This is the first of a few baby-related books I want to post about! My husband has a huge compilation of book notes and I thought it might be fun to copy him, especially as I'm reading baby books pretty aggressively these days.
For those new here, I found out that I was pregnant in February and am now a little over 20 weeks along, which is halfway there. It's crazy to think about how quickly time has flown, but now seems like as good of a time as ever to publish my notes and thoughts while they're fresh. Plus, I don't want to have to read all these books again with future pregnancies unless I want to.
I've been doing a boatload of research about my birthing options since I got my BFP (Big Fat Positive). If I'm being honest, I used to think that people who wanted unmedicated births were a little crazy and a little too "woo" for me, but after reading and listening more, my plan is to also have an unmedicated birth in the comfort of a birthing center. I would like to avoid going to a hospital, so long as my and baby's health and safety remain ideal. So given this, several friends recommended Ina May's Guide to Childbirth. It's considered a staple resource, especially for those seeking a more holistic and less medical-y birthing experience.
As a disclaimer, I am trying out this format for my book notes, but it may change as I continue. Generally though, I'll summarize sections from the book, throw in a quote if Ina May just explained it best, and then also provide my interpretation of it (see "My Take" bullet points when applicable). By no means is this medical advice, so I trust that you will draw your own conclusions just as I did. I am simply writing these up for future myself and publishing them in case they're helpful to anyone else out there.
Now that we've got that covered, let's get to it!
About the Author
For those less familiar with the birthing space, Ina May is considered "The nation's leading midwife" and "The mother of authentic midwifery". Her story is genuinely fascinating and she's helped bring thousands of lives into this world throughout her tenure. She has pretty much paved the way for midwifery as we know it today in the United States, and her insight and experiences are invaluable within the birthing community.
Her introduction to birth took place in the late 60s, when her first child was delivered via forceps. After such a terrible experience, she knew that she wanted better for herself and for other women. By 1971, she and her husband established The Farm, which created The Farm Midwifery Center, one of the first birthing centers in America. This was considered the rebirth of midwifery in the States and continues to serve as not only a birthing center, but also as an educational hub for midwives, doctors, nurses, and other birthing professionals.
The most updated version of the book starts with a large collection of birth stories.
I've been reading a few a week as my pregnancy progresses and I love it! Reading them helps me to see that there positive birth stories from real women exist, not just the scary ones I see on TV or in movies.
After finding out that I'm pregnant, I think people just automatically assume that I'm interested in hearing about traumatic birth stories, whether it's their own or a that of a friend. They probably do this because they want to warn me of possible disasters ahead, but hearing traumatic story after traumatic story doesn't help me personally. I much prefer to logically know the potential outcomes and be as educated as possible. But beyond that, I firmly believe that surrounding yourself with positive vibes and stories is key in mentally prepping for birth, which is why this section is so great.
There's no need to read them in one straight shot, but I really recommend casually reading all of them throughout pregnancy. Keep the good vibes rolling!
Chapter 1: The Powerful Mind-Body Connection
The wrong environment can stall or reverse labor (page 158): "My midwife colleagues and I learned by observation and experience that the presence of even one person who is not exquisitely attuned to the mother's feelings can stop some women's labors".
- My Take: This means that I'm going to try and labor as long as possible in the comfort of my own home with my husband. And once I'm at the birthing center, I'll be particular about who can be in the room, when possible.
Encouragement matters: "Most women need encouragement and companionship more than they need drugs" (page 162).
Chapter 2: What Happens in Labor
The cervix's role (page 164): "The cervix (the word means "neck in Latin), the circular opening like a bottleneck at the lower end of the uterus, is a powerful band of muscles that holds the uterus tightly closed until labor begins. Picture a knit purse with a gathered opening held tight by a string. This thick cervical muscle has to be strong enough to hold the uterus shut despite the pressure of approximately fifteen pounds of baby, placenta, and fluid against it...The cervical muscle is the kind that is able to remain closed without exertion in its prelabor state. (Once labor begins, its task is to thin and get out of the way.) The cervix is sealed during pregnancy with a plug of thick mucus, which is expelled during the house before labor begins."
