Abby Epstein and Ricki Lake Give Birth--Really!
(from brinkzine.com 1/8/08)
- Ricki and Abby
"The Business of Being Born." which debuts at the IFC Center beginning Wednesday, was one of the best films at last spring's Tribeca Film Festival but the word didn't get out. One reason is that the press screening for director Abby Epstein and executive producer Ricki Lake's documentary was held at about the time a rooster wakes up. The theater was so empty that before the lights dimmed, I carried on a loud, screwy conversation with John Waters (he insisted Divine would screw Eraserhead), who had come to support Lake, from aisles apart and nobody listened or complained. I questioned why I was there to watch a film about child birth, but I was soon sucked in. Here was an original, deeply personal, eye-opening, and, best of all, subversive film that I thought should be compulsive viewing for everyone, just like "An Inconvenient Truth." It convincingly makes the case for home-births with the aid of midwives over births in hospitals-- because of the incredible, life-altering experience, but also because it's becoming increasingly risky for pregnant women to deliver their babies in American hospitals. There they typically are subjected to C-sections by impatient, lazy doctors who have supper or a golf game waiting. (The film points out that the number of C-sections actually goes up dramatically prior to doctors' departure times.) Moreover, Cesareans given to women who have had them in past deliveries increases the chances of trouble. Epstein and Lake point out that it's becoming more difficult to employ midwives because America's medical establishment and insurance companies are driving out their competitors systematically to force all pregnant women to deliver their babies in hospitals. It's a fascinating story. After the screening at Tribeca, I eagerly talked to Epstein and Lake about their movie. Having watched them deliver babies a few minutes earlier on the screen, I felt like I knew them both intimately…
Danny Peary: How did you decide on the title?
Abby Epstein: We had a really hard time coming up with a title, but we knew we wanted it to reflect that birth is really an industry now. A multi-billion-dollar industry. What can be more pure and natural than being born? So there's an irony when the word business is attached to that. There's something icky about it, as we try to point out in the film. Business-- making money and industry--and babies coming into the world are two concepts that, ideally, should not be related.
DP: At what point did you decide to make this film with Ricki? Was she interested before you were?
AE: Yeah, I had no interest in the topic because I had no knowledge of it. Ricki and I met when I directed her in "The Vagina Monologues," and we've been friends for many years. We were working together on some theater projects and I knew she was having a baby and I knew she'd have the baby at home in her bathtub with a midwife. I thought it was the craziest thing I ever heard. I thought it was stupid and reckless. I was judgmental and couldn't understand how someone could have a baby like that. A few years later, when she approached me as a filmmaker about making this movie, I said, "It sounds really cool to work with you, but I don't know about this topic. I don't know anything about it." She gave me two books and I read them, and I just got it—I just got it right away.
DP: What were the books?
AE: One of the books was Spiritual Midwifery" by Ina May Gaskin. It's a classic written thirty years ago and it's mostly birth stories of people on a farm commune. And they're so groovy and so funny. It's such a great book. What you get from it is that birth has a psychological and emotional component. So that a woman's emotional and mental state affects her ability to have labor in birth. That was new to me. I didn't know that feelings affected birth in any way. I had thought it was just a mechanical, physical thing. The other book was "Birth Is an American Rite of Passage," by Robbie E. Davis-Floyd. It's a really interesting book that's more from an anthropological perspective. It shows that America is a technocracy, where everything in our culture is geared to instill our faith in technology, and birth is a ritual that America has turned into a technocratic rite of passage. Birth reinforces a woman's connection to an institution. It's going to the hospital and being put in a wheelchair right away, losing your clothes and having to put on a hospital gown, and having an IV put in your arm so you're literally connected to the hospital. This whole ritual strips women of their identities and power and replaces that with electronic fetal monitors and machines that are supposed to be more reliable than the woman's body.
DP: In your movie there is the talk of the increase in dangerous Cesareans in hospitals at the same time midwives are being pushed aside because they are denied insurance. If there's not a crisis, there's at least a sense of urgency. So are you thinking that this is the perfect time for your movie to get the message across?
Ricki Lake: The perfect time. The timing of our making the movie was extraordinary because so many people are writing us from all over the United States, saying, "Help us! Our midwife has been pushed out of our hospital!"
AE: Or "Our clinic is closing down!"
RL: In our film a midwife meets with an insurance company and it says its hands are tied. It won't insure midwives. Her birth center was shut down later that year. Midwives can't stay in business because they can't afford to stay in business without insurance."
AE: Some of them can't even get licenses!
RL: Certain states won't give licenses, so they operate secretly. At one point in the movie, we talk to a home-birth midwife in Indiana on the speakerphone. She's completely illegal and committing a felony every day. They literally won't license them because they don't want them.
DP: So she can't get insurance?
RL: No! A lot of them exist like that. A lot of home-birth midwives can't afford malpractice insurance. Others don't choose to buy it.
DP: So will people who have money ever go to these uninsured and possibly illegal midwives?
RL: Ah, you're looking at one. I had to fight with my insurance company to get paid back. Oh, yeah, it was a total fight. My whole prenatal, postnatal, postpartum was like $4,500.
DP: The film mentions the sum $13,000.
RL: That's for spontaneous vaginal birth in the hospital. A C-section could be as much as $33,000.
AE: I had no trouble with my insurance company with the home birth for some reason, but I had a lot of trouble when I tried to see the midwives in the hospital. They wouldn't accept my insurance plan. I even switched insurance plans and they were like, "Oh, we just dropped that plan." They took only one plan.
DP: Abby, you give birth to your son, your first child, in the movie. If you have a second child, would you go the same route, and plan on using a midwife?
