Movie: The Business of Being Born

[nex0s]

I'm not going to pretend that I don't have a bias, because I was already in the homebirthing camp before I saw The Business of Being Born as a result of the birth experience of one of my best friends, a woman I refer to as "The Mama" in this journal

Comments

[nex0s]

They do, in fact, discuss the fear of malpractice as a driver of CSections, they discuss the difference in cost between hospital birth and home birth (about $9000 more for a non-intervention vaginal hospital birth).

Regarding the rates of c-section vs. home/center, OTOH, you are correct. OTOH, only 1% of American babies are born at home. I don't remember the percent born at at a center versus a hospital, but it was in the single digets. Let's say 5%. So... you have about 94% of women giving birth at the hospital, with section rates of 30% on average (NYC is high). 30% is still WAY high. Partiuclarly when you consider that most other developed countries (Australia, all of Europe, etc.) still use midwives, have 30% of their children born at home) and have section rates of between 5% and 15%. Oh, and they all have lower rates of mortality than we do, except for one (but they don't say who is lower than us in the film).

ETA: "all the birthing centers in the world"
I just wanted to note that in my city of 8 million, we now have ONE birthing center that is open in the five boroughs. But about 30 hospitals. We used to have three, and two have been closed due to malpractice insurance rates.

The producers of the film are working with a group to open a 2nd birthing center in NYC and to get the "temporarily closed" birthing center open again.

N.

[docorion]

Since I'm not in the business (of birthing, as opposed to the larger business of 'medicine'), what is the advantage of a birthing center over, say, a home birth? Also, not a few hospitals have opened things they call 'birthing centers'; are those not the same in some way, and are there none of those in NYC?

I really don't know the answers to these questions, BTW. OB is an aspect of medical care whose politics and policy I have shied away from hard (as opposed to the mechanics, which I'm very comfortable with, having delivered more than my share of babies (for an ER doc), and as opposed to the politics of other aspects of health care, where I have passionate and strongly held opinions, often backed by facts :-).

[la_directora]

When my ex-husband was considering medical specialties during med school, he dismissed OB almost immediately because, "When the outcome is good, which is most of the time, it's very good, and everyone is happy. But when the outcome is bad, it's AWFUL and tragic." Which is kind of funny, since he went into ER where the outcome is almost never very good and no one is ever very happy. But I guess the kinds of awful and tragic outcomes on the scale of losing a baby are incredibly rare.

[docorion]

I dismissed it for some of the same reasons. And honestly, a conversation I had recently with my partner did not encourage male students to enter that field, either; we were searching for a new to her OB/GYN, and as we looked over the on-line lists, there were a fair number of male docs. Her comment: "What are they doing in OB/GYN anyway? It's not like they can have any understanding of bleeding from your crotch every month, or cramps, or pushing a watermelon out through your vagina" [paraphrased, but pretty accurate].

That was always the feeling I got when on an OB/GYN rotation in school; the clear sense of 'What the hell are you doing here, boy?' Emphasis on the 'boy'. Well, what I hoped I was doing there was learning OB/GYN, which I would need to know some things about whether I was a boy or not, since even in most other fields one ends up caring for, oh, 50% women :-)

Tragedy follows one wherever one goes in medicine; you can choose less or more (not a lot of tragedy in dermatology, but there is still some). Tragedy involving babies, though, is harder than most. I've done some work in the NICU during residency, and lost a couple of babies (and saved one, which was the shining moment of the NICU for me); it sucked pretty hard for me. I can't imagine what it was like for the parents.

[la_directora]

I have to admit that I fall into the camp that GREATLY prefers a female OB/GYN, though I don't have the same feelings of, "What are you doing here?" for men who practice in that branch of medicine. But my theory has always been that I wouldn't buy a car from someone who doesn't know how to drive. :) I just also accept that everyone doesn't feel the same way.

[nex0s]

what is the advantage of a birthing center over, say, a home birth?

More stuff. They will likely have a tub in the room, and tend to be located in/near hospitals for easy transfer, if transfer is needed. Some women feel that their homes are not good enough (clean, safe, big) for homebirth, or that homebirth is too messy (see comments). The birthcenter Other than that, I've had trouble finding out the big difference is. The idea is to give a "home birth experience but not at home".

Also, not a few hospitals have opened things they call 'birthing centers'; are those not the same in some way, and are there none of those in NYC?

There were two independant centers and one attached to a hospital. One of the independents has closed, and the hospital one one is "closed temporarily".

N.

[bklyndirt]

Hospital based birthing centers are very different from an actual birthing center. In the hospital based ones they make an effort to make things cozier: the rooms look much more like bedrooms and there is usually a more open relationship with midwives and doulas but an OB has to be in attendance or at least on call. The hospital birthing centers still follow all the standard hospital policy when it comes to birthing. In many cases this means that a laboring woman will be placed on an IV the minute she arrives "just in case." A fetal monitor is also attached right away, which, depending on whether it is internal or external, either limits movement somewhat or completely. One of the keys to successful vaginal births involves freedom of movement.

Birthing centers are designed to be low-tech and rarely attach things like fetal monitors and instead use a simple stethescope to monitor the fetal heart rate. Far less invasive. Also, birthing centers are far more likely to use alternate methods of induction and will take pains to avoid procedures such as episiotomies by doing stretching and massage - something many hospitals and hospital based birthing centers don't even consider.