The first stage of labor (page 165): "Hormones called prostaglandins cause the thick cervical muscle to begin to soften and thin in readiness for labor. This process is called ripening. The cervix...becomes extremely soft to the touch when ripe, losing its distinctive necklike shape. No longer a bottleneck, it becomes part of the bottle. The part of labor when the cervix is opening is called the first stage. Given the choice, most mammals are restless during this part of labor, for this is the time when the baby is pushed, jostled, wriggled, and turned into the most advantageous position to pass through the maternal passageway if she is not already well positioned."
The second stage of labor (page 165): "Once the cervix is pulled completely open, a combination of uterine contractions and some pressure from the abdominal muscles pushes the baby outside of the mother's body. This is called the second stage of labor. It lasts until the birth of the baby."
Your pelvis probably isn't the problem (page 166): "Only rarely do the dimensions of a woman's pelvis significantly interfere with the birth of her baby".
- My Take: If your doctor is telling you that you can't vaginally birth your baby because your body or your baby aren't the right sizes, be sure to press them on this. Many doctors are quick to spit out "reasons" why you need a C-section. On page 192, she caveats this by explaining that there are a few extreme cases where severe mismatch in size can prevent a normal vaginal birth.
Make sure your Vitamin D levels are superb (page 166): "Civilized nineteenth-century women, or poor women forced to work inside through all daylight hours...often suffered from pelvic deformities caused by vitamin D deficiency, and such deformities did obstruct vaginal birth".
- My Take: I started taking supplements because I am one of those women who work inside! My vitamin D levels were GARBAGE...I was at an 18ng/mL when I should be at around 50ng/mL. My midwives recommended that start with 10,000IU of vitamin D3 per day with 50-150mcg of K2, as it's important that you pair vitamin D with K to help with absorption. I take 2 of these supplements per day and try to be outside with my skin exposed when the Texas heat isn't disgusting.
"Sometimes during a first labor, it may seem that the baby's head goes back up between pushes. Don't be discouraged by this" (page 166): This just seems like something that's good to know!
The third stage of labor (page 166): "Lasts from the birth of the baby until the expulsion of the placenta. The uterus continues to contract after the birth of the baby, quickly diminishing its size to that of the placenta. Further contractions shear the placenta from the uterine lining. This even is usually signaled by the expulsion of dark red blood within fifteen or twenty minutes after birth. More contractions then expel the placenta. Gravity and gentle traction on the umbilical cord by an attendant may aid this process."
The fourth stage of labor (page 167). "Is the postpartum or newborn period, roughly the six weeks that follow childbirth."
Chapter 3: The Pain/Pleasure Riddle
Orgasmic birth (page 187): "It's the women who do their best to understand the rushes [of labor] and as calmly or philosophically as possible work with them who seem to me most apt to have an orgasmic birth."
- My Take: Surrender and don't fight the waves. Try your best to ride them out...probably MUCH easier said than done, but still good to keep in mind.
Chapter 4: "Sphincter Law"
Laughter helps open the sphincters (page 200): "Pain-numbing endorphins, nature's opiates, are instantly effective and have no negative side effects. A smile is good. A chuckle is better. A good belly laugh is one of the most effective forms of anesthesia."
- My Take: Tell my husband to try and be funny, but without making me want to kill him!
"Singing will maximize the ability of the body's sphincters to open" (page 203): The sounds that accomplish this best are the notes that come from as deep down in the body as possible, the ones that vibrate the entire chest. Even the woman who makes no sound as she gives birth can deliberately hold her mouth and throat in a loose, relaxed position as she pushes. If she holds her mouth and throat open rather than clenching her jaw or biting down, her perineum responds accordingly. Its muscles instantaneously become more flexible and stretchy and thus more able to slip around the baby's head and body without tearing or being cut."
- My Take: Try and keep a loose jaw while in labor.
