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for her whole-life's work teaching and advocating safe, woman-centred childbirth methods that best promote the physical and mental health of mother and child.
Ina May Gaskin has been called "the most famous midwife in the world". A pioneer in a millennium-old profession on the brink of extinction in her country, she combines scientific evidence and analysis with her own broad experience in exercising natural medicine. Ina May Gaskin is a role model for midwives who still dare to think in different paths, trying to implement more humane obstetrics in their countries, and providing women with the chance to choose the way of giving birth that seems right for them.
Ina May Gaskin
149 Apple Orchard Lane
Ina May Gaskin was born on 8 March, 1940. She is the wife of the first Right Livelihood Award Laureate Stephen Gaskin, who received the Prize with his organisation PLENTY International in 1980.
Ina May Gaskin's first midwifery experience was in 1970, when she assisted at a birth in a schoolbus on Stephen's speaking tour of universities and churches prior to the establishment of The Farm, an intentional community in Tennessee, and the subsequent development of Plenty International. This experience inspired her to study midwifery as a way of providing birth choices for women in her country, where the profession of midwifery had been eliminated early in the 20th century, because obstetrical leaders at the time saw no reason for its continued existence, and because of the benefits medicated birth and caesarean sections provide to for-profit hospitals, insurance companies and the drug industry, though often not to the women.
With a strong motivation to become a midwife in a country that lacked opportunities for such an educational path, Gaskin founded The Farm Midwifery Center in 1971. The Center became well known during the 1970s as a place where authentic midwifery was practiced and taught.
Over all these years, Gaskin has assisted some 1200 unmedicated births and together with her partners, more than 3000. Her work and expertise have pioneered midwifery education for decades, preserving knowledge mostly forgotten in technically dominated births. Her 'Gaskin Maneuver', an obstetrical procedure she learned from traditional Guatemalan midwives, is now taught internationally. Birth videos have helped promote her techniques for the prevention of protracted labours, routine episiotomies, and for successful breech and twin births.
For more than a decade, Gaskin has led a campaign to promote awareness of the dangers of the use of Cytotec (generic name: misoprostol) to induce labour for reasons of convenience. Her 2000 article published by the online journal Salon.com has been credited with prompting the drug's manufacturer, G.D. Searle, to issue a letter to all U.S. maternity care providers warning against its use in pregnant women.
In 1982, recognising the need for high standards for midwifery practice and education, Gaskin became one of the founding members of the Midwives Alliance of North America (MANA). She served on the MANA Board of Directors from 1982 to 2002, and as its President for six years.
MANA later gave rise to the Midwifery Education and Accreditation Council (MEAC), and to the North American Registry of Midwives (NARM), an organisation which created a national competency-based certification credential for U.S. midwives. These developments have led to the passage of laws recognising the NARM midwifery credential in more than half of the states so far. Gaskin and her colleagues have been deeply involved in this process for more than 25 years.
In the late 90s, in order to build a valid case for policy recommendations, Gaskin began her study of maternal mortality rates. While anecdotal evidence suggests that rising death rates are at least partly - if not even to a significant degree - due to the rise in caesarean sections and the use of misoprostol to induce labour, autopsies after maternal deaths are rare even in the U.S. In addition, the lack of any mandatory federal standard death certificate makes collecting data difficult and incomplete.
In April 2011, the Maternal Accountability Act got introduced into Congress, which would make mandatory the use of a standard Death Certificate allowing the extent of birth-related deaths to be recorded. Ina May Gaskin has been a fierce supporter of this Act.
In 2011, Ina May Gaskin's main mission was:
The Safe Motherhood Quilt Project, in which a quilt is made of patches, each with the name of a woman who died in childbirth in the US since 1982. The Project aims at summoning the national will to take the first step toward lowering the currently rising maternal death rate by creating a consistent, mandatory system for reporting, classifying, and counting the maternal deaths in the US and reviewing and analysing their causes.
An information campaign, aiming at women, midwives, nurses and physicians, about the potential 'side effects' (maternal and fetal death) of using misoprostol to induce labour.
Teaching. Gaskin has lectured to physicians and midwives throughout the U.S., in Argentina, Canada, Mexico, Brazil, Costa Rica, Sweden, Norway, Denmark, Iceland, Germany, Switzerland, Israel, Italy, Austria, France, the Netherlands, Slovenia, Russia, Hungary, the Czech Republic, Spain, Australia, New Zealand, and Japan.
