Photo by: NCA

Is Birthing a Business?

Photo by: NCA

Last week, I picked up The Business of Being Born from the library. It’s a documentary made by Ricki Lake and Abby Epstein about birth in the United States. I’m very interested in the topic, and lately have been reading and looking on the internet. No, I’m not pregnant, and it’s actually possible that I won’t be pregnant again. But I feel that after my own birth experience, I became even more interested in other women’s experiences and what birth can be.

This was a very informative movie. Yes, it is one sided. But I think that a lot of valuable information is included about how we see birth in the United States.

I thought about having a midwife for my son, but never did anything about it. I liked my OB, in hindsight he wasn’t the best before conception and should have referred us to a fertility specialist sooner, but as far as the pregnancy and birth went, he was great. Midwives attend over 70% of births in Europe & Japan. In the United States, it’s less than 8%. In the movie, they point out that very few doctors have ever observed a normal, natural birth in med school or at the hospital. Obstetricians are trained surgeons. That’s what they are trained to do. Midwives are trained to help women give birth, and to help their bodies do what they are supposed to do. Dr. Jacques Moritz, one of the doctors featured in the film, goes as far as to say “For a normal, low risk woman, it’s overkill going to a doctor. It’s just too much, the doctor’s not really excited about things when they’re normal.” -Dr. Jacques Moritz, St. Luke’s Roosevelt Hospital.

The bottom line is that the average labor is 12 hours, a c-section takes 20 minutes. Peak times for c-sections taking place are 4 pm and 10 pm. Once you’re in a hospital setting, it’s almost certain that you will be in one of two situations. Either your labor will progress so fast that drugs are not an option, or you’ll be given pitocin to augment and speed along your labor. Once that pitocin drip starts, you’re on a slippery slope into a situation that starts to snowball. I experienced it during my labor – I new when they gave me pitocin that I wanted the epidural first. Pitocin pushes you into hard labor fast. Without drugs, it can get really painful really fast without working up to it. 90% of patients at some hospitals are put on pitocin. The pitocin leads to an epidural, which can lead to slowed labor, more pitocin and contractions that are so long and hard they send the baby into distress, leading to a c-section. If pitocin hadn’t been given in the first place, a lot of mothers might be experiencing a more normal and natural labor instead of major surgery. Speaking of which, it seems like people forget that a c-section is a major surgery. The more you have, the higher the risk, and sometimes it can lead to antibiotic resistant infections. Yet, in subsequent pregnancies, many doctors will not recommend a vbac (vaginal birth after cesearian). Maybe they’re afraid of getting sued, maybe they want to take the route that’s easier on the schedule and just get that c-section fit in to a day at work. Whatever the reason, many women who could easily and safely experience natural childbirth after a c-section are not really given the opportunity. I think that a lot of women don’t know, or it doesn’t occur to them, that they can choose to switch doctors or fight harder if it’s something they really want. We tend to blindly trust in medical professionals even when we might have a few doubts.

I knew before I went into labor that I wanted to try something different. I knew that birthing laying down on your back is not ideal, and I wanted to try squatting with a birthing bar, but the epidural made that impossible. One of the doctors in the film pointed out that the vertical birth (squatting or sitting up) is on the mother’s time and will happen more smoothly on it’s own.
There was one video of a woman giving birth at a birthing center. She was in the position that felt comfortable for her, leaning against a bed with her knees slightly bent. The midwives/support people were all squatting around her, on the floor, accommodating HER. It immediately came to my mind that this is the way birth SHOULD be.

I totally agree with the point they make in the movie that women in America don’t have a normal picture of birth – TV shows screaming women and chaos, and women become afraid of the experience of giving birth. now, I think a certain amount of fear or reverence is healthy, but I definitely think I was more afraid than I needed to be about giving birth and the labor process. I was provided with plenty of images of hard births, of sweating and screaming. I was not provided with any images like some of the ones in the video, women birthing quietly, peacefully, on their own terms. There were a couple of videos of home births with midwives in the movie. One in particular was amazing, an African-American woman giving birth in a birthing pool. She moans during labor, but the delivery is serene and peaceful and almost spiritual. Ricki Lake had her 2nd birth at home and had her baby in the bathtub. Not as quiet, but also obviously a transcendent moment.

