3 Important things we can learn from Ina May Gaskin, with Sarah Culver | Maryland Birth Photograher
Greer, the owner of Heartwish Healing Center got me in touch with Sarah and I was so excited to speak with her. Birth isn't her main gig but she has some incredible experience and since she's a Delmarvian I knew she would be perfect for the interview series! I do want to note that we get on the topic of loss and so if you're not in the place to handle that right now, it may be a good idea to skip this one and come back when you are ready! You definitely want to read what Sarah has to say though!
Sarah: Thank you for doing this!
Me: Thank you so much for taking the time to do this! I want to be respectful of your time so if you don't mind starting off by telling us a little bit about who you are and what you do?
Sarah: Sure! I am a college professor. I teach ancient history and art history at two different universities. I am a mother of four. I'm starting nursing school in the fall, so that's really exciting. In the past, I was the founder and director of the Lighthouse Birth Collective. But most recently I am the assistant to Ina May Gaskin who is a world-famous midwife. She reintroduced out of hospital birth in American, and she's just wonderful.
Me: That's so awesome! So you're a history professor for your day job, what brought you to birth work?
Sarah: After the medicated hospital birth of my first child, which was fine, the outcome was fine. But I felt like I missed out on this beautiful and empowering experience that people talk about and I knew I wanted to do things differently the next time. I was determined to be more informed, more prepared, feel more powerful, and more active in the process. I knew I wanted more children so in my quest to have a really great birth the next time around I was so fatefully gifted a copy of Spiritual Midwifery and Ina May Gaskin's Guide to Childbirth. I hired a doula who was a retired CNM who was lovely. And I did have a really wonderful and fun hospital birth. But I knew I wanted a home birth for the next one. I felt like I had it down, I was good, I was ready to be at home. So for my 3rd pregnancy, I tried to seek out a homebirth midwife here in Delaware. But I learned quickly that unless I was Amish or Mennonite, it was illegal in Delaware. CPMs were being charged with practicing without a license which is a felony in DE and so the only legal way to have a home birth in DE was to do it unassisted. Which many women choose to do. I knew that that was not the right thing for me.
So this law against home birth and criminalization of certified and trained CPMs struck me as a violation of my rights to choose with whom and where I gave birth. Especially when there is so much evidence to support planned home birth with trained midwives and knowing that it was the norm in so many parts of the world. So I needed to see the laws overturned. Not only for myself but for all the families in DE. I became involved in the legislative efforts to license CPMs in DE and to rewrite those regulations. I became the president of Delaware Families for Safe Birth. And in very genuine collaboration with maternity care professionals from all across the spectrum, we were successful in 2015 in changing the laws and having CPMs be successfully licensed in DE, legalizing homebirth and creating a system in which families can welcome their babies in a setting and the attendant of their choice.
I also spent about a decade of that chuck of time as a doula and a birth assistant here in DE and in the Amish community in Dover which was a true privilege and a really wonderful experience.
Me: That's so awesome. What was the timeframe between when you started trying to change the laws to 2015 when you were successful?
Sarah: it was about 3 years that I was involved but to be fair it was a movement that was growing before I got involved. It was already starting to take place, there were families just like me who wanted a home birth who wanted certified and trained and professional midwives. and it didn't make any sense to us that it would have been legal in the state of DE for me to go into labor at home and call my electrician. But if I were to call a certified professional homebirth midwife she would be a felon and we would all be in big trouble with the law. It just didn't make sense to any of us.
But we had a lot of skilled CPMs that worked with us and there were many wonderful Obstetricians, Neonatal fetal specialists, L&D nurses who also believed that it was unfair to limit a woman's choice of where she could have her baby at that time. So it wasn’t just homebirth families and midwives that were pushing for it, we had an outstanding group of physicians and nurses and homebirth midwives and families that really worked together to make it happen. It was a collaborative effort in the most genuine way.
Me: That is so beautiful! Thank you to you and all those who helped make that change. I think it should be a right but it's also a wonderful privilege to have all the options available.
Sarah: Yeah, that's what it's about, women should have choices!
Me: I agree. So I don't want to make this all about working with the great Ina May Gaskin but I do have to ask what's it like working with her and how has it impacted what you do?
