Birth Matters: Ina May Gaskin's recommendations to improve maternity care
We’ve been reading legendary midwife Ina May Gaskin’s fascinating new book Birth Matters: A Midwife’s Manifesta.
Unlike her other recent books, Ina May’s Guide to Childbirth and Ina May’s Guide to Breastfeeding, this latest book isn’t a practical guide for moms but a policy statement which spells out her recommendations for changing our maternity care system. It also includes a history of obstetrics/midwifery care, explores sexuality and birth, and discusses feminism and birth, among other topics. And as with her previous books it’s spiced with captivating birth stories from her many years of practice.
But the heart of the book is a call for women to come together to fix the ways in which our maternity care system is broken. Gaskin details these problems with U.S. maternity care:
A rising maternal mortality rate (near tripling in California between 1996 and 2006), which doubles the risk of mortality for mothers birthing today compared to their mothers. This increase is occurring despite despite the fact that the U.S. spends more on maternity care per capita than any mother country in the world.
A flawed mortality reporting system which, according to the CDC, could mask a rate up to three times what is currently reported. This lack of reliable data leaves the system poorly equipped to make changes necessary to lower the rate.
High rates of unnecessary induction and other interventions in labor and birth, leaving mothers unable to labor and birth normally, and leading to poor outcomes.
The highest recorded cesarean rates, which far exceed recommended levels for safety of mothers and infants.
Here are her recommendations for reform, presented in detail in Birth Matters:
Establish woman-centered maternity care (including midwifery care) as a human right.
Revise medical education to train doctors in the support of normal birth before they study related pathologies.
Establish maternity care standards to ensure evidence-based practice for all women.
Salary physicians instead of paying them based on the number of births they take on.
Make birth centers available to mothers in all parts of the U.S..
Ensure that every maternal death is accurately reported and reviewed.
Give consideration to the young mothers who give birth without knowing they were pregnant.
Recognize postpartum home as a necessity, to avoid preventable outcomes ranging from mortality to postpartum depression.
What do you think of Ina May Gaskin’s recommendations? What would you add or subtract? How have the problems she outlines affected you?