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The Business of Being Born - Review & Critique

(In a Jaunt Review Sort of Way)

The Business of Being Born, Ricki Lake's movie project to educate the masses about how insurance companies, hospitals and doctors have a near-monopoly on the minds and wallets of birthing women around the United States. After Ms. Lake’s first (typical) hospital birth, she became quite the birth activist, becoming a doula, attending conferences, reading as voraciously as the rest of us reading this right now. She had, at one time, said she wanted to be a midwife, but when she had her second child at home, in her bathtub, she decided she could better use her power/clout/money/influence by making this movie. While that might be debatable, she has certainly done a wonderful job with this movie.

Note: Major spoilers ahead. If you do not want to hear anything negative about this movie, do not want to know small nitpicky details that only a midwife, doctor, nurse or childbirth buff would notice, DO NOT READ FURTHER!


My apprentice Donna, her 3.5 month old daughter Kyra, my new apprentice Lexi, her almost 3 month old son Hunter and I filled my red Explorer with car seats and cackly women yacking about birth and placentas and leaking milk and we headed north from San Diego having borrowed Tom Tom (the Australian Navigator) from my partner Sarah. It seemed like a blink before we were there. It’s that way when you are with good friends and talking about birth, isn’t it?

We’d learned about the movie being in Los Angeles from a midwife semi-spammer – this was actually one thing I appreciated getting from her. I spread the word about the limited release – it was in LA for a mere 7 days – with no publicity at all, only there so it would be able to qualify for the Academy Award Documentary category. Still, we assumed the theater would be swarming with birth activists and I was frantic to make sure we bought our tickets on-line as soon as we knew for sure we were going… the morning of the day we were heading north. Happily, we got the tickets. They were only $8.50! A bargain – and they were for 8:30pm!

We got there about 90 minutes early and exchanged our on-line receipts for tickets and then went to eat dinner at a restaurant across the street. We had the WORST service I have had in years and it was clearly because we were three women, two who had their boobs out. The other women who had their boobs out got great service. I don’t know what their issue was, but for crying in a bucket, if he would have even come around for more than 10 seconds twice, I could have told him my mother was a server and he might have gotten more than a 9% tip. He was vile. Grrrr.

So, we high-tail it back to the theater to make sure we get good seats and on our way in see a gaggle of La Leche League folks from the LA area and one from the desert. Hugs all around by Donna (also a LLL leader) and we go right into the theater where, I am stunned to say, there are about FIVE people there! What?!?

With the LLL folks and the few other people that wander in, there turn out to be about 20 people total in the very small theater. I almost cried.

An adorable blonde woman came up to me and asked if I was a midwife and when I introduced myself, she did, too, and she said she read my blog all the time and we had corresponded and I loved meeting her! She sat with her husband and was as sweet as could be. I am bummed I can’t remember her name – please email me and tell me again!

So, the movie opens with a midwife getting ready to go to a birth, getting her supplies ready… IV solutions, her instruments out of the oven, suture equipment… and then she eventually gets to the laboring mom’s house. It was an interesting opening, this vision of homebirth midwifery with emergency supplies – oxygen… it was extremely apparent the audience (OBs? RNs? Vanilla people everywhere?) was being told “Midwives are not illiterate, horseback riding, barefoot witches. They are professional, emergency supply-carrying, car driving women.”

The people we crunchy granola folks know and sometimes love that were in the movie included Ina May Gaskin (looking extremely crunchy and very, very matriarchal to our homebirth midwifery sisters – she was very well-spoken!), Michel Odent (thankfully, with subtitles… I adore that man… and realized, during the movie that Dr. Wonderful is Michel Odent 30 years ago) and Robbie Davis-Floyd (who had wonderful things to say about the history of midwifery).

Interspersed throughout the film, Ms. Lake gently and unobtrusively talks to folks we know and don’t know. Sometimes, voices of frustration come across as sarcastic or licked with disdain (and you know I completely understand why) , but I think would have been better for the director (Abby Epstein) to really encourage folks to speak as unemotionally as possible – and perhaps she did. Because I know if she had interviewed me, she would have had to do 35 takes to get all the sardonic-ness out for a final cut.

