Jennifer (center) giving birth at home with the assistance of a nurse (left) and Melanie Comer, a certified midwife, in a moment from "The Business of Being Born", a documentary directed by Abby Epstein and executive-produced by Ricki Lake.  (Photo: Paulo Netto)

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Baby Business: The Cost of Being Born Free

Filmmaker and mother Abby Epstein talks about her new documentary "The Business of Being Born", now playing in select American cities

By Omar P.L. Moore/The Popcorn Reel

February 14, 2008

It was extremely hard to do . . . it was extremely hard to sell," confessed Abby Epstein, director of the documentary "The Business of Being Born", which is continuing to make its way around the U.S. right now.  After being held over in New York and Los Angeles due to overwhelming popular demand, Ms. Epstein's film exploring the pros-and-cons of hospital childbirth vs. midwife-aided home births has struck a chord.  Last month, the director and mother spoke about the experience of making the film. 

"We went to a lot of the women's television networks trying to get funding figuring that Ricki (Lake) was a television personality and they might be able to finance the film that way, and you know, none of them really would bite.  I think that for whatever reason sort of, kind of really afraid to go against the status quo in terms of the whole medicalization of childbirth," added Ms. Epstein, who said that obtaining information was difficult to say the least.

"Just the filming itself -- it's now become such a hostile environment in a lot of these labor delivery wards with the malpractice situation -- they are so, so uptight about filming . . . they would not even let a couple going to have baby videotape their own birth for their own personal purposes."  Ms. Epstein, with her boyfriend and film cameraman Paulo Netto gave birth during the documentary detailed instances where only the labor process was being filmed.  "Even as professional filmmakers, they would not let us film the moment of birth', due the liability for malpractice. 

Disturbingly enough, to hear Ms. Epstein tell it, television networks, including those geared towards women, refused to finance the film or show it on television, fearing that they would lose their advertisers if they financed or aired it.  "Really, the only way to do this film and get this information out there was to do it independently." 

Whenever commerce, politics and convention collide, the idea conveyed is that the the license to depict, film or finance a project detailing the history of women giving birth in America over a 100-year-period would come up against stiff opposition in the form of companies, namely those in the medical profession and those elsewhere that are aligned to the best interests of what Ms. Epstein calls the "medical industrial complex". 

"It's very, very tricky territory," said Ms. Epstein who talked about the challenges of getting financing for the film, dealing with a subject that she termed "one of the next big feminist issues of the century."
The United States is still in the smallest minority (only one other country Australia) where more than 90% of the childbirths in the country are still conducted in hospitals.  C-sections are escalated, to the point where some women inside the U.S. have been seeking them out when they are not necessary s medical emergencies.  Mayra, one of three expectant mothers in "The Business of Being Born" mentions the phenomenon of "designer births", where women she says get tummy tucks not long after having elective caesarean sections.  "I don't go to big enough parties as those other women do," she quips on camera.  Mayra is implicitly referring to stars like Victoria Beckham, who according to Ms. Epstein's documentary scheduled her c-section childbirths around the football season of her world-famous husband.
On the topic of hospital births and homebirths, "a lot of the studies that are done are funded by pharmaceutical companies," said Ms. Epstein, but the studies that give a more complete and thorough picture of homebirths and their outcomes in the U.S. and Canada, were detailed in such publications as the British Lancet, a medical journal publication that asserted that the homebirth successes were equal to if not greater than hospital births.  The director described the politicizing response to such journals, including an effort by the establishment medical boards to designify the study's impact.  "American College of Obstetricians and Gynecologists, they immediately come out with another statement issuing their stance against homebirth.  There's no study behind it -- it's really more, sort of a media war . . . if you really want to find good solid studies to really understand what's behind this fear-based mythology . . . they're out there . . . they just don't get that much press," said Ms. Epstein, who mentioned the occasional story that would appear in The New York Times, but by and large are absent from American mainstream press.  "But it's out there if you look for it," she said.
"It's staggering people don't know about it," said Ms. Epstein of midwife home birthing.

