By Anna Payawal-Scanlon
Issue 126 May/June 2004
I'm not a medical expert, midwife, doula, childbirth educator, or childbirth activist. I am the mother of two little girls, proud and happy about my drug-free hospital births, which took place with my husband in a quiet hospital birthing room with what I consider to be minimal and bearable interventions: the donning of a hospital gown; intermittent fetal monitoring; and, in labor, a heparin lock to keep a vein open, in case I needed an IV line (I didn't).
I'm also lucky. Not all hospitals are as flexible as the one in which I gave birth. Not all women live in a community where working with a midwife or a birth center are possibilities, and where parenting resource centers (with book and video libraries, educational workshops, and so on) are readily available. I didn't have a midwife or doula present at either birth, but I could have. As a woman with low-risk pregnancies in a major city in California, I had choices and resources. Some women don't. And some women who have them choose to decline them. Why choices for birthing naturally are nonexistent or rejected is the subject of much debate"hand many a childbirth video, some of which are reviewed here. Note that these are not the latest releases, but rather ones that have been recommended as informative and provocative by several childbirth experts. With a nudge or a push, most of these films help to move us away from the prevalent perception of birth as a medical procedure, and closer to the understanding that birth can be a natural and less complicated process--no matter where you choose to deliver. They have been suggested not because there is only one "true" way to give birth, but because there is more than one way to approach a birth.
Filmed by Frank Ferrel and Georges Vinaver. Produced by Sage Femme, Inc., 1999. 11 min. $29.95. www.homebirthvideos.com
"Every time I've been very proud and excited about something in my life, I've wanted to share it with my family." So begins Birth Day, a brief documentary about one family's experience with childbirth. Naoli Vinaver Lopez, a mesmerizing and articulate midwife and mother, shares with us the labor and delivery of her third child, Tamaya. "The day of the birth, to me, couldn't have been without my family" Naoli observes. "It felt as if it was an event that we all had to share together. like a picnic, like a birthday party. We see Naoli and her family as they go through the day of the birth at home in Veracruz, Mexico, hiking, sharing a meal as Naoli goes through contractions, and finally watching Naoli in active labor in the family tub.
In one of the film's many indelible moments, Naoli and her husband, Hiroyuki, walk back and forth together, holding each other's arms in a sort of labor dance. The tenderness captured by filmmaker George Vinaver, Naoli's father, is striking, and becomes even more so as we hear Naoli's recollection of the events that led up to it. Whenever she walks, in labor, toward Hiroyuki (she tells us in voiceover), she feels their love "swollen" in her belly, and envisions her contractions as the sun wanting to burst out of her body. But as she walks away from Hiroyuki, the contractions become more painful. When Hiroyuki hears this, they begin their dance, in an effort to make labor feel only "like love bursting out, and not so much like pain.
Birth Day quietly demonstrates that birthing without intervention is not only possible but can also be profoundly beautiful and safe. Naoli gives every woman hope when she says, "If you just give them the space, [women giving birth] will know exactly what to do. Women have insight, the deep knowledge of how to move, exactly when to push. The body who has made this baby knows exactly how to get it out of the body." With their openness and harmony during labor, Naoli and Hiroyuki show us how birthing can remain an intimate experience for a couple, even as it is shared with the whole family. Powerful but not judgmental, Birth Day raises the bar for birth videos and offers expecting families an inspiring image of where birth can take them.
Birth in the Squatting Position
Produced by Polymorph Films in association with MoysA(C)s and Claudio Paciornik, 1979. Updated by the American Academy of Husband-Coached Childbirth, 2002. 10 min. $59.95. AAHCC, 800-4-A-Birth.
Filmed in Brazil more than two decades ago, this extraordinary video shows a string of entirely hands-off natural birth - something so unusual in our culture that it's shocking to see. In all of the births shown, the baby is allowed to make its way out of the birth canal untouched, to land softly on a blanket placed beneath the squatting mother. The few times we do see a pair of gloved hands appear onscreen, they are there only to reach out to catch the baby's head, after the baby's body has flopped toward the nest of fabric below. In each birth, the mother's body is left to its own devices during the final stages of delivery, in silent testimony to a woman's innate knowledge and power in labor. One baby is seen turning its shoulder as it leaves its mother's body, unaided by midwives or doctors' glimpse of the birthing wisdom that babies, too, possess. None of the parents are interviewed, but their faces, tears, and gestures tell us that birth can be as rapturous as it is laborious.
