Illustrating the Need for Change

More Business of Being Born, four more films by Ricki Lake and Abby Epstein, is about to be released on November 8th. I wanted to take a minute to reflect upon how Business of Being Born has impacted my work as a doula.

While I was in the middle of watching the original Business of Being Born at a screening here in Montreal, I was called out to a birth. It was a first time mom, who had begun having contractions at about 37 weeks gestation. Right from the get go, things were speeding along, so I had to leave during the scene where the Woodstock hippies are dancing around. I was disappointed that I had to leave what was going to be a great night complete with a long awaited birth movie and a panel discussion, but hey, a baby was on the way. The knowledge that I was going to see a new being into the world quickly soothed my disappointment. I arrived at the hospital and Baby Danica was born smoothly and naturally very soon afterwards to her lioness of a mom.

A friend of mine had bought a dvd of BOBB, so I had the opportunity to catch up on what I had missed.

BOBB has impacted my work significantly. As a birth doula, my concern is with contributing to the necessary healing of our birth culture, which, in my humble opinion, is extremely challenged. Natural birth is seen as radical, and even crazy to the average person. More and more healthy babies are being delivered of healthy mothers via major abdominal surgery, grossly overreaching the 15% Cesarean rate the WHO recommends. The epidural rate for first time mothers in many Montreal hospitals is 98%. The vast majority of women receive some kind of hormonal stimulation to increase the "efficacy" of their contractions. Woman are delivering in positions that are antithetical to the natural mechanics of their birthing bodies. The way labouring mothers are engaged with intellectually, the room often filled with idle chatter or conversations which should be taken outside, when what they need is support for their primal brains to come to the forefront, impinges upon the natural flow of oxytocin, thus impacting a birth experience for the negative much of the time. Birth is essentially contained within an environment which places far more trust in the technology and medications than in the process itself. Ultimately, though, what frightens me the most is how the average woman views even the idea of normal birth as something actually unnatural, really having no idea of what the physical/emotional/and psychological benefits of normal birth are. When normal, physiological birth is held in contempt even by the women themselves, it is clear we have lost our way.

Business of Being Born serves as a critical and necessary change agent, illuminating the problems with modern North American birth practices. It teaches us how despite our oodles of technological obstetric know how, medications, and hospital beds, our birth outcomes are inferior to countries such as Holland and Norway which use midwives to support normal birth, and obstetricians mostly for treating pathologies in birth. The film shows evidence of the iatrogenic problems that can arise in birth when there is simply too much medical interference with a process that goes normally the vast majority of the time. We also get a necessary wake up call by witnessing American women being interviewed at random in New York City, being asked if they'd ever have a midwife. Not only do most say "no", but many look startled and begin extolling the virtues of planned Cesareans because they eliminate the big messy unpredictability of childbirth. I know many women AND obstetricians who watched this film with eyes wide open, the glimmering of an understanding of how essential change is if we want to protect the act of straight up, garden variety, unmedicated vaginal birth from becoming obsolete. Because honestly, in North America, we are almost there.

Not only does Business of Being Born depict the problems and illustrate the need for change, narrated by midwives AND obstetricians, it also lets us know how deeply moving, empowering, and incredible natural birth can be. Yeah, it hurts. Fair enough. But how that wonderful dance of hormones and baby love transforms women into powerful mothers when the journey is over is at the heart of this film.

What I found most important about Business of Being Born was that it isn't just a film which preaches to the choir. Sure, every "birthie" in town saw it, but so did many pregnant women and mothers who were not yet "converted" to regarding the possibility of natural birth as a desired thing. This film reached out to everyone, and many heard the message loud and clear. Personally, my clientele increased because more women were now savvy of what to expect for a hospital birth and wanted to come in with a presence who supported their desires for their experience, as well as honoured the safety net obstetrics and hospitals are seen to provide. BOBB emphasises how critical the support of a doula is for birthing, especially in hospital birth. The presence of a doula helps to increase one's chances of a more positive birth experience. Many of my initial contacts from my clients begin with their saying, "I watched this film called Business of Being Born, and I need your help to give birth within the hospital system".

One of the greatest gifts of this film, I felt, was the sharing of the personal birth stories of the creators, Ricki Lake and Abby Epstein. Ricki Lake is a well known public figure. She's been in films and has her own talk show. She discussed the birth of her first child, which was a hospital birth and not something she felt went the way she wanted. So she chose to have her second baby at home with a midwife. She honestly describes the struggle and pain of her natural birth, and her desire to quit a few times, as most of us do in labour, yet keeps on going with the encouragement of her partner and midwife. Ricki generously shares with us the image of her naked self in the bathtub of her home, birthing her baby, as something natural, beautiful, and absolutely triumphant, as an experience that helped her reclaim the power she felt she didn't have during her first birth. Hers is a story of healing and inspiration. Using her inspiration and her status as a public figure to illuminate the challenges of our birth culture, giving us a glimpse of how amazing birth can be by showing us her own story, has inspired thousands upon thousands of women to examine their own desires for their births. I wanted to stand up and applaud that someone whom, as a celebrity, celebrities being mostly viewed at the "too posh to push" types, was willing to share something so intimate for the purpose of illumination.

