Film Review

Sunday, January 27, 2008
I'm glad I saw "The Business of Being Born," but to be honest, I was a little disappointed in its content. Based on the title, I was hoping the documentary would go more into depth about why insurance companies aren't paying for homebirths, and why birthing in this country seems to be monopolized by the medical community. The point I took away from the film is that the insurance companies are advised by a board of OB-GYN's that tell them homebirths are dangerous & should not be covered, and so for the most part, they aren't covered.

Overall, this documentary is an overview of the changes that have occurred in the way we birth babies in this country over the past one hundred years, and also includes clips of Ricki Lake birthing her second son Milo at home in a bathtub. Director Abby Epstein gets pregnant during the making of the documentary, so her pregnancy and C-section with her son Mateo is also documented. Her midwife is interviewed several times in the film, and she accurately represents the model of care that midwives provide. A special treat in the film includes interviews with Ina Mae, a midwife and mother whom I highly respect.

I stayed for a discussion afterwards led by Jesse Remer Henderson, a doula from Mothertree Birth Services, as well as some women from UrbanMamas. It was interesting to hear women share their personal birth experiences in hospitals and at home, as well as conversation about how their decision where to birth was influenced heavily by insurance companies. It seems to me that until insurance companies change their policies to cover homebirth and broaden their board of advisers to fairly include those from the midwifery community that many women may not have a choice to pursue the birth they desire. I know that we were lucky enough to have out-of-network coverage, which paid 70% of our midwifery services. This was frustrating to me early on in my pregnancy with Juniper when I looked at the numbers. For my prenatal, birth, and postnatal services, the cost was only $2800.00 with an LPM (licensed professional midwife). On average, vaginal births in a hospital run around 10K, and C-sections around 30K. So, it was insulting to me that they wouldn't cover 100% of $2800.00. Our insurance company pays 100% if you see an OB-GYN, but actually reduces payment to 90% for care under a CNM (Certified Nurse Midwife), a midwife that practices along with OB-GYN's and only delivers in hospitals for the most part (I think there is one CNM in Portland that does attend homebirths). By going to a LPM, I was out-of-network, so payment was at 70%. For most people, they would have no choice financially but to go with the 100% coverage, so really, insurance companies are twisting their customer's arms to receive the care that they have decided is ideal.

A couple of things I learned in the film is that C-section rates peak at 4PM (doctors want to get home for dinner) and 10PM (don't want to be at the hospital all night). I don't know if these are really the reasons, but those are the reasons given within the film. I do know that the C-section rate in this country is steadily going up and is currently hanging around 28%. This is major surgery, and as someone interviewed in the documentary says, C-sections in this country are being made out to be as simple as cutting your fingernails. The US has the 2nd highest infant mortality rate in the developed world . The Netherlands has one of the lowest infant mortality rates, and women there are under the care of midwives and deliver at home unless there is a medical reason not to. Something tells me that there's something there that needs to be looked at closely. When it comes to childbirth, I personally see the hospital as a resource if one should need it, but unnecessary with a normal pregnancy and birth. Most women do have normal pregnancies and births. I'd like to see childbirth in this country become more like the Netherlands, but at the very least, women should be able to make their own birth choices without restrictions from insurance companies and government (homebirth and midwifery care is illegal in some states).

If you saw the film, what did you think?


Jeremy said...

This is so interesting Karli. I read something similar in the paper about how it didn't delve deep enough into the topic. I'm really interested in seeing it since I've experienced both types of birth.

The conversation afterwards sounds great!

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