Easing Tension and Fear in Natural Childbirth by Understanding Sphincter Law: A Conversation with Ina May Gaskin

By Erika-Marie S. Geiss

According to the December 2007 report "Births, Preliminary Data for 2006" issued by the National Vital Statistics System at the Centers for Disease Control: "The cesarean delivery rate in the United States increased in 2006 to over 31 percent, a new record high and further evidence pointing towards a nationwide change in obstetric practices. The cesarean rate has increased more than 50 percent over the past decade." Among the mitigating factors for planned or scheduled caesarean deliveries are multiple births, obesity, and other health considerations as well as maternal choice for a variety of reasons. Sometimes voluntarily opting for a scheduled cesarean delivery is related to a lack of preparedness and fear about the natural childbirth process (as opposed to taking control of it as a recent article by Alice Park in the April 28 edition of Time magazine asserts is the evolution of childbirth).

Among the preparedness tips and suggestions for mothers who want to deliver naturally, Ina May Gaskin's Sphincter Law is rarely cited in mainstream publications geared to pregnant women or those trying to conceive. Teaching pregnant women to understand the cervix as a sphincter is an unfortunate omission in the literature and discussion for labor and delivery. Becoming equipped with the knowledge of Sphincter Law could not only change women's attitudes towards natural, vaginal delivery, but could also give pregnant women more control over their experience in the third trimester and during labor and delivery itself.

The mother of one child, and labeled elderly prima gravida when pregnant, I had an unmedicated vaginal delivery without any complications, to which I owe Sphincter Law a lot of credit. While trying to conceive and during pregnancy, among the many texts I read were Ina May Gaskin's Spiritual Midwifery (1977) and Ina May's Guide to Childbirth (2003), which is where I first learned about Sphincter Law. There was something about Sphincter Law that made sense, especially during my third trimester when my son seemed to live perched on my intestines and bladder, making waste elimination beyond uncomfortable. Employing Sphincter Law during my third trimester not only eased the difficulty of going to the bathroom, but afforded the opportunity to practice it, thus preparing myself physically and mentally for a natural delivery.

Several months after my son was born, I had the opportunity to speak with Ina May Gaskin about the genesis of Sphincter Law and how and why it works. Gaskin is the first to have discussed the cervix as a sphincter, tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. In effect, the sphincters include any of the bodily openings from which an organ expels an object whether it is air, waste, or a child. Human socialization has taught us keep our sphincters in check?asserting control over them so as not to be inappropriate or impolite. This same control, however, can serve to hinder the natural childbirth process, but understanding and using Gaskin's Sphincter Law can instead help and ease both the tension and fear associated with natural childbirth.

Erika-Marie S. Geiss: How did you discover Sphincter Law?

Ina May Gaskin: I discovered it through observation, particularly with one of my patients who was also a singer. During a difficult stage in her labor, I knew that she could not bear to hear or sing a wrong note, so I had her sing. It was purely instinctive on my part, to have her sing, because I realized that if you want the bottom end to do something, yet you can't control it, then [you have to] work on the top end. By breathing deeply so that the middle expands, and you open your upper openings (the mouth and larynx), then the other openings will follow and also open. It's the principle of "as above, so below."

Geiss: For those readers who are not familiar with your work, what are the basics of Sphincter Law?

Gaskin: When the voluntary muscles get tired, the sphincters don't get tired. Those are connected to the organs that fill up with something?the bladder, uterus, intestines. They expand and contract, and when they yawn open, whatever is inside comes out, and then they close again. But, they work better in privacy?they're shy?and this is true of humans and most animals. We seek privacy to allow our sphincters to do their jobs, jobs that at the most basic level, have to do with hormone levels in the body. For example, oxytocin levels in blood rise when something big comes out (whether it's a baby or a bowel movement). Laughter is one thing that can help open the sphincters. I ask women to laugh when they're having a baby because it helps the process along; it also adds to oxytocin and endorphin levels. But on the converse, if someone is afraid or feels violated, for example, the sphincter can slam shut [what is sometimes called cervical reversal].

Geiss: How did you come up with the term?