Review – The Business of Being Born

The Business of Being Born is a documentary film on childbirth practices in the United States directed by Abby Epstein and produced by Ricki Lake. It was inspired by Lake’s first hospital birth, after which she felt that there must be a better way for women to give birth, and set about finding out how and why midwives are supporting that very thing.

The film follows several women throughout pregnancy and labor, primarily depicting midwife-assisted home births and dispelling the myths of home birth as necessarily unsafe and of midwives as eccentric hippie women. In fact, the midwives in the documentary are women who could be your neighbor or your friend, trudging around New York City in taxis in order to help women give birth in supported, non-interventionist environments. In other words, normal.

The births we see on screen, however, are anything but normal under today’s active management of labor – they starkly illustrate how different a physiological birth can be as compared to the restrained, flat-on-her-back screaming and poking of the hospital environment. Although many of the physicians interviewed said they had never seen a normal birth, the viewer is treated to something that feels just right – women in a comfortable environment, supported by caring and skilled individuals, rocking their hips and giving birth with a grunt and a smile. The imagery of the medically managed woman with her whisked away infant, separated and left lying alone on a table, could not contrast more with the imagery of women who are instructed to “reach down and take your baby,” whose babies are immediately cradled against their damp skin and welcomed into the world in a hands-on, not instruments-on, manner.

The film also incorporated historical trends in the management of labor that clearly demonstrated how much of what was done, as is being done now, was not properly understood at the time for the real or long-term effects on women and babies, such as anti-midwife propaganda despite higher death rates in hospitals, and the use of thalidomide and cytotec. It reminds us that many of the interventions used so commonly today are often not medically necessary, and that very few have stopped to ask an extremely important question – is this helping or harming?

The Business of Being Born has two major strengths. The first is that important information about the cascade of interventions in managed birth, U.S. practices vs. other countries and the resulting outcomes, drugs, c-section rates, and medical evidence is presented in a way that is accessible and informative even to those who are taking their first look at birth issues. The relevant information is conveyed alongside the women’s stories, leaving the viewer better informed without beating her over the head with medical jargon and data, making it a perfect introduction to the topic for those who have not already immersed themselves in the literature of birth. There is a growing contingent of women who are informing themselves and speaking out on birth practices, but this film presents the story of birth management in a way that could reasonably encourage the uninitiated to seek more, and to speak up.

The second major strength is that the film clearly locates birth issues inside feminism and choice, noting the power disparities of the traditional hospital birth system, the often misguided focus on outcomes and potential litigation that ignores women’s needs and experiences, and the empowerment that many women feel when able to give birth on their own terms. The film notes the current emphasis solely on “taking a healthy baby home” and the playing of the “for the baby” card in hospitals that strips women of their ability to fully participate in a life-altering experience, and contrasts this with home birthing women who state afterwards, “If I could do that, I can do anything.” While the documentary does not suggest that the outcomes for babies are not important (as anti-home birth/anti-midwifery folks often seem to think), it does clearly illustrate how women are ignored, under-informed, over-powered, and failed by the current system. As Aunt B notes, “Women getting dicked around by the system is always a feminist issue.”

I would recommend this film to anyone who has given birth, plans to give birth, knows someone who might give birth, or assists women in birth. In other words, just about everyone. A list of upcoming screenings is available, and the documentary is expected to become available via Netflix in February; it can be saved to your queue now.