Tuesday, Jun 1, 1999 4:00 PM UTC

The midwife of modern midwifery

From her Tennessee commune, Ina May Gaskin almost single-handedly inspired the rebirth of midwifery in the United States.

With her long, graying hair, often in braids, and her flashback
’60s clothes, Ina May Gaskin isn’t as glamorous as many other pregnancy and
childbirth “experts” seen frequently on television and in the glossy
parenting magazines. Instead, Gaskin looks like what she is: a
hard-working, grandmotherly ex-hippie who still lives on the Farm, the
legendary Tennessee commune that she and several hundred others founded in
1971. Yet despite her relative personal anonymity, Gaskin’s influence on
U.S. birthing culture has been profound. She’s widely credited with
having created the modern home-birth
movement, as well as with
almost single-handedly inspiring the renaissance of midwifery
in
the United States. And her 1976 book, “Spiritual Midwifery,” a smallish trade
paperback with a psychedelic cover design reminiscent of the Indian-print
curtains on a ’73 VW bus, is in its third printing, with more than a
half-million copies sold.

“Ina May’s contribution to the culture of childbirth in the U.S. has been
enormous,” says Robbie Davis-Floyd, Ph.D., a research fellow in the
department of anthropology at the University of Texas and author of “Birth
as an American Rite of Passage.” “I have known for years that she is the
most famous midwife in North America; now I can say without hesitation that
she is also the most famous midwife in the world.”

Although this sort of professional recognition from academics, physicians
and researchers has become routine for Ina May Gaskin, it is somewhat
unusual, considering that this “most famous midwife in the world” has neither
a Ph.D. nor any formal medical training. Instead, Ina May Gaskin’s road to
prominence has been decidedly nontraditional.

The woman called “the mother of authentic midwifery” by Midwifery
Today
editor Jan Tritten began life 59
years ago in Marshalltown,
Iowa, as Ina May Middleton, the daughter of what she describes as a “stable,
Midwestern, Protestant family.” She grew up a tomboy, wrestling with her
brother, delivering newspapers and reading voraciously. Although Gaskin
claims she never imagined she’d one day become a
midwife — planning instead to become an engineer — she does remember
checking out of the local library the early natural-childbirth classic
“Childbirth Without Fear,” by Grantly Dick-Read. Gaskin concedes that this
was an unusual reading selection for a 16-year-old Iowan in 1956.

“Birth just always fascinated me,” explains Gaskin. “As a teenager, I could
always tell you every detail of the birth stories in the historical romances I read.”

An excellent student, Gaskin graduated from high school in Marshalltown in
1958 and decided to turn her academic aspirations to English after being
denied a scholarship to study any of the “men’s subjects” she was
interested in. Married at 19, Gaskin attended
community college before transferring to the University of Iowa, where she
earned her English degree. After graduation, she joined the Peace Corps with
her husband and lived in Malaysia teaching English, later returning to the
Midwest to obtain her master’s in English from Northern Illinois
University in 1967.

While she was a graduate student, Gaskin gave birth to her first baby in a
hospital with an obstetrician in attendance. Despite her confidence that
she could have the natural, unmedicated birth she wanted within the
strictures of the medicalized childbirth system, her experience wasn’t a
pleasant one. “During birth at the hospital, I was left alone and treated
like I had done
something nasty. Then I was approached by a gang of masked attendants who
came in the room and treated me like a ritual victim. They used forceps, and
then I wasn’t allowed to see my baby for 18 hours,” remembers Gaskin.

Not long after becoming a mother, and radicalized by her own childbirth
experience, 27-year-old Gaskin and her husband and daughter packed
up and left for California — the epicenter of the cultural universe in the
late 1960s — to, as Gaskin succinctly puts it, “become hippies.”

There Gaskin’s transformation from mother to mother of midwifery commenced in
earnest. She began attending a lecture series given by
the man she would later marry, San Francisco counterculture guru Stephen
Gaskin, in which he spoke to groups of up to 2,000 young hippies on
everything from religion to politics to sex. At these classes, Ina May Gaskin
was exposed for the first time to a variety of women relating tales of their
own unmedicated, outside-the-hospital births, an experience she found so
affecting that to this day she remembers virtually every detail of the
stories she heard a generation ago. For the first time, recalls Gaskin, she
understood how beautiful a birth could be, given the right setting and
support.

