Here to maternity

Ricki Lake is exhausted. Dressed in black, the 39-year-old actress and talk show host gnaws a little of her burger, rifles through her chips, and seems to collapse in on herself.

'I'm sorry,' she says. 'We flew in at six this morning and I'm just wasted.' The person that makes up the 'we' is director Abby Epstein; the mission that led to them touring cities around the world is to promote The Business of Being Born, their documentary on the economics and politics of childbirth.

Slimmer and smaller than when she appears on television, Lake allowed graphic footage of the 2001 water birth of her second son, Owen, to be used in the film - when the actress was naked and weighing in at 88.5kg. Epstein says: 'This isn't Angelina Jolie traipsing through Kenya with an economist.'

A lot of women who saw the film thought they were happy with their birth, Lake says. 'They thought they loved their epidurals,' she says. 'But afterwards, they were like, 'God! If I had seen this movie first, I would have tried it that way.' Pregnant women have walked in thinking one thing, and walking out wanting to change their care provider.'

Three years in the making and due to be released on DVD early next month, The Business of Being Born is Lake's project. In her first attempt as executive producer, she hired Epstein to explore the experience of giving birth within the context of medicalised culture. As Epstein embarked on her research, she discovered that the business of being born is another way medical traditions and institutions - hospitals and insurance companies - 'discourage choice and even infringe on parents' intimate rites, ultimately obstructing the powerful natural connection between mother and newborn child ... nowhere does the tension between technology and nature play out more dramatically than birth.'

The film premiered at the Tribeca Film Festival, where it was lauded as 'the Inconvenient Truth of childbirth' - referring to Davis Guggenheim's Al Gore-starring, Oscar-winning documentary about global warming.

Unsettled by her first experience of childbirth, Lake began educating herself about the process and its politics. Maternity care, she discovered, is in crisis. Despite being the richest country in the world with some of the most advanced technology, America has the second-worst infant mortality rate in the developed world. And internationally, medical decisions are being made for commercial and legal reasons, rather than for the benefit of mothers and babies. Doctors have succeeded in convincing women that they do not know how to