(It was a very educational lesson for me – watching the movie and my “seeing” it through The Mainstream’s eyes – and paying attention to how I need to modulate my own words and voice when speaking to doctors, nurses and vanilla folks. I can see an argument for not caring what The Mainstream thinks about “us,” but I also know you get more flies with honey than vinegar. I’ve been a lot of balsamic vinegar in my birthing career. I’ve been more cotton candy [at least in front of the docs & nurses] in the last decade and feel I have made a lot more progress for midwifery and my clients. The questions are: Does the end justify the means? And when does it compromise one’s values? Do we overlook a lot so we get a lot more for all of us? Ongoing questions… always ongoing.)

But, I suppose if Ms. Epstein would have had to ask the midwifery contingent to watch their snideness, she would have had to ask the medical folks to check their snottiness at the door – and that would have probably been impossible. In fact, the different vocal nuances were probably critically important and imparted a great deal of the message that might otherwise have been missed. I think, though, that that is part of why I suggested the midwifery folks remained less modulated, so the medical ones sounded more shrill and hysterical.

Some of the comments by the doctors bordered on the absurd. Well, were absurd. One doctor who was saying how dangerous it was to have a homebirth said as an afterthought (something like), “I don’t know. Do they carry oxygen or anything for an emergency? I don’t even know.”

One of my biggest complaints about the movie is there were no Licensed/Certified Professional Midwives in the movie except Ina May. Because the homebirths shown were in New York State and non-CNM midwifery is illegal in New York, no other types of homebirths were shown but CNM births.

(Let me step sideways and critique for a moment. The main CNM shown in the movie, during several births, wore no gloves! During births, she wore no gloves – during land or water births. Do we think the medical folks will pick up on this and run with it? Absolutely! Sure, she may carry emergency supplies, but if she doesn’t practice the basic universal precautions, she looks foolish at best. If her clients didn’t want her to wear gloves – which happens – and she agrees to that, then some mention needed to made of that fact. Completely ignoring her obvious departure from the norm of birth protocol was reckless on the part of the moviemakers, in my humble opinion.

And the director, who got pregnant during the filming, used this midwife, was pregnant with a baby with IUGR [Did the midwife catch it? It didn’t seem like it. Ricki Lake did, though.] and they all knew the baby was breech [footling or kneeling, if I recall] and the mom went into pre-term labor – and the midwife went over to her house to check on her first! I was absolutely stunned watching because this mom was in full-blown labor and obviously needed to get to the hospital. When the midwife got to her, she did a vaginal exam [!!!!!][with a glove] and she was, in fact, quite dilated and then came an hysterical [not the funny kind] trip to the hospital before her eventual cesarean section. I can imagine the medical establishment folks having a field day with this entire scenario – if the midwife had ruptured the woman’s membranes and the cord prolapsed or a foot came out… oh, the commentary could be endless. Why this transport had to be shown is beyond me. I understand it was the director’s but it is not the typical midwifery transport!

All that said, I know I could never, never withstand the scrutiny of being filmed like this and shown to the masses. I would be judged mercilessly, too. I do know that. But, I know my thoughts and expressions won’t be unique.)

So, positives included salient points made by moms about their reasons for homebirthing and birthing with midwives, the wonderful quiet births that were captured beautifully on film, the exhilaratingly joyous birth of Ricki Lake’s second child, being able to see the sad history of childbirth in our country as it has unfolded thus far and the realization that it is doing nothing but continuing right this very minute, watching women birth in bliss at home compared to women birthing in blah in the hospital, knowing we aren’t alone in our beliefs and the thrill of anticipation of owning this movie to show our friends, family, childbirth classes and clients (who won’t pick it apart like me because they won’t recognize the stuff I did).

I only wish the movie ended with a glorious homebirth. Instead, it ended with the above mentioned cesarean and the director’s postpartum processing, including her difficulties with breastfeeding. She was feeding her baby a bottle (the LLL women in the audience groaned seeing it) – why couldn’t the bottle have been left out of the movie? There were no breastfeeding women that I can remember. Anyone else remember any? I don’t even remember any slings. I could be wrong, though.

