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]

Yeah... I've heard a lot of stories like that :( I was already going to go birth center or homebirth - but it turns out in NYC that there are only TWO birthing centers.

Homebirth it is!

I'd rather pay out of pocket than be compromised.

N.

[la_directora]

If you ever give birth in a hospital, I have two words for you: Birth Plan. I've watched several friends go through birthing experiences where having a birth plan written beforehand, before any drugs were in their system or any contractions were blurring their minds, saved the day for them. Of course, it helps to do research and make sure the hospital or birthing center you choose honors birth plans. But if they do, USE one. That way things like that can't happen.

My best friend had a really detailed birth plan, something like 5 typed pages. It was a fascinating document.

[la_directora]

When I was about 10 or 12 years old, my aunt gave birth to my cousin in a home water birth, at a time when such things weren't done. The letter she wrote about it and the pictures she shared made me decide that if I ever gave birth, I wanted to do it at home. The whole thing felt so warm and beautiful

[nex0s]

Just so you know, seeing at the IFC will help them get their numbers up. Apparently it's *this close* to having good enough numbers to release it nationally!

N.

[la_directora]

I gotta stop telling my friends I used to be Catholic so they won't know that guilt gets me every time. :)

[nex0s]

LOL

See icon!

N.

[docorion]

I'm not going to argue with any of this, except to point out that the statistic you mention (40% c-sections at hospitals/10% at birthing centers) has a built-in bias: birthing centers carefully screen for 2 major criteria-desire to vaginally deliver, and likelihood of vaginally delivering; hospitals must take all comers. So naturally, birthing centers are going to have a lower rate of sections.

There are a couple of drivers of sectioning which I suspect aren't mentioned in the film, as well. Most common malpractice suit for an OB: failure to commit perform timely c-section (leading, presumptively, to some sort of bad outcome for baby, most often cerebral palsy, although it can be shown that CP is not due to events at birth pretty conclusively). Penalty for sectioning: none; in fact, it pays better (which is, I agree, A Problem). So, if all of the incentives run in the same direction, we all shouldn't be surprised if we get more of the incentivized behaviour. Also, a non-trivial proportion of c-sections at hospitals are driven

[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

[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.

[sashajwolf]

I saw a very similar film when I was pregnant with orangebird, and it was very helpful. I chose a hospital birth for that because of my circumstances at the time (living in a shared and somewhat cramped student house - not the right sort of environment for a home birth), and because I haemorrhaged afterwards, chose hospital again for the other two births - but I did choose a hospital with a lower Caesarean rate than our local hospital, as well as researching other aspects of the care. The average rate in the UK at that time was 15%, but in our local hospital it was 50%; it was a university hospital, so I'd expect them to get slightly more problematic cases than average - but since maternity was not one of their specialisms, it shouldn't have been that much higher. The hospital where orangebird was born was a specialist unit, also in a teaching hospital, and had a rate of 17% IIRC

[nex0s]

Of course YMMV! I'll note though that you are in the UK and the system I believe is significantly different.

Here in my city, the lowest rate hospital was one in the Bronx that had an 18% rate ... and was one of the TWO hospitals with a birthing center... a birthing center that has just been "temporarily closed" this past month. Interestingly enough, the poorer the neighborhood, the lower the CSection rate. Which suggests some scary things about insurance and greed.

You'll note that in my review I say that if I am not high risk I'll do it. I might be high risk due to age, but maybe not.

N.

[ailbhe]

Well, you know I believe in homebirth! I still believe that if I'd had access to pain relief at home Linnea would have been born less traumatically.

I won't be watching this film.

[nex0s]

The midwives in this film bring pain relief with them. Along with pitocin, oxygen, etc. They just rarely use them.

I didn't think you'd be seeing it. I think it would be too hard.

N.

[ailbhe]

Yes, it's standard practice here for midwives attending a home birth to have gas'n'air and pethidine, as far as I'm aware.

I am appalled by the 40% figure. Here it's about 25%, which is also appallingly high, but 40% is just ridiculous.

[nex0s]

Yeah :( As much as it pains me, I'll likely not be using my OB/GYN for my birth, because her hospital is the highest in NYC at 46%. I will ask her to be my "back up" doc though.

I've been going to her since I was 19 years old and I love her. But.

46%? That's a little much to swallow.

N.