Home birth gurus on facebook part 1

We start today with the home birth guru Ina May Gaskin and her advice about the vaccine, Gardisil.

Ina may says “Here’s a vaccine that should have never made it onto the market. I’ve read too many of these reports.”

Too bad she hasn’t bothered to fact check the reports she has read, as the source material says that the girl’s autopsy was inconclusive. There is no evidence that the shot killed her. No one knows what did. All we have is one data point of correlation. Oops! I just hope no one ends up with cancer because they listened to her quackery.

Secondly, we have Gloria Lemay:

“One of the big problems that we have in sorting out cesarean birth stories is that doctors lie to the family/midwife about the “justification” for the c/section in order to avoid criticism and/or lawsuits. The stories always have to be highly dramatic.”

It isn’t as though Lemay is talking about sorting out the data from the doctors or reports, she is talking about sorting out the details based on what the family says. She figures if there is a lot of dramatic explanation the family must have been lied to by doctors.

This is an occam’s razor situation- the likely explanation is that if they are talking to Gloria Lemay and said they had a c-section, she is going to criticize them for their medical decision and therefore the details might get fudged a bit just to get her to shut up about it. I know I would be tempted. Its really none of her business, until she gets an adequate education and presents some type of actual need to dissect if a c/section was “really” needed or not.

proof that natural child birth advocates don’t care about choice

An article is making the rounds on facebook, it is called “State bans elective inductions and c-sections! victory!”

They don’t give a shit if you don’t want to give birth vaginally for whatever reason. Many women choose elective c-section because of abuse histories, or perhaps because they want the baby to see their father he gets deployed, there are really countless reasons and circumstances which make elective c section or induction completely understandable. They believe its a victory to try and force you to do so.

They believe that legislators are totally correct to restrict the choices of pregnant women, based on the (incorrect) concept that vaginal birth is always preferable to surgical birth in terms of safety. However, the same people will tell you that its incorrect to ban direct entry midwifery because it limits the choices that women have.

Hypocrites. Every last one.

Never Good Enough

I found an article today that made my eye go a bit twitchy. It is called “A family centered cesarean is not a substitute for a fully supported natural birth or VBAC“.

I have no idea why the author thinks they are the authority on what is or isn’t a substitute for a natural birth, I would think that the woman giving birth would have to decide that on her own. I am sure there are mothers that have had a vbac and then a c-section for a later pregnancy. A poll of them would be more useful than just making a blanket statement.

The article is intended to demonize c-sections, as usual. What struck me is that physicians who do not feel comfortable with a “natural” vbac (see: almost none) are still considered bad for offering what is called a family-centered c-section.

And mothers, if when you are discussing your desires for your natural birth with your provider, they immediately start talking about the “family centered cesareans” they offer for mothers like you, please please please recognize this as a red flag, and consider transferring care to a more supportive provider….one whose immediate response is what they can do to facilitate your natural birth and then, only if all other options are exhausted, will perform the most family centered cesarean possible

No matter how much OBGYNs pander to natural child birth advocates, its just never good enough. I think I would do the same thing if I were in the OBGYN’s shoes, just to try and prevent anyone from having a dangerous birth at home.

The reason that most providers require close monitoring and epidural anesthesia for VBAC in the hospital is that the risk of a catastrophic uterine rupture is best managed under those conditions. A life saving c-section can be performed quickly under those conditions. An unmedicated VBAC makes it impossible to catch the problem early, which can result in death for the infant. It can cost the mother her uterus, or her life.

I just wish people like the author of the Birth Blissfully article  had to explain how superior a natural vbac is to women who have suffered a uterine rupture during a vbac. Here is one from baby center:

The room filled with people, they threw the sheet curtain on me, didn’t even have time to hang it up before I heard the doctor say “cutting!”  Thank goodess I had the epidural so there was no time wasted there.  She had my baby out so fast, literally within a minute or so.  DD’s arm and shoulder had went through my rupture into my abdominal cavity.  She was breathing but a little limp – it’s so scary to think that minutes later would’ve been a different story.  They rushed her to the NICU, right by DH who had no idea that she had even been born yet.

It seems that she came pretty close to death, too. She lost 2 pints of blood, had multiple transfusions, and had to stay in the ICU for monitoring. One of the big things people dislike about c-sections is that you may have to spend time away from the baby while getting stitched up, but this mom ended up going days without seeing her daughter because they were both in their respective ICUs and couldn’t visit each other. Here is what she has to say about her decision to vbac:

I spent more time thinking, praying, and researching this vbac decision than any other in my life.  Ironically, it was the worst decision of my life.

I feel the exact same way about my choice to birth out of hospital with direct entry midwives (though luckily I did not have this type of health outcome). I looked into it so much, but sometimes doing research is just assuring yourself that what you want is really what you need. It takes a lot of humility to realize when you are reinforcing your previously held beliefs vs when you are actually trying to get to the truth.

A fully supported VBAC, for this mom, would have meant death or serious injury to mom, baby, or both. A c/section is a fine substitute for that risk, that is probably why the vast majority of moms choose repeat c-section over VBAC when presented with information about risks. It isn’t because women are stupid or uneducated, they just have different priorities than NCB advocates. There is nothing wrong with that.

Debunking the Business of Being Born: part 8

This is part 8 in a series on debunking The Business of Being born, the popular documentary by Ricki Lake and Abbey Epstein. You can find the other parts of the series here. My descriptions of the movie are in bold. My commentary is in regular text.

Dr Michael Odent says that there are people that claim “that in the future most women will prefer to have an elective cesarean section. But when you talk about that with certain women, [they] still have some sort of intuitive knowledge of the importance of what’s happening when the baby is being born. They cannot accept that cesarean section is the future.” 

