The Business of Being Born, a documentary directed by Abby Epstein and produced by talk-show host Ricki Lake, is a generous-spirited tribute to the practice of home birth. It's full of moving (and surprisingly ungross) filmed deliveries, including those by Epstein and Lake themselves. Unfortunately, the movie is also a propagandistic brief on behalf of the home-birth movement that's so selective in its presentation of information that it makes Michael Moore look like a fat lady in a blindfold holding a pair of scales.
Lake was inspired to make the film after a disappointing experience giving birth to her first child in a hospital (exactly what was so traumatic about it we never learn). She then had her second baby at home in her bathtub, attended by a midwife, and was so changed by the experience that she briefly considered becoming a midwife herself before deciding to make this film instead. Lake is also joining forces with Rosie O'Donnell and Gloria Steinem to raise funds for a projected $7 million birthing center in Manhattan. Lake's passion for her new cause is admirable, but her movie's gauzy idealization of the home-birth experience may have the opposite effect from the one she intended. Instead of adding to the store of useful information available to pregnant women, it may serve only to calcify the already annoyingly rigid debate between advocates of "natural" childbirth and practitioners of … well, whatever the opposite is.
Perhaps part of the problem is that The Business of Being Born never poses the above question: What do we mean when we talk about "natural childbirth"? The truth is, there's a vast continuum of choices that separate über-crunchydom (having a baby at home with a midwife, a choice made by less than 1 percent of the population and championed by this movie) from ultra-technologization (celebrities who schedule their C-sections in advance, followed by tummy tucks). The vast majority of American women—99 percent—choose to give birth in hospitals. Out of those, about 90 percent opt for some form of pain relief, usually an epidural, while others go drug-free at hospital-based birthing centers. Most hope for a vaginal delivery if possible, while accepting that unforeseen circumstances may lead to an emergency C-section. And yes, a few do schedule Posh Spice-style planned Caesareans. But this film's roster of talking heads (many of them professional advocates for the home-birth movement) compresses that whole range of experience into a simple either/or dichotomy: The sterile impersonality of hospital births (satirized in a clip from The Meaning of Life in which John Cleese shushes a laboring woman while demanding a nurse for "the machine that goes ping!") vs. the sacred beauty of laboring at home.
That's not to say that The Business of Being Born doesn't get some things right. One interviewee offers a smart critique of cable health shows like Birth Day and A Baby Story, which concentrate on emergency delivery situations, edited down for maximum dramatic appeal. It's true that the popular portrayal of birth as something out of a Cronenberg movie, best managed by all-knowing doctors and discreetly placed sheets, creates a needless culture of fear. But positing a conspiracy on the part of the medical establishment to rob women of their autonomy does nothing to dispel that fear. The natural childbirth mantra that "Birth is not a medical event" ignores the unfortunate fact that, in that percentage of cases in which something goes wrong (as Lake herself says in the movie, about 1 case in 10), things can get very medical very fast. Studies in the United States, Australia, and Britain have suggested that the fetal death rate in home births, while still extremely low, is approximately double the rate for hospital births. A statistic that Epstein and Lake would have been free to contest—had they bothered to address it at all.
There's so much to critique about this documentary: its unacknowledged classism (Epstein and Lake, like all but one of the mothers whose births they document, are white women in a financial position to customize their birth experiences); its reliance on undocumentable claims (the crackpot French obstetrician Michel Odent's suggestion that women deprived of the "love cocktail" of hormones released by natural childbirth will be unable to nurture their babies, for example). But it feels cruel to be too hard on The Business of Being Born, which, in spite of its idealistic quest to present home birth in the best possible light, concludes on an unintended counterargument.The director herself, who became pregnant unexpectedly in the course of filming, goes into breech labor a month before her due date and is sent by her midwife directly to the hospital, where she undergoes an emergency C-section. In the movie's last scene, giving her healthy baby a bottle 8 months later, she seems fine with the subversion of her expectations: "Maybe that's the way he needed to come."
What bugged me most about The Business of Being Born may have been Ricki Lake's insistence that home-birthing advocates, happy as they may be with their own experiences, know what's best for the rest of us. "So many women are missing this amazing opportunity and this life-altering experience," she lectures early on, explaining her motivation for making the film. But who's to say other kinds of births—in delivery rooms, ORs, or, God forbid, taxicabs—can't be amazing and life-altering too? Maybe some of us want our birth attendants to assure us, in the words of Epstein's midwife, Cara Muhlhaun, that they will be "the guardian of safety and the witness of your process."Others might prefer to hear something like, say, "I graduated first in my class at Johns Hopkins." Ultimately, the business of being born ain't nobody's business but our own.