Sarah: It is my greatest honor to work with Ina May, to be her assistant and her friend is extraordinary. She's as genuine as it gets, there's no self-importance, she's not one that considers herself a celebrity. She's honored by everyone who comes up to her and tells her their story of how she's impacted their life. She's lovely, she's a grandmother! She's genuine, kind, and easy to be around as anyone. She's just a joy. I love to be her friend and chat with her on the phone. I love talking about presentations that she's doing and what she wants to get across. So my role with her is to help create a presentation that reflects her intentions. She's 81 and she still lives very much off grid. She's not an internet person or a cell phone person. So my job is to be the middle man between Ina May and the modern world. I help to bring her message, which is timeless and has not changed since she started in the 70's, I help bring that to the modern world and connect with them in a way that she would probably not be inclined to do on her own. She loves her garden and her chickens. She's just as genuine as it gets.
Recently, I was with Ina May at the Tennesee State Museum in Nashville with Dr. Amber Price, when Ina May discovered for the very first time, as a complete surprise to her, that there was an exhibit about her. She was just as surprised as she could be. To watch her stumble across an exhibit about her, just fascinated her!
And she's just as purposeful about keeping birth in the hands of mothers and families as she ever was. She's wonderful and it's my true privilege to be her friend.
Me: That's so cool. I think your job is so important! Having her voice still out there, she brought home birth care back to the US and her message is still the same and having that available to people. When I read guide to childbirth that totally changed everything that I thought about birth.
Sarah: You know she just put out a second edition of guide to childbirth and she was much more intent to include stories of loss, and miscarriage, and where the outcome was not all rainbows and butterflies. She wanted the understanding that that is a part of birth too. That in maternity care, not every outcome is ideal and she really wanted to honor the stories of families who didn't get the birth that they wanted or the outcome they wanted. So, anyone who has or has read the first edition, the second edition is more comprehensive in terms of the stories that are showcased and honored, and highlighted in that book.
Me: That's so good to know, I'll definitely be getting a copy of that one. And that is something that I have been thinking about with my work. I haven't officially done anything yet but if you're familiar with Now I Lay Me Down To Sleep which is a Nonprofit for families that experience loss, that's something that I want to offer. Whether with that organization or on my own. I think it's something that is so important to acknowledge and normalize it. They are still parents.
Sarah: Yes, it's such a disservice to those babies and those families to pretend it doesn't happen and turn a blind eye to it. It's so important to honor, and raise up, and support and encourage every experience. Even when it wasn't exactly what we wanted or the outcome wasn't what we hoped for because that's reality. Not everyone survives. Not every mother gets to bring her baby home from the hospital. And to acknowledge that and to welcome it to say we see what happened, we see what you're going through and we are here to honor and support you I think would make a world of difference. It can't be this taboo topic anymore because that's dangerous, for the mothers especially, who are left with enormous grief but also the feeling that there is no outlet, no relief, or support. It's an isolating experience that can really pour salt into an already egregious wound. Anything that we can do to uplift these families and support them. To say we aren't afraid to say your baby's name, we aren't afraid to talk about the experience you had because it happened to you it's real and needs to be acknowledged just the way a beautiful birth is. We do such a disservice to these families when we just erase it from the spectrum.
Me: yeah, this is kind of off topic but this made me think of it. I don't know if you've seen this on social media where people will put trigger warnings for loss. I've been thinking how yeah, we don't want to upset people but the people that would be upset about loss are people who haven't experienced it and are scared of it. Whereas the people who have actually experienced loss may be triggered by your living baby and we don't trigger warn that! We need to normalize it, let those parents decide what's ok and not ok to do. The more we talk about it and put it out there the better for everyone.
Sarah: That's exactly right who are we to say what is a trigger! Triggers are as individual as the person viewing the thing. There's no way to say this is a trigger to everyone. Let's stop labeling and pretentious. It's like the internet version of what to expect when you're expecting. Who are you to tell anyone what to expect! Your experience is as individual and unique as you are and so to tell someone what to expect is to do nothing but set them up for that feeling of panic, failure, or inadequacy. Expect what happens to you, what's relevant to you and your life.
