The Business of Being Born - A review

So Dave and I braved the snowstorm and went downtown for the documentary last night. Overall, I loved it. But, being a birth junkie, I figured I would love it. Dave thought it was a bit overly sensational, speaking to a woman's emotions and not addressing the facts clearly enough for him. (however, I do have all sorts of fact sheets to show him now.)

After the movie, there was a panel Q&A session. The panel included local professionals. An OB, a Pediatrician, a Midwife, a Doula and a new mom who had experienced both an in hospital birth complete with epidural and a fully natural home birth.

The movie, being a movie about birth, obviously showed several births. If you've never witnessed a home birth, I would recommend you see the movie for that reason alone. Seeing an unmedicated birth in a calm environment is amazing and empowering. The movie had opinions by many of the top midwives and OBs in the world and I thought it presented the facts clearly. It did have a bias towards midwife attended births, but that was kinda the whole point since we are inundated with images of medicated hospital births and c-sections from the mass media.

Some interesting facts that were presented...

1. In every other country in the world that has 400,000+ births, 80% of the births are attended by midwives, with 20% being only high risk births attended by OBs. The US stands alone as the only country where 99% of the births are attended by OBs in a hospital setting.

2. Of those same countries, the US has more infant and maternal deaths than any other country.

3. C-section rates are up 50% in the last 10 years, with the national rate being around 32% (1 in 3) of all births being c-sections.

4. It has been proven (and admitted as such by the OBs interviewed in the film) that birth interventions, including induction with pit, use of epidurals and admitting a laboring mother too early (3 cms or less) have greatly increased the c-section rate. One OB said that when looking at a chart of the data, you see peaks in "emergency" c-sections at 4PM and 10PM daily. 4PM being the Dr's that want to be home for dinner and 10PM being the Dr's that want to go home to bed.

5. When comparing midwife attended births (which are always normal, low risk births) to normal, low risk hospital births (high risk births are not included in these studies), home births are just as safe and sometimes safer than hospital births.

6. Back in the early 1900's a smear campaign went out against midwives that has perpetuated the notion to this day that midwives are low class, uneducated, anti-conformists that don't have the mothers best interest at heart. When birth moved to a hospital setting during those years, the midwives weren't allowed to go with it, which caused the division that exists today. In all those other countries mentioned before, midwives work with the OBs in the hospitals.

7. Pitocin is synthetic. It makes a woman's contractions, harder, longer, closer together and much more painful. An epidural will remove the pain for the woman, but what about the baby, who is also feeling the effects of those much more difficult contractions?

The movie did have opinions from a couple of OB's who were very against midwifery care of any sort. The interesting thing was, though, that they had never witnessed a homebirth, never bothered to look into a midwives certification process. One OB didn't even know that midwives carry lifesaving measures with them and are trained to use them. (things like oxygen and pitocin for bleeding). How can you speak so strongly against something that you havn't bothered to learn anything about?

While I very much enjoyed the film, I think my favorite part was the discussion panel at the end. I was quite impressed by the OB they had brought in. He was clear that he thought hospital births were the safest way to deliver, but he was fair in his assessments. He said that while he, personally, respects what midwives offer and would love to have a Certified Nurse Midwife in his practice, it's not up to him. He has to follow the rules and regulations of the hospital, plus there must be an agreement between all the practicing OBs at the hospital. He feels that bringing midwifery care into the mainstream is still a long way off.

I was also interested in information on VBAC's (vaginal birth after a c-section). At the hospital he practices at (Holy Family, for you locals), they are pro-VBAC. The reason they can be is because it's hospital policy for the on-call OB to sleep at the hospital when he/she is on call. Since they're already there, they can be there for the laboring mother who is attempting a VBAC. At many other hospitals (including the other main two local hospitals), the on-call Dr sleeps at home and just responds to his/her pager. They are more likely to not be VBAC friendly in that type of environment because the Dr has the promise of home and a warm bed to return to if he/she is able to just perform a c-section and go. This Dr said it's a lifestyle choice that each Dr makes when choosing a hospital to practice with.

The panel pretty much agreed that where to birth is a choice for each mother to make, and I agree. But I did leave with the feeling that somehow pregnant women should become more informed of what their own body is capable of. They should be armed with information of everything from side effects of interventions, to what a doula is and how one could help. (if you're wondering, a doula is a labor support person who stays with the laboring mother and is her physical and mental support and her advocate for her choices). I think that fear needs to stop being a tool used by Drs and nurses to bend a mothers will to their schedules. I believe that information is the first step to bringing midwives back into the birthing world.

I loved one statement that the midwife on the panel made. "The best epidural you'll ever have is a caring doula or loved one and an attentive midwife."