[REVIEW] Birth Story: Ina May Gaskin & the Farm Midwives (Documentary)

I was surprised to see this documentary on the shelf at the library. I thought the only way to see it was through a live screening. I've seen it twice before but I giddily checked it out from the library and watched it again at home. This time, I viewed it with my 7-year-old daughter.

Ina May Gaskin has been called "the most famous midwife in the world." This film details how she got her start in midwifery and how The Farm Midwifery Center has developed and changed over the years.

Her husband, Stephen Gaskin was the founder of The Farm after he traveled the country on a speaking tour with a caravan of followers in the early 1970s. The Farm became the largest intentional community (commune) in the U.S. reaching a membership of 1000 at its peak.

"We had a dream to be in community, to help each other out, to raise our children in a different way and to take care of the planet." - Farm resident

With a large amount of young families, navigating birth quickly became a priority. Ina May assumed this role by chance but it became evident that this was her life's purpose and she has now been in midwifery for over 40 years.

"I've learned from books. I've learned from doctors. I've learned from midwives. A lot of stuff I've learned from women and allowing myself to be instructed by women." - Ina May Gaskin

The women of the original community would often get together to share their birth stories and eventually they turned them into written pieces.

"If a woman is afraid, she will not be relaxed. We were creating our own culture about birth and fear was not going to be a part of that." - Ina May Gaskin

A compilation of these stories was put together into a book entitled Spiritual Midwifery published in 1975. This book has now been distributed all over the world and is even used as a textbook in some countries.

"Midwives predate doctors but this profession is in danger of being wiped out by the ever increasing Cesarean rate... If nobody has labor there will be no need of a midwife and a lot of knowledge will be lost." - Ina May Gaskin

Currently, women are coming from all over the world to have their babies at The Farm, even as far as Africa.  Families typically come a couple weeks before their baby is due and stay up to a week afterwards.

Ina May has been working on a project for many years, The Safe Motherhood Quilt, which brings awareness to the increasing maternal death rate in the United States. America ranks 50th in maternal death despite the face that we spend more per capita than any other country. Ms. Gaskin maintains that this problem is fixable.

"We need more people to see real birth." - Ina May Gaskin

The Farm has delivered all types of babies in a variety of scenarios. They still train their midwives for breech deliveries which is currently not being taught in obstetrics. Ina May also has a technique named after her, The Gaskin Maneuver, that works well in a shoulder dystocia situation. The Farm Midwives have a large Amish population that they work with and continue to deliver those babies by candlelight with no running water. They do not induce women and have a very low Cesarean rate.

"We still follow the same principals that we always did. You always do the least invasive thing first." -Ina May Gaskin

Overall, I felt this was a beautiful film that really captured the spirit of The Farm. They interviewed many of the retired midwives as well as the new generation of midwives who are filling the gap. Ina May is often seen at home with her husband Stephen and it's interesting to see how their love and respect for each other has grown over the years.

My daughter was hesitant about seeing the birth scenes at the start of the movie. She even said she didn't want to have babies. By the end of the film, she declared that she, in fact, did want to have babies. Not only that, but she wants to have them at home in the tub with a doula and a midwife. As an aside, she also said she didn't want to go to the hospital because "they are too fancy and might mess something up." I love that she is being shown from an early age that there is nothing to fear about birth and it's an everyday, normal occurrence where fancy hospitals aren't required.

If you want to see Birth Story, a digital download is available online or you can purchase the DVD. Or you may check your local library to see if they have it available, as mine did! ;) Be sure to check out the extras. They were full of great information too.

REVIEW: The Business of Being Born

I recently watched The Business of Being Born for the second time. The first time I saw it was almost 5 years ago. It was interesting to note the difference in my reaction this time around. I still maintain that every expectant family should see this film! Personally, I'm excited to watch their new film, MORE Business of Being Born.

