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Born In the USA

Director and producer Abby Epstein speaks about her new documentary The Business of Being Born, co-produced with actress Ricki Lake, which explores the childbirth industry in America today.
by Meg Reber

Abby Epstein is one busy, busy lady. She began her theatrical directing career by founding Chicago-based Roadworks Productions, where she presented premieres of works by writers such as Eric Bogosian, Patrick Marber, and Mike Leigh. After relocating to New York to become the resident director of Rent, she also became associate director of The Vagina Monologues, for which she worked with more than 100 celebrity actresses. One was former talk-show host Ricki Lake, who suggested the idea of a documentary about the American birthing industry. Epstein had some documentary experience, having directed Until the Violence Stops, which premiered at the 2004 Sundance Film Festival. “I was really excited to work with Ricki,” she said, “but I actually wasn’t really interested in birth. I wasn’t sure if it was a film, or if it would be very exciting.”

But after reading a few birthing books and seeing Lake’s footage of her own home birth—in a bathtub!—Epstein was sold. “Ricki taped her birth with no idea that she would ever show it to anybody—it was just for her own archival purposes. But after seeing that and reading those books I realized what an incredibly juicy topic this was going to be. It’s a major flashpoint right now.”


The result is The Business of Being Born, a film that takes a hard look at the crisis of birthing culture in America today. The statistics are alarming: in 1900, 95% of births took place at home, assisted by midwives and doulas, but by 1955 less than one percent did, and it has stayed that way ever since. Midwives have been overseeing the birthing process since ancient times, but after a century-long campaign by obstetrics professionals to relocate childbirth to hospitals—a move that has itself given birth to a billion-dollar industry—most American women have forgotten that they can have a baby without induced labor, C-sections, and epidurals. Lake and Epstein trace the development of, and problems with, hospital births and practices, while also following an independently practicing New York midwife who works with couples who decide to forego the hospital system and give birth on their own terms.


Epstein became pregnant herself during filming, and with the release of her film and the birth of her son coming in the same year, she's had no lack of excitement in her life. But between press interviews, a theatrical release, and a baby who is a bit under the weather this week, she found a few minutes to speak about how the film has been received in different countries and by different genders, and about the success she and Lake have felt in empowering women to discover their birthing options and choose what is right for them.


The Business of Being Born premiered at the Tribeca Film Festival last April, and opens theatrically this evening at the IFC Center in New York. The film will also be released theatrically in San Francisco and Los Angeles this week, and the DVD will be available on Netflix in mid-February.


The issues covered in the film seem to be mostly American problems. Do the same sorts of problems exist overseas in Europe and Asia? What sort of response have you gotten from audiences abroad?


We played in Europe at the Zurich Film Festival, and we also just recently went to Sydney for some screenings. It’s funny, because Australia has socialized medicine, and they have tons of midwives, and yet they have a higher C-section rate than the U.S. So this problem exists for different reasons and different circumstances, but it’s still there. When we screened in Zurich, the audiences there told us that Europe is sort of headed down the same path, and that Switzerland has the highest C-section rates in Europe, and that they could completely relate to the film. The specifics might be different, but the issues are the same. Even though we stuck pretty closely to the American maternity care system, I think that audiences abroad, unfortunately, identify with the film.


What about male audiences? This film is, of course, aimed at women, but what has the male response been like?

It’s unbelievable, really. We just did two interviews for two different radio shows where the hosts were gay men, and they had no interest in this topic, and no real desire to see the film other than the fact that they had to for their press coverage. And they both said, “I came away from this completely enlightened, and found it fascinating.” It’s amazing, because even if you don’t have a personal connection or don’t want to have a baby or never want to be a parent, everybody on the planet was born, and I think it’s just endlessly fascinating to watch. I think a lot of men—even more than women—are deeply moved by this film; I’ve had so many women say, “Oh my god, my husband didn’t even cry at my birth, and he was bawling through your movie.” There is something really emotional and spiritual about the act of birth, and I think that men are equally moved by it.

What sorts of stories have you heard from audiences that have been particularly moving to you?


We’ve heard from a lot of older women who gave birth during the scopolamine era in the 1940s, where they were completely isolated, strapped down to a bed and knocked unconscious [by injections of morphine and scopolamine], and they have no memory of their births. It’s really emotional when they watch the film and see what they were robbed of. We’ve had a lot of stories from men, too, who say that they were not allowed in the hospital or the birthing room, and how painful it was for them to be kept away from their wife and their child at the moment of birth. And then there are stories of people who have come to the film pregnant and walk out saying that they’re going to change their whole birth plan.


That must feel pretty good for you—not that you’re trying to persuade people one way or another—but to see them realizing there are other options.


Absolutely! We really made this film to empower women and promote choice. It’s funny because today we had a screening at a hospital in Manhattan—which was a pretty interesting place to screen this film—and a lot of the doctors were very defensive about the film, and felt like they were mis-portrayed. It was sort of hilarious to us, because it’s amazing that they would think we’d spend all this time and money and energy creating some propaganda film against obstetricians. No offense, but who cares about obstetricians? We’re doing this for women, to create more awareness about birth choices, and women are the ones who are responding to this film—blogging about it and emailing about it, and creating this huge buzz. It was just funny that these doctors were acting like we were Michael Moore trying to slander the medical establishment. But I’m extremely pleased that the film has gone so far, and is reaching audiences the way we wanted it to. No matter what a woman’s birth experience, she’s not feeling shamed or judged or pressured. And then with my birth... It was a huge decision to include that [at the end of the film]. It really would not have been how you would write the film if you were trying to make a one-sided point.


Well, it made the point that even if you have everything planned one way, you have to be prepared for the chance that something can change or go wrong, and you just have to go with it.


Yes! And I think that’s so, so important, because this isn’t about reaching a goal. It isn’t about being attached to having your baby this way or that way. You have to have a healthy mom and a healthy baby, and have your baby in a way that feels safe and appropriate and empowered for you. But you shouldn’t box yourself in, because ultimately you don’t have that much control. The baby determines how the birth is going to go, so the most you can do is sit back and try to enjoy the ride, and be as well-informed as you can be.


The Business of Being Born opens at New York's IFC Center January 9, before expanding to Los Angeles, San Francisco, and Seattle. For more information, or to set up your own screening of the film, visit


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