The Business of Being Born
Most people looked at me like I was crazy when I told them I wanted to have a non-medicated natural birth. I actually wanted to go one step further and have a home birth, but Lee was very uncomfortable with the idea and so I didn't press the issue, especially because I found an OB that I really loved. I know a lot of people disagree with me, but I think it's a travesty that women are made to fear childbirth and are set up to feel like they can't handle it. I won't get too preachy, or rather any preachy-er, but if you haven't seen the documentary The Business of Being Born, here is a link to the movie online.
http://video.google.com/googleplayer.swf?docId=8597620254789409121
17 comments:
Interesting video, Pegs. A good alternate perspective.
All I have to say is that our friend, Mark Juravic, has made this crazy device to help decrease complications from natural childbirth. I was helping him write up a clinical plan and read a bunch of journal articles about all the possible complications, etc. -- and while the rate isn't alarming, I HAD NO IDEA NO IDEA NO IDEA. I think they women shouldn't read graphic medical articles on the topic if they haven't given birth yet. I have been severly traumatized and motivated to help out with any product that can help out with the OH MY GOODNESS I HAD NO IDEA stuff I now wish I didn't know about.
Sorry, Pegs. Doesn't help you with your point, I'm afraid. I think you are a far better woman than I'll ever be. I think I'm going to adopt.
Or maybe I just made your point altogether. I'm definitely one of the cowering masses of women. Maybe the world needs more Pegs who have been-there-and-done-that to tell the rest of us "fear not." I know you're going to be the first person I call for encouragement if I ever change my mind about the whole adoption thing.
I'm glad you watched it Rachel. I didn't really expect that anybody who reads this blog (yes, all 12 of them) would actually watch it. I think it's extremely powerful and I think I pretty much cried through a lot of it. The percentage of complications during a birth are very, very, very, very small. And, as the documentary points out, the US has the second highest infant mortality rate of all developed countries and is pretty much the only developed country that doesn't use midwifes during childbirth. The amount of interventions that are used is absolutely frightening and completely unnecessary 99.9% of the time. But we are set up to think it's too hard and that we can't do it on our own. Anyway, if you ever really do want to talk about it, I experienced a complication, an induction, dysfunctional labor, a c-section, not being allowed to hold my baby after the birth and postpartum depression (which I think was a direct result of all of that), so I got loads to talk about!
Hi Pegs - Ariel and I watched the movie last night, too. My feelings on it are...mixed. While I think what the film talks about is really important and that midwifery is on the whole a good thing, I'm not sure the film itself is. Or at least, I'm not sure it did as good a job as I think it should have.
I wanted the film to really investigate why the U.S. uses so few midwives rather than simply chalking it up to a conspiracy of hospitals and insurance companies. For example, does the fact that midwifery experienced a resurgence in the late 60s within the hippie movements also contribute to its minimized role in the current U.S. "birthing business"? The fact that such a self-selecting and explicitly counter-cultural group of people chose this approach to birth did not meet with broader acceptance when reintroduced into the U.S. Which is not to say that the women on those communes were bad or wrong (though it is meant to de-romanticize them somewhat) - it's just to explain that in some ways their efforts were doomed from the start. Second, how does going through pregnancy with a midwife instead of an OB/GYN work? Do you still go to the doctor for ultrasounds, etc., or do midwives and/or birthing centers have access to such equipment themselves? This may be simple, silly questions, but one of the very legitimate complaints of the film is that there is a profound lack of information passed on to the general public about childbirth, much less midwives. It's disappointing, then, that the film didn't supply some of that information, or at the very least point the viewer in directions to find them.
Another major question I had was how midwifery works in other countries. People in the film constantly refer to the Netherlands but have no explanation of how the Netherlands system actually functions. Do midwifes work primarily in birthing centers? In hospitals themselves? Is it all home birth? Or is there another approach that the film does not even go into that Europeans use? Do Dutch (and European more broadly) midwives work alone or in tandem with doctors? What kind of procedures or techniques do they use? Why did U.S. doctors went on a rampage against midwives in the early 20th century while European doctors (who were presumably also increasing dramatically at that time) did not? Also, while I highly doubt it, it is still possible that midwives in Europe do the same things that doctors do in the U.S. Finally, what role does the universalized healthcare in a place like Europe make midwifery more acceptable than in the privatized U.S. system? In short, a counter-example would have been very helpful, I think.
