Use of Big-Screen Films in Multiple Childbirth Education Classroom Settings

Abstract

Although two recent films, Orgasmic Birth and Pregnant in America, were intended for the big screen, they can also serve as valuable teaching resources in multiple childbirth education settings. Each film conveys powerful messages about birth and today's birthing culture. Depending on a childbirth educator's classroom setting (hospital, birthing center, or home birth environment), particular portions in each film, along with extra clips featured on the films' DVDs, can enhance an educator's curriculum and spark compelling discussions with class participants.

As much as I loved watching Orgasmic Birth and Pregnant in America at the 2008 Lamaze International Annual Conference in Louisville, Kentucky, I was immediately perplexed about how I could use these films to connect with students in my childbirth education classes. Could I show them in class? Were there sections that the hospital I work for would actually approve of my showing? The creators of these movies conceived them for very different purposes than teaching a childbirth education series; they wanted to strike at the root of a problem and engage the general public emotionally to care about and get involved in a solution. These differences mean that the structure, content, and flow of the films are not what childbirth educators are accustomed to showing in their classroom.

These differences, however, should not hinder childbirth educators from using Orgasmic Birth and Pregnant in America. Yes, you can show these films in a classroom setting. The copyright policy is different for each movie, but representatives from both films are open to providing classroom opportunities and hopeful that educators will use their movie as an educational tool (see Table). Some of the copyright complexities that educators may face in using either of these two films for business use are simple, such as for-profit versus non-profit use; also, copyright issues seem to be flexible, as I learned when I spoke with individuals in charge of each of the movies' licensing. There are many unique situations regarding use or employers, so if you have any questions regarding how or where you would like to use these two films, I highly suggest contacting representatives from each movie's production or distribution company.^*

TABLE.

Comparison of Orgasmic Birth and Pregnant in America

	Orgasmic Birth	Pregnant in America
Private use price	$35.00	$24.95
Public screening price (with signed license agreement)	• Not-for-profit educational use: $350.	• $24.95 for use in classroom only.
	• For-profit educational use: $500.	• Individual screening: $75 rental (profit sharing, if applicable).
	• College/University educational use: $500.	• Organizational screening (a group of 75 people or less): $150 (profit sharing, if applicable).
Where to purchase or rent	Purchase:	Purchase:
	• www.orgasmicbirth.com	• www.pregnantinamerica.com
	• Personal-use video can be purchased at Lamaze's online bookstore.	Rent:
		• From Netflix.
	Rent:	• From Blockbuster's online service.
	• From Netflix.
Length of movie	85 minutes	107 minutes
Languages available	Subtitles in Spanish, French, German, and Portuguese. Closed captioning for the hearing impaired.	English only, no subtitles.
Extras	• CD of soundtrack available: $18.	• Organizational screening prices include some promotional materials such as postcards and posters.
	• Purchase multiple copies of DVD at a discount.
	• With a public screening license, you can purchase private-use copies at a discounted price to sell.	• “Natural Birth Guide” booklet.
DVD extras	Trailer for the movie, Birth by the Numbers.	Fifteen clips of material that is worth seeing but did not make it into the movie.
Experts consulted	Sarah J. Buckley, MD; Carrie Contey, PhD; Maureen Corry, MPH; Elizabeth Davis, CPM; Robbie Davis-Floyd, PhD; Eugene R. Declercq, PhD; Ina May Gaskin, MA, CPM; Richard Jennings, CNM, MS; Ricardo Herbert Jones, MD; Jacques Moritz, MD; Lonnie C. Morris, CNM, ND; Christiane Northrup, MD; Lawrence D. Rosen, MD; Penny Simkin, PT; Naoli Vinaver, CPM; Marsden Wagner, MD; and Billee Wolff, RN, CD, LCCE.	Robbie Davis-Floyd, PhD; Joel Evans, MD; Barbara Harper, RN; Ina May Gaskin, MA, CPM; Tom Kreuning, MD; Liliana Lammers; Bruce Lipton, PhD; Elizabeth Maiash; Stephanie Mines, PhD; Michel Odent, MD; Joseph Chilton Pearce; George Ritzer; Barbara Katz Rothman, PhD; Kerry Tuschhoff, HCHI, CHt; and Marsden Wagner, MD.

