Debunking The Business of Being Born: Part 6

This is part 6 in a series on 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 found here.

There is more footage of a woman laboring at home with someone applying counter pressure to her back during a contraction.

Dr Odent says “Today what we have to rediscover is how easy birth can be… when we don’t try to make things too complicated. When ideally there is nobody around but an experienced, motherly, and silent low profile midwife”

There is footage of the same woman as before pushing her baby out in a birthing pool at home. 

I am a bit confused- is birth easy if the conditions are right, or is it so hard that you ‘claim a victory’ when you achieve it?  This is how politicians talk- vaguely, and out of both sides of their mouth. The point is that you will hear whatever you want to hear and get a good feeling listening to the person talking. It isn’t a good way to convey actual information or make testable claims. The doctor had an awful lot of subjective conditions around his claim of easy labors, so if a woman had an unbearable labor he could make use of the no true scotsman fallacy to deny that conditions had been correct.

I should also note how gross it is for a man to be lecturing women on how to make their labors easy. He has no idea because he will never give birth to a baby, and is unlikely to be an authority on the experience. He might as well be explaining how to optimally menstruate.

The woman delivers her baby and holds them. The midwife checks the baby and is very unobtrusive while doing so.

It is a beautiful moment. This is the most emotionally loaded type of scene in the Business of Being Born- scenes of moms having idyllic births in their homes.  What I dislike is how this was combined with audio of a doctor talking about ‘easy’ birth. They have taken the birth of that woman’s baby and used it to sell a point, one she may not agree with. I find this deeply disrespectful of the woman who was kind enough to let them into her home and tape her giving birth. We never get to ask the woman who had the baby if she considered it easy or not, nor are we given any information on how many women doing a home birth would consider it ‘easy’, which would be more useful than anecdotes anyway. The way that the footage is edited makes it look like it was effortless because all we see are glimpses of the process. A documentary can never do justice to something that often takes hours and hours (like childbirth).

A different pregnant woman says “I went online, and I found that new york hospitals had some of the highest cesarean rates in the nation. That actually really surprised me, I guess I expected new york women to be more like, ‘Hey, I’m taking charge.’ So I was surprised.”

Having a c-section does not indicate a lack of “taking charge”.  Having a vaginal birth does not mean you are ‘taking charge’ any more than seeing without glasses is ‘taking charge’ of your sight.  All the insults to women who don’t want (or cannot have) NCB are not stated outright, but they are certainly there.

she continues: “And I was scared. I mean I knew what interventions I was okay with, and they were pretty much zero. You know, I mean, I really understand that things can go wrong during pregnancy, just like with anything else. But I don’t want that to be precipitated, so to speak. I said “David, this isn’t looking good.” And that’s why I started to interview midwives in the city.”

What is the trade off for lower c-section rates though? It seems impossible to me that practicing in a radically different way (the selling point of midwives in TBBB) would produce only a lower rate of c-section and not affect any other outcome. Of course, now it is well established that the trade off for a lower c-section rate is a higher rate of perinatal death and brain damaged infants. That is why no one besides NCB advocates care much about lowering c-section rates.

The name “Mayra” appears on the screen while the same woman as the previous scene continues. “I just feel like I trust my body. I really just kind of want to, and I mean, have a feeling that this is kind of the way you run things anyway, but I just wanted to let my body do what it’s gonna do. 

Cara (the midwife) replies “Oh and it totally does. And the truth is I don’t even run things. Your body runs things, and its respecting that. And then I’m like the gaurdian of safety, and the witness of your process. I really do firmly believe often times the body is smarter than me, and I’m not that dumb.

The matter of ‘trusting your body’ is an interesting question- I am fairly certain that the majority of men trust their bodies, they do not see it as an opposing force or something to overcome. Women are constantly told to see their bodies as adversarial and untrustworthy- too weak, too fat, too this, too that. In need of cosmetic surgeries or products to fix ‘flaws’. The majority of women know the pain of repeated dieting and regaining weight, or not losing much to begin with, and then judging themselves for failing.  Women fight their bodies all the time, so the idea of trusting it can seem very relieving to women. I find it distasteful that they exploit the low self esteem of women for profit.  A much more powerful message would be one of unconditional acceptance of your body. I would say that you can trust that your body is amazing, that you don’t need to prove the value of it to anyone, ever. Your body will carry you through life however it can, and one way isn’t better than another. You don’t have to walk or give birth vaginally or be strong or thin or anything for your body to be trustworthy or valuable.

