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Maternity Care in the US: Perfect or Broken? A look at the Business of Being Born

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Maternity care in the United States is in crisis. In many ways it’s a disaster, says Ricki Lake’s documentary journey, The Business of Being Born (BOBB). She made the film to learn more about the system of birth in this country after the birth of her first child left her feeling cheated.

In part one a two-part series, I’m going to take a look at both The Business of Being Born and the follow-up documentary, More Business of Being Born.

I’m a little late jumping on the original grassroots excitement that Ms. Lake’s documentary has created. BOBB was released in 2008. A friend of mine even had a viewing party when it was released. I missed the party.

Ms. Lake has made a follow-up documentary, More Business of Being Born (MBOBB), released November, 2011, because she says there was so much information about birth options that didn’t make it into the first film. It’s this second film that caught my attention and led me to watch the first.

I didn’t just watch BOBB, I embraced it, cried through it and reminisced about my own homebirth experiences. The four-year gap from release to my viewing doesn’t date or diminish the material. The questions raised about maternity care are still overwhelmingly relevant.

This film took hold of me and I don’t even have any interest in having more children. Maybe it’s that Spring is in the air and Mother’s Day is around the corner.

The topic and the process of birth is powerful. Ricki Lake captures that power and questions where birth has gone in this country.

To be clear, I am a home birthing, breastfeeding, cloth diapering, homeschooling hippie mama. My bias was already strongly aligned with the premise of the film and the beliefs that inspired it. I feel Ms. Lake and I are long-lost sisters connecting for the first time. Her passion about natural birth is tangible and brought me to tears because it so closely mirrored my own beliefs and experiences.

In college, working at The Chico Peace & Justice Center, I met women who had transcendental natural birth experiences. These women still glowed with the bliss of their natural births – and their children were teenagers. I began forming an opinion that giving birth is a magical experience. That’s what I wanted, not just children but, the experience of creating and giving birth to children that would be life-changing for me.

After college and marriage, the time felt right to start planning. I turned to books. It started with Spiritual Midwifery by Ina May Gaskin, the bible of natural birth and homebirth. That was my gateway book. Next, I ordered Gentle Birth Choices by Barbara Harper and Natural Childbirth the Bradley Way by Susan McCutcheon and I picked up The Natural Pregnancy Book by Aviva Jill Romm.

Paying for the books, the woman behind the counter asked when I was due. Oh, I’m not pregnant. I just want to be pregnant and I want to have a natural birth. Common enough, right? Not really. I was in the minority and all these years later I’m still in the minority.

Medical decisions around maternity care are being made for monetary and legal reasons not because they are good for the mother and the baby, says the experts in BOBB. There is less and less magic around the phenomenon of giving birth and more and more industrialization that removes the mysticism.

What isn’t magical about the miracle of conception and development of a little person inside the body of a woman? I’ve had two children and I’m still in awe when I see a pregnant belly. There is a little person inside her body! It’s a staggering miracle to me that the two little people I gave birth to were formed, strengthened, nourished, cherished inside my own body.

I still feel like I’m not worthy to have been apart of this great mysticism because it all still feels so wondrous and bigger then just little ol’ me. In my mind, pregnancy and birth are spiritual journeys. The idea of creating new life inside my body continues to feel like a privilege, an honor, a great responsibility and I am still floored that I took on the physical and mental challenge of giving birth.

Birth in this country has come to be viewed as an illness, a medical state that requires drugs, interventions, and a lot of machinery. Some women choose to have a “designer birth” where a cesarean is scheduled for a convenient date along with a tummy tuck after. That’s one option.

The cesarean rate continues to rise in the US. Why is that? Are women less healthy? Are women becoming less able to give birth? Have American women physically devolved to a point where natural birth is no longer safe or possible? This is the central tenant of BOBB.

“In 1900, 95% of births in the United States took place at home. In 1938, half of all births took place at home. By 1955, less than 1% of births took place at home. It remains that number today.” says BOBB.

