Understanding Birth and Sphincter Law: Page 2 of 2

• owner. This other person might be the mother of toddler or a midwife assisting a woman giving birth
• The opening of sphincters can be facilitated by laughter (the owner's)
• When a person's sphincter is in the process of opening, it may suddenly close if that person becomes frightened, upset, embarrassed, or self-conscious. This is because high levels of adrenaline in the bloodstream do not favor (sometimes they actually prevent) the opening of the sphincters
• The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, the vagina, and the anus to open to full capacity. A relaxed and open mouth favours a more open vagina and cervix.

I would argue that Sphincter Law may apply in both the first and second stages of labour. In the first stage, most of us who have been midwives for several years have noticed that, once in labour, a woman's cervix will occasionally close. I described the first such case (Gaskin, 1978), but I have found no other documentation in the 20th and 21st century medical literature of this rather common phenomenon. I have, however, found frequent mention of it in the obstetric literature of the 19th century, when most women still gave birth at home. (Betschler, 1880; Cazeaux, 1884). There are other features of Sphincter Law (Gaskin, 2003).

How different might be the outcomes of childbirth be if the principles of Sphincter Law were observed in modern hospital maternity units? No longer would people enter the birth room without the consent of the mother or the trusted person assisting her. No longer would physicians, midwives or nurses exhort women to push harder and harder in an effort to beat the clock. No longer would women's labours be labelled 'dysfunctional' simply because they decrease in intensity because of emotional factors or a lack of privacy. No longer would there be large clocks on the wall of the birth room.

I do not suggest that conscientious understanding and observation of Sphincter Law would remedy everything that I find puzzling, illogical or unhelpful in the medical model of maternity care. However, I do strongly feel that incorporating the implications of Sphincter Law would go a long way toward ameliorating a lot of what is wrong with maternity care today, and would definitely lower the incidence of episiotomy and perineal damage.

INA MAY GASKIN Midwife, The Farm Midwifery Center, Tennessee

Betschler (1880) In: Engelmann G. Labor Among Primitive Peoples. AMS Press, New York

Cazeaux P (1894) Obstetrics: The Theory and Practice. 7th ed. P Blakiston, Son & Co, Philadelphia

Dewees WP (1850) Compendious System of Midwifery. 4th edn , Carey & Lea, Philadephia

Curtis A (1846) Lectures on Midwifery . Carey & Lea, Philadelphia

Gaskin IM (1978) Spiritual Midwifery . The Book Publishing Company, Tennessee

Gaskin IM (2003) Ina May's Guide to Childbirth . Bantam/Dell, New York

Newman WA (1901) Modern Obstetrics . Dorland, New York

Ramsbotham F (1961) The Principles and Practice of Obstetric Medicine and Surgery . Lea & Blanchard, New York

WHO (1985) Appropriate technology following birth. Lancet 2: 1587-88