Ricki Lake Has Unfinished Business

When The Business of Being Born premiered to a sold-out audience at the Tribeca Film Festival in 2007, the atmosphere was like “a religious revival meeting,” as Variety put it. The audience of actors, critics, film executives, midwives, and doulas wept and cheered at the cinematic depictions of real home births, as well as the raw footage of Ricki Lake — Hairspray star, beloved talk show host, and the film’s producer — giving birth in her bathtub. At the Q&A, renowned midwife Ina May Gaskin, sporting Princess Leia braids and a hippie skirt, told the house that this was the best film on birth ever.

Months later, a few miles uptown, the film had a very different reception. Lake and director Abby Epstein screened the documentary at St. Luke’s-Roosevelt Hospital on the Upper West Side, where Lake gave birth to her first son. It was part of grand rounds, traditionally a chance for hospital faculty to hear a speaker and engage in professional dialogue.

“They screamed at us,” Lake recalls. “We were called Nazi propaganda filmmakers.” And “baby killers.” The obstetrician who had been on call during Lake’s labor was there. “She didn’t open her mouth, but if looks could kill…”

The film showed doctors talking about “upping the pit,” for labor-inducing pitocin, on various patients, as if trying to turn tables at a busy restaurant. So, Lake says, “I get it. The film did not really reflect well on the hospitals we filmed at.” Lake is rifling through a box of VHS tapes, looking for footage of the hospital showdown. She recalls that a local news channel had been there, but she can’t find the tape.

Just as well. The anxiety of that moment, when she wasn’t sure what the legacy of her film would be, couldn’t be farther away. It’s a brilliant spring day in Malibu, 16 years later, and we’re in the living room of what Lake calls her dream home. She built it around an elaborate vine that takes up an entire wall of a covered patio and had crystals embedded in the walls. Perhaps with that heightened awareness of temperature that comes with middle age, she checks several times to make sure I’m comfortable. The modern hearth is aflame and the sliding glass door is cracked open to receive the ocean breeze. Lake tells me she’s the happiest she’s ever been, which makes it a good time to look back on the film she marks as “the pinnacle” of a career she loves, “this little movie that was a big deal to a lot of people.”

If you’ve given birth in the past decade and a half, it’s likely that your experience was touched by The Business of Being Born. The film normalized home birth, rebranding it as hip, urban, and reasonable, though these still account for less than 2% of U.S. births. But its impact reaches far beyond that. Lake and Epstein popularized the critique that American obstetric practices, such as inducing labor, benefit hospital logistics and finances more than the humans giving birth and being born, and exposed a generation to the idea that midwives and doulas had a remedy.

“I watched the film three or four times during the course of my pregnancy, and halfway through I called up my aunt and said I want to be a midwife,” says Abby Vidikan, who left a politics job in D.C. and is now a home birth midwife based in LA. Tyla Leach, a newly certified midwife in New York, found the film by chance one afternoon in her college dorm. “I watched it and I was like holy sh*t, maybe I want to be a midwife.” Lake and Epstein hear these stories all the time — women who changed careers, changed birth plans. “We get social media posts every day, still,” says Epstein.

Thanks to its many years on Netflix — and a continuous supply of pregnant or curious viewers looking for information — the documentary never stopped finding new audiences. When the film came out, “no one was colloquially talking about the problems with maternity care, it wasn’t part of public conversation,” says Tamara Taitt, co-founder of a birth center in Miami. “There were many years not immediately adjacent to the film’s release, where clients were like, ‘I saw this movie… I don’t know if you’ve heard of it?’”

Yes, there had been Lamaze, La Leche League, and the “natural” birth movement, but the film’s depiction of labor and delivery wards and its compact, unvarnished history of medicalized childbirth crafted a compelling narrative about the external forces affecting birth, the stuff that could not be influenced by breathing through the contractions. Before the film came out, New York City doula and childbirth educator Ceridwen Morris says, “I think I had to explain a little bit more about why an institution might not have your best interests at heart, why continuous fetal monitoring in a low-risk pregnancy is more for their liability than your health. There’s an understanding of needing advocacy in the hospital that wasn’t there 15 years ago.”

