Ricki Lake and Abby Epstein Talk About Birth

Known for her breakout role in Hairspray and as host of her own talk show for over a decade, Ricki Lake has also become known for her passionate dedication to empowering women in their decisions about childbirth.  In 2008, Lake partnered with director Abby Epstein to make the powerful documentary, The Business of Being Born.  In the film, the two set out to explore maternity care in the U.S. and in the process documented Lake’s homebirth as well as Epstein’s birth experience.

The Business of Being Born sparked a good deal of controversy thrusting Lake and Epstein to the forefront of conversations surrounding birth and maternity care.  They have since followed up with a book, Your Best Birth, and now a second film, More Business of Being Born, both of which take an educational approach to birthing options.  They also have a website, My Best Birth, with an active online community.

We had a chance to talk with these ladies about their projects, birth, and empowerment.

Q: What prompted the making of The Business of Being Born?

RL: I had always wanted to do a project around childbirth.  I had such amazing experiences delivering my children and I wanted to share positive birth stories with other women.  My younger son’s birth at home was the single most empowering and transformative experience of my life. I had done so much research leading up to that birth and I wanted to share this information with more women.  I also felt like midwives and natural birth were poorly understood and I wanted to show another side of birthing.

Q: What are some of the various birthing methods?

AE: Mostly really it’s about a philosophy and then people can see where they fall in once they gauge their basic birth philosophy.  Most people don’t have a strong, preordained idea of what type of birth they want or even that it’s a choice they have.  People don’t realize that there are tons of options.

With a basic birth there is the hospital, birth center and home.  A lot of people don’t know about birth centers, which are great options.  Home births are a much smaller percentage that’s a wonderful choice.  Within those locations there are different levels of intervention: No intervention, no drugs or painkillers, et cetera all the way to the person who wants the epidural the second she checks in to the hospital to the person who has an elective cesarean and just shows up.  It’s overwhelming because there are so many choices from one extreme to the other.  It’s a big range. 

The most important thing is you find where you fit in the paradigm and then choose a birth style that fits you, your partner, and your comfort range, but most importantly feels like you are making decisions and participating in the process.  As long as you feel like everyone was doing the best for you and no one was pressuring you or pushing you into a certain outcome then most women walk away feeling good.

Q: Can you talk a bit about what it means to give power back to women in terms of giving birth?

RL: I think that giving birth is an amazing gift that our bodies were born to do, but somehow the medical profession has turned pregnancy into a disease.  You are not sick when you are pregnant and you should not be treated like a patient who has to follow orders.   Most women like to be in control, but when it comes to birth it’s shocking how we will give up our power and defer to an “expert” out of fear.  So I think giving the power backing to women is eliminating all this fear and anxiety and allowing women to birth their babies the way that they see fit – whether that it is in a hospital with pain medication, or in an operating room, or in their own bedroom.  Women need to feel empowered when they give birth so that they can begin motherhood from a place of confidence and strength.

AE: Having power and feeling like a participant in the process and not a subject being told what to do—that quality transitions with you into motherhood.  Your birth can really affect the way you feel.  A mother who feels respected and a part of the decision process, who has some autonomy over the room, the space, how you want to labor, having your husband coach are ways that women can have ownership over this process.  It’s about the empowerment you need to pull you through becoming a mother.

Q: How do you see the role of medical intervention in terms of women’s power and the birthing experience?

RL: I think medical intervention is often necessary.  But, these interventions should not be overused or forced upon women who do not want or need them. Whenever a woman feels pressured into a certain procedure, she is losing her voice in the birth process and that can be really difficult for her to process postpartum.  It can often lead to post traumatic stress disorder because women feel their bodies have been violated.

Q: What is the benefit of using a midwife versus an OB?

AE: For low-risk women the benefit of midwifery care is a different training from obstetrics.  Appointments are quite long; it’s not uncommon to spend up to an hour talking about your diet, sleep, your relationship, your fears, anything. I think they really look at the woman from a full emotional, psychological, and physical point of view.  They’re really looking at this from other aspects.  Some OB’s are similar but most have a different kind of schedule to include surgeries.  Their time is more limited and they can see fewer patients in a day. 

Q: Some women fear home births in case of complications.  What advice or safety statistics do you have for them?

RL: There have been studies proving that home birth is just as safe as hospital birth for low-risk mothers, but the problem with statistics is that there is always a counter study that proves the opposite.  So really, I don’t think statistics are helpful when talking about birth or risks because everyone seems to twist these studies around to suit their points of view.  The bottom line is that complications arise at home and complications arise at the hospital.  Most home birth transfers are non-emergent and midwives are careful to transfer in plenty of time if there are any complications.  Midwives also bring a ton of medical and emergency equipment to a home birth, which most people don’t realize.

AE: If you’re going to have a home birth and you’re worried about it then you shouldn’t do it.  There really shouldn’t be any fear around a home birth.  Women should be thrilled and confident and happy about birthing at home.  They put all that concern on the midwife.  For the birthing woman I don’t think there’s a lot of room for that.  I think if you find yourself hedging risk assessment than home birth is not for you.  You should be giving birth where you feel safe and if that’s a hospital than that’s where you should be.