It is indeed true that certain women prefer some things and other ones do not. Its almost like we are individuals!

Rickie lake is talking with Abbey Epstein. Ricki Lake says  “I couldn’t get enough information. I was just blown away by what I didn’t know the first time around. I knew, even before I planned a second pregnancy, that I wanted it different. I wanted to do it on my terms. “

That’s fine. The unfortunate part about The Business of Being Born is that they pretend that unmedicated births are the only way to have a child on your own terms. Women who want c-sections, or who do not want assistance at all, are not represented. The contrast between the extremes would make for an interesting movie, but it becomes obvious that this is a movie intended to make home birth look good in the public eye, not to explore any issues surrounding womens preferences during child birth.

Abbey Epstein remarks that she thought it was just an eccentricity for Ricki to prefer home birth. Ricki replies that she loves pain medication and takes it when she has a headache. “But when it came to giving birth, it wasn’t an illness. It wasn’t something that needed to be numbed. It needed to be… experienced, you know?”

Ricki Lake filmed her home birth and footage of it is shown. She has multiple people trying to relieve her pain during contractions.

Rickis voice narrates over the footage “I remember I was in a LOT of pain. I was enduring just about the worst part, almost the worst part. I didn’t lose my sense of humor. I was naked and going ‘uhhh’ and we heard an ambulance go by, and I was like ‘That’s my ride, get me the fuck out of here! I want to go to the hospital, I want my epidural.’ “

Footage is shown of Ricki’s home birth where she is obviously in a lot of pain and says “I don’t think I can do this.” Ricki narrates over the footage saying “My midwife reminded me of all the reasons I was at home, and what I wanted to avoid, and the gift I was giving my baby.” and I thought “yes” and I got through that contraction, and I was one step closer.

This footage would be extremely disturbing if you hadn’t been prepped with natural child birth talk for 40 minutes beforehand. If you had seen the footage without being pummelled with the film’s conclusion (that vaginal unmedicated childbirth is optimal, is an amazing experience, etc) you would have thought it is cruel to deprive a woman of pain relief when she was in intense pain and requested relief. I also have a feeling that when women trust their midwives it is easier to go with their narrative of birth rather than to see their actions for what they are- cruelty. It is cruel to deprive someone of pain relief when they are desperate for it. After all, ricki isn’t experiencing the pain now, so it is easy to look back on it and make light of how horrendously painful it was.

More footage of ricki’s birth. She is in pain and her midwife wispers “this is you having a baby.” 

Ricki says “I feel like pushing.” her midwife responds encouragingly. 

Ricki’s narration over the footage says “At a certain point, I just gave in to the pain. I just let go and surrendered, and that’s when things went really quickly. “

Again, incredibly disturbing to someone who hasn’t been told repeatedly that doing things this way is optimal. It seems so needless to hurt that much. Ricki looks exhausted and dazed by having endured hours and hours of painful contractions. I remember that before I had my baby, I thought that midwives who acted like Ricki’s were acting like they believed in her, but after having been that patient, in tons of pain, with a midwife inadequately prepared to deal with my pain… it seems very cruel. I think that midwives witnessing pain so regularly without the means to solve it can harden them to the pain other women are enduring.

There is footage of ricki pushing her baby out in her bathtub, her midwives encourage her to pick up the baby.  Ricki is crying and saying “My baby” over and over.

This is the bread and butter of the business of being born: birth footage chopped into bits that emphasizes the baby being born and minimizes the labor and pain. I just wish that they would have been forced to show footage in proportion to the time spent on different portions of the actual labor. Women typically labor for hours, and the moment of birth is just that- a moment. There is a disproportionate amount of focus on the end of the birth.

Ricki remarks “That was just…everything to me. I mean, I could start sobbing right now. It was so empowering.”

Statements like this try to establish the objective supremacy of natural birth, when in reality it is just Ricki’s opinion of home vs hospital. Other women with different experiences are not represented.

A Doula is giving a couple lessons in their home on how to deal with contractions and talks about different techniques to provide relief. The woman’s husband is interviewed and talks about how he was on board with home birth from the start. Footage is shown of the midwife providing prenatal appointments in the couples home. 

Eugene Declerq, an MPH says “The research on home birth is pretty consisten in showing that in a supported environment, (he clarifies this to mean well trained attendants with quick hospital transfer), the outcomes of home births are very, very good. Generally better than they would be at a hospital birth.”

The outcome of home birth with nurse midwives with quick transfer are better than the outcomes of home births without those things, but the majority of home birth midwives have none of the things he listed. Regarding the numbers, its quite a stretch to call them “very, very good”, and its an outright lie to say the outcomes are better than hospitals. It is difficult to evaluate what studies he is referencing because they are never named, nor do they tell you what they believe to be a good outcome. I can bet that they care more about the c-section rate than the death rate.  The majority of studies show a decrease in interventions and an increase in perinatal death. MANA’s numbers, which came out this past year, demonstrate the same thing (if you look past their flowerly press release that tries to ignore the obvious conclusion that comes from looking at the numbers and then comparing it to hospital statistics).

The midwife talks about screening out patients for risk and other safe guards in place to protect moms (like preparing for transfer and making the call to do so in time). 

That’s nice and all, but those things only matter if the midwife actually decides to do them. There are so many cases of midwives taking high risk patients, of midwifery publications calling dangerous conditions “variations of normal”, etc. This seems like another attempt to make home birth midwives look like something they are not. Most of them are not nurses, most of them do not have adequate training, most do not have adequately quick transfer, and most of them do not have a good working relationship with hospitals.