Third point: I really resented some of the tactics used in the filmmaking process, which I didn't think were necessary and in fact could potentially turn off skeptical viewers. For example, the filmmakers' somewhat cavalier and irresponsible use of interview segments in which they would vilify a doctor in one instance when he (it was always the male doctors) said something going against the movie's argument but then present him glowingly when he made a point that favored their argument. Similarly, in the first half of the movie the filmmakers refer to the drug called "pit" as some horrible, unnatural chemical that doctors blithely inject into these pregnant women, presenting it as one of the major problems with going to a hospital; but then later in the film when they're defending midwives from the "accusations of incompetence" made by interviewed doctors (which in my mind were really just legitimate concerns/critiques voiced by individuals admittedly uninformed about midwifery that the film never actually addressed), they do so by noting that all midwives have access to medicines, especially mentioning "pit." In other words, at one moment pit's existence is the reason hospitals are bad; the next minute it's the reason why midwives are qualified. I know that what the film means to say is that the medicine is overused, though at times necessary - but that's not really what it says. It never explains what the drug does and why it's important, making the film come across as anti-technology and anti-modern-medicine, which can be fairly off-putting. And a final note about the filmmaking style: the movie had the perfect opportunity at the end, when the director herself had complications in her childbirth, to discuss when it's good to go to the hospital and when midwifery might be a better rout, etc. (and to a certain extent it did do this in showing the switch from home birth to hospital), but instead they have the midwife emphasize how immediately after the birth we saw on film, she went to ANOTHER, off-camera home birth that went oh-so-well. It seemed like a cop-out to me, and it kind of irked me. Oh, and the Michael Moore-ish cartoon in the early part of the film was simply unnecessary.
So, yeah, those are my complaints - which, like I said, are primarily about the movie and not the subject matter itself. At the same time, maybe I'm being too harsh. After all, I wouldn't even be thinking about these questions or critiques if it weren't for the movie, so I'm definitely glad I watched it. And Ariel is too - probably more so than me. Neither of us had seen a real child-birth before (in person or even in a movie) and were basing our assumptions about it on shows that you watch and Vanessa's freak-outs during her OB/GYN rotation - and if this film does one thing, it definitely makes childbirth look more beautiful (or at least manageable) than those chaotic hospital scenes in the movies with stressed out mothers-to-be, loads of doctors, and machines that go BING!
P.S. Pegs, if you're willing to talk about it, I for one would be very interested to hear your thoughts about your pregnancy and childbirth. Maybe off blog, though, since this comment is already ridiculously long.
I agree with one of your points, Derek -- the film tactis. I think that is common, though, in a lot of documentaries lately, so I've gotten used to it and just ignored them.
The overall point of the documentary, though, I thought had some really valid points. I guess I should be more specific in that I'm afraid of pregnancy in general (not necessarily of having a baby naturally) -- but I agree the use of midwifery is so much more the way to go. I have a family friend who is a midwife and after talking to her about some of the "complications" that so horrify me -- she tells me that there are techniques that can prevent the horrible tearing that happens often in hospitals. Most of it sounds so common sense but her opinion is that in hospitals, simple stretching/massaging is ignored in preference to epidurals and episiotomies -- which she asserts can exacerbate the issues.
So...to amend what I said -- I'm still freaked out by some of the stuff and while I personally feel there is a very valid place for MDs or DOs in birthing as you really never know when that 0.001% complication can occur that might cause the baby distress -- the idea of using a midwife seems very appealing as well.
Maybe I can just get Vanessa to deliver any babies I decide to have. She's going to be an MD but she has a hippy-dippy streak. Vanessa -- you'll fly out if that ever happens, right?
Derek, thanks for the comment. I know we just chatted a bit about all this, but I think this conversation is hard to have over chat. There is too much to talk about!