THEN

• I saw the film at a pre-screening about a year after the traumatic birth of my daughter.
• I didn't recognize a single person in the film aside from Ricki Lake.
• The C-section in the film bothered me. In a way, I almost felt it made the film a failure. I wanted the film to show how wonderful homebirth can be resulting in low, low rates of transfer.

NOW

• I'm now a certified doula and have processed and healed from my birth experience.
• I immediately recognized probably 75% of the experts they interviewed and knew them by name without having to read the subtitle.
• I'm glad the C-section was included because it shows how well a midwife and backup doctor can work together to get the care that mom needs when an emergency arises. However, I don't think they did a great job of explaining why she needed to transfer. I know enough now that I was able to figure it out and then confirmed my theory by watching the interviews in the bonus features. Here's the explanation. Not everyone is a candidate for homebirth. Abby was a candidate until she went into early labor with a breech baby. The combination risked her out of homebirth. At the hospital, we learn that the baby had intrauterine growth restriction (IUGR). This explains why mom was measuring so small earlier in the film. IUGR babies have big heads and small bodies. This is not a good combination with a breech baby as the body can emerge but the head get stuck. Therefore, a Cesarean was warranted. So, I'm totally okay that they included this in the film because it wasn't an unncecessarean. I just wish that it would have been explained better.

Moving on, here are some of my favorite quotes from the movie and points raised by the theme of the film. I missed a few of the speakers/titles but tagged the ones I knew. Still, you just need to watch it. It's SO good! The preview/trailer is at the bottom of this post.

U.S. MATERNITY CARE

• Maternity care in the United States is in crisis. - Dr. Marsden Wagner
• What the medical profession has done over the last 40-50 years is convince the vast majority of women that they don't know how to birth. - Nadine Goodman, Public Health Specialist
• Are we benefitting mothers and babies or not? - Ricki Lake
• The U.S. has the 2nd worst newborn death rate in the developed world. The U.S. has one of the highest maternal mortality rates among all industrialized countries.
• When you look at our data and the amount of money we spend versus the outcomes we get, it sucks! There are countries who spend a third of what we have and have a lower infant mortality so more doesn't mean more in this case and maybe less is more. - Dr. Jaquez Moritz, OB/GYN Saint Luke's Roosevelt Hospital
• People in our culture spend more time and effort researching to buy a stereo system, a car, probably a camera than they do checking out what their choices are for birth.
• What we have to rediscover is that birth can be easy when we don't try to make things too complicated.

MIDWIVES

• Midwives attend over 70% of births in Europe and Japan and less than 8% in the United States.
• Trained homebirth midwives are incredibly skilled at what they do. The fact of the matter is that they bring pitocin, oxygen, equipment for suturing, and recessitation of the baby.
• For a normal, low-risk woman it's overkill going to a doctor, it's just too much. The doctor is not really excited about things when they are normal. - Dr. Jaquez Moritz, OB/GYN Saint Luke's Roosevelt Hospital

HOMEBIRTH

• In 1900, 95% of births in the U.S. took place at home. In 1938 it was 50%. By 1955, it was less than 1%.
• In a supported environment the outcomes of homebirths are very, very good and consistently at least as good and generally better than a hospital birth. - Eugene Declerq, Ph.D. Professor of Maternal & Fetal Health Boston University
• We spend twice as much in this country, per birth, than any other country in the world. This is one of those very rare instances where cheaper is truly better. - Dr. Marsden Wagner

C-SECTIONS

• There is clearly an association of induction and cesarean delivery. - Dr. Michael Silverstein OB/GYN
• The cesarean rate climbed from 4% to 23% after the introduction of the electronic fetal monitor. - Robbie Davis-Floyd, medical anthropologist
• There was a study that came out many years ago, which showed that if you looked over a 24 hour period the peaks in C-sections were 4 in the afternoon and 10:00 at night. - Dr. Michael Brodman Chairman of Dept of OB/GYn at Mount Sinai Hospital
• The literature is very clear that having a vaginal birth statistically is the way to go. Dr. Michael Brodman Chairman of Dept of OB/GYn at Mount Sinai Hospital

