INA MAY’S
GUIDE TO
CHILDBIRTH

1 3 5 7 9 10 8 6 4 2

Published in 2008 by Vermilion, an imprint of Ebury Publishing
First published in the USA by Bantam Dell, a division of Random House, Inc., in 2003

Ebury Publishing is a Random House Group company

Copyright © Ina May Gaskin 2003

Ina May Gaskin has asserted her right to be identified as the author of this Work in accordance with the Copyright, Designs and Patents Act 1988.

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CONTENTS

Cover

About the Author

Title Page

Dedication

NOTE OF THANKS

ILLUSTRATION CREDITS

AN INVITATION

Part I: BIRTH STORIES

INTRODUCTION TO THE BIRTH STORIES

Part II: THE ESSENTIALS OF BIRTH

INTRODUCTION

1. THE POWERFUL MIND/BODY CONNECTION

2. WHAT HAPPENS IN LABOR

3. THE PAIN/PLEASURE RIDDLE

4. SPHINCTER LAW

5. WHAT YOU NEED TO KNOW ABOUT YOUR PREGNANCY AND PRENATAL CARE

6. GOING INTO LABOR

7. GIVING BIRTH: MOVE FREELY, LET GRAVITY WORK FOR YOU

8. FORGOTTEN VAGINAL POWERS AND EPISIOTOMY

9. THE THIRD STAGE OF LABOR

10. BENCHMARKS IN MIDWIFERY

11. WHAT YOU LEAST EXPECT WHEN YOU’RE EXPECTING

12. VAGINAL BIRTH AFTER CESAREAN (VBAC)

13. CHOOSING A CAREGIVER

14. A VISION FOR MIDWIFERY AND MOTHERS IN THE TWENTY-FIRST CENTURY

GLOSSARY

APPENDIX

RESOURCES

Copyright

To the women and the doctors who helped me
become a midwife

A NOTE OF THANKS

I want to thank my husband, Stephen Gaskin, for his unfailing willingness to help me during the long process of writing this book. I literally could not have done this project without him. My thanks go also to my agent, Stephany Evans; Pamela Hunt; Carol Nelson; Deborah Flowers; Joanne Santana; Sharon Wells; Pamela Maurath; John O. Williams, Jr., MD; Wendy Savage, MD; A. Mark Durand, MD; Alan Graf; Anna Meenan, MD; Joseph Bruner, MD; Marsden Wagner; Kenneth Johnson; David Frohman; Leigh Kahan; Robbie Davis-Floyd; Elise Harvey; Leslie Hunt; Dana Gaskin Wenig; Claudia Oblasser; Angelika Rodler; Michael Stohrer; Verena Schmidt; Betty Anne Daviss; and Ken Starratt. I would also like to thank my editors, Robin Michaelson and Beth Rashbaum, and their assistant, Stacie Fine.

Ina May Gaskin, CPM

ILLUSTRATION CREDITS

page i, 38: Karen Dombrovski-Sobel

page xi: Douglas Stevenson

page 11: Ina May Gaskin

page 12: Ina May Gaskin

page 21: Michael Jones

page 23: Mary Buttrick

page 29: Susanna Frohman

page 46: Ina May Gaskin

page 47: Ina May Gaskin

page 49: Ina May Gaskin

page 58: David Frohman

page 58: David Frohman

page 72: David Frohman

page 75: Lee Meltzer

page 94: David Frohman

page 96: Ina May Gaskin

page 102: David Frohman

page 105: Ina May Gaskin

page 109: Ina May Gaskin

page 110: Ina May Gaskin

page 120: Ina May Gaskin

page 124: Ina May Gaskin

page 161: Ina May Gaskin

page 162: Valerie Gramm

page 163: Valerie Gramm

page 206: Ina May Gaskin

pages 227–229: Line art by Jackie Aher, based upon illustrations found in: Engelmann, G. Labor Among Primitive Peoples (Second Edition). St. Louis: J. H. Chambers, 1883; Witkowski, Histoire des accouchements chez tous les peuples. Paris: G. Steinheil, 1887

page 246: Ina May Gaskin

page 252: Ina May Gaskin

page 253: Ina May Gaskin

page 255: Ina May Gaskin

page 267: Stephen Gaskin

page 315: Studio Merjenburgh

AN INVITATION

Whatever your reason for picking up this book, I salute your curiosity and your desire to know more about the important work of having babies. For those who are pregnant, I kept you especially in mind as I wrote this book.