I think we should be asking ourselves why the US has the second worst newborn death rate in the developed world. We also have one of the highest maternal mortality rates in all industrialized countries. Dr. Michael Odent, one of the doctors featured in the film says “The fact that midwives have disappeared is a symptom of the fact that we no longer remember what women in labor NEED [basic needs]. Today what we need to discover is how easy birth can be.”

Why is home birth ‘abnormal’? In 1900, 95% of births took place at home. In 1938 it was down to half, and today less than 1% of births take place at home. It’s really interesting to me, because just like the doctor who said that a doctor may be overkill for a regular birth, perhaps it’s true that a hospital may be overkill for a normal, uncomplicated birth. Women had their babies at home for hundreds and hundreds of years, and in many parts of the world, that’s still the norm. But because of the way that birthing is portrayed in our society, I don’t think that most women even consider home birth an option. Going to the hospital is just what we do. But, guess what? Midwife/home birth can run $4000 while a normal hospital birth can run $13,000. We spend twice as much in the US per birth than any other country in the world. Why?

In the 1970s, fetal monitoring started to become the norm during labor. The c-section rate went from 5% to 25. By 2005, it was up to 33. Sometimes, having too much information might not be a good thing. Fetal monitoring allows the doctors to see every tiny thing. In some cases, it probably does save mothers lives and babies lives. But it’s also worth thinking about what is being ‘too careful’ and leading to unnecessary interventions for mothers and their babies.

At some point during the movie, someone wonders if there could be a link between ADD, Autism etc. and birth interventions. Now, I freely admit that I don’t know any facts about this, but it’s an interesting idea. We could discover later that certain things being done now are having effects we don’t know about (like Thalidomide). It’s always a possibility.

Oxytocin, the natural chemical released during labor, birth and breastfeeding, promotes maternal aggression. They are a love hormone, create a state of dependency, addiction, attachment and maternal protection of the baby. Pitocin doesn’t affect the brain the same way. could this be having an effect on the way we bond with our babies? In my mind, undoubtedly it causes changes. I’m not saying that it’s the same for all women, but I wonder how many of the women who are not able to bond with their child right away might have been able to if they’d had a more natural labor? It’s incredibly sad to me. It makes me wonder what I would have felt during birth if I’d held out and not augmented so soon, how much different would my experience have been? What would I have felt?

The filmmakers still believe that there are many options for every woman. Abby Epstein, the director, is pregnant and before the movie is over she goes into labor early and ends up having a c-section because her baby is breech and can’t be turned. And it’s okay, because that’s what is best for that baby and that mother in that particular situation. Despite the fact that the film is providing information that is obviously skewed in one direction, I didn’t feel like it was condemning any women for their choices. It’s facts, it’s information, it’s another side to the story.

I don’t know if I’ll ever have another baby. Right now we’re on the fence, and we’re just not sure if another child is in the cards for us. If I have another one, I’ll do things differently. I will check out the birth center here in Bellingham, and I will probably try hypnobirthing, and maybe water birth. I will try going much further into labor before asking for drugs. I wasn’t at my breaking point last time, I only got the epidural at that point because I knew the pitocin would throw me into hard labor. If I knew then what I know now, I would have waited longer before getting the pitocin, if I got it at all. I’m sharing this stuff because I think it’s important, I think that women need both sides of the story before they make their decisions, and a lot of the time they’re not getting that.

How was your birth experience? Would you have done anything different? Did you do things differently with your first, second, third?

Rachael Heiner is a mom, writer and avid reader from Bellingham, WA. She has a three year old ball of energy and is expecting her second child in May 2010. She loves connecting with other moms through her blog and sites like!

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I recently watched this video. I am pregnant with my 6th child and decided to use a midwife this time. Part of my decision is b/c of my age (40) and the way traditional docs treated me. I feel like I am receiving the best care EVER with my midwife!! I also have been taking Bradley Birth Classes which have been very helpful and I highly recommend...

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I just wanted to comment that you can have pitocin and still have natural childbirth. I had pitocin with my third baby and was in labor right away with strong contractions (but for the most part I labored quietly with my husband) for 7 hours and never had any drugs or epidural at all. Just focus on the outcome and stay strong inwardly and it can be done. I also bonded right away with my baby.

I had a wonderful pregnancy and birth experience with my midwife. I felt very well taken care of during my entire pregnancy and the actual birth, which happened at a small community hospital. I was very clear about my expectations and what I wanted and my wishes were respected both my my midwife and by the hospital staff.
I actually experienced a "complication" towards the end of my pregnancy, as my baby was breech...