Ms. Lake says her issue is that 90% of normal births happen in the hospital. Many of those women want to have a normal vaginal birth but so many things are stacked up against them.

The hospital system is set up for one type of birth, says Tina Cassidy, journalist and author of Birth: The Surprising History of How We Are Born, and it’s a fight to not be put through that system. In the hospital there is a limit to how long a woman can be in labor. Once women reach that time-limit, interventions are inevitable.

BOBB goes through a brief history of birth in hospitals. It isn’t pretty. In fact, it’s down right torturous.

In the 1920’s laboring women were blindfolded and put in a straight-jacket. Women were given the drug scopolamine which induced what is called twilight sleep. These women were left alone to labor, tied to a table in a drug-induced stupor that took away self-awareness, self-control but, left the pain.

In the 1930’s pregnant women were x-rayed to monitor their progress. In the 40’s it was discovered that exposure to x-rays caused cancer in the baby.

Introduced in the 1970s, the electronic fetal monitor become pervasive in hospital births. With it’s rising use, so rose the c-section rate, going from 4% to 23% in that decade.

In the 1990’s induction drugs caused uterine ruptures and fetal death. By 1999, it was determined that the drug wasn’t a good idea anymore.

“Since 1996 the Cesarean section rate in the U.S. has risen 46%. In 2005 it was one out of every three births.” Says the stark graphic on the screen.

Studies have shown that the peak time women receive c-sections are 4pm and 10pm. The c-section, a 20 minute operation, is doctor friendly, says the film. A 4pm c-section means the doctor will be home for dinner. A 10pm c-section shows that the doctor didn’t want to be up all night.

Pitocin is administered to a majority of women in the hospital to speed up labor causing stronger and more frequent contractions than what a woman would experience during natural labor. The pain of those drug-induced stronger contraction leads women to be offered an epidural which has the side-effect of slowing down labor. When labor stalls, more pitocin is given creating more pain and another option for pain-relief.

It’s a vicious cycle, the film shows us. When one intervention is given, the need arises for more from the effects of the first.

The result is a lower standard of maternity care, a higher rate of infant death, and a loss of the spirituality of the birth process.

Birth is seen as a scary predicament and women are encouraged to disassociate themselves from the pain of the birthing process. Pregnant women are assailed with birth horror stories from their female friends. “A Baby Story”, on TLC, shows more births that go wrong than normal births that run their natural course.

BOBB strives to show natural birth and the innate strength of woman through giving birth. Ms. Lake’s own homebirth of her second child is featured. Giving birth in her own bathtub, Ms. Lake was completely transfixed and transformed through the process. She says so herself but, watching the birth you can see her go through it, through all those emotions and it’s a joyous, incredible miracle to watch.

Eugene Declerq, Ph.D., Professor, Maternal & Fetal Health, Boston University School of Public Health says, “The research on homebirth is pretty consistent in showing that in a supported environment, with trained people, outcomes of homebirth are very good, consistently good if not better than in a hospital. Trained homebirth midwives are incredibly skilled at what they do.”

My own homebirths were incredibly empowering. Sure it’s painful but, for me the pain was overcome by a sense of purpose and when I held each of my children the connection was instant, immense, breath-taking.

Watching BOBB, the fact that many women are not able to have a natural birth if they choose because birth has been turned into an industry and a medical procedure is beyond disappointing to me. There are many instances where interventions are necessary, life-saving tools however, BOBB puts forth the idea that interventions are grossly overused.

The film’s director, Abby Epstein became pregnant while making the film and chose to have a homebirth. Ms. Epstein ended up having an emergency c-section. She went into labor 4-weeks early and her son was breech. After his birth, doctors determined he was suffering from a disorder that didn’t allow blood flow and nutrients from the placenta to reach him. Ms. Epstein and her son needed a c-section.

More often then not though, woman in the hospital are not informed of the options available in the course of a normal labor and birth and they become the object of a system focused on getting the baby out quickly not on letting birth progress naturally.

