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THE BUSINESS OF BEING BORN
Directed by Abby Epstein
Produced by Epstein, Amy Slotnick & Paulo Netto
Photographed by Netto
Edited by Madeleine Gavin
Released by Red Envelope Entertainment/International Film Circuit
USA. 87 min. Not Rated
With Ricki Lake

There isn’t a lot new about the U. S. obstetrics industry in The Business of Being Born, so it is surprising that after decades of criticism and successful demonstrations of alternative models, the faults in the system are even more glaring.

Soon after Abby Epstein was commissioned by actress/TV host Ricki Lake to direct this documentary, she and her cinematographer/boyfriend Paulo Netto found they were to become parents and incorporated their choices and experiences into the film.

At its strongest, Business pokes holes, Sicko-style, in the claims of the medical and pharmaceutical establishment, particularly regarding the starkly negative statistics of U.S. infant and maternal mortality in comparison to other industrialized countries and the alarming, if well-known, facts about the rising rate and suspicious timing of caesarean sections around doctors’ schedules, despite the risk of surgery. Sadly amusing are admissions by medical students and OB/GYNs that they have never witnessed natural child birth; they have no experiential evidence for their objections.

Gruesome historical photographs and training films testify to the medical establishment’s insensitivity to women in labor over the past 100 years. (Even in a 1940’s hospital, my healthy mother, who had been born on her family’s kitchen table, wasn’t permitted to touch her normal newborn for a week, allegedly for sanitary reasons). While the troublesome track record of drug interventions during and after labor is usefully detailed (hammering home the importance of immediate, drug-free bonding between mother and child), the classic 1950’s footage of French obstetrician Fernand Lamaze didactically imposing his breathing regimen as a strict pain control alternative is conveniently excluded.

But the documentary too often equates midwifery with at-home births, which is just one option if a woman chooses to use a certified professional. This impression is emphasized by spending so much time documenting the house calls of one New York City midwife, Cara Muhlhahn, who also encourages giving birth under water (several such deliveries are seen on screen). Lake and Epstein mock midwifery’s image, describing one long-braided midwife as “so granola,” reinforcing Summer-of-Love stereotypes, but they neglect to credit the impact of the feminist health guide Our Bodies, Ourselves for popularizing natural childbirth. Balancing this representation, Epsteins interview mainstream obstetricians, nurses, academics, and various experts.

A few of the prenatal consultations and births are seen at independent and hospital-based maternity centers, but their differences are never explained, nor their guidelines of strict prescreening for high-risk births. Another option only implied are obstetricians who cooperate with midwives or incorporate them within their offices (which, despite this film’s castigation of the entertainment media for over-dramatizing labor pains, could become more popular following the new hit TV show Private Practice, which features a cute male midwife on its homeopathic staff).

Epstein damns the insurance industry for the drastic rise in malpractice premiums that have shut down some midwifery practices, but does not point out that insurers sponsored out-of-hospital birthing centers to prove the feasibility of competitively priced alternatives for low-risk births. By focusing on labor and gliding by pre- and post-natal care, the film also ignores how such centers significantly reduce the length of baby and mother aftercare that hospitals rely on as a profit center.

When I gave birth to my children over 20 years ago in an out-of-hospital midwife center, coming comfortably home 10 hours after the first, six hours after the second, I never considered myself a hippie or fanatic or a public health policy campaigner, just a normal woman having normal babies through a normal process. This film did startle me to learn that my healthy and happy experiences are now considered unusual. Despite its faults, the arguments in The Business of Being Born are worth bringing to a new generation of health care providers and expectant parents. Nora Lee Mandel
January 9, 2008