“Spiritual Midwifery” (2003), by Ina May Gaskin

In 1976, midwife Ina May Gaskin published Spiritual Midwifery, with other editions published in 1980, 1990, and 2003. Spiritual Midwifery is a book about pregnancy, birth, and postpartum, or the time period after birth. During the 1970s, it was common for women to receive an epidural, a medication that reduces pain during labor, and for physicians to monitor a fetus’s heartbeat while separating women from their infants after birth. However, according to Gaskin, some women wanted to give birth outside of the hospital without medical interventions. Spiritual Midwifery is a collection of birth stories from women, information about pregnancy and giving birth, and instructions to midwives on how to care for women during childbirth and the period that followed. In Spiritual Midwifery, Gaskin introduced homebirth and midwifery to a broader audience, which helped repopularize midwifery in the US.

Gaskin is a Certified Professional Midwife, or CPM, whose midwifery practice and books advocate for the involvement of midwives during childbirth. A midwife is a trained professional who helps women deliver infants during labor and after the birth of the infant. Labor is the process of the woman physically pushing the fetus out of her uterus. Jan Tritten, the founder and editor of the magazine Midwifery Today, called Gaskin the mother of authentic midwifery due to Gaskin’s belief that the experience of giving birth is spiritual. In 1971, Gaskin founded the Farm Midwifery Center in Summertown, Tennessee, where she practiced midwifery care for local women. There she and other women, who trained with Gaskin, used low intervention methods without the use of medication or surgery to assist women in giving birth. In 1976, Gaskin introduced the all-fours maneuver, a technique later called the Gaskin Maneuver, to the US. That Gaskin Maneuver was a technique Gaskin learned in Guatemala to resolve shoulder dystocia, which occurs when a fetus’s head is stuck behind the women’s pelvic region.

According to Gaskin, the purpose of writing Spiritual Midwifery was to provide a book about birth for women by women, especially in industrialized societies. Gaskin’s book, Spiritual Midwifery, consists of twenty-four chapters split among four general sections. Gaskin begins the book with the titled “Amazing Birth Tales,” which includes a collection of stories of several women's experiences giving birth. Gaskin includes stories such as the breech births, twin births, and hospital births. In the second section, “To the Parents”, Gaskin writes about the experiences that women have during pregnancy, childbirth, and postpartum. She also discusses the partner’s responsibilities in each of those processes. She finishes that section with advice on taking care of infants. Gaskin then begins the third section, “Instructions to Midwives,” by describing what midwives should do during those times. Later in that section, she describes the anatomy of the pregnant woman and other topics about birth and infant care. In the fourth section, “Appendices”, Gaskin provides further resources, readings, and advice to physicians and midwives on how to care for women before, during, and after delivery. She provides tables, charts, how to keep records, important skills to learn, and which equipment is most useful during delivery. Finally, Gaskin provides statistics on the total live births managed by the Farm midwives, as well as the number of mortalities in fetuses, infants, and mothers for the Farm Midwifery Center from 1970 to 1994.

In the first section, “Amazing Birth Tales,” Gaskin includes several birth stories written by women who gave birth while on their journey to the Farm or during their stay the on Farm. She begins with a story written by Carolyn, who had birthed her second infant while traveling to Summertown. Gaskin shares that she chose to include Carolyn's story because she had learned a lot from it, as she was not a midwife at the time. She later states that the birth taught her how to support a woman in labor, and that only the pregnant woman’s family and other women should be at the birth so as not to not put stress on the woman and in turn lengthen her time in labor. The next story Gaskin includes was the first time she took a woman to the hospital to give birth, which was due to the fetus being breech, or a part of the fetus being birthed first before the head, and she had no experience with that complication, which could be dangerous if not assisted properly. She then states that the main lesson from that birth was learning how to collaborate with the obstetricians at the hospital to allow the pregnant woman to give birth as she would at the Farm, with the added assistance of the obstetrician. Gaskin also states that the birth amazed the obstetrician because of the way that Carolyn, the pregnant woman, was able to stay calm through the birth without medication.