In 1970, a pregnant Ina May (who by this time was involved in what she describes as a “group family situation” with her husband and Stephen
Gaskin and his then-wife) set off with
approximately 250 other followers of Stephen Gaskin on what came to be known
as “the Caravan” — a five-month-long speaking tour across the United States.
Traveling in colorful converted school buses, the group
stopped in towns, cities and on college campuses so that Stephen Gaskin
could lecture. One evening, while the buses were parked
at Northwestern University, a pregnant woman from among the Caravan group
went into labor. The sojourners had no money to pay doctors, and according to
Ina May, their beliefs didn’t allow them to accept welfare. Thus, with no
physician in attendance, and with the woman’s own husband catching the baby, she easily gave birth to a healthy boy. This turned out to be the
first of 11 babies born on the buses during the Caravan.

“When each birth took place,” writes Gaskin in “Spiritual Midwifery,” “we all
parked in a sort of protective formation around the bus in which the birth
would take place, and everyone waited for the baby’s first cry.”

By the third birth within the group, Ina May Gaskin had emerged as a
natural at attending births. Mothers began to request her presence during
their labors and
deliveries. She knew she was feeling a calling to become a
midwife. But Gaskin still had had no medical training, until a Rhode Island
obstetrician, having read in the local newspaper about the visiting hippies’
bus births, took the trouble to visit the Caravan and offer
her and a few other women some training in the essentials of midwifery.

“He gave [us] a hands-on seminar on how to recognize any complications we
were likely to encounter, and what to do if we did, demonstrating how to
stimulate a baby to breathe, what to do if the umbilical cord was wrapped
tightly around the baby’s neck, what to do if the mother hemorrhaged. He
taught us sterile technique and provided us with some necessary medications
and instruments, my first obstetrics textbook and gave us instructions on how
to provide good prenatal care,” remembers Gaskin.

With this rudimentary start to her education as a midwife, Ina May Gaskin was
present for each of the next births that took place on the Caravan. Sadly,
the 10th birth — that of her own child — ended with the death of her
two-months-premature son, born on a bus in Grand Platte, Neb. At only 3 pounds,
the baby lived a mere 12 hours and died in Gaskin’s arms. Her
grief over her loss only strengthened her resolve to continue helping other
women to achieve empowering births with healthy babies.

Shortly after the Caravan returned to San Francisco, the group of 250
Gaskin-ites decided to establish a commune in
the rolling farmland of middle Tennessee. Named the Farm, the commune
flourished during the ’70s and early ’80s, eventually reaching a
population peak of 1,500 in 1980. Since the early ’80s the Farm population
has held steady at more than 200 residents.

With a thriving community of men and women of childbearing age living on the
Farm, pregnancy and childbirth became common occurrences. Soon after the
commune’s founding, and with the support of a sympathetic local
doctor, Ina May and several other women established an on-site
midwifery clinic to which Farm residents could come for prenatal and
childbirth care. Births took place wherever the mother wished to be — usually
in her home. Women from outside the community were also able to hire the
Farm’s midwives as birth attendants at a cost of less than half that for OB
care. Today, the majority of the 100 births a year the Farm midwives handle
are of women living outside the community.

With the publication of “Spiritual Midwifery,” in 1976,
Ina May Gaskin’s work on the Farm began to receive wider notice. A
mix of first-person homebirth stories, black-and-white birth
photography and information on caring for women in pregnancy and
childbirth, the book laid out Gaskin’s philosophy that birth is a spiritual
event akin to making love, and that women could take back the power to
give birth
without excessive and unnecessary medical intervention. These were
revolutionary ideas at a time when the ancient profession of direct-entry or
“lay” midwifery — in which midwives receive the majority of their training
through apprenticeship with other skilled midwives rather than in medical
or nursing school — had all but died out in the United States under intense
pressure from physicians’ groups such as the American Medical Association and
the American College of Obstetricians and Gynecologists.

Gaskin’s book introduced an entire generation of young women to the
possibility of homebirth and midwifery. Passed from
mother to daughter and from friend to friend, the book’s impact stretched far
beyond its actual sales figures. Many of today’s midwives and midwifery
advocates report having discovered their career calling in the pages of
“Spiritual Midwifery.”

