The Birth Monologues


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The Business of Being Born
Directed by Abby Epstein
Produced by Ricki Lake

The Business of Being Born focuses on birth culture in the U.S. in much the same way Sicko spotlights healthcare. And the stats are equally shocking: America (tied with Hungary, Slovakia, Poland and Malta) has the second worst newborn death rate (five in 1,000 babies) among 33 industrialized nations in the developed world. Cesarean section is the most frequently performed surgery in the U.S., at a cost of $14 billion annually, and 82 percent of physicians said (in a 1999 survey) they performed C-sections to avoid negligence claims. And the reality slaps just keep coming.

The film asserts that OB/GYNs and hospital birthing centers can’t handle natural childbirth, relying instead on drugs to stimulate contractions, C-sections and other invasive techniques that are distancing moms-to-be from essential physical and spiritual aspects—from the miracle—of giving birth.


That’s what Ricki Lake, the film’s producer, experienced when she birthed her first child in a hospital setting. Her second child’s midwife-guided delivery at home (in her bathtub) was more satisfying in every way.


Determined to compare the two experiences for the public, Lake pitched the film to director Abby Epstein, whom she’d befriended while acting in The Vagina Monologues. Epstein was intrigued by Lake’s birthing stories and topical books and, coincidentally, she became pregnant a year into the three-year project. (Both women appear in the film.)


“We’re not preaching,” says Lake. “Everyone should do what they’re comfortable with. We just want women to know their options. Many women don’t understand natural childbirth, don’t know that midwifery and homebirth are long-standing, very successful practices in other advanced nations with better statistics than ours. Here, we have great technology: 50 year old women, infertile women can have babies. We’ve got these great possibilities, but we’re quickly losing the possibility of natural birthing.”


“This subject’s a tsunami. The water’s breaking—pun intended. In Somalia, one-in-seven women dies in childbirth. And here, in our advanced, rich country, that the death rate for mothers and infants during childbirth is so high is shocking. Why is this happening here?”


MERIN: Well, I guess we’re not that advanced...
LAKE: Right. Ohio, Alabama and some other states are really bad for having a child outside a hospital, yet many women are forced to do that because they don’t have health insurance. That’s not acceptable.

You’ve never retreated from personal exposure in your career, but showing the birth of your child—as you do in the film—seems particularly brave...
Uh, oh……I don’t have to be scared do I?

No, not at all. But, I’m curious to know where that courage comes from.
I’d say I’m naive. I’ve always jumped into whatever job came along. That’s what happened with the talk show: People said I’d transformed myself into Oprah, but I was just offered a job. Same thing with Hairspray. I didn’t know who John Waters was; I just took a job.

With this film, I’d no idea how to do it. So I went to Abby for help. I had my experiences, books about birthing and home video we’d shot of my son’s birth. That tape was made to show my son when he reached 20, so he could see how he was born. It wasn’t meant to be shown to the world.


I don’t look beautiful, but it’s a beautiful moment. I don’t want people to think I’m exploiting it.
It’s an important part of the film, but it’s just one moment. The film’s not about me, and we’re not saying everyone should home birth like Ricki. Actually, there was a lot of discussion about where the scene fit into the film, and it was excluded from some cuts.

Has making the film been transformational for you?
I think the film shows Ricki in a different light. After 11 years on TV, talking about important issues—and unimportant things—I feel I’m doing something that can have real impact. Women have alternatives for this extremely important aspect of their lives.

The film was a labor of love. I funded it. We thought we’d get backing, but nobody wanted to fund it. HBO said to come back with the finished film. So I funded the entire project, everyone contributed, worked for nothing. And it’s paid off. We’ve made an important movie for women, one that can promote change. I can’t believe I’m doing that with my life.


I’m evolving into the person I want to be. My recent weight loss is part of that, too. I’m purging myself. I’m on a high. Holy shit! We went to Australia recently with the film—I’m on the cover of Australia’s People magazine, wearing a size-four couture dress. I’m speaking at the U.N., discussing the status of childbearing around the world with Norway’s prime minister and Somalia’s president. It’s important. It can help change things. That’s quite a transformation from doing hoochie momma makeovers and hanging around the honey wagon. I don’t mean to sound smug, but I think I’ve done pretty well.


It’s surreal, almost. I’m very grateful. I’ve had hardships—marriages, divorces and everything—that I’ve not been quiet about. So this feels good, but I know it’s fleeting. Life circumstances change all the time. You’re up one minute, down the next. The film’s a lasting statement, and I feel it can make a difference. And that’s very important to me.


How did you get others to reveal their most intimate decisions, experiences on camera?
To start, Abby and I walked around New York with a camera, asking women with strollers about their experiences. We went to baby groups on the East Side. They’re all regular women who wanted to tell their birthing stories. We heard a lot of horror stories, but we didn’t want to make this film an exposé. We wanted to show that women have a choice of alternatives, so they can take control and make the choice that’s right for them. If they want home childbirth, that’s fine; if they choose an epidural or C-section, that’s fine. But they need to know the choice is theirs.

Still, the stats you present are a horror story. Has there been any backlash from the America Medical Association?
No. We’re not judgmental, so why should there be? As I’ve said, the medical profession has made wonderful contributions, and there are child-birthing emergencies where doctors and invasive procedures are crucial. They save lives. But invasive procedures are often done unnecessarily and women who’ve experienced them feel they’ve been denied the birthing experience they longed for. I had that feeling. That’s what led me to make this film.

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