a little scary, the degree of fear probably depends on your expectations. It can also be comforting to know that no matter your childbirth experience, it is yours and it is ok and it is what it is. Whether it is fast and easy or slow and easy or horrible, fast or slow….you did it right and you are amazing. People should know that going into it.
    —Each mom is different and each baby is different and the childbirth is about both people. The combination of the two of you creates your unique birth experience…good or bad! And some are bad experiences. And even the same person giving birth later with a new pregnancy is a different mom than she was in previous childbirths because she has had new experiences that make her who she is that day.
    —and the professionals are great and should be trusted (if you feel they have your interests and needs in the forefront…and they don’t always). anyway as great and well-intentioned as they are, they don’t know everything and you won’t either…ESPECIALLY as a first time mom. But ask questions and make them tell you what’s going on and ask ask ask when you want something or are confused or worried or mad. You are the only one who knows what you are feeling in that moment…you are having a new and unique experience and you nor no one else knows what will happen because it hasn’t happened yet and you feel like you know nothing but you are in the process of becoming your own expert. You are your own expert.

    Also I noticed some of the fears and personal experience that motivated Ina May’s books may not be the same as the fears of women giving birth in the 2010s. This should definitely be part of the new chapter or next book! For example, many moms are having babies for the first time in their 30s rather than their early 20s…having babies younger, before you feel your own mortality, must be a different experience….the worries are different, more energy, younger body, perhaps more accustomed to things being out of your control…etc etc. Forceps aren’t as common now, and I’m sure there are many other differences and nuances to childbirth in the 70s to childbirth now. Cultural expectations around birth, mothering, equality between the sexes, work concerns, etc.

    My kids are 6 and 3 and I just started listening to this podcast a month or so ago. I’m enjoying it immensely and am feeling healed and strengthened and supported in my many parenting woes!!! Thank you, Hilary, for making me feel like I’m not alone.

  7. I was catching up on some old podcasts and listened to this one today. I also watched the documentary Milk by Noemi Weis today, so my thoughts have been very directed towards thoughts of childbirth, breastfeeding and the decisions we make as mothers (or are made for us) impact not only our children and their health and well-being, but also our own confidence and understanding of self.
    I had also intended to have a fully natural birth and experience a very empowering and peaceful day (and a bit) of labouring just over 18 months ago. That day ended in an emergency c-section due to my son having a full facial presentation which I was told I could not deliver. I was broken when they told me this and completely panicked. My confidence in myself and my body was gone in a moment. I don’t want to go into much detail, only to say that the experience of breastfeeding (exclusively for 6 months.. and with complementary foods until now) helped me to gain this back. I remembered that my body had grown my child and would continue to provide him nutrients and as he steadily grew in my arms I knew I was not a failure.
    Thank you for speaking with Ina May. I thoroughly enjoyed your frank conversation.

  8. I’m also coming late to the conversation. I feel like the biggest thing that could have helped me not feel guilty about my less than ideal birth was more frank discussion from those who knew. I would have really appreciated being encouraged by the natural birth community to be educated about interventions, especially pain management. When I was in labor and not handling it well, I didn’t know my options. I also would have appreciated being told that they were talking about the ideal, when in reality there are plenty of women who do all they can and circumstances make the ideal birth impossible. I would have felt much less guilty had I gone in with a better understanding of the necessity of interventions sometimes. To be fair, I haven’t read Ina May’s books, so I don’t know if this is her rhetoric or not, but I heard all the rhetoric about how the female body is made to birth from Hypnobirthing. Women have given birth for thousands of years without drugs and modern medicine. I absolutely believe that, and I think it’s incredible. However, they fail to mention the infant and mother mortality in those thousands of years. I don’t know the numbers, but somehow I think they were higher than they are today. Modern medicine does save babies and mothers. I think both sides should be presented. Of course natural birth is the ideal, but women need to know beforehand that they are not broken if they require medical help to safely bring their child into the world.

    1. I realize this may not be the case in all hypnobirthing classes, but mine went over all the pain management options and many possible types of interventions. This really helped reduce my fear and feel prepared to respond to special circumstances (complications) for me and my baby.

  9. I’ve just come across this podcast (2 years late it seems), and I hope Ina May is still getting the feedback here. My daughter was born three months ago by c-section due to a footling breech presentation. I’ve read all your books and was so PUMPED for a natural birth that I willed myself into active labour the morning of the booked c-section and enjoyed every rush up until 7cm before having it all taken away by a scary scary spinal. As is so common in c-sections, even when we’d previously agreed to immediate skin-to-skin and other mother-oriented practices, our daughter had a low APGAR at birth and was whisked away to the NICU so that we missed the golden hour. Even when her APGAR was a perfect score at 5 minutes they refused to give her back for 3 horrible hours. I spent the last trimester in tears trying to turn her, and whenever I have a free moment and my mind drifts back to her birth I sob and sob. Please will you write on grieving a birth gone wrong. Please will you research and write on the causes of breech presentation. I just know I did something wrong for her to be in the wrong position and I don’t want it to happen again. I want a VBAC so badly, and now it’ll have to be in that horrible hospital because the midwives won’t do it at the birth centre or home.

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