Gaskin also includes stories of when pregnant women miscarried, which is an event when a fetus dies before the estimated due date of labor. Additionally, she includes stories of premature births, which occur when an infant is born three or more weeks before the estimated due date of labor. Gaskin also includes birth stories that detail various complications such as when the umbilical cord is wrapped around an infant’s neck, breech births, and multiple births occurred. Next to each story, Gaskin includes a photograph of the infant, and at times also includes a photograph of the parents.

In the second section, “To the Parents,” Gaskin provides pregnant women and their partners with information on how to have a healthy pregnancy and labor, as well as how to care for an infant. She begins by describing how pregnant women should take care of themselves, which includes maintaining proper nutrition and prenatal care. Gaskin also gives advice on how a woman’s body may change through pregnancy and how to deal with physical discomforts such as morning sickness. Gaskin describes how to prepare to give birth, outlines what happens during labor, and advises who should be present when the woman gives birth. She then discusses the bonding between a mother and her infant immediately after birth. Gaskin states that for bonding to occur, it is crucial for healthcare providers to deliver proper maternal care, since that is the time when emotional and chemical bonds form. Gaskin then advises women on how to care for themselves after giving birth, including exercises and information about what physical symptoms, such as postpartum bleeding, are normal. Postpartum bleeding is an event that resembles a heavy menstrual period and occurs after birth as the uterus contracts back into its proper shape. Next, Gaskin describes how to care for an infant, including how to care for the umbilical cord stub, how to bathe an infant, and how to help the infant get enough sleep. She also gives advice on breastfeeding, including when to start, how often an infant should eat, how to burp an infant, and different styles of breastfeeding.

Gaskin then describes various problems that an infant may have and how to resolve them, as well as what to do if the infant dies. She includes problems such as diaper rash, fever, colds, and infections to the skin, such as scaly scalp and thrush. She briefly gives more information about breastfeeding, specifically discussing potential problems such as inverted nipples, which is when the woman’s nipples face inward toward the body rather than out, and how to make more milk if the woman’s supply is low. Gaskin concludes the section with what to do if the infant dies. She states in that conclusion that the best way to heal from the death of a child is to let yourself feel the loss and grieve, as well as staying close to those you love.

In the third section, “Instructions to Midwives,” Gaskin describes what it means to be a midwife and includes anatomical drawings to teach midwives about the anatomy of a fetus and pregnant woman so they can provide the best care. She states that the job of a midwife is to put the health of the woman and the fetus, and later, the infant, above all else. She also says that a spiritual midwife treats all women and infants the same regardless of their size, shape, color, or heritage. Then, Gaskin provides drawings of a pregnant woman’s anatomy, along with descriptions of each body part’s structure and function. Next, she describes, in both images and words, the anatomies of a fetus and its placenta. A placenta is an organ in the woman’s uterus that provides oxygen, glucose, and essential nutrients to the fetus during pregnancy.

Gaskin then discusses how midwives should care for women before birth, including the equipment midwives need and how to give a pregnant woman her first checkup. She includes taking a woman’s medical history and giving a pelvic exam as important parts of a checkup. Pelvic exams are the physical and visual inspection of a woman’s reproductive organs, which can be used to check for pregnancy or disease. Gaskin then describes routine procedures that healthcare providers would do at the following checkups, such as checking the woman’s blood pressure, weight, measuring the woman’s belly, and checking for the position of the fetus. She then explains how to prepare the woman for labor.

Gaskin discusses how a midwife manages a normal labor and instructs readers on how to deal with complications that may arise. She begins by describing signs that indicate when a woman is ready to go into labor and when her labor actually begins. Gaskin states that there are several stages of labor. She goes on to explain the different stages of labor and what they each entail, as well as how to manage each stage. Gaskin states that the first stage of labor is the time from the first contractions of true labor to when the cervix is fully dilated, or open, to ten centimeters. The cervix is a tube of tissue that connects the uterus to the vagina. The cervix needs to expand, or open, for the fetus to travel from the uterus to the vagina, where it can be birthed. Then she describes the second stage of labor, the time from the full dilation of the cervix to the time the infant is born. Finally, she states that the third stage is the delivery of the placenta, or afterbirth. In the third stage, the placenta that fed the fetus during pregnancy is no longer useful to the woman and so it too is birthed.