Now that you know these big-screen films are accessible to childbirth educators, the next question is, “How will these films benefit my class?” Each film has its own set of selling points within a variety of classroom environments, so let's examine the films separately.

ORGASMIC BIRTH

What started out as Ecstatic Birth became Orgasmic Birth. If the title frightens you or your employer, you can simply refer to it as “OB”—a safer while still appropriate title to use in a hospital setting. Nevertheless, it is worth keeping in mind the opportunity to educate others on how the title reflects the film's purpose: to demonstrate to a generally unaware public a higher level of birth satisfaction and safety. The chapters are set up so that they start as the movie announces each birth. However, I found that there was always some little snippet of the couple or the labor just before each announcement that I would have included as well. For this reason, I include the time stamps as references, below, rather than chapter numbers.

Despite its title, Orgasmic Birth is really not that controversial to any childbirth educator familiar with the normal birth movement. The film's topics that you might cover in a classroom setting include the positive aspects of a natural, safe, healthy birth (as envisioned by Lamaze's approaches to pregnancy, birth, and parenting): hormones of birth; birth as part of being a woman; empowerment; and the sensual side of birth. The film also covers the negative aspects of birth in our culture, including disrespect of women's rights, loss of power from women, induction, birth as a medical event, overuse of interventions, iatrogenic troubles, and discrimination against midwives and home birth. In short, Orgasmic Birth provides not only beautiful births to show class participants but also a variety of topics and expert interviews for you to use to spice up your class.

The extra Birth by the Numbers feature on the Orgasmic Birth DVD provides a wealth of information and statistics regarding birth in the United States. The feature is narrated by Eugene Declercq, PhD, Professor of Maternal and Child Health at Boston University School of Public Health, and offers a roughly 20-minute lecture with plenty of charts and graphs to satisfy the “show-me-the-numbers” type of person as well as a great look at how to answer criticisms of the normal birth movement that are commonly voiced by the medical community. It is not entirely clear who the best audience is for Birth by the Numbers. You could show the feature to expectant parents who are looking for technical information about birth; however, if you have normal-birth-friendly staff, I recommend showing Birth by the Numbers for an in-service program. Perhaps the multiple applications for Orgasmic Birth and its extra feature, Birth by the Numbers, will encourage hospital or organizational department heads to purchase the film.

Hospital Environment

I work for a hospital, so I was immediately concerned with finding sections of Orgasmic Birth that I could show in a somewhat conservative setting. Although there are scenes that I do not think I can show in my hospital-based class, I did find more than enough to justify purchasing the movie. The cost might be your biggest setback (see Table).

The opening birth is a beautiful prophysiological birth with a natural-birth orientation; Mom moves as she needs to, her support team is very loving, and siblings are present. If you have a number of students in your class series who do not want an epidural, you could show this section (beginning until 7:22); however, be aware that it depicts a couple birthing at home. In some hospitals, the home setting can slip under the radar, but in others it might not. You could use the segment as an opportunity to brainstorm what class participants liked about this birth and how to transfer similar aspects to their chosen place of birth.

The section that begins by observing couples in an independent childbirth education class is very usable in a hospital class setting (7:23 until 11:38). You see couples practicing in class and hear experts talk about how the media influences our perception of birth and how hormones affect a woman during labor. This section leads right into “Piper and Chaz's birth” (11:39–17:07), which would also be fine to show in a conservative birthing environment. This African American couple's birth shows some great position changes while they labor at home. After active labor appears to kick in, however, Piper does not want to get in the car, so Chaz calls an ambulance to take her to the hospital—the one downside to an otherwise normal birth. However, in the end, Piper describes her birth as “ecstatic.”

“Dierdre and Kevin's birth” (39:24–47:40) is a hospital birth that is intended to contrast the normalcy of the home births depicted earlier in Orgasmic Birth. This birth focuses on pain medication. If you do not show your students the home births, the contrast will not be as great, but this section would still benefit your childbirth education class because it leads into a discussion about epidurals. Kevin is greatly relieved that Dierdre is willing to have an epidural; next, a childbirth expert comments on the phenomenon of epidurals that are administered for the comfort of someone other than the laboring woman. In class, you could show the segment on Dierdre and Kevin's birth to highlight cultural and social influences on childbirth choices.