How many women, who were not high-risk and were able to have a “normal” labor and birth subjected to unnecessary interventions because the hospital wants women to fit within a framework driven by income statements?

How many of those women were left feeling it could have been different, their bodies could have gone through birth in a beautiful, fulfilling way that leaves mother and baby empowered and connected?

Ms. Epstein says, 8 months after her c-section, she didn’t feel like she gave birth. It felt more like a car accident to her and she ended up with a newborn afterward. There was a disconnect.

Watching the film, I wanted to jump up and scream, Women! We were made for this! This is what becoming a mother is all about! Embrace your fears of the pain of giving birth and willingly take on the challenge of a transformative experience to bring your children into the world! Let’s support women as a community in making the birthing choices that are right for them!

That’s what BOBB is all about: To bring light to the option of natural childbirth in low-risk pregnancies.

In June, I’ll take a look More Business Being Born and the birth options it presents.

How do you view natural birth and homebirth? Moms, was your birth a positive experience? Do you feel you were thoroughly and properly informed every step of the way? Could your birth experience have been different if you had more information? Ricki Lake: revolutionary or tree-hugging hippie?

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  • comment avatar Anna April 12, 2012

    I had all three in the hospital – 1 au naturel, and the other 2 meds and epidurals galore.

  • comment avatar Christina April 12, 2012

    Both hospital–one 9 pounder with epidurual one 10 pounder by c-section.

  • comment avatar Gina April 12, 2012

    One hospital, two home. The homebirths changed my life forever–I am now a midwife. 😉

  • comment avatar Lana April 12, 2012

    I don’t claim to know a lot about this issue. However, I think modern medicine is given to us for a reason. Just take a look at the world’s infant mortality rates and how they’ve changed over the years thanks to medical intervention.

    I respect a woman’s right to have a natural birth, realizing she is taking a risk with her child’s life in her own hands (I have a neighbor who would have died if she and her child had not been rushed to the hospital after home birth). Sure, there are risks in the hospital but it just doesn’t seem as many.

    What I don’t like: either side of the argument judging the other.

    • comment avatar Heather April 12, 2012

      I agree that modern medicine is given to us for a reason. If I break an bone I definately want acute care. What BOBB is saying is that normal birth is being treated more like an illness instead of a natural process. It’s unusual for a woman not to have an intervention in the hosptial.

      As intervention rates rise in the US, says BOBB, mother and baby safety has not improved along with them. Many has said that more interventions in the hospital have led to greater dangers for both mom and baby.

      For many women a natural birth or a homebirth is not the right choice and the hospital is the place for them. Being informed and prepared for all possibilities is a smart way to approach pregnancy and birth.

  • comment avatar Kimberly April 12, 2012

    We watched BOBB before the birth of our 1st daughter, my husband said its the one thing that taught him what I needed from him in a natural birth.
    My first labor was 21 hours of my water being broken with little progression, even with pitocin so I was given an epidural and csection. Not the natural birth I had hoped for…. Our 2nd daughter was csection also, her head was stuck in the birth canal. I don’t think I could have been more prepared, but was definitely disappointed that my body didn’t do “what its supposed to”.

  • comment avatar Melissa April 12, 2012

    I love this movie. I recommend it to all of my pregnant friends. I nearly died having my first child in the hospital and I still believe it was because of all of the interventions the hospital used.

    • comment avatar Heather April 12, 2012

      Melissa, I’m glad you made it through the birth of your first child. I can only imagine how scary that must have been.

  • comment avatar Naomi April 12, 2012

    DS was born in a hospital with an epidural, DD was born at Mtn Midwifery, and this baby will be born at Swedish (assuming I don’t wait too long at home lol). I watched BOBB and thought it was a good movie, but it doesn’t really give women a solution to the problem with OB care in this country.

    • comment avatar Heather April 12, 2012

      Congratulations and well wishes on your pregnancy and birth! Sounds like you’ve been able to find maternity care that works for you.

