September read – Birth Matters: a midwife’s manifesta


Ina May really has a way of getting my midwife blood pumping. Birth Matters: a midwife’s manifesta is evidence supporting the natural, history educating the present, and proof rationalizing the logical. For those entrenched in the work, it is wood to the fire. For those pregnant and researching their care, it is eye-opening. For those with past birth experiences both positive and negative, the ring of fire burns anew with a flame of knowledge and power. It is a battle-cry, it is a megaphone to long-term advocates and new audiences, it is a the one-sentence answer to questions about “Why midwives?” or “Why natural birth?” Because birth, and women, matter.

Birth Matters: a midwife’s manifesta simply describes issues across women’s healthcare and birth that can be downtrodden in complexity. Thankfully, in clear language Ina May reminds that really, it is simple. The past has taught us that innovations often do not mean improvements in something related to a natural process such as birth. We add, we change, we invent, we think that knowing more is somehow knowing better, and somehow with each step forward take a step away from that which makes birth beautiful or normal or end naturally. Providers and women cave to peer pressure and media campaigns, drugs that work for a presumed purpose in the short-term hit the ground running without long-term evidence, and polarized arguments keep people far enough apart that the middle ground is a grey space that disappears.

Birth is powerful, beautiful, a natural high, a life-long experience of telling and retelling, and shared among many women internationally. It is also wrought with research, evidence, politics, power struggles, cost, legal involvement, and provider burn-out. No woman should feel those external forces at work during her prenatal visits or labor experience. Without inducing the need for empathy, Ina May describes the ways in which providers, namely midwives, carry a heavy load in the fight to keep women’s human rights to safe maternity care in the forefront. I learn this more every day through my own first year of practice and from conversations with other midwives in my same setting. Each day, each visit, each birth, each chart could potentially be under scrutiny by those who do not support midwives, who challenge our approaches, who are waiting for one slip to allow an opportunity to speak against us. Women may become involved in this struggle through their own experiences or upon the targeting of their provider or friend. Ina May’s entire book series, from Spiritual Midwifery through Guide to Childbirth, connects women immediately not only with the beauty of their experiences but also with the paralleled struggle of those who provide their care. Her books, and Birth Matters most of all, create a circle of advocacy work, slogans, understanding, and emotional involvement to the issue that the reader cannot complete the last page without standing up and finding a way to be involved.

True to style, the book is thick with stories: stories of birth, stories told by the people who lived them, stories of natural processes causing calm or surprise. But true to an importance of people connecting to stories, this way of writing truth allows the reader to become intimately involved, to relate to the details, to remember the emotional response. Stories allow those with singular experiences to know of other options. “Women who have had very painful experiences during labor and birth often don’t think that they could possibly have experienced less pain if they had done something differently or if they had been treated differently, even when this is true. Unless they have a chance to witness another way of giving birth, they usually remain stuck in the idea that what they experienced was somehow inevitable.” (p. 25)

Ina May also recounts the separation of the idea of vaginal birth as separate from the same pathway of vaginal sex. As obstetricians, initially men, came into the birth scene, there was reassurance needed by baby-daddy’s that nothing sexual was going on when the Doctor assessed the woman in labor. “Orgasm, of course, is an experience that we almost exclusively associate with making love – so much so that some women become offended and upset even thinking about the possibility of having such an experience while giving birth. I think this model of birth has successfully wiped from most people’s minds the obvious fact that women give birth with their sexual organ. Further confusion results because women in our culture are not taught that their vaginal tissues have the ability to swell in a way that is every bit as impressive (and surprising, viewed for the first time!) as the change in the flaccid penis when it becomes erect… Vaginas do fancy tricks too.” (p. 35)

She reviews some of the books in her queue of feminist history, detailing their importance of knowing where women have come, and the unfortunate repetition that persists for those who do not name, rename, and speak out loud the past errors of women’s health ways. Just when I think I am well-read on feminism, I hit another important point in history, and Ina May leads  through the bulk of feminist thought quickly and understandably. This history is tangled with separation between “‘difference’ feminists, such as the authors of Our Bodies, Ourselves - the classic groundbreaking book on women’s health that burst upon the scene in 1970 – placed the female body at the center of their identity, while ‘equality’ feminists, such as Simone de Beauvoir and Shulamith Firestone, promoted the idea that women could transcend the biological barrier to women’s progress only by deemphasizing the female body.” (p. 145) In this case, relating feminist history to the use of drugs, surgery, and media to tell women that their bodies need something extra or different to function, to perform, or to appear normal. DES, thalidomide, breast implants: all use under the auspices of “for women,” and yet, against them through the structure of society, of advancing medicine, of making money. Women’s bodies are used and abused throughout history, and today’s practices being no exception. The academic argument of feminism is important, but the central theme remains the same: women, and their bodies, matter.

