The Business of Being Born

[Michele]

I know we've debated the C-section/induction/epidural/au naturel thing before...and I was too lazy to search to bump with regards to the movie....soo....


Anyone watch this move? http://www.thebusinessofbeingborn.com/ For those who don't know about it, it's a documentary by Ricki Lake (yes the talk show host) and her friend Abby Epstein about OB/GYN care and midwife care, as well as the C-section rate in America.

Some things I found rather disturbing:
- historical use of scopolamine
- highest C-section rate is ~4 pm and ~10 pm if looked at over 24 hour period


There was a bit of doctor/medical bashing...and definitely a mild-moderate glorification of midwifery...but overall I thought it could've been much more agressive/shock inducing than it was....and in the end modern medicine saved the day.

Anyone else see it?? I got it from Netflix but I think BB might also have it....also many crunchy groups were having screenings of it.

[spotty_dog]

Re: The Business of Being Born

I'm definitely interested in seeing it. I've seen the suggestion to do a free trial of online Netflix so you can download it and then cancel. I might have to do that.

[Auspicious]

Re: The Business of Being Born

Ooh! I've been eager to see this and didn't realize it had made it to DVD already--I'll be back after I get a chance to watch it (currently procrastinating, er um, working under deadline).

[Auspicious]

Re: The Business of Being Born

When I first saw the ad for this I thought "I wonder if it will be like a movie version of Naomi Wolf's Misconceptions." I would have to say that the answer to that is pretty much Yes. It's been like five or six years since I read Misconceptions, but I remember that book being in this same vein but much more extreme, so TBoBB seemed almost tame in comparison.

It's kind of one of those movies you could go through line by line saying "Oh, I totally agree with that" and "Oh c'mon, that's "

There wasn't too much in there I hadn't heard before, which is probably why it annoys me when they take on this attitude of "women just don't know. If women could only be informed, they'd all choose to give birth in their home bathtub like me!" Sorry, still no.

I do think something is wrong with the c-section rate, though.

P.S. I've never been a huge Ricki fan or anything, but I have to say she's looking terrific and aging well!

[Ladybug122]

Re: The Business of Being Born

Ok, so this is my first time delving into the debates forum... Should I be scared?

I haven't seen this movie, but I am an OB RN, and I have a possible explanation for why the c-section rate may be higher between 4-10 pm... This is just my observation...

Many times an induction starts in the evening (btwn 5-10pm) or in the early am (5-8am). A "failed" induction may declare themselves between 4-10pm, depending on gravida. Failure to dilate, failure to descend, unsuccessful pushing, etc. I'll bet that overall a large percentage of babies are born between 4-10pm (natural and c-section).

I'm a big fan of midwives...but I'm also a big fan of MD's... They all have their place and purpose. I've known of more than a couple scary stories of women who are dead set on avoiding a c-section...and almost kill their babies or themselves in the process.

Again, this is not based on anything scientific, just my observation.

[Auspicious]

Re: The Business of Being Born

The movie claimed a peak at 4 pm (doctor wants to be home for dinner) and another peak at 10 pm (doctor wants to go to sleep), but that's a good point about the start time of inductions. (Though the movie's point of view is that there are far too many inductions and that far too much attention is paid to the clock in hospital births and that all those "failure to"s you mentioned are practically made up by the medical establishment.)

[Michele]

Re: The Business of Being Born

I'm glad you were able to watch it Julie! I watched it solo and then held a screening for all my cunchy LLL/AP friends and we were all "duh, we know that already" and I wonder whether that's just the group. Though most of them did say "I wish I had seen this before my first." Most of the people I know fall in two categories: 1) crunchy and varying degrees of doctor-hating so those who would love this movie and what it stands for and 2)convenience-driven and hospital/epidural focused so people who wouldn't watch this movie. (One of the reasons I love iMSN is that most of the people fall somewhere in the middle!! )

**spoiler** (highlight to read)I was glad I watched it solo first because Abby has an emergency C-section for a breech preterm baby...and then not hearing the baby cry right away....and all the memories...and seeing the little one in the incubator made me cry**end**

I do think the 4pm and 10pm peak represent doctor convenience. Is that necessarily wrong...I'm not sure. Certainly I want someone cutting me when they are the most rested and thinking clearest!....but is the surgery necessary? Probably in many cases it isn't.

