Film actress and television host Ricki Lake, twice pregnant (in real life and also in the movie Mrs. Winterbourne, alongside his royal hotness, Brendan Fraser), brings one of her birth experiences to the silver screen in The Business of Being Born. Upset with the hospital birth experience the first time, Ms. Lake opts for a home birth the second time (Go Ricki! Go Ricki! Go Ricki!). Her second son, Owen Sussman (now 9 years old), greets the world in gooey glory about 45 minutes into the movie, so you know it’s good. The only thing that might have made it better is, as is the case for all movies, Brendan Fraser.
Somewhere between Frontline and Fahrenheit 911, this documentary presents a fact-based albeit slightly sanctimonious (and one-sided) examination of midwifery (mid-whiff-er-ee) and birthing options in America. The statistics are frequently sobering – the one that really stuck with me was that, in 1900, 95% of all U.S. births took place at home, which was down to 50% by 1938 and <1% by 1955 (where it is today). The movie partially credits hippy communes with the “rebirth” of midwifery in the U.S., noting necessity and the empowerment aspects of home birth.
One part my mom certainly agrees with is the discussion of how U.S. women don’t have an accurate image of what natural birth looks like, particularly when all their preconceptions (no pun intended) come from television and movies. Screaming, agony, hospitals, gurneys. As Sylvie Blausten, Owner and Director of Midwifery of Manhattan, puts it: “Why should women feel confident about giving birth when the whole culture is telling them this is scary, this is dangerous.” The scary part for me, though, came in this movie. Like when they started talking about the “your baby’s in danger card” which, according to the interviewees, is a manipulative tool for when women giving birth start to question the need for all this intervention. The medical providers tell them “your baby’s in danger” and the options are quickly reduced down to whatever they say, part maternal instinct and part power disparity (doctor = “expert”).
There’s also a humorous animated montage depicting hospital care as a pharmaceutical-ridden conveyer belt of pain transporting induced moms straight to surgery. The film discusses the rise of the cesarean section, which went from 1 in 15 live births to 1 in 3 during the course of my lifetime. During LSRJ’s Reproductive Justice Intern Training Day, I learned that, as a lawyer, I have almost no shot at having a vaginal birth in a hospital. And neither would my spouse (if he were a woman and I lived in an awesome state). The movie supports this, noting the increase in cesarean sections is due in large part to litigation concerns. I did a little research on this and found that, in the early 1990’s, a CDC report included a recommendation for a reduction in the rate of cesarean sections because “there is little evidence that maternal and child health status has improved [during the period of increase] and because cesareans are associated with an increased risk for complications of childbirth.” At that time, 23% of live births were by cesarean and, instead of a reduction, the rate has since risen by over 50%.
The director became pregnant while the movie was filming and she takes the audience through her home birth planning. She ends up going into labor about a month early and her son is breech. On the advice of her midwife, everyone jumps into a cab to get her to the hospital. I wish they’d have had the camera on the surprisingly cool taxi driver’s face when she announced her water broke a couple blocks from the hospital. They show footage of the cesarean and it poses a fascinating and ironic comparison to the real-time home birth scenes in the film.
Watching this movie came super close to making me refuse to even drive past a hospital while pregnant. However, I happen to know an OB/GYN who is pro-midwife and also my hero. I started going to her after reading her legislative testimony opposing Alaska’s SB 30 – an attempt to mandate a 24-hour waiting period before obtaining an abortion – which she told the senate committee “is discriminatory” and “makes no sense for any form of health care.” She talked about how women coming to her seeking abortion were courageously defying a society “where women are not allowed to put their needs first.” She even took on the system herself a few years ago when the local hospital felt she wasn’t performing “enough” cesarean sections (10%) and revoked her privileges. So, although the movie maligns doctors a bit (particularly in the discussion on cesarean sections), I know it doesn’t have to be like that. In fact, for when the time comes, I’m counting on it.
When I spoke with my OB/GYN about this blog, she made some fascinating observations that I hadn’t considered. For instance, in 1900 (when only 1% of births in the U.S. took place in a hospital), the U.S. boasted around a 1 in 100 maternal mortality rate, as compared to the around 1 in 7,500 today – the result of (a) smaller families; (b) antibiotics; (c) blood banks and control of postpartum hemorrhage; (d) earlier recognition and care of preeclampsia & eclampsia; and, (e) earlier recognition and treatment of ectopic pregnancies.
She agrees that the medico-legal climate is contributory to the rise in cesarean section rates, but notes that a workable and immediate solution would involve changing the insurance reimbursement schedule, meaning have the most money paid to vaginal birth after cesarean (also known as VBAC) and the least money paid for primary cesarean sections. Of the movie, she noted:
This movie undermedicalizes home birth. “The Manhattan midwife did not wear gloves delivering babies. Most notably, they never showed her checking maternal or fetal signs in labor. I think there was one example at a prenatal check.” Further, the director’s pre-term breech by cesarean section was a disaster. “The condition developed while under the care of Manhattan midwife and she failed to diagnose the decreased fetal growth and malpresentation. She got off the hook while the [director] attempted to blame the valiant doctor who did not abandon her in a time of need. He accepted her decision to transfer and care and her choice of home birth. He graciously said that he would ‘be available if she needed him.’”
She also told me she had heard the doctor in the movie was ostracized after the film for advocating alternative care. When I contacted him, he said this was indeed the case – that after screening the film to around 200 OB/GYNs, they were not very welcoming, a reaction which surprised him.
Although I am not a fan of scare tactics, I think the film does alright from an advocacy perspective. Even if it tilts the scale a little, it’s still telling an often silent story. There are people out there who had no idea any of this was possible, let alone prevalent. And if it helps a single woman not get shanghaied, blindsided, or bullied out of her chosen birth experience, I’ll quickly forgive the overarching but reasonable bias. I even teared up a little during a few of the home birth scenes, succumbing to the “power of birthing.” All in all, a decent non-fic flick, interesting and enlightening.
The Business of Being Born
Starring: Ricki Lake
Directed by: Abby Epstein
Year of Release: 2007
Duration: 85 minutes
“Professional” opinions of the movie:
My Favorite Quote:
“This blaming of women is farcical. It’s not about mothers, it’s about the way we treat care in the United States.”
Can’t get enough Ricki? Follow her tweets @Msrickilake and check out her 2009 book Your Best Birth, an examination of birthing options emphasizing informed decision making.