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Born free

Pranoti Chirmuley, Tahmeed Contractor


The business of being born: English documentary film, 83 mins. Directed by Abby Epstein.

Many people may be under the impression that the United States of America provides safe health care to its people — health services of the type that they want. But is this true? Does the health care system in the US really permit people to make choices about their health care? The business of being born investigates one aspect of the health care system in the United States – the childbirth industry – and concludes that this industry is neither safe nor woman-friendly. It attacks mainstream practices in childbirth and argues that natural childbirth is best. It suggests that natural childbirth practices will "deliver" us from the evils of obstetrics.

The business of being born has been produced by Ricki Lake, a prominent actor and producer. Ms Lake had a horrifying experience during her first pregnancy and was angry about her helplessness and her complete dependence on the doctor. So she decided to explore the realities of childbirth practices in the United States. For this film, she did extensive research, collected statistics, met dozens of people, and got the support of a filmmaker (who coincidentally was also pregnant during this time). The film is a series of interviews with expecting mothers (and their partners), doctors and researchers, interspersed with video recordings of home and hospital births. It is punctuated with humorous clippings of an English movie, a joke on doctors who shout orders to "unqualified" mothers strapped up for labour. Through the views of prominent people in the field and by contrasting the scenes of home and hospital births, the filmmaker leaves the viewer in awe of natural childbirth.

The opening scene highlights the public’s ignorance about natural birth practices. Several women are asked how they would like to experience labour. Would they rather deliver at home with the help of a midwife or would they prefer to be under the supervision of a doctor in a hospital? All the women say they’d prefer to be under the care of a doctor in a hospital. Clearly they are worried about their safety and want the protection offered by facilities in a hospital.

However, the women’s concerns don’t match the statistics. The film states that countries in Europe, which spend a lot less on health care than the USA, have lower infant and maternal mortality figures. In many of these countries 70 to 80 per cent of deliveries are carried out by midwives in homes and birthing centres.

The film criticises the injudicious use of drugs during labour, and epidural anaesthesia and pitocin are indicted for resulting in high rates of Caesarean section deliveries. It is also not in favour of the traditional lithotomy position; the sitting position, preferably in water, is recommended for easy and safe delivery.

The film briefly traces the history of childbirth practices. As doctors began to specialise in obstetrics and with the development of pain medications in the early 1900s, natural childbirth came under threat. There was a brief revival of the use of midwives in the 1960s, but this did not last. The electronic foetal monitor in 1970 was, effectively, the last nail in the coffin of natural childbirth as a routine option. After the introduction of the electronic foetal monitor, Caesarean section rates in the US shot up from 4 per cent to 20 per cent of births.

The recordings of natural childbirths are the film’s best feature. While the mother-to-be walks around the house during her contractions, her entire family is by her side. When the time for delivery nears, she sits down in a tub filled with water. For the viewers of this film, women experiencing natural childbirth seem to tolerate the pain much better than do women who experience birth in a hospital. When the baby is born, the mother lifts it and puts it to her chest. The delivery seems almost effortless – as if it is something that the woman always knew how to "do". Her joy, and the joy experienced by her family, reaches out to every viewer. This depiction is quite unlike the hospital scenes showing women in intense pain.

The business of being born does a good job of educating viewers about childbirth practises outside today’s mainstream. Many of us will find it hard to imagine a delivery without doctors, nurses, hospitals and drugs. The film exposes some serious problems in traditional obstetric care. But how relevant is this option for middle class women in countries like India? In the film all the women who have opted for a home delivery seem to be relatively well off. The midwife spends a lot of time with each woman before, during and after her delivery. The women’s partners are supportive and attentive. Is this the case with middle-class women in urban India? No. And rural India, where the majority live, has even bigger problems. There is a big knowledge gap between our traditional dais and western midwives.

The business of being born is certainly an eye-opener for those familiar with the way things work in labour rooms in our big hospitals. But how feasible are such services in our country?

About the Authors

Pranoti Chirmuley ([email protected])

Senior Programme officer

Centre for Studies in Ethics and Rights, Mumbai

Tahmeed Contractor ([email protected])

Medical graduate and intern

Centre for Studies in Ethics and Rights, Mumbai




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