OBGYNs express doubt that midwives could adequately manage complications without the equipment available in the hospital. One dr compares it to driving without seat belts using previous safe driving as a justification for the risk. Eugene comes back on the screen to dispel the myth that midwives are using archaic methods to manage labor or pain. He says they bring pitocin, oxygen, etc to births. Home birth midwives are shown packing up this gear.

Once again, this movie tries to make it seem like most midwives are nurse midwives (the only highly trained midwives in the usa), but most home birth midwives aren’t. Most home birth midwives are direct entry or “lay” midwives who do not have adequate training to deliver babies. Direct entry midwives are not allowed to carry medicine in all states, and some don’t do it because they think that complications should be managed by homeopathy or other techniques.

It is worth noting that midwifery is “traditional” or “ancient” when it suits natural child birth advocates, and its contemporary and evidence-based when it suits them.

Eugene continues “Home birth midwives are incredibly skilled at what they do.”

Then why is their death rate so high? Why is it that in many states I can become a home birth midwife simply by calling myself one? I have no skills or training outside of a doula class, but no one can prevent me from attending home births in my state because the standards are non-existent.

An OBGYN says “In a postpartum hemorrhage, you can lose your entire blood supply in about five minutes.” 

The midwife says “if you think a mother has a higher risk of bleeding you have the pitocin drawn up. You have the IV warmed here, right by her side.”

Anyone who has attended codes or traumas knows how hard it is to start an IV on someone who is bleeding heavily.  Having it ready doesn’t mean a lot if it isn’t physically inside the person’s vein. When they get really desperate for a line they jam a huge IV into your bone to provide fluids. Its not pretty. I doubt midwives have the equipment for that. Anyone who has watched the beginning of this movie knows home birth is all about NOT having IVs or other medical interventions, even “just in case”. They only bring it up when safety concerns are being addressed, to make it appear safer than it actually is.  They again they ignore the fact that the majority of american home birth midwives are not nurses and have no real medical training.

My patience for this is wearing thin. There is so, so much deception at this point that it is hard to conclude that it was not intentional. Either that or the film makers are in so deep that they are basically acting as cult members, who believe that it is okay to lie as long as you are serving the cause.  An entire portion of the film is dedicated to talking about how skilled and trained and prepared home birth midwives are, but they take absolutely no time to discuss the difference in training and preparation between the majority of home birth midwives (direct entry midwives) and the majority of hospital midwives (certified nurse midwives). Its a truly glaring omission.

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.

For first time mothers who want a Natural Child Birth

Dear first time mom who wants NCB,

I used to be one of you. I tried very, very hard to have a natural childbirth in a free standing birth center. I would have chosen home birth if my house did not have so many negative memories attached to it (although that is another post for another day). I tried.

I cannot overstate how much I felt like a failure rolling down the hall at the hospital in a wheelchair to the L&D unit. It was the place I desperately did not want to be. I had a great doula with me, but the midwives I trusted with my labor had abused me, and so I declined to have any of them accompany me to the hospital.  I knew I was going to have to give birth with strangers, and I dreaded a fight with them over what I would consent to or not.

I won’t lie to you- it was an awful experience. A procedure was done without my permission. My trust in any medical professional was shattered. I still haven’t gone to an OB or a midwife since my baby’s birth, despite the fact that I had surgery and was told to follow up with someone. Some nights I worry that I will have cervical or ovarian cancer and not find out until its too late. The fear of that is outweighed by the fear of being violated again.

I learned the hard way that people are not always what they say they are. I learned the hard way that it didn’t matter if it was a midwife or a doctor, I couldn’t control what anyone decided to do to me during my labor. I felt especially upset because I believed that I had avoided a lot of problems by picking midwives, that they would respect me and my wishes. I felt bad for having chose to have a baby, that I was too weak or stupid to properly care for my child. I felt that the way things went during my labor was proof that I shouldn’t have even tried in the first place, that my judgment must be terrible to have ended up like I did.

I had to make my decision about care providers without a lot of crucial information, because it there was so little data about first time mothers in home birth. Most women in the NCB movement had a traumatic or less than ideal birth in the hospital and decided to home birth after that. I searched endlessly for anecdotes from first time mothers who home birthed, and found very few reassuring stories. What I didn’t know was that in other countries first time mom status was enough to consider a patient high risk. There isn’t a way to know if some kind of issue inherent to an individual will arise in a mother until it happens. Most of the time the occurrence of a complication in the first birth is an indication of a problem in the subsequent births. I still want to know the rate of transfer for home birth midwives with first time mothers ONLY, I know it is usually about 10% over all, but I am willing to bet that first time mothers have a disproportionately high rate of transfer.

What I want first time mothers to know most of all is this: You can’t control your birth. You can roll the dice and choose a birth provider that brags a certain percentage for certain things, but there is no way to know if it will be you or not. Anyone who has played D&D or any other table top RPG knows that sometimes you strike out, even with a 90% skill. 10% happens, and its not because you did anything wrong. Its just life. If you had a c-section or an instrumental delivery or an epidural you did not fail at anything.  It literally means nothing about you as a human being if you had a c section vs a vaginal birth- you can force it to be meaningful, and therefore you also have the power to decide it isn’t worth worrying about.   Having a vaginal birth or a c-section isn’t inherent in anyones character- how much meaning could it really have outside of one constructed by culture?

