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

This is a well written article and I applaude the author. I've been a Certified Nurse Midwife for more than 10 years and just had my 3rd baby last month and I can tell you that there is a difference between natural labor and induced or augmented labor with Pitocin especially when it comes to bonding and recovery. I had my first 10 days late with an induction and it was horrible. I hemorrhaged, had terrible edema (swelling)for a week post, huge laceration, and felt weak and tired for a month...

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Thank you for writing this article. It summarizes my own research (a research project for college), and is certainly something that more women need to be aware of.

I was shocked by what I found--all that you described, and more (but you covered the important bits!)

So when I had my baby, I had him at home with a midwife. I had pre-natal appointments with both my doctor and my midwife throughout the pregnancy (just in case a complication arose)...

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If I were not at the hospital with my third child, I wouldn't have a third child. She became an emergency C-section. Her chances were mentally retarded or dead. Thankfully she came out normal after a long night of praying over her. 17 months later I had my 4th child normally. They tried to get me to have another c-section and I refused. Everything came out fine. All four of my children I did not take any drugs to have. I think the doctors today use too many drugs to have a child...

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I considered myself educated, signed up with the local birth center and midwives, and still wound up on the epidural-pitocin-surgery slope. My cesarean broke me, and definitely impacted our bonding.

I've read all the info the hospital had, and can't find any indicator *why* surgery was even suggested to get my son out - no fetal distress, no running out of time on water breaking, no fevers...

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I agree that there are some serious issues with the way we birth children in our society. I think the biggest issue that pushes us in this direction is law suits. The fear of lawsuits is very very real, and unfortunately, many doctors/hospitals do what's best to protect themselves and not necessarily their patients.

I truly hope that Betsy's C-section was necessary.

Doctors/hospitals/care providers lie. And the 3% claim of scheduled for convenience is on shaky ground. There are plenty of OBs who induce for convenience and then it turns into a C-section for AND there are plenty of C-sections that need to happen for the health of the baby or mother. What gets left out of that equation is the mental well-being of the mother...

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I think what is most disturbing is that obstetrics is not being practiced following their own research results and this is being supported by insurance companies (who could make more money following the research). As birthing mothers we have trusted that the system must have been developed scientifically...

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I agree with this article. I have 3 children all delivered naturally, with midwives, and no drugs (I am not against them, just was able to control pain by focusing). I did have to have my water broken twice(once to deliver and once to get the process going as I had had begun labor 3 different morning, then it stopped. With my third child, I used a birthing chair which puts you in the squatting position but not relying on the quad muscles to support you and lets gravity do some of the work...

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For those who are interested in learning more, check out Spiritual Midwifery and Ina May's Guide to Childbirth - both books by Ina May Gaskin.

I had my first son in a hospital attended by a midwife. It was a difficult, but incredible experience. I labored on my own for 8.5 hours and then ended up getting an epidural because I was simply exhausted and wasn't dialiating. Within a couple of hours on the epidural, I was able to rest and become fully dialiated...

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I had the "in-between" option of using a midwife at the hospital. My husband was not comfortable enough with the idea of a home birth. I had no early labor, with my first contraction arriving hard and strong at 2:35AM. I tried to labor at home as long as I could, but my labor was very fast. My husband and I called the midwife, then walked to the hospital (it was in Brooklyn, about 6 city blocks from our apartment)...

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I had my 2 children in a birthing center with midwives, both were amazing, wonderful experiences. In my opinion I think the problem is that we as women need to do our research, not only of the different types of labor and delivery but the statistics of our doctors, midwives, and hospitals in the area that we live. For example in the town where I live the c-section rates at the 2 hospitals are 49% and 51%. My midwives was 5%...

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Very well-written article that raises excellent points. I'm pregnant with #3 as we speak, but if I'd truly considered the information presented here while I was pregnant with #1, I think my outcomes could quite possibly have been different. Baby #1 had a stroke during delivery, which was handled poorly at a military installation hospital with sub-par care. Now, I am grateful for hospitalization to bring my baby girl back to life (she was rushed to the city hospital's NICU)...

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Omg!!I have not seen the movie, but I totally agree wtith the article. Before giving birth I honestly did consider a doula, but I knew my husband wouldn't agree and would probably be offended.
I would have to say that my birthing experience in a hospital was the worst experience of my life. I purposely stayed at home as long as possible. I was 8cm when I arrived...

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My first child was born in the hospital with an OB, and I plan on my next being the same way. I have a WONDERFUL OB and they take the time for me, and don't ever rush me. I even asked during the labor process about the c-section and what all that entails as a just in case, and she said that she will avoid it as much as possbile. She checked on me about every hour during the day I was in labor, I went in on friday at 3 and had my daughter Sunday at 1a...

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There have been many great comments and experiences shared.

As a mother and professional in the birth community for most of my adult life, and having attended a number of births both at home and in the hospital, I'd like to point out that birthing in the hospital is not without risks. There is a HUGE myth that home is about the "nice" experience for the mom and compromises safety of the baby while a hospital birth means safety for the baby at the compromise of mom's experience...

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