Hearing the CNM talk about the body being ‘smart’ is a bit troublesome as well- if something goes wrong in labor that necessitates an intervention it is not the body being ‘dumb’. If you don’t need an intervention your body wasn’t “smarter” than someone who did need one. The privileging of one group of bodies for their ability to perform certain tasks that others can not is the essence of abelism. What each of our bodies are capable of isn’t an hierarchy or a moral obligation, its just whatever cards we were dealt. Its only unfortunate to be a c-section mom in a culture that demonizes c-sections and exalts vaginal birth. Natural childbirth advocates and The Business of Being born push that agenda precisely, but fail to investigate or even mention the logical outcome of that world view. The obvious conclusion is that women who do not have vaginal births will feel broken or foolish for it, or like they ‘failed’ at birth. There are a lot of people who feel unnecessarily guilty about having agreed to a c-section. I know I did. I tried to figure out what I did wrong or where things could have possibly turned out differently, and I’ve talked to some old friends online who feel the exact same way after trying to have a natural birth.

There is footage of a midwifery clinic in new york. They discuss their support of choosing NCB style childbirth when patients request them.  They talk about their commitment to patients, and how they believe that it is in contrast to most OBs style of practice. 

That’s fine. These are all hospital births with advanced practice nurses in attendance. I am not really sure what this has to do with home birth or natural birth.

Abbey Epstien and Ricki Lake are in a cab looking at history books about birth and look at creepy photos from the past. There were some awful practices back then. There is more creepy hospital footage.

There are historical examples of abuse of patients in any non-privileged population. This is a very real fear that women, people of color, fat people, gay people, people with mental illnesses, poor people, etc experience when seeking care from physicians or hospitals. It is not an unfounded fear, care disparities exist and are well evidenced, but midwives are equally as capable of being culturally or ethically incompetent in their profession. Even if NCB advocates are right and midwives are the answer to this problem, then it is a woefully inadequate one. Virtually everyone except women of childbearing age, who need specific care that midwives can provide, are not served by using midwives as a solution to historically based oppression. There must be system wide changes put in place to protect all vulnerable people from the inhumane treatment that can exist within hospitals.

An anthropologist says “The drug scopolamine was invented in germany in the early 1900s. And american women found out about it. Remember that, at that time, women were still being told that the pain of childbirth was the curse of eve. And that it was because of eve’s sin in the garden of eden that women had to suffer during childbirth. So you could imagine how the modern, liberated, feminist attitude at the time would be “I certainly do not have to suffer, and if there are drugs around that keep me from having to suffer then I’m going to go find those drugs because I’m a modern woman.” 

The implication here is that women who fought hard to get pain relief during childbirth were misguided, victims of the times, and avoided pain in an attempt to be ‘modern’ or trendy.  This is a very strange way to weasel out of the fact that many women find that childbirth is unbearably painful, and they wanted drugs because pain is unpleasant.  It is a much simpler and believable explanation that what the anthropologist has argued.

Yes, even more creepy hospital footage. This time paired with a twilight sleep re-enactment complete w/writhing, struggling, crying. The anthropologist continues “Women thought that it [scopolomine] took away pain during childbirth, but it doesn’t.

Women who had ‘twilight sleep’ births were usually given scopolomine and opiates, so there was pain relief, just not from the drug being discussed.

It actually just takes away your memory of the experience. So scopolamine spread rapidly across the united states, and by the 1960s almost everyone was having twilight sleep. Now it does take away memory, but it also takes away self control. It takes away self-awareness. ” She continues on about the horrors of twilight sleep and how women were strapped down if they freaked out too much, how they could be left for days laboring and drugged, etc. 