EMOTIONS

• A woman, as long as she lives, will remember how she was made to feel at her birth - Anna, doula.
• Many people have described birth as a right of passage and it is certainly a life-altering experience and it can be a beautiful, incredible, empowering life-altering experience or it can be a devastating, traumatic, scarring, literally and figuratively, experience.
• What are the basic needs of women in labor?
• We knew that feelings affected birth. - Ina May Gaskin, Founder of The Farm Midwifery Program

HORMONES

• You get the highest oxytocin rush that you will ever get in your life when you give birth naturally. - Robbie Davis-Floyd, medical anthropologist
• In monkeys, if they give birth by C-section they are not interested and will not take care of their babies because the love-hormone cocktail is not released. So you wonder, but what about our civilization, what about the future of humanity. If most women have babies without releasing this cocktail of hormones, can we survive without love?

For more information, visit www.thebusinessofbeingborn.com.

REVIEW: Pregnant In America (Documentary)

• Overview

I was recently able to watch Pregnant In America and I cannot say enough positive things about this documentary. I honestly wish every expectant mother and father in the U.S. could watch it. It exposes some very interesting pieces to the American maternity care puzzle.

I love that this film was directed, filmed, and produced by a father-to-be simply seeking out the truth. On his wedding day, he vowed to protect his wife. When she became pregnant, they began a journey to know their options for childbirth. The result is a very powerful disclosure of what is going wrong with the maternity system in the U.S. Below you will find direct quotes from the movie, which pretty much sum up everything I wish the general public knew.

I think the worst thing we are doing to women is not telling them the truth. -Barbara Harper, RN

There are 4 million births each year in the U.S and 98% of them occur in hospitals. Yet, our country is 28th on the list of infant mortality rate.

We aren't saving any more babies with all this technology.

We have, for 50 years, been brainwashing American women about childbirth, about how dangerous it is, how all the terrible things that can go wrong, and how you need to be in the hospital where all the doctors are, where all the machines are, and all the operating tables so that we can take care of those horrendous emergencies when they occur. It is absoletely not true. - Dr. Marsden Wagoner

• Induction

In my opinion, induction is the #1 barrier to a healthy, happy delivery for mom and baby. An induction commonly leads to one intervention after another. In fact, 50% of inductions end in a C-section. The main reason for induction is convenience, for parents, for doctors, for hospitals, which I think is absolutely absurd.

The pharmacological induction of labor is one of the most serious, drastic and dangerous interventions that you can make. - Dr. Marsden Wagoner

The main drug to facilitate an induction is Pitocin, which is basically man-made oxytocin, the chemical your body releases to start and maintain contractions. The problem with Pitocin is that it can make labor more painful by causing overly strong contractions. This also may be detrimental to the baby.

We don't know the long-term effects of Pitocin. - Barbara Harper, RN

Another popular drug used for induction is Cytotec, which is not indicated for this purpose. In fact, the literature clearly states that this drug should NOT be used on pregnant womenbecause of a huge potential for uterine rupture leading to maternal and fetal death. Yet, hospitals across the country continue to use it regularly.

This drug is not approved by the FDA for this purpose.

This is a humongous obstetric emergency.

The hospital pays a lot of money [lawsuit] but the women pay the price.

- Dr. Marsden Wagoner

• Epidural

For some reason, in America, we think we are entitled to avoid experiencing pain in childbirth. Yet, this is just another intervention that can cause long-term side effects. Still, 80% of women in labor receive an epidural. Did you know that there are 58 (yes, FIFTY EIGHT) risks to having an epidural? Because the medication crosses the placental barrier, there are even studies which are linking epidurals to behavior problems, obesity, suicide, drug addiction, cardiovascular disease, and cancer. The effect is seeded as an infant only to manifest itself as an adult.

Mother and baby are both designed to work together in labor and, when drugs are used, they are both drug impaired so they are not working together.