Me: Yes! Ok, we can talk about something else now! What is the favorite thing about what you do?
Sarah: It is a privilege to watch families be made, especially on their own terms. When babies are born in an environment of gentleness, support, and love, and that can happen in homes and in a hospital. A beautiful and empowering birth can happen in the operating room just as it can happen in a water tub in someone's room. But helping to facilitate that and helping families feel like they did it themselves and they accomplished it themselves is my favorite part of birth work.
Me: Yeah, that's beautiful thank you for sharing that. If you could change one thing about the standard of maternity care either prenatally or postpartum what would that be?
Sarah: To be honest, something that I would change isn't necessarily in the perspective of maternity care but in thinking about the professionals OBs, CPMs, CNMs, nurses, etc- we can not think of them in extremes. Many homebirth midwives are skilled and knowledgeable and wonderful. And some of them are very dangerous. Many Obs are skilled and compassionate and respectful and some are very dangerous. there's this big shift that's happening in American hospitals with respect to hospital maternity care. I think that we are seeing the tides turn. There are certain change leaders in hospital administration right now, like Dr. Amber Price, who is the chief operating officer of Tristar Centennial in Nashville and she is also a midwife. She's the only hospital administrator in the country who is also a midwife. She has implemented policies that are so rooted in respectful care and has built such a standard of excellence that all of her hospitals have a 0% preventable mortality rate. She has teams at the ready to save people and babies, she has helicopters flying all over, staffed with the best of the best. She has developed these relationships with homebirth midwives that are so strong that when they need to transfer they come to her hospitals because they know they will be cared for with compassion and understanding. She insists that the doctors and nurses that work in the L&D ward are respectful of homebirth midwives so they are allowed to transfer in and stay with their client and aren't counted as a guest. This kind of respect in maternity care is happening in American hospitals and I think that we have to get out of this mindset that one kind of provider is good and one is bad. I had a homebirth and love homebirth but some homebirths are very traumatizing. There are some women who go into hospitals and have traumatizing experiences but there are also women who have empowering and beautiful, awesome hospital births. There are beautiful cesareans, in the same way, there are bad homebirths. So this mentality of extremes is something we need to get away from. I don't trust a midwife who hates all OBs I don't trust any OBs who hate all midwives. Good midwives respect OBs and know that there are times when they are needed. Good OBs respect homebirth midwives because they know that they aren't always the person that is necessary.
With all things, there has to be a balance. So when it comes to hospital policy in terms f maternity care in this country, change leaders like Dr. Price and her hospital, Christin Puscucci of birth monopoly who equips women with the legal support that they need when they are not satisfied with their care. They are changing the game. They are setting an example that should be followed and that deserves credit. We need to see the people doing the good and follow their lead. There are great homebirth midwives and support for people wanted an out-of-hospital birth but we must not discredit the good work that is happening in hospitals too. Balance is the goal! That's what I wish I had known 10 years ago. A hospital is nothing, it's the staff, care providers, and their own standards of practice. And there is a lot of good work happening in hospitals right now and that is encouraging to me and has changed my mindset for sure because I wasn't always as open-minded to the medical sides of things as I am now and it's because of people like Dr. Price and other executive and physicians like her. Things are changing across the board not just at home but in hospitals too.
Me: Yes! I love that. It's so true, that's part of why I'm doing this. I want to interview different types of birth workers from every side of the spectrum, partially because if someone can resonate with their provider and birth team before they even choose them, that's going to help their outcome, even just mentally. But you're exactly right from my own experience when my daughter was born it was a hospital birth and it was completely empowering and beautiful and I have great memories thoughts about it. If I was going to have another baby it would definitely be a home birth but that's just because my midwife retired. I agree with everything you said and I can't wait for people to read it! I hope that it helps them.
Sarah: Yes! I'm happy to chat with you, I've been working behind the scenes for the last couple of years so this is really nice.
Me: Awesome. So what is one thing that you want every woman to know?
