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Ina May’s Guide to Childbirth: A Review for a Highly Recommended Book by PreNatal Massage Therapist
In describing how these statistics were obtained, she goes into detail about the methods used by her and the other midwives in her practice. Her statistics include a ridiculously low intervention rate (caesarean section, forceps and vacuum extraction interventions are very low compared to national averages). Her practice has an intervention rate of about 3%, while national averages are much higher. Just to mention the cesarean rate, and New Jersey as the example I’m most familiar with, the rate in that state is somewhere around 34%. And while various medical publications and articles online cite this as a number that needs to be reduced, it hasn’t changed much.
To give the correct national averages, I cite a study done by the North American Midwives Alliance. The fact sheet they distribute lists the national averages for each available intervention, which are as follows: C-section: 31%; forceps or vacuum: 3.5%; episiotomy: 25%; oxytocin: induction – 24%, augmentation – 16%; epidurals: 67%. This fact sheet compares the rates of these interventions with those of midwives performing home births. Needless to say, home birth intervention rates are much lower (for example, the caesarean section rate is 5% compared to the national average). There are some interesting findings from the research in this fact sheet, and it’s a very important read for those considering a home or birth center birth. This study was conducted using data from the North American Midwives Alliance between 2004 and 2009, and also cited five other studies found in the footnotes on the page cited here: mana.org/pdfs/DOR-Outcomes-Paper-Fact-Sheet- on-Risk.pdf
The early part of her book includes birth stories from women she or her partners have worked with. These birth stories have been an encouragement to many women, as over the years she has received letters from women who read them either before giving birth or when they still had children.
One of the most important aspects of Ina May’s book is her tendency to describe childbirth as a natural event with certain physiological functions that occur normally. In a normal birth, the uterus begins to contract, the cervix dilates to become a large opening that the baby can easily pass through, and then the body begins stronger contractions to push the baby out. In most cases, this happens naturally if no intervention is done.
Unfortunately, this natural physiological function is not respected in hospital settings. Women can be given epidurals to ease the pain, and in the past have even been completely sedated while their baby was delivered by one of the various extraction methods.
Ina May’s experience is in a rural community in Tennessee and she also attends births in an Amish and Mennonite village in Tennessee. As most people know, the Amish generally do not accept medical interventions. Recent studies of the Amish show that they seek prenatal medical care for their first child and only accept technology that aligns with their religious beliefs. Members of the Ina May community will usually have a midwife at home, although they do not seem to be religiously oriented. In other words, women at The Farm will usually give birth with a midwife unless a hospital birth is absolutely necessary.
Thanks to her experience, Ina May’s practice has been able to develop methods that work well in childbirth. The most important part of childbirth that Ina May emphasizes throughout her book is that the body knows what it is doing. The body has evolved over thousands of years to give birth. If birth was not a natural process and required the intervention of doctors, then humanity would have died out centuries ago.
Ina May mentions that many of the interventions performed by obstetricians are actually unnecessary and are due to the lack of patience of doctors. For example, Pitocin, or artificial oxytocin, is often given during the early stages of labor. If patience were to be used, in many cases when it is given, the body’s natural birthing process would automatically take place to expel the child. Because many hospitals have a time limit for the labor process, as well as for each phase (whether the mother is first time or second time), this chemical is administered. The author points out that it is not unusual for a first-time mother to have a one- or two-day labor. This period of labor is widely known, yet often overlooked. Ina May also points out some of the dangers of these medications, including the possibility of uterine rupture due to the violence of the contractions. These ruptures occur not only in the case of a previous caesarean section, but usually this danger is not mentioned to the pregnant woman.
Another commonly used procedure is forceps extraction. The author also points out many dangers associated with this practice. These dangers include damage to the baby (including fetal death) and the need for an episiotomy. Although vaginal rupture does not always occur, it does occur frequently and has led to widespread episiotomy, or cutting of the vaginal opening, to prevent such a rupture. However, many doctors fail to mention that there may be long-term consequences to having this procedure.
On the plus side, Ina May also details how to avoid some of these measures, as well as natural ways to speed up labor. For example, if a woman chooses to give birth in a hospital, she may choose not to be associated with immobilizing monitors. She may choose to reject the fetal monitor attached to her abdomen and insist on using the fetoscope every fifteen minutes. She may ask not to have an IV because she may refuse medication. She may insist on being able to stand up and walk (which is not inhibited by an IV as it may be on casters) and reject all other anchoring interventions such as catheters and epidurals. Since gravity can definitely help with labor, this is one way to move labor.
Mostly, though, she advises women to find a birth center with a midwife or have a home birth if they really want to avoid any interventions. Most birthing centers and also most people’s homes (unless they live in the middle of nowhere) are not very far from the hospital. If the birth goes very wrong, transport is usually quick enough to allow for an emergency C-section, which saves the life of the mother or the baby. The author supports the Mother-Friendly Childbirth Initiative, a very valuable initiative dedicated to helping women have a more natural birth.
Because many medical interventions can have unexpected and long-term consequences for the woman who has them, it is often best to try to avoid them. Even most doctors would agree that no surgery is preferable. A C-section is a major surgery with a recovery time similar to any other major surgery that involves cutting skin and muscle. This means a long rest period, which is not always possible for women who need to return to work quickly.
Since most women do not live in rural Tennessee, Ina May’s instructions are aimed at those women who do not have access to a home birth midwife and who may prefer to be in a hospital where they feel an extra level of safety for their baby. . Most of her advice is aimed at these women and will help them gain confidence in their body’s ability to produce the child they long for. Therefore, this book is highly recommended reading for any pregnant or planning woman. If you can only read one book during pregnancy, I would recommend this book.
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