Saturday, January 25, 2014

a midwifely mixed bag of a book

So this week I read Ina May's Guide to Childbirth, by Ina May Gaskin. She is a midwife who founded a hippie commune / birthing center in Tennessee called The Farm. The book is new-agey as all-get-out, but I expected that, and it contained some interest for me nonetheless. 

I liked a lot of what the book had to say about childbirth, and it had stuff that I know will be personally useful to me, particularly about how women underestimate their bodies and how the Western obsession with telling pregnant women horrifying birth stories actually propagates more horrifying birth stories, because if you go into your labor convinced that it's going to be thirty hours of the worst pain you could possibly imagine, your tension and fear probably will make it pretty awful. I didn't even realize how much I'd been thinking of the labor process as something to be dreaded and endured until I read that part, and I feel like I can have a different attitude about it now. But I have some major quibbles, and quibbling being my way, I'll talk at length about those.

The first section of the book contains the personal birth stories of women the author knows and/or has worked with. For the most part, these stories aren't bad, although they start to blend together into one patchouli-scented, self-congratulatory mass after a while. Of course they are all written by women who wanted midwife-supervised births, because otherwise those women wouldn't have come in contact with the author. But not all of them have the births at The Farm that they planned: some have home births either by choice or necessity, and some end up giving birth in the hospital. Only a few of them push the objectionable perception that your birth choices are either a misogynistic male obstetrician or a loving female midwife, with nothing in between (yes, many of the stories are quite dated, but I have heard this perception, in almost literally those words, come out of the mouths of women I know within the last couple years, and I always want to respond, "You do know they let women go to medical school now, right?"). There are many stories which are hilariously hippie-ish (I never thought I'd have to read the word "yoni" again), and some which were clearly written by women who think they're special snowflakes ("a hospital birth is fine for women who don't care, but I actually wanted to bond with my child" or "I was briefly crazy enough to realize why other women ask for pain medication, but my strength pulled me through that insane moment") but even in those there was usually something which made me say, "Hmm, I could use that."

HOWEVER. QUIBBLE NUMBER ONE. There was one story in this section which stood out, and for all the wrong reasons. In it a woman describes her child's birth under circumstances which could only be explained by her having no prenatal care whatsoever and thus, when she goes into labor, ending up at an inner-city ER on a Friday night (there is no background given other than that she's in NYC, but it's clear she has no doctor of her own and hasn't been to this hospital before). Her experience involves being unattended for hours, strapped to a bed in an open ward, forcibly sedated, and unable to find a single doctor on the floor who speaks English. And she opens her story by saying she had a "standard-procedure hospital birth". Really. 

The fact that the author allows this phrase to stand, without any editorial comment, made me very annoyed, because it goes completely against her claims of being anti-fear-mongering. She lets the claim that this is a standard-procedure hospital birth go unchallenged, even though there are several other stories in this section about women ending up in a hospital and having good experiences with good doctors. This one nightmare story is the one I remember, and Gaskin (I believe) knows perfectly well it's the one the reader will remember, and that said reader will subsequently be too terrified to go to a hospital lest the same thing happen to her. So I felt manipulated, and cranky about that. (There will be more about this manipulation later, because it unfortunately didn't end here.) 