In the next part of “Instructions to Midwives,” Gaskin describes the care for both a woman and her infant after birth. Gaskin describes various birthing situations such as breech births, multiple births, and complications such as face presentation, when the baby is born face first. She states that a midwife should check the infant’s breathing, pulse, and temperature after birth to ensure the infant does not need medical care. She then describes the care the infant and woman should receive one day following the birth, as well as the following week. Gaskin explains how to manage any injuries to the woman or infant, as well as any complications or unusual situations during birth. Gaskin mentions possible complications after birth, such as the woman having injuries to her reproductive organs or the infant not breathing immediately after birth. Finally, Gaskin describes abnormalities and diseases that may be present in either the woman or fetus.

In the fourth section, “Appendices,” Gaskin suggests books for further reading for pregnant women and healthcare providers. She also lists equipment and supplies she uses in her midwifery practice such as surgical scissors, tweezers, exam gloves, and a speculum. A speculum is a medical instrument that, when inserted into the vagina, widens the opening of the vagina to enable the practitioner to see the woman’s internal anatomy. Gaskin also describes skills needed for practitioners such as how to take blood pressure and give injections. Gaskin then gives examples of how to keep records including prenatal information, birthing records, and infant physicals. She also provides tables used to estimate the due date of the fetus, conversion tables from pounds to grams and Celsius to Fahrenheit, as well as a chart for clinical estimation of gestational age. Gaskin provides those charts to assist in keeping records. Lastly, Gaskin gives statistics from 1970 to 1994 for midwives at the Farm in Summertown. Those statistics include the total number of births managed by the Farm midwives, which was listed as 1,917 births. Of the 1,917 births, Gaskin writes that 1,842 were home births, meaning that the women did not give birth in a hospital. She also lists other categories such as the number of breech births, twin births, and vaginal births in which she used medical tools such as forceps or vacuum extraction, and the number of pregnancies that had various complications. Gaskin also states between 1970 and 1994, the maternal mortality at the Farm was zero, and infant mortality was thirteen, with five fetuses dying from lethal abnormalities.

Gaskin’s book Spiritual Midwifery has four editions published as of 2021. The first edition released in 1976, the second in 1980, the third in 1990, and finally, the fourth in 2003. Each of the editions include birth stories from women whose births the Farm midwives managed. They include information for parents about prenatal care and infant care, information for midwives, and an appendix with further information. The newer editions include more birthing stories and an emphasis on any important concepts, as well as an updated forward section that describes what makes that edition special.

According to a press release on NBC News, Spiritual Midwifery is one of the most popular books to read when a woman gets pregnant, and it has also inspired a new generation of midwives. In 2012, The New York Times wrote that the book, which frames giving birth as a positive and possibly euphoric experience, had been translated into six languages and has sold over half a million copies. According to an article in The Guardian, the book has been popularized by actresses Isla Fisher and Demi Moore, who proclaimed themselves as fans. The book also captured the attention of actress Ricki Lake and filmmaker Abby Epstein, who featured Gaskin and her story in the homebirth documentary The Business of Being Born. The film looked at the different ways in which women give birth in the US, with the focus being on the contrast between hospital births and homebirths.

As of 2021, Spiritual Midwifery has also been cited over 400 times by social science studies that range from cross-cultural studies of childbirth practices in different countries to scientific studies looking at the relationship between massage and trauma to women’s bodies during labor. Roger Eardley-Pryoe, a historian at the Science History Institute, wrote an article about how Gaskin’s book introduced people to the idea that medical doctors were not the only ones who could deliver healthy babies, stating that the book inspired a revolution of birth practices, increasing the popularity of midwifery.

Gaskin’s book, Spiritual Midwifery, approaches the way that women give birth in a way that does not focus on controlling pain, but rather embracing the experience and finding pleasure in the process of childbirth. She states the importance of healthcare providers allowing women to be in charge of giving birth so that the woman and her fetus can form a stronger bond. The book, Spiritual Midwifery, introduces midwifery as a way to assist women during pregnancy. Its publication has led to an increase in the popularity of homebirths and has influenced the practice of midwifery to be recognized by social scientists, historians, actresses, and filmmakers alike.