Debunking the Business of Being Born: Part 7

This is part 7 in my series on The Business of Being Born. The other parts can be found here. Descriptions or quotes from the movie will be in bold, and my commentary will be in normal text.

Bad Company’s “feel like makin’ love” plays

Footage of hippies dancing, presumably from the 1960s, is shown

Patricia Burkhardt, proffessor at NYU’s midwifery program says says “Historically, the home birth movement grew apace again after it was basically cut out from under the midwives at the turn of the century. During the hippie era, when there were communes, and the communes mimicked, in many ways, immigration communities. They mimic, you know, extended families, and so midwives were reborn, in a sense, during that era. “

I have always had a lot of interest in communes and other non-conventional communities. I’ve read about more than I could count. One thing I know for sure is that each commune I have read about was very different from others and it is difficult to generalize about them in any meaningful way. Some are religious, some are not. Some are vegan, others are not. Some are polyamarous, some are not.  Some are violent other not. Every difference you could imagine existed in these societies.

The movie shows a lot of happy hippies while the midwives speak in an attempt to (once again) associate the pro-midwife speakers with positive imagery. Once you recognize that technique in the movie it becomes quite grating to watch it, because you know exactly what to expect in terms of imagery based on if the person speaking is pro or anti home birth.

Ina May Gaskin says “We wanted the choices. We didn’t want somebody else making the rules. That didn’t understand us, that thought we were machines instead of people with feelings. ‘Cause we knew that feelings affected birth.

The last line here is something that the movie glosses over, which is curious because ‘feelings affect birth’ is a major part of Natural Child Birth and home birth philosophically.  A film maker with integrity would delve deeply into core tenants of NCB and explore if they have merit or not.

There is no real evidence that feelings affect birth- it is hard to measure feelings outside of self reporting.  I cannot find any research about feelings during labor and their impact on outcome. It is important to base childbirth choices on good information, for instance lets say that Ina May is right and feelings do affect child birth. How much of an affect is there? What outcomes do maternal feelings influence? Is it more or less than the affect on outcomes that birthing out of hospital is associated with? Again, critical questions are not asked in this movie, and it does a disservice to women who believe this film is educational.

More hippy footage and “feel like makin’ love” soundtrack

An anthropologist from earlier in the movie says “That was part of what sparked the natural childbirth movement, was a reaction against the abuses of the scopolamine era, the twilight sleep era, because some people realized the only way to get away from that was to get out of the hospital altogether.”

This is one theory about where NCB came from. Another is explained here, basically it explains that the origins of the natural childbirth movement can be found in stalinist russia. There was a lack of pain medication for laboring women so the government told women that there was merit to foregoing pain relief. The same dynamic can be found with midwives- they cannot provide pain relief that is as effective as hospitals, It is hard to say with any authority which one of these is the true origin of NCB (it may be a mix of the two theories, or neither). However the belief out necessity dynamic is absolutely present in home birth situations because midwives have very limited options for pain relief compared to OBGYNs in a hospital setting.

This portion of the film tries very hard to make it seem like the NCB movement, as a political movement, is about the rights of laboring women. From what I can tell, based on the political actions endorsed by midwives, it is a movement to let midwives operate without accountability or adequate training. Midwives and NCB advocates will fight hard to prevent a midwife from being held accountable for a death. They will fight hard to prevent any educational or licensing requirements for midwives. If anyone is aware of a political campaign by NCB or midwives that does not fall into one of those two categories, please let me know. I have literally never seen it. What a political movement represents is better understood through its own actions than its stated aims- virtually no one is willing to broadcast shocking aspects of a groups political ideology to the uninitiated.

She continues “Just as we were getting someplace, technology caught up to us again. The electronic fetal monitor got introduced into hospitals starting in 1970, and by the end of the 70s it was pervasive in hospital birth.”

creepy music and footage of 1970s hospital births are shown 

“And the cesarean rate in that decade went from 4% to 23%”

No word on what the perinatal mortality rate was at the beginning and end of the 70s. I decided to look into it myself. According to the CDC:

From 1970 to 1979, neonatal mortality plummeted 41%

If you look at the table the CDC provides, neonatal, perinatal, and infant mortality all fell significantly during that time period. It is completely irresponsible to fail to report this information while decrying the use of the technology that facilitated the drop in death rates, because its a totally obvious question that should have been asked and answered during the film.

Footage of a younger Ina May Gaskin is shown. She says 

“See, when I started, only 5% of women in the US had cesarean. Ten years passed, and it was up to about one woman in four. I couldn’t believe it. And we didn’t, in our group, didn’t need the first cesarean until birth number 187. So we were going the other way from the rest of the country. And we were doing that safely. So that told me something about the pelvis of the American woman, its just quite fine, thank you very much. And we didn’t have another c-section until birth 324.”

There is absolutely no word about the outcomes of these births except for c-section. Absolutely NONE. That is very difficult for me to understand, because there are many other outcomes to consider, such as birth injuries, debilitating tears, pelvic floor damage, disability (for either infants or mothers), PPH, and of course death. We are not given the numbers to examine if Ina May’s practices were producing an extremely low c-section result ‘safely’. Even if she had done it safely, three hundred or so births are not adequate as a sample size to determine if their practices at the farm were optimal or not.

Text appears on the screen that reads “since 1996 the cesarean section rate in the U.S. has risen 46%

In 2005 it was one out of every three births “

news footage of reporters discussing high c-section rates in America are spliced together

This is a pretty blatant argument from tradition- they are making it seem as though newer protocols are bad just because they differ from the past. The only other reason that the audience has been given to worry about the c-section rate so far is that it isn’t a vaginal birth. They have not demonstrated any benefit of one form of birth over the other yet, but we are supposed to be shocked about the rates.

Dr Marsden Wagner says “As we all know, The cesarean section rate in this country is going up, up, up. Why? What is really, really underneath this? Cesarean is extremely doctor-friendly, because of instead of having a woman in labor for an average of 12 hours, 7 days a week, It’s 20 minutes, and “I’ll be home for dinner”. 

Once again, we are made to believe that midwives never behave poorly because of the inconvenience of looking after a laboring woman. There is no evidence for that, and I do actually know of two cases that ended in death because midwives couldn’t be bothered to look after their patients. My midwives were eager to get me out of their birth center when I was in labor too.  Midwives are once again shown as the answer to a problem when they are equally as capable of being unethical. I am sure there are bad doctors out there that do this, but to claim that it is industry wide practice so that OBGYNs can go home earlier would require a lot more evidence than the film offers.

The difference, as far as I can tell, is that if you have an unethical OBGYN you can end up with procedures done against your will or without your permission, a c-section, and extremely rarely a preventable death.  Deaths or injuries caused by unethical OBGYNs can be reasonably sued for in a malpractice case. A doctor can lose his or her ability to practice based on their actions. If you have an unethical home birth midwife you can end up with procedures done againt your will or without your permission, birthing unassisted, preventable death or injury at a much higher rate than physicians. You can not readily sue them in malpractice court, and if you sue it is hard to collect. You cannot prevent them from simply moving to another state and setting up shop again.

These are big differences that women deserve to know about, but the film leaves them out because it does not fit the film maker’s beliefs about birth.

Stay tuned for part 8.

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