Ina May's Guide to Childbirth - A Book Review

As many of you know, I love to read. But something I love almost as much is recommending a good book to someone else and finding out that they loved it too! So, I though I would jot down some thoughts about some books I've read recently in the hopes of spreading the news about some good reads.

My first book of choice is Ina May's Guide to Childbirth. I highly recommend this book to anyone who is pregnant, who could become pregnant at any time in the future, or who knows anybody in either of these situations (yes, I realize that that includes pretty much everybody).

So, you may wonder, why I would recommend a book on childbirth to such a wide audience? Well, first of all, I would like to point out that maternity care is not something that only a minority of people need. The majority of women have babies at some point in their life time. Second, there is a crisis in maternity care in the US that most of us are not aware of. For example, the fact that the World Health Organization has long been after the US for its ridiculously high C-section and induction rates (WHO recommends that we get our C-section rates below 15%, yet we are double that. Some doctors in Las Vegas have C-section rates of 65%!).

The US has one of the highest maternal and infant mortality rates in the industrialized world. The WHO is aiming for a 3.3 maternal deaths/100,000 live births, and the latest figure I found for the US was 13/100,000. Twenty countries have managed to obtain better outcomes than us.

There has been a 10% increase in preterm deliveries between 2000 and 2006(http://www.nytimes.com/2009/04/07/health/07stat.html). Obstetric textbooks had to add a new term to their vocabulary for doctor-caused prematurity because C-sections and inductions were being performed too early (I'd tell you what the term is, but I already returned the book to my midwife, and I can't find it anywhere on the Internet!).

Interestingly, the country with the best statistics in pregnancy and birth outcomes is the Netherlands where midwives provide all maternity care accept for higher risk pregnancies, which are attended by obstetricians. Also, 1/3 of all births in the Netherlands are homebirths.

I know that is a lot of info, but I just want to get across the idea that our maternal health care is not so great. Ina May Gaskin, the author of the book, has been a midwife since the '70's, and is a very intelligent woman with a wealth of knowledge accumulated from the 1,200+ births she has attended. Her wisdom has been sought by many obstetricians, and in she 2003 she was chosen as Visiting Fellow of Morse College, Yale University. She also is the 1st midwife to have an obstetrical procedure named after her (the Gaskin Maneuver, a highly effective method of handling shoulder dystocia, one of the most dreaded complications in birth). For more info on her go to http://inamay.com/biography.php.

I guess I should say something about the book itself. I found the layout to be friendly even to those who aren't big readers. The first half of the book is a compilation of birth stories written by mothers who had Ina May as a midwife. Brutally honest, refreshing, eye-opening. This is a great help in overcoming the fear of birth that has been so ingrained into our culture (think of the movies - screaming, clawing, rushing to the emergency room - drama, drama, drama!). Real birth isn't like this. These stories help women to realize this and can be a great aid in reducing fear.

The second half of the book addresses particular issues - the connection between the way we think and how our bodies respond, the amazing ability our bodies have to handle labor, the importance of moving around during labor, the different procedures commonly used during labor (which ones work and which ones are more harmful than beneficial), the VBAC controversy.

Gaskin doesn't just throw around her opinions in this book, though many of the techniques she uses to help women progress further and cope in labor are based on what she has found to work by trial and error in her hands-on experience in over 1,000 births. She is a very good writer and knows how to compile research, adding a legitiamcy to her work that is needed if it is to have the desired impact.

Birth doesn't have to be traumatic. It is a rite of passage that women deserve to exprience. Women also need to know the risks involved in interventions commonly used during labor, and they need to know the lack of evidence supporting many standard policies like no food or drink during labor (why are we asking women to perform the most strenuous 15+ hours of hard work in their lives, telling them they can't eat during the entire time, and then expect them to have enough energy at the end to complete the most demanding part of the whole task?!) , continuous fetal monitoring, and intravenous lines (which are needed because we told these women not to eat or drink anything and now they are dehydrated and hypoglycemic). We need to know.

So, again, if you are pregnant, or know someone who is, please mention this book. I realize not everyone will choose to use a midwife or to deliver at home as I have, but every woman needs to know that what is best for her and her baby may not be what she automatically gets from her health care provider. Even with the push for "informed consent" in hospitals, many women aren't being adiquately informed, and if they were, in many cases I believe they would not give consent. These aren't simply issues of personal comfort and preference, but of preventing death and disease in both our mothers and their babies.