There are great documentaries about artists (like Crumb or Valentino), or documentaries that shine a light on brain-tickling cultural phenomena (like Paris Is Burning or The King of Kong: A Fistful of Quarters). But I think it’s fair to say that the vast majority of documentaries that get shown at festivals, that win awards, that arrive in theaters near you — or video-on-demand schedules — are political or social or historical exposés. They’re about the war in Iraq, or the food we eat, or climate change, or convicted killers who may be innocent, or illegal oil drilling in South America, or inner-city basketball, or the economics of Walmart, or gun laws, or autism…
These movies — many of us have seen hundreds of them — have an implicit purpose beyond the passion to inform. The vast majority of documentaries strive, on some level, to effect change. They want to change how you see an issue, or maybe the world. They want to change perspective, change policy, change our way of doing things. As a documentary fanatic, I watch a lot of these films, every year, with quiet awe. Week after week, I’m inspired and often amazed by their quality, their fearlessness and insight, their way of getting me to think about things in a new and lasting way. And yet, let’s be brutally honest: How much do any of these films actually change the world that we live in? The answer, in almost every case, is probably not at all. An Inconvenient Truth, which I loved, stirred up a healthy noise about global warming, but really, not to be cynical about it, has that movie altered anything in a concrete, measurable way? Certainly, there are a few documentaries — Errol Morris’s The Thin Blue Line (1988), and Joe Berlinger and Bruce Sinofsky’s Paradise Lost films — that resulted in the overturning of verdicts in homicide cases. That’s documentary activism at its most dramatic. But it’s also an incredible anomaly.
And yet, within the ardent blizzard of nonfiction cinematic information, there is one American documentary I can name that is changing perspectives, and lives, every day, even though it has never won any awards, or much critical acclaim, and didn’t play in theaters to any great fanfare. In a way, it was virtually off the radar. Yet in the three years since it first opened (quite briefly) in a handful of theaters, The Business of Being Born has become a grassroots phenomenon, a kind of one-DVD postfeminist revolution. It’s a documentary, produced by Ricki Lake and directed by Abby Epstein (the two women, pictured here, are both featured in it), that looks at the experience of childbirth in the United States, and at all the things that are going wrong with it, and at all the things that can make it better.
If you’re part of a couple who are expecting a baby, and you attend a birth class, then chances are that someone in that class — one of the eager, nervous parents-to-be, or quite possibly the teacher — will ask if anyone has seen The Business of Being Born. And then, sure enough, people will begin to talk about the movie, with a kind of bright-eyed intensity, and about their reactions to it. I’d seen the film already, and then heard about it constantly in the birth classes that my wife and I took. I even heard about it during visits to places like Babies “R” Us, where expectant parents would chatter on about it as they tried to decide which Pack N Play or City Select stroller to buy. The movie was like a secret, game-changing underground handbook — the maternal equivalent of Thomas Paine’s Common Sense. And more or less everyone who sees it wants to at least consider and discuss the questions the film raises: questions about the overly controlled environments — the interventionist overkill — of contemporary, technologically driven hospital births. And about the alternatives that more and more women are turning to. Alternatives like natural childbirth. Or the ultimate in natural childbirth — a simple, rather old-fashioned phrase that strikes terror (although it shouldn’t) in the hearts of many who hear it. The phrase is home birth.
Why is home birth, and natural childbirth in hospital birthing centers, now on the rise in America? It begins with the simple perception that something is very wrong in a country where the Caesarean rate, which was 4.5 percent in 1965, now stands at close to 33 percent. (Indeed, the rate of Caesareans doubled between 1996 and 2008. Meanwhile, the maternal mortality rate today is twice what it was in 1982.) Why the drastic rise in the drastic procedure that is a Caesarean? And also in the rate of births that are induced? In no small part, it’s because our hospitals, marching in lockstep to the insurance companies, are geared, as never before, to efficiency, to getting women in and out of the delivery room, to not having labor stretch on as it naturally would. But it’s fair to say that there is now so much intervention — the epidurals, the inducements, the Caesareans — that birth, for a great many women, has become an essentially unnatural process. It’s become an act of clinical intrusion rather than a sacredly intense rite of passage.
That’s the trend that Lake and Epstein push back against in The Business of Being Born. As it turns out, their little movie has had such a profound impact on how people are thinking that earlier this week, on Nov. 8, they released their long-time-in-the-works follow-up: a four-DVD sequel called More Business of Being Born. It’s a series of mini-documentaries that ripple with insight, with the wise words of midwives, doulas, obstetricians, and mothers who want to recapture the primal reality of the birth experience. And — no small issue — mothers who want to feel powerfully connected to their babies right after they’re born. In a hospital, the baby is taken away from you, which is one reason — not often talked about — that a lot of women have trouble breastfeeding, getting their babies to “latch on.” The organic process of feeding has been interrupted from the start.
