Meeting Ina May is always a pleasure

It is always a great pleasure to see Ina May Gaskin. She is as funny and down to earth out of the limelight as she is on stage and in her books. We do not meet often but each encounter since we first met at Findhorn in 1993 has been heartening and nurturing in a similar way to encounters with dear indigenous midwife friends. A lot is said with non verbal communication and then there are little phrases that echo for a long time: “shy vaginas”, “what if men were ordered to have an erection” and lots more that go into midwives’ and doulas’ speaking and thinking.

When I first met Ina May, there were no trained doulas as yet in the UK. I had effectively been a doula or rather what I then called an “empirical midwife” (as non-registered midwives were then called all over the world), attending births with UK midwives at home when possible and in maternity hospitals in Cambridge, Hinchingbrooke, Harlow and London. Often it was an enjoyable partnership. Still fresh from my apprenticeship in Peru with an outstanding Amazonian shaman-midwife whose rates of success compared with Ina May’s Farm data collected a decade later, I gave presentations about Peruvian practices to meetings of Radical Midwives, an association that welcomed non-registered birth attendants. The “Changing Childbirth” report produced in 1993 by the Expert Maternity Group, chaired by Baroness Cumberlege, built on the recommendations of the 1992 Winterton Report and gave priority to ensuring women’s choice, control and continuity of carer, creating a wave of optimism.

The first version of the Cochrane review published by Hodnett et al in 1995 on the use of continuous support for women during childbirth galvanised all sectors of maternity care into action. Yet the 2012 updated report showed that the fight for continuity of care and support remains relevant. More than ever, there is a need to uphold the importance of continuity in antenatal preparation, birth attendance and the often neglected but key fourth trimester that is at the core of our Birthlight vision, supporting the primal continuum. This cannot happen easily within the NHS due to its own constraints, but, as we know, through developing more effective links between community-based support and maternity hospital care as recommended in the NICE Guidelines.  In 1992, the budding Birthlight group had hosted Michel Odent for an event called “Birth at a Turning Point” in the Cambridge Institute of Education. We then planned the first Birthlight conference on "Midwives and Mothers in the Community” (held at Homerton College in 1994) with a memorable talk by Lesley Page, our keynote speaker, on how she was inspired by the Canadian indigenous myths of Raven. Our "Birthlight Dialogues”, gathering birth professionals with opposite viewpoints in friendly conversation, were well attended and contributed to unity of purpose among local birth workers.

1993 was also the year when the still very readable book by Marshall and Phyllis Klaus with the late John Kennell, Mothering the Mother: How a Doula can Help You Have a Shorter, Easier and Healthier Birth, was published in paperback by Da Capo Press.*
It was indeed a very exciting year to be involved in the nurture of mothers and babies!
 
Sharon Ledbetter, who pioneered the doula movement in the USA (1992 Launch of the Doula Association of North America) also came to England in 1993.  We had meetings about starting a UK-based doula association. There was a lot of resistance from doctors and midwives who already found fathers’ presence in labour wards obtrusive. In quite a few hospitals only one person other than the mother was permitted. There were objections to the use of the term “doula”, meaning servant in Greek, but then, why not? we are serving women when supporting them for birth. As with all innovations, there was not just one current but several in this growing momentum, with different styles of birth attendance and emerging training programmes. I would like to highlight the key roles of Ingrid Lewis (Birthlight trustee and training tutor) in the foundation years of the UK movement after partaking in births among Congo forest people, and the inspirational modelling by Liliana Lamners, who now offers the Paramana Doulas’ training courses with Michel Odent. In conformity with early randomised controlled trials and birth attendance among rainforest people, Liliana has shown that, in many cases, a sheer friendly human presence can be a powerful positive force to help release the orchestrated hormones that facilitate a labour and birth. It is important to heed the messages of these early pioneers; that the effectiveness of labour support may be more in “non-doing” than in “doing”, even though it is of course important to have extensive knowledge and skills as a birth attendant.

Ina May has come over from The Farm to give the keynote speech at the fifth annual Doula UK conference due to take place at the Manchester Renaissance Hotel on Saturday 25 March 2017, and later this year she will speak at the MaMa Conference (28 & 29 April 2017 at the Princess Royal Suite, Ayr Racecourse, Ayr, Scotland). In just over a decade, Doula UK has created an effective recognised platform to support "Positive Birth" ( Milli Hill) and ensure that women and couples have gentle birth companions besides receiving best maternity care. It’s very heartening to see that a grassroots-led demand for birth attendance is prevailing and that, as Amali Lokugamage’s current work points out, there is increased receptivity among both midwives and doctors to developing the quality of communication and inter-relation in maternity care. The 17th March 2017 legal proceedings served on the Nursing & Midwifery Council in a claim brought by IMUK (Independent Midwives UK) members to ensure women can access the care and support they need at the most important time of their lives, together with the vindication of the Albany Midwifery services in London **, both support the style of midwifery care that Ina May has championed throughout her life.



At the 2006 international Birthlight conference “Visions of Infant Joy” in Cambridge, Ina May talked about the importance of emotions, images and symbols that women take with them into labour. As we punted on the River Cam to Grantchester for our social dinner, we went on talking about gestures, movements and how birth is an embodied process in which women’s emotional imaginary (my words not hers) plays a central part. Ina May likes the Sri Lanka country dances that helped Amali Lokugamage stay mobile during her pregnancy (see birthlight yoga dances for pregnancy). For years, we have been talking about showing the basic movements that help women give birth more easily - besides Ina May’s famous recommended “one hundred squats a day” during pregnancy. It may happen! Soon! Each meeting with her is a new inspiration and it was an added pleasure to meet her son Samuel on this visit.


Thanks to Sara Wickham (www.sarawickham.com) and to her husband Chris for accompanying us to walk among the amazing stones at Avebury last Sunday together with Amali and her family.

Françoise Freedman

* Based on the article published in 1991 by Kennell J. et al. "Continuous emotional support during labor in a US hospital. A randomized controlled trial.” JAMA 265(17):2197-201following two studies in Guatemala showing how the continuous presence of a supportive companion (doula) during labor and delivery shortened labor and reduced the need for caesarean section and other interventions.

**Midwifery continuity of carer in an area of high socio-economic disadvantage in London: A retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997–2009) by C. Homer et al.  (to be published in Midwifery 2017 Vol 48. Pp1-10. Downloadable now).

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