The Future of Birth:

Combining the Best of
Modern Obstetrics with
Respect for Nature and
Traditional Midwifery
Approaches
Ina May Gaskin, MA, CPM
Executive Director, The Farm
Midwifery Center
The Farm Midwifery Center: Outcomes
for 2286 Births, 1970 - 2005
 Births
Births completed
completed at
at
home
home
95.1%
95.1%
 Transports
Transports
4.9%
4.9%
 Emergency
Emergency transports
transports
1.3%
1.3%
 First-time
First-time mothers
mothers
44.7%
44.7%
 Multigravidas
Multigravidas
55.3%
55.3%
 Grand
Grand multiparas
multiparas
8.4%
8.4%
The Farm Midwifery Center: Outcomes
for 2286 Births, 1970 - 2005
 Cesareans
 Forceps
deliveries
 Vacuumextractor
deliveries
1.5%
0.4%
0.1%
The Farm Midwifery Center: Outcomes
for 2286 Births, 1970 - 2005
 Vaginal births
after cesarean
 5.3% (117
(117 of
of 119)
119)
 Twins
 19 sets
 C-sec rate for
twins
 0%
 Breech births
 81 (3.6% of
total)
 8.6%
 C-sec rate for
breeches
were
were successful
successful
The Farm Midwifery Center: Outcomes
for 2286 Births, 1970 - 2005
 Postpartum
hemorrhage
 1.8%
 Inductions
 5.4%
 Ate & drank in
labor
 29.1%
 Meconium
staining

 10.6%
The Farm Midwifery Center: Outcomes
for 2286 Births, 1970 - 2005
 Lethal anomalies
 Maternal
mortality

 Neonatal
mortality
excluding lethal
anomalies
 5 (0.2%)
0
 0.36%
Farm Midwifery Center Outcomes
Compared with U.S.
 Cesarean rates
 Epidural rates
 1.5%
1.5% (FMC)
(FMC) vs
vs 27.6%
27.6%
 1.5%
1.5% (FMC)
(FMC) vs
vs 80+%
80+%
 Breastfeeding
initiation rates
 99%
99% (FMC)
(FMC) vs
vs 50%
50%
 Preeclampsia
 0.39%
0.39% (FMC)
(FMC) vs
vs 7%
7%

Cesarean Rates: Global Extremes
 Brazil
 50 - 95%
 The Netherlands
 13.7%
(2002)
Education
 Patient
Education
 A. Nutrition
 B. Mind/body
interaction
 C. Hormones of
birth
 D. Sphincter
Law - trusting
birth
Basics of Good Nutrition
 Food, not chemical additives or
preservatives
 Plenty of protein (beans, nuts,
seeds, dairy products, seafood,
meat)
 Fruits and vegetables
 Water, the principal beverage
 Break the junk food habit
Hormones of Birth
 W.A. Newman Dorland (1901): “On
The ‘Pains,’ or Uterine Contractions:
Mental emotion of any kind will
temporarily diminish their intensity or
even absolutely suppress them; the
entrance of the physician into the
lying-in room may have the same
effect.”