If you are able to show an example of a water birth in your class, “Renee and Paddy's birth” (49:01–53:59) is a wonderful segment with an engaging baby. The birth takes place at home, and Ina May Gaskin comments about how birth is different when surrounded by women.

“Trisha and Arp's birth” (56:60–1:03:23) is a home birth, and the statistics for the safety of home birth are discussed. However, if you begin to show the birth with Trisha in active labor (about 58:18), you can make use of the great dialogue without drawing attention to the fact that the couple is not in a hospital. Trisha comments that she is scared, and her birth team is very encouraging. After the birth, Trisha talks about the need to have people around who are accepting and will allow a laboring woman to totally let go. She talks about her need to scream during birth—not because of the pain but because her birth was emotionally overwhelming, and screaming was a satisfying response for her.

The section with Penny Simkin and Helen's birth story (1:04:19–1:08:20) focuses on survivors of trauma/abuse and how they can find strength in birthing. This would be an excellent section for an in-service program.

As childbirth educators, we know the importance and wonder of hormones in labor. If you are looking for a new way to give more information regarding the hormones during labor and birth, you can hear experts talk during photo montages (1:10:45–1:11:45).

Birth Center Environment

If you teach in a less conservative medical environment, you can use any of the Orgasmic Birth portions mentioned above in the “Hospital Environment” section. You also might be able to show some portions of Orgasmic Birth that are supportive of intervention-free birth.

If your birth center aims to be as different from a hospital setting as it can be, you will appreciate a portion in Orgasmic Birth with experts talking about the misuse of routine interventions (17:07–about 20:10). If you work for a group of midwives, you can add the portion regarding the benefits of midwives (22:20–about 25:51), as told by experts and moms alike.

Amber is the one mom in the film who is shown having an orgasm during her labor (1:15:52–1:20:04). The experts' comments during her birth focus on the hormones of childbirth and how many women have orgasms during labor. Amber's birth is a home water birth, with a woman having multiple, rolling orgasms. This is the last birth on the DVD, and it leads into a summary of the film.

Home Birth Environment

In the open environment of a home birth classroom, you will be able to make the most use of Orgasmic Birth. You should be able to show the entire movie without a problem. Even just the highlights of the movie, as described below, may motivate you to purchase the film.

“Alexandra and John's birth” is one of the longest segments on the DVD (25:51–32:57), and it does an excellent job of showing the benefits of home birth over a hospital birth for a low-risk mom. I particularly like the drum music playing as Alexandra rolls on the birth ball while being supported by a “sling” hung from the rafters.

This birth is followed by a section of experts talking about how the medicalization of birth has lead to the current climate of induction (33:00–39:24). We see snippets of an Asian mom laboring in a hospital where a language barrier prohibits her from understanding everything that is going on, but she still trusts that her induction is necessary. Other laboring couples are shown in a hospital setting, with the movie's music and tone making it clear that a hospital is not the ideal setting for birth.

“Dierdre and Kevin's birth” (39:24–47:40) has a much different feel after you have shown “Alexandra and John's birth.” You get the full benefit of the earlier tone used to convey the loss of power and respect that women receive in some hospital settings.

In a home birth classroom setting, “Trisha and Arp's birth” can be shown in its entirety from the beginning (53:60–1:03:23). The entire segment will allow your class participants to view what a midwife brings with her to a birth and to hear the statistics on the safety of home birth.

PREGNANT IN AMERICA

Pregnant in America is the first of the big-screen movies in the last several years that is told from the viewpoint of a dad. This documentary follows Steve and his wife Mandy through her pregnancy and birth, and includes Steve's interviews with childbirth experts and everyday people on the street. At least three other birth stories play a role in the film, and these mothers offer a number of comments about their birth experiences during one-on-one interviews.

The Pregnant in America DVD includes many extras. One is the “Natural Birth Guide” booklet inside the case. The booklet includes information on midwifery care, Lamaze International, and DONA International and is a valuable resource for the newly pregnant woman. The video extras on the DVD are set up to watch as separate clips that did not make it into the movie. There are 15 clips, including the last one titled “Labor, Delivery, and Hospital Extended Version,” which expands our understanding of Mandy's labor. Pregnant in America is only available in English and does not appear to include subtitles. As described below, parts or all of the movie as well as the extra clips can be used effectively in various childbirth education class settings.