Not having labored, my opinion is based largely on what I've read....so take it for what it's worth....but I can understand the point of view of wanting to move during labor (esp if it's anything like bad menstrual cramps)....and I can understand the theory that without gravity and movement keeping the head engaged, labor could stall....AND I can totally understand how that's not profitable for a hospital and rather time-consuming for an OB....and definitely in my own practice I can honestly say I jump to C-section faster than I'd probably like.....because I don't have a good handle on what is normal in birth (of course by the time my services are usually called upon, things are way past normal)....but why should an OB have a strong handle of what is normal??

I think a nice compromise would be a birth center headed by an OB or 3 with like 20 or so midwives doing the majority of the work.....then if there are questions an OB is there to consult with and help facilitate transfer or what need be. I know these types of places are available in some cities, but it be nice if it was more widespread. Let the midwives handle the emotional/frou-frou of labor and birth and the experience....and let the OBs handle the medicine of it.

As for the homebirth aspect....while I wish I could really go for it....I can totally see the serious risks involved. A friend in town argued with me about it...that if you are laboring naturally on a hosp floor with no hep-lock....that "the doctor said it would take 20 min to get into an emerg C-section" and that if you are laboring at home, "by the time you get to the ER it would take 10 min for the emerg C-sect"...so her logic is that if you live within 10 min of the hosp you are fine. Umm.....yeah right! I can't see that you could get an emergency C-section quicker by walking into the ER than by already being a patient on the floor. Even my urgent 5ish pm C-section with an IV in place already took about 20 minutes. I think the only way it could've been faster was if they intubated me and cut me in the elevator. Besides all that sometimes 20 minutes is too long....and you don't know that usually until it's too late. I kinda liked the analogy about riding in a car without seat belts...it wasn't totally accurate but sometimes I find that the homebirth/midwife community seems to almost think like that. (the quote was something like "a homebirth with a midwife is like driving in a car with someone who says 'you don't have to wear a seat belt because I'm a really good driver'") I think the midwife they followed seemed on top of her game....she always had a plan in place for the what if and she talked about planning for "the inevitability of transfer" not just the "oh maybe we'll transfer if we need to". But I've met midwives who were almost delusional that they could handle anything and that bad stuff only happens because of doctor intervention.

On a yahoo group I belong to, they are discussing the difference between Nurse Midwives (nicknamed MEDWIVES) and lay midwives.....that while some people may feel more comfortable with the nurse trained one, she may do just as many interventions as an OB, so what's the point?

I don't have a choice anymore, being high risk, wanting to VBAC and all....but I think about my sister and I want her to have a choice...but like Abby's doc said, I don't want her to feel like a leper if she ends up in a hospital after seeing a midwife or vise versa.

So anyway, that was a big ramble. If you stuck with me to the end, thanks.

[Ladybug122]

Re: The Business of Being Born

Oh ok, I misunderstood.

I'd like to see the movie - sounds interesting. I definately think that births are "scheduled" more and more...but is this necessarily a bad thing? I don't know. If the pregnancy is term, the baby healthy, and Mom is DONE with the whole ordeal, what's the harm? As long as the patient agrees, of course. If patients are being strong-armed into inductions, that's a different story.

As far as c-sections at 4 and at 10... that's the first time I've heard that...I'd be interested in learning more about how that data was compiled.