She also names doctors who have or continue to fight the good fight, even at the risk of their licenses. Importantly, midwives and their practice remain under constant scrutiny: more evidence is needed about normalcy, about midwifery care, about cost. “Without the facts, women, midwives, and home birth will continue to be made the scapegoats for whatever is wrong with maternity care in the US, and we will not solve our problems.” (p. 163)

The book is summarized with her “Vision for the Future.” She lists that we need more midwives than doctors (especially in rural areas), we need to enlist midwives to teach medical students normal birth, and we need researchers and providers to conduct the accurate reporting of maternal mortality that is expected of other countries internationally. The United States is by no means the safest place in the world to give birth, which is shocking to many people. I have seen equally difficult and unsafe maternity care in the United States that I have seen internationally in developing nations: nations without any healthcare infrastructure, without backup, without essential medicines. Maternal morbidity and mortality in the US must be accurately reported, understood, named, and decreased.

“Since we find ourselves with a rising maternal death rate despite our spending more per capita on maternity care than any other nation in the world, it is clear that we are doing something wrong. Most likely, we are doing a lot of things wrong. How do we identify and prioritize these things?” (p. 163)

“I am convinced that it will be possible for women to agree on at least some of the changes that I have outlined in this book. I suggest that the goal of setting up a confidential system for accurate reporting and assessment of maternal deaths is one that all women, regardless of their politics, can agree upon. That is one important reason why I would like to see it rise to the top of a list of priorities for us to achieve. Most US women today have become used to feeling judged by each other – used to hearing endless polarizing arguments between mothers and women who have no children; those who stay in their homes with their children on a full-time basis and those who work outside the home; those who give birth with or without pain medication; those who favor home birth or hospital birth; those who breast-feed and those who bottle-feed; those who favor abortion rights and those who don’t; and the list goes on and on. What a delicious thing it would be to take this issue that we all could agree on and make the solution happen. What a life-affirming and lifesaving campaign this would be.” (p. 206)

I had music playing in the background as I finished the last pages, and read through the appendices. I came across the statistics of births at The Farm, statistics that include the time during Ina May and Pamela’s training. It was almost like in a movie, where the music swells at the really emotional part. There were many parts during this book where I cried, partly because I’m one of those midwives who cries, but partly because I believe women’s healthcare matters. Those statistics are proof: proof that home birth is possible, breech birth is possible, twin vaginal birth with midwives is possible, VBAC is possible, minimal tearing is possible, brow and face presentations are possible, and with positive outcomes. Those two pages of statistics should be published everywhere, posted on trees in communities, put on billboards on major highways, listed on the evening news. Proof that birth is natural, normal, possible.

A manifesta is a public declaration, a mantra, a life stance. To say that birth matters is to say that women matter, that care for women especially during pregnancy and birth is an example of how we care for women overall.

Seven Stories Press has graciously provided one copy of Birth Matters: a midwife’s manifesta to give away to Feminist Midwife readers. A bit more about them: “Seven Stores Press is an independent book publisher based in New York City, with a distribution throughout the world. We publish works of the imagination… together with political titles by voices of conscience. Seven Stories Press believes publishers have a special responsibility to defend free speech and human rights, and to celebrate gifts of the human imagination, wherever we can. For additional information, visit”

Leave a comment below about why you believe that birth matters or why women matter, and enter into the drawing for a free copy of Ina May Gaskin’s Birth Matters: A Midwife’s Manifesta. Or, answer the question posed by Ani DiFranco in the forward: “What if society acknowledged all the ways in which Birth Matters?” Spread the word that not only is there a giveaway for this great book, but that there is a list of wicked cool people talking about why these issues are important, on this blog and others. Let these comments be a part of your personal manifesta in your work, let them be in support of Ina May and all midwives who have this vision for the future, let them be heard.

Logistics: Tuesday night at 7:00pm CT the winner will be selected by a random number generator, also known as my partner being told the number from 1 to ? and picking at random. I will inform the commenter of their winning here and individually.

Congratulations to Susan! Thank you for reading and commenting!