This is part nine in a series on debunking the Business of Being Born. The other parts can be found here. The description of what is happening in the movie is in bold, while my commentary in in plain text.
A female OBGYN says “Fetal distress, cord prolapse, a fetal brachycardia that doesn’t come up… how are you going to get someone sectioned or emergently delivered from home? Its not so easy.”
These comments being allowed in the movie provide a false sense of balance to the film. Noam Chomsky once pointed out that if you only allow two view points, and then allow vigorous debate between the two view points, you can achieve the appearance of democracy and free speech without ever actually having it. At this point in the film the arguments between the doctors and midwives boils down to hypotheticals, and only the midwives are allowed to discuss the research that they have reviewed. The film picked doctors unfamiliar with home birth rather than those who are well versed in it for a good reason- its much easier to control the debate and make it appear balanced.
Midwife Cara says “People think when you do birth at home, you’re not necessarily prepared for that eventuality, and that everything has to go great. But it doesn’t.”
No explanation given of how to resolve the conditions the OBGYN brought up earlier.
Marsden Wagner says “The netherlands loses fewer women than we do, the netherlands loses fewer babies than we do, and one third of their births are planned home births.”
The safety data Wagner cites simply is not true. Multiple studies exist to evidence the fact that planned home birth has horrible outcomes compared to hospital birth, regardless of what country it takes place in.
The scene shows Abbey Epstein and Ricki Lake discussing strollers. The scene changes to Abbey and her husband at an OBGYN office. They are discussing the baby’s position. They perform an ultrasound and say the growth is right on track. Abbey discusses home birth with the doctor. “We really are very, really considering the home birth with Cara.”
Abbey’s doctor replies “Go. I’ll be your back up.” He is very encouraging. They discuss the logistics of being a back up. He is concerned about his patient being treated poorly at the hospital if he is not their back up.
Cara is talking to Abbey in her car now. Cara says “I’ve had (inaudable) back me many times. And, you know, I could go to saint vincents, or we could go there. It would depend on what the circumstances were.
This exchange makes for a false continuity of care. There is none. A back up means the midwife dumps you there and may or may not come in, may or may not tell the truth to the staff. Having your doctor willing to be on call is a step up, but it might not matter depending on how emergent your transfer is. New York magazine has talked to former patients of Cara Muhlhahn and area hospitals- they say the same thing.
Physicians that say they “back up” midwives never bet their insurance on it, and that’s because its a very bad bet.
Abbey mentions that she would love the possibility of transferring to a birth center. Cara points out that if they need transfer its going to be to a hospital because something is wrong. Abbey says she fears she would change her mind about home birth in the heat of labor. Cara replies that she personally begged for a cesarean during her home birth. Quirky music plays and footage from Cara Muhlhahn’s home birth is shown. It is obviously intended to be funny.
I have taken a break from this series and haven’t been buttered up by the first half of the movie, so I feel absolutely terrible for a woman who desperately wants pain relief and denies herself. I know that Cara likely felt like she couldn’t get pain relief because of the business she works in and her ideological beliefs about child birth.
Cara says she felt like she was between a rock and a hard place, was trying to escape her labor. Footage shows her in obvious pain many times. She says “Every single woman that is having a natural birth feels that way at a certain point. The rock is ‘I’m not pushing because it hurts too much’, and the hard place is ‘Ok then, you are staying pregnant forever, and its going to hurt forever’. Its the most infuriating place to be.” Footage shows Cara crying and whimpering during labor. You can make out her saying “just awful” while she is crying in the labor footage.
This is terrible to watch. I personally would not have included this. It normalizes suffering that is needless. No one should hurt that bad and have a room full of people look on apathetically.
Cara discusses how mean she was to other people during her labor. She is shown in the bathtub crying. She narrates “I looked at the faucet and said thats me, I’m either dying or pushing the baby out.” She talks about having a difficult labor making her a better midwife because she knows how hard it can get.
If you think about it, Cara was in an interesting position after her difficult labor. She was at an impasse, she knew she had aided other women that were obviously suffering like she had. In light of that she could have either chosen to stop promoting natural birth and worked in a hospital again. She could have stopped practicing altogether. She could have apologized to people she knew that she encouraged to suffer needlessly.
Instead it seems she took the easier option, which is to justify what happened. It is easy to forget pain when you aren’t feeling it right then, and it is easy to forget just how badly something hurt you.