Consider this your invitation to learn about the true capacities of the female body during labor and birth. I’m not talking about a summary of current medical knowledge translated from technical to popular language. You can find plenty of that in bookstores. What I mean by true capacities of the female body are those that are experienced by real women, whether or not these abilities are recognized by medical authorities. The way I see it, the most trustworthy knowledge about women’s bodies combines the best of what medical science has offered over the past century or two with what women have always been able to learn about themselves before birth moved into hospitals. The purpose of this book is to point you toward the best information currently available about women’s real capacities in labor and birth and to show you how these can mesh with the most effective use of modern birth technology. My intention is to encourage and inform you.

I have been a community midwife for more than three decades. I live in a village in the United States in which women and girls have little or no fear of childbirth. My partners and I have attended the births of more than 2,200 babies, most of them born in their parents’ homes or at our birth center. Working in this way has enabled me to learn things about women that are generally unknown in the world of medical education. It’s not easy to say whether the women in my village have less fear of birth because we know that our capabilities go beyond medical understanding or that our capabilities are greater without anxiety. Actually, both are true.

The village is called The Farm, and it’s located in southern Tennessee, near Summertown. My husband and I, along with several hundred others, founded it in 1971, and there we still live and work. One of the unique features of our community is that, from its beginning, the men have not interfered with the women’s desire to organize our own system of birth care. At the same time, the men have always lent a good deal of support and technological expertise to make our care more readily accessible and available. They have never dictated where or how our babies would be born.

Let me be clear about what I say about fear and birth at The Farm. I don’t mean that these women in my village never experienced a few moments of anxiety at the prospect of giving birth or wondered, Will I be able to accomplish this seemingly impossible act? I’m sure that many of us did wonder about this from time to time. Virtually all women do. After all, it is not immediately obvious to most people who grow up in civilized cultures—especially those in which most people live totally apart from animals—how birth can happen. When such moments of doubt occur to women in my village, they are able to fall back on the sure knowledge that their closest friends and sisters and mothers have been able to do it. This knowledge then makes it possible for them to believe that they can too—whether or not they’ve ever witnessed the act of birth itself. The women at The Farm have relearned and been highly successful at kinds of female behavior that modern women in civilized cultures aren’t known to be good at—those that go beyond the common medical understanding of women’s bodies and birth.

My experiences as a midwife have taught me that women’s bodies still work. Here is your chance to be exposed to a new understanding of an ancient system of knowledge that you can add to your general understanding of what birth means. Wherever 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.

The women in my village * expect to give birth vaginally, for that is the way all but one or two out of every hundred have their babies. Yes, we do sometimes have to transport a woman to the hospital for a cesarean or instrumental delivery, but such interventions are comparatively rare for the women who give birth at The Farm. (Our cesarean rate up to the year 2000 was 1.4 percent; our forceps-and vacuum-extraction rate was 0.05 percent. The U.S. national cesarean rate for 2001 was 31.1 percent, and the instrumental delivery rate was about 10 percent.) Women at The Farm know that labor can be painful, but many of them know as well that labor and birth can be ecstatic—even orgasmic. Above all, whether or not they experienced labor as painful, to a woman, they found labor and birth a tremendously empowering passage.

Have you never heard anyone speak positively about labor and birth before? If so, you are not alone. One of the best-kept secrets in North American culture is that birth can be ecstatic and strengthening. Ecstatic birth gives inner power and wisdom to the woman who experiences it, as you will learn from many of the birth stories told here. Even when women in my village experience pain in labor, they understand that there are ways of making the sensations of labor and birth tolerable that do not involve numbing the senses with drugs. They know that it is better to keep their senses alive if they are to experience the true wisdom and power that labor and birth have to offer.

In Part I of this book, you will hear the voices of these women as they tell their birth stories. Some of the stories are told by the pioneering generation that collectively created the birth culture of our village; others are told by their daughters and daughters-in-law, who grew up within this culture or whose partner did. A few are told by women who were born at home and grew up within our birth culture, who gave birth with other midwives. Other stories are those of women who decided to partake of our successful birth culture by having their babies at our birth center. If you are pregnant or plan a pregnancy in the near future, you may want to return to these birth stories again and again to strengthen your own spirit in preparation for giving birth.

My first book, Spiritual Midwifery, was one of the first North American books about midwifery and birth when its first edition was published in 1975. It quickly sold more than half a million copies and was translated into several languages, introducing me not only to a generation of childbearing women and their partners but to a surprising number of doctors and other birth professionals as well. In some countries, the book was made part of the curriculum of midwifery schools. In several, doctors told me that they read it in order to recover from some of the more frightening aspects of their training in obstetrics. I began to meet a breed of doctors who called themselves MDs (Midwives in Disguise). Because of the book and the birth statistics published in it, I was invited to travel all over the world and to share the results of my colleagues’ and my work with birth professionals and women from many different countries and cultures. This kind of cross-cultural experience has let me look at birth and maternity care with a broad perspective and compare how certain obstetrical practices and habits that become entrenched in certain countries actually work against the most efficient functioning of women’s bodies. My experience has also taught me how necessary the midwife’s role is in any given society and how important it is that the profession of midwifery stand on its own—independent of obstetrics but always able to work with obstetricians in the comparatively rare instances when the need arises.

