Friday, March 28, 2008

The Business of Being Born - Follow-Up

Yesterday, I received a copy of the film through NetFlix. I've taken some time to think about the film and thought a post update would be appropriate.

Upon viewing the trailer, one would think that the film is primarily focused on bashing c-sections. It is not. While the film mentions the disturbing rise of "designer birth" (c-section+tummy tuck), it focuses more on the abuse of pitocin and the customary position of laying down to push that OBs in America use (in most other countries, it is not commonly used). It also touches on the rise of scheduled inductions, OBs extreme fear of lawsuits which often guide their decisions, and how patients need to be reminded that hospitals are businesses.

The film makes clear that midwives are not delivering babies at home without a plan and proper back-up. They come to a home with pitocin in case a mother begins to bleed out, resuscitation devices, transfer plans including back-up OBs on-call. It highlights how most midwives are better trained at laboring with mothers and delivering babies than most OBs (who are well-trained surgeons, not necessarily well-trained at delivering babies).

Pitocin labors, no matter how a mother ended up with one, are tough and often cause the baby great stress (i.e. irregular heartbeat - one complication, among many). Pitocin may be given when a women fails to progress at one centimeter an hour and OBs decide to "help" out. It is very commonly given when a woman receives an epidural.

Not mentioned in the film, but recently written about at, is how pit is also given when a mother's water breaks and she surpasses the 12-hour policy most hospitals have in allowing a mother to go into labor on her own (It can take up to 48-hours for a woman to go into labor after her water breaks. Most American women do not know this). If a woman's body isn't truly ready to go into labor, pit may do little more than stress and tire baby and mom out. Women have had agonizing, long labors before a decision is made to do a c-section because baby never came down and mom didn't dilate well. OBs are infamous for diagnosing "failure to descend and/or progress" often telling mothers they could never have a vaginal birth, when in fact, it was the steps taken by the OB and hospital staff that led to the complication. OBs are very good at convincing parents that their diagnosis is the absolute fact.

Laying down to labor and push can cause failure to descend or slow descent. Since laying down isn't the optimal position for helping baby come down, pushing can take much longer than usual or lead to a c-section. Often baby will be of poor presentation (a woman laboring naturally instinctively moves her body in such a way and uses gravity to move baby down and into proper position) which can lead to several complications during final delivery. Forceps and suction are commonly used when a woman lays down to push (also used because a woman cannot feel to push the way she can when she is laboring without drugs).

The film highlights unrealistic expectations hospitals and OBs tend to have. It highlights successful midwives and their more gentle birth choices for patients and their unborn babies. Gentle choices such as quiet homebirths and waterbirths - which provides a gentle, warm birth for baby, pain relief and drastically reduced peritoneal tearing for mom.

The film brings to light that modern interventions can cause a domino effect that has help lead to America's c-section rate of 1 in 3. This film was meant to bring this to the attention of American parents.

The two flaws I felt this film had were 1. Not mentioning when a c-section and modern interventions would be most appropriate. Parents watching the film are left to do their own research in that area. 2. I also wished they spoke about doulas a bit more. I, and anyone I know who had one, feel they are mandatory in achieving a drug-free birth (dads will appreciate them, despite initial apprehension), especially in a hospital when the lure of drugs is so enticing.

On the other hand, I found it very interesting that many hospitals c-sections are done at 4pm and 10pm. I'll leave it up to you to figure out why those hours are popular. Talk about pressuring a laboring mother!

I also sobbed with joy when witnessing the natural births and hearing mothers talk about the rush they felt and how the event empowered them and change their life forever. I realize, and respect, that some women don't wish to feel the pain it takes to get to feel that rush of natural oxytocin (something not typically felt with an epidural birth), but am still saddened that so many women miss out on it. I enjoyed feeling validated during the film and hearing women describe the exact feelings I felt after my waterbirth with Lila!

All in all, it gives expectant parents "food for thought," an awareness that there are other choices out their in regards to birth and awareness of what is going on in American obstetrics. Expectant parents can use this film as one of their many tools in their research during pregnancy.


Amie said...

Thanks Nat for a great review. Now if only I can figure out where to find it! I have and they do not have it available.

Tricia said...

Thanks Nat, although talking about babies is just going to make Amie want to have babies even more.

The Dunns said...

Thanks for the review! I, too, want to see it.

I definitely felt the oxytocin rush more with my 2 unmedicated births than with my 1 epidural birth. But my unmeds were much better controlled (by me) and I just naturally chose a semi-reclined position to do most of my laboring and pushing in. It was much more comfortable and able to keep my focus that way. My labors were all pretty quick, so that helps!

I'm interested in seeing all the details. Thanks!

Natalie said...

Amie, I'm going to buy the film to have on hand. I can lend it to you.

Holly, I pushed sitting up straight with both my girls. I've talked to other mothers who labored naturally and they had an uncontrollable urge to squat or stand, etc. It's so interesting how your body tells you what to do.

I felt obvious joy at Olivia's birth. I did not feel the morphine-like oxtocin rush and bonding hormones I felt with Lila. I had to fall in love with Olivia over a period of days and weeks. I fell in love with Lila deeply and intensly within seconds after she was born. It sounds shallow but something uncontrollable (for me-my body's reaction) and it's something a doctor brings up in the film that I didn't write about b/c he made a statement that I wasn't sure I knew how to talk about-but could relate to personally...