My Daily Domestic Diigolet 02/27/2008

But the image that viewers may find most shocking is that of a baby being cut out of a woman’s abdomen via Caesarean. This, according to Lake, the executive producer of the film, and Abby Epstein, the film’s director, is the right reactio

should not be a first choice for healthy mothers.

perinatal specialist Dr. Jose Villar found the risk of death for mothers who had Caesareans, while slight (.01 percent of the women who delivered vaginally died vs. .04 percent who had elective C-sections), was triple that of those who delivered vaginally.

The risk of death for infants delivered via C-section—who are more likely to have a low birth weight—was double that of vaginal births, and C-section babies were more likely to have respiratory problems. According to a study published in the journal Birth, labor clears liquid from the infant’s lungs, preparing the baby to breathe outside the womb. Caesareans impede this process. Yet the rate of Caesareans is spiking: in 2006, C-sections accounted for 31.1 percent of births nationwide, a 50 percent increase over the past 10 years. Natural birth—without drugs or interventions—whether at home or in a hospital, remains a rarity (despite the fact that home births don’t have an appreciably higher risk rate than hospital births).

But defining medical necessity is complicated

Natural-birth advocates say that hospitals, driven by profits and worried about malpractice, are too quick to intervene.

One of the knowledge gaps is a clear understanding of the indications for C-sections,” she says.

If nothing else, “The Business of Being Born,” with its indelible image of a naked, exhilarated Ricki Lake cooing “Hi there!” to her seconds-old son in her bathtub, will give them another view.

But I don’t think Lake and Epstein are pursuing fairness and accuracy, exactly; they’re trying to drive home a simple argument that’s both intuitive and logical, while battling enormous ingrained prejudice and the cumulative power of the medical establishment and the insurance industry. That argument is that entrusting childbirth to doctors and hospitals is a relatively recent idea in American social history, and not such a good one. Most women can and should deliver most babies outside the pharmaceutically driven production line of the maternity ward, with a midwife’s assistance, either at home or in a hospital-affiliated birthing center.

This is clearly a controversial and, for many Americans, a counterintuitive idea. Epstein drives it home with a dual strategy, by showing us Lake and numerous other women giving birth at home, and by drawing in a series of experts to tell us that the United States is (sigh) virtually alone in its industrial approach to childbirth. Nearly all American babies are born in hospitals, yet we rank near the bottom of the list, among advanced nations, in infant and mother mortality.

I can imagine that some viewers don’t want to see this material quite so up close and personal, but speaking as a male human who has witnessed exactly two births in person (two minutes apart, and in an operating room), I found the home-birth scenes shattering, inspiring and prodigiously emotional

When Muhlhahn sees that Epstein has gone into labor weeks ahead of schedule (and that her baby is breech), she sends Epstein to the hospital without hesitation, and that turns out to be a very good decision.

Lake and Epstein are not in fact trying to stigmatize other women’s choices about how and where to give birth. Instead, they’re trying to introduce an entire universe of history and information that should inform those choices, and that the medical establishment has virtually erased from American memory. Whether the bizarre character of American healthcare overall can ever be changed is an open question, but no one, male or female, pregnant or childless, who sees “The Business of Being Born” will ever see the hospital maternity ward as a normal environment again.

In the case of Abby Epstein’s documentary “The Business of Being Born” (which Rebecca Traister covered last year at the Tribeca Film Festival), Netflix is arguably the film’s principal exhibitor. After screening in a few major cities this month, Epstein’s button-pusher on the natural-childbirth and midwifery movements will be made available by Netflix “to women everywhere” in February, as the film’s press kit puts it.

It only makes sense to reach an audience that largely consists of pregnant women (or would-be pregnant ones) in their living rooms.