(If I were making the movie, I would have seen it as an opportunity to de-sensitize the vanilla masses to a lot of crunchy things! – but it was probably best for them not to. I can see Ms. Lake and Ms. Epstein saying to each other, over and over, “Stay on-track, only midwives, only homebirths, only birth….”)

Overall, I enjoyed the movie. I know it might seem funny considering the critiques here, but I am really so, so happy Ricki Lake did this movie for us. We needed this movie. Sure, there are things we could have all added – and left out – but overall, she did a beautiful job and I am proud to call her our own. She knows her stuff. This movie also offers the rest of us who consider ourselves activists a springboard from which to fly! If you have a talent, skill, money or art – put your gift towards The Cause of Birth. Ricki Lake did it. So can we!

After the movie, I gathered the women in the audience together for a picture and we introduced ourselves to each other. There was a Family Practice Physician (who teaches medical students how to be humane, she said), a Certified Nurse-Midwife, the LLL folks, a few doulas and others. It was so wonderful! I asked permission to put the picture on my blog and when asked where the blog was, I wrote it down on the back of my business card and handed it out. A woman next to me began squealing after reading it, “You’re the Navelgazing Midwife!” and I laughed saying I was, indeed. Her friend next to her also started jumping up and down. Donna came over and said, “You’ve been blog-sided again.” Laughing, I hugged the women and felt like a mini-celeb for a moment. Several of the women there said they read my blog (waving hi!), so I’m glad to finally be getting this out there. Picture and all! I look forward to what you all have to say about the movie, too. Share, share!

Our drive home was stalled by lane closures, but we kept ourselves occupied talking about UFOs and how to see sub-atomic particles with the naked eye. Nahhh, we talked about birth! We dreamt about birth that night, too. I’m sure we woke up the next day and talked birth again, as well. In fact, I am sure we did. We had a full day of prenatals – starting at 9am.

Isn’t it amazing how we never get tired of talking about birth?

The Business of Being Born opens in Los Angeles, New York and San Francisco at the end of October and then will be available for rent only through Netflix by the end of the year. New Line Cinema will be selling the DVDs sometime next year.

Reader Comments (19)

I can't wait to see it! I am glad to hear it was good, overall.

September 3, 2007 | Unregistered Commenterradical mama

I hope it's picked up by an indie theater in Minneapolis so I can see it soon! I guess I'll put it on my netflix queue just to be safe though. Have you heard anything about this one; http://www.pregnantinamerica.com/newsite/

September 3, 2007 | Unregistered CommenterJennifer

OH I wish I had know about this. I would have loved to met you & Donna & the other LLL folks there! I will check it out in October for sure.

September 3, 2007 | Unregistered CommenterDebstmomy


That link is horrid! I can't navigate anywhere there without it tossing me off, blinking everywhere, it saying I am forbidden to see the film clip... blargh! They need to fix that site! So I haven't heard about the movie and still can't comment on it. :(

September 4, 2007 | Unregistered CommenterNavelgazing Midwife

I'm being obnoxious now, I just asked "Home Birth Diaries" what is the goal for birth in this side of things? I would love to see some kind of "mission statement" or defined goal. I have birthed 5 (soon to be 6, I'm due on the 10th) and they are all hospital births. There are things that happened in hospital that were lovely, there were things that happened that were scary. I have never had a c-section nor epidural. I have had one episiotomy (one stitch) and have torn without one (because of overzealous directed pushing). I have had babies without OB present because I dilated fast, and one even with no one catching but the bed and God. All this in the hospital. I am overall satisfied with my experiences, but also had been blissfully unaware of all that happened that wasn't needed. One thing that has helped keep me from epidurals and extra intervention (I did get intervention...just not extra traumatic) was childbirth education. The nurse encouraged us to go natural, encouraged us to wait 15 minutes when we think we need medication, see if we can make it, encouraged us to make a reasonable birthplan. She taught us birth was natural and normal. I have not felt I was forced into anything, but I just didn't know how much I could refuse, how much I could do for myself. For me, one thing I think would be important is education for pregnant women...before they get pregnant. It's too much of a learning curve in the 7-8 months most have before they deliver. Also, some sort of education for anyone assisting a woman birth. (some people don't like the word delivery). What is the goal, the mission statement?