Horse Lips (page 204): "I developed another relaxation technique to help women keep their mouths and throats relaxed during labor. This is called "horse lips" or "blowing raspberries". When a person totally relaxes the lips and blows a good amount of air through them at considerable pressure, softly flapping them together in the process, it is reminiscent of the soft, lip-flapping sound that horses make. I find that when women in labor attempt to make this sound...it significantly relaxes their mouth, throat, and at the same time, their bottom (cervix and perineum)."
Chapter 5: What You Need to Know About Your Pregnancy and Prenatal Care
Screening for Gestational Diabetes (page 225): The test that's often given isn't great because it's not reliable or very accurate. More than half of women, if retested, will have different results test to test. There's also nothing to really be done if you develop GD, so even if you test positively for it, you wouldn't really change your behavior beyond what you should be doing already (eating well, exercising, etc).
- My Take: Wear a continuous glucose monitor (CGM) starting at 24 weeks and track levels that way. I had signed up for Levels in 2020 but stopped my subscription earlier this year. I just resumed it today though, so I'm excited to track my glucose levels for the rest of my pregnancy.
Prenatal Rhogam (page 228): Your midwife or OB should screen you for this. "If you are Rh-positive or if both you and the father of your baby are Rh-negative, you have no particular need to understand the details of prenatal Rhogam. But if you are Rg-negative and your baby's father is Rh-positive, Rh incompatibility problems can become an increasing possibility with each succeeding pregnancy.
- My Take: Make sure you get this tested and take the necessary steps if you fall into that second category. I personally was positive, so we were okay.
Chapter 6: Going into Labor
It's okay for labor to start and stop (page 234): "It may help to know that labor often starts and stops a time or two before it becomes powerful enough to complete the birth process. This situation is most likely to happen in the early or latent phase of labor. If you think you are in labor and it's late in the day, try taking a warm bath, drinking a glass of wine, and going to bed for a while. You may be able to take a nap before labor becomes intense...Even a well-advanced labor can stall or go more slowly once you travel from your home to your hospital or birth center."
- My Take: Further encouragement to try and labor at home for as long as possible!
Distract yourself with an arm wrestle (page 236): Ina May found that asking laboring women to arm wrestle between rushes helped progress labor because "contracting the arm muscles during labor distracts women's attention from holding their pelvic. and thigh muscles right to "protect" themselves during labor".
- My Take: Try arm wrestling while in active labor. I'll try anything once!
Induction of Labor
It's sometimes necessary to induce labor (page 241): "If the mother has cancer, hypertension, diabetes, kidney disease, preeclampsia, a small-for-dates baby, a decrease in the amount of amniotic fluid, or an intrauterine death following by a long wait for labor to begin or maternal choice for induction after fetal demise."
However, it should be avoided unless medically necessary (pages 242 - 243): There are several risk factors to the mother and the baby when inducing labor. There are clearly a lot of things that must be in balance and working together to birth a child, so upsetting that balance will inevitably have downstream effects, including medical interventions. "Women tend to have harsher, stronger, significantly more painful contractions with chemically induced labors, so one who can cope with a spontaneous labor often finds that she needs pain medication to bear the more insistent contractions of an induced one". There are also risks to the baby. "When induction is purely elective, there is a higher incidence of fetal distress than in labors that begin spontaneously".
- My Take: I don't plan to schedule my birth, whether that's an induction or a cesarean, unless it's for the safety of myself or baby. There's simply no rush when you have a healthy pregnancy, and the baby will come on her own. If I get to 41 weeks and she's still not here, I will speak with my midwives about natural ways to induce (ex: castor oil, herbs, sex, nipple stimulation, etc.)
Common Induction Methods
Amniotomy: Breaking the water bag (page 245).
- Pros: Used alone, it's not too risky, but it's often combined with with other induction drugs that can overstimulate the uterus and cause further issues. Done alone, it can start labor within four hours if the mother has already given birth.
