Wednesday, May 5, 2010

Review: The Business of Being Born

Last month, my wife and I visited Mountain Midwifery Center, where we'll probably go to deliver our baby (assuming we successfully get that far; we're not even pregnant yet). Tracy Ryan, owner of the midwifery, praised The Business of Being Born, a film we'd already purchased (and which is now available on Netflix online). A couple nights ago my wife and I finally watched the video.

The main thesis of the movie (as it was with Ryan's presentation) is that, in the large majority of cases, baby deliveries work best with minimal medical intervention. In unusual, abnormal cases, medical intervention, including C-section surgery, is necessary to protect the life of the mother and baby.

The film goes into this theme in greater depth. I am persuaded that, for normal deliveries, inducement of labor often makes labor worse by interfering with the flow of hormones between the woman's body and the in utero baby. The drugs given to induce labor tend to stress the baby's body, interfere with natural delivery, and make C-section surgery much more likely.

One of the greatest things about the film is simply that it shows several normal deliveries. (I had already watched some water births on YouTube.) Watching these more-natural births was an eye-opener for me. I had always just assumed that delivery is living hell, with the woman laying down on her back, legs in the air, with the doctor peering up her vagina. Well, delivery does hurt, a lot; on that point I remain persuaded. But it need not involve the excruciating pain and screaming we've always seen on television. Instead, the natural births I've seen usually involve a woman squatting or in a tub of water. The head blurts out, then the shoulders with the rest of the body.

Seriously: if you've never witnessed a normal delivery, you owe it to yourself to watch a video of one. See the movie, or watch the YouTube videos I've found.

I was horrified to watch how U.S. medical doctors treated deliveries in the 1920s. Doctors gave women horrifying drugs and strapped women to their beds, sometimes for days. In general this was a period of treating people as though they were machines, rather than viewing technology as a means to meeting human needs. This trend was also evident in the rise of factory education and, to a far uglier extent, the rise of fascism.

While today's medical interventions are more humane, they are largely unnecessary and counterproductive. The movie mentions that U.S. infant and mother mortality rates are high relative to the rest of the industrialized world. While this does not take into account the fact that U.S. doctors try to save more premature babies or the fact that mortality is much higher among narrow segments of the U.S. population, I am persuaded that, in most cases, inducement drugs and C-section surgeries cause more problems than they solve.

I do worry that the "all natural" attitude may make those women who do need medical intervention feel somehow inadequate. Generally it is not a mother's fault if something goes wrong in delivery. Yet one of the people interviewed for the film claimed that, because a C-section interrupts the flow of hormones spurring motherly attachment, such births somehow lack love. But especially for humans love is not reducible to hormones, and a woman who gives birth by C-section is just as able to love her baby as is any other parent. The movie explicitly makes room for necessary medical interventions, but I'm not sure it sufficiently emphasized that a troubled delivery manifests no moral failing.

The director of the film, Abby Epstein, got pregnant in the course of making the film. Unfortunately, she had a severe complication in her pregnancy; her body stopped delivering nutrition to her fetus, who redirected nutrition to the brain and away from the rest of the body. Epstein went into delivery several weeks early. Because of the premature delivery (and because the baby was breech), Epstein went with her midwife to the hospital, where she gave birth by C-section. Thankfully, everything turned out fine. However, the incident does reinforce the need to get good prenatal care and to seek medical attention when needed. While deeply unfortunate for Epstein, the silver lining is that the story made for a much more balanced and informative film.

Another thing that struck me about the movie is how much it reinforced my existing political views about modern American medicine and health insurance. One person interviewed for the film claimed that often a C-section surgery is a legal strategy. The idea is that, if a doctor performs a C-section, he or she has made every possible medical intervention, and so cannot be sued. So the problems with American torts certainly show in this area.

I have long argued that third-party insurance payments -- entrenched by decades of federal tax policy and controls -- subvert individual responsibility. One women in the film said, "People in our culture spend more time and effort researching to buy a stereo system, a car, probably a camera, than they do checking out what their choices are for birth." In our third-party system of prepaid health care, most people have no incentive to seek out good value for their health dollars. Moreover, most people get the health care their employer's insurance company tells them to get, rather than the health care that would best serve their needs.

My wife and I, on the other hand, buy low-cost, high-deductible health insurance and pay for routine and expected care through our Health Savings Account. We're going to pay for our delivery by writing a check or running the debit card. We know what care we're getting and how much it costs. It is only if something goes terribly wrong, resulting in higher bills, that our insurance would kick in.

Nothing is more central to the continuance of the human race than the delivery of babies. People should know more about that, and The Business of Being Born provides not only a wealth of information but wisdom on the matter.

1 comment:

  1. My wife birthed our two kids (now 1 and 3-years old) at home with a direct entry midwife, her assistant, and myself. There is no place like home.

    On the money/insurance topic you bring up: Both times we paid most ourselves, with insurance kicking in and reimbursing me for a portion after our deductible was met (the second time even at in-network rates). Between the two we probably averaged spending what our share would have been with a hospital birth, but saved my insurer lots of money. One thing you certainly won't get at a hospital is knowing the fee up front (save for the very rare instance where transport to hospital is necessary).

    On that rare necessity: You wrote, "The movie explicitly makes room for necessary medical interventions, but I'm not sure it sufficiently emphasized that a troubled delivery manifests no moral failing." I don't recall the movie enough to judge the balance you speak of. Even if it is off in the direction you mention it is but a whisper against the deafening shout of the medical establishment and popular culture (which are much farther off, in the other direction).

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