Let me start with a huge word of congratulations to our friends Katherine and James for the birth of their son, Seamus Patrick Harte. He was born yesterday at 2:00 pm, weighing 7lbs 5 oz, and was 19 inches long. Katherine and James found the Bradley method class we took, and we're looking forward to raising our kids concurrently (especially for what that means as far as babysitting duties and socialization of the critter). This news leads right into...

Book #3: Ina May's Guide To Childbirth by Ina May Gaskin



This one's going to be preachy, folks. Let me first say that I wouldn't have included this in a normal year because it's more self-help book than, say, a novel or book of essays. However, three reasons compel me to include it: 1) I have strong feelings on the subject, as I'll explain below; 2) although the first half of the book consists primarily of birth stories, the second half is a clear and concise screed about the wrongheadedness of modern obstetrics disguised as a guide to midwifery; and 3) considering that I probably won't have time to finish many books in the first few months of my baby's life, I will take all of the books I finish.

I'm a policy wonk in real life, so let me start with bias. Ina May Gaskin is the head midwife at the hippy-dippy TN recluse The Farm. Most of the hippy types I knew in Alabama eventually took a pilgrimage to The Farm (those that weren't brought up there, that is), and a few moved there and may still be there for all I know. I don't see how Gaskin's choice to live and work on the Farm makes her any less of an expert in childbirth, especially given her vast experience in the subject. Gaskin and the other Farm midwives have delivered over 2000 babies and have lower incidence of complications than the national average, primarily because, as Gaskin asserts, modern obstetrics is built around a cost-obsessed concept of convenience rather than common sense and health.

Gaskin doesn't have all of the statistics she needs. In fact, no one is collecting statistics on the entire population of U.S. childbirths. Most hospitals won't allow information on problem births to be released. Very few HMOs have a financial incentive to investigate hospital birth methodology because hospitals lean towards birth methods that are cheaper in the short-term. Let me repeat this: no one is looking at the long-term implications of current birth procedures, and no one is tracking the incidence or cause of problem births.

Most women talk about the pain of childbirth and the necessary recovery time. Many of our friends have told us to listen to the hospital staff because they are professionals and know what they are doing. Then we hear the horror stories about the difficulties they experienced after administration of the Pitocin or the epidural. Somehow, people have gotten it into their heads that childbirth is something that should be regulated with drugs as intrusive as chemotherapeutical drugs. Childbirth. An experience that, unlike cancer or most other life-threatening diseases, has happened to every single person (indeed, every single animal) who is alive and who has ever been alive. Why do obstetricians treat this process, the largest and most profound experience in the life of the parents and child, like a life-threatening medical procedure?

Take the Caesarian. Sure, there are some women who need major abdominal surgery to birth their child due to unforeseen complications. Out of mothers choosing natural, normal childbirth, the rate is less than 5 percent. In the world at large, the rate is closer to 8 to 10 percent. However, in the U.S. population, the rate is over 20 percent. Why is this? As with any odd behavior, there's a variety of reasons, but the policy wonk in me is swayed that cost is the primary factor. It is expensive to allow a women to have a long labor because the hospital (and HMO) must pay for the use of the room, the time of the staff, and there is a risk - albeit a small one - that the mother is having a long labor because of a complication that could lead to a lawsuit against the hospital. In the face of cost risks, hospitals and hospital staff prefer to go with the easier and cheaper option of major abdominal surgery, the Caesarian. After all, with the C-section, the doctor makes a small incision, rips the stomach and uterus open (ripped skin tends to heal faster than sliced), and removes the baby that way. A few stitches (and -- another digression -- it has become common practice in very short time [i.e. without any sort of long-term testing period] for U.S. hospitals to use a single-stitch repair for C-section birth because it takes only 5 minutes, compared to the safer 10- to 15-minute layer-stitch) and a prescription to a regimen of drugs later (and, oh yeah, don't nurse that baby for the next few months), and everything is finished. Medical schools institutionalize these rationales, and voila! high Caesarian rate.

There's more. Ultrasound has only been in use since the early 70s. No one knows the long-term effects of exposing a fetus to ultrasound. There have been very few studies on the effect to cellular development. It's ubiquitous because it's incredibly convenient. However, it would be convenient to simply kill subnormal children, too, but no one is recommending that. My point: convenience is not an acceptable rationale to propagate a process that has the potential for vast negative implications in the real world, but this method has spread like wildfire across the medical community. Say, why don't we just siphon nuclear waste into nearby water sources? After all, there would be no short-term effects!

Hospitals often use fetal monitoring machines that attach to the baby's head and monitor the heartbeat via electronic pulses. Yes, hospital attach a machine that transmits an electric pulse to the unformed and unprotected skin over the brain of a fetus in utero. Think about that. These machines are notoriously unreliable, too, often leading hospital staff to push for quicker delivery than necessary.

Episiotomies (that's the cut to enlarge the vaginal area, men) are commonly used in hospital deliveries, despite billions of years of evidence that the episiotomy is a mostly unnecessary procedure. With a little preparation and exercise, a women should easily be able to give birth without a cut.

Vaginal Birth After Caesarian (VBAC) is currently strongly discouraged in modern obstetrics because there is a small risk that the abdominal walls will tear (especially given the incidence of single-stitch repairs) and C-sections, as I pointed out above, are shorter and more convenient procedures for hospital staff.

Finally (although there's a lot more to talk about here, I would need to consult this book and the others we've read on normal childbirth beyond this point), epidurals cause the mother to feel more pain because she can't react to her body, lead to long back labor (and Gaskin's history of back labor -- which is a bad idea, as anyone with a conception of physics and gravity could immediately grasp -- is fascinating, too, now that I think about it, similarly built around convenience for hospital staff with a side dose of prudishness for good measure), and suppress both the infant's natural breastfeeding reflex and the mother's ability to produce milk.

Gaskin's book demonstrates how topsy-turvy childbirth in the U.S. has become. Modern obstetrics treats the mother like a patient with a life-threatening disease and treats childbirth itself like a routine medical procedure to shuffle through. What sort of brave new world is this? Doctors and HMOs would doubtlessly attempt to medicate crises of conscience away. Actually, that was supposed to be a joke, but what is the prevalence of purple pills if not just that? Maybe a better way of putting it is that doctors would give Buddhist monks happy pills. Science should never alienate people from their most profound experiences (and, honestly, I can't think of experiences more life-altering than childbirth or positive action [we could also call it satori] based on real, hard, sometimes depressing soul-searching), but we have come to the point that we treat these experiences as if they were problems, not solutions.

I want to encourage any expecting couples to look into normal childbirth options. Childbirth is one of the few definitive times in your life that you can embrace the sweet mystery of life. Don't give up that experience out of fear, especially when that fear is fostered by someone's desire for profit. If Ina May's book is too hippy-dippy for you (and, unlike her book Spiritual Midwifery, I seriously doubt that anyone would find the second part of this book hippy-dippy; it greatly pleased the meat-and-potatoes policy-wonk side of my brain), look into Bradley classes, talk to the La Leche League, meet with the midwives at your local birthing center. Childbirth tops the list of experiences too precious to let fear obscure your need for wisdom.