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In describing how these stats were achieved, she delves with detail into the methods that she and her practices’ other midwives use. Her statistics include a ridiculously low intervention rate (interventions by cesarean, forceps, and vacuum extraction are very low compared to national averages). Her practices’ interventions are at around 3%, whereas the national averages are much higher. Simply mentioning rates of cesarean section, with New Jersey as an example that I am most familiar with, the rate in that state is somewhere around 34%. And while this is cited by various physician publications and articles online as a number to be reduced, it has not budged very much.
To provide the correct national average numbers, I am citing a research study conducted by the Midwives Alliance of North America. The factsheet distributed by them states the national averages for each of the interventions available, which are as follows: cesarean: 31%; forceps or vacuum: 3.5%; episiotomy: 25%; oxytocin: induction – 24%, augmentation – 16%; epidurals: 67%. This factsheet compares the rates of these interventions with the rates from midwives conducting homebirths. Needless to say, the homebirth intervention rates are much smaller (for example a 5% cesarean section rate compared to the national average). Interesting conclusions are drawn from the studies conducted on this factsheet, and it is very important reading for those considering a home or birthing center birth. This study was conducted using data from 2004 – 2009 by the Midwives Alliance of North America, and it also cited five other studies which can be found in the footnotes on the page cited here: mana.org/pdfs/DOR-Outcomes-Paper-Fact-Sheet-on-Risk.pdf
The initial part of her book shares birth stories from women who she or her partners have worked with. These birth stories have been an encouragement to many women, as she has received letters over the years from women who read them either before they gave birth or when they were having more children.
One of the most important aspects of Ina May’s book is her propensity 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 pass through easily, and then the body begins stronger contractions to push the baby out. When interventions are not performed, in most cases this will occur naturally.
Unfortunately, in a hospital setting this natural physiological function is not respected. Women may be given epidurals to alleviate pain, and in the past they 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 the Amish and Mennonite village in Tennessee. As most people know, Amish people do not generally accept medical interventions. Recent studies of the Amish have shown that they do seek prenatal medical care for their first child, and accept only technologies for their birth that are consistent with their religious beliefs. The members of Ina May’s community will generally have a midwife for their birth at home, although they do not seem to be religiously oriented. In other words, the women at The Farm will generally give birth with a midwife unless a hospital birth is absolutely necessary.
Through her experience, it has been possible for Ina May’s practice to develop methods that work well for childbirth. The most important part of childbirth that Ina May stresses 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 were not a natural process, and it required the intervention of doctors, then humanity would have become extinct centuries ago.
Ina May mentions that many of the interventions performed by obstetricians are actually unnecessary and are due to a lack of patience on the part of the doctors. For example, Pitocin, or artificial oxytocin, is often administered in the beginning phases of labor. If patience was exercised, in many of those cases where this is given, the body’s natural process of labor would have automatically performed as necessary to expel the baby. Since in many hospitals there is a time limit to the process of labor, as well as to each phase (regardless of whether the mother is a first time or second time mother) this is why this chemical is administered. It is not unusual, the author points out, for a first time mother to have a one or two day labor. This time period for labor is widely known, however, it is often ignored. Ina May also points out some of the dangers of these medications, including the possibility of uterine rupture from the violence of the contractions. These ruptures do not only happen in the case of a prior cesarean, however, this danger is not normally mentioned to the laboring woman.
Another procedure that is widely used is forceps extraction. The author points out many of the dangers related to this practice as well. These dangers include damage to the baby (including fetal death), as well as the need for use of episiotomy. While vaginal tearing does not always happen, it does happen often, and this has led to the widespread use of episiotomy or cutting of the vaginal opening to prevent such a tear. However, many doctors do not mention that there can be long term consequences to having this procedure.
On the positive side, Ina May also goes into detail on prevention of some of these measures as well as natural ways to accelerate labor. For example, if a woman chooses a hospital birth, she can choose to not be hooked up to immobilizing monitors. She can choose to reject the fetal monitor that is attached to her stomach and insist on the use of a fetoscope every fifteen minutes. She can request not to have an IV, since she may refuse medications. She may insist on being able to get up and walk around (which an IV would not prevent since it can be on rollers), and reject all other attachment interventions such as catheters and epidurals. Since the force of gravity can definitely help with the progress of labor, this is one way to move labor along.
Mostly, though, she recommends that women find a birthing center with a midwife, or have a home birth if they truly want to prevent all interventions. For most birthing centers, and also for most people’s homes (unless they live in the middle of nowhere), a hospital is not very far away. If the labor goes very wrong, transport is usually fast enough to allow for an emergency C-section which saves the mother’s or infant’s life. The author is a supporter of the Mother Friendly Childbirth Initiative, which is a very worthwhile cause dedicated to helping women have more natural childbirths.
Since many of the medical interventions can have unexpected and long term consequences for a woman who has them, it is often best to try to avoid them. Even most doctors would agree that a lack of surgical interventions is preferred. C-section is a major surgery, with similar recovery time as from any other major surgery where the skin and muscles are cut. This means a long recovery time of rest, which is not always possible for women who have to return to work quickly.
Since most women do not live in rural Tennessee, Ina May’s guidance is geared toward those women who do not have access to a home birth midwife, and who may prefer to be in a hospital where they perceive an added layer of safety to their child’s birth. Most of her advice is geared toward these women, and will help them to have confidence in their own body’s ability to produce the child they long for. Thus, this book is highly recommended reading for every woman who is pregnant or who is planning to become pregnant. If you can read only one book during your pregnancy, I would recommend this book.