- Cons: Introduces a host of potential complications, including a "...commitment to delivery, a heightened incidence of intrauterine infection, and a greater chance of umbilical cord prolapse (in which the cord falls out of the cervix below the baby's head, which usually triggers an emergency cesarean)...If labor doesn't begin within four to six hours following amniotomy, a contraction-stimulating drug such as oxytocin or prostaglandin will be recommended."
Pitocin Intravenous Drip: A synthetic version of oxytocin. It's administered at regular intervals until the "desired contraction rate and strength is reached" (page 245).
- Pros: Sometimes it's necessary to speed labor along, such as when the risks of waiting for spontaneous labor become greater than the induction itself. It also can become necessary if the cervix is not yet ripe.
- Cons: When given Pitocin, you're twice as likely to end up in an instrumental delivery or c-section compared to a spontaneous labor without it. Pitocin also causes longer and more intense contractions, sometimes to the point of disrupting the blood flow from placenta to the baby, so continuous fetal monitoring devices must be used. When such devices are attached, it's more likely for the doctor to incorrectly flag that the baby is in distress, even if all is normal. All it takes is one person to misinterpret the readings and order an emergency c-section for no good reason. The mother must also be still when hooked up to such devices, so it limits mobility. Finally, because Pitocin also causes longer and more intense contractions, many women opt for an epidural. Once you have an epidural, you cannot move from the bed (your whole lower body is numb!), which can further hinder labor, as the ability to move during labor is crucial. Lack of ability to move may stall labor further, which may cause your birth team to push even more Pitocin to "speed things along". And thus, the cycle of interventions continues.
Cytotec (Misoprostol): A pill that became super popular during the 90s to induce labor, even though it wasn't approved by the FDA for pregnant women (the FDA approved it to prevent ulcers, not to induce labor!) (page 247). This is a busy maternity ward's tool to keep their flow of patients steady.
- Pros: Probably the most effective way to start labor, even when the cervix isn't ripe. If it's given in the early morning, you are pretty much guaranteed a baby before dark. It's also very cheap. This is a huge pro for hospitals' throughput.
- Cons: The cons are extremely disturbing and women should refuse Cytotec at all costs. Negative effects include uterine rupture, uncontrollable maternal bleeding in labor or following birth, amniotic fluid embolism, maternal death, fetal asphyxia, cerebral palsy, stillbirth, and death of the newborn.
Natural Induction Methods
Sex (page 249): What gets the baby in, gets the baby out. Having sex during the last weeks of pregnancy helps to prepare your body for labor.
Breast Stimulation (page 249): Nipple stimulation (manual and oral) are very effective in releasing oxytocin, which encourages contractions.
Castor Oil (page 250): This has been used for centuries by indigenous people all over the world to induce labor. Take one tablespoon of castor oil in the morning with eggs or mix it into juice. You can take another tablespoon an hour after the first if necessary.
Sweeping the Membranes (page 250): "With a sterile-gloved finger, whoever (your choice) sweeps the membranes. Insert two fingers just inside the cervix and gently separate the bag of waters from the inside edge of the cervix. One sweep 360 degrees around and another in the opposite direction. That's it."
Chapter 7: Giving Birth
Lying on your back isn't a good position to give birth in (page 260): This is just the position that's best for the doctor delivering the baby. But the best positions to give birth in are sitting, kneeling, standing, squatting, or on all fours. Use gravity to your advantage!
Epidurals are common, but can come at a cost (page 267). There are a lot of risks that come with an epidural, but of course, the major pro is the great reduction of pain/intensity. I won't go into the pros and cons of epidurals here, but heavily encourage you to do your own research.
- My Take: I won't be opting for an epidural. Of course, I will try and stay flexible and get an epidural if the pain becomes too much to manage over an extended period of time.
Doulas are great assets to have throughout your pregnancy and birthing experience (page 270): Their sole job is to help you prenatally, perinatally, and postnatally. "Quite simply, hiring one cuts in half the odds of your having an unnecessary cesarean. It also halves the odds of your having a forceps or vacuum-extractor delivery. That's not all! Having a doula shortens labor by greatly reducing stress, pain, and anxiety."
