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 Mamapedia.com!

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138 Comments

I'm French but have been living in the United States for the last 4 years and my two children were born in Boston.
My belief is that being pregnant is a blessing, not an illness. When sick, I go to the doctor, when pregnant, I look for peer support. I had an amazing experience with midwives. They offer an amazing care, appointment were more about how I felt than about medical numbers (but they still performed all testings, measuring.....

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Thank you for your continuing to let people know about importance of letting women take charge of their bodies and their births. Too many women are scared that they'll F-up giving birth, but the truth is women get to the hospitals, a strange environment, and then freak out then their bodies start to stall the labor and the doctors think there's something wrong and immediately go to do c-sections...

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I had my first baby in the hospital with an OB, but I was fortunate enough to have a doctor and hospital that were extremely supportive of natural childbirth. I arrived at the hospital after laboring at home for 14 hours, and as soon as I was checked in I got to labor in an oversize jacuzzi tub until I was ready to push. I was pacing around the room when I started pushing and naturally leaned on the bed during contractions...

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thank you so much for this post. i am amazed that only one response was unsupportive of your position! and that person apparently hadn't read your post carefully enough to notice the unjustifiable increases in the numbers of c-sections in this country. the numbers speak for themselves. maybe she's a doctor or married to one and just can't step back and see the big picture due to emotional involvement.

anyway, i birthed at home for 51 hours. it was a totally normal, LOOONG labor...

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I had a hospital birth with my first and a homebirth with my second. We chose very medically minded and well trained midwives who gave me MUCH better care than my OB did. They helped me avert the first "emergency" I had. I had a natural, normal childbirth experience and although, I don't think it's the right choice for everyone. It was the right choice for our family. "The Business of Being Born" is not the only information that should be researched but, hey, it worked for me...

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Wow that was, interesting. Had I not been at the hospital no i wouldnt have been induced but i for sure would have died. I had severe high blood pressure. I was in a coma most of my labor. the fact that people think its safer to do it at home is insane to me. and fyi an epi does not slow down labor. and the ting about doctors wanting to do a 20 min surgery over labor....

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Hi!
Your info says you're expecting in May 2010. Congrats!! It's not too late to begin HypnoBirthing and have a wonderful experience. In fact, it is the pwrfect time to begin HypnoBirthing. Why not have a comfortable, easier birth? I am a certified HypnoBirthing instructor in Massachusetts. I had my 2 babies with HB and it was amazing. One was a beautiful natural birth in the hospital, and one was in a birth center...

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I gave birth to my son at home, with a wonderful midwife. It was the most beautiful birth EVER,better than I imagined.
I had my first two in a hospital, stuck in a bed,overloaded with pit and drugged, and there is no way I would EVER do it that way again.
I think it is very true a lot of drs abuse their position, and tell woman they can't birth, to get a bigger pay check and be home for dinner. You know the sad statistic that most c sections are performed right before dinner time...

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I have 5 children. Baby #1 and Baby #4 were born at birth centers. Baby #2 and Baby #3 were born at home, in the water. Baby #5 was born at a hospital. My favorite, easiest, most relaxed birth experiences were the homebirth, waterbirth babies. Many, many women have the power within them to naturally birth their children. Pain during labor means a) you need to find a new position or b) the head is crowning and it will be over in 2 seconds...

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This film is very good at inspiring women to rediscover the Beauty and Brilliance of Birth. There is billions being made from childbirth, think of all the supporting industries that have come about since birth left the bedroom & enter the hospital. The World Health Organization strongly suggest a 15% national c-section rate for the US. In New Jersey several hospitals have a 60% rate and a 0% VBAC-yikes...

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I actually don't see at all how this movie is one sided. It presents the facts clearly, the history of childbirth, the problems with high intervention rates and poor outcomes for mothers and babies in the. U.S. They interview so many health proffesionals, including highly interventive ones, they have the opportunity to defend their actions, they just don't do a good job of it...

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Sorry I just don't understand why women want to blame others for their own choices. The internet has been available for how long? There are tons of books, research we can do on our own...as you pointed out there is HISTORY. I believe everyone is responsible for their own choices, if you don't agree with your doc then go elsewhere..there's no bullying about it. Same with our children's health care...

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I have 3 children. My first 2 were completely natural hospital births. 2 hour labor 47 minutes of pushing my oldest and 10 minutes of pushing with my 2nd and bam I had my girls. I had no clue with my first what I was doing. I was very young. I just went with the flow. I did have a midwife deliver her. I did tear a lot. I did have an upset doctor come in around midnight when it was all done to sew me up. Then I was pumped full of demerol and could still feel him stitching me up...

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Well I had 2 children previously in the hospital and especially on one did not have a good experience. I became pregnant again and gave birth in 2008. I started like most women with an OB but I am 40 and he seemed liked he did not care at all about me, I was another number. I started to pray about my situation and one thing led to another, and I decided I would have a midwife. So, I met Anne at the Birthing Center in Hurst, Texas...

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I have been bitter about my birthing story for almost 5 years. I went int completely trusting OBs, thought they knew everything, would be honest and do what was best for my baby and me. I WAS WRONG. I will NEVER use an OB again, unless the Midwife I go to says that is my last option in case of an emergency...

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