Not long ago an obstetrician acquaintance remarked, “The two most interesting pages in Spiritual Midwifery were the last two.” He meant the pages devoted to reporting our birth outcomes at The Farm. He said, “You need to explain how you were able to accomplish what you did, so that we who work in hospitals may incorporate your work into what we do.” Part II of this book is for him and for everyone who wants to understand why the birth culture of The Farm has been such a success. I discuss the guiding principles that surround and define our work and recommend techniques that can be transposed from home birth to hospital birth.

In Part II, I discuss in detail why there is so much mystery surrounding the functioning of women’s bodies in birth and how we at The Farm were able to remove much of that mystery and turn it into working knowledge available to virtually everyone in our community. I explain why there is such a wide range of women’s experiences in birth and why there can be such divergent interpretations of what is safe or unsafe in birth-giving. There is a logical explanation for all of this. The same goes for pain in labor: In Part II, I delve into how it is that birth can be experienced as painless—even orgasmic—or, more commonly in civilized cultures, as the most intense kind of pain. You’ll learn that a woman’s uterus in labor can close as well as open and about the conditions that are likely to make labor stall or go backward. You’ll read about some practical ways to make the sexuality of birth work for you, not against you.

In addition, Part II includes an overview of the practices and treatments you are likely to encounter in a North American hospital, along with a guide to those that are based upon solid scientific evidence and those that are not.

Birthing is so integral with life—so common—that choices surrounding it often get relegated to chance. We tend to go along with what everyone else is doing, assuming that must be for the best. Living in a technological society, we tend to think that the best of everything is the most expensive kind available. This is generally true, whether we are talking about cell phones, cameras, cars, or computers. When it comes to birth, it ain’t necessarily so.

—Ina May Gaskin

My partners and I. Left to right: Joanne Santana, CPM; Deborah Flowers, CPM; Pamela Hunt, CPM; Ina May Gaskin, CPM; Carol Nelson, CPM; and Sharon Wells, CPM

*I want you to understand that this village includes a school, a clinic, a water system, a soy foods production plant, and several businesses, including a small factory that manufactures and markets a personal radiation detector that was invented in our village.

I

BIRTH STORIES

INTRODUCTION TO THE BIRTH STORIES

There is extraordinary psychological benefit in belonging to a group of women who have positive stories to tell about their birth experiences. This phenomenon is exactly what developed within our village. So many horror stories circulate about birth—especially in the United States—that it can be difficult for women to believe that labor and birth can be a beneficial experience. If you have been pregnant for a while, it’s probable that you’ve already heard some scary birth stories from friends or relatives. This is especially true if you live in the United States, where telling pregnant women gory stories has been a national pastime for at least a century. Now that birth has become a favorite subject of television dramas and situation comedies, this trend has been even more pronounced. No one has explained the situation more succinctly than Stephen King in his novella “The Breathing Method.” * Commenting on the fear many women have of birth, his fictional character observes, “Believe me: if you are told that some experience is going to hurt, it will hurt. Most pain is in the mind, and when a woman absorbs the idea that the act of giving birth is excruciatingly painful—when she gets this information from her mother, her sisters, her married friends, and her physician—that woman has been mentally prepared to feel great agony.” King, you may not know, is the father of several children born at home.

The best way I know to counter the effects of frightening stories is to hear or read empowering ones. I mean stories that change you because you read or heard them, because the teller of the story taught you something you didn’t know before or helped you look at things from a different angle than you ever had before. For this reason, Part I of this book is largely devoted to stories told by women who planned to have home or birth-center births with me and my midwife partners. You may find this part of the book to be the one you want to read the most during pregnancy. At The Farm, the only horror stories we shared were those of previous births in which the care had been radically different from that given by Farm midwives. As women began to have positive experiences giving birth, their stories helped to calm the fears and worries of those who had not yet had babies. The confidence that these women gained from one another was a significant factor in why the midwifery care at The Farm has produced such good results.

Stories teach us in ways we can remember. They teach us that each woman responds to birth in her unique way and how very wide-ranging that way can be. Sometimes they teach us about silly practices once widely held that were finally discarded. They teach us the occasional difference between accepted medical knowledge and the real bodily experiences that women have—including those that are never reported in medical textbooks nor admitted as possibilities in the medical world. They also demonstrate the mind/body connection in a way that medical studies cannot. Birth stories told by women who were active participants in giving birth often express a good deal of practical wisdom, inspiration, and information for other women. Positive stories shared by women who have had wonderful childbirth experiences are an irreplaceable way to transmit knowledge of a woman’s true capacities in pregnancy and birth.