I don’t think there is anything wrong with wanting a specific experience in childbirth. I don’t think there is anything wrong with being disappointed when it turns out differently. I am not someone who will complain that women who tried for NCB and ended up with something else are selfish or ungrateful, because I know that isn’t what its about.  No one needs permission for their feelings or their hopes- they just are, and should be accepted. What I do think is wrong is women blaming themselves for something that they don’t have the power to change.  I don’t think women blaming themselves are wrong, I think the people who perpetuate a culture that blames women are wrong.  This means that home birth midwives are wrong- they perpetuate a culture of sexism where mothers are at fault for virtually anything that happens during a birth, and where women who have the ‘right’ child birth experience get bragging rights and support for something that happened by luck instead of skill.  I remember ruminating over my c-section, wondering at what critical point I fucked up and made the small odds of having a primary c-section become a certainty. I’m reminded now of the aftermath of sexual abuse, where victims wonder what they did to “make” the other person hurt them, all of us search for absurd ways to make it our fault.  Women cannot control the outcome of giving birth any more than we can control the actions of other people. We can say “no” to people or interventions, but it guarantees nothing.  Women should not be made to blame themselves for any of it. Picking up the pieces, working through what happened and moving on takes a lot of strength. Energy should not be wasted on self hatred during something so difficult.

Take care!

-An ex home birther

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.

Debunking the Business of Being Born: part 4

This is part 4 in a series debunking the Business of Being Born. Descriptions of the movie are in bold.

A woman complains about the ‘intense interventions’ and claims that there is no medically justified reason for interventions in obstetrics.  She also says that there is no common sense reason for many things, such as the lithotomy position in labor.

Once again, no evidence is presented and the claims are so vague that they are impossible to investigate. Its an opinion, that is all. I cannot tell if she is saying that there is never a good reason for ‘intense’ interventions, or if there is never a good reason for any of the interventions OBGYNs use, or that there is not a medical reason the majority of the time.

There is a montage of hospital births and interventions that seem selected to make viewers feel uncomfortable. They cut to a home birth mother. She says “the more you can move with labor, the more you can move through your contractions, they don’t seem as intense.” There is footage of her moving during a contraction. “To lay still its like ‘who would want to do this? I just want to get up and move my hips!’ “

That was her experience during labor. I believed that it was the experience of women in general because of this movie and other NCB advocates. I believed it fully until I went into labor and tried it. I tried for hours to ‘move through’ my contractions. It didn’t do a god damn thing for the pain, it actually made it worse. I’m not saying the mom in the movie is full of shit, just that her experience isn’t shared by everyone. Even if every hospital pushed NCB on patients there would still be people like me who need something stronger than a butt-dance to deal with the pain.

The same woman as before claims “the lithotomy position is the most physiologically dysfunctional position ever invented for birth. Because putting a woman flat on her back literally makes the pelvis smaller. It makes it much more difficult for the woman to use her stomach muscles to push. And therefore makes it much more likely that an episiotomy will be cut or forceps will be used. Or the vaccuum extractor will be used. ” More creepy hospital footage and modern hospital deliveries are shown on screen. 

I could not find any real data about these claims, but (as I discussed in part 3) epidurals are the intervention most strongly correlated with instrumental deliveries. It makes absolute sense that moms who use epidural anesthesia would be positioned in a way that could facilitate interventions, because women with epidurals obviously cannot move around without assistance and any emergency interventions would be delayed by having to re-position her.

What is really strange is that I watched The MORE business of being born, and recall one of the super models talking about how being on her back was most comfortable for her during her unmedicated birth. If our bodies “know how to give birth” and all that I am not sure why her body would choose the most “physiologically dysfunctional position ever invented for birth”, which resulted in an uncomplicated vaginal delivery.

A man speaks a foreign language, he gestures towards a patient bed and references the lithotomy position. Subtitles read “this position here, it is easiest for the doctor. But its nearly impossible for the baby to come out alone in this position.

If its “nearly impossible” why does it happen so often? All the information I could find demonstrated that operative vaginal deliveries were 5% or less of all births in the U.S., and the vast majority of vaginal delivery patients were in the lithotomy position.

A woman uses a toy doll and a foam pelvis to demonstrate that babies need to turn after their heads engage in the pelvis in order to be born. She claims that shaking the pelvis and moving around helps. 

The same man as before (who we now know is an OBGYN) says Now if she was squatting I would have to be sitting on this little seat right here…

Footage of a birth where the mother is moving around on her own is shown, presumably not in a hospital. 

The dr continues: So the mother is active and thats very important, shes participating. As opposed to when shes laying down, the doctor is telling her “Push! Stronger now!”

Footage is shown on the screen of a hospital birth with a lot of people telling a mom to push. She is yelping in pain and there are hands all over her. Her face is blurred out.

This kind of footage freaked me out when I watched this movie. Peoples hands all over the mom while they barked orders at her really squicked me out as a person with an abuse history. Pretending that midwives are never grabby or never yell at women to push or that all doctors are aggressive in this manner is just nonsense. It is another attempt to put anecdotes in our minds instead of actual data. The degree a person obtains does not determine how much respect they will give you.

A doula/rn says: Women here have given up their autonomy about birth. Women are so afraid of birth. Because you do not have an image of what birth looks like. Women in america don’t know what’s normal about birth.

A CNM says “they watch A Baby Story and they watch Maternity Ward. They watch these programs. I think there is a lot of fear instilled in women around birth.”

The screen shows footage of terrified mothers in hospitals, presumably from the programs mentioned by the CNM.

