2008 - 87 minutes

Abby Epstein .... director/producer
Ricki Lake .... executive producer
Paulo Netto .... producer
Amy Slotnick .... producer

Yes, there are spoilers in here.

A documentary about the medicalization of giving birth and the transformation of a powerful and natural experience into a scheduled event more about convenience. In the film the convenience aspect is not only one used more and more by New York mothers and celebrities such as Victoria Beckham, who scheduled her three births around her husband's soccer schedule, but a convenience for doctors as well. They stress how swift a c-section is, how hospitals are treating labor rooms much like restaurants treat their seating areas, something to be filled, emptied and refilled as quicly as possible. One of the most noteable statements made is how most c-sections seem to occur at 4pm and 10pm...when doctors want to get the heck home.

Another aspect of the documentary is the reintroduction of the midwife to the general public as more than backwoods character in a fairytale. Midwives seem to dominate other first world countries yet here, in the U.S., they struggle. Part of the historical reason for this, as presented by the film, was the rise in doctors that needed something to do. More doctors were graduated than jobs existed so the ob/gyn made an appearance and the safety of hospital births was advertised. Along these lines a smear campaign was instituted and images of dirty foreigners with captions reading 'would you want this woman delivering your baby?' illustrated the dangers of midwives. Today the word midwife conjures up images from third-world countries or closed communities, such as the Amish, for many. In truth midwives are commonly called Certified Nurse Midwives and work in hospitals and birthing centers as often as they work in homes. They have access to the same scalpels and medicines as most hospitals and the only thing they lack are heavy equipment such as fetal heart rate monitors.

This isn't to say that hospital births haven't saved many lives, but over the decades something has gone wrong in the process and now more women and babies are dying in the United States, where hospital births dominate, than in countries where midwives and at-home births dominate. Part of this can be explained, in my mind, by the rise in obesity in expectant mothers in the U.S. which can greatly complicate the entire experience. But another part of the problem is the way births are handled in hospitals. There are a series of interventions the film depicts that start a cascade of events that ultimately result in emergency c-sections to "save the life of the baby."

As a woman contemplating her own labor experience I found it interesting how these interventions, which are presented as being necessary by hospital staff, aren't always needed and lead to other interventions that are only necessary because of the earlier interventions. For example: When the doctor perceives the labor has gone on too long (remember they want to empty and refill those labor rooms) they give the woman pitocin through her IV. This intensifies contractions making them longer and harder to spead up the delivery. These longer contractions are much more painful so then they give the woman an epidural to numb the pain. This reduces the effect of the pitocin so they give her more of that. She can't feel the pain so much, but the longer contractions are more intense for the baby which causes their heart rate to skyrocket. This is picked up by the fetal heart rate monitor and interpreted to be an emergency by the doctor and staff and an emergency c-section is needed to "save the life of the child" all thanks to that induced labor.

What woman in their right mind would go through a process like this by choice? This is where we learn that women aren't exactly given informed consent during the delivery process and, as one woman admits in the film, it was really easy for the nurses to inject whatever they wanted into the already established IV without really informing or asking the patient.


Overall this film has received rave reviews despite almost completely lacking in a wide viewing audience due to limited showings.

Of the crackpot variety there were complaints about Ricki Lake walking around her home nude and what did that have to do with birthing babies. Lake's birthing scenes lasted maybe 5 minutes total of the entire documentary and the only portions really showing her own nudity were when she was in the bathtub. Ooo..boobies. Who cares? This is a film about giving birth, and as such I expected way more crotch shots than there were so I think a little boob action is negligible.

One of the reviews that I'm labeling crackpot but could potentially be legitimate is the complaint that Ricki Lake is in the documentary too much herself. It's too much about her, they said. It would have been better without her story in it. I have to say this is a load of bull hockey. Again, she doesn't dominate the film and frankly her telling her own brief story about her first birth experience in the hospital and how that led to her exploration of options, choices, interventions, etc. is sort of necessary so the viewer understands why this talk show host/actor is doing a documentary on this issue at all. I can understand why some people think the film maker shouldn't be in the film if it's going to be serious, but many documentarians do it and it is important for a certain amount of transparency.

A legitimate concern voiced by a reviewer is that it is one sided. And it is. In considering my own home birth I have come across some frightening stories about midwives that did something wrong and the baby died or was irrevocably damaged. Then these midwives aren't held accountable or are rallied around by other midwives, which I can certainly understand to a point but sometimes you have to admit when one of your own has caused damage to the profession, a life, a family. In the film they don't really address the 'things that can go wrong' aspect of home births, instead the film makes those that voice concern about home births as fear-mongerers who don't know what they're talking about. Newspaper clippings are flashed across the screen illustrating how midwives have been physically attacked and demonized throughout history as a tactic to get women into hospitals. Where were the newspaper clippings I've seen with neglegent midwives who have caused more harm than good? It would have been great if they had given us some idea of how to go about choosing the best midwife since all midwives are not created equally.

Of the many births depicted in this documentary, one at-home birth is shown that has complications and the mother and child are safely taken to the hospital where a back-up doctor addresses the breech birth by performing a C-section as well as getting the cord from around the baby's neck. In this instance the midwife was highly qualified, came prepared with a full medical onslaught, diagnosed the breech with plenty of time and got the woman to the hospital. This story wonderfully illustrated the importance of having a back-up doctor in place, though I felt they should have emphasized that a bit more and perhaps mentioned proximity to a hospital as an important consideration.

Overall I would count this film as a success despite its few flaws. It is an eye-opening experience for women who have not gone through the birth process yet as well as for the spouses, boyfriends and significant others of women who are expecting. We just assume doctors will do what is right, but we all know that in the U.S. today too many doctors, hospitals and insurance agencies are more about making money than they are about what is best for their patients.

For more info go to www.thebusinessofbeingborn.com

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