Saturday, January 23, 2010

Review of "Pregnant in America"

For Christmas, I was given a copy of Pregnant in America a documentary film that chronicles an expectant couple as they learn about the process of birth and their options as parents and consumers. Over the course of the pregnancy, they unearth the whole drama that is choosing between hospital and out of hospital birth with all the propaganda employed against parents who desire to become apart of the statistical exception.

In some ways, I liked this movie more than the Business of Being Born. I like that the film follows the journey of a family and especially enjoyed how the filmmaker connected personally to the experts that he interviewed. Robbie Davis Floyd was featured in a touching interview where she turned it around and became the interviewer anthropologist that she is. I was touched by her compassion, astuteness and understanding. Another interview that I found very compelling took place outside the FDA offices where Maddie Oden delivered a petition to stop the administering of Cytotec to pregnant women. It highlights the story of the Tatia Oden French Foundation in such a way that the issue is made clear how its misuse can harm families.

The facts and statistics presented were consistent with all that I've read and learned about birth and provides a companion film to the Business of Being Born and Orgasmic Birth.

All three are great movies to share with expectant families who may be among the uninitiated in the discrepancy between evidence and practice. In a way, I feel that Pregnant in American is more convincing on this score, showing how the choice to birth at home is a valid choice where help when needed is effective and accessible.

*Spoiler* The family chooses to transfer to the hospital after a peaceful home birth because of concern over the baby's breathing. The transfer may not have been necessary, but the parents chose to consult with experts over a valid concern. They, and the viewers, learned how a transfer can occur smoothly, without harm coming to baby or mother and that emergency care is available when needed.

The style of the documentary imitates the style of Michael Moore pretty closely. I don't have a problem with this because I had been hoping that the controversy with birth issues would be presented in the same style. In fact, if Michael Moore tackled the topic, I don't think he would have done it as well. Michael Moore enjoys being over the top and for birth, that's not necessary. The tone of Pregnant in America is sweet and endearing with just enough anger and frustration to highlight the injustice inherent in the American maternity system.

I'm hoping to host a screening of this movie soon for a Meet-up group I belong to.


Jennifer said...

I didn't really have such a favorable impression of this film. I think out of the three films mentioned, this was my least favorite. My reasons for not caring for it so much are:

1. It was very fear based. They seemed to be trying to scare you away from the hospital throughout the entire thing. I felt they were a bit dishonest when they scrolled the risks of things like epidural, and they would list things like "death" right along with "headaches" as if they were both just as common. I know that a lot of movies do that, but I don't care for the tactic.

2. They spend the entire first half of the movie trying to establish how horrible it is that hospitals and doctors do interventions for no reason at all, and that those interventions have risks, etc. Then, his wife (before she was even due, or just a couple days after, I think) has her membranes stripped by her midwife. Um, hello? Where did the skepticism over unnecessary interventions go? It really bugs me when midwives are toted as the ones who wont intervene only to show them intervening throughout the births (I saw this in all three movies mentioned). The most blatant offender was BOBB when they splice Michel Odent's statement about a low profile silent midwife with Chatty Cathy midwife chatting away right after the birth. It was jarring. I know that they are showing *less* intervention with midwives and that is supposed to be better, but these are still interventions with risks and that whole fact is ignored.

3. The father was a jerk to his wife. He had the camera up in her face the whole time and gave her no breathing room. When she had her membranes stripped, they were walking all over the house and every five minutes he would bug her about if things were starting up or not. He was very impatient and annoying, and I didn't think he had the same charm as Michael Moore.

4. They transferred for no reason! And they left their baby isolated for no reason! I actually saw this at an event and there was a discussion afterward attended by birth professionals including midwives. The midwives could not figure out why they transferred, unless there was something that was not shown on screen (but how weird to not show the reason for transferring). They said the baby was just breathing slightly fast and they saw no indication for transfer. I thought that was a really bad way to sell homebirth to the public, by showing that you need to transfer to the hospital anyway for no reason. The whole thing was very strange.

Anyway, I didn't care for the film. I don't care for most birth films though, so that is no surprise. I don't think I will ever watch it again though.

Jenne said...

I can see why the husband came across as annoying and a little bit of a jerk. To me, he was acting the way I do when I excited--a lot like an overzealous puppy who needs to be reminded to calm down. It was that behavior that you describe as jerky, that I consider endearing. To me, its cute to see a dad all excited and interested in his wife- even if I were the wife in that situation, I'd probably feel annoyed by it too, but I know that I could communicate to him what I need at the time.

You are right that the transfer was for no reason, even the parents described later that it was probably not necessary, but the parents were concerned and the parents made a choice to transfer just to make sure. I can understand the desire to make sure that everything is alright and to consult with medical professionals. Ideally, that's why they are there. They got the typical NICU ride too, the baby was kept separate and isolated from her parents longer than was necessary in the face of nothing evidently wrong. Transferring to the hospital was probably overkill, its likely that a trip to a pediatrician would have been more appropriate, but time of day and day of the week can make that prohibitive.

I was glad to see the risks listed out and including death on there. That was is a very important one to be highlighted because how many women are totally unaware that the epidural can kill them and how many doctors explain this as a risk. Informed consent requires that the risks are explained.

I agree with you on the stripping membranes. If we were to give them the benefit of the doubt, the mom may have made an informed choice in accepting that procedure. Even if it may not have been the choice that we would make, she is free to make that choice for herself. However; I would have preferred to see a splash screen like those used for the epidural to describe the risks of vaginal exams and membrane sweeps too. They do present risks too. Since even those were glossed over, the viewing audience is at a disservice for not being informed in the way that the filmmakers stated being the purpose of the film.

Jennifer said...

The transfer bugged because I thought it showed incompetence on the midwive's part. The parents chose to transfer because she recommended it, not because they had any concerns before she said something. I thought she was maybe nervous about the movie being made and didn't want to make any mistakes, or, maybe she was very inexperienced. Either way, not a great pictures of homebirth there.

I was fine with the fact that they listed the risks of an epidural and of course death should be included because death is a risk. I would have liked to see a percentage of incidence though. It would be like listing "fatal uterine rupture" as a risk of VBAC without listing the percentage of incidence. We don't let them get away with that when it is the other way around, and that is the same standard I hold even when I agree with the message. And then, yeah, I would have liked to see an explanation for the stripping the membranes. Like show that this is intervention that they chose despite the risks, and list the risks. And when they list "infant death from infection" they should also list the percentage of incidence ;-)

Mommy Bee said...

I watched it during my last pregnancy too, here's my review I thought it was ok, but mostly because of the fearmongering I wouldn't recommend it to would be good for some people, but not for everyone. I feel the same about Orgasmic Birth, or BOBB. I think you need to know your audience, and recommend different movies to different people.