Interview with Ricki Lake and Abby Epstein, Authors of Your Best Birth and Filmakers of The Business of Being Born

I had the amazing opportunity to interview Abby Epstein and Ricki Lake about their new book, Your Best Birth (which I am giving away here). These two women have been spirited advocates of natural birth, more informed choices for women, and medical care that honors women, families and babies.

Here is the interview:

Congrats on the publishing of the book and the amazing documentary, the Business of Being Born. What was the impetus for you to write a book in addition to the documentary?

We realized from the discussions after screenings of BOBB that we were just beginning the dialogue. There were so many questions after the screenings about what doulas and midwives do and about VBAC's and issues that we just didn't have time to get into within an 80-min film. We felt a responsibility to get the information about options out there for every woman in a more complete way.

You both had remarkably different birthing experiences. How did that inform how you wrote the book?

We intentionally began the book with our personal birth stories because they were so different. We wanted to make sure that the book focused on choice and how to also make decisions and work within a limited scope of maternity care options. We also wanted to make sure there was no judgement about any woman's birth choices or that one type of birth was superior to another. We know that be both had limited control over our birthing experiences and that part of this process demands some form of surrender. Sometimes you cant plan the type of birth you will have, but you can become informed and empowered in a way that will benefit whatever type of birth your baby needs.

What do you think is the most important thing for pregnant women to know about birthing in the U.S.?

The most important thing for women to know is that you DO have options and not to be afraid to speak up and demand alternatives. Even if you are limited by your insurance plan, your financial situation or the lack of options in your community - there is always a way to advocate for yourself within that system. The US system is broken and must be navigated very carefully. Even if you have to switch providers multiple times during your pregnancy, it will be worth it if your instincts tell you that you are not being respected and properly informed of your options. In the US, you have almost a one in three chance of ending up with a cesarean birth, (in some hospitals almost a 50% chance!) even if its not medically necessary so do your homework and be an active participant in your care.

What would you change about prenatal and delivery care of women in the U.S. if you could?

The number one thing we need to change is education and empowerment during prenatal care. This education needs to begin well before a woman starts having children. We think the midwifery model of care, which emphasizes trust in the mother's body and ability to birth on her own, needs to be integrated into the healthcare system. All women should have the right to see a midwife and choose the right delivery environment for her body and her baby. Other countries manage to offer these options and spend far less on maternity care than the US.


How has writing this book, and listening to the midwives and mothers you've interviewed changed your perspective about birthing, parenthood, and health care in the U.S.?

In writing the book and hearing the stories of birthing women from around the country, we are so moved to see that parents are inspired by our film and book and are making choices they'd never imagined. Countless parents have written to tell us about their amazing birth stories which never would have been possible without first seeing BOBB. So it's amazing but also alarming that for so many parents, a 2007 documentary was their first exposure to these issues.
It seems that there is a strong movement of parents, OB/GYN's, midwives and doulas who are trying to change the direction of childbirth in this country - but there is a disconnect between this movement and the insurance companies and training of doctors who aren't aware of the full spectrum of birth choices and how they can impact a woman's rite of passage into motherhood. On some days we feel hopeful and that things are really going improve for mothers in the US but other days it seems like the issues are just too complex and impossible to surmount. We need to really look at the economic and political forces that are driving the system toward more medicalized births - because the well being of women and babies needs to take priority.

Women have been thrilled with the book. It covers a lot of ground in terms of the psychological, emotional and clinical aspects of pregnancy. Women will gain a strong understanding of the landscape and politics of birth culture in the US, which is critical when making decisions about your birth. We also think it will allow women to explore and address all their fears in a healthy way - instead of creating more fear and anxiety about "what can go wrong."

What are your three favorite books about childbirth?

We love Ina May Gaskin's Spiritual Midwifery, Robbie Davis-Floyd's Birth as an American Rite of Passage, and Henci Goer's Gentle Birth Choices. (Also everything by Michele Odent.)

Where do you see childbirth heading in the U.S.? What can women do to help change the way childbirth is "handled" in a way that supports natural childbirth, VBACs, and less intervention in general?Right now we are at a crossroads in childbirth. If you look at the statistics, we are headed toward skyrocketing c-section rates and less VBAC's. But birth trends tend to follow a pendulum movement and there is a strong opposition to this increase of surgical birth. As long as insurance companies are calling the shots, women need to insist that their insurance carrier covers midwives, doulas, birth centers, home birth and other alternatives. Unfortunately, its all about profit so if more women demand coverage for these cheaper options then insurance companies may start covering them. Women also need to become savvy, informed, consumers and not blindly follow doctors orders when it comes to maternity care. Our book gives you tips on how to interview doctors and midwives and to do your own research. Once women realize they have the power over how they birth their babies, the rest will follow. But right now, women are scared into submission and afraid to challenge authority. They are giving all their power away to the medical institutions instead of trusting their bodies. That's why we are trying to show more celebrities and positive role models for natural birth and empowered births.

Amen to that. Thanks to these two inspiring women for this interview, and for their hard work to promote better, integrated maternal health care, and informed choices for all expecting moms.