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Re: The 'Infamous' Ina May GaskinFrom: Anna Meenan, MD (annam@uic.edu)Mon Sep 25 13:15:31 2000
At Sat, 23 Sep 2000, Luis Sanchez-Ramos, MD wrote: > >I get the feeling that there are a lot of Gaskin "fans" on this list. >You can definitely count me out. I hope her statistics are more >credible than her statements on misoprostol and other subjects published >in her midwifery magazine. >A cesarean rate of 1.4% is reasonable for a midwifery practice >performing deliveries outside of a hospital. First of all we must all >remember that she couldn't perform a cesarean if she wanted to. >Therefore, patients are permitted to labor longer than usual. My >personal cesarean delivery rate at the University of Florida Health >Science Center in jacksonville is less than 5%. We are a level III >(regional perinatal care center)and take care of mostly indigent and >very high risk women. Our overall cesarean rate in 1990 was 8.5%. Thus >a cesarean rate of 1.4% (even if it were true) does not impress me that >much: those are very low risk patients! >With regard to the maneuver she claims to have "invented", it was >practiced in the continent of Africa before she was even born. >I doubt very much that members of an academic institution(Vanderbilt) >would bother to even go to listen to her. She would be lucky to have a >couple of midwives in the audience at our Grand Rounds. >A few months ago I wrote a "Letter to the Editor" in response to some >irresponsible claims she made against the use of misoprostol for >cervical ripening and labor induction (on the internet). She took my >letter and statements and entered them in a "debate" (in her midwifery >magazine) on the subject of misoprostol. Of course, it was not a debate >since I didn't get an opportunity to respond to her unsupported claims. >I personally think that was very irresponsible. If at anytime she would >like to engage in a true debate with me on the use of misoprostol or any >other subject, I WOULD WELCOME IT! >With regard to her statistics on perinatal and maternal morbidity and >mortality: who knows if they are accurate? > Luis (and Daniel), Her statistics are both accurate and complete. She includes ALL her births in her statistics, no matter where the birth occurred. (if she excluded the ones that occurred in the hospital, I guess she would be claiming a 0% c-sect rate, now wouldn't she?) I found the statistics difficult to believe when I first read them (published in the appendix to the first edition of Spiritual Midwifery) In her first 372 births, there were two c-sections: one for transverse lie and one for abruption. I was amazed and did not believe them either. I wanted to see for myself, so I eventually visited the Farm. I have seen her birth log and even met some of her babies. She documents some of the stories behind her mortality statistics in her books. In fact, the first loss they experienced at the Farm was the loss of one of Ina May's own babies, born prematurely in a snowbound bus while they were still on the caravan. These statistics are REAL and she will defend them to anyone. They are broken down fairly completely in the Journal of Public Health article I cited in an earlier post. Regarding the all-fours maneuver, Ina May is well aware that she did not "invent" it and has never claimed to have done so. In a personal communication to me years ago, she said that folks had told her she should call it the Gaskin Maneuver and her response to that was that she preferred the all-fours maneuver because it was more descriptive, and thinking of it that way would help someone who had only heard of it but never done it to know what to do. She has frequently repeated the story of how she was taught the maneuver by indiginous midwives in the highlands of Guatamala, who, when asked where they learned it, only looked upwards and said "Dios". Credit was given to George Engelmann in our original article in the Journal of Family Practice (1991, vol.2 p.625), which I wrote after my first successful use of the maneuver. I was so amazed at how well it worked that I decided I had to let as many other folks know about it as possible, and bring it into the mainstream medical literature so it would be taken seriously. Our first article was followed later by Joe Bruner's article. He felt we needed to expose more obstetricians to the information. Incidentally, ACOG has also included it in their shoulder dystocia videotape, without giving credit to ANYONE. The Gaskin Maneuver label has been applied by Dr. Bruner and many other admirers of Ina May's work, and frankly I think Ina May is just a bit embarrassed by the whole thing, because she is a very modest person who is most concerned with the welfare of mothers and babies in all walks of life. Incidentally, she has spoken to standing room only crowds at many medical centers over the years.
--
Anna Meenan, MD, FAAFP
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