If you found yourself asking a provider whether you’d be able to push in a squatting position, that might have been Lake’s impact. If your hospital had a birth tub or ball, the film might have had a hand in that, too. The footage of a woman glistening in a tub in her living room, swaying and moaning as she lifts her newborn out of the water with her own hands, was a tantalizing suggestion of what birth can be like. But even if you loved your epidural or accepted the necessity of your C-section, maybe you also dreaded judgment from people whose takeaway from the film was that you’d been cheated — or worse, cheated yourself — out of a special experience.

“I wanted women to know that they’re missing a potential opportunity to really be empowered,” Lake tells me.

We’ve been touring the Y2K years — before people uploaded their birth videos to YouTube, when Lake had to explain in Q&As what “doula” meant — but Lake, 54, is not exactly in retrospective mode. Empowerment is something she still wants for women. Though, in many ways, it feels farther out of reach than it did 15 years ago. She and Epstein now have the film rights back and are in the process of digitizing their documentary for the 21st century. And they are working on an update, a docuseries, working title: The Unfinished Business of Being Born.

Lake never expected anyone to see the footage of her pushing out her second son in the bathtub. “I would have worn a top, number one,” she says, and she would have moved the shampoo bottles. But that birth, in the summer of 2001, was “life-changing beyond becoming a mom. I was tapping into my primal power, making all the decisions of what I wanted in that experience.” Lake suffered sexual abuse as a child; she battled her weight. She felt her second birth showed her what her body was capable of, and she looked at herself differently. “My body was a magic vessel,” she tells me.

Three months after her son’s birth, standing on her roof in New York’s West Village, watching the Twin Towers smolder and then disappear, she had a sort of epiphany: “I remember thinking, if I live through this I want to make some changes in my life.” Whatever had happened to her in that bathtub needed to guide the way forward. Within two years she had left New York, her successful daytime talk show, and her marriage.

This was no small thing. Ricki Lake was in its 11th year; the hours were amazing, she had on-site child care and a dedicated assistant. All she really had to do was show up, be herself, and collect her paycheck. But “I’m not someone who’s motivated by money,” she tells me. “I had made what I considered to be enough at the time.” She wanted a project that was “more impactful, more personal. I really stopped and thought, where can I make a difference, what do I care about? The thing I kept going back to was how impacted I was by my birth experiences, both of them: one with interventions that I considered unnecessary looking back, and one that was completely empowering.”

The subject still fires her up like nothing else. “I think on a big-picture scale, what is it doing when women are being robbed of that? It’s just so vital that women know they have options.”

Lake worked through the rest of her contract, the “gnarly” divorce, and landed in Brentwood, in Los Angeles. She invited Abby Epstein, who had directed her in a production of Eve Ensler’s The Vagina Monologues, to come visit her new home. “I said, look, I have this idea, I want to do a project exploring birth.” She gave Epstein two books, Robbie Davis-Floyd’s Birth as an American Rite of Passage and Ina May Gaskin’s Spiritual Midwifery, “and my nine-hour birth video that I’d never watched. I literally took it out of the camcorder and handed her the tape,” says Lake.

A week or two later, Epstein called. “She said, ‘I think it’s a documentary.’” Lake ordered film equipment. She financed the film with $500,000 of her own money.

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The resulting film was hardly the first effort to expose the indignities and injustices of standard U.S. maternity care and illuminate the alternative. My book Pushed came out in 2007 and stood on the shoulders of many journalists and scholars who’d tackled the issue, from Jessica Mitford to Barbara Ehrenreich to Adrienne Rich. But when Lake and Epstein’s film came out, it was a watershed moment. The premiere felt like “a very a big deal,” says Mayra Vazquez Radzinski, whose laboring silhouette became one of the most iconic images from the film. “It felt like, OK this is going to get the traction it needs, because this is Hollywood.”

