This paper is meant to compare and contract the two models of birth (home births and hospital births) presented in the film The Business of Being Born directed by Abby Epstein in 2008. The film implies that the cost of comprehensive trust in hospital technology is reflected in the US infant-mortality level, the second-highest among all industrialized nations. Why? The film asserts that a cultural hatred to normal home childbirth is a causative factor. The thought-provoking film highlights just how far the American maternity system has fallen from evidence-based practice by letting responsibility and the bottom line dictate procedures and policies.

Two Models of Birth

In 2001, Ricki Lake delivered her second baby with the help of a midwife in her bathtub. She made this choice because she experienced unnecessary medical interventions whilst delivering her first baby at hospital birthing center. The woman succeeded in delivering on her own terms and this experience was so empowering and life-changing that she felt every female should realize what they could be missing out on. So, she called filmmaker Abby Epstein to work together on a film which would investigate birth culture in the USA. However, to most people, just the thought of giving birth outside of a clinic appears foolish and hazardous. They do not understand why any parent would limit the baby’s access to technology in the case of emergency. The film does not promote the home births; it merely asserts that parents need to have a choice: “In the culture where all of rituals have become too commercialized, birth has to remain individualized and blessed if parents know the truth behind the therapeutic myths,” declares Epstein in the film The Business of Being Born.

The statistics mentioned in this movie suggests that the revolution in births from home to clinic was spurred by technology that turned it in the surgical process counting the multiple, frequently pointless interventions. In 1900 95% of births in the USA occurred at home. By 1938 the figure had reduced to half of the previous percentage. Nowadays, the amount is less than one percent. The birth has become overly medicalized and too expensive. General idea of “normal altered”, as clinics specializing in obstetrics began springing up around the nation, increasing a demand for their services as well as the stigmatizing alternatives.

Also, as clinics are businesses which thrive on a high turnover, drugs to encourage and speed labor (that often make it more painful) serve the system by emptying clinic beds at a faster level. However, as Ricki Lake asserts, the use of one medicine during her initial delivery led to “a snowball effect” (Epstein). The epidural reduces pain but it also delays the normal contractions. To maintain the contractions active, another medicine, pitocin, is frequently used. It makes contractions longer and stronger, however, causes more pain and another epidural. This demands more pitocin, which again leads to stronger contractions, and stress to a child. Finally, this frequently causes an emergency Cesarean section. The conclusion of all these interventions is apparently a shorter delivery, benefiting the clinic, but far more stressful experience for the mother and child.

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According to the movie, normal birth is not a medical problem. The issued safety statistics for home births are pretty good,but the clinic establishments would argue a clinic is the safest location to give birth as if something goes wrong, speed is crucial. At the very same time, obstetricians have surgical education, but many have never observed a natural birth and are, thus, not ready to oversee one. Epstein’s camera confirms this once she asks three females from NYU’s Bellevue Hospital Center how frequently they get to observe “natural births.” “Rarely”, one answers.  “Almost never”, adds another girl.

Also, there are terrible accounts here of broadly adopted medical practices, which were subsequently demonstrated to be unsafe to a baby. The administration of scopolamine in the ’40s-’60s was believed to stop pain but, in fact, eradicated the memory of pain, frequently leaving the mother suffering noticeable post-traumatic stress. The X-rays of pelvis was ordinary till the discovery that some children got cancer as a consequence. The usage of the well-known medicine thalidomide for morning sickness was discovered to lead to birth defects. In the 90s, to increase contractions Cytotec was discovered to lead to ruptured uteruses.

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The film also touches upon the issue of Caesarean section. It is supposed to be the final resort in the case of emergency, but has become extremely commonplace because it is so proficient. But, as several experts point out, a C-section is, in fact, a major surgery. Though female’s initial C-section poses few risks, the risks of severe complications raise with every repetition. It is also really expensive. Midwives assert that if females were permitted to ambulate, to deliver squatting, and to avoid some interventions like fetal monitoring and epidurals, many C-sections could be avoided. Numerous C-sections are done due to the fact that the obstetricians actually think this is the safest choice. However, most likely those decisions are pressured by a fear of the lawsuits and the doctor’s necessity to be capable to demonstrate the jury that he did everything possible to avoid possible problems for mother and baby. Some doctors even perform C-sections on request for patient preference, which is awful. The US legal system has to bear part of responsibility. No physician wishes to appear on the witness stand clarifying why he did not use fetal monitor or perform ultrasound.

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Furthermore, the film criticizes “lithotomy” position, in which mother, lying on a back has to “push”. Due to the fact that it makes the pelvis smaller, the position augments the probability of having to deliver a child with forceps or vacuum extractor. Squatting is less stressful for mother, but more so for physician who has to catch a child. To offer a contrast, the normal births in the movie, counting Ms. Lake’s, are performed in squatting position in water with midwife. The exception in the film is the hospital delivery of the film’s director Abby Epstein. The film’s acknowledgment that normal childbirth at home is not the answer for everybody helps to keep the film from turning into one-note debate.


Epstein leads the audience to the conclusion that females frequently give up a potentially life-changing experience. A hospital environment is not favorable to the genuine needs of a laboring female, making births with no intervention practically impossible. Thus, the doctors, instead of the mother, deliver a child. 

Highly-paid obstetrical proficiency is not required for the majority of births. There is no ground well-trained and prepared midwives could not convey children at home for those parents who want it and are ready to accept certain risk. There is also no ground midwives could not help to give birth to most children within the clinic in patient-friendly surroundings with expert emergency backing right next door. That would definitely be the best of both worlds.

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