One would be hard-pressed to find another film that shows actual childbirth with such revealing images, such honesty and simplicity, and so few words. There is no dialogue, just an occasional voice-over commenting on the births, which are shown in their naked glory. There are numerous straight-on shots of heads crowning, with subsequent gushes of body fluids, including blood. This is probably not the first birth video to show nervous and uninitiated parents-to-be.
In this updated edition, the American Academy of Husband-Coached Childbirth has added helpful commentary, pointing out in one birth a compound presentation (the baby's head and hand presenting at the same time) that I wouldn't have noticed on my own. Seeing this phenomenon may be useful to some women down the road, encouraging them with the knowledge that, even when complications occur, a natural birth might still be within their reach.
Gentle Birth Choices
Produced by Barbara Harper and Win-Win Productions, 2000. 47 min. $29.95. www.waterbirth.org
In Gentle Birth Choices, Dr. Marsden Wagner, former director of maternal and child health for the World Health Organization, decries in plain language the "utter madness" that has become a byproduct of birth intervention in the US. With the tide of history and politics having all but washed away the more gentle birth philosophy of midwifery which he considers "absolutely essential" in providing "the right balance for the best maternity care""hWagner observes that "the overwhelming use of technology" (cesareans, forceps, and vacuums) has led to an abnormally high number of babies "cut out or pulled out" of their mothers.
From here, mother, nurse, and childbirth activist Barbara Harper takes up the torch, illuminating the various opportunities we have for demedicalizing childbirth. When, after a difficult and painful posterior birth, a homebirthed baby takes a few minutes to show signs of activity, the midwife simply massages the exhausted newborn and tells the mother that everything is OK, the baby is still receiving oxygen through the umbilical cord. There is no sense of panic, no hospital staff whisking the baby off for tests. Soon after the massage, the baby opens its eyes.
While a woman attempting a vaginal birth after cesarean is in the throes of labor, her midwife gives her one clear, simple instruction: "Don't be scared of the pain." The focus on the mother's emotional state as a tool to help her with the physical pain of labor was in stark contrast to the pain medications, anesthesia, and surgery imposed on her in two previous and unwanted C-sections, and highlights the difference between the medical and midwifery models of birth. With her midwife's support, the woman delivers her baby vaginally in elation and disbelief. And in a birth-center delivery, when the baby is born with the umbilical cord around its neck, an oxygen mask is applied to help the baby breathe. Again, the movements are confident and precise, causing the family no needless worry.
Complications arise in these births, but they are handled calmly, swiftly, and successfully. Those who doubt the value of a midwife or the safety of a birth center will find compelling reasons here for rethinking their position. Gentle Birth Choices is a good starting point for women who want to know more about the politics of birth and the whole spectrum of birth choices available to them.
The Elk and the Epidural: How to Have an Epidural in Awareness
Illustrations by Pam England. Produced by Great Dane Productions, Inc., 2001. 15 min. $25.95.www.birthingfromwithin.com
"The purpose of childbirth preparation is to prepare mothers to give birth in awareness, not to achieve a specific birth outcome," says the Birthing From Within website. With this in mind, Pam England, the nurse-midwife and mother behind the Birthing From Within philosophy, created a video to help women develop an open mind for labor, "so that if medical support (including epidurals) becomes necessary, they can stay present emotionally and spiritually for the birth of their child, without experiencing feelings of loss or regret."
Using her own lighthearted drawings of an elk couple and their mouse doula laboring at a hospital, England illustrates the serious risks involved with epidurals, as well as their benefits in the context of real emergencies"ha C-section, a "long and abnormal" labor, or a long Pitocin induction"hwithout joining the debate on why interventions occur in the first place. This video doesn't endorse the blind or rote use of epidurals, but takes a pragmatic look at the actualities of birth and suggests that labor, for some, can be so physically and psychologically overpowering that pain management becomes a necessity. In such cases, argues England, administering an epidural may in fact be "compassionate and wise."
Remaining sensitive toward the need for mothers to birth as naturally as possible, England advises us to consider that some women who ask for epidurals may be communicating a need for something else"hnamely, more support from their loved ones to get them through the pain and uncertainty of giving birth.
