"The Business of Being Born"

Last night we watched Ricki Lake's documentary "The Business of Being Born". It has stirred up quite a lot of controversy for its very pro-home/natural birth and anti-hospital/intervention stance.

Basically, the movie talks about how the modern hospital birth is a bad thing. It points out that it is in a hospital's best interest to get the baby out as quickly as possible, and with that goal in mind they make decisions that are not the right ones for the mother. Most significantly they tend to rush into intervention options such as drugs and induction, both of which increase the chances of a Caesarean-section. A C-section is quick, easy and easily billable to the insurance companies. One interviewee in the movie noted that C-section rates spiked at 4pm and 10pm, and hypothesized that this was due to doctors either wanting to get home for dinner or for bed.

We agree with all of this, and my friend Eric, who has two kids, pointed out a very clear cycle that mothers must try to avoid in a hospital delivery:

• Labour is not progressing "fast" enough e.g. cheaply enough for the hospital
  
• Doctor prescribes pitocin (a drug that induces labour contractions)
• Pitocin creates unusually strong contractions
• Strong contractions require pain management
• Pain management (epidural) slows down labour
• More pitocin required
• More drugs, more pitocin, stronger contractions all lead to putting the baby in distress
• C-section

He noted that any interventions (e.g. drugs) set in action a course of events that make it difficult to predict and increase risk - 70% of inductions end in a C-section. Once you're at the hospital, you're on their timeline, and although you can decline any intervention, all it takes is for them to say "the baby is starting to get in distress, we should do XYZ" and the parents will do what they say. The movie made the same point.

However, where the movie's opinion and ours diverge is with the conclusion that the only "real" option is a home birth. Taking Eric's advice and the advice of birthing professionals, it seems that the way around this is to not go to the hospital until you're absolutely ready. This means one full hour of strong contractions, five minutes apart. Then you call the doc. Only then do you go in. By that time, you're well on the way before the hospital timer even starts ticking.

Home birth is simply not what we want. We can weigh the possibility of a "normal" birth going into the progression above in a hospital, versus a home birth going wrong to the point of needing immediate emergency medical attention, and it's clear that the downsides of one (a birth that yields a healthy baby and mother, but does so in an unideal way) far outweigh the other (complete maternal haemmorhage in less than five minutes). Nope, we'll stick with the hospital, but we'll try to be disciplined about when we go in and how we stand up for ourselves against intervention when we get there.

You would think that a movie that primarily deals with the well-being of women and their babies would be lauded by feminist commentators, but that has certainly not been the case. Check out this article from Salon.com's Rebecca Traister, who regularly writes on women's issues. She takes major issue with how the movie portrays a "best" way to deliver, somehow denigrating any birth that doesn't fit that mould. Traister points to a terrific New York Times article that profiles the midwife most prominently featured in the movie, expressing the same concerns about the home birth approach that we have. Traister asks why giving birth should be "a contest about who feels better about themselves or more at one with their bodies", and suggests "not buying into the idea that birthing choices become your earliest parenting gold star or your scarlet letters of birthing shame." Her conclusion is that "all the bellowing [presumably pointing to this movie as an example of such bellowing] on either side only work to make women feel underqualified for motherhood right from the start." That certainly sounds like the words of a feminist, and I'll be the first to agree with her.