Hospital Environment

The extra clips available on the Pregnant in America DVD are potentially the most useful to use in a conservative medical setting. Perhaps whetting the appetite of students with the following clips will entice them to rent or buy the entire movie on their own:

• “Congratulations…You're Pregnant” is a great minute and a half of inspirational clips.

• “Final Thoughts Before Birth” follows Mandy to one of her last prenatal visits with her midwife, and Mandy waxes poetic about the new life growing inside her. This segment is short and would be a good clip to include in a class covering late-pregnancy topics.

• “What Is Natural Childbirth Anyway?” is a humorous collection of clips regarding the use of the phrase “natural birth” to simply mean “vaginal birth.” This clip is appropriate for classes that address comfort measures as well as how culture affects birth.

• “Life Itself Is an Orgasm” is short and funny if you cover the ecstatic side of birth.

• “The Moms and Dads Club” would fit nicely into discussions regarding how we process other women's horror stories of birth, but it would be even better in the postpartum class to get parents excited about this new “club” they are joining.

• “Labor, Delivery, and Hospital Extended Version” is a powerful piece that highlights Steve's realization that couples must have flexible expectations about birth. I highly recommend using this extra clip, but there are a few times in which Steve and Mandy refer to hospitals as places where they do not want to be. If this outlook might create a problem in your teaching environment, you can simply fast-forward through these statements. You also can stop at about 52:06, but you will need to verbally share the ending to the story with the couples in your class because they will be anxious regarding the health of Steve and Mandy's baby.

In a conservative medical environment, you might be limited to showing only a few portions of Pregnant in America or working them into a PowerPoint presentation for your classes. Your main issue will be that the movie does not shrink from pointing out when evidence-based care is being ignored and who is ignoring the evidence. In the following paragraphs, I point out sections in the movie that will go over well even in the most medical of environments. I feel that it is important to at least introduce Pregnant in America to people and build up their interest enough so they will purchase or rent the movie on their own.

A series of informal street interviews addressing the fears of birth and the pain of labor (7:21–about 11:25) are a good way to illuminate the typical view of birth in American culture. This segment introduces the idea of pleasure in birth, even orgasms, without being preachy. Another good segment (about 11:55–13:33) describes the psychological benefit of labor and the pride that it can create in women. Again, without getting heavy handed and negative, this segment offers a nice way to point out how the emotions of a woman in labor are often pushed aside. A short segment at 14:29 nicely complements the same theme. Between these two segments and just after the second is a bias for natural birth (the kind without pain medications). But if you have a class that is open to natural birth, you can show a lengthened version of the clip. Another segment offers an excellent focus on the need for privacy and a feeling of safety during labor (32:55–about 34:55). The point is nicely illustrated when Mandy gets camera shy and fades when she hears Steve step out, ready to film her. You could show Mandy and Steve's birth as it appears in the movie (beginning at 1:18:29), though you might have more time and less stress showing “Labor, Delivery, and Hospital Extended Version” in the extras section. (Just remember that you'll need to fast-forward through part of it, as I mentioned earlier.)

I am intrigued by the idea of offering an in-service program using the portion from 24:09 until 30:00 in Pregnant in America. This segment shows birth in a German hospital, complete with interesting, useful labor toys. The segment transitions into talking about midwifery care and the politics behind the shift from birth being attended by midwives to being managed by doctors. Another segment from 55:18 to 60:00 has numerous interviews of women telling their birth stories. Some of the women express fear and anger directed at hospital staff, but with a receptive audience of nursing students, their stories could be wonderful lessons in the humanity of caring for patients.

Birth Center Environment

All of the Pregnant in America extra clips mentioned above in the “Hospital Environment” section can be used in addition to others discussed here. You could show the “Introduction with Steve and Mandy” to get couples interested in renting the entire movie for themselves. In this extra, Steve makes a comment that would make the clip unacceptable to use in a conservative medical setting, but if you have midwives or your birth center practices the Midwifery Model of Care, you will be fine. If your hospital practices Kangaroo Care or adheres to Lamaze's sixth Healthy Birth Practice (“Keep mother and baby together—It's best for mother, baby, and breastfeeding”), you can show the clip “Is Home Birth Better for Families Than Hospital Birth?” because it presents a doula explaining how a hospital treats a newborn versus how the home birth setting treats the newborn/mother dyad. Even I could get away with showing this clip at the hospital where I teach because Kangaroo Care is so strongly encouraged. “What Do Hospitals in Holland Say?” would be a good clip to show if you advocate the use of a birth center as being safer than a hospital for women who are low-risk. (It is important to note, however, that although the clip contrasts home vs. hospital, a birth center is not an option in Holland). “Are All Hospital Procedures Necessary?” would be an excellent clip to show if your birth center prides itself on not routinely using interventions. “Mandy's Pre-birth Challenges” is a humorous yet earnest look at some physical challenges Mandy endured to prepare herself for what she hoped would be a natural birth.