September 4, 2007 | Unregistered CommenterAnonymous

thanks for the review on this! i am saddened by the lean towards CNMs...and the transport situation. sometimes those subtle things do more to hurt our cause than help it. :(

still, I may see it when it arrives!

September 4, 2007 | Unregistered CommenterSage Femme

I'm so glad you reviewed this movie! I can't wait to see it, but I have no idea when that might be. Man it IS hard to modulate ourselves when talking about homebirth, everytime someone at work (the hospital) assails me with doubts and questions I just about want to scream but I try to answer calmly and simply. The other day a nurse was suprised to hear that I had prenatals with my
DE midwife. WTF?! Ummm yeah, and they last an hour to an hour and a half not six minutes like you get with doc or even the twenty you get with the CNM. *rolls eyes*

September 4, 2007 | Unregistered CommenterRed Pomegranate

Oops, sorry, haven't been to that site in while so I didn't realize they took the trailer down from that page.

Try this link;


Or this one;


September 4, 2007 | Unregistered CommenterJennifer

I have my own disclaimer: I was interviewed for the film and appear in it on several occasions, offering historical perspective that I learned writing my book, Birth: The Surprising History of How We are Born. I spent many, many hours with Ricki and the producer, Abby, whose baby was premature. That said, I believe the film dealt with Abby's pregnancy honestly and made clear one very important thing: Home birth is great for low risk pregnancy, but it's more than OK to go to the hospital for a high-risk situation. The only way the mainstream will ever pay attention to home birth is if they feel this issue is acknowledged. And I think Ricki's goal is to reach as wide an audiencfe as possible. Afterall, birth activists don't need to preach to each other.

September 9, 2007 | Unregistered CommenterTina Cassidy


Thank you for your wonderful work!! Thank you a million billion times for ALL you do and for appearing in the movie. I remember you clearly and knew your name immediately.

You are right. We birth folks talk incessantly to each other about what we can do to change the world, how to do it, and then we are left, in most cases, immobilized about where to go from that point. Ms. Lake was able to crash forward, far, far beyond anywhere most of us ever dreamt of going and I am so overwhelmingly proud and somewhat (pretty) envious at the impact she is making/going to make on our birthing community.

I really hope you - or anyone else from the movie - don't take my critiques as terribly negative. Please remember I write for midwives and doulas and I *know* that as the movie is more seen, medical folks will say something about the things I saw because I wasn't the only one in the audience of 20 who said something. I think it is imperative of us to have a way to explain *why* the midwife did what she did... instead of letting them think she was a flake and "See? those homebirth midwives ARE flakes!" Does that make sense?

If we can explain that some homebirthing clients request and sign consents re: gloves... and that the midwife was close to the couples house when she went to check her before they went on the wild ride to the hospital... that perhaps she *wasn't* sure she was in labor... it would be good for us to have more information, that's all, so we can explain it better. I hope that makes sense.

I don't want *anyone* to think I am "dissing" the movie. I am not. It is absolutely something we must see, take others to see, own, show. It is power-FULL. It says so many things we've wanted to say for so long. It *shows* so many things we've wanted to show for so long.

But there is always so much more to say and show.

Always so much more.

That leaves room for the rest of us to do our parts.

Just like there are hundreds of books on natural childbirth, there is PLENTY of room for more documentaries, books, art depictions, poems, musical interpretations, photographs, articles - and blog pieces - about birth as it is in the world today.

We ALL need to keep speaking up as Tina, Ms. Lake and Ms. Epstein have done.

Tina, thank you so so much for writing. It means so much that you did. Thank you again for all you've done and I cannot WAIT to read your book. Everyone... ORDER It TODAY!

September 9, 2007 | Unregistered CommenterNavelgazing Midwife


you can see the trailer here too. hth. - momdoulajen

October 1, 2007 | Unregistered CommenterAnonymous

There is another movie that is supposed to have come out already, called Pregnant in America. It is a documentary about the same thing, doctors, midwives, etc and how hard it is to have a normal birth in our medical culture.