According to Morris, the childbirth educator, the film was helpful in showing people what birth really looks like. She is particularly fond of the footage of hipster midwife Cara Muhlhahn stomping around her apartment and searching for an escape. “You see someone really doing it and it’s hard,” she says. “It’s not a fantasy, it’s not an aaaamazing birth, it’s not someone who has no pain threshold.”

In between footage of women laboring, viewers saw disturbing images from the early 20th century “twilight sleep” era, when women (not actually asleep and not always relieved of pain) were routinely strapped down and sometimes even blindfolded. The footage of 21st-century hospital routines wasn’t exactly redeeming. One of the scenes that I could never get out of my head is a doctor towering over a woman, pushing her legs above her hips and into the stirrups.

“The film made me really sad,” says Marjorie Greenfield, a professor of obstetrics and gynecology based in Cleveland. A proponent of midwifery care who published a pregnancy guide the same year as the film’s release, she laments the “disconnect” between the experience many women want — to move around freely during labor, to not be rushed — and what they can actually achieve in the hospital. “It made me sad because there’s a loss there.”

“We can’t have the birth we want, it doesn’t work that way. It’s a lesson in surrender.”

Lisa Perriera, an OB-GYN based in Philadelphia who appeared in the film as a resident at one of the hospitals, found it hard to watch. “It made OB-GYNS look really bad, whether or not it was intended to do that,” she says. Though she found the documentary broadly accurate, she thought it caricatured the patient-physician relationship as adversarial, when it should be based on teamwork and trust. “I think the film helped create this culture where folks believe they need to have a 27-page birth plan,” she says. “If you’re walking into your birth experience with that level of detail, you’re almost certainly going to be disappointed.”

Even glorious home births have their disappointments. Radzinski, who gave birth in the film, says she was determined to birth in the squatting position, resulting in a bad perineal tear. Healing and processing, she says, “made me have a little bit more grace for doctors, honestly, because I saw how I had asked for something, and my midwife and doula were honoring that, and in the end that wasn’t the best position for me.”

This is the burdensome side of choice, according to Morris. “There’s this idea that you’re going to choose your birth like you’re choosing your cabinets,” she says. “We’re mammals. This is birth. You want to make good decisions about your care provider and what institution you’re going to be in — or not — but you can’t just choose a happy story.” If you think that’s what you’re doing and you get a “sh*tty complicated birth,” then you’re going to feel you made the wrong choice.

Something few people seem to remember about the film is that it includes a C-section. When Epstein’s planned home birth turned into an emergency cesarean, the director became a human caveat, a testament to the fact that home birth is not for everyone and OB-GYNs save lives. But memory is funny, and some people remember the movie as proselytizing unmedicated birth. “I don’t know that the movie was nearly as judgmental as the way that it traveled out,” Morris says.

The film was “just trying to clue you in that you have agency, and that there’s a built environment that is designed to disempower you. [The filmmakers] just want you to know that’s what’s going on here,” says Taitt. “They weren’t actually trying to convince you to have an out-of-hospital birth.”

The question of the film’s agenda is one Lake answers confidently, as though she has already answered it many times. “I don’t have a desire for anyone to have any other experience than one in which they were informed of all their options,” she says. “We can’t have the birth we want, it doesn’t work that way. It’s a lesson in surrender.”

Lake has said she is missing “the celebrity gene,” and it’s true that, walking around her house and grounds, she seems to hardly believe it’s hers. She shows me her cannabis plants, and a picture of the adorable 3-year-old to whom she is “bubbe.” Her hair is platinum. I’m reminded of the everywoman credibility that made her such a brilliant talk show host.

Still, Lake proved to be a big enough celebrity for organizations hoping to discredit The Business of Being Born. At the time it came out, legislative efforts were ramping up to license certified professional midwives, with the hope of increasing access to out-of-hospital maternity care and delivery options. (Back then, fewer than half of states recognized the credential; now it’s 37 going on 38.) In 2008, the American Medical Association adopted a draft resolution against home deliveries that cited Lake by name. (The draft was leaked to the LA Times and the organization ultimately dropped the mention.) In its own 2008 statement against home birth, the American College of Obstetricians and Gynecologists wrote that “childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre," and that “choosing to deliver a baby at home … is to place the process of giving birth over the goal of having a healthy baby.” (ACOG has since softened its position.)