Susan Hodges, the president of Citizens for Midwifery, says of Gaskin’s
book: “I first heard of Ina May Gaskin when my Bradley Method childbirth
educator loaned me her copy of ‘Spiritual Midwifery’ when I was pregnant
the first time. This book had an enormous impact on me and changed the way
I thought about childbirth.”

Karen Lupa, who went on to become a certified nurse-midwife, remembers, “I
was first exposed to ‘Spiritual Midwifery’ while riding on a train in the
’70s. A fellow passenger had a torn-up copy that I got to read various
pages of … enough to see that it was way different from what I learned in
nursing school. It seems like ‘Spiritual Midwifery’ has been such a
milestone in the natural birth movement that it couldn’t have quite
happened without it.”

As women read and talked about “Spiritual Midwifery,” demand for midwifery
care began to grow, and by the early 1980s, despite the fact that the
practice was illegal in many states, the number of
midwives in this country was again slowly on the rise. Awareness of midwifery
in the United States has been increasing ever since: The American College of
Nurse-Midwives
reports that while only 6.14 percent of
this country’s total
births are attended by midwives, preference for in-hospital,
midwife-attended births in the United States grew from about 20,000 in 1975
to almost 239,090 in 1996. Currently, approximately 30,000 women each year
give birth in planned homebirths, and there are now approximately 10,000
midwives, both direct-entry and nurse-midwives, practicing in this country —
still
many fewer per capita than in other Western nations.

In addition to her writing, Ina May Gaskin’s renown has spread through her
clinical midwifery skills, developed entirely through independent study and
apprenticeship with other midwives around the world. The statistics for
Gaskin’s midwifery practice, which has delivered more than 2,300 babies,
tell the tale. In contrast to the national Cesarean
rate of over 22 percent, the Farm’s midwives have a rate of only 1.8
percent. And in 1992, a peer-reviewed study of the work of the Farm
midwives in the Journal of the American Public Health Association compared
over 1,700 planned, direct-entry, midwife-assisted home births with
approximately 14,000 statistically matched hospital births. Only 2
percent of the women who gave birth at home experienced such interventions
as forceps, vacuum extractors or C-sections, while 26 percent of those
giving birth in the hospital encountered these outcomes.

Additionally, Gaskin is now credited with the development and growing use of
the Gaskin Maneuver,
a revolutionary approach to dealing with the life-threatening obstetrical complication known as “shoulder dystocia,”
in which a baby’s shoulders become stuck in a laboring woman’s birth canal.
In collaboration with Dr. Joe Bruner, a professor at Vanderbilt University
College of Medicine, the Gaskin Maneuver has now been written up in the May
1998 issue of the Journal of Reproductive Medicine, as well as presented at
medical conferences. This marks an extraordinary achievement for a
direct-entry midwife.

According to Robbie Davis-Floyd, Gaskin’s ability to bring together the
sometimes hostile opposing camps from the worlds of medicine and midwifery
has been perhaps her greatest achievement. Ina May is “warm, funny,
good-hearted, brilliant, politically savvy and
aware — a postmodern hippie who holds a very strong space for her alternative
knowledge system yet moves with fluidity and ease in the professional,
political and medical realms,” notes Davis-Floyd.

As one of the founders and the current president of MANA — the Midwives’
Alliance of North America — Gaskin has been at the
forefront of legalizing
and
credentialing direct-entry midwifery while maintaining a “separate but equal”
status with certified nurse-midwives. She has been instrumental in the
development of the rigorous Certified Professional Midwife (CPM)
certification process, which is rapidly gaining momentum within the midwifery
community. And Gaskin also
acts as publisher of Birth Gazette, a respected quarterly magazine for
midwives and others, and conducts training for other midwives both at the
Farm and around the world. Lastly, she has just written a book, tentatively titled “Ina May’s New Birth Book: Breaking the Spell of Fear,”
which has attracted interest from several major publishers.
Currently, however, she says that her favorite activity is spending time with
her newly born grandaughter, born at home on the Farm with Gaskin and the
baby’s other grandmother — also a Farm midwife — in attendance.

Gaskin says that if people take one message from her life’s work it should be
that birth is normal. “As a culture we really have to figure out how we got
so afraid of birth and why, of all places in the world, we got rid of
midwives here.”