Despite living on a commune in rural Tennessee, Ina May Gaskin has had the kind of career success most people only dream about.

A midwife who never formally studied nursing, Gaskin has helped to bring home birth and lay midwifery back from the brink of extinction in the U.S.

An obstetrical maneuver she learned from the indigenous Mayans of Guatemala has made it into scientific journals and medical textbooks, and her insistence on the rights of a birthing mother empowered a generation of women to demand changes from doctors and hospitals.

With a lifetime of accomplishment, the 67-year-old Gaskin has earned the right to slow down. But that is the farthest thing from her mind.

“At the time we began, I couldn’t have dreamed that in 25 years’ time women would be actively seeking Caesareans,” she said.

Gaskin largely blames the nation’s rising maternal death rate on the increase in Caesarean section births and the drugs sometimes used to induce labor.

The National Center for Health Statistics reported last month that the maternal death rate for 2005 has risen to about 15 women per 100,000 live births, more than double the 1998 rate of 7.

At least part of that increase is due to better reporting, but researchers say Caesareans also may be a factor.

Promoting natural birth

Gaskin passionately believes natural childbirth is the answer. The number of women giving birth with a midwife has doubled over the last decade and accounts for about 8 percent of births today — the vast majority in hospitals. Still, she says it’s a challenge to promote natural birth to a generation that favors comfort and convenience.

Promoting home births is an even tougher sell. The American College of Obstetricians and Gynecologists has continuously warned against home births as too risky.

In 1975, Gaskin published “Spiritual Midwifery,” which included birth stories and a primer on delivering babies. Her book has sold around 750,000 copies, has been translated into four languages and has inspired a generation of women to become midwives.

Part of Gaskin’s success has been that she combines an analytical mind with an instinctual understanding of birth.

She promoted the idea that a woman’s state of mind will influence how easy her birth is and encouraged unorthodox ways to improve the woman’s experience, like encouraging her to make out with her husband during labor.

At the same time, she kept detailed records of each birth, providing her commune, The Farm, with statistics that would prove important in the debate over the safety of out-of-hospital births.

She has tried to widen the reach of her message by airing natural birth videos from The Farm on television. “The women are so beautiful giving birth,” she said.

TV stations rarely have run them, calling them too graphic.

“I started to think I should put them on YouTube,” Gaskin said.