Ina May Gaskin talking:
We don’t count maternal death. We’ve let so many maternal deaths go invisible in these United States. I got my information from the Centers for Disease Control itself. And sort of like I.F. Stone digging out of curiosity, I found this really shocking fact that maybe as much as more than half to two-thirds of the maternal deaths that take place aren’t reported to the CDC. You know, that’s very shocking, because, you know, in most industrialized countries, there’s a huge effort to identify every single maternal death, so that you can say, “OK, how do we reduce it next year?”
Rate of maternal mortality in US compare to other industrialized countries.
Depending on whether you’re looking at World Health Organization data or The Lancet’s recent study that was funded by the Gates Foundation, we are 40th or 50th, OK? Now, if you add in the underreporting factor, we have no way of knowing how much farther down list we go, but we’re following—you know, we’re behind Czech Republic, we’re behind Poland, we’re behind Bosnia-Herzegovina, we’re behind Slovakia, we’re—the list goes on.
How is that possible? Because we don’t give feedback. We don’t have feedback to our obstetricians, to our hospitals or maternity wards, to find out what we’re doing wrong and why the United States is one of four countries in the world where the maternal death rate is going up, not down.
when you do too much surgery, when you enter the abdominal cavity, you know, you’ve introduced whole new kinds of complications that can take place. You can have women dying from pulmonary embolism, and that can happen hours or during a C-section. It can happen after. It can happen after the woman goes home. It can be days or weeks. And there can be just—boom, because she doesn’t know that a pain in her leg is a sign of danger. You can have scar tissue that grows and can cause a bowel obstruction, causing a death that way. You can have a scalpel slip and cut the uteran artery and bleed to death. You can have the bowel knicked and then have an infection set up that might mean an early death from bowel obstruction.
All of these are represented on this quilt. So it’s become a educational device for me to know what the dangers are. And the fact that California reported a tripling of the maternal death rate between 1996 and 2006 should—and the fact that here in New York, the New York Academy of Medicine reported that the death rate, which according to the Health and Human Services should be no higher than three to four per 100,000 births, for African-American women has reached an astounding 79 per 100,000. Should be three or four.
A midwife is a woman who—this is a profession that’s the most ancient for women, OK? It precedes the other one that’s, you know, reputed to be the oldest profession. It certainly preceded medicine. But about five centuries ago, the medical profession, which was just becoming a profession, actually took the first steps of encroaching on this previously women-held territory and then really absorbed midwifery. And that extreme—it went to the greatest extreme here in the United States, where the whole profession was obliterated a century ago.
And what happens in a society when that happens is you have women and practitioners, meaning doctors, and then our case here, nurses, become more and more afraid of birth, because they may never have seen a normal one, and so what becomes a kind of behavior that gets obliterated and made invisible. So, we have—we went to having huge numbers of forceps births. And when I had my first baby, I was pretty much moved into a channel, because I went to a hospital, as everybody did. Little did I know that two-thirds of women in this United States had forceps deliveries in the mid-’60s.
Big metal tongs, they put it inside the woman, and they pull the baby out, rather forcibly. And being, you know, the fact that I had a master’s degree in English, I knew this wasn’t a good idea. And I had another piece of my upbringing, which was Dad was a farmer, and I knew that all these animals could give birth, and no forceps, and this didn’t make sense to me. I thought, how could medicine have gotten so crazy to think that…
So then I was part of the ’60s eruption, where suddenly it was like it rained overnight and then all these midwives cropped up. And I was one of them. And I got a little instruction from some kind-hearted obstetrician and general practitioner along the way. And counting from the first birth I ever saw, bringing my friends into it to be my midwives for my next births, we were able to safely achieve a statistic that I think people would find incredible: we didn’t need a C-section until we got to almost 200 births. And we didn’t endanger anybody in the process.
So we learned how to do—deal with breech deliveries, with twins. And our doctor, the local general practitioner, who had extended his medical education by taking care of Amish people, learned that home birth wasn’t dangerous and that we were much like the Amish. And he helped us and taught us these skills that are—I never knew would be disappearing. So now, you know, 40 years after I got into this, we’re living in a time where it’s rare for me to meet a U.S. doctor who’s allowed to do breech deliveries or twins. At the same time, I have women on this quilt who died for lack of doctors knowing these skills. And I’m watching this dry up in different countries, because a lot of countries are under the impression that we are the country to imitate in birth, when we are absolutely not the country to imitate when it comes to birth. We should be looking at countries where fewer women die.
midwives are marginalized. Fewer than maybe 10,000—10 percent of women are able to have a midwife. And in many of these situations, midwives are working with restrictions placed on them, so that they’re often not able to learn even the traditional skills that are associated with midwifery. So, you have midwives taking care of too many women at a time, for instance, and that’s not the same as having your own midwife, or in our care, where you’re probably going to have two midwives with you, because it makes births sweeter to do it that way.
So, we are having now this—with the evaporating skills, it’s come to the point where we’re even having some women who aren’t pregnant who have undergone C-sections, because—yes, just published my article in Birth Journal about a phenomenon that few people know about, but I learned about early from reading it in the obstetrics book that there’s such a thing as a false pregnancy that can even trick the body into mimicking signs of pregnancy when it’s not. And if you don’t put your hands on the woman and feel well, you can miss the fact that there’s no baby in there. And this can progress to a point where she gets cut open, and we go, “Oh, she wasn’t pregnant.” It’s no longer in the obstetrics book.
we’re blessed to live on 1,750 acres of Tennessee woodland. So it’s a forest. We built a whole community there starting in 1971.
Now we’re about maybe 150 people, but when we settled we were around 300. And my husband Stephen became the first recipient of the Right Livelihood Award, you know, for the work we did, because in learning to build that community, we developed skills that were helpful, and so we had a world outreach, you know, organization we called Plenty. And we did work in Guatemala after an earthquake, and we did work in Lesotho and with Native Americans. And that’s ongoing. So, we lived there. We were vegetarian, had our babies at home, ran a free ambulance service here in the Bronx starting in the late ’70s. And so, we’re just all over the place doing these sort of different things, and the community is 40 years old now.
Insurance has incredible power now, power that it didn’t have 70 years ago. It’s the reason that doctors aren’t learning to do breech deliveries anymore. It’s the reason that midwives are—it’s one of the huge reasons that we have very few midwives in this country. We need 120,000 more easily.
midwives are at the bottom of the pile, basically, on getting coverage, and especially if we work at home. We’re—we’ve become the scapegoat for all of this distraction, you know? And so, we need payment. We need a lot more midwives. And we also need postpartum care, which midwives could be giving.
Discussion with Ina May Gaskin.
Ina May Gaskin, the founder and director of the Farm Midwifery Center in Tennessee. She is the winner of the 2011 Right Livelihood Award. She is the author of Ina May’s Guide to Childbirth and, most recently, Birth Matters: A Midwife’s Manifesta. She is also the founder of the Safe Motherhood Quilt Project, which seeks to draw public attention to the high maternal mortality rate in the United States.
– source democracynow.org