Doula Essentials

The first obstetrical maneuver in modern medicine to be named for a midwife was learned from indigenous midwives in the highlands of Guatemala.

Ina May Gaskin visited the Quetzaltenango region of Guatemala in 1976. She watched Mayan traditional midwives use an all-fours position to resolve a complication called shoulder dystocia — a situation in which an infant's head has emerged but a shoulder remains stuck behind the mother's pelvic bone. She documented the technique in the second edition of her book Spiritual Midwifery in 1977. By 1998 it was published in the Journal of Reproductive Medicine.

It is known in the medical literature as the Gaskin Maneuver.

Ina May Middleton was born on the eighth of March, 1940, in Marshalltown, Iowa. She earned a bachelor's degree in English. She served in the Peace Corps and taught English in Malaysia for two years. She returned to the United States and earned a master's degree.

Her first child was delivered in a hospital in the early nineteen-sixties using forceps — a delivery method she later described as traumatic and unnecessary. The experience pushed her to look for a different model of birth.

In 1970 she met Stephen Gaskin, the founder of a San Francisco discussion group called the Monday Night Class. She and several hundred members of that group bought sixty school buses, painted them, and drove east in a caravan in 1970 and 1971. They were searching for land on which to build an intentional community. They settled on seventeen hundred and fifty acres outside Summertown, Tennessee, in October of 1971.

The community called itself The Farm.

During the bus caravan, several women in the community became pregnant. The community had no relationship with conventional medical institutions and would have been unwelcome at most rural Southern hospitals in 1970 and 1971. Ina May, who had no formal midwifery training but had been reading about childbirth for years, attended several births on the caravan. She was supervised on one of those births by Louis La Pere, an obstetrician in Rhode Island who consented to teach her the basics over the telephone.

The structural fact of the next fifty-five years is that Ina May Gaskin built and sustained an institutional infrastructure for American midwifery.

She founded the Farm Midwifery Center at the community in Tennessee in 1971. The Center has attended approximately three thousand births in the years since. Gaskin herself has attended more than twelve hundred. The Center's published outcome statistics — collected and analyzed by independent obstetric researchers — have been notable for low rates of medical intervention, cesarean section, and maternal and infant mortality.

She wrote and published Spiritual Midwifery in 1975. The first half of the book was a collection of first-person birth narratives told by The Farm mothers. The second half was a practical midwifery manual. The book was the first midwifery text written by a midwife and published in the United States in the modern period. It is now in its fourth edition. It has been translated into multiple languages.

The book's first-person structure was deliberate. Gaskin's editorial position was that the transmission of birth knowledge happens through women's accounts of their own labors — that the wisdom is in the corpus of stories, not in the abstract authority of a single text.

In 1976 she traveled to the highlands of Guatemala to study with traditional midwives of the Maya communities of the Quetzaltenango region. She watched experienced indigenous midwives use a position — the mother on her hands and knees rather than on her back — to resolve cases of shoulder dystocia, a complication that conventional Western obstetric practice had been treating with increasingly invasive interventions.

The position works mechanically. With the mother on her back, the coccyx is pushed forward toward the symphysis p***s, narrowing the pelvic outlet. With the mother on her hands and knees, the coccyx is free and the baby's weight on the symphysis p***s widens the anterior-posterior diameter of the pelvic outlet. The shoulder, in many cases, slips free.

Gaskin documented the technique in the second edition of Spiritual Midwifery in 1977. She published a longer informal article in the journal Birth Gazette in 1988. She and her co-authors published peer-reviewed articles in the Journal of Family Practice in 1991 and in the Journal of Reproductive Medicine in 1998.

The technique entered formal medical literature as the Gaskin Maneuver. It is the first obstetrical procedure in modern medicine to be named for a midwife. It is taught in medical schools and in midwifery training programs internationally.

Gaskin has consistently said that the maneuver was not her invention. She learned it from Mayan midwives who had been using it for generations. Her contribution was documentation and transmission into the formal medical literature.

Her broader institutional work includes the publication of Birth Gazette for twenty-two years; presidency of the Midwives Alliance of North America from 1996 to 2002; participation in the creation of the North American Registry of Midwives, which established the national competency-based certification credential for American direct-entry midwives.

In 1997 she received the Tennessee Perinatal Association Recognition Award and the ASPO/Lamaze Irwin Chabon Award. In 2003 she was named a Visiting Fellow of Morse College at Yale University. In 2009 she received an honorary doctorate from Thames Valley University in London.

In 2011 she received the Right Livelihood Award — sometimes called the Alternative Nobel — at a ceremony before the Swedish Parliament in Stockholm. The award citation specified her life's work teaching and advocating safe, woman-centered childbirth methods that promote the physical and mental health of mother and child.

Her later books include Babies, Breastfeeding, and Bonding in 1987, Ina May's Guide to Childbirth in 2003, Ina May's Guide to Breastfeeding in 2009, and Birth Matters: A Midwife's Manifesta in 2011.

Her husband Stephen Gaskin died in 2014. They had four children.

Ina May Gaskin is eighty-five years old in June of 2026. She continues to live at The Farm in Tennessee.

The structural reading of her life is that the transmission of midwifery wisdom is a documented, institutional, continuously published practice. It runs from indigenous Mayan midwives through Gaskin into the peer-reviewed medical literature where the Gaskin Maneuver now lives. It runs from the first-person birth narratives in Spiritual Midwifery through fifty years of readers into hundreds of midwifery practices worldwide. It runs from the Farm Midwifery Center's training of apprentices through the Midwives Alliance of North America and the North American Registry of Midwives into the national certification credentialing of American direct-entry midwives.

The wisdom is not a single speech remembered through one lifetime.

It is fifty-five years of books, training programs, peer-reviewed papers, and approximately three thousand documented births at one small clinic in rural Tennessee.

The Mayan midwives of Quetzaltenango passed a technique to a young American midwife in 1976.

She passed it to the rest of us.

If her story moved you, drop one word in the comments — Ina May, Farm, Gaskin, anything that comes to mind. Tap the like button so more people find this story. The page is small. Every reaction helps us keep telling the stories where the wisdom is fifty-five years of books and training programs, not a single remembered speech.

Interesting

By 1853, Queen Victoria had done something most women of her era did entirely without choice: she had endured seven childbirths, each one painful, each one dangerous, each one faced with little more than determination and prayer.
For the birth of her eighth child, Prince Leopold, she made a different decision.
She asked for chloroform.
Administered carefully by the pioneering physician Dr. John Snow, the anaesthetic dulled her pain and left her, by her own account, deeply relieved. Victoria described the experience as "soothing, quieting, and delightful." She was so convinced of its value that she used it again for the births of her ninth and tenth children.
But outside the palace walls, the controversy was fierce.
Certain voices in the Church pointed to the Book of Genesis — where pain in childbirth was described as divine consequence — and argued that relieving it interfered with God's intention. Some medical professionals warned that chloroform was simply too dangerous, with a narrow margin between effective dosage and fatal outcome.
Victoria, characteristically, was unbothered.
And her influence proved decisive. When the Queen of England — the most publicly scrutinized woman in the world — openly endorsed pain relief during childbirth and suffered no ill effects, the argument shifted. If it was safe enough and acceptable enough for the monarch, the moral and medical objections began to lose their grip.
What had been scandalous became standard.
Within a generation, anaesthesia during childbirth moved from dangerous controversy to accepted medical practice — not because of a scientific paper or a parliamentary debate, but because one woman decided that unnecessary suffering was not a virtue, and said so loudly enough for the world to hear.
She was the Queen. But in that moment, she was also speaking for every woman who had ever had no choice.