And Rachel, I could write a book about episiotomies and how horrible and unnecessary they are.
Brace yourselves for another long comment:
Rachel,
I completely agree that the film had valid points, and there are some really wonderful and astute scenes in it. After watching the film, I agreed that midwifery is a good thing and seriously underused in the U.S., and it takes no stretch of the imagination to believe that the American approach to childbirth (along with a whole slew of other things in our health care system) could use some serious revision.
I guess my complaint with the film itself, which I tried to convey in my earlier comment, is that I find its explanation of WHY the American system is the way it is lacking. It essentially tells us that the problem is institutional: hospitals and insurance companies created this situation. And there's a dash of political/cultural explanation tossed in, too: feminist movements rejecting religious stygma by embracing German techniques. In the end, though, I think find those arguments not wholly convincing. As I said before, similar events happened in Europe (professionalization of medicine and increases in hospitals, feminist movements, etc.) but it didn't turn out the same way there. So, what's different? I think there are broader sociological and cultural issues at play - though I can't say what, exactly. I guess what I'm saying here is that I wanted more historical explanations. Surprise, surprise.
But with such explanations, I think stronger solutions would also become apparent - and that's part of my complaint, too. In the end, all this film can say is midwifery is good, we should do more of it. Fine. But as it shows, birth centers face a constant uphill battle and apparently are closing down, and many women (as well as doctors of both genders) are woefully uninformed about the practice of midwives. It (unfairly) remains a fringe practice associated with New Age-ish and crunchy people (which is what I was referring to when I mentioned its resurgence in the late 60s). So, something more systematic has to take place. Even if we just keep to the institutional diagnosis of the problem, that suggests the need for institutional solutions. What are they? Unfortunately, grass roots tactics only take you so far.
One could make the argument that the film was simply trying to illustrate a problem and provide one alternative. Fair enough. But I wanted it to go deeper, beyond symptoms and into causes and solutions. Maybe my expectations were too high.
And this is all I'm going to say about this topic on the blog - like Pegs said, this conversation just doesn't work in chat/comment form.
Derek, is your PhD in history or documentary film criticism? Seriously, man, I don't put that much thought into my career, much less a movie.
I clearly haven't been working as much on my dissertation as I should.
Okay, since I actually want to deliver babies, I guess I should chime in. First of all, it is entirely over simplified to say that our unfortunate ranking as #2 in infant mortality is due solely to increased interventions during delivery. That is a part of it, but you also have to look at what comes first...prenatal care. Other developed nations have nationalized healthcare and every woman can get access to prenatal care. That does not happen here. A large majority of women in certain populations either never see a doctor until it's time to deliver or they see one very late during the pregnancy. By this time, a lot of complications can happen that might have been avoided with better prenatal care.
That being said, I agree that ob/gyns and hospitals are using too many interventions and I think it is egregious. There are many reasons why unnecessary interventions occur...many of which were discussed in the film. First of all, many women come to the hospital too soon during labor because they are not properly educated on the signs they should be looking for. Hospitals don't want to tell them to turn around, go home, and come back in a few hours (and they also don't want them waiting in the waiting room), so they often induce. And it is proven that inducing too early on the labor curve often results in c-sections. Proper use of induction with pitocin, however, can have amazing outcomes...yes, vaginal outcomes. Secondly, hospitals do over use fetal monitoring. In some instances, it is important to have constant fetal monitoring to identify complications early enough for intervention, but not every woman needs to be strapped to a fetal monitor. There is a movement to change this but it is very difficult due to staffing. Women would still need to have fetal monitoring at routine intervals, and there is rarely enough staff to do this. It is much easier to strap the woman into the fetal monitor and leave it running. When this happens, doctors are more likely to interpret occasional drops in the baby's heart rate as an ominous sign and perform a c-section. Constant fetal monitoring also limits the mother's movement which often results in a more difficult labor. And the last thing that I will mention, although I am sure there are many more, is that inductions and c-sections definitely fit into their schedules better...and I think that is disgusting.