Sarah: What a good question. One thing that I've learned from Ina May has taught me and that she feels very strongly about is that birth is not fair. At its most basic element birth is a force and act of nature. Nature even at its most pure is not fair. I don't say this to make birthing families feel helpless but to feel freer! Less guilty less consumed with the feeling they have to control every element of birth or that birth can be controlled down to the details. Of course, there are many elements that you can control and I encourage all birthing people and their support systems to do their research and to put together the best team, environment and plan that they can but really you only have to watch like one David Attenborough documentary or the experience of one good sailor to know that when it comes to nature it can be beautiful and it can be a beast. And even the most skilled navigator on the ocean will come across overpowering storms. Truly when I watch these Attenborough documentaries you see nature gives us these flowers but see an adorable baby zebra picked off in a heartbeat but a bunch of hungry lions. So birth is nature and that's just the truth of natural events. WE can participate in nature and it can be beautiful and challenging. We must not ever forget that birth is still a part of nature and nature is not fair.
As soon as we free ourselves that we can control, that it was somehow our fault, it probably wasn't. There are no other species in nature that every baby survives or that every mother survives. Anyone that reads from Dr. Michel Odent, is so skilled and eloquent in communicating that we have in the last couple of decades changed birth by intervening in the many ways that we do medically. Birth is changing in the way we do things, not for the better in some ways and certainly for the better in lots of cases. But we are changing birth by our various interventions in it but even to that extent, it is still nature. So it's important for mothers to get out of the mindset that something went wrong and it was their fault or that it was something that they could have controlled. Probably it wasn't because birth is not fair.
Me: yeah that's really an empowering thought! Knowing that you can't control it all, it's just how it is.
Sarah: Free yourself from this guilt that it was something wrong that you did. It probably was not. We can participate and manipulate but there will always be elements of birth that can not be controlled and outcomes that wont be our choice and that is just how it is.
Me: So this is just the fun question! If you were stranded on a deserted island, what 5 things would you HAVE to have with you?
Sarah: I love this, such a fun question. Coffee for sure I have a coffee problem if I could I would have a little tugboat just of coffee. I don't know what to do with coffee if I had it but I'm sure I could figure it out out of sheer desperation if nothing else! I would bring my swim bag. I'm a swimmer so the thought of being alone on a deserted island, I wouldn't even have to wear a bathing suit, no tan lines! But I would have my goggles and swim cap and I would just swim all day every day. Logistically I would probably bring a knife, I don't know what I would do with it but I would figure it out. A fire starting kit too because I failed girl scouts pretty badly. I would need that third-party help for sure. I've seen a lot of man vs wild but none of it stuck with me. And probably, last but not least I would have my David Sedaris books. Which I will never get tired of. I've been a David Sedaris fan for 25 years and I never ever get tired of reading his books. So I would be a really happy camper just swimming around, drinking coffee, and reading David Sedaris it would be great. If someone came to pick me up off the island I would probably say that's ok, I'm good!
Me: That's awesome! Ok, bonus question! If you were to describe yourself in three words, what would they be?
Sarah: oh gosh, Open-minded. I like to be challenged and given new information and change my mind and opinion about stuff. Another thing, I am patient. I have 4 young kids, I'm a teacher, a hope to become a nurse, I think that I've learned the virtue of patience in a lot of ways, I'm not perfect at it in any way. There are times I need a lot more but for the most part, I'm pretty patient. And I like to think that I'm durable. I like to think that I am not easily shaken by challenges and that I rise to the occasion when necessary I think that I can handle a lot and I can accomplish a lot.
Me: That's awesome. Is there anything else that you would like to add?
Sarah: I don't think so, I'm a very happy camper. I would love to see the people that you have interviewed so far I'm honored to be a part of the series that you're doing. I'd really like to encourage women to remember that it doesn't have to be an extreme thing. You don't have to be only in favor of homebirth or only in favor of hospital birth. That something that I've learned from Ina May, who herself has a lot of physicians she respects she was trained by a physician. IF she can appreciate obstetricians and good medical care and be grateful that it is there when it's needed I think that is something that we can all do . even those of us who have planted ourselves firmly in the homebirth camp. I think it is important to know that change is happening in American hospitals the same way it is happening at home. It's important to find the change and find the people that are doing good and follow their example.
Me: Yes! So if anyone wants to connect with you what's the best way to do that?
Sarah: I'm on Facebook and Instagram, email@example.com you can always find me somewhere that's for sure!