She also promotes breastfeeding and fights against hospital routines which unnecessarily separate newborns from their mothers, as well as puritanical attitudes which discourage many women from breastfeeding. In some U.S. states it is still unusual for breastfeeding mothers to be seen in public, and some mothers have been threatened with arrest for doing so.
In 1975, Gaskin's Spiritual Midwifery was an immediate bestseller and soon became regarded as the bible of home birth and woman-centred midwifery. Having been translated into Dutch, German, Danish, Russian, and Spanish, the book has convinced countless women that labour and birth can be approached without fear, and with confidence that most women's bodies are still perfectly capable of giving birth. Recent books include Ina May's Guide to Childbirth (2003), Ina May's Guide to Breastfeeding (2009), and Birth Matters: A Midwife's Manifesta (2011). Ina May Gaskin also contributed to an anthology of U.S. midwifes that pioneered the return of that profession in the USA called Into These Hands. Wisdom from Midwives (2011).
In 2009, Gaskin received an Honorary Doctorate from West London University, and in 2013 she received an Honorary Doctor of Science from Shenandoah University, Winchester, Virginia.
In your view, how dangerous is it for a woman to have a caesarian?
It's probably safe to say that a large proportion of women do not know that death from caesarean surgery is three times greater than for vaginal birth. In the case of emergency caesarean, this figure rises to four times greater.
Most maternal deaths from pulmonary embolism follow caesareans. That's a well known fact. According to figures published by the UK's Confidential Enquiries into Maternal Deaths, it's possible to see how the number of pulmonary embolisms has risen with the increase in caesareans: 32 maternal deaths were recorded in the period of 1985-87, 48 were recorded in 1994-96, and 41 were recorded in 2003-05.
Most women are probably unaware of problems in subsequent pregnancies, with complications such as placenta previa, placenta accreta, and abruption.
Are natural births on the increase in the US or is it still seen as an alternative experience?
The US caesarean rate reached 34 percent in 2008 (the last year for which we have national data). I'm sure that natural births would be on the increase here if most women had choices in regard to how they will give birth, but we have such a small number of midwives, (10,000 at the most - consider that 4.3 million births take place every year) that choices for most women don't exist. Keep in mind that those midwives working in hospitals are usually responsible for caring for several women at a time - far from an ideal situation. As for home birth, even after a 20 percent increase in home birth between 2004 and 2008, still only 1 percent of women can have a planned home birth. This means that a larger number of women every year are having home births that are not assisted by a qualified midwife.
Are things getting worse for women in terms of information about the benefits of natural birth?
Actually, I think that US women are beginning to get a little more information of this kind from films such as Ricki Lake and Abby Epstein's The Business of Being Born and their new More Business of Being Born and Debra Pascali-Bonaro's Orgasmic Birth. More and more women are wanting to become doulas and more and more are hiring doulas. But if we look at the mainstream media and how it reports on birth, I see no improvement yet in that sphere.
Are you still delivering babies?
Yes. I'm waiting on a woman in early labor as I write. Although I still travel quite a bit, I schedule in blocks of time to be spent at home, and during these times, I continue to attend births (usually being a co-midwife with one of my partners). I get most of my writing done while I'm at home.
Your husband was the first recipient of the Right Livelihood Award in 1980. What does becoming a Laureate in 2011 mean to you and how will it help your work?
I can't express how grateful I am to become a Laureate. The previous recipients of the award are some of the bravest, most visionary, selfless, and most effective people in the world. To be in their company is quite an honor.
This award will give me a chance to warn people in the UK and in many European countries that it is a great mistake for countries with lower maternal and newborn death rates to imitate maternity care practices that had their origin in the US. The US maternal death rate is underreported to a large but unknown degree, and it is currently rising rather sharply. At least 49 other countries reported lower maternal death rates than we do in the US (despite our underreporting). Our newborn death rates also do not compare favorably with innumerable countries, all of which spend less on maternity care than is spent here.
According to the Centers for Disease Control (CDC), US women today face more than twice the chance of dying from causes directly related to pregnancy and birth than their mothers did. The myth that we have the greatest maternity care system in the world pervades most media coverage of birth issues in the US. Yet, in some states the maternal death rate has more than doubled what it was years earlier. In 2010, California, for instance, reported a tripling of the death rate between 1996 and 2006, attributing a significant part of the sudden rise to an excess of caesareans. I have been writing about these issues for more than a decade, but the mainstream media has not yet seen fit to report anything on this shocking situation, despite my attempts to spoonfeed it. Perhaps the award will bring these important issues before the US public. I certainly hope so