AE: I'd definitely use a midwife. Definitely, definitely, definitely. I started with an OB and then switched over to a midwife and the difference is so striking. You wait two hours in the OB's waiting room for a ten-minute appointment; you never wait for a midwife and she spends an hour with you. It's about the opposite time-ratio. So I'd definitely do it again.
DP: Does the relationship with a midwife become your entire life? Is she there every couple of days? Does she almost move in with you?
AE: No, no. The midwife sees women at the exact same intervals as an obstetrician. You have your six-week appointment, your eight-week appointment, your twelve-week appointment.
RL: You kind of want them to move in with you at the end. But they don't.
DP: Remarkably, you both give birth in the film, though your birth, Ricki, with a midwife attending wasn't filmed for this movie. You use the word "empowered" and say "good for my child" during the delivery, which is a great mother thing.
RL: I believe that a big part of who we are stems from how we come into the world. If you come into the world in a gentle, easy way, it will affect you. It felt like a gift that I gave to my son by wanting so badly and being able to achieve it. It wasn’t just about me, it really was also about him. Particularly water was important. I did a lot of research about water births. Everyone would ask, "Well, how does he breathe under water when his head is out?" I'd say, "He's still attached to the umbilical cord." These simple things people don't know, which is why I'm trying to shed some light and be an advocate, it's a privilege for me. Because these are things I didn't know myself going into my first birth experience. I didn't know what I know now, and I just love the idea of us being a vessel of opportunity for women to learn about this through this film.
DP: You didn't have an epidural, right?
RL: My first one I did. My second one, the one in the film, I didn't have anything.
DP: Your film advocates the pain in a sense.
RL: It makes the point that you can't have the ecstasy without a little bit of the agony. They go together. I'm not a martyr but I wanted to feel and remember everything. That's why I filmed it. I certainly didn't have this movie in mind. I wanted to watch it twenty years from now and remember what I felt and was saying at that moment. I wanted it to be something I could recollect.
DP: So you didn't feel you were on a mission to do anything?
RL: No. Personally, I wanted that experience as much as I wanted a second child. It wasn't about making a film or proving to the world that I could do it. It was about something in me. I'd done all this research after my first son was born. I learned so much talking to a lot of the women we interviewed in the film. I wanted a home birth. I wanted to do it on my terms. That was really important to me personally.
DP: Abby, a woman who gives birth with a midwife in your movie talks about the light switch going on and off and going to the moon. Since you end up giving birth in a hospital, did you feel that? At one point the word "cheated" is used.
AE: Yeah, Ricki asks me if I felt cheated. No, I didn't feel that going-to-the-moon experience. I felt that having an emergency C-section was more or less like having been in a car accident. It was like having a major surgery with a horrible recovery. But I think the feeling of becoming a mother eventually is the same. In the beginning of the labor it was all very exciting and surreal, but once I got the hospital and all that machinery took over and I prepped for surgery, it didn't feel like going to the moon at all!
DP: Do you worry how people will react to having the hospital rescue you, since this is a film that advocates home birth?
AE: No, that's what the hospital is for. The hospital is there to rescue you. A Cesarean-section is a brilliant surgery that is a rescue operation. It's supposed to rescue a child or mother. I feel that my birth was very magical on many levels and I feel it proved the point that this is how the system should function when it works. The midwife and mother decide what's best for the birth. The midwife calls in her backup at the hospital and you go to the hospital. For us to present a film in which every birth happens without a hitch and everything works out naturally and beautifully is not real life. Shit happens during birth, like with everything else. There is a place for the hospital, for sure. Our point is that it's being overused and abused.
DP: Do you think the film's message is strongest for women who have already had one child?
ME: No, it's for all pregnant women.
DP: I asked that because the film makes that point about C-sections becoming increasingly dangerous as they are becoming increasingly frequent.
ME: VBACs are very uncommon because there's a risk of the scar rupturing.
RL: It is important not to have a C-section on the first baby, because you could get stuck having it the second time. A lot of doctors won't even do VBACs. It's a slippery slope. I didn't even know about that when I was having my kids. We learned a lot about the dangers when making the film.
DP: I like the footage showing the demonizing of midwives in the old days.
ME: That's one of the horrible things they did in this country. Pregnant women were comfortable with midwives, but then the obstetricians came around and they didn't allow the midwives into the hospitals or allow women to go to med school, didn't allow them to be a part of the healthcare community.
DP: So is there a conspiracy between the AMA and the insurance companies against women?
RL: I wouldn't say it's a conspiracy.
ME: I think it's about money. I think it's about profit.
RL: Women's health issues have a hard time getting media attention. Women, especially with birth, can be very complacent. Birth is a weird thing because you care only about that baby; you don't care about yourself. So you're in this vulnerable state, where you find yourself say, "Sure, cut me open, do whatever you have to do, but save that baby!"
ME: And if they have a bad experience they don't go home and talk about it. I think there hasn't been a change because there haven't been a lot of women out there demanding it.
DP: Ricki, I mentioned before that you used the word "empowerment" in relation to giving birth at home. What did you mean?
RL: It's getting in touch with your power. I've taken away from my experience the theory that I can do anything. I can get through any hardship. I certainly went through a difficult time with my divorce but it had stayed with me—wanting something so badly and achieving it. And even with making this film. This was an idea in my head for a long time before I even talked to Abby about doing it. I do feel like I can do anything. That is something so important to give to women. This is a really great opportunity to help women get in touch with their power.
DP: So has anybody mentioned this film being the "An Inconvenient Truth?" on home birth?
RL: New York Magazine called me "the Al Gore of Natural Birth." That's the nicest compliment, other than being told I'm too thin. Of course, I hope "The Business of Being Born" does what "An Inconvenient Truth" has done to raise awareness. I don’t see how this film can't wake people up.