The Business of Being Born

The Business of Being Born, a documentary about the problems with big business hospital births, is exactly the sort of thing that you should never watch: it reminds you how much of modern medicine is just doctors making things up. I've had suspicions that this was the case ever since reading The Death of Ivan Ilych. There are certain thing that doctors are pretty good at, like taking out appendixes or setting broken bones. And then there are other things that you read up on a little bit and you realize that there just isn't that much information available (for instance, the very controversial HPV vaccine).

This documentary unintentionally gives you the impression that you're in a catch-22: on the one hand, medicine has made loads of advances with regard to birthing that help keep mothers and babies alive; on the other hand, doctors, both in the past and in the present, have made a lot of bad medical choices, and we ought not unreflectively defer to them. The film emphasizes the decisions that hospitals make because they're businesses that don't want women in labor to fill up a bed for too long, such as inducing labor with pitocin, which often leads to further medical interventions in the birth. It claims that cesarean section rates sharply rise at 4 and 11 p.m., when doctors want to get home.

The answer that the film suggests is home births assisted by midwives who are prepared to take women to the hospital, should that be necessary. In fact, the woman who is filming the documentary (she's working with Ricki Lake on it) gets pregnant in the course of making the film and decides on a home birth. She goes into premature labor, however, and the baby's head is not down, and she has to have a cesarean section, without which it isn't clear that her baby would have survived. I'm not sure that home births are a financially feasible solution for everyone (the film mentioned that some insurance companies will not cover a home birth, even though it is often significantly cheaper than a hospital birth). In addition, this requires living close enough to a hospital to make it there quickly in case of an emergency.

The film was pretty persuasive in its feminist rhetoric. It claims that birth is empowering for women--it's something that women's bodies are capable of (in most cases). It claims that hospitals too often take the process of birthing away from women and turn it into a medical procedure. It claims that midwives have a practical knowledge of birthing experience that is being lost (and that many doctors have never observed a natural birth).

One really disturbing part of the film was its coverage of the "twilight births" of the 20s, where women were given a medication that did not dull the pain, but rather made them forget the pain. They were sometimes tied to their bed, then, to give birth. And sometimes men didn't know what was going on with their wives. There was a Mad Men episode in which Betty Draper has a similar birth. The Business of Being Born connected the twilight births and other unsound decisions (such as taking x-rays of pregnant mothers) to epidurals and cesarean sections. I think this is probably a stretch and a really anxiety-inducing stretch at that. However, it raises the really important point that technological progress should be always evaluated to make sure that it's really steps forward and not steps backward (as some of our technological "progress" has, in the past, proven to be).