Four years ago I was traveling through India when I came face to face (as it were) with the reality of the ‘Sphincter Law’. First allow me to describe my experience, as I think that it will illustrate why Ina May Gaskin has so termed this ‘law’.
When I arrived at Amma’s ashram, I had hitherto avoided the foot-tread toilets for the necessity of pooping. (I tried to think of a better way to say it - but couldn’t - so there it is!) So here I was, my very first experience relieving myself on anything but an English toilet, and my sphincters locked up. The area was somewhat private, but I knew there was a line waiting for my stall and just a short wall between me and everyone else. With the pressure of people waiting, my body not knowing how to handle this new experience and not wanting to spend too much time in my stall, I literally had to ‘doula’ myself through the experience. So I shut my eyes, pretended I was by myself and kept repeating a mantra, “Open! Let go!” I consciously softened my mouth and my jaw, knowing that there is a direct correlation between a tight throat and a tight bottom. Eventually, my body relaxed and I was able to go.
So what does this very personal toilet experience have to do with birthing??? Everything! Take my experience and translate that into birth. Imagine you are in a hospital, with unfamiliar people and bright lights, exposed in a revealing hospital gown, a clock ticking and people continuously checking to see if you have progressed. Does this sound like the ideal situation to allow your body to open up? Could you possibly poop in this situation? At least pooping you do on a regular basis so there is familiarity with it and very little pressure. How can we expect the laboring mother to feel comfortable enough to open her body and birth her baby in these circumstances?
Ina May Gaskin describes the Sphincter Law in the following way:
o Sphincter muscles of both anus and vagina do not respond on command.
o Sphincter muscles open more easily in a comfortable intimate atmosphere where a woman feels safe.
o The muscles are more likely to open if the woman feels positive about herself; where she feels inspired and enjoys the birth process.
o Sphincter muscles may suddenly close even if they have already dilated, if the woman feels threatened in any way.
One way we can help a mother adhere to the rules of the Sphincter Law is to allow her to have a sense of privacy with as little distraction as possible. Keep the lights low, the traffic in and out of the room to a minimum, and try not to stimulate the neocortex (the ‘thinking mind’) with unnecessary questions. Even if there is a schedule within which she needs to fit in accordance with the hospital’s protocol, do not let her know that. When the mother is feeling safe and cared for, her body will respond. The sphincters will open, and her baby will come out more easily, with less stress for all involved.
Open! Let go! And always, always obey the law! 
Below is a clip of Ina May Gaskin at a lecture at The Farm talking about the Sphincter Law:
Ina May Gaskin and the Sphincter Law
December 9th, 2008
I love when a study comes out that supports normal, healthy birth. This fall’s edition of The Journal of Perinatal Education features the article “Doula Care For Middle-Class Women With Male Partners Substantially Lowers Cesarean Rates”. The article describes a recent study that demonstrates some of the benefits of having a doula present.
Of course, being a labor support doula, I am a little biased towards the rewards of having continuous labor support from someone in addition to one’s partner. But more importantly, this study is relevant because of the negative press doulas are getting lately in mainstream America. Last year in the New York Times, Pamela Paul wrote a not-so-supportive piece, And Doula Makes Four, about problems with doulas in the labor and delivery room. Just a few weeks ago, The Today Show aired a segment about doulas in which a doctor discussed how bothersome doulas were at her hospital and in fact, that particular hospital has banned doulas from coming into the labor and delivery room. I would be curious to see that hospital’s cesarean rate! The segment, especially the written transcript, did try to create some balance by highlighting some of the positive aspects of having a doula present. However, the piece did not provide hard facts about the upside of adding a doula to the support team. That is why I am thrilled to share some of this new study:
A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery Rates
Authors: McGrath, Susan K.; Kennell, John H.1
Source: Birth, Volume 35, Number 2, June 2008 , pp. 92-97(6)
Publisher: Blackwell Publishing
Background: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery. Methods: Nulliparous (First time mothers) women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner.
Results: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively.
Conclusions: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula. (BIRTH 35:2 June 2008)
I like facts and studies. I know it makes me slightly geeky and maybe it is the result of having a lawyer for a father, or being part of the Lamaze Association (I am also a certified Lamaze teacher), which is always impressing on me the importance of substantiating the work with evidence-based research. Whatever the reason, it feels very empowering to have current research supporting a topic that is near and dear to my heart and that lately has garnered some negative attention in our society.
December 3rd, 2008
