I think Ozymandias gave a great little reply when they said:
"The Business of Being Born" is, most definitely, one-sided. Home birth in the United States has increased 20% since the film came out, largely in part due to its influence. Unfortunately, "The Business of Being Born" is so slanted and leaves out so much information that I feel like I can call it propaganda without exaggeration.Though I haven't seen the actual film, you would be correct in assuming that it is one-sided. Simply the description on IMDB already gives a hint of bias: "Compelled to find answers after a disappointing birth experience with her first child, actress Ricki Lake recruits filmmaker Abby Epstein to explore the maternity care system in America." When a film-maker is specifically looking for something, they can typically find enough material to make a movie.
You know how in my last post in the "Labor Positions" thread that I said that I'm tired of hearing babies die of preventable deaths due to the fear and misinformation spread by the leaders of the natural birth movement? Well, the whole film "The Business of Being Born" is a perfect example of that fear and misinformation.
First of all, the fear that I'm talking about that "natural childbirth advocates" perpetuate is a fear of hospitals and everyone who works in them (doctors, nurses, anesthesiologists). Most people don't have any fear of those things before watching "The Business of Being Born." After watching the movie, which is filled mistruths, lies-by-omission, and emotional quotes played over scary hospital scenes, women feel like to have any sort of peaceful, happy birth, they will have to fight the doctor and the hospital every step of the way. They become afraid of the normal hospital process, and have been told that the normal interventions are (at best) unnecessary and (at worse) dangerous.
This simply isn't true! Doctors aren't out to get you. Hospitals aren't out to get you. The routine "interventions" during labor (electronic fetal monitor, IV fluids, etc.) have been shown to lower maternal and neonatal mortality rates. Many, many, many women have great, happy, peaceful births at the hospital.
And the misinformation - holy cow, the whole show is full of misinformation and half-truths. (One of the half-truths, about the US having a high infant mortality rate, was already addressed by a commenter in response to Ozymandias's answer. Infant mortality measures deaths up to one year of age is a measure of pediatric care; neonatal mortality is the measure of obstetrical care {it measures death up to 28 days of age} and the US has one of the best neonatal mortality rates in the world.) The first thing you see when the movie starts is a scene about midwives, and you see a midwife drive up to a woman's house. On top of this comes the quote, "Midwives attend 70% of the births in Europe and Japan. In the US they attend less than 8%." This is true. What it doesn't tell you is that there are two types of midwives in the US - Certified Nurse Midwives (CNMs) and Certified Professional (lay) Midwives (CPMs). CNMs are "real" midwives - they have education and training that exceeds that of all other midwives in the world. However, the huge majority of out-of-hospital births are not attended by CNMs. They are attended by CPMs, who do not have the education or training required by midwives in ALL other first world countries. CPMs would not qualify for licensure in ANY other first world country. One ob explains: "In the UK, the Netherlands, Canada, Australia, etc., you need a university level degree to practice midwifery. In the US, you need a master’s degree in midwifery. In contrast, the requirements of the CPM were 'strengthened' in September 2012 to require a high school diploma." And these are the people attending the huge majority of out-of-hospital births.
In addition to leaving out the fact that the majority of midwives attending out-of-hospital births could not be credentialed in any other first world country because of their lack of education and training, "The Business of Being Born" also fails to address the huge differences between the US's health care system and those in Europe in Japan. In places like the UK, Canada, and the Netherlands, home birth is officially integrated within the medical system. There are strict "risking-out" criteria to make sure only the lowest risk women attempt home birth, and well set-up transfer systems so that women are more smoothly transferred to the hospital if complications arise during labor. In some of the countries the transfer rate to the hospital exceeds 40%. And even with those precautions, studies in places like the Netherlands have shown that the perinatal mortality rate (number of stillbirths and deaths in the first week of life) is higher for LOW risk women under the care of midwives than HIGH risk women under the care of obstetricians.
The authors of this study, Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands concluded:
The Netherlands is often touted as an ideal country by home birth advocates because of its high home birth rate, but in reality is a stunning indictment of the idea that "low risk" women can be cared for just as safely by a midwife as an obstetrician.We found that delivery related perinatal death was significantly higher among low risk pregnancies in midwife supervised primary care than among high risk pregnancies in obstetrician supervised secondary care. This difference was even greater among the cases that were referred from primary to secondary care during labour...
In summary, the Dutch obstetric care system is based on the assumptions that pregnant women and women in labour can be divided into a low risk group and a high risk group, that the first group of women can be supervised by a midwife (primary care) and the second group by an obstetrician (secondary care), and that women in the primary care group can deliver at home or in hospital with their own midwife. When complications occur or risk factors arise antenatally, during labour, or in the puerperium in primary care, the women is referred to secondary care. We found that the perinatal death rate of normal term infants was higher in the low risk group than in the high risk group, so the Dutch system of risk selection in relation to perinatal death at term is not as effective as was once thought. This also implies that the high perinatal death rate in the Netherlands compared with other European countries may be caused by the obstetric care system itself, among other factors. A critical evaluation of the obstetric care system in the Netherlands is thus urgently needed.
So the opening quote of "The Business of Being Born," that less than 8% of US births are attended by midwives? Great. We're probably saving a lot of babies that way.
There is so much more to say about this subject, but I feel like I'm making my post too long again.
For a great breakdown on several of the quotes from the BOBB, check out this post on "What Ifs & Fears Are Welcome": The Business of Being Misled
Or this article: "What Ricki Lake Doesn't Tell You About Homebirth"
Or this series of posts: Debunking the Business of Being Born
Annnnd I should probably stop there because this is already tl;dr.