Pregnant with controversy

Has the home-birth movement become overzealous? A New York magazine story looks at the ongoing debate over the best way to have a baby.

Published March 23, 2009 6:13PM (EDT)

Two years ago, I interviewed Rikki Lake and her producer Abby Epstein about "The Business of Being Born," their documentary about midwifery and home birth that had recently premiered at the Tribeca Film Festival. A year later, Andrew O'Hehir wrote about the same film, just as it was about to become available to a Netflix audience. These days, according to a New York Magazine profile of the movie's featured midwife, Cara Muhlhahn, the film is referred to in baby-birthing circles simply as BOBB, and its presence and impact on the decisions of expectant women is ubiquitous. Clearly, this was a movie with legs (and arms and crowning heads and swollen breasts and a lot of vagina).

I imagine that Broadsheet readers will have a lot to say about Andrew Goldman's story on Muhlhahn, who recently published her own book, "Labor of Love." In it, Goldman describes the pressures of selecting a doctor and a birth plan during his wife's potentially high-risk pregnancy (I should disclose that I am friends with Goldman, his wife and their new baby), and the influence of BOBB, which he writes "de-radicalized home birth, conflating it with garden-variety natural childbirth and allowing Muhlhahn, largely unchallenged, to argue for its safety." He also notes that watching the film gives the impression that "there are only two options when it comes to childbirth," since it repeatedly compares "shots of ecstatic mothers hoisting their babies at home with shots of women under bad hospital light screaming for rescue."

Goldman explores the culture of pregnancy planning, in which women and doctors and midwives all seem to have very specific ideas of exactly how things should go. Many of these questions naturally revolve around concerns about medication, surgical intervention, and natural birth methods, but can also extend to issues of choreography, decor, lighting and music selection.

On many levels, it makes sense that for a process that can be so profound, and is so important, women and men would go in with strong opinions and desires. But as Goldman points out in his story, labor and delivery do not always go as planned; pregnancies are unpredictable. It's often necessary to throw out the blueprint and do some intense (and terrifying) improvisation.

That's when the questions surrounding home birth become sticky, and when Goldman's questions about the fervor surrounding BOBB and the wildly successful Muhlhahn become controversial.

Muhlhahn, who has delivered more than 700 babies, has written in her memoir about losing a baby, and Goldman reports on a lawsuit that she settled over a child born with a paralyzed right arm after his shoulder became stuck behind his mother's pelvis and Muhlhahn pulled him out. Goldman also quotes some doctors at St. Vincent's, the unusually midwifery-friendly hospital where Muhlhahn takes (or "dumps," in the words of one of the doctors) her patients in distress, as saying that by the time Muhlhahn's laboring mothers get to the hospitals, they are "train wrecks."

He reports on at least one Muhlhahn delivery that went awry, in which the mother labored for more than 72 hours before insisting that the midwife take her to the hospital, where she awoke the next day with a fever and barely dilated; the baby had to be delivered by Caesarian and kept in the NICU for five days. When they next saw Muhlhahn, Goldman reports that the first question she posed to the couple was a query they heard as disapproving: "How do you feel about having a C-section?" Goldman goes on to report that Muhlhahn chided them that she had had a plan all along, but that "you just didn't trust me." The notion of "trust" seems to be crucial to home birth advocates. As BOBB producer Epstein tells Goldman, Muhlhahn will take on riskier pregnancies than many other midwives. "It's not that she's a cowboy," Epstein says. "It's because she wants to serve these couples that say, 'I trust my body. I believe in this process.'"

And this is where all the tussles over home-birth/hospital-birth, C-section/vaginal delivery, natural/epidural both lose and enrage me. I am not a mother yet, but I have now seen dozens of friends get pulled through this particular psychological ringer, tugged on in every direction, made to feel not simply the pressure of producing a baby via one painful route or another, but of making that delivery perfect, calm, natural, trusting, of keeping it simple, keeping it clean, keeping it safe, keeping themselves from tearing, keeping it somehow "real." There is some ambient, finger-wagging sense -- a sense that Lake's film may have set out to battle -- that there is a "correct" way to have a baby; the trouble is that no one can agree on what that correct way is.

I appreciate and laud those who wish to make childbirth a more humane process than it has been historically, and who wish, as many midwives do, to make it more open and comfortable and personal and gentle whenever possible. But privileging that kind of lucky experience over other kinds of labors, that involve hospitals or drugs or surgeries, is just as invidious and smothering a trap as the big-business-over-pathologized one from which mothers and midwives have tried to escape.

As far as I'm concerned, one human body emerging healthily from another human body is happy victory enough. How wonderful for those who wish to have a baby at home to have the opportunity to do so, and how lucky for those who prefer to be in hospitals to make it there in time. But why should having a baby at home mean that a woman trusts her body or the process more than a woman who wishes or needs to be in a hospital?

Giving birth doesn't have to be, nor should it be, a contest about who feels better about themselves, or more at one with their bodies. Nor should it entail the most dastardly implication of home-birth enthusiasts, that the at-home mother is somehow more naturally attuned to and prepared for parenthood, or more readily prepared and able to bond with her child. Goldman's piece includes examples of understated but unmissable crowing from mothers and midwives about how home-birthed babies are calmer, or their bonds with their parents stronger.

I have met babies born at home and in hospitals and through vaginas and through surgery, and I call total bullshit on the idea that there is any one path you can take, or any song you can play as your child is being pushed into the world, that can determine who that child is going to turn out to be. Make the choices that work best for your family, for your body, for your budget and for your sense of well-being. But don't buy into the idea that those choices become your earliest parenting gold stars, or your scarlet letters of birthing shame.

To my ears, these arguments all have the same tune and timbre as breast-feeding debates and mommy wars. While there are lots of valid things to say about the benefits and draw-backs of both sides of every issue, all the bellowing -- or more realistically, the quiet self-satisfactions -- on either side only work to make women feel underqualified for motherhood from the start.

By Rebecca Traister

Rebecca Traister writes for Salon. She is the author of "Big Girls Don't Cry: The Election that Changed Everything for American Women" (Free Press). Follow @rtraister on Twitter.

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