• Interventions

In the United States, childbirth is not seen as a normal event at all and women are not allowed to let it take its natural course. Pregnancy is closely monitored and labor & delivery are scrutinized and micromanaged. In turn, the interventions make more of a mess than what they aim to fix not that the process needs to be "fixed" to begin with.

In countries where they do not use [interventions] just as a normal management of labor technique or protocol, they have much better statistics, much better outcomes, and we can learn from that. - Kerry Tuschhoff

Doctors use the intervention and then have to save the baby because they have used the intervention. - Barbara Harper, RN

• Cesarean Section

In 1975 the C-section rate in the United States was 7%. It is now well above 30% and continuing to rise. The World Health Organization recommends a maximum rate of 15%.

FYI: All OB/GYNs receive surgical training.

It's kind of a no brainer to say how come the U.S. has a high Cesarean section rate. Well, it has a high surgical rate because the people you ask to take care of it are surgeons. - Barbara Katz Rothman, PhD

To a surgeon, every problem looks like a surgical problem.

There are more than 42 risks of Cesarean section. Most of these risks are not discussed with patients. One doctor in the film goes as far as to say this nondisclosure is ethically inappropriate. I would whole-heartedly agree.

It's MAJOR abdominal surgery. - Dr. Marsden Wagoner {emphasis mine because I know first hand}

From the mother's point of view, if she didn't want the Cesarean, she has just been robbed of the chance to have the kind of empowering birth that she wanted. She may have been robbed of her change to bond with the baby and she may have been robbed of the chance to successfully breastfeed. - Robbie Davis Floyd, PhD

• Vaginal Birth after Cesarean (VBAC)

This is where things get even more complicated. Most Cesareans are unnecessary to begin with and it is becoming increasingly more difficult be given a chance for a VBAC. Many hospitals forbid VBACs and some insurance policies refuse to pay for them. In some states it is even illegal.

There are women right now in this state [Washington] that are getting cut open because everybody around them is telling them that is their only option. - Betsy Chasse.

The above quote is from a mother whose insurance company refused to pay for her VBAC so she chose to cross the border and deliver her baby in Canada instead.

We are victims of our insurance.

Less patients are taking an active role in what they want. Some are even requesting surgery when it doesn't need to be done. - Dr. Sancetta (Miami, FL)

• Homebirth

The filmmakers traveled to other countries to examine how maternity care and childbirth are handled in those areas. I was most intrigued by Holland, where 87% of women deliver at home. In fact, if a low-risk woman shows up to a hospital to deliver her baby, then send her right back home. In Holland, home births are covered by insurance and are drastically less expensive. Plus, contrary to popular belief, there is less bacteria at home compared to the hospital.

Women continue to be disappointed in hospital births.

• Midwives

Here are some statistics on a very well-known Tennessee midwife, Ina May Gaskin. She has a mere 1.5% C-section rate in over 2000 deliveries where 95% of women delivered outside of a hospital. Impressive!

It is interesting to note that women using midwives in other countries may receive daily visits for up to three weeks post partum.

We don't say patients, we say clients, because they are not ill. - Dr. Tom Kreuning (Holland midwife)

• Conclusion

There were many more topics covered in this movie and several topics not covered that I think are important. The film also includes the story of Steve & Mandy and you follow them throughout the pregnancy and through delivery. However, this movie is great for getting your brain thinking about the current state of affairs regarding childbirth in the U.S. The bottom line is that we need to take control of our own births, do the research, and determine what options are appropriate for us.

Doctors in America do not want any significant change in the present system. They have all the power, they have all the control, and they are making the big bucks. - Dr. Marsden Wagoner

It's so sad what women are missing and they don't even know that they are missing it.

We skip the sense of empowerment.

There are really only two ways to improve obstetrics; 0ne is litigation and the other one iseducation. - Dr. Marsden Wagoner

The goal of Steve Buonaugurio (director) was to inspire families to reclaim control of their birth experience. I want to encourage you to do the same.

If you would like to watch Pregnant In America, you can view it online or rent it from Netflix. It is also available for purchase.

Have you seen the movie. What are your thoughts?