[Ladybug122]

Re: The Business of Being Born

Michele,
I just read your last post. I agree with your opinion about home births. In theory, they're wonderful. When all goes well, it's a dream. But when births go bad, they tend to go quickly and being outside the hospital when that happens is a gamble. Just this weekend we had a patient whose labor turned ugly really quickly (she was a full-term uncomplicated pregnancy with a totally normal progression of labor up to that point). It took 16 minutes to get the baby delivered via c-section...and the baby required extensive resuscitation. Scary for everyone. Thank God everything turned out ok. I can't imagine that this delivery would have gone as well if the woman had labored at home.

I work with a nurse who has had 3 home births herself, and she raves about her experiences...

Does a birth story like the one above happen often? No, but I just don't think I could take the chance. That's just me.

[Michele]

Re: The Business of Being Born

I'm trying to find the study...but the actual quotation is

Dr. Michael Brodman, Chief OB/GYN at New York’s Mount Sinai Hospital, cites a study that reveals the peak hours for Cesarean section procedures are 4:00pm and 10:00pm. Brodman interprets the data from the perspective of the hospital-based physician: “It’s obvious,” he says, “that four in the afternoon is ‘It’s late in the day, I don’t know what’s going on here, I want to get out of here and the ten o’clock at night is, ‘I don’t want to be up all night.’”

from the Preliminary Press Notes put out by Jeremy Walker and Associates.

[Vishenka69]

Re: The Business of Being Born

I obviously have nothing personal to add but about a year ago NYTimes ran an article about how the current trend in NY is for women to schedule their c-sections. The article particularly forcused on women living on Upper East Side, which is where Mt Sinai is located. The hospital also services Medicade and non-insured population of Spanish Harlem. Not sure if that plays any role in the statistics. I remember hearing somewhere that Medicade paid more for c-section than vaginal birth.

[Michele]

Re: The Business of Being Born

The documentary was based in NY and they did say the the trend was towards scheduled C-section. I think Medicaid and all insurances pay more for a C-section than vaginal birth...they did also mention that in the movie. With a C-section for a Medicaid patient sometimes (right or wrong) they can encourage a tubal ligation at the same time.

The didn't mention length of labor etc when citing that study....I also can't find the study and have looked pretty hard.

Also at the end of the day, with a C-section the doc can say that s/he did everything possible to ensure the health of the baby....the biggest concern of the movie was whether the interventions up to that point (pit, membrane rupture, bed bound, epidural) made the C-section inevitable.

[Auspicious]

Re: The Business of Being Born

The few parents I knew in NYC were definitely at the crunchy end of the spectrum, and in fact the only home-birther I know IRL gave birth in her 17th floor Manhattan apartment on John Street. :huh:

Re: The Business of Being Born

Three days past my due date is probably not the best time to watch that documentary but I couldn't help myself Honestly, there was not a lot that I didn't know already but it was still interesting. I thought it was pretty amazing that those women, including Ricki, would put their birth experiences out there on film.
My feeling right now is that I want as little intervention as possible, but I would not want a home birth the first time, just in case. Plus, who knows maybe I will want an epidural, this is my first time, I dont know what to expect from labour. Home birth is something I would consider for later births though. I do strongly believe that women should have that choice anyway.
I would have liked to go with a midwife, because that is what I am used to being from England, but it just seemed so complicated here with the health insurance issues etc. Even the term midwife means something different. So I wanted to go with the 'norm'. In the UK, low risk women see a midwife for their obstetrical care and only see a doctor if there is a problem. That midwife would have had a certain amount of training to be called a midwife. And from my friends experiences, the midwives usually work in teams, so that you may see different ones through your pregnancy, but then would know them all by the time the birth comes. It seems wacky to me that when I go to the hospital I will mostly be with nurses who I have never met, and when a doctor shows up at the end there is a good chance it will be a doctor that I have never met from the same practice as mine. :huh:
One thing that really scares me is the "cycle of intervention" starting off with induction, and I just hope my baby comes in the next week so that this is not something I have to worry about. At least it will not be like those images from the 40's (?) with the women tied down and doped up, that was freaky

[Michele]

Re: The Business of Being Born

Kirsty, I was thinking about you yesterday...glad you posted!