A birth center owner says “Every birth that you see on television is women screaming and being rushed down the hallway and looking like an absolute dire emergency. So why should women feel confident about giving birth when the whole culture is telling them this is scary, this is dangerous? “

Those shows are the real stories of real women who really did have a terrifying experience. Why are women supposed to ignore the possibility of something terrifying happening? How are women supposed to make reasonable plans without contemplating what could go wrong? I am not advocating for anxiety or non-stop worry about complications, but the experiences of women who had emergencies in birth shouldn’t be ignored or buried in favor of the more positive experiences. I also know for a fact that they have shown unmedicated and home births on the shows mentioned. I remember being a teenager and watching a woman give birth in a kiddie pool in her home on the discovery health channel. I usually did not watch the birth shows, but she was screaming “CYOTEEEEEEEEEE” over and over again and I needed to know why she would yell “cyote” during birth so I tuned in. It was what she named her son.

Anyway.

Birth is what it is- why does it need to be portrayed a certain way?

NCBers know why- they believe, like many alt-med folks, that your attitude can determine your outcome. They believe that if you just aren’t afraid of birth it won’t hurt you. It sounds ridiculous when the theory is stated outright, so the movie does a good job of easing you into the idea that your attitude will determine the outcome of childbirth.  Several NCB icons like grantly dick reed and Ina May Gaskin state this theory in their books. They believe that giving birth while scared is like trying to pee with an audience- fear interrupts the process. It is a hypothesis, but it isn’t one that is testable. The hypothesis relies on the subjective inner experiences of women over a period of hours, it is something that can change dramatically in a matter of minutes. If a woman has even a moment of fear during childbirth any problem that occurred can be blamed on her. It is unspeakably cruel to blame women for something they have no control over. The movie accomplishes it very stealthily, and I believe that women are so used to accepting blame for things that it can be hard to even notice that its happening.

“Women expect to have traumatic experiences. Thats why women are having epidurals, they are all terrified of what this is.”

This is another subtle jab at women who chose interventions. She is implying that women chose epidurals because they are ninnies who were brainwashed by the media into believing they needed one. Women have epidurals because they are in pain.

A childbirth educator complains about the fear present in the depictions on television. She says that once the doctor plays the “your baby is in danger card” the battle is over. There is footage of a mom whose baby is having heart trouble during delivery, her OB is trying to avoid instrumental delivery but mentions it as a possibility. He tells her to push. 

“That’s one of the great manipulative techniques that are used, is when a woman starts to question, “wait, why do we need to do this? Wait, is there something else we can do? the first thing you turn to is ‘its for the good of the baby’.  Weather or not it is, you’ll do anything because if you go on to question it, well, then you’re a bad mom. 

There is more footage of a different OB recommending a vaccuum assisted delivery in a hospital.

As I stated before, there are very few instrumental deliveries. This part of the film gives the impression that it is much more likely to happen than it actually is, and they pretend that there is no danger in maternal exhaustion or pushing for a very long time.

Sometimes ‘its for the good of the baby’ is just the simple truth of the matter, or it is the truth to the best of the physician’s knowledge.  This film basically promotes paranoia about why your physician would recommend something. Why are midwives exempt from paranoia about non-intervention? The Business of Being Born very rarely questions the actions or recommendations of midwives, but constantly questions physicians. The physicians have the disadvantage of having many years of training based on a large amount of complicated data. Issues like that are hard to explain concisely. Midwives can usually explain themselves in a slogan. It is superficially more convincing to lay people. It is very much the same as creationism, where snappy lines are more compelling to people who do not know better.

Discussion of the themes so far:

Negligence is usually defined as doing something a reasonable person would not do, or failing to do something a reasonable person would do. Both can cause death or problems. The Business of Being Born makes it seem like only the first kind of negligence is dangerous, when in fact both are.  The movie, and NCB advocates, repeatedly suggests the second kind of negligence as desirable without explaining why. The fact of the matter is that many women find the risk of intervention preferable to the risk of not using an intervention, and its understandable. There is a certain percentage of the time that the intervention would not have been needed, but it is not possible to know until something bad has happened.

I got irritated with statements that I could not investigate in this portion of the movie. If you make a statement using dramatic, emotional language, but never get specific enough to actually have your statement investigated for validity then people will hear whatever they want to hear when they listen. Its something politicians are experts at. It is a red flag for dishonesty. I wish I had spotted it before I decided to use a midwife at an out of hospital birth.

Debunking The Business of Being Born: Part 2

This is part 2 in a series attempting to debunk the claims made in The Business of Being Born. Descriptions of the movie are in bold, my commentary is in normal font.

“most obs have no idea of what a birth can be like.” says Dr. Michael Odent.

“very few doctors have ever observed a normal birth, in medical school or in the hospital. Its almost an oxy-moron.” says the president of citizens for midwifery

cut to ricki lake asking 3 ob residents how often they get to see a fully natural birth. Two of them respond. One says ‘rarely’. One says “almost never”. 

A ‘fully natural birth’ is a matter of opinion. It is a laundry list of requirements that may or may not have anything to do with how humans have given birth in the past (for instance water birth is an entirely new idea, but is considered natural in NCB circles).  If a woman has an IV line, its not a fully natural birth.  If she had a shot of pain medication, that later wore off, it is not a fully natural birth. These distinctions seem pretty trivial to me.

I am sure that I could take all the possible choices in birth, make a list of the ones I thought were the best, and then ask OB residents “how often have you seen this kind of birth?” They would probably say the same thing, because the range of choices available makes for a large number of possible birth scenarios. I also do not think that 3 peoples opinions are the best way to demonstrate this point (if it is even true). They are in the same residency program at the same hospital- it could be evidence of that specific hospitals practices, or of what women in the region want, etc. We are not told how far these women are into their residency or how many births they have seen. Again, these factors are never explored, and hard numbers are never given.

