Tom RostonIndependent journalist Tom Roston checks in and writes about the world of documentaries in his column, Doc Soup.

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Doc Soup: When the Unexpected Happens on Film: ‘The Business of Being Born’

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I know. You’d think I’d post something about the major doc happenings this week: POV airing Food, Inc. (Wednesday, April 21 at 9:00 pm – check local listings) and the kick-off of the Tribeca Film Fest. I might get to those later, but for now I can’t help it — I’ve got an itch and I’ve got to scratch it. And besides, this is going to be about dealing with the unexpected, so at least I’m being consistent.

The Business of Being BornLast week, I saw The Business of Being Born, the 2008 documentary about how the birthing industry in America is screwed up because expectant mothers are hooked on drugs when they go to the hospital, pushed toward getting c-sections and taught to shun the notion of home births (which are quite popular in Europe). It’s a good film — well-executed by director Abby Epstein, with good pacing, interesting interview subjects and a compelling cause. The film doesn’t even try to hide that it is a “cause” movie with a capital C: Epstein has a point of view, so much so that the film veers toward propaganda. But, hey, when you believe the message (as I mostly do), then you’re happy to see the word get out.

[Spoiler alert!]

Epstein slowly builds her case as she covers the subject, talking to midwives and moms and doctors, while she herself progresses toward giving birth to her first child. The film is clearly on the trajectory of showing Epstein’s own triumphantly wonderful home birth. But then, the unexpected happens. Epstein develops complications when she has a premature birth; her midwife rushes her to a hospital where Epstein gets a c-section.

It’s a WTF? moment, if there ever was one in a documentary film. I’m thinking, “I didn’t see this coming,” and I know that Epstein and her team must have been totally blindsided by this sudden encroachment of reality’s unpredictable circumstances. How they handle it is really the test of the film, and I have to say, I was a little disappointed.

Throughout the film, Epstein underlines the notion that the vast majority of home births are fine, and that only a slim minority necessitate a doctor and hospital. But, when that minority includes her so vividly, she doesn’t really take the issue head on. She suggests she’s a little disappointed that things turned out this way, but doesn’t acknowledge that, wow, this really changes the thrust of the film. It might not change the overall thesis, but it certainly puts a new spin on the narrative. The whole time, the doc was heading in one direction, and it ends, well, way off somewhere else, in the realm of life’s unpredictable absurdities — but Epstein doesn’t seize the moment and acknowledge it as she could have.

I don’t know how Epstein edited the film. It seemed to me that she had been editing it at the same time that she was shooting, going in one direction, and that when the early birth happened, she sort of slapped on an ending. I’d like to ask her.

I can’t think of another documentary that takes such an abrupt turn. It made me think of how so many filmmakers start out making a particular movie, only to find that their research pointed them in a new direction. Errol MorrisThin Blue Line went from being a film about a psychiatrist who was a murder expert to being about a specific case of injustice. Andrew Jarecki‘s Capturing the Friedmans was originally about party clowns, but became an epic tale of a family with a dark secret.

But those changes happened off-camera. In The Business of Being Born, the shift happens at the climactic moment — on screen.

Nonfiction filmmaking has many distinct advantages over fiction, and one of them is that life can take such unexpected turns. When it does, a filmmaker should revel in that moment, and use it to his or her advantage. I wish I could think of a film where this really happens. Can you?

By the way, Epstein has a lively website, which you can check out at

Tom Roston
Tom Roston
Tom Roston is a guest columnist for POV's documentary blog. He comes to us as a ten-year veteran of Premiere magazine, where he was a Senior Editor, and where he wrote the column, Notes from the Dream Factory. Tom was born and raised in New York City. He graduated from Brown University and started his career in journalism at The Nation and then Vanity Fair. Tom has also written for The New York Times, The Los Angeles Times, GQ, New York, Elle and other publications. Tom's favorite documentaries are: 1. Koyanisqaatsi - Godfrey Reggio 2. Hoop Dreams - Steve James 3. The Up series - Michael Apted 4. Crumb - Terry Zwigoff 5. Capturing the Friedmans - Andrew Jarecki
  • Jeanmarie Todd

    FOREIGNID: 23575
    I also enjoyed this documentary. I wonder how the author thinks the film should have been edited at the end. It didn’t shatter my world when the filmmaker ended up having to be rushed to the hospital; it was just honest. There were other home births recorded in the film. It showed a range of experiences and was very eye-opening.

  • Cristine

    FOREIGNID: 23629
    I thought that Ms. Epstein’s “suprise” ending actually supported the argument her film made, by demonstrating that a midwife and a mother are capable of making a rational and timely decision in the best interests of the baby without getting hung up on their ideals of how things were “supposed to happen.” By demonstrating a successful birth even when complications arose it reinforces the idea that home births can be safe, as most people’s fears of home births stem from the idea that a midwife will not be educated enough to make the decision to send a patient to the hospital in time to prevent catastrophe in the event of complications.
    I also appreciated her not trying to rationalize, judge or explain what happened to her. She just let the footage speak for itself, and it did not detract from the film’s overall message in my mind.

  • Kim

    FOREIGNID: 23708
    Cristine, your comment was right on the mark. As a homebirth midwife myself, I appreciated the honest portrayal of the turn of events and the validation of midwifery as a profession in which we are educated and do perform appropriately in both normal and high-risk situations. I agree, though, that the situation could have been explained a little more thoroughly.
    I just finished reading Cara Muhlhahn’s (the midwife featured in the movie) memoir, Labor of Love, in which she describes how she came to be involved in the movie and her desire for more clarity around Epstein’s delivery. She explains that the DVD features outtakes that help put the missing pieces in place to clear up confusion.
    Mr. Roston, I highly recommend that you view the documentary, Pregnant in America, which is the story of one family’s journey through pregnancy, midwifery care, homebirth, and subsequent transfer to the hospital from a father’s perspective. I found it more fluid and riveting than BoBB.

  • Doc Soup Man

    FOREIGNID: 23839
    I’m going to have to check out those DVD extras. You know, Cristine, I hear you; I guess I’m not faulting Epstein as a person so much as a filmmaker. I agree that she should be praised for not overrationalizing or explaining her decision, but I think that the film goes in such a dramatically different direction, that it had to be better accounted for–in some way. And, Jeanmarie, I’m not sure how, but in some way. I mean…just a few minutes earlier, there’s a doctor saying that c-sections break the bond of love between a child and mother! And then our star director goes through that very process! That’s too big a shift to just let it slide by…

  • Crunchy Nurse

    FOREIGNID: 23845
    I don’t like the way the film was edited concerning the emergency transfer. This sheds some further light on what was not shown in the film.
    Basically, the decision to transfer was made more quickly than it appeared, and also, when the physician states that the baby has IUGR, he was under the impression that the baby was full term, which was not true.