Saturday, March 30, 2013

Review of Ina May Gaskin`s book: Ina May`s Guide to Childbirth

Ina May Gaskin: Ina May`s Guide to Childbirth

Ina May, the famous midwife and founder of the independent birthing center The Farm introduces us to art of birthing naturally, informing us about true capacities of female body as experienced by real women which are or are not recognized by medical 
authorities. She suggest that childbirth affect women health and wellbeing later in life.
" Whoever and however you intend to give birth, your experience will impact your
 emotions, your mind , your body , and your spirit for the rest of your life."
She provides her deep insights on how labour can be painful and ecstatic  in the same 
time , reviving an ancient system of knowledge about birth. 

She states that ecstatic birth gives inner power and wisdom to the woman who experience it and there are ways of making sensations of labour and birth tolerable that do not involve numbing woman`s senses with drugs and suggests that it`s better to keep senses alive if the woman is to experience the true wisdom and power that labour have to offer.
Ina May reminds the readers that birth is a normal , physiological process and strengthening rite of passage for women. She also install into women  confidence that labour and birth can be a beneficial experience and each woman respond to birth in her unique way which can range widely.  She encourages women to trust  that their bodies will function well as intended and birth will go well. She empathizes on women`s  ability to endure labour. She also suggests that caregiver`s skills ( intellectual, manual, observational and intuitive ) define the quality of care, not the setting and she highly 
praises woman-centered maternity care.
Ina May explains Body-mind connection , which is unity of mind and body and how they affect each other during childbirth. She describes correlation of emotional changes with following physical changes. She suggests that labour should take place in calm and confident environment in order to progress well and that emotional distress or situation when woman does not feel safe or feel observed  can effectively block further progress in labour . She advises that laboring woman become aware of her thoughts because they can be creators of reality, use positive , affirming and grateful thoughts and discharge any negative emotions , worries, anger, fear to restore the progress.
Ina May describes changes which take place in woman`s body during  pregnancy and labour. She describes the labour as orchestrated symphony of woman`s body physiological changes responding to different woman`s body hormones involved in giving birth. Very interesting are her insights about 1st and 2nd stage of labour.
She refers to the  1st stage of  labour as the stage when woman needs to be active and change her position frequently in order to help opening of the cervix  " Given the choice, most mammals are restless during this part of labour, for this is time when the baby is pushed, jostled, wriggled and turned into most advantageous position to pass through maternal passageway …to be born vaginally . "
And she describes the 2nd stage of labour which lasts until baby is born as   cooperation between contraction of uterus and woman`s effective pushing which enable the baby to pass through the birth canal  " Once the cervix is pulled completely open, a combination of uterine contractions and some pressure from abdominal muscles pushes the baby outside of the mother`s body."  She suggests that gravity can greatly affect progress of this part of labour and advices gravity friendly pushing positions, like squatting or on all four.
Ina May also elaborates on perception of pain during the labour and suggests that perception of pain in labour is influenced by cultural factors and concepts ( " If you believe it`s going to hurt, it will hurt ) , former negative experiences and lack of prenatal education.
Ina May introduces concept of Sphincter Law , which states that cervical and vaginal sphincters function best in an atmosphere of intimacy and privacy ( for example: bathroom functions) . Also that the relaxation of jaw and mouth is directly correlated to the ability of the cervix, vagina and anus to open to its full capacity and when person`s sphincter is in the process of opening, it may suddenly close down if the person becomes upset, frightened , humiliated or self conscious because high levels of adrenaline in the bloodstream do not favor opening of the sphincters. Activities which promotes opening of the sphincters are: intimate atmosphere, laughter, slow deep breathing, immersion in hot water, vocalization- moaning, grunting, groaning, lip-flapping exhalation, positive affirmations. Ina May observed that women with relaxed jaws during pushing have usually do not tear or need episiotomy, because their perineum stretch well as opposed to women who clench their jaw and their perineal tissues are more rigid. She suggests that relaxation of cervix and perineal tissues are directly correlated to relaxation of the jaw.
Ina May also empathizes on good nutrition and speaks about some condition related to pregnancy caused by poor nutrition, like eclampsia and gestational diabetes.
Ina May also elaborates on certain routinely performed obstetric interventions during labour  ( induction of labour, breaking the waters, pitocin drips, fasting during labour,  ) and their risks  and compare them to non invasive methods used by midwives  .
Ina May speaks in detail about  historical evolution of childbirth and provides  views about different approaches to labour. She makes suggestion for maximizing chances of having unmedicated labour and birth:
Hiring a doula
Drinking, eating and peeing
Having your own cloth
Hydrotherapy  ( shower, bath, )
Nipple stimulation ( when having ineffective contractions)
Vocalization ( moaning, groaning , grunting)
Positive reafirmations
Massage ( release of any muscle tension)
Shaking the body or extremities ( "shaking apples " while standing)
Listening to one own`s  instincts
Mother directed pushing – slow pushing and slow and deep breathing with lip-flapping between contraction
Applying oil on perineum while the head is crowning
When baby get stuck : Pelvic press ( putting pressure on the upper part of the woman`s hips while standing) or Gaskin maneuver ( turn to on all four position)   
Ina May`s book is very educational and inspirational. She shared her experiences and skills from her long career as a midwife and clearly states that natural birth is possible to achieve even in our modern times of technological society. This book has potential to change the world.  


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