This argument for ‘natural’ birth also invokes the naturalistic fallacy. Ditto for calling spontaneous vaginal delivery ‘normal birth’. I would imagine ‘normal’ birth is whatever kind of birth most people have, and they have already said that NCB is not the norm.

“well I always think that midwives do a better job at the normal deliveries than we do. For a normal, low risk woman, its overkill going to a doctor. The doctors not really excited about things when theyre normal.” says dr jacques moritz. 

“because OBs are socialized to search for pathology, they often see pathology where it does not exist. They find pathology because then they have something to do.”  says a medical anthropologist

“an obstetrician is a trained surgeon, and usually very, very good at what he or she does. And thank goodness we have them! Im so greatful that we have OBGYNS.” says a midwife

“They’re surgeons! They should be doing surgery all day, every day. When its needed. They should not be doing normal births. cause they’re not trained in it. They have no idea how to do it.” says another.

These are opinions, and they are impossible to prove or disprove because they are subjective judgments about the services of OBGYNs. The movie sticks to this kind of rhetoric a lot, mainly because the objective measures of safety for women and infants in out of hospital birth are pretty damning. If OBs are not well suited to spontaneous vaginal births then why are their outcomes so much better than midwives? You have to dress up the argument with a lot of flowery rhetoric, or just plain lie, to get people to ignore the evidence.

Cut to dr marsden wagner repeating the same stuff about how other developed countries use midwives more than the USA. He claims a lower rate of maternal and perinatal death in countries that use more midwives.

Correlation does not equal causation. There are a million reasons that differences could exist in rates of perinatal and maternal deaths. Attempting to attribute it solely to midwives is not warranted by the evidence available, and since the film is making the claim of causation it is up to them to demonstrate it. They fail miserably to provide any evidence outside of “two things happened at the same time, so one must have caused the other”.

I am always reminded of this exchange when someone mistakes correlation for causation:

Lisa: Dad, what if I were to tell you that this rock keeps away tigers.
Homer: Uh-huh, and how does it work?
Lisa: It doesn’t work. It’s just a stupid rock.
Homer: I see.
Lisa: But you don’t see any tigers around, do you?
Homer: Lisa, I’d like to buy your rock.

Text appears on the screen that reads:

The United States has the second worst newborn death rate in the developed world.

No source is cited, so I don’t know what year they are discussing or what countries they count as developed or not. I can’t even investigate the claim because there is not enough information given. Not only that, but they don’t talk about how close we are to the top ranking country. What if all the perinatal death rates in the developed world were excellent, and very close? That is what I found when I took a cursory look into the data for 2004-2008.

A Phd in public health says “the united states is ranked poorly in infant mortality.” 

That is true, but infant mortality is different than perinatal mortality (which is deaths that occur 0-28 days of life). Infant mortality rates aren’t pertinent in a discussion of home birth.

“one of the arguments made is we have different women. We have more high risk women. But this blaming of women is farcical, its not about mothers. Its about the way we treat care in the united states. ” he continues.

If it is true that the US has more high risk women, I am not sure how hospitals are supposed to magically compensate for that. He should have demonstrated that the US has equivalent rates of high risk pregnancies or lower rates of high risk pregnancies in his comparison. I am betting that he avoids talking about the numbers because they aren’t in his favor.

text appears on the screen:

The US has one of the highest maternal mortality rates among all industrialized countries. 

I looked into what counts as a maternal mortality, and it is anything pregnancy related that causes death within 42 days of pregnancy being terminated (either by birth or miscarriage). I am not sure why lack of insurance and socialized medicine is ignored as a factor in the difference in health outcomes. It is a factor that worsens health outcome statistics for the entire country. Why would there be surprise about this?  I am sure that someone with access to data could give the film makers information about the causes of these deaths, and then they could investigate if midwives are a solution to the complications that are resulting in these deaths. If they could demonstrate that, why wouldn’t they?

“This is the outcome when you are a century or so post-midwives. You lose a lot of knowledge. We are the one country where, when birth went into the hospital, the midwives didn’t go there with it. ” says Ina May Gaskin.

The cultural anthropologist talks about smear campaigns against midwives in the early 1900s to explain why they weren’t accepted in hospitals. They discuss the racism of some of the campaigns.

An author talks about the cultural shift in the USA away from midwives. She says that during that time it was more dangerous to give birth in hospitals than with midwives because physicians did not have adequate training in labor and delivery.

creepy footage of old hospitals and pregnant women about to get c-sections are played over an ominous soundtrack while this same narrative gets repeated. 

This has nothing to do with how safe home birth is NOW vs hospital birth, considering that a lot has changed in medicine since the 1900s. The film carefully avoids comparing direct entry midwives outcomes to physicians today. If midwives have such a superior outcome, why won’t their professional organization (MANA) release its death rate statistics?

This part seems to only be there to reinforce the narrative that midwives are good, hospitals are bad. The footage does a good job of instilling a sense of unease in the viewer. Old hospitals are indeed creepy, but do little to prove that anything was lost by moving birth into hospitals.

text appears on screen:

In 1900, 95% of births in the united states took place at home

In 1938, half of all births took place at home

by 1955, less than 1% of births took place at home

It remains at that rate today.

With all the talk about mortality rates before, you would think they would talk about the rate of perinatal and maternal fatalities in the times listed.  If their analysis is correct, then as hospital births increased the rate of maternal and perinatal death would increase as well. Here is what I found when I looked into it:

At the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications, and approximately 100 infants died before age 1 year (1,2). From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births, and from 1900 through 1997, the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 live births

You can see the graph here, that shows an over all decline in maternal mortality that coincides with births being done in the hospital (with an uptick in 1920). Even the increase in 1920 is not as high as the 1900s numbers. The increase in 1920 caused government oversight, which then changed the common practices in hospitals, and resulted in a mortality rate much lower than the pre-hospital era. It is worth noting that this is exactly the kind of government oversight that midwives are currently resisting.

