Debunking the Business of Being Born: Part 5

This part 5 in a series debunking the Business of Being Born. Descriptions of the movie are in bold, my commentary is in normal text. The other parts of the series can be accessed by clicking here.

A woman says “Its very easy to convince a woman that they need this procedure or that procedure, because there is a huge power disparity.”

There is an inherent power disparity in any situation with patient care. Doctors are trained in how to deal ethically with the disparity, while I have noticed a tendency in midwives to ignore the problem or pretend that it can be overcome by force of will.  There is also the issue of accountability- doctors are not very accountable for unethical behavior that does not result in bodily harm, but they are still much more accountable than midwives. The film makes it seem as though midwives are the solution to patients being given misleading information and coerced/forced treatments, but midwives are equally as capable of doing this to pregnant women. I know because it happened to me, and have since found many stories of women who have been through it, too.

There is footage of a laboring woman in a hospital  asking “What is the risk to the baby?” and a doctor replying “minimal”. 

Combining this footage with the previous statements gives the impression that the doctor is lying to the patient. We are not given enough information about the procedure or the patient to judge if it is true or not.  This scene is emotional for me- I feel for the woman who may be uneasy about what her doctor has told her (or maybe she is feeling fine? We don’t get to speak with her again so we cannot know, her face is blurred so its impossible to know if she was even anxious or not). This movie expertly manipulates feelings of helplessness that women almost universally experience in patriarchal society.

A woman says “So if you’re in labor and the doctor says, ‘wow, I think we need to do x,’  you’re gonna say ‘yeah we need to do x’. The doctor may think he is giving you an option, but you hear the expert advising you to do something. ” The woman making the statement is revealed to be a part of citizens for midwifery, a political group whose aims are to increase the access of women to midwifery. 

I agree that patient consent violations are an enormous problem in medicine. It isn’t just a problem for pregnant women, and so using homebirth midwives as a solution leaves out a wealth of people who could benefit from a more universal solution. Almost dying in an accident, or surviving cancer, or any other situation that causes a person to face their mortality is a major life event and transformative in the same way that giving birth can be. People who actually care about solving a problem are always looking for possibilities to better deal with the problem, they ask meaningful questions about what strategy is best. They do not push a single solution and fail to discuss any others. That is a sign of pushing an ideology or a belief system instead of practical solutions for practical problems.

(more footage from monty python)

Ricki Lake and Abbey Epstein are on the phone with an indiana midwife talking about her interest in their project. They discuss that Ricki Lake is the driving force behind the movie because she had 2 babies, the 2nd one at home. Ricki discusses how it was important for her to experience everything, to feel everything, to have the memory of pregnancy and birth. She notes how a lot of women she knows don’t care about any of it, they just care about a healthy baby. She wanted to explore it because she feels that so many women are missing out on an amazing life altering experience of natural child birth. The midwife agrees that it is hugely transformative. 

(footage of a happy unmedicated birth)

Something I really resent now is that someone like Ricki Lake can use her class privilege to push whatever agenda she wants, simply because it was important to her personally.  I would personally love to make a documentary about the dark side of midwifery in america, but I am not rich or connected in the entertainment industry so its unlikely that I would ever get the opportunity. My message isn’t less important than Ricki’s, but only one of us will be heard on a national scale. People who wield that kind of privilege have a duty to others to act with integrity and avoid misleading others. This movie is grating in its emotional appeals and telling omissions. Shame on you, ricki lake.

Several other women discuss how powerful having a baby was for them and the reverence the occasion deserves. There is more footage of a different woman during her home birth labor.

“A woman doesn’t really need to be rescued. Its not a place for a knight in shining armor. Its the place for her to face her darkest moment and lay claim to her victory.” Says Cara Muhlhahn

At the time that I fell for this movie this line of thinking seemed empowering. In reality, none of us have any real control over if an unmedicated vaginal birth is possible for any individual woman. When I was in a doula training I remember the instructor saying “the baby will come out if she is in a coma. The uterus pushes the baby out.” I felt a little confused- how was it an achievement (or a ‘victory’) if it can just happen while you are unconscious? I ignored the cognitive dissonance involved with that. I admired how amazing our bodies are instead of questioning the premise of NCB- that you can control how your birth ends up. You can’t. All you can do is make a bet based on statistics and hope you are in the majority.

There is footage of cara assisting a laboring mom at home in a birth pool. 

