by Mary Jessica Hammes
May 18, 2008

I already knew what I was in for before I watched The Business of Being Born, a documentary that claims maternity care and birth in the United States (U.S.) is in crisis.

After all, I wrote an article for a local newspaper about the birth situation in both the country and in Georgia, where I live, and where homebirth is technically illegal at the moment (although that might change soon following the advice of a legislative study committee).

I was familiar with the numbers. Midwives attend around 70 percent of births in Europe and Japan; they attend less than 8 percent in the U.S., which has the second highest worst newborn death rate in the developed world. The World Health Organization recommends a cesarean section (c-section) rate of 15 percent or less; in the U.S., it’s 31.3 percent, and has increased 50 percent in the last decade.

And before I gave birth to my own son in 2006, I did my own research on how to avoid a c-section, thus settling on my choice for natural childbirth.

Still, I wasn’t prepared for the rush of emotion I felt as I watched the film.

And it made me remember my own maternity care experiences.

The doctor I wanted to punch (but didn’t, because I’m a pacifist)
“I can’t have you screaming and disturbing the other patients on the hall.”

“You can’t squat—I’m not going to get beneath you on the floor.”

“I’ve been doing this for years, and I can’t understand why a woman wouldn’t want to have drugs.”

I sat, dumbfounded and blinking back tears, facing my male OB-GYN in the exam room. This was his response to my overly meek suggestion for a drug-free labor. (Oh, and when I asked in a feeble voice whether everything was OK after a hurried fetal monitoring? “Everything’s fine,” he said, breezing out the door, “Or we wouldn’t have wasted time answering your questions.”)

Thank goodness I worked up the nerve to change practices—true, it did take me until I was around 8 months pregnant, and I certainly did waffle about it. My new OB-GYN was an utter gem: She welcomed the presence of my doula. She let me eat my fill while in the hospital (my water broke on a Friday night, but I didn’t go into active labor until late Saturday). She never pushed for pitocin or an epidural. She treated us with respect. Most amazingly in this day and age, she stayed the entire four-plus hours I pushed—all without drugs—and cheered me on with unflagging enthusiasm (aided by countless Dr. Peppers) as I delivered my 10 pound, 1 ounce bundle of Tommy.

My husband Robert told me later—I was off in laborland and took no heed of the outside world—that at one time or another, around 10 nurses came into watch.

I learned later that they had never seen a natural birth before.

Even Ricki Lake made me cry
You can imagine, then, that I spent much of the time watching The Business of Being Born crying like an overwrought sap.

I cried for women just a few generations before me who spent labor drugged, hooded, thrashing in hellish “twilight sleep” and bound with lambswool (to keep suspicious marks away from husbands).

And I absolutely bawled at the beautiful, awe-inspiring natural homebirths shown in the film: the woman in the birthing tub, quietly and meditatively pushing out her baby; the woman squatting in the dark, her midwife’s flashlight trained on the child slipping out. Even the film’s producer, Ricki Lake (who I already loved for her presence in several John Waters films and her “Go, Ricki! Go Ricki!”-fueled status as tongue-in-cheek talkshow queen), made me slobber all over myself as she gave birth in her bathtub.

“Oh, honey,” my husband teased, “Don’t cry because Ricki Lake had a baby!”

He was trying to cheer me up, but the truth was, both of us were moved by the film. Not to mention a little angry.

Consider these statements made in the film:
“Maternity care in the United States is in crisis,” says Dr. Marsden Wagner, former director of Women’s and Children’s Health for the World Health Organization. “It’s in many ways a disaster.”

“I call it feminist machoism,” says Dr. Michael Brodman, an OB/GYN at New York’s Mount Sinai Hospital. “When you’re pushing your baby in a stroller three months later to say I did it naturally—personally, I don’t think it’s important.”

“There’s so little understanding of how incredibly important this process is to a woman,” says Elan Vital McAllister, president of Choices in Childbirth.

“Basically, what the medical profession has done over the past 40, 50 years is convince the vast majority of women that they don’t know how to birth,” says public health specialist Nadine Goodman.

“Today, most obstetricians have no idea of what a (natural) birth can be like,” says OB-GYN and researcher Michel Odent.

“Very few doctors have ever observed a normal birth in medical school or in the hospital,” says Susan Hodges, president of Citizens for Midwifery.

“For the doctor, this position right here is much better,” says OB-GYN Ronaldo Cortes, indicating a woman lying on her back. “But it’s nearly impossible for the baby to come out alone in this position. Now, if she was squatting I would have to be sitting on this little seat here. That’s her position and that’s the bench I sit on. So the mother is active and that’s very important, she’s participating. As opposed to when she’s laying down, the doctor is telling her, ‘Push!’ ‘Stronger now!’ There’s no need for this. The vertical birth is on her time and the baby will slide down on his own.”

And finally, here’s a quote from my husband, Robert Newsome: “It’s ridiculous that women’s vaginas get bossed around like that.”

How have we gotten ourselves into this mess? Director Abby Epstein offers a theory.

“As I did the research,” she writes in a statement, “I discovered that the business of being born is another infuriating way medical traditions and institutions—hospitals and insurance companies—actually discourage choice and even infringe on parents’ intimate rites, ultimately obstructing the powerful natural connection between mother and newborn child.”

The underlying message of the film? Birth is big business, and hospitals want to fill and empty beds.

Back to the basics
The film doesn’t condemn necessary medical intervention at all; in fact, Epstein, who was pregnant while filming, is shown having an emergency c-section that saved her baby’s life.

Still, it’s clear that there is a problem. And even though I cried while watching the film, I was not depressed—in fact, I felt excited that these issues are being brought to light, and that it’s not too late to change the face of birth in this country.

But how? Odent offers a pretty simple solution.

“We are completely lost,” he says. “And we have even forgotten to raise the most simple questions. What are the basic needs of women in labor? And the fact that midwives have disappeared is a symptom of the lack of understanding of the basic needs of women in labor. Like a traveler who suddenly can realize that he took a wrong way…the best thing to do in this case is to go back to square one, the point of departure, and to take another direction.”

Mary Jessica Hammes is an Athens, Georgia-based writer, trapeze instructor, knitter, gardener, comic book enthusiast, and hula hooper. She is mom to Tommy.