Ina May's Guide to Childbirth: Updated With New Material

by Ina May Gaskin

I learned that true words spoken can sometimes relax pelvic muscles by discharging emotions that effectively block further progress in labor.

Remember this, for it is as true as true gets: Your body is not a badly designed machine. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceroses, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.

The physical changes that take place in a woman’s body during labor are perhaps the most dramatic that occur in humans. They involve more movement, more shape-changing of various organs, more prolonged physical sensation, and considerably more effort than do other physiological functions of the body such as yawning, swallowing, burping, sneezing, coughing, laughing, crying, digesting, breathing, peeing, vomiting, pooping, farting, and coming—the functions we experience on a more regular basis. Birth—as experienced by the mother—is the Mount Everest of physical functions in any mammal.

Deep, slow breathing; meditation; singing; dancing; laughing; pleasurable touch; kissing; praise; hugging; and prayer all stimulate natural oxytocin release. All of these actions have the power to reduce fear with no unpleasant or risky side effects.

You may even feel like you are being horribly injured inside during a contraction, but your midwife’s calm, understanding manner or words tell you that no injury is actually taking place. This knowledge at such moments is so reassuring that often it is possible to feel either the pain diminish or your own ability to bear it increase.

Here’s an example of how our cultural mythology of birth is affected by them: In real life, labor usually starts rather gradually. In dramas, it usually strikes like lightning. One minute a character is brushing her hair or enjoying dinner in a restaurant, and within seconds her labor overwhelms her with such force that she is immediately carried away to the hospital to be saved from it. Pain is portrayed as if it could be fatal. Women and girls raised on this sort of thing without a source of more accurate knowledge learn to equate labor pain with danger.

Optimum functioning of our various sphincters is easier to obtain when we understand how to better accommodate our thoughts to the needs of our bottoms. I often say that our bottom parts function best when our top part—our mind—is either grateful or amused at the antics or activities of our bottoms. It is amazing how much better our bottoms work when we think of them with humor and affection rather than with terror, revulsion, or, worst of all, look away from them in shame.

Here are a couple of techniques for facilitating your baby to roll so he is facing your side or toward your back. Sit far enough forward on a rocking chair so your bottom is at the edge (your thighs will be unsupported) and your knees are lower than your hips. Rock forward and back for a while. Crawl on the floor frequently. Making a daily practice of the crawl will help many an OP baby to roll 90 degrees. Another favorable position is to sit on the floor with your knees flexed under you and your hands resting on a cushion in front of you. If you are sure your baby is OP, you can also kneel on the floor and rest your elbows and upper body on the floor. Adopting any posture in which your

tummy is down (rather like a hammock for your baby) or your knees are also down (which also creates more space for baby to roll) will encourage the baby to find the OA or OT position. Avoid armchairs and sofas that cause you to lean back. Shallow squats onto a stool about a foot from the floor are a good idea as well. Keep your spine vertical against the wall as you slide up and down.

Your body—your choice. Get up and move. Take control. Your body was made for this. You are chosen, not cursed. And birth without fear.

Changing the normal pattern often causes other problems, necessitating more obstetrical interventions. An induced labor is quite a different process from spontaneous labor. Women tend to have harsher, stronger, significantly more painful contractions with chemically induced labors, so one who can cope with a spontaneous labor often finds that she needs pain medication to bear the more insistent contractions of an induced one. There is no shame in needing pain medication in a chemically induced labor.

The labor postures common to traditional women’s cultures all over the world include sitting, kneeling, standing, squatting, or the hands-and-knees position.

The list of benefits of upright positions in labor includes:

better use of gravity maximum circulation between mother and baby (no compression caused by the baby’s weight on the mother’s major blood vessels, which can lessen oxygen-rich blood to the baby) better alignment of the baby to pass through the pelvis stronger rushes increased pelvic diameters when squatting or kneeling

The “golden hour” is a phrase that I could do without, because it makes it sound as if bad things automatically happen if temporary separation places you and your baby in different places for a time. This is simply not true. Love is more powerful than missing some minutes together right after birth. Remember: Expressing love, whenever and wherever you do it, releases more oxytocin. You can always give expression to love, no matter how scared or low you may feel.

ACOG also recommended that women with two or more cesareans with no contraindications should not be discouraged from trying for a vaginal birth, that women with large babies should not be automatically exempted from trying a VBAC, and that VBACs should not be limited to the largest hospitals. All of these recommendations were supported by published evidence cited in the references to the bulletin.

Avoid labor induction and augmentation. If there is pressure for you to dilate more quickly, get into water or walk and arrange for privacy. Make sure you are well fed before you get to the hospital (if that’s where you plan to give birth). Try to find one where you can eat and drink during labor if you want. Finally, keep vaginal exams to a minimum. Skilled practitioners can usually closely estimate dilation by your breathing and your body language. If there is any pressure on you to have an epidural, try to resist it. (There are instances in later labor where one can help, but epidurals should not be used early in VBAC labors, in my opinion.)

You were brave. Remember that. You did what you could. Give yourself credit for the work you did.