Sisterhood and birthing: Mothers Ricki Lake (left) who executive produced, and Abby Epstein, who directed "The Business Of Being Born".  Both have prominent roles onscreen in the documentary and have been good friends for almost a decade.
"I think that generally there are women who are very nervous about the birthing process and are more than happy to surrender all of their power to the experts," the director said, adding that the trust in doctors, in the system and in the technology makes most women "feel safe."  The trouble with that mindset, Ms. Epstein said, was that there's no such thing as a perfect birth.  "Of course you sue," she said, "because you've been set up to believe that they're gonna take care of everything and as long as you do A, B, C and D, you're gonna have a perfect birth.  And that's just . . . impossible."
Under the two models of giving birth as stated by Ms Epstein, there is "the medical model of care" and "the midwifery model of care", the second of which she posits gives the woman much more autonomy than in a hospital setting.  "I think the midwifery model of care really encourages an expectant mother to take more control and power and responsibility for her own pregnancy, to be able to find her inner voice and to listen to her instincts, and that kind of goes through the whole prenatal process and the birth, so that at the birth it's really the mother who has the wisdom and the midwife is asking the mother, 'well, how do you feel comfortable,  do you want to be in the pool, do you want to be in the shower, do you want to be in the bed, what's your body telling you to do?'"  The psychological and the emotional aspects are more confluent under this model, said the director, giving a woman a more holistic and complete aspect of what is happening to her and her body during the nine-month process plus labor and childbirth itself.

Ms. Epstein posited that the process of giving birth was "very much a sexual process, very much like having sex, or having an orgasm -- you know -- to have a really smooth, successful birth, you need to feel safe and comforted, and you need to feel privacy and you can really surrender to this." 

Ricki Lake, a good friend of Abby Epstein's for almost a decade, was ultimately the key to the documentary being made in the first place.  Ms. Lake, a former actress and television daytime talk show host, first gave birth at a hospital several years ago to her son and was profoundly disappointed by the atmosphere in which it took place.  She resolved to give birth in an environment that was far more comforting to her -- namely home -- and her second child, also a boy, was born in her own bathtub in the peace and tranquility of her New Jersey home, with a midwife and Ms. Lake's husband on hand to witness the event.  The video of the birth of her second son is shown in Ms. Epstein's documentary, showing an ecstatic Ms. Lake, who in later and prior comments during "The Business of Being Born" could be said to have an epiphany of sorts when realizing that the birthing process could be taken home with her in a place where she was most comfortable. 

"I think it can be such a hugely transformative life experience . . . it really helped (Ricki) kind of change as a person . . . that's a huge opportunity you're sacrificing (when having a hospital birth)," Ms. Epstein said.
Ms. Lake, who executive produced "The Business of Being Born", became a figure of inspiration to the director, researching in detail childbirths at home assisted by midwives versus at hospitals, where from her estimation it appeared that doctors were less interested in the comfort of the process for the mother to be than what time the doctor's shift ended.  After some encouragement and pushing, Ms. Epstein herself decided to become a mother, if almost reluctantly.  On becoming pregnant during the filming of "Business", "my instinct," she declared was, "'well, let's just ignore it -- I'm just gonna be a filmmaker behind the camera.'"  In addition to Ms. Lake, Ms. Epstein's editor encouraged her to film several of the director's appointments at clinics. 
From there, the film took on a life of its own, one that Ms. Epstein had hardly expected, or imagined, even in her most wild and unlikely dreams.  "We had been working on the film for two years before I became even pregnant."  Being pregnant, she said, wasn't really in her short term plans.  "It was all sort of serendipitous.  And I was really nervous about the whole thing," in the context of the film, which the filmmaker who lives in Brooklyn, New York envisioned as an expert-driven film, not a personal film ala "Super Size Me".  Ms. Epstein was not about to make herself as a guinea pig as Morgan Spurlock did in the 2004 documentary on fast food.  "It was a little bit uncomfortable for me," she said, on her own personal transformation from documentary filmmaker to documentary subject.
Despite her own discomfort about her personal birthing process being part of the documentary, she was grateful for the experience that "Business" taught her.  "I'm so indebted to the film, you know, for sort of helping me through my birth process because I know for sure that had I not made the film, had I not done all this research, had I not you know, been working on this with Ricki for the past two years, I absolutely am 100% sure that I would have been one of those women who just didn't take a lot of time to research this, just kind of went with whatever doctor and showed up at whatever hospital and just said, 'give me the drugs as soon as you can, and let's get this over with,'" positing that most women who give birth find themselves in this predicament.

Abby Epstein mentions that her film clearly "was not about pretending that we don't need modern medicine," and when speaking of Ms. Lake's experience said that she was skeptical about homebirth, not unlike how most women feel when hearing about midwifery birthing, a process which the medical industry in America had historically demonized.  "She gave me a book called, Spiritual Midwifery, by Ida Mae Gaskin, which is a really fun groovy book about birth on the farm, like in the sixties."  After Ms. Epstein read it, Ms. Lake showed her a video of Ms. Lake giving birth at home, and was "staggered". 
"She really kind of led me to water", Ms. Epstein said.