Abby's birth story happens near the end of BOBB. She goes into premature, very fast active labour with a breech baby. We follow her from her home where her midwife lets her know it's time to get to the hospital, to the lobby of her apartment where she is on her knees of the floor vocalizing with her friend Ricki doula-ing her, to the cab in which her waters break. She makes it to the hospital in time to have the Cesarean she and her obstetrician have agreed upon, and delivers a baby who is very underweight and with major breastfeeding challenges who has to spend time in the NICU. While she is sad that her experience was not the birth she was hoping for, this part of the film does clearly embrace the fact that problems DO occur in labour, and that our safety net of hospitals and obstetricians are clearly a good thing that we can celebrate, even as we move as a culture towards the idea of exploring more natural options for birth.

Business of Being Born presents two distinctly different worlds: midwife attended natural births, mostly at home, and highly medicated hospital births with obstetricians. One of the criticisms of the film I encoutered was that it gave Medicine a bad rap. Some of my doctor and nurse friends felt hurt. While they know there definitely major problems with the hospital system, their intent is never to do "bad" to mothers. As a developed nation, we do have the luxury of embracing home birth as a great option because of the safety net obstetrics provides if complications occur. They felt there was a suggestion in the film that midwife attented home birth is mostly good, and OB attended hospital birth is mostly bad. I would like to see a world in which both choices can be consistently fantastic and meet every mother's personal needs/desires.

As a doula, my challenge is to strike a balance between the two worlds and embrace the possibilities in both. While I do get to work with midwives outside of the hospital, the vast majority of my clients are hospital birthers. Many of these women wish to have, or must have due to health risks or lack of midwifery resources, their babies in the hospital. There are no pools to birth in, no opportunities to birth on the floor or a bathtub or by the side of the bed, and a lot of interruption from strangers. My goal is to bridge this gap, to facilitate the best, most natural birth process we can within this challenging hospital environment. A lot of the time, while women still receive the benefits of my tlc, they don't have the birth they wanted because they simply didn't have the control over the environment they wished to. I can do my best, but it takes two to tango. For the best hospital birth possible, medical caregivers need to be on board and respectful of the mother's wishes. There must be more openness to the mother's desire for more control over her environment, such as remaining quiet and observant whenever possible, following the mother instead of insisting she do what is easiest for the caregiver, and encouraging unmedicated birth if the mother wishes as well as unrestricted bonding with the newborn. The wonderful thing is that an openness is just beginning within the hospital system, as evidenced by many of the happy births I have been witnessing of late.

This is the exciting thing: several doctors I work with have seen BOBB as well. While it is never easy and can make one initially feel prickly to be lumped into the collective "problem" and negatively scrutinized when all you're trying to do is your work of keeping everyone safe and actually doing some great life saving work, I have certainly seen the acknowledgement of the need for change, and some changes in action. I have seen a general shift of more consciousness towards protecting the experiences of the family, more openness to women birthing naturally and in different positions, and more compassionate treatment. Many of the physicians I work with agree that the medical system is extremely challenged. While they are going to continue doing what they do, there are more who are trying to do it in a way that honours the importance of the experience of birth, not only focusing on a good clinical outcome. Obviously, as a mainly hospital birth doula, this shift in consciousness impacts my life immensely for the positive. While challenges are still rampant and there is much work to be done, I do feel the tides turning slowly.

In my lifetime, I doubt I will see a mass exodus from the hospital back to a homebirth majority. But hopefully I will see an environment where women can have what they feel is the best of both worlds: mostly uninterfered with, undirected births, but with quick access to the medicine and technology they want close by. If Dr. Michel Odent could create this environment within his clinic in France and enjoy both fabulous clinical outcomes and triumphant new families, maybe, just maybe, we can dream this hope into reality in North America for those who want and/or need a hospital birth. I am myself a home birther. This is where I feel safest and most confident. I am an avid supporter of the midwifery model of care, and hope there will soon be enough midwives in and out of hospital births to meet women's demands for them. But most women don't feel this way in North America. These ladies who prefer the hospital make up the majority of the beloved clients I provide support for. For the sense of security they get from being in the hospital, which is essential to their personal sense of safety, it is my wish they should never have to pay the exhorbitant physical and emotional price of having their decent birth experiences potentially put at risk with an often overuse of medical interventions without proper informed consent, an impersonal environment, and caregivers who are sometimes unaware of good birth etiquette. So instead of dividing the two worlds, for the sake of most women and not just the ones who are on either end of the majority, I strive to work on healing the divide so that everyone can have the best chance at a beautiful birth.

It is my greatest hope that this impetus towards a healing of our birth culture continues. The more awareness we bring to issues in and potential of birth, the greater the healing will be. I offer many thanks to all the creators and participants of Business of Being Born for having generated this necessary awareness on a huge scale, and am very much looking forward to More Business of Being Born to keep the momentum going.

Lesley Everest