In a nurturing manner, The Elk and the Epidural spells out the consequences of an epidural"hwhat she calls the accompanying "cascade" of interventions and its lingering side-effects"hto enable parents to make more informed decisions about their childbirth experiences. It does not fight mightily to convert women who remain unconvinced of their own capacities for drug-free births, but it does address a population often ignored in the dialogue about childbirth: those who, for whatever reason, cannot attain the ideal of natural childbirth, and who must deal with the complex reality of their situation.
Doulas Making a Difference
Produced by Doulas of North America, 2001. 14 min. $25. www.dona.org
With an introduction from veteran childbirth educator Penny Simkin, a founder of Doulas of North America (DONA), and reactions from couples who have experienced the guidance of doulas, this is a must-see for those curious about what a labor assistant can offer. We see doulas in action during delivery"himperturbable, supportive, and completely focused on the needs of the laboring woman"hand hear parents aglow with their birth stories.
Skeptics might object that this is merely a promotional film with an agenda, but research has shown a correlation between fewer medical interventions and the presence of a doula during labor. The numbers are remarkable: reductions of 60 percent in the use of epidurals, of 50 percent in the need for cesareans, of 40 percent in the application of forceps, and of 25 percent in the length of labor.
One of the strengths of Doulas Making a Difference is the support it offers to fathers, who might be unsure of their place when a doula is present. "I never for a minute felt like the doula was replacing me," says one new dad, "only enhancing what I was trying to accomplish with my partner."
Birth Into Being: The Russian Waterbirth Experience
Filmed by Alexei Sargunas. Produced by Barbara Harper for Global Maternal/Child Health Association and Waterbirth International, 1999. 28 min. $39.95. www.waterbirth.org
Birth Into Being: The Russian Waterbirth Experience was produced by Barbara Harper, who also created Gentle Birth Choices (see the review above). The impetus for this unique film were the efforts of Russian "spiritual midwife" Tatyana Sargunas and her filmmaker husband, Alexei, to help liberate pregnant women from their nation's usual obstetrical practices. During childbirth, Harper reports, Russian women "suffer from abuse, both physical and mental, and separation from their babies and their families." So Tatyana and Alexei, experienced in waterbirth through the births of their own children, each year lead dozens of families to the warm waters of the Black Sea for completely natural births.
Birth Into Being is a fascinating look at waterbirth, whether in the clear birthing pools handmade by Tatyana and Alexei, or in the tidal pools of Novy Svet (New Light), where they run their Birth Camp. The Black Sea footage"hwith mother, father, midwife, and siblings fully immersed in nature, both through their surroundings and by the process of birth itself"his spellbinding. The sight of newborns emerging from the inner sea of their mothers to the outer sea of the world is complete and uplifting.
Woven through the film are scenes of mothers swimming with their children on their backs, and of very young children and infants swimming skillfully on their own. The children move and play like graceful sea creatures, showing a deep connection with their watery roots. The video's sleeve claimed that this story would leave me "inspired, entertained, deeply moved and challenged to look at birth in a new light." I was.
Giving Birth: Challenges and Choices (Professional Version)
Produced by Suzanne Arms and Susan Berthiaume, 1998. 35 min. $59.95. www.birthingthefuture.com
In this video by prominent childbirth activist Suzanne Arms, we see a homebirth with a knowledgeable midwife, a supportive father, and an active, present, and drug-free mother. We learn about the various risks and complications of often routine hospital interventions, and see beautiful black-and-white images of a couple and their new baby, as a young woman narrates her experience of witnessing her older sister give birth at home, in water.
We see other pictures, too"hof sterile, harsh hospital wards and nurseries far removed from the wonders of birth; of ORs as delivery rooms; of a gowned and masked hospital staffer holding up a newborn in a gesture almost trophy-like. Statistics about cesareans are shown on screen with ominous music in the background. Members of the medical profession warn of obstetricians' inherent resistance to birthing naturally.
The juxtapositions of these images are meant to be jarring, to shake us out of our complacencies about medicalized birthing practices and our growing detachment from natural birth. However, the heavy-handed tone is likely to alienate the great majority of women who have yet to disentangle themselves from the concept of the hospital as the only place to give birth, let alone embrace the idea of natural childbirth. Moreover, in focusing on the difficulty of avoiding birth intervention in a hospital setting rather than the possibility of doing so, the video ultimately sends a mixed message: Trust in your own abilities to birth naturally, but not if you find yourself at a hospital.