- My Take: Hire a doula! I personally hired one the week after I found out I was pregnant and have loved having her as a resource and friend throughout my pregnancy. I'll also be taking a private and personalized birthing class with her and Nat later on in my pregnancy. I feel way more at peace knowing that she has been with me throughout my wholepregnancy and will be there to guide me and advocate for me during and after birth.
Let your monkey do it (page 277): In this section, Ina May encourages you to "let your monkey do it". "Monkeys don't think of technology as necessary to birth-giving; monkeys don't obsess about their bodies being inadequate; monkeys don't blame their condition on anyone else; monkeys don't do math about their dilation to speculate how long labor might take (ie it's taken be eight hors to get to five centimeters. That means it will take eight more hours to get to ten or full dilation), etc".
Chapter 8: Forgotten Vaginal Powers
This section basically covers how a woman's body is designed to know how to birth, so an intervention like an episiotomy are really unnecessary.
"Medical science knows that routine episiotomy has no benefits and carries many serious disadvantages" (page 286): They can rarely be justified and cause more trouble than they're worth. Episiotomies can cause pain that can last for weeks or months, increase blood loss, cause more serious tears, often become infected, are associated with wound breakdown, abscesses, permanent damage to the pelvic-floor muscles.
Chapter 9: The Third Stage of Labor and Postpartum
Birthing the placenta (page 289): This usually happens within half an hour or so of the baby being born. Once the baby is born, move to a comfortable and restful position and hold your baby, as this can trigger more uterine contractions that will help get the placenta out.
Delayed cord-clamping has proven benefits (page 290): "Studies have shown that delayed cord-clamping allows 40 percent of the baby's blood volume to flow into the baby from the mother. Early cord-clamping definitely results in lower hematocrit or hemoglobin values in the newborn. Premature babies especially benefit from later cord-clamping.
- My Take: I will be asking my midwife to delay cord clamping until the cord stops pulsating and becomes white.
Chapter 10: Benchmarks in Midwifery
I didn't flag anything in this chapter, but it goes over those who have made their marks of excellence in maternity care.
Chapter 11: What You Least Expect When You're Expecting
If you do need a cesarean, ask for your uterus to be closed in two layers (page 332): There's a new trendy method called the "Misgav Ladach method" that calls for stitching the uterine incision in one layer instead of two. But this method can cause life-threatening placental problems like placenta accreta in recent years.
If you have already had a cesarean and are pregnant again, make sure that your placenta is not overlying your previous uterine scar before you go for a vaginal birth after cesarean (page 332).
Chapter 12: Vaginal Birth After Cesarean (VBAC)
- Most women who would like to have a VBAC have a good reason to feel secure in planning for one (page 330), so if you want one, your chances are good that you can have one.
- Wait at least 18 months between pregnancies (page 340).
- Pick a caregiver with a VBAC rate of 70 percent or more (page 340).
- Avoid labor induction or augmentation (page 340).
- Make sure you're well fed before you get to the hospital and try to find one that will let you eat and drink during labor (page 340).
- Keep vaginal examinations to a minimum (page 340).
- Avoid an epidural (page 340).
Chapter 13: Choosing a Caregiver
This chapter is only four pages long and I didn't flag anything. But this section goes over questions to ask when interviewing a caregiver, such as an OBGYN, family doctor, home-birth midwife, hospital-based midwife, and doula.
Chapter 14: Birth in the Twenty-First Century
This chapter is also only four pages long and I didn't flag anything here, either. In this section, Ina May uses the Netherlands as a foil to demonstrate that the United States has come a long way in midwifery, but still has ways to go.
The biggest takeaway from this chapter is that American women need to stop believing that their bodies are poorly made to give birth (page 351).
Her final line is powerful, "If I have convinced you of nothing else in this book, I hope that one message will stay with you. Your body is not a lemon!"
And That's It!
Those are all my notes on Ina May's Guide to Childbirth. If you'd like to stay up to date on other things I write, you can join my email list below. And if you'd like to check out my personal Pregnancy Google Drive, you can see that here. Otherwise, I'll catch you next time!