I really enjoy your blog so far--I just found it tonight!

October 25, 2007 | Unregistered CommenterPhoebe

Yes, I was told about "Pregnant in America," but haven't seen it yet. Please read the other things I have to say about BoBB... I ended up LOVING it - much more than this initial critique makes it sound like.

Thanks for being here! I'm glad you found me and hope you settle in and stay a good long time. :)


October 25, 2007 | Unregistered CommenterNavelgazing Midwife

it was wonderful to read a review of BOBB from a midwife's perspective. i haven't yet seen the film - can't wait 'til it comes out on netflix next month - but i am looking forward to it. i'm glad to hear that you thought it was good overall.

mama to ava (born in the hospital) and julian (a surprise footling breech born at home)

January 3, 2008 | Unregistered CommenterCrunchy Domestic Goddess

Thank you so much for the thoughtful critique. I was able to see "The Business of Being Born" yesterday in NY, and Ricki Lake and Abby Epstein did a short Q & A after the film which addresses some of your points.

As far as the midwife coming to Abby's house, she said it was not clear in the movie after editing, but she actually did not think she was in labor and was mentally believing even if she was in labor it was going to be at least 10 hrs or so long, and that is why the events unfolded as they did.

Ms. Epstein also took lots of heat over the bottlefeeding scene. She said she actually had extreme nursing difficulties due to her son's size and the NICU situation and, while that was touched on in the movie, I too felt as if it just should have been left out. However, at that point Ricki chimed in about her nursing experiences. She stated she had a breast reduction in her early twenties and was only able to partially nurse with each child. However, instead of turning to formula with baby #2, instead she purchased banked breastmilk instead (which earned her a loud ovation!)

Abby and Ricki are also planning a book to hopefully be out in 2009 - they stated that they plan on addressing many of the issues in the book which they simply did not have time to address in the movie.

Hope you don't mind me weighing in here :)

January 9, 2008 | Unregistered CommenterAPmominPA

To answer your question about other nursing and sibling shots--yes! There were a number of siblings present and helping at prenatal visits, and during "Mayra's" birth there were child-sounds intermingled with her labor song, and then after the baby was born her toddler came around behind her and patted the head of the baby she had just pulled from the tub water onto her chest. Really cute. Also, I was stunned that Abby wasn't able to nurse, because there was a long shot of her breastfeeding her premie in the NICU, and he was really going to town, remember? There were also shots of Ricki nursing, and at least one of the other moms. Too bad Abby didn't get better support for troubleshooting her breastfeeding, but our system is so bad with premies in the NICU, in so many hospitals--it may have just posed insurmountable barriers for a first-time mom. All in all, I thought it was a very beautiful film, and I am very glad this is where Ricki Lake decided to put her considerable energy. Thanks for your great comments--love your blog!

January 10, 2008 | Unregistered CommenterMairi

Just to clarify, non-CNM midwifery is not illegal in New York state. Instead, all midwives in NY are regulated by a board of midwifery (as opposed to a board of nursing or, heaven forfend, a board of medicine) and licensed identically. The difference is that only CNMs can use the title "nurse-midwife". Otherwise the regulations are identical for nurse- and non-nurse midwives.

Looking forward to seeing this with a group of labor nurses and midwifery students next week!

January 17, 2008 | Unregistered CommenterMeg

Just to clarify, non-CNM midwifery in NY state is not illegal. All midwives have the same license (LM) and are subject to the same regulations by a board of midwifery (not nursing or medicine, for a change). The only difference is that non-nurse midwives cannot use the title "nurse-midwife".

Looking forward to seeing this with a gaggle of progressive labor nurses and midwifery students next week...

January 17, 2008 | Unregistered CommenterMeg

Birth As We Know It (Natural Childbirth with Grace and Ease Waterbirth Midwife Elena Tonetti 2006)

Another excellent movie about birthing and midwives with a Russian twist

July 30, 2011 | Unregistered CommenterOubli

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