James’s Birth—November 16, 1986

By Karen Lovell

Huntsville, Alabama—Rocket City, U.S.A., where “the sky is not the limit.” My husband, Ron, had gone to work for the maker of the world’s fastest supercomputers and was stationed at the NASA Marshall Space Flight Center. For all intents and purposes, it appeared that we were people geared toward state-of-the-art technology, people who would accept the latest and greatest, even when it came to childbirth. So why The Farm?

That answer begins with the birth of my first son, Christopher. I had just completed working for teacher certification. My plan was to get a job teaching that fall, but before that could happen, I realized I was pregnant. Here I was, fresh out of school with a lot of science courses under my belt, and I felt I didn’t know anything about childbirth. Yes, I knew the mechanics, how the body responded, what happened, but I was totally ignorant as to how hospitals and medical professionals responded to childbirth. Learning something about what options I had started me on my search for alternatives.

My first visit with a highly recommended obstetrician in town was pretty unpleasant. The first thing I was told was the temperature in the delivery room could not be adjusted, although the lights could. When I asked to not have an episiotomy, he skirted the issue entirely by asking me what kind of episiotomy I meant, never once saying whether he would or would not give me one. This bothered me, but I knew this was about as magnanimous as he was going to get, so I let it slide. For the time being, I was getting good prenatal care. I could change later. However, as time went on, I was less and less sure of this doctor. In fact, I grew to distrust him. All along, there were little hints that he and I were in different head spaces. The biggest came during the sixth month of pregnancy, when I was sent a certified letter that made no sense whatsoever, unless one read it do it my way or else. Finally, in the seventh month, the doctor said there could be no Leboyer birth, * after leading me to believe all these months there would be. It was at that point that I knew I didn’t want this man touching me—and internal exams were to begin in two weeks. I knew I had to find someone else.

A nurse who practiced as an underground midwife suggested a doctor from a nearby town who would provide more considerate care. Under his care I was able to have a Leboyer birth experience, but the hospital gowns and masks meant to create a more “sterile” environment were just that—sterile, cold, and intimidating. Also I had to labor on my back because of the monitor and ended up with a big episiotomy and forceps delivery.

One of the pregnant women, who became my friend after the birth of my son, used an original copy of Spiritual Midwifery as her bible, and even tore out pictures and pages and pasted them on her wall. Her daughter’s birth, which took place at home, had a profound effect on me. In the back of my mind I thought that, perhaps someday, I would have a child whose passage into this world would be really loving and spiritual.

My second pregnancy was hardly noticeable. It seemed that the baby sort of slipped in and was no problem. The only indications of my pregnancy were that I missed my March and April periods and my clothes were a little tight around my waist. I wasted no time in finding the most “lenient” obstetrician in town. I had no problems with him and found he was very honest with me. He flatly told me he insisted on an I.V. and that the hospital required an internal fetal monitor, although I could sign a legal waiver and not have the monitor. I had resigned myself to this type of birth if necessary but decided to investigate further. I finally obtained a copy of Spiritual Midwifery from a health-food store in Nashville, where I grew up. Several weeks later I wrote to The Farm, and Deborah Flowers responded.

I immediately felt as if a deep-seated prayer had been answered and prayed that if The Farm was right for me I’d end up there. When I told Ron about hearing from The Farm, I think he was worried. After all, I had seemed so content this time and the hospital was only ten minutes away. Why did I want to go up to The Farm, which was about seventy miles away?

Ron and I had a continuing dialogue about childbirth at The Farm. Finally, we both decided to go visit with an open mind (although I must admit I wasn’t quite as open-minded as Ron; I simply knew I wanted to be at The Farm). When we arrived, we met Deborah Flowers and Pamela Hunt, who showed us the facilities and checked me. Deborah said I was one centimeter dilated and loose, which I attribute to her absolute gentleness and the strong rapport I felt with her.

Ron was impressed that the birth cottage had hospital equipment to stabilize an infant in an emergency. He was also impressed with the fact that the midwives were emergency medical technicians and very qualified in their work. He decided to go along with a birthing at The Farm if our insurance would cover it. We found out in a few days that it would.

Because Deborah was my main midwife, I would bare my soul to her. I just knew things would go well. The Farm had it all: “in tune” midwives, a birthing house, a clinic with a holistic outlook, and doctor/hospital backup if necessary. I also liked subtle nuances such as helping the baby’s head stretch the mother out without tearing, not relying on cold machines such as ultrasound and internal fetal monitors, knowing how to deliver breech babies, and having faith in the universe.