Q: You followed up the film with a book, Your Best Birth, and now a second film, More Business of Being Born.  Can you talk about the new film?

RL: Yes, our book is fabulous – we are so proud of it and have gotten tons of great feedback from birth professionals. It covers every type of birth option available. Our follow-up film More Business of Being Born is actually a series of four films. We made them because there were still so many unanswered questions after the Business of Being Born and we wanted to cover a wider range of topics. So the first film is called Down on the Farm and it’s about our trip to see Ina May Gaskin at the Farm birth center and we have some amazing conversations with her.  The second film is called Special Deliveries and it’s a moving and powerful collection of birth stories from some high profile moms like Alanis Morissette, Cindy Crawford, Christy Turlington Burns, Gisele Bundchen, Laila Ali, Melissa Joan Hart, Alyson Hannigan, and more.   People love this film and are surprised by the intimacy and humor of the stories. The third film is called Explore Your Options and this one has the most practical information about doulas, birth centers, and cesareans.  The last film is called The VBAC Dilemma and it focuses on vaginal birth after cesarean.

Q: In your opinion, why is VBAC (Vaginal Birth After Cesarean) such an important topic?

AE: I think if you look up the statistics one in three women are having cesareans for their first birth.  There are many hospitals with rates closer to fifty percent especially in urban areas, so to walk into a hospital and say you have a one in three chance isn’t necessarily accurate.  It’s a little deceptive.  That leaves 1.3 million women every year that could potentially choose to have subsequent cesarean or vaginal births.  The numbers are so huge that VBAC is taking on more significance.  If many of those women are having second and third cesareans than the numbers are through the roof.  VBAC restrictions have gotten so severe and they are finally loosening.  Even the professional doctors’ associations are saying ok; it’s not as dangerous as we thought.  We can allow much more women to qualify.  It’s not trickling down to women though.  Hospitals and insurers are hostile to it in many places.  Now we have to almost fight for the right to VBAC. I think many women had cesareans for their first baby and didn’t have good experience, and felt coerced or like it wasn’t necessary and it’s something I think a VBAC can really heal.  It’s such a big loss to the whole maternity system to have VBACs disappear or become rare.

RL: I think VBAC is one of the most controversial issues in modern maternity care.  The fact that some hospitals are forcing healthy women to undergo a repeat cesarean when they could instead opt for a vaginal birth is criminal. But, insurance and liability issues have made getting a VBAC so difficult today and it’s a shame to see political and economic factors determining how a woman can give birth. 

Q: Many women want a natural or vaginal birth but end up with a cesarean often feeling cheated of their right as a woman to give birth.  What advice do you have for them to maintain or reclaim their power?

AE: In some ways it’s not that different from recovering from a sexual traumatic experience; it’s an unwanted invasion of your body.  For many women who didn’t want a cesarean it feels like you were invaded.  Seek help.  There’s ICAN, the International Cesarean Awareness Network, which has chapters all over the country with meetings.  The most important thing I’ve learned from hearing these stories is that you have to talk about it.  You don’t have to shut up about it and just be grateful that you had a healthy baby.  Something still feels wounded inside. Validate your feelings.  There are therapists that deal with this.  Many women have post traumatic stress disorder after an unwanted cesarean.  Make sure that it’s not all bottled up inside in a shameful or painful way or that you feel that it’s not worthy of talking about or addressing.  It can be painful and it doesn’t mean that you’re not a good mom or appreciative that you have a healthy baby, but you need to find a community or therapist to share and let it out.

Q: Is there anything else you’d like to add?

AE: We have Business of Being Born (BOBB) and More Business of Being Born (More BOBB) and now we have a classroom version called Education Business of Being Born or E-BOBB that we are launching this year.  It’s a 30-minute version of BOBB with a study guide.

RL: We also have an incredible community on our site, MyBestBirth.com, so please check it out!  You can get all our films on itunes, Amazon or on our website, TheBusinessofBeingBorn.com.

On Monday, March 5, 2012, childbirth advocacy group, Choices in Childbirth, will host filmmakers Ricki Lake and Abby Epstein for the launch of the The Business of Being Born: Classroom Edition (BoBB:CE) at UCLA’s Fowler Museum - Lenart Auditorium.  Screening of the half hour film is free and open to the public and will be followed by a panel Q & A discussion with Lake, Epstein, Dr. Suzanne Gilberg-Lenz, MD and actress Kellie Martin.    

Event details

Date:              Monday, March 5, 2012

Time:              4:00 - 5:30pm

Location:          UCLA, Fowler Museum, Lenart Auditorium

      308 Charles E. Young Drive North

              Los Angeles, CA 90095-154

This event is free and open to the public. 

To RSVP or for more information about the event contact Julia@choicesinchildbirth.org  212-983-4122.