Another midwife talks about how birth can be empowering and wonderful or traumatic and scarring. They show footage of a woman being wheeled off to an emergency c-section who is obviously in a lot of pain. 

The implication is that her birth by c-section was traumatic. We can’t know because we cannot speak to her. We are made to feel sad for her when really, the reality for women without access to c-sections is much more grim.

“We are completely lost. 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.” says dr michael odent. 

He continues “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. 

This isn’t necessarily true. The best course of action may be to find out what is working and what isn’t, and make revisions to the things that are obviously not working. He doesn’t ever get specific about the ‘basic needs of women in labor’, but makes it the basis for his entire argument to return to home birth using midwives. Another claim that is impossible to actually examine for validity. Its boring at this point to type that out.

There is footage of Cara looking at a map and planning a route to a patient, and discussing her credentials as a CNM. She says that her reasons for preferring home births is that the client gets to have their baby at home. Her secord reason is that she would prefer to be on their turf instead of the other way around. She discusses the philosophical underpinnings of “giving the power back to the woman.”

This mindset isn’t restricted to midwives, there are OBGYNs who believe in giving power back to female patients. There are midwives who believe that they know better than patients. It is so easy to exploit the human tendency to stereotype groups of people, and this movie is absolutely shameless about it. They never ask if there are abusive midwives or feminist leaning physicians. Its an obvious question that the film makers failed to examine.

(footage of cara during prenatal visits. She is very nice to the patients and their families)

“I do believe that women who choose homebirth, they do share something. It could be just a feeling that she knows how she wants to do things. And then I think when she’s in labor, she can interact with her labor in a different way than if everyone is doing things to her and making decisions about her.” 

Examination of the themes so far:

I think women who choose home birth may or may not share things. I do know that most of them are white, middle or upper class, and college educated.  Something women of that demographic share more often than other groups is anorexia or bulimia. Until there is research about this I can only offer my opinion, but I do believe there is a connection. Natural Child Birth has a lot in common with the twisted thinking of an eating disorder. There is a lot of perfectionism, judgment, black and white thinking, and the belief that your body will perform a certain way if you are Good Enough. Your body will be proof that you are Good Enough. Your body, its pain, its resistance, is a thing to overcome to prove to yourself, and others, that you are acceptable. If you accomplish it you will finally feel amazing, whole, at peace. There is only one ideal birth to chase, just like there is only one ideal body.  Craving an unhealthy level of control over yourself or your life is a feature common to many women with eating disorders, it may be because there is such a large proportion of eating disordered women who have survived sexual abuse. Midwives are not helping these women, they are preying on them for income. This is such a horrible, dangerous idea to give women who cannot control if they need a c-section, or if natural child birth is a meritless agony to them in retrospect.

The movie deceptively pairs footage of doctors with negative statements and midwifery footage with positive ones. Where are the women like me, like so many others, who had awful midwives? Where are the vignettes of births that women considered ideal that were not NCB?  I have a hard time believing that the film makers could not access anyone with a contradictory opinion, they simply chose not to show anything damaging to the image of midwives.

Something that really made me dig in my heels and adhere more strictly to NCB ideology was the way that anti-home birth advocates ridiculed the idea that women highly value the experience of giving birth. It was extremely personal to me. I identified with this movie a lot because of the value it placed on women and their experiences.  I was at a positive place in my life after overcoming a lot of adversity, and after seeing this movie I thought “Hey, why not me? Maybe I can have the best experience and a healthy baby. Why not aim for the best life can offer?” When other women ridiculed chasing the ‘ideal’ experience of child birth I felt very sensitive about it. Who were they to tell me what I should or should not want?  They always framed it as an experience vs safety, but it seemed like a false dichotomy to me. Why not both? I had to fight for so long to feel like I was worth anything, or that things might turn out well for me in the next chapter of my life.  It also made me think that anti home birth advocates were sexist. The ridicule of a woman who wants ‘too much’ from life is rampant, and it seemed to me that this was yet another example. The worst thing a woman can be is someone who takes more than their share- of food, sex partners, of a conversation, of attention, of decision making, of authority. We are constantly told to be happy with our lot, even when it is woefully inadequate. It is unfortunate that anti-NCB groups are not sensitive to the hopes of women in NCB. I empathize completely with those wishes and do not see them as selfish or narcissistic.  I am hoping that this blog will be a place to show sensitivity to the valid concerns raised by NCB advocates while also being critical of their message about the proper solution to these problems. Stay tuned for more.

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