When I went into labor back in Huntsville, I didn’t believe it at first and continued my project of cleaning all the carpets in the house. Intermittently, I rested on the bed to reduce the contractions until 4:00 P.M., when I realized I could no longer clean rugs. I waited a while to make sure of what I was feeling, then at 5:00 I called Ron to come home. He showed up, took things to the car, and we took off down the road after calling the midwives.

Contractions were steady and strong. Ron clocked them at seven minutes apart. Because I sat as still as possible, they remained unchanged. My back hurt with each contraction, which surprised me. Our drive was a little over two hours, and I was grateful for almost no traffic. Once at The Farm, Ron called Deborah, who came to let us in. I crawled onto the bed, where Deborah checked me. Ron brought things in while Deborah helped me through my labor. Chris had fallen asleep on a nearby fold-down chair. Ron sat down on the bed to help me with my back, which really hurt. Deborah grabbed my thigh while Ron pushed my back. It helped, and I told them so.

I could feel the baby moving down. I remembered Kim, this young woman giving birth on a video that Deborah had shown me. She had been really calm and didn’t have a husband to rely on. What a chicken I was, groaning, “Oh, my back!”

Just at transition, * I wailed, “My back is killing me.” Then, and it was truly a prayer, “Oh, God, help me.” Just then I felt my whole bottom bulge. The midwives commented on how stretchy I was. I pushed, and they could see the head. I pushed again and out came the head. Such a relief. The rest of the body seemed like nothing. Ron got to cut the umbilical cord after it was clamped, and Chris awoke in time to see the cut. A few minutes later I was easily able to push the squishy blob (the placenta) out of me.

I had a beautiful baby boy, born around 11:50 P.M. with hardly any head molding. He wanted to relax before nursing. We looked him over, then gave him to Joanne to weigh and dress while Deborah and Pamela gave me two stitches for a small tear.

I was grateful to have had such an easy pregnancy and that the birth itself was not just a psychosocial event but spiritual as well. I was thankful to have such loving, caring midwives and such a loving, thoughtful husband. I knew that this was the right way to have a baby. I enjoyed how the midwives paid attention to every detail and looked at things intuitively as well as on the surface.

The next day I felt so good. I looked at the clear blue November sky and the brown oak leaves left on the trees and basked in the warmth of the sun. I realized that I was truly blessed, that there really were some things on which technology could not improve—one of those was the billion-year-old evolutionary process of human childbirth. To some it may have seemed primitive; to me it was perfect.

Harley’s Birth—October 19, 1995

By Celeste Kuklinski

Around five o’clock I started feeling unusual cramps. Not wanting to give a false alarm, I didn’t say anything. I had my General Education Development (GED) class that night, and I didn’t really feel like going. Playing “truant officer,” Donna, my mentor and friend, drove me to class. Mary, the teacher, said I was probably just having those fake, practice cramps (Braxton-Hicks). I went home early, unable to concentrate.

The cramps were getting stronger, and I was feeling warm and excited. I still didn’t want to call these cramps “contractions” in case it wasn’t really happening. I timed them and they were about four minutes apart. Donna asked if I wanted to go see a midwife, but I decided to hold off until I was sure I wasn’t getting excited over nothing.

Finally, in the middle of a Star Trek rerun, while my body was positioning itself in contorted ways all over the chair I was trying to sit in, I concluded that I had better see a midwife. Donna and I drove over to Pamela’s. She checked me and informed me that I was three centimeters dilated and that I would probably give birth that same night. Surprised and happy, we went home to prepare.

Finally, the moment had come. Pamela soon arrived, followed by Ina May and Deborah. By this time, my ability to converse had deteriorated. I was just trying to deal with what was happening to my body. Things were happening quickly. I didn’t try to hold any of the contractions back. I just let them come as fast as they wanted to, knowing that would help the birth happen without delay. It all felt very natural. I just “went with it.” I went with taking a bath too, which was very helpful and relaxing. Ina May and my mother gave me support in the bathtub. Ina May showed me how to breathe deeply and slowly.

I tried it, and just then one of the strongest contractions yet overwhelmed me. I had to stand up. Some bloody, gray stuff dribbled and plopped into the bathwater. About this time, I started saying, “Oh, God!” I came out of the bathroom and did what I had to do, whether it was squat, bend over, walk around, say, “Oh, my God,” or dance like a whooping crane. The contractions were getting very intense. I hardly had time between them to rest.

I remember looking at all the ladies there, who had done this quite a few times, and thinking they had been nuts!

I got on the bed and kind of writhed around. My mother said something about letting gravity do its thing; I could really feel it working. Watching the baby move downward in my belly, I tried to breathe effectively and let the birthing happen as best it could.

The time came when I felt the need to push. I instinctively massaged my gates of life to help them open. Then I felt the baby’s head crowning, ready to come out. The contractions were so heavy, I just wanted them to be over with. So I gathered all my might and, with a big push and some loud primal grunts and yells, I finally oozed the baby’s head out. Then, with another push, out slid the rest of the body. What a relief!

