Beyond the Multiplex

"The Business of Being Born": Fighting back against the maternity-industrial complex
Produced by talk-show host Ricki Lake as part of her personal campaign to spread the gospel of midwifery and natural childbirth, Abby Epstein's "The Business of Being Born" is a messy, didactic and propagandistic film whose very premise -- judging by the reader response when Salon covered it last year -- makes many people uncomfortable. (Watching Ricki Lake giving birth buck-naked in the bathtub of her New York apartment may make some people uncomfortable too, but that's their problem.)

I know very little about the history of American childbirth and how it became so medicalized relative to nearly every other country in the world, so I can't really evaluate "The Business of Being Born" on the basis of fairness or accuracy. Needless to say, I don't have to face the choices outlined by the film myself, so unlike some women who have chosen medically assisted hospital births, I'm not likely to feel defensive in the face of Lake and Epstein's assault. (For the record, my wife had a cesarean section in a New York hospital -- but she was carrying twins, one of them breech and the other transverse. Even the crunchiest natural-childbirth fanatic in the universe would have sent her to an obstetrician.)

But I don't think Lake and Epstein are pursuing fairness and accuracy, exactly; they're trying to drive home a simple argument that's both intuitive and logical, while battling enormous ingrained prejudice and the cumulative power of the medical establishment and the insurance industry. That argument is that entrusting childbirth to doctors and hospitals is a relatively recent idea in American social history, and not such a good one. Most women can and should deliver most babies outside the pharmaceutically driven production line of the maternity ward, with a midwife's assistance, either at home or in a hospital-affiliated birthing center.

This is clearly a controversial and, for many Americans, a counterintuitive idea. Epstein drives it home with a dual strategy, by showing us Lake and numerous other women giving birth at home, and by drawing in a series of experts to tell us that the United States is (sigh) virtually alone in its industrial approach to childbirth. Nearly all American babies are born in hospitals, yet we rank near the bottom of the list, among advanced nations, in infant and mother mortality. (Yes, the film addresses the fact that those statistics can be sliced and diced different ways: We need all those medical interventions because we have more high-risk women than European nations. We have more high-risk women because of our crappy lifestyles and our endemic poverty problem. Quite a defense, isn't it?)

So for part of the film Epstein is following New York midwife Cara Muhlhahn around town, in her eccentric hairdo and post-Goth get-ups, from one gloppy home birth to another. I can imagine that some viewers don't want to see this material quite so up close and personal, but speaking as a male human who has witnessed exactly two births in person (two minutes apart, and in an operating room), I found the home-birth scenes shattering, inspiring and prodigiously emotional. Then we meet an impressive series of OB/GYN's, medical researchers, midwives and anthropologists who explain how we wound up with a childbirth system that is more expensive and more dangerous than the rest of the world's. Good old Yankee ingenuity.

Epstein herself became pregnant while making the film, and her experience becomes an intriguing counterpoint to Lake's -- and a reminder that we should be appropriately grateful that all those doctors and hospitals exist. Midwives are not, after all, a bunch of self-taught Wiccans with towels and candles, but trained medical professionals who are prepared for emergencies and know their limitations. When Muhlhahn sees that Epstein has gone into labor weeks ahead of schedule (and that her baby is breech), she sends Epstein to the hospital without hesitation, and that turns out to be a very good decision.

Lake and Epstein are not in fact trying to stigmatize other women's choices about how and where to give birth. Instead, they're trying to introduce an entire universe of history and information that should inform those choices, and that the medical establishment has virtually erased from American memory. Whether the bizarre character of American healthcare overall can ever be changed is an open question, but no one, male or female, pregnant or childless, who sees "The Business of Being Born" will ever see the hospital maternity ward as a normal environment again.

"The Business of Being Born" is now playing at the IFC Center in New York. It opens Jan. 16 at the Laemmle Sunset 5 in Los Angeles, Jan. 18 at the Roxie Cinema in San Francisco, and Feb. 29 in Seattle. The DVD will be available for rent from Netflix in February, and for general sale in March.

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