Reviews and Reactions: A Rhetorical-Cultural Analysis of The Business of Being Born

Abstract

This article analyzes The Business of Being Born, a documentary that critiques dominant American childbirth practices, practitioners, and locations as overmedicalized, and offers midwife-attended homebirth as a safe, viable option. The rhetorical-cultural analysis focuses on the documentary's reception, including twenty-six film reviews and two statements issued by the American Medical Association and the American Congress of Obstetricians and Gynecologists. The article demonstrates the role of ethos in genre reception, with a particular look at celebrity ethos associated with documentaries. The article suggests not only that visual arguments such as documentaries currently affect cultural conversations more readily than print arguments but also that dominant discourses and ideologies delimit those conversations' boundaries.

Notes

1 The author thanks Rhetoric Review readers Steven Mailloux and Barbara Heifferon for invaluable revision advice. Thanks also to JKAP: Janine Solberg, Amy Wan, and Peter Mortensen, who reviewed multiple drafts and suggested sources; to the University of Rhode Island Career Enhancement Grant Program, and to Barbara L'Eplattenier, Carrie Leverenz, Nikki Myers, and especially Lori Ostergaard.

2 See Janet Staiger: “Even if some message seems possibly to reach the potential for an effect on an individual, research suggests that the best chance for it to work is if the individual has direct contact with someone else who holds the view being considered and if the contact is positive. Such a personal supplementation enhances any mass communication” (40).

3 Cesarean-section, often shortened to “c-section,” is a medical term. Women's advocates prefer “cesarean birth” to preserve women's bodily autonomy and sense of participation. I use the medical term for consistency's sake. For a fascinating history of cesarean myths and images, see Renate Blumenfeld-Kosinski.

4 Breech-positioned babies can be born safely without c-sections, but the skills necessary require significant, nuanced, situationally dependent practice and training, unlike cesareans, which can be “perfected.” See Atul Gawande. Many homebirth midwives have conceded breech births to obstetricians (for an assumed cesarean). As Mary M. Lay shows in The Rhetoric of Midwifery, some homebirth midwives “trade” types of births in order to gain legal rights to attend homebirths. As fewer birth attendants perform breech deliveries, skills diminish, increasing the likelihood of cesareans for all breech presentations.

5 According to Marion H. Hall and Susan Bewley, “Maternal Mortality and Mode of Delivery,” relying on data from over two million deliveries in the UK: for elective cesareans, the maternal mortality rate per million was 58.5, 2.84 times that for vaginal delivery. For emergency cesareans, the rate per million was 182.0, or 8.84 times that for vaginal delivery. Cesareans overall have a maternal mortality rate that is more than six times higher (6.22) than that for vaginal deliveries.

6 See Kenneth C. Johnson and Betty-Anne Daviss, “Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America,” British Medical Journal 330 (2005). This large-scale study of same-risk hospital and homebirths in the United States shows lower risk of interventions for homebirthing women, but similar risks for all other outcomes in both locations. A comparison of all homebirths with all hospital births would be problematic because hospital births include more emergency situations and have more resultant negative outcomes. Conversely, negative outcomes for homebirths are overrepresented by studies that rely solely on birth certificate data, with no distinctions made between planned and unplanned homebirths, types of attendants or types of prenatal care.