The history of medicine is full of horrifying practices and inequality.  This is essentially an argument from tradition- that group x was wrong in the past, so they are probably wrong today. It is a logical fallacy. If they are wrong today then there will be evidence that demonstrates it.

Marsden Wagner says: If you look at obstetrics for the last 50 years, what do you find? IN the 1930s they were giving x-rays on every pregnant woman to measure her pelvis. And then in the 1940s they discovered that that caused the baby to have cancer, so they had to stop it. And then in the 1950s and 60s, they had another drug called thalidomide, which caused babies to be born without arms and legs. And then they had to stop that. In every case it was after the fact. In the 1990s, They were giving cytotec to induce labor in women who had had a previous cesarean, and they ended up with hundreds and hundreds of ruptured uteruses and many many many dead babies before they found out, finally, in 1999 that they shouldn’t do that. But, you see, theres not a good history in obstetric practice of careful study of the long term effects of all these interventions. This is why, if you really want a humanized birth, the best thing to do is to get the hell out of the hospital. 

You could say something negative about virtually every branch of medicine, or any profession ever, and that is because medicine is practiced by people. People make errors. The best thing you can do is try to fix it when problems arise, and that is exactly what happened according to him. Problems were identified and so practices were changed. Midwives do not change their practices when problems arise. MANA has not changed any policies in light of the fact that they felt that the mortality numbers for out of hospital breech and twin births were unacceptably high. They still decline to define low-risk pregnancy and want homebirth midwives to be able to attend any births that the midwife and client agree upon, even those proven to have extremely high rates of death and disability, all without any insurance in case of an emergency or mistake. Its deplorable.

Something that Dr Wagner failed to mention was all of the exciting successes of OBGYN care over the past 50 years. There are many more successes than failures in terms of technology and outcomes. This is a triumph of science and the work of many hands over many years. Its something worth celebrating, or at a minimum mentioning when discussing the history of OBGYN care over the past 50 years. There isn’t even an attempt to give a balanced account of events here, and its pretty shameful.

Discussion of the themes in this portion of the movie:

Midwives are fond of saying that physicians are scaremongers or bullies, but this portion of the movie is definitely intended to cause fear. You are supposed to be afraid of your doctor, of medical technology, of the hospital, and of c-sections.  It scared me, and midwives profited off my fear of going to the hospital, then they subsequently dumped me on the hospital staff during labor.

The way that this portion of the movie attempted to use feminism to sell midwives upset me. I was reminded of a story from Roseanne Barr, about all the opposition she faced in getting her show on the air at all. She assumed other women in the media would be her allies, because they shared the same struggles:

My breakdown deepened around the fourth episode, when I confronted the wardrobe master about the Sears, Roebuck outfits that made me look like a show pony rather than a working-class mom. I wanted vintage plaid shirts, T-shirts, and jeans, not purple stretch pants with green-and-blue smocks. She bought everything but what I requested, so I wore my own clothes to work, thinking she was just absent-minded. I was still clueless about the extent of the subterfuge.

Eventually she told me that she had been told by one of Matt’s producers—his chief mouthpiece—“not to listen to what Roseanne wants to wear.” This producer was a woman, a type I became acquainted with at the beginning of my stand-up career in Denver. I cared little for them: blondes in high heels who were so anxious to reach the professional level of the men they worshipped, fawned over, served, built up, and flattered that they would stab other women in the back. They are the ultimate weapon used by men against actual feminists who try to work in media, and they are never friends to other women, you can trust me on that.

This is how I feel about midwives now. They will talk the talk to get you to sign a contract, but they don’t really care about any of this stuff once the check clears. They won’t support women who leave NCB or who are mad about the way a midwife has treated them. The men that the NCB movement fawns over are mostly old white men who claim to know how women can have their ‘best’ birth. Real feminists let women lead the movement, or at a minimum question the sex disparity in the leadership. You would think that a movement that is overwhelmingly female would have more women than men as Big Names, but you would be wrong. It doesn’t look anything like the feminism I know, because its not feminism at all.

Next up is the nauseating ina may portion of the film. stay tuned.

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