Even though I hadn’t been able to say much other than, “Oh, my God,” and “Oh, baby,” I was about to utter, “Get the camera!”

When I look at Harley, my heart overflows with love. I’m taken by his pure presence, his innocence, his so adorably cute noises and expressions, and his wonderful, sweet sleeping face. Even though having him was painful, I wouldn’t call it that; I’d call it INTENSELY NATURAL.

Pamela’s labor with her first baby seemed endless to me (as well as to her, I’m sure). After I had been with her for twenty-four hours or so, I got the idea of calling in our mutual friend, Mary, who had given birth a few days earlier. Most of the women of our community were in awe of Mary’s birth-giving abilities, since she had a history of having her babies either without knowing that she was in labor or before we midwives could get there.

A Story of Sisterhood—February 13, 1972

By Mary Shelton

I had given birth to my second son a week or two before I got the call to see if I could assist Pamela with her rather difficult, long-lasting birth process. My son’s birth had been smooth, energizing, and delightful, so Ina May thought maybe I could help Pamela.

On the afternoon before my son, Jon, was born, I was reading Ram Dass’s book Be Here Now and feeling very centered and high with it. I remember I fastened on a particular word and meaning: surrender. I began having contractions and feeling big waves of energy moving. I visualized my yoni as a big, open cave beneath the surface of the ocean, with huge, surging currents sweeping in and out. As the wave of water rushed into my cave, my contraction would grow and swell and fill, reach a full peak, then ebb smoothly back out. I surrendered over and over to the great oceanic, engulfing waves. It was really delightful—very orgasmic and invigorating. Michael, my husband, was lying with me, and we experienced the wonderful rushing together for some time.

Finally, when it came time to call the midwives, the phone didn’t work, so Michael delivered Jon himself. It all went very smoothly, and Michael and I were clear, focused, and very high.

When I went to Pamela’s birth, I was still quite full of the invigorating energy from my son’s birth. Pamela had been working very hard at dilating for hours, and she was tired and afraid. I sensed that she was frightened that she wasn’t going to be able to pull off getting this baby out. I wanted to connect deeply with her and share my recent experience to help her relax and open. Pamela was naked, propped up on pillows on the bed, holding on to her knees. I took my clothes off (except for my underpants and pad since I was still bleeding from Jon’s birth) and crawled up on the bed with her. I laid next to her—head to head, breast to breast, womb to womb. I told her about my cave and ocean and the great rushing, swelling, and opening. I told her about surrendering over and over and letting go. We began experiencing her contractions together. We held each other and rushed and soared together. My womb, though empty, was swelling and contracting too. I could feel blood rushing out with the contractions, but not too much—I knew it was okay.

As Pamela relaxed and shared her wondrous birthing energy with me, she began to open and dilate smoothly. Before long, she gave birth to a beautiful, serene little boy. What a glorious experience!

Njeri and Ramez

Ramez’s Birth Story—May 30, 2003

By Njeri Emanuel

When I was pregnant, I thought I would probably want an epidural, because I heard that labor was going to be excruciatingly painful. They talked a lot about pain in my labor class. At first, I thought I might want a C-section, because then I wouldn’t have to push, and I had heard that pushing was the hardest part. But when I thought about it more, I knew I didn’t want a C-section, because it would take a long time to heal. (My mom used to go to births with The Farm midwives during the five years we lived on The Farm, so I knew a little about natural birth.)

When my labor actually started, I got into the shower for a while, but that didn’t help my back labor as much as walking did. My midwife at the hospital kept asking if I wanted to lie back down in bed, but I said, “No, I like walking.” My aunt Carolyn stayed with me and applied pressure to my back during contractions.

Pushing turned out to be the easiest part—a big relief. Someone held a mirror so I could see my progress while I was pushing. They told me to expect burning, but there wasn’t any. I didn’t have an episiotomy or a tear, and my mom says that my son, Ramez, was born with his eyes wide open. After he was born, I was more happy than tired. My total labor took eight hours. Ramez is six weeks old now, and he’s good at breastfeeding. He has gained five pounds since his birth.

Brianna Joy’s Birth—June 20, 1995

By Bernadette Bartelt

I was thirty-eight and pregnant with my first child. I was so excited. I had a fairly easy pregnancy, with no morning sickness or any other complication. I worked out regularly at Jazzercise, doing the low-impact exercises recommended by my obstetrician. I planned to have my baby in Nashville, where I had been living for more than a decade. I had an ultrasound at four months but was scared to look at the pictures because of all the talk about the risk of being over thirty-five.