Most of the information on that site is for infant mortality (up to one year), but there is a table demonstrating the reduction of neonatal mortality and the results are the same- a consistent decrease in the death rate over time, which quickly became superior to the pre-hospital era. The article has a lot of information about what technologies and techniques are responsible for the decrease (and the increase of maternal mortality in the 1920s).  There is thoughtful discussion of the history of labor and delivery in the united states. You’ll note that using a midwife is not listed as a strategy associated with decreased mortality, because it simply isn’t supported by the available evidence.

Discussions of the themes so far:

This movie constantly frames the argument as natural birth being in direct opposition to medicalized childbirth,  but I don’t see ‘nature’ and ‘technology’ as opposing forces at all. I would argue that science and technology is absolutely a natural thing for humans to do. Science is a very organized form of what is innate human behavior- to try to understand the world, to experiment, to test our theories about the world. Technology is an application of what is learned through science. It is entirely natural for human beings to work together to invent solutions to problems, like excrutiating labor pain or fetal distress.

These sorts of opinions are aimed at providing empowerment to women who are pregnant or planning on having children. I get that, it certainly appealed to me.  Pregnant women usually experience some fear of childbirth, and these messages from the natural birth community aim to exploit that fear for profit. It is so comforting to hear midwives say that everything is okay, and so frightening to hear doctors talk about what can go wrong. It is a case of your real friends telling you stuff that you don’t want to hear.

Debunking The Business of Being Born: Part 1

This is a series on The Business of Being Born (TBBB), a powerful film that has influenced many women to give birth outside of a hospital. I’m going to do my best to point out the factual problems with different aspects of the film.  The descriptions of the film are in bold.

The film opens with a montage of a midwife, Cara Muhlhahn, packing various medical supplies at 3 in the morning (IV kits, oxygen, towels out of an oven, etc).  Scenes are spliced in where people describe their thoughts about midwives, most of them are from people who either dislike the idea of using midwives or who are ignorant of what midwives do.   

The midwife drives to a clients house. They fill up a birth tub. She says she will just stay out of the way and advises the client to pretend she isn’t there. We see a woman coping with a contraction, and the screen fades to white and says:

“Midwives attend of 70% of births in Europe and Japan

In The United States they attend less than 8%”

This is intended to make you question why the United States is so different than the rest of the world. What they left out is that most of the midwives featured in TBBB  are not considered actual midwives in places like Europe and Japan. Most of them are direct entry midwives or ‘lay’ midwives, they are not nurses and do not have anywhere near the training that a nurse does.  On page 8 of this document from a Japanese Midwives organization you can see that midwives in japan must either first become nurses, or be proficient enough in nursing to pass the national nursing exam, before being able to apply for a midwifery program.   The European union’s midwifery standards are very similar. Their document is pretty confusing, so I’ll just point out one part that makes it clear that European midwives are also either nurses, or equivalent to nurses in training and education. You can see on page 8 of this document that one condition of being a midwife in the European union is carrying out treatment prescribed by doctors, something direct entry midwives are not capable of doing (because they aren’t nurses).  The american equivalent of european and japanese midwives are Certified Nurse Midwives (CNM), advanced practice nurses who got midwifery education after being a registered nurse for a number of years.  In some states in the US you can simply claim to be a midwife and you are legally qualified to be one. It is that way in Utah, and the midwifery community here pats itself on the back for having “one of the best” midwifery laws in the country.  Since direct entry midwifery is legislated on the state level, a dangerous midwife can just pack up and move somewhere new if they cause an injury or a death, or if they do anything else unsavory that they would rather not take responsibility for.

There isn’t any mention of the radical difference between Japan, Europe, and America’s health care systems, either.  There are many differences between the care people receive in different countries, and it can sometimes be attributed to a public vs private health system. There could be many contributing factors to explain the difference in the % of births attended by midwives, but the only one they explore in The Business of Being Born is ignorance about midwives, discrimination against midwives, and greed from OBGYNs and hospitals.

The next scene is Dr. Marsden Wagner exclaiming that “maternity care in the united states is in crisis. It’s, in many ways, a disaster.”

A provocative statement like this should be supported with some kind of explanation, but its not. They are planting the seed that hospital birth is problematic without explaining why exactly. Its a technique used by advertisers and scam artists all the time- they appeal to some feeling, in this case, fear or curiosity, and then don’t provide enough information to examine it for validity. You are left with whatever gut feeling is evoked by the imagery.  It is good film making, but it is a very poor way to educate anyone.

Another person says “Medical decisions are being made for monetary and legal reasons, not because they are good for the mother and the baby.

“Monetary and legal reasons” meaning avoiding a lawsuit. The unexamined assumption is that preventing a lawsuit is different than preventing a bad outcome. In reality, bad outcomes cause lawsuits against hospitals and physicians. The film talks about how doctors are trying to prevent lawsuits, but did not feel it was important to discuss what patients go through when they have to sue for malpractice. It is a glaring omission.

A doctor says “Technology is technology, its not stopping. This is what life is all about. So if you’re gonna have good stuff you might as well use it to get the best outcome. ” with a grin. 

Someone else says “We should constantly be asking ourselves, ‘is this an improvement, or are we making things worse?’