Cara Muhlhahn (left), a midwife, at an prenatal appointment with La Juana Smith-Huener (center) and husband Gregor, during the documentary "The Business of Being Born".

As for right now, the film has been well-received.  When it world premiered at the 2007 Tribeca Film Festival last April, the director said that "Ricki and I were both actually shocked.  We were shocked at how much press that the film was getting.  I mean, we knew it was a good documentary . . . but we were shocked at how much media interest there was."  A lot of people were touched and deeply moved by the film.  "There was an overwhelming emotional response, like emotional response people had to the film, and I mean people all across the board, you know, like gay men to older men, to, you know, young teenage girls who weren't ever thinking about having a baby . . . we realized that with Tribeca we hit a nerve here!", Ms. Epstein said, commenting that some of the moviegoers at one screening of the film said "'this was like 'An Inconvenient Truth' for women!'"  Ms. Lake and Ms. Epstein realized that the film was "a revolution, a movement", one that had literally come into being through word of mouth, spreading like wildfire. 

With everything said, Ms. Epstein is happy about one other thing:  "I think what I'm most proud of is that the film is not polarizing people."

Ms. Epstein said that the film has screened at hospitals including Brookdale Hospital in Brooklyn, and numerous other places across the United States, as well as screenings in Canada and Australia, among other countries.

In a nutshell, Ms. Epstein defines the effect of her film this way: "I think we've managed to bring these issues to light in a way that have a strong point of view but has enough balance that the medical community can't really ignore this film, you know, and they don't really feel attacked by it.  They feel like it raises serious issues that affect their profession too. " 

Most of all, the filmmaker has been staggered by the wide range of appeal that "The Business of Being Born" has.  "And then in the same breath we've got a whole world of Amish women and Mennonite women that want us to do a version of the film without any bad language so that they can screen it for their communities.  It's just unbelievable how diverse a group this film is touching, and I really think that it's because it's resonating within people in the sense that we all are somehow affected by our own birth experience or perhaps our child's birth experience.  I mean I've been at screenings where 75-year-old men have come up to me in tears after the movie, recollecting when his son was born and he couldn't even be in the hospital grounds, and he wasn't allowed to see his son for three days until his wife got out of the hospital."

When the question of whether midwifery as a course should be included in mainstream college curricula was asked, Ms. Epstein responded that it was a "good idea", and added that "one thing that's sort of misunderstood is that midwives are trained to really care for a woman from the onset of her first menstrual cycle all the way through menopause."  Dispelling the idea that midwives and physicians are akin to ships passing each other in the night, Ms. Epstein said that "midwives always work in collaboration with physicians in case there's complications." 

The filmmaker added that from the time young girls start having their menstrual cycles and going to the gynecologist, they should be getting midwifery practice so that they do not feel so alone.  "It's a lot less intimidating.  Anybody can tell you -- if you go and see your OB-GYN for your annual exam, you usually wait in the waiting room far longer than you ever actually get to speak to the physicians.  It's a usually kind of a very rushed appointment and it's quite uncomfortable to try to bring up other issues or questions, and you definitely feel like the doctor is on a very quick timeframe.  When you see a midwife it's not uncommon to sit for an hour, or an hour and a half.  And talk about whatever may be going on.  I mean, for young girls that might be more about sexual questions.  They might have more questions just about sexuality."

In about a year from now, Abby Epstein said, an educational book, companion literature and possibly an education DVD to supplement her film will be released.  In the meantime, "The Business of Being Born", which had extended runs in New York and Los Angeles last month, and San Francisco this month, begins at the Music Box Theater in Chicago tomorrow (Feb. 15), the Circle Cinema in Tulsa, Oklahoma on the 17th, and next week at the Cinema Arts Center in Huntington, New York and a one week run theatrical run beginning on Feb. 22 at Filmstreams in Omaha, Nebraska, as well as a one week-theatrical run at the Seattle International Film Festival (Feb. 29-March 6).  Although the film will soon be heading to a permanent home on Netflix, the film is expected to be added to more theaters across the U.S. because of the continued response to it.

"It's absolutely key that we get this information (about midwives and home births) to younger women in high school, in college, before they choose a practitioner to develop a relationship with someone who might one day deliver their baby," Ms. Epstein said.

For more information on "The Business of Being Born" visit

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