On the one hand, Giving Birth: Challenges and Choices is a well-intentioned film underscoring the facts that midwifery is a precious counterbalance to the excesses of birth technology, and that natural childbirth is an empowering experience unlike any other. On the other, it seems a missed opportunity in the effort to encourage and support low-risk women to attempt unmedicated births regardless of their surroundings.
Noa Was Born
Produced by Wisewoman Childbirth Traditions, 2001. 16 min. Mail $4.00 to Wisewoman Childbirth Traditions, 206 27th Street, San Fancisco 94131. Or contact Maria Iorillo, 415-285-9233.
Like Birth Day, Noa Was Born is an intimate record of a homebirth in water. While the production isn't quite as slick as Birth Day's, the result is the same: a lasting impression of the beauty of birthing naturally.
There is a sense of serenity at this birth, something many parents may not automatically associate with labor. Part of that serenity stems from being in Carmen and Nevo's home, their unruffled demeanor, and the soothing nature of water. But much of it seems to arise from the bond forged during labor by Carmen and Nevo, working in tandem and without agitation, and at last holding their daughter between them in the birthing pool.
The image of little Noa just minutes after birth, kicking her tiny feet in the water and gazing at her parents, already fully engaged with them, may do more than warm hearts"hit may encourage some to think differently about medication during labor. No altered behavior from drugs from this happy, energetic baby.
Born in the USA
Filmed by Marcia Jarmel and Ken Schneider. Produced by PatchWorks Productions, 2000. 56 min. $29.95 for individual use. Professionals contact Fanlight Productions about institutional and educational pricing: 800-937-4113;www.fanlight.com. For more information, visit www.itvs.org
Through the observations of an obstetrician at a large city hospital, a licensed midwife attending a homebirth, and a certified nurse-midwife at an independent birth center, Born in the USA examines the state of birth and the untapped potential of midwifery in America. Although studies have shown that out-of-hospital births guided by midwives can be safe for women with uncomplicated pregnancies, this documentary states a revealing statistic: 99 percent of the babies born in the US enter the world through the doors of a hospital and some form of medical intervention. Despite the many efforts of health and choice advocates, midwives are still perceived by many as givers of second-rate care. And birth centers, a safe middle ground between hospital and home for low-risk pregnancies, still struggle to gain widespread acceptance.
While this informative documentary questions our almost mindless interference with birth, and shows us what is so myopic about the popular view of pregnancy as an automatic medical emergency, it avoids painting a one-dimensional picture of obstetricians. The physicians shown here are tragically shortsighted, unaware of how they contribute to some of the poor maternal-care outcomes they fight so hard to control. Like us, they are human; they admit to hospital policies and procedures being influenced by peer pressure and the bottom line, citing the lack of one-on-one care at maternity wards, the tendency to practice obstetrics with an eye to what other institutions are doing, and the all-too-tempting onslaught of pharmaceuticals, medical equipment, and ingrained behaviors that promise improved birth outcomes.
Some may argue that such honesty is all the more frightening and inexcusable, given the costly and long-lasting consequences that medicalized births can produce. Nevertheless, I respect and appreciate Born in the USA's well-balanced reporting; it can help us better understand the gulf between obstetricians and midwives, and act as a gauge to show us how much further natural birth advocacy and education have still to go in this country.
FOR MORE INFORMATION
Midwifery, Childbirth Education, and Doula Organizations
Association of Labor Assistants and Childbirth Educators (ALACE), PO Box 390436, Cambridge, MA 02139; 888-222-5223;firstname.lastname@example.org; www.alace.org
Birthing From Within, PO Box 4528, Albuquerque, NM 87196; 505-254-4884; ; www.birthingfromwithin.com
The Bradley Method of Natural Childbirth, American Academy of Husband-Coached Childbirth, PO Box 5224, Sherman Oaks, CA 91413-5224; 800-4-A-BIRTH; www.bradleybirth.com
California Association of Midwives; 800-829-5791.
Doulas of North America, PO Box 626, Jasper, IN 47547; 888-788-DONA; www.dona.org
International Childbirth Education Association, Inc., PO Box 20048, Minneapolis, MN 55420; 952-854-8660; www.icea.orgLamaze International, 2025 M Street, Suite 800, Washington, DC 20036-3309; 800-368-4404; www.lamaze.org
Waterbirth International, PO Box 1400, Wilsonville, OR 97070; 800-641-2229; www.waterbirth.org
Anna Payawal-Scanlon is a freelance writer based in San Francisco.