This contrast implies that the doctor quoted beforehand has not thought about this, or that there is no one constantly asking if technology in birth is an improvement or a hindrance. In reality, scientists and doctors are asking these questions.  The protocols in hospitals aren’t developed out of preference, they are developed based off of hard data from physicians and researchers about outcomes. They are reviewed, based on the data, at regular intervals. Changes are made based on the reviews. It is not a perfect system, so there are things that aren’t needed or cause problems, but it is a system that constantly aims for improvement of outcomes. The same can not be said about natural child birth.

“if we don’t quickly take ahold of this, we’re gonna lose normal birth” exclaims a woman.

A doctor says “I call it feminist machosim, you know, when you’re pushing your baby in a stroller three months later to say ‘I did it naturally.’ Personally, I don’t think its important.”

Anyone who has worked with physicians knows that its really not hard to find a mean one to cast the profession in a bad light. It doesn’t really reflect on if the care protocols in a hospital are better or worse than at home with a midwife. Ideally, a system of maternity care would have a level of accountability that would ensure that even the most sociopathic practitioner would have to try and ensure the best outcome. Malpractice lawsuits and medical licensing accomplish this (to a certain degree), but midwives do not carry malpractice insurance so they are not subject to these rules. There are also states where licensing is not required, or penalties are small for illegally practicing midwifery.

A woman says “There is so little understanding, of how incredibly important this process is to women.

A man says “Theres something going on in the nature of care in the united states thats troublesome. Women, they’ve been told for years now, that they’re not responsible for their own birth process.”

“Basically what the medical profession has done over the last 40, 50 years, is convince the vast majority of women that they don’t know how to birth.”

These are all slight digs at women who needed interventions in their birth. What is wrong with women who don’t know how ‘incredibly important this process is’? Are women who choose a doctor or a c-section less ‘responsible for their own birth process’ than someone who doesn’t? If a woman has an intervention, is it because she has been convinced that she ‘doesn’t know how to birth’? What actual women would prefer and why is left out of the equation, there is a strong implication that natural childbirth is The Best Way to have a baby.

There is a discussion of new york women scheduling their births because they are so busy. The discussion takes place at a photo shoot with a pregnant model who is planning a home birth. There is obvious disapproval of scheduled birth, though it is not stated outright.

Cut to a pregnant woman discussing how she prefers midwives for well woman care. Her husband discussed his feelings about doctors and how they can change your birth plan with seemingly no medical reason.

I am not sure why we get to hear so much from people who prefer natural child birth and so little from women who do not.  The clips of women talking about preferring a c-section or an epidural are usually used to demonstrate that they are ignorant somehow, or that these methods aren’t preferred by most women.  This is such a crappy message for first time mothers, because they cannot know what type of birth they will prefer. You can guess what you would prefer, but you cannot know for sure until you’ve experienced it. Women who have had babies can’t prepare another woman either, because her labor will be different than yours This film attempts to make one type of birth seem ideal for everyone and all others inferior, regardless of what individual women have to say about their non natural births.

Cut to footage of Ricki Lake on her talk show while pregnant, and then an interview with her about her birth experience with her first child. She wanted NCB, and ended up having a lot of interventions that she felt were not needed.  She felt cheated, and decided to do things differently next time. She reccomends Ina May Gaskin books for educational purposes. She states the aim of the documentary- to explore the birth system in the US, and ask if they are benefitting mothers & babies or not.

Cut to a monty python sketch about birth. 

The monty python sketch represents how some patients feel in a hospital, but there is no way to know how commonly women feel like that during their hospital births. There are endless complaints in this movie about doctors and hospitals, but there is no data (not even surveys) presented about how common these problems are at the hospital vs at home.

An analysis of the themes so far-

There are a lot of feminist dog whistles in this movie- things that would seem innocuous to people not involved in womens rights movements, but very note worthy to feminists (like myself). I instantly became interested in hearing the NCB side of the story because of the use of feminist themes in the film. The way that the majority of pro-NCB people in the film were women also made me more willing to believe their side of the story- after all, women are the ones having babies, not men.  Feminist women who are interested in NCB need to be aware of the way that midwives treat women who have been wronged by other midwives. The will support the midwife instead of women who lost their children because of negligence, or women who were abused or mistreated by midwives. The line that they support women’s choices is a good way to sell the services, but is it actually true? In my case, a midwife with decades of experience testified in court that doing exams against a patients will is the ‘standard of care’ in midwifery.   Either she is willing to lie in court to help her colleagues, or she is willing to lie to patients when she tells them that the midwifery model of care is about dignity and respect.  This was after the one midwife did the exam against my will, and the owner of the birth center said it was my fault. I reached out to prominent members of the community for help, and there was none. That is when I started to find out that a lot of midwives won’t refund a fee or even apologize after they cause a death by negligence, and that the same lack of help existed for women who had suffered much more than I did at the hands of negligent midwives.  Midwives are not more or less likely to be feminists than anyone else, but they present themselves ambiguously to appeal to feminists.

Feminism has helped me immensely in dealing with misogyny (including internalized misogyny), I now find it very offensive that Natural Child Birth has hijacked something I care about so deeply in order to sell midwives. I was lied to. The regard for women and their choices that is sold by midwives is only practiced if your midwife feels it is important. You can’t tell if she actually believes it is important until its too late.

I should have seen their political appeals as a red flag- If natural child birth is better, even just psychologically, then data will reflect that clearly.  An Inconvenient Truth managed to be a data-heavy documentary that gained popularity because it was so educational and concise. The Business of Being Born is more geared towards playing on the emotions of women to convince them of the inherent merit of natural child birth. It is the only way that I can make sense of the content of the film, knowing what I do now, and knowing what Ricki Lake must have discovered when she did interviews and research for this film. I would love to know what interview footage ended up on the cutting room floor.

stay tuned for the rest of the series!