According to Katherine Hemple, a former professor of English and women’s studies who advocated for certified professional midwives in state legislatures, it was common for legislators and lobbyists to insinuate that trend-seeking, selfish women were behind growing demands for midwife care. “But to put it in formal resolution, to assume we’re all followers of Ricki Lake, was absurd,” Hemple says. In reality, “health and safety are the primary reasons people choose to go outside of the [hospital] system,” she says. “They’re typically people who are taking a proactive evidence-based approach.”

While Lake and I are talking, her phone buzzes. It’s Epstein, calling on FaceTime. She got a DM on Instagram from a dad in New Jersey with a harrowing birth story: he could see the baby’s head crowning, yet clinicians held the baby back in the pelvis and his wife was wheeled away to the OR.

“Is everyone OK?” Lake asks. She means, is everyone alive?

“Yeah everyone’s OK. But no, they’re not OK. She’s not OK,” says Epstein. “He reached out because he watched The Business of Being Born when he was 19, and he knew things were going wrong.” They go back and forth about whether or not to send a film crew.

The story reminded me of a similar-sounding case — in 2012, a woman in Alabama was restrained by nurses who held her baby back for six excruciating minutes, causing chronic nerve damage. (She won an unprecedented $16 million in damages.) Not long after Lake and I spoke, Texas CPS took a less-than-1-week-old newborn from her parents after her home birth because it seemed their pediatrician did not trust their midwife to manage in-home jaundice care.

The Business of Being Born started from a premise that laboring patients have rights and options — people just needed to be aware of them. The film showed how power, authority, and profit complicate best practices, but choice was the salve. In the 15 years since the film came out, however, it has become alarmingly clear what is truly at stake when we talk about maternity care. It’s not just disappointing, disempowering experiences; it’s obstetric violence, family separation, and death, disproportionately affecting Black and Native women.

In 2008, “we weren’t in the historical moment that would lend itself to a public mainstream conversation” about health disparities or social determinants or implicit racial bias, says Sevonna Brown, a birthworker and the national director of Black Women’s Blueprint. She credits the growing awareness of these issues to Black Lives Matter, critical race theory, and “the exposure of the maternal mortality crisis that came from Serena Williams” — a woman with unmatched physical and socioeconomic capacity, who still wasn’t listened to when she cried out that something was wrong during her 2017 birth. Taitt says of her midwife-led birthing center, “We get Black women who are like, ‘I’m here because I don’t want to die by accident, and I think I’m going to get better care with a midwife.’”

It’s in this landscape that Lake now finds herself trying to figure out how the project she started 15 years ago can help. The Business of Being Born is screening for free online through May 14, and she’s drumming up support among the LA birth community and her Hollywood connections, like new mom Rumer Willis and actor Nikki Reed. Compared to the hopeful energy circa 2008, the topical conversations today are grim. In 2021, U.S. maternal mortality was the highest it has been since 1965. The criminalization of abortion post-Roe is causing OB-GYNs to delay necessary medical care. Even the comparatively small reforms the film amplified — a more judicious approach to induction and cesareans, more hands-on labor support — have been compromised by Covid-era hospital policies. “It’s dire,” says Lake. “The birth trauma that’s happening to so many women, it’s just out of control.”

She tells me that the new docuseries she is working on with Epstein will focus on systemic failures like rising maternal mortality, and racial disparities in outcome. This time around, in other words, Lake’s call to action is less personal, but it’s even more urgent.

“I’m not hungry to stay relevant,” Lake says. “But this birth work is not done.”

Top Image Credits: Michael Kors Collection dress, Talent’s own earrings, Alexis Bittar cuffs

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