I finally had a chance to see The Business of Being Born, Ricki Lake’s documentary about birth and midwifery care in the U.S. I’d heard a lot about it and I’ll be the first to confess that initially, I was very cynical about the whole thing – it seemed like more of the same preaching to the choir was going to be about all we could expect. Well, it turns out that I was wrong, much to my delight – it seems that a lot of people have seen it and it seems that some people are a bit rattled by it (If anyone doubts that, just read ACOG’s latest statement on homebirth and their supposition that it is a choice made to be “trendy and fashionable” – they never quite mention Ricki or the movie by name but I can’t think of anything else that would provoke that sort of language.) Anyway, one of the criticisms that I’d heard from various sources was that the movie ended on a bad note, with the director Abby (who was unexpectedly pregnant during the filming and thus became a subject of the film as well) ending up with a cesarean, instead of the homebirth she’d planned. There has been some discussion of how she talked about “maybe this was just the way he needed to come” as if she were totally fine with the outcome and this was in direct contradiction to the message of the film. Maybe it’s just because I see her with the eyes of a woman who has shared the experience of an unwanted cesarean completely derailing plans, maybe it’s because I’ve spent so much of my life listening to and walking alongside other women as they journey through life post-cesarean, but it was incredibly obvious to me that Abby was NOT ok with the cesarean at all, and that at 8 months post-cesarean (not very long at all) she was still wrestling with trying to make sense of the experience. Even though her cesarean probably was the best choice for her baby, even though her cesarean wasn’t a doctor convenience or institutional protocol cesarean, but in fact, her baby was sick and needed to be born quickly, her grief and loss were real and understandable. I was sad with her while also being thankful that her boy was healthy and thriving 8 months later. Her experience actually illustrates how safe homebirth really is, because her midwife knew when they needed to go to the hospital, because the prenatal care she got might have been the reason her baby did survive, because planning a homebirth doesn’t mean refusing to change plans when it becomes in the best interest of mom and baby to do so. It is very common (and very wrong) to assume that those of us who work against the rising tide of cesarean surgery are opposed to any cesareans at all – nothing could be farther from the truth. Obviously there are times when a cesarean is life saving and we are happy that they are available and reasonably safe. More than anything, I think what I oppose is the normalization of cesarean surgery – and the refusal to acknowledge the loss that having a cesarean entails (I’d argue the loss is there even if the woman doesn’t perceive it) even when it does save the life of the mother and baby.
So I hope the next movie is about VBAC and the struggles that we post-cesarean moms face when we try to plan a normal, non-surgical birth the next time. And I hope, if and when Abby does get pregnant again, she is able to plan and have the birth of her dreams. The birth that is both what she wants AND the best birth for her and her baby.