Catecholamines
Oxytocin
Neuroendorphins
Prolactin
High level of endorphins
High level of endorphins
Sphincter Law
 Sphincters don’t obey orders.
 Sphincters function best in
atmospheres of intimacy and
privacy.
 Sphincters may suddenly close
when intimacy, privacy or trust
are violated.
 Sphincters open most effectively
when mouth and jaw are open
and relaxed.
Provider Education
 Need for exposure to normal birth.
 Full set of skills: Leopold’s maneuvers,
breech maneuvers from mannequin
training, etc.
 Recognize patient miseducation by
media.
 Understand impact of language (How to
Talk to Women: 101)
Interaction, Not Intervention
 A. When to admit
 When labor stops during or after
admission, there are alternatives to
intervention.
 Walking, sleeping, smooching, going
home
 B. Labor support
 Trained, committed, accessible
Inductions/alternatives
EDD between 38 and 42 weeks.
Women’s labors don’t start like cars.
Induction only needed when not inducing poses
real dangers to mother or baby.
Intercourse a source of inexpensive and effective
prostaglandins.
Sweeping the membranes
Borage oil.
Epidurals/alternatives
Midwifery model of care
Tubs for laboring in water
Hospitals that don’t have epidurals
Eating & drinking in labor allowed
No routine intravenous lines
Free movement encouraged
Birth ball
Continuous presence of midwife or
doula
Love What You Do
Nurture the caregiver
Learn to read and analyze data
The birth is not about you!
a. Be satisfied with the good work of
the mother
b. Appreciate and utilize skilled staff
c. Respect informed choice
There is a difference between fear and
prudence.
Caution!
 CDC (1995): “The magnitude of
the pregnancy-related mortality
problem is grossly understated.”
 CDC (1998): “The number of
deaths attributed to pregnancy
and its complications is
estimated to be 1.3 to 3 times
that reported in the vital
statistics records.”
Dangerous Experiments
 Routine induction with Cytotec
(Check www.inamay.com for
summary of the literature in
English about Cytotec
inductions)
 Single-layer suturing of the
uterus, routinized without solid
evidence of safety
Bujold et al. Am J Obstet Gynecol
2002;186:1326-30
Durnwald et al. Am J Obstet Gynecol
2003;189:925-9
Benchmarks in Midwifery
 Margaret Charles Smith (1943-1981) Eutaw,
Alabama: 3500 births with 0 maternal
mortality
 Catharina Schrader (1695-1745) Netherlands:
3017 births (14 maternal deaths, 4.6/1000
births)
 Martha Ballard (1785-1812) Maine: 814 births
(5 maternal deaths)
 Alfred Rockenschaub (1965-85) Vienna:
44,500 births with 1.3% cesarean rate, lower
neonatal mortality/morbidity
 12 Years
Years &
& More
More than
than 30,000
30,000 Births,
Births, the
the LA
LA
Co. & USC Women’s Hospital B. C.
Experience, Greylich et al, J NurseMidwifery;1994;39:185-96.
The Safe Motherhood Quilt
 What it shows:
Most maternal deaths can be
prevented
Too much casual induction of labor
Ditto for elective c-sections
16 of 289 Women
Two Websites:
www.inamay.com
www.rememberthemothers.org
Ley de la
Resisténcia del
Esfínter
Un Modelo para Entender
el Mistério del Nacimiento
La Historia de “The Farm”
Stephen Gaskin, mi esposo, condujó
“Monday Night Class” en San
Francisco 1966-1970.
En 1970, 300 personas quienes habían
atendido esta clase pidieron
acompañar a nuestra família en una
série de congresos en 42 ciudades
americanos.
Fué en este “Caravan” que empezé mis
estudios del parto y de la partería.
11 bebés nacieron mientras viajábamos.
The Farm Midwifery Center: Resultados
de 2286 Partos, 1970 - 2005
 Partos en casa
 Transportes
 Transportes de
emergéncia
 Primigrávidas
 Multigrávidas
 Gran multíparas
95.1%
4.9%
1.3%
44.7%
55.3%
8.4%
The Farm Midwifery Center: Resultados
de 2286 Partos, 1970 - 2005



Cesareanas
Forceps
Vacuumextractor
1.5%
0.4%
0.1%
The Farm Midwifery Center: Resultados
de los primeros 400 partos



Cesáreas
Forceps
Vacuumextractor
0.5%
0.4%
0.1%
Ley del Esfínter
 Sfínteres no obedecen órdenes.
 Sfínteres funcionan mejor en
ambientes de intimicidad y
privacidad.
 Sfínteres se pueden cerrar
cuando se viola la intimicidad y
privacidad.
 Sfíncteres abren con mas eficáz
cuando la boca y “jaw” estan
abiertos y relajados.
The Bathroom Prayer
Interacción Mente-Cuerpo
 Poder del miedo para prevenir
dilatación del cervix.
 Evitar oir cuentos horibles sobre el
parto.
 Poder de palabras positivas. “Eres
maravillosa.”
 Necesidád de la preséncia contínua
de una partera, enfermera o doula.
 Necesidád que las mujeres crean que
sus cuerpos no eran malcreados.
 La curva de Friedman vista muy raras
veces en el “Farm.”
Hormonas de Parto y
Nacimiento
 W.A. Newman Dorland (1901): “Sobre los
dolores de las contracciónes uterinas:
emociones mentales de cualquier tipo
diminuirán su intensidad o hasta pueden
reprimirlas; la entrada del obstetra en la sala
de parto podría tener el mismo efecto.”




Catecolaminas
Oxitocina
Neuroendorfinas
Prolactina
Alto nivel de endorfinas
Alto nivel de endorfinas
Mi Sítio del Internet
www.inamay.co
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