Consider the following fact: More or less every baby in the history of the human race was born at home, until about 1920. That’s when hospitals took over. The first thing that a lot of people will say about that, and they’ll be right, is that we have far less infant mortality in the hospital- birth era. Yet if you look at the statistics on home birth (in, say, Western European and Scandinavian countries, where it’s far more prevalent and accepted than it is here, in part because those countries’ health care systems support it), you will see that home birth is actually, overall, statistically safer than hospital birth. The numbers don’t lie. Yet what has happened in the United States — and The Business of Being Born captures this powerfully — is that birth now takes place in a climate of fear, and of bureaucratic control that is really a reaction to that fear. Jacques Moritz, a highly prestigious New York OB-GYN, is at the shiny white center of the medical establishment, yet Moritz, in The Business of Being Born, goes on record discussing the vast problems with contemporary hospital births. What’s been almost entirely lost in hospitals is the notion that pregnancy is not, at heart, a medical condition, and — assuming the woman is healthy — that it doesn’t need to be treated as one.
Let me say right up front that just about exactly one year ago (at 1:06 p.m. on Nov. 12, to be precise), my wife, Sharon, had a home birth, and our darling daughter Lily was born. Watching The Business of Being Born was one of the experiences that set us on that path. Obviously, I’m writing this post with a dimension of personal passion, and I want to put that right out there. It would be wrong to hide it. Yet I agree, deeply, with the way that Ricki Lake and Abby Epstein, in The Business of Being Born and in More Business of Being Born, aren’t so much advocates for one way of doing things as they are advocates for choice. A big part of their message is that birth in America has, increasingly, become a matter of vast institutions that take away choices. That encourage women, often manipulatively, to think that if they labor for a few hours more, they’re doing something wrong rather than listening to their bodies.
In More Business of Being Born, the two filmmakers do a terrific job of coloring in the alternatives. They talk to people like Ina May Gaskin, a pioneering midwife and spellbindingly eloquent woman who has been running a birthing compound called The Farm in Summertown, Tenn., since 1971. (After nearly three thousand births, the Caesarean rate at The Farm is 1.7 percent.) Gaskin, who says that she hasn’t given an episiotomy in 25 years, describes, with a startling mixture of Old WASP effrontery and earth-mother compassion, how the women who come to The Farm get in touch with the deep simplicity of birth, and how approaching the process with less complication leads…to fewer complications. There’s no denying, of course, that the prospect of home birth raises a primal safety issue: What happens if something goes wrong? Hospital interventions — or, at least, the possibility of them — have to be an integral part of the process, and for a lot of people that sets off alarm bells. Surely it can’t be safe! But once again, statistically, it’s a lot safer than you think. What isn’t nearly as safe as people think it is is giving birth in a hospital. (When my wife first told me that she wanted to give birth at home, I had my doubts, too. I needed to be convinced. But the experience was transformative. I felt, in the end, that I came around to something essential.)
More Business of Being Born is full of extraordinary information, like the startling fact that the average person who becomes an obstetrician today will have never, not even once, seen a natural childbirth. Or the fact that Brazil, with a C-section rate of 93 percent in private clinics, is becoming a sci-fi nightmare of where we could be headed. (The women in Brazil schedule their births like hair appointments. They’re having Stepford Births.) The film also includes an hour’s worth of testimonials from Christy Turlington Burns (above right, with Abby Epstein), Cindy Crawford, Alyson Hannigan, Melissa Joan Hart, Gisele Bundchen, and a highly compelling Alanis Morissette, all of whom describe a wide range of birth experiences, including some tellingly unhappy ones. Their voices fuse into a compelling chorus of maternal will and desire. They don’t pretend that birth is easy; they testify to its mystery and pain and transcendence. And though it’s easy to mock the inclusion of former supermodels who are now advocates for natural and/or home birth, I think that for a lot of women, it’s important, if we’re going to be honest about it, that a number of celebrities are now embracing and going public with what is still a very controversial way of doing things. That, like it or not, is part of how society changes. The famous become trend-setters, and in this case extremely sensitive and articulate advocates for the choices they’ve made.
I know that I’m coming off as a bit of an advocate myself. The real point, though, is that wherever one stands on these issues, they are vital to the health of our children and our society, and that anyone who’s considering becoming a parent — especially a mother — can hardly afford to be ill-informed. These days, home birth is easy enough to caricature (as it was, with an affectionate semi-endorsement, in the J. Lo romcom The Back-Up Plan). Yet years from now, I predict that a new generation of women, reacting against the forces of the medical-industrial complex that have turned birth from an experience into a procedure, will be far more casual about being far crunchier. And that The Business of Being Born will have played a major part in igniting that movement. So if you’re thinking of having a baby, do what more and more people are doing. See The Business of Being Born (and More Business of Being Born). And decide what to do for yourself.
Follow Owen on Twitter: @OwenGleiberman