Brianna Joy

Late in my pregnancy, concerned that my doctor was so busy that my husband, Rick, and I didn’t get much time with her, I decided to visit the midwives at The Farm in March. I had lived at The Farm when I was in my early twenties, having moved there with my father and siblings. The way the midwives checked me made me feel comfortable. Their clinic was not as modern as the doctor’s office had been, but I sensed a friendlier feeling about the place. After doing some research and asking lots of questions, I decided that I wanted the midwives to attend my birth. I realized that if my labor lasted longer than twelve hours, my obstetrician was more likely to get scared of my being almost thirty-nine than the midwives were, and that increases the chance of a cesarean.

I was hoping that Ina May could attend my birth, but there was a problem with this plan. She had to speak at a midwifery conference and wouldn’t be back until June 19. Carol checked me on June 12 and said I was dilated one centimeter. I went for a long walk the next day. My uterus contracted a lot throughout the next two days. On the night of the 15th, I had a hard time getting any sleep because of contractions that came every ten minutes. Carol came over to check me the next morning and said that my cervix was thinning and was open to three centimeters. She advised me to continue walking, so I did. I went to bed that night but had another hard time sleeping, because of contractions. This time they were much more intense. Rick and I walked down to the creek, where I sat with my feet in the water for a while. It felt so cool and relaxing. That night I had part of a wine cooler to help me sleep, but it didn’t work. I paced the floor for part of the night. The next time Carol checked me, though, she gave me good news. I was open to five centimeters.

By the morning of June 18, Carol apparently thought that my labor needed a boost, because she came over with some castor oil. I was close to six centimeters open, but I could eat, sleep (short naps between contractions, that is), walk, and continue functioning. I went to a potluck meal at the house of one of the midwives. That night Carol stayed with me and helped me get through the contractions, since there was no way I could sleep at all. I tried a lot of positions. I sat on a birthing chair for a while. I knelt beside the bed and hung over a pillow. I pulled on a rope that was hanging from the ceiling. It was hard to stay relaxed. I tried to focus on my breathing instead of the incredible amount of back labor I was having. At this stage, I could really understand why women might resort to the use of some pain relief. I was about seven centimeters open. I appreciated the help I was getting from Carol, and that kept me from worrying about future pain. I should also add that I know a lot of women who have had home births, and I thought that if they could do it, so could I.

On June 19, the midwives encouraged me to eat some breakfast. I had some toast and jelly. I was a little nervous, but somehow I knew that I was in such good hands that everything was going to be all right. I ate some soup around noon, and Carol came back with some energy-replenishing drink to bring up my strength for the labor ahead of me. Rick went upstairs and slept for a while, because he hadn’t gotten much sleep from trying to make me comfortable for the last few nights. Ina May called me from the airport and said she would see me in about two hours. She came right over and said she would stay until my baby was born.

She encouraged me right away to try to get some rest. I slept a little, and Rick rubbed my feet. I got nauseous and vomited, which made me feel a little better. I began having stronger contractions down lower and some burning pain. The next time someone checked me, I was eight centimeters open. I tried many other positions and took a shower. Ina May heard me making some sounds and helped me focus on slowing and deepening my breathing. That helped me relax, since I needed to focus on something besides my back labor. When she checked me again, I was at nine centimeters—big progress. Then I thought I needed to go to the bathroom, but I was starting to push the baby down. I moved from the toilet to the birthing stool, and very soon the head was crowning. I felt that I had to lean on someone, so Rick sat behind me. I kept concentrating on breathing slowly in between urges to push. The midwives were talking about how strong I was, because I wasn’t complaining or fighting the feeling. Actually, I felt relieved to be pushing and liked this part of the labor. I hadn’t thought I would, but now I remember this part as the most fun. It went the quickest, and I knew that I would soon see my baby.

Someone held up a mirror, and I could see the baby’s hair. The head was scrunched up so it didn’t really look like a head to me. The most intense part was when the baby’s head came through. I felt a burning pain and was told not to hurry through this part. I pushed for about forty-five minutes. It was easier after the baby’s head was out. Actually, her hand had come out with her head. The rest of her came out real quick and smooth.

She cried right away, and they immediately put her on my stomach. She was so beautiful. She weighed eight pounds thirteen ounces and was in perfect condition. I felt so much relief after the birthing was over. Deborah made some breakfast for me. It felt so good to eat again. Brianna Joy was the 1,937th baby born on The Farm. I was too excited and having too much fun to go to sleep for a while.

Abigail Rosalee’s Birth—April 21, 2000

By Katie Hurgeton

My husband, George, was born in The Farm Birthing House almost twenty-three years before we found out that I was pregnant, and as an outspoken advocate of natural and home birth, he was adamant that our baby would be born in that same house. It didn’t take too much arm-twisting to convince me that this was the best method of birth for my baby as well as for myself.

