By Chris Lombardi

Rebecca Benghiat, director of Friends of the Birthing Center, was softly gleeful this week about her organization’s upcoming documentary-film launch party next Wednesday at the IFC Center for its New Space for Women’s Health.

“We’re gonna be delivering babies on the day we open,” she said.

That day is not scheduled to occur until 2010—though it feels like the day after tomorrow to Benghiat and her board, some of whom have been working toward that day since the 2003 closure of Chelsea’s Elizabeth Seton Center on West 14th Street.

In addition to preliminary drawings of the planned $7 million center on West 30th Street by famed “green” architect Peter Gunther and appearances by celebrity supporters like Eve Ensler and Ricki Lake, Wednesday’s event will unveil Lake’s documentary “The Business of Being Born.” The film, which chronicles the home-based birth of Lake’s second child, also describes what Benghiat, Lake and their allies in the natural-birth movement see as a crisis: the degradation of maternal and child health by invasive medical procedures.

Hurry up please, it’s time

As “The Business of Being Born” opens, it throws some rough facts: that the United States has the highest rate of infant mortality in the industrialized world, and also has a far, far higher rate of births by caesarean section than that of other industrialized nations. “Countries with some of the lowest perinatal mortality rates in the world have caesarean section rates under 10 percent,” reads a summary report of WHO’s Joint Interregional Conference on Appropriate Technology for Birth. “Clearly there is no justification in any specific geographic region to have more than 10-15 percent caesarean section birth.”

Yet, as the film points out, more than one in three U.S. babies arrive that way. “They say it’s because we have different women in the U.S.—more high-risk women,” says San Francisco–based physician Marsden Wagner in the film. “But this blaming of women is farcical.”

Instead, says Wagner, blame the hospitals—or, rather, the transformation of birth into a high-stress medical event, governed nearly as much by the economics of hospital care as by concerns for the mother and child.

Starting with the well-known difficulty of giving birth flat on one’s back, with help from neither gravity nor abdominal muscles, the film demonstrates and denounces a “cascade of interventions” during many U.S. births. It shows women being wheeled down hospital corridors with intravenous tubes already in their arms, through which they receive a mix of nutrients and hormonal stimulants.

In one scene, doctors talk in front of a schedule on which half the women in the ward are receiving pitocin, a hormonal stimulant given if labor is not proceeding quickly. “If things aren’t going along at the pace we want, then we’ll up the ‘pit,’” says one cheerful doctor.

Advocates like Wagner, Benghiat and Friends of the Birthing Center believe that “the pace we want” is determined more by the sped-up, clinical mindset of the surgery than anything else. “They have to fill those beds and empty them,” Friends board member Elan McAllister says in the film. “In the hospital, you’re not allowed to have very long labors.”

The result, McAllister says onscreen, is a kind of domino effect: “The pitocin makes the contractions longer and stronger and closer together. The pain gets worse; so, you up the epidural [anesthesia injection]. That slows labor, so you up the pitocin. Meanwhile, your baby is getting compressed, decreasing its oxygen supply…. So, the baby’s going to go into distress, which then leads to an intervention.”

These interventions include forceps delivery, vacuum induction or a caesarean section. While television and the tabloid press have attributed the increase in C-sections to American women’s self-indulgence, or the “too posh to push” syndrome, the film contends that decisions to “section it” are normally made under something strongly resembling duress.

In Lake and Epstein’s film, one lab-coated doctor after another approaches an exhausted mother. “If you don’t get the baby out with this next contraction, I’m gonna use the vacuum, okay?” one doctor is seen saying to his patient. “Mommy, we need to deliver this baby okay?” Yet another says, slowly and calmly: “It’s been two hours. I recommend a vacuum-assisted delivery…because it’s time.”

While such statements are offered to obtain legally required patient consent, the possibility of refusal is always accompanied by a warning that the baby might not be safe, “so then she’s a bad mommy,” says McAllister and the other advocates in the film.

Have you ever seen a natural birth?

“The Business of Being Born” also offers, by contrast, the ongoing story of women choosing from the first day where and how to give birth, working in partnership with their nurse-midwives, as is done in most of the rest of the world. “You go anywhere else—France, Germany, the Scandinavian countries—where they are losing far fewer babies, and what do you see?” says Wagner in the film. “You see midwives delivering 70-80 percent of the babies.”

The film recounts how unlike Europe, where midwives have become part of the system of births in hospitals, U.S. physicians long campaigned against all such deliveries, claiming that midwives were “unclean” and such births dangerous. Yet in addition to Europe’s far better maternal- and child-survival rates, numerous U.S. studies have found midwives have similar or better health outcomes than obstetricians.

Through a trio of birth narratives including Lake’s, viewers watch certified nurse-midwives work, a process that begins with the initial consultation and ends, in most cases, with the mother catching her own baby in a pool of water. Even the conclusion of the film, which describes how director Abigail Epstein’s birth ended in a hospital and a C-section after the child turned breech at the last minute, emphasizes that the natural-birth process is overall an empowering experience for women. Mothers in labor howl, walk, move around and cry out until they hit what they describe as a marathoner’s wall, “when you give into the pain and know you’ll get through it. And then—you know you can get through anything,” says McAllister.

To Epstein and Lake, the film is reaching out to what McAllister calls “a whole generation of women who think they don’t know how to birth.” To Benghiat and her board (including McAllister), the creation of the New Space for Women is a similar process for a city whose caesarean rates routinely approach 40 percent per annum.

A proud past, a new model

Benghiat, who began her career in nonprofit management with Steppenwolf Theatre Company, first became involved with the defunct Elizabeth Seton Childbearing Center in January 2004, when she was in her first year at Cardozo Law School, even before she became pregnant with her daughter Amalia. In 2005, after nurses and other staff had already incorporated Friends of the Birthing Center, they asked for help in opening it, and Benghiat became Friends’ executive director, setting about enlisting the support and expertise to make the new women’s health center a reality.

The Seton Center’s 1996 opening occurred as midwifery was experiencing a revival in the United States, where the percentage of births attended by midwives had fallen from more than 50 percent in 1900 to 1 percent by 1976, according to the National Center for Health Statistics. The revival was gradual but real, with certified nurse-midwives attending 3 percent of births in 1987, 5 percent in 1994 and 7 percent in 1998.

And Seton, part of an 89-year-old New York City midwivery tradition started by the Maternity Center Association, was hailed as a revolution in Village and Chelsea health care. “The center is a far cry from the traditional hospital setting,” wrote New York Times reporter C.J. Chivers, “with rooms equipped with home-style double beds, seating for family members, whirlpool baths…. Even the floors of the three birthing rooms are finished with wood, rather than institutional tile.”

But in the 21st-century managed-care era, few companies offered full coverage to births by midwives (despite the fact that they tend to cost 30-50 percent less than physician-assisted births). And skyrocketing malpractice insurance rates led to the closure of many birthing centers, including Seton.

Seton’s closure was due to “management decisions” made by St. Vincent’s Hospital, which owned the center, Benghiat said Monday. The New Space, she added, “will avoid that by being autonomous.”

Still, the last thing anyone wanted was to raise the money, hire the staff and end up in the same financial hole that had doomed Seton. “We had to make sure it would work financially,” said Benghiat.

The planned center envisions 17,000 visits a year and 1,000 births. The facility will offer round-the-clock nursing services, a staff medical director and social worker, and births steered by its three or four in-house nurse-midwives, each of whom will be licensed to transfer cases to a local hospital if needed. In addition, Benghiat sees the Center offering a range of other women’s health services, from nutrition counseling to lactation support to inseminations—to counseling for post-partum depression.

Each of the midwives will also carry her own malpractice insurance, as many do already, and will operate as independent contractors. “We’ll have the second floor equipped for them,” said Benghiat. “We’ll receive the ‘facility fee’ paid by the women who see them, but the rest of the fees are theirs.” The center will carry no malpractice policy of its own, avoiding the prospect of multimillion-dollar premiums.

To ensure that the model would work, in 2006 Friends of the Birthing Center sought help from New York University’s Wagner School of Business. The students pored through industry data, collected best practices and were “incredibly helpful with the financial forecasting,” Benghiat told Chelsea Now. “The students also helped us develop a sample business model for the private midwifery practices.”

All that planning seems way in the past this week, as Benghiat and her board prepare for the big IFC party. In addition to celebrating with her high-powered board, including McAllister (a Broadway producer whose work includes “Spamalot”) and president Alexandra Lally Peters, the party will exhibit drawings of the new facility by architect Gunther, “who wrote the book on green hospitals,” Benghiat said.

Those drawings, she added, were developed as part of the exciting next step for the New Space: applying for official New York State certification. That process is expected to take a year, she said, and then she and the board can finally get on with building their new home.

“I know 2010 sounds a long way away,” said Benghiat, “but for a hospital? That’s actually pretty short.”