We all have certain beliefs about ourselves or the world that are deeply painful to confront. I have a feeling that Cara’s self image as a helper, as a sacred journey keeper for women in labor, was more painful to betray than labor itself.
triumphant music plays. Cara is pushing. The baby emerges and is put on her knee. One of her arms is grasping someone elses with a white knuckle grip that she doesn’t release, even to hold her baby. Her other hand keeps the baby somewhat more secure on her lap. She looks down at the baby with a rather stoic expression.
Cara did not have the amazing moment that Ricki Lake did during her birth. There are editing tricks employed to imply that it happened, but from what I can see she was just terribly exhausted, to the point where it was difficult to enjoy her baby’s birth. The hand she haphazardly extends so her baby doesn’t fall on the floor seems to be all she could manage right then. The scene ends rather abruptly, making me wonder what else happened after that.
The fashion model patient is trying to hear something through a stethescope. Cara is examining her and helps her use it. The client talks about her insurance company being unsure about what to do with a non-hospital birth plan. She says its cheaper to have a baby at home.
They cut to Carol Leonard, lay midwife and owner of Longmeadow Farm Birth center says that a spontaneous vaginal birth at a hospital costs about 13,000$. She exclaims “Hello! I’m charging 4000$ for everything!”
There are many factors as to why midwives charge less. These aren’t highlighted in a frank manner, so I will do so here:
1. They provide fewer services (no OR, anestesia, continuous fetal monitoring, emergent labs, blood bank, etc)
2. They do not have insurance (if they screw something up they won’t be able to pay, and if barred from practice in one state they can move to another one and set up shop again, unlike a physician that banks their whole career on retaining their license)
3. Their education costs next to nothing (a CPM can usually get their whole degree for about 3K)
The old addage that you get what you pay for is true here. So is the fact that insurance varies wildly in the US, you may pay less than 4K for a hospital birth depending on your insurance and its terms.
Fashion model patient wonders “what their agenda is” in pushing a far more expensive hospital birth on the insured.
I can tell you right now- it is making sure the insurance company doesn’t have to pay out for a costly NICU stay, or perhaps a lifetime of special education or disability related doctor visits from hypoxic brain damage. The bet of paying on a hospital birth pays off in the long run. The people who run insurance companies just crunch the numbers and charge based on the results. They do not have much of an agenda outside of trying their best not to screw over their stockholders by insuring things that will ultimately cost the company more than it makes.
Marsden Wagner says “The insurance companies, are part of the establishment, and so when the obstetricians who are giving the advice to the insurance companies say that home birth is dangerous or that midwives are not as safe as doctors and all of this nonsense, the establishment CEO in the insurance company believes them.”
Things really do not work that way, but that is beside the point. The assumption is that OBGYNs say home birth is dangerous because they have a bias instead of because they actually know what they are talking about. The questions brought up earlier about specific problems that require emergency c-sections are still hanging heavy in the air, and no one has answered them. I’ve been tracking home birth fatalities enough to answer the question- depending on the problem that occurs at a home birth, someone either dies, is injured, or disabled. There are far too many complications that cannot sustain life between home and the hospital, even if it is minutes away.
A woman says “I’ve interviewed many nurse midwives who noticed that once their practice reaches more than 30 percent of the patients in a hospital the doctors will start firing them, because that is too much competition.”
We are again inundated with gossip from the point of view of midwives with no opposing viewpoint given from the people who are (supposedly) firing nurse midwives. No one knows if this is actually happening or why. OBGYNs do much more than CNMs ever will. It isn’t as though every OB’s bread and butter is delivering babies. Here is a list of specialties that OBGYNs can branch into if delivering babies isn’t their preference. CNMs can do almost nothing that OBs can on that list.
A woman says “The AMA as the trade organization for physicians, has a very clear and public position that holds that they will not allow non-physicians to do anything that physicians do. You wanna talk big lobbies, big dollars, they can call a lot of shots.”
The name of the statement or any reference of it isn’t provided so that it can be verified.
The AMA has a lobby like every trade organization. They are infinitely more ethical than trade organizations like MANA, that had horrendous perinatal mortality rates on the books for several years before privileging the rest of us with them. The period of time between the collection of those numbers and the release of them was the period of time I was pregnant. I was not allowed to make an informed choice because MANA wanted to keep the data secret.
The biggest difference between MANA and the AMA is that the AMA changes its policies based on data. MANA does not. MANA only cares about protecting the legality of home birth instead of the safety of patients. They refuse of even define what constitutes a low-risk pregnancy, despite insisting left and right that home birth is only for low risk pregnancies.
The attempt to smear physicians and their organizations is pretty rich when its coming from midwives. They have very little room to speak.
stay tuned for part 10.