The most important thing is to find someone that you trust to help you birth your baby, whether you choose the hospital route or a home delivery. The point is that the doctor or the midwife is there to ensure the health of you and your baby and to give you the birthing plan that you want. Doctors sometimes make it more difficult since they have more interventions at their disposal, but it is ultimately your choice and they should respect that. And there are definitely a lot of doctors, who do and agree with the essential point of this movie.
Personally, I think that family practioners trained in obstretrics have similar roles as midwives with an added bonus. Most do not perform high risk deliveries as they are not trained to perform c-sections outside of residency, so they transfer the care to an OB in the case that it is needed. Also, most of the family doctors that I know who also perform low-risk vaginal deliveries fight for their patients birthing plans, which often include no IVs, no induction, no constant fetal monitoring, etc. The benefit is that the mother gets good prenatal care, the delivery she wants, and postnatal care for both the mother and child. Also, family practioners are trained in certain acute care interventions for vaginal deliveries like forceps and vaccuums...which unfortunately are sometimes necessary.
Finally, I'd like to end my extremely long post by saying that the process of birthing a baby can be a simple, beautiful event. But it can also be a medical nightmare, and thank god we have doctors who are trained to work miracles in those situations. Yes, we need to change our way of thinking so that we don't continue to overuse the interventions that were originally designed for those emergencies, but at least be thankful that we have them. Doctors are not the enemies...even though they seemed to be portrayed as such.
And Derek, I'm sorry to have scared you on my rotation. I think I only discussed my first vaginal delivery with you which was, admittedly, an absolute nightmare from which I think I had acute stress disorder. The next few that I saw were absolutely amazing experiences and part of why I want to deliver babies as a family practitioner.
Interestingly, the nightmare delivery that I saw was a woman who refused an epidural and had a very serious laceration because she pushed too quickly due to the pain. And the doctor really, really sucked. The other vaginal deliveries that I witnessed that went smoothly generally involved epidurals placed at the proper time and very good coaching on the part of good doctors. That's not to say that everyone should get an epidural, but I don't think they are all that bad either when given at the proper time (i.e. not too early). Basically, it's a choice that is neither right nor wrong.
Good God, I'm so glad I stayed out of this one (if you wish to have a copy of these blog comments, they will be posted in book form and available at Amazon.com shortly)
Damien, who ahs just completed a 157 page masters thesis entitled "Numerical and Experimental Study of a Pyroelectric Energy Converter for Harvesting Waste Heat" clearly has no use for "words."
Goddamn typos.
I really, really want to type something coherent, but I'm so tired. All the time tired. You all left really great comments, thank you. Some of the comments I agree with and some I don't. I can't wait to talk about all of this in person. Vanessa, I didn't mean to give the impression that I think doctors are evil. I love my OB. I shudder to think what could have happened to Sofia if we didn't get her out when we did as the placenta had already started dying. I absolutely think OBs are necessary. I just think they are a huge part of the problem.
hey pegs,
I didn't get that impression from you at all. I know and am very glad that you loved your OB because that is an incredibly important relationship. I actually agree with a lot of what was said in the film. I had two main points....
1) it really boils down to deciding on your personal birthing plan and finding the right method for you whether that is a hospital with an OB or a family doctor or at home with a midwife or, in some cases, a family doctor.
2. OBs definitely need to step up because there is an egregious misuse of interventions like I mentioned in my earlier post but I think the main issue is that it's a flawed system - teaching, insurance companies, hospital policies, staffing issues, etc - not just flawed doctors (or their way of thought). But you are right, the mentality of many American OBs is definitely not helping.
That's why I want to be a family doctor who delivers babies rather than an OB. :) As far as I've experienced, the mentality of a family practitioner is much more in tune with a midwife. We want natural births (except maybe with an epidural if the patient requests it...early). I'm not sure how many perform home births (I'd definitely consider it), but I do know a lot who are as astounded by the numbers and facts brought up in this movie as you were and want to make a difference....starting with education for both future doctors and the patients. Plus, we get to be the baby's doctor too, which is awesome.
Love you! Give all my love to Sofia and Lee!
I feel cerebrally inadequate around you guys. You have big enough IQs between the 6 of you for 12 people.
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