Now we come to QUIBBLE NUMBER TWO. The number of times Gaskin uses the adjective "orgasmic" in the introduction alone was excessive to say the least, and throughout the entire book she never lets that topic go (there's a whole section entitled: "Remember, Birth is Sexual"). Look, I am all for as positive an experience of childbirth as I can possibly have, but I don't need that to mean it's orgasmic, any more than I need a delicious savory food to be sweet, or a good book to be the same as a good walk with the dogs, or even the endorphins from exercise to be the same as the endorphins from sex. Positive experiences can be positive in different ways. Women can have powerful and wonderful physical sensations which are completely non-sexual, and setting the bar for natural childbirth at "you should have an orgasm if you're doing it right" doesn't seem to me like it could possibly make a laboring woman feel better about herself. Also, if you need to come up with an analogy for your female patients about feeling physically strong and bodily-present, and you can only think of using an orgasm... that's a little sad. But it seems to be all Gaskin has to draw on, and all that she thinks her patients and readers have to draw on. Does she assume women don't run, or climb mountains, or dance, or do intense yoga, or practice martial arts, or... anything else physical, for heaven's sake? That the only time we like being women or being in our bodies is when we're having sex? (And that some of us would not run screaming for the nearest restraint-equipped hospital bed if our midwives instructed us and our partner to make out as passionately as possible, during labor, in front of everyone, as is apparently standard practice at The Farm?)

And on to QUIBBLE NUMBER THREE. The second section of the book is split in two parts: the first contains a lot of useful labor advice from Gaskin, which I liked; the second part is all the fear-mongering Gaskin swore she wouldn't use and then some. I had to skim most of that part, once I realized that the chapters might as well be entitled: 

If You Give Birth In a Hospital, You Will, Literally, Die: Here's How

Hospitals Perform Caesarians Just For the Heck of It

You Can and Must Have a Vaginal Birth After Caesarian: What Kind of Woman Would Let Something That Unnatural Happen Twice

I did read, in its entirety, the "You Will Die" chapter, and it was TERRIFYING. I sat there quaking and saying to Berowne, "Oh God, what if they tell us this intervention is necessary? Because this book says it will KILL ME," and he had to talk me through remembering that I actually feel very safe with our team and I trust them, and that we had a good talk with the midwife at our first visit about the very low rate of interventions at this hospital. And then I was so mad at Gaskin, especially since at the chapter's end she tacks on this blatant lie about how she's not trying to scare anyone away from necessary medical intervention. Seriously? The chapter has no purpose but to scare women away from hospitals and medical intervention! And that is so awful for someone like me, who has medical issues which mean that a home or birthing center birth would be stupidly risky. (Gaskin claims there is virtually no medical issue which requires anything other than a bunch of voyeuristic midwives to resolve, and I'm sorry, but that's just not true.) I skimmed or outright skipped the rest of the chapters in this section. 

That said - and this may seem bizarre after all that ranting - on balance I am less afraid of labor than I was before reading this book. I know that if medical interventions become necessary, I'm going to trust the OB team in front of me, because I know them and respect their expertise. And as far as pain and my ability to cope go, I do feel more prepared. Even in the birth environment I've chosen (which may be a hospital but has tubs in every maternity suite, midwives as part of every prenatal team, and rooming-in as the standard), I think I got a lot of advice from this book that I can use. 

Final quibble: Gaskin is NOT pro-choice. Two minutes on Wikipedia reveal that The Farm community is strongly anti-abortion. One woman's ostensible "birth story" is actually not about her child's birth at all, but about having had an abortion years before and being justifiably punished for it (!) with severe post-partum depression; that story's inclusion made so little sense to me, and set off so many alarm bells, that I ventured into the internet search territory. What I suspected was quickly verified, and then I needed to make a definite choice to set that knowledge aside if I wanted to finish the book. I was able to, because I was already pretty sure the practical benefits would outweigh the preaching, and because I hoped that story would be the last of it (which it was; hence my decision to not make this a Major Quibble). But it added an extra-sour layer to the orgasm obsession, making me think that perhaps Gaskin believes birth is as sexual as she claims it is because she believes that sex unconnected to procreation is wrong. I believe you cannot profess to empower women and women's bodies as your life's work if you make an exception for birth control and abortion. Just... no. 

In conclusion: I object to a lot of Gaskin's prejudices against hospitals and hospital-based doctors, rolled my eyes at the orgasmic stuff, and there are parts of this book which are really blatant fear-mongering. But even as a non-new-agey, pro-choice woman, I came away from this book with a fair amount of practical advice, and I'm glad I read it.

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