      I agree that BOBB doesn’t give solutions which is why Ricki Lake made the follow-up More Business of Being Born. BOBB showed what natural, low-risks births can look like and also what an emergency birth looks like with director Abby Epstein’s c-section.

      I think BOBB provids a picture to a mainstream audienceof how natural births can transpire and start a conversation with women and families about birth options outside of the hospital-intervention-birth-box.

  • comment avatar Catherine April 12, 2012

    I had my first daughter in the hospital with an epidural. I didn’t know to question the hospitals system. I’m pregnant with my second daughter now and my husband and I are planning a homebirth with a well qualified midwife. Pregnancy is not a medical condition to be treated, it’s a natural physiological process. I’m so thankful there are hospitals and medical technology for cases when it is needed but I firmly believe all the hospital has to offer in the way of monitoring, interventions and schedules is not always needed.

    To each her own. I am glad I have options, the ability to educate myself about the options and choose the path that is right for me.

    • comment avatar Heather April 12, 2012

      Congratulations and well wishes for you and your baby during your pregnancy and birth! I’m glad you have found the options that work for you and your family!

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  • comment avatar Lynn April 15, 2012

    Thank you for posting this. I think the movie is unfair to those doctors and certified midwives who use evidence based practices and really care about a mother’s birth experience in the hospital. It gives women an impression that medical professionals are the bad guys and only care about money snd getting home in time for dinner. The hospital where I work has a 9-16% c-section rate (which is fairly good) and we do peer reviews of our c-sections, vacuum assisted deliveries and poor outcomes to make sure moms and newborns continue to get the very best quality care. We celebrate when moms have natural, intervention free deliveries. I agree that women should empower and educate themselves about their bodies and the birthing process. I also don’t think there’s anything wrong with moms who just want an epidural and a healthy baby, no matter how it’s born (with or without interventions). Home births, yes, are probably just as safe as hospital birth but would I take the chance? Absolutely not! I’ve seen plenty of routine births have serious complications requiring infant resuscitation that no lay midwife would be able to manage at home. Talk with your doctor about your concerns with hospital birth if you have them and find a different doc/midwife if his/her views about birth don’t align with yours. In other words, don’t accept that the movie’s portrayal of hospitals is true for your community’s hospital. Go talk to a health professional or two and decide for yourself. Then, if you decide to have a home birth at least you explored your options and didn’t just trust the opinion of a talk show host.

    • comment avatar Misty April 15, 2012

      There are certainly plenty of hospital births that turn out alright. Would I take that chance? Absolutely not! I have had two hospital births and three homebirths. I’ve seen both sides of the coin. I had issues with four of my five births. The ones at home were handled with competence combined with gentleness which is not how they were handled in the hospital. Midwives are highly trained professionals who know natural, normal childbirth and also know how to deal with complications (and know when mothers and babies need hospital care). Way too many doctors are only trained in medical childbirth. Of course it is not true that ALL doctors are bad or cause problems. Our system of maternity care in this country is broken. For low risk mothers, hospitals cause more problems than they fix. You could not pay me to have a have a hospital birth if I were having a normal, low risk pregnancy. I am very grateful that the technology exists for those that truly need it. Unfortunately, that technology is all too often used inappropriately and cause a higher percentage of interventions and even death.

      • comment avatar Heather April 18, 2012

        Thanks for your comment Misty. I appreciate your insights having experienced both hospital and home births. You echoed the point of the movie very well, interventions can life-saving when used properly however they are vastly over used to the detriment of mother and baby care.

    • comment avatar Heather April 18, 2012

      Thanks for your comment, Lynn and the work you do at your hospital. I agree, the movie does show one side and is biased toward natural home births. I also completely agree with you that every woman should be able to chose the birth she wants and that not every hospital treats birth the same.

      What you said is well worth repeating, “Talk with your doctor about your concerns with hospital birth if you have them and find a different doc/midwife if his/her views about birth don’t align with yours.”

      Start a conversation to explore your options and discover what will make sense for you, for this birth.

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