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Hi, just wanted to say what an interesting article that was. I live in England, and had home births with both my children, both 12 days past my due date, one lying on my side, and one on hands-and-knees. First labour was 3 hours, second was 80 minutes start to finish. I didn't see a doctor with either pregnancy - just midwives and sonographers. This is very common here - home births aren't 'common' but non-medicalised birth is and we have fantastic midwives here...

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Women need to be more diligent about protecting the right to birth how and where they prefer or the choices will be made for them. The system that is in place now in the US does not produce better outcomes for mothers or babies. Why have young women been made to believe that they can't birth a baby without medical intervention? As Mothers, Sisters, Aunts & Mentors to young girls we need to reinforce our belief that God's design of the female body is perfect...

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This is one of my pet peeves. I am appalled at the current percentage of c-sections. From what I hear women often buy into them because they believe them convenient.They prefer to SCHEDULE a birth for all kinds of reasons from avoiding tax season to avoiding the September first cut off date to enter kindergarten. It is shame that the media and medical world have convinced so many women that birth is too difficult to experience without drugs...

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My daughter had her baby in a birth center. her midwife and staff were great. The experience was wonderful. Afterwards was a nightmare. Right after the baby was born it became apparent that my daughter had a emergency situation. She was in horrible pain. She had a hematoma. They called the ambulance. It took 30 minutes or so to get her into the emergency room. (The hospital was very close.)They did not have an ob in the hospital. They sent her up to obstetrics without any treatment to speak of....

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I agree that the C-Section rate in the US is really high (partially because of women who want a C-Section, to avoid labor or for scheduling convenience!) A friend of mine who gave birth at a large hospital in Miami swears that every woman who was there at the same time as her who had insurance ended up having an emergency C-Section (including her, basically against her will.) All those w/o insurance delivered vaginally. That's definitely her perception anyway...

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I had both of my kids at home, and I also watched the documentary. While I'm so glad that it exists, I also felt it was very black and white. I feel like they either focused on hospital births with tons of medical intervention, or homebirths. They didn't let people know about birthing centers or even all the wonderful midwives that works with OBs in hospitals...

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I had a home birth 17 years ago, with a midwife--the midwife really wasn't the warmest person, no more "personal" than a doctor, but the overall experience was great. My midwife had a fully-worked out emergency plan set up, including notifying the hospital we would have used, that we might be coming in if there were complications. The nurse monitored my daughter's heartbeat with a portable monitor, to be sure that there wasn't any distress...

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I have now had two children and I have been very fortunate both times, but it was not without planning. Women must own this time - conceiving, being pregnant and then birthing - and learn as much as they can about each step. Also, it should be noted that being pregnant is 9 months of preparation for your labor. If you wait until the end to decide what you want, it will be too late and someone (like the doctor) will decide for you.

With my first child, I left my first OB at 28 weeks...

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I have given birth 4 times each very very different. First time was with a midwife in the hospital. I did not want to be in the hospital, but my husband insisted so I went. I really regret that. The birth was natural, but not a good experience overall anyway, my midwife did not arrive until just before our son was born, so my labor was "managed" by the nurse who I hated, knowing what I know now ( I am now a certified childbirth educator) I pushed way to early...

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Both my children were born in hospitals, the first w/ an OB (who previously had been my surgeon) the second w/ a midwife. Both were unmedicated, but the first was very hard, w/o any support besides my husband. The Dr came to catch the baby. He was literally there for about 1 minute before the birth. The second I had a midwife, doula, my sister, and an amazing nurse and my awesome husband and it was very gentle...

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Thanks for the article. I had also watched the documentary and thought it was great. I had a natural delivery in a hospital, but I did have pitocin because after 20 hours of labor, I was still at 2 cm. I had a midwife, who I really loved. I think the term "midwife" is scary to people. Hopefully more people will become educated on birthing!

Thank God for my OB and my C-section. Without it my beautiful son would not be here, and I might not be either. How about we let doctors and their patients, not actors, make medical decisions? The myth of the c-section scheduled for convenience, is just that, a myth. Studies have shown that fewer than 3 % of c-sections are scheduled for convenience or because mom is "too posh to push", and in those many of them are for moms who would have had to have a repeat section anyway...

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