I expected my mother to be excited and pleased that we had decided on a home birth and would be taken care of by the most renowned midwives in the country. She was neither excited nor pleased. Instead, she and my father joined forces in telling me that I was endangering not only myself but their unborn grandchild as well. Every time I spoke with my mother, she had another birthing horror story that ended with “… and if she hadn’t been at the hospital, she would have died.” After she had exhausted those stories, she expounded on my choosing not to have an epidural.

“You’re going to need one,” she’d say and smile sweetly. George and I finally had to tell my parents that we knew what their opinion was, that we were going to do this our way, and that the topic was not open for further discussion. We also let them know that if they continued to attack or question our decision on this matter, we would simply have to stop coming over. They stopped bringing it up—with us. My mother proceeded to call my pediatrician, my physician, her best friend—who is a registered nurse at Vanderbilt Hospital in the labor and delivery ward—and my former obstetrician/gynecologist to check up on the midwives’ credentials. She eventually came back and told me that all of these people had told her The Farm midwives were the most knowledgeable and experienced midwives to be had anywhere, that they knew what they were doing, and that my mother should RELAX!

This was still only the beginning.

At my next prenatal visit Ina May and Pamela went down a check-list, asking me if I had been exposed to any of these various diseases since I’d been pregnant. When they got to rubella, I stopped them. “The first month I was pregnant, I got a rubella vaccination that was required for me to be admitted to college.” They froze and looked at me with half smiles of disbelief. Ina May said, “But they’re supposed to make sure that you’re not pregnant before they give you that shot.”

“Well, they asked me,” I explained, “but I was on birth control and my period hadn’t been late yet so they gave me the shot.” Neither of them said anything. I started to get nervous. “Maybe I’m wrong. I’ll call my doctor tomorrow and find out.”

“Yes,” Ina May said, still half disbelieving, “do that and then call us.”

I didn’t ask any questions, but when George and I got home I looked up rubella in my copy of What to Expect When You’re Expecting and cried for the rest of the night. The question in the book read something like, “Should I have an abortion if I’ve been exposed to rubella in my first three months of pregnancy?” And the answer began, “Not necessarily.” The book also warned that rubella could cause congenital heart deformities. I was shocked and grief-stricken. When I called my doctor the next day, he informed me that the shot had merely been a booster and he didn’t think it would have any adverse effect on the baby. An ultrasound at twenty-two weeks indicated that mine was still a low-risk pregnancy and could be handled at the Birthing House.

Our second trip to the hospital came quite unexpectedly. We were visiting the midwives for what would be one of the last times before the actual birth. They took my blood pressure, as usual, and began running down the list of standard questions.

“Any headaches?”

“Yes.” It was really the first bad headache I’d had since I’d become pregnant.

“When?”

“This morning.”

“Did you take anything for it?”

“Yes, some Tylenol. But it didn’t do anything.”

“I’m going to take your blood pressure again. It’s high.”

I didn’t really think anything of it. The midwives left the room to talk. When they came back in, Ina May approached the table where I was still reclining and said, “We feel that you have enough of the signs that we would like for you to—” And here George and I were both holding our breath. We were positive that Ina May was about to tell us that they wanted me to go ahead and move into the Birthing House because they thought I’d be going into labor soon. Our joy at this thought was short-lived. “—go to the hospital to have some tests run. You are showing symptoms of pregnancy-induced hypertension.” George and I both deflated. The hospital? Pregnancy-induced hypertension? After they had explained to us what PIH was and some of the risks associated with it, we drove, heavyhearted, to meet them at the hospital. If I had PIH, the midwives would not handle my birth on The Farm and I would have to have my baby in a hospital.

At the hospital I was given a room and a gown and was hooked up to heart and blood-pressure monitors. After about an hour of observation and my doctor’s comment that “Maybe your high blood pressure is due to your being nervous about having your baby on The Farm” (my blood pressure was normal at the hospital), I was issued a clean bill of health. (Doctors call what I had “white coat hypertension.”)

This little run-in, however, made my already nervous parents even more so. My mother provided me with a portable blood-pressure cuff so that I could intermittently monitor my blood pressure at home. It was a couple of days after my visit to the hospital that I got an alarmingly high blood-pressure reading. My husband was on a conference call at work, so I called my mother, who immediately suggested that I go to the hospital. Unfortunately, the hospital that my primary-care physician worked for was at least two hours from our apartment. And because my mother would’ve been enormously relieved if I had to have my baby at a hospital, I decided to call her friend, Anne, the Vanderbilt labor and delivery nurse who had been incredibly supportive of my decision from the start and had an amazingly calming effect on my mom. On this point, however, she agreed with my mother. She thought that I had enough symptoms and found my blood-pressure readings way too