Toward the end of the extra clip “Labor, Delivery, and Hospital Extended Version,” Steve briefly talks about his reluctance to go to the hospital and why he is hesitant. If it were not for the short 1-minute duration of this portion of the clip, I would have no trouble showing it to just about any audience. If you can fast-forward from 52:06 to 53:25, then I strongly suggest you use this brief segment in class. The segment gets high marks for its portrayal of the conflict between reality and expectations during labor and birth, how hard it was for Steve to see Mandy in pain, the importance of support for dads during labor and birth, and the importance of expectant parents being flexible and willing to change their perspective on what they think is the “best” way to give birth.

In the full-length feature of Pregnant in America, you could show any segments referred to in the “Hospital Environment” section of this article as well as some of the segments that provide more detail about the effects of pain medications during labor and birth. One of these segments begins (at 15:05) with Steve talking lovingly about his own mother's decision not to use pain medications during her births. The risks associated with epidurals scroll across the screen for about 40 seconds, enough to make any parent realize that there are benefits and risks associated with this intervention. The segment can be ended nicely just after addressing the topic of drugs crossing through the placenta. Mandy's labor and birth can be shown through the end of the film; however, be aware that Steve and Mandy did not have a reassuring hospital experience due to what they believed was a lack of understanding from staff.

Home Birth Environment

Show this movie! You might not be able to present the entire film in a classroom setting, so I'll outline which portions would offer the most clear and concise use of your class time. Definitely show the extras clip “Labor, Delivery, and Hospital Extended Version” after presenting any other segments of Mandy and Steve's birth from the movie that you would like to show. For a home birth audience, this clip provides a wonderful focus on the need to balance a loving atmosphere at home with the sometimes necessary use of medical technology. It also addresses the importance of flexibility with regard to individuals' expectations—even to the point of having to accept challenges to their views of what birth should be.

Home birth environments could use any of the extra clips on the Pregnant in America DVD. Other useful extras include clips titled “Defensive Obstetrics,” “What Side is ACOG On?”, “I'm Skipping All Tests,” and “Circumcision Protest.”

Any segment of Pregnant in America could be shown in a home birth environment, depending on what issues you need to focus on. The cost of purchasing the movie certainly makes it an affordable option, even though you are not likely to show all of it in class. I was struck by how powerful it is to hear this birth story through the dad's voice. Most birth videos are, rightfully, focused on the woman in childbirth, but it is refreshing and interesting to hear the story of normal birth from a dad's perspective.

Pregnant in America also includes other topics and segments worth showing in a hospital or birth center environment. Additional discussion topics include oxytocin's role in labor, reasons for and the misuse of induction, the American Congress of Obstetricians and Gynecologists, cesarean surgery, a comparison of the rates of vaginal birth after cesarean in Canada versus the United States, Cytotec (a very personal look at its effects and politics of its use), and the politics of birth in the hospital or at home in several other countries. One interesting section of the movie looks at Steve's sister's birth experience (1:08:38–1:15:19). This portion is affirming to expectant parents who are choosing home birth. Steve makes a quest of getting answers on his sister's behalf, and he encounters many interesting turns. There also is a great segment of Marsden Wagner describing the first time he saw a woman giving birth naturally and unencumbered and offering information about hormones after birth (1:27:55–1:29:41).

SUMMARY

I have taken the time to go through Orgasmic Birth and Pregnant in America in the hope that more childbirth educators will show these films in their classes. I hope this article makes it easier for you to figure out how and where these films and the powerful messages they contain could fit into your curriculum. Both films have much to add to the understanding of birth in our culture. Because they are designed for expectant parents and not childbirth professionals, Orgasmic Birth and Pregnant in America tell their stories in a compelling way that can motivate and inspire families to take an active interest in preparing for their birth experience.