Ina May Gaskin drives cautiously round the winding dirt tracks of the Farm, an eco-community buried deep in a 100-acre backwood south of Nashville. She slows down to wave to a young woman with her two children: "Both those were born at home," she murmurs, "as was the mother." ... We overtake a large, bearded teenager on a bicycle. "That guy just fell into my hands," she chuckles. "He was enormous."
... For four decades, it has been Ina May's domain. Revered as one of the world's most knowledgable experts on natural birth, she has delivered most of the Farm's current inhabitants and seen more than 2,000 births. Her experience is unique. Because the Farm is relatively cut-off from civilisation, Ina May has the knowledge and experience of a midwife working hundreds of years ago. Some might call her methods primitive or even brutal – they're certainly hippyish. But to her fans, she's just helping women do what comes naturally.
... She is the only midwife – and only woman – in history to have an obstetric technique named after her, the Gaskin manoeuvre ... Her new book, Ina May's Guide To Breastfeeding, is a collection of advice and anecdotes described by the US's bestselling health writer, Dr Christiane Northrup, as "the best thing ever written on the subject".
... When she wrote Spiritual Midwifery, it was full of hippies describing how "psychedelic" and "trippy" their wives looked in labour: "It does a man good to see his lady being brave while she has their baby – it inspires him." When I meet Stephen ... he hands me a book of pictures of the original Farm: Cat Stevens lookalikes with long, flowing hair and huge beards tending the crops, women in flowery kaftans breastfeeding their babies, unkempt children making their way to school through fields. Looks like you got to live your Utopian dream, I say. Stephen laughs: "Utopia means nowhere. The Farm has a zip code."
"It looks like fun," Ina May says, "and it almost always was. You didn't need to watch a soap opera: there was one happening all around you."
... In their heyday ... the Farm's community swelled to 1,200 people and her team of midwives handled around 30 births a month. Now it has eased back to 10, many from the large Amish community in the surrounding countryside. Outsiders come from all over the world – most recently from Ireland and Singapore – to have their babies.
... A private delivery here costs $3,500 with $300 a week for accommodation. You pay extra, of course, if you end up going into hospital in Columbia, a half-hour drive away, but with Ina May's statistics – a 95% homebirth rate – that's unlikely. Even more impressively, many of the births she has handled are usually regarded as high risk and not recommended outside hospital: more than 20 sets of twins, several hundred births by women who have had more than five pregnancies (most of them Amish) and more than 90 breech births, including several feet first. All delivered naturally with no pain relief and no complications.
It's worth noting, however, that her team has effectively worked in a cultural vacuum: all the mothers she has treated are a self-selecting group, committed to natural birth. The Farm is popular with middle-class American mothers who like to do things holistically ...
Bonnie Reed, 37, a teacher from Bowling Green, Kentucky, a two-hour drive away, came here to have Margaret, her second child, now five days old. "Yes, with a natural birth you have a lot of intense sensations," she laughs, "but it's over instantly." This is her second birth on the Farm: Truman, two, was also born here and he, like dozens of other babies, has his footprint on the wall of the birthing room in a log cabin in the forest ... In her home state ... labouring women are shaved and given enemas as soon as they arrive at hospital, and homebirth is not legal, so if she had stayed at home, she would have had to find a midwife willing to operate outside the law. "That's the sad part. I had to travel two and a half hours to get the birth I wanted."
... "I don't understand why they don't encourage midwifery," she adds. "It's less expensive."
Ina May agrees, of course. She had her first baby in hospital in the late 60s and says it was a terrible experience. "I was offended by what happened [she was given anaesthesia without her consent], then they expected me to pay for it! I was so pissed off."
A graduate from the English faculty of the University of Iowa, Ina May became a midwife by default. At the age of 30 ... she was travelling with the convoy that was eventually to settle at the Farm. As one of the few women ... who already had a child, she attended her first birth ... on board a bus in 1970. Weeks later, two more babies were born in a truckers' garage in Wyoming. It was -20C outside. At first she struggled with the idea of becoming "the midwife", but then accepted it was her vocation. "I had to learn not to let anyone push me around, to be brave and to say things I knew might make people mad."
... She got married in 1959, aged 19, to an arts student. "I didn't know how to say no and I didn't want to hurt his feelings." The two of them went to Malaysia with the Peace Corps. She became a hippy late, she jokes, at 28. Two years later she met Stephen through her first husband when they were in San Francisco. There, Stephen was running his legendary Monday Night Class where he drew crowds of 1,500 students wanting to share his philosophy of peace and spirituality. This was the era of free love and, as Ina May puts it, "We were two couples together for a while. Things got very complicated. It was about challenging norms. I don't like to talk about it because I don't want to be defined by it." She and Stephen soon ended up together, and she set off on the road with him, with her toddler daughter in tow.
Within a year, the pair had become the focus of the Farm community: Stephen was the unofficial guru, Ina May the community's midwife, pouring her own experience into her bedside manner – in the early 70s she had two miscarriages and a premature baby who died. Much later, her eldest child, Sydney, died from a brain tumour just after her 20th birthday. Her surviving children are Eva Marie, 37, a teacher, Samuel, 35, a personal trainer, and Paul, 34, a web designer – all were delivered on the Farm. She has six grandchildren.
Some of the farm's birthing ethos is harsh: in Spiritual Midwifery, there is an extraordinary scene where a woman giving birth to a stillborn baby is told off by a Farm midwife (not Ina May) for being "complainy". The mother takes it as good advice and stops moaning. ...
The Farm's C-section rate remains at a tiny 1.4%. Ina May's techniques ensure that almost two-thirds of the women she delivers keep their perineum intact. She notes in her figures from 1970 to 2000 that, out of 2,028 births, eight babies were lost. This number includes the Farm's first infant death, Ina May's own premature son who had a rare heart condition: "I felt grateful it was me and not another mother." Other babies were stillborn or too premature. But she says she has never lost a baby due to the birth being at home.
The maternal mortality rate in 39 years is zero. During a Farm birth, you apparently do not experience pain, you have "interesting sensations to which you must pay full attention". You do not have contractions, you have "rushes". In all her years of midwifery, Ina May has only ever known one woman who couldn't cope and was taken to hospital at her own request. "We use a lot of tricks," she says. "We tell stories, we keep calm, we prepare the woman for how she's going to feel. Sometimes humour ... is what works best. It's good to laugh at times that feel inappropriate."
Ina May's no-nonsense attitude stands in opposition to the culture of fear that surrounds non-medicalised birth in the US. She has an interesting theory about this. In 1900, half of all US households lived on farms. Now only 1% live on the land. "It makes it easier to dupe people. They don't know animal behaviour and they have no basic understanding of birthing processes or of nature." Her latest campaign is for increased awareness of maternal death: there has been no improvement in maternal death rates in the US since the 80s. Rather, statistics show the rate has increased, from 7.5 deaths per 100,000 live births in 1982 to 11 in 2005 – and the US Centers for Disease Control and Prevention believe the true figure could in reality be as much as three times higher than that reported.
Several years ago, Ina May founded the Safe Motherhood Quilt Project (a giant quilt featuring the names of women who have died in childbirth, most from complications following C-sections and inductions) and is building up her own bank of statistics. "I started to add the names of women who had died. It looked to me like we weren't counting carefully, like we weren't even trying. It might be possible that now a C-section here is actually more dangerous than in, say, the UK. Meanwhile, internationally, people are unwittingly copying the worst model for obstetrics in the world."
... She worries that things are getting worse for women ... "We are seeing whole populations moving towards, 'Cut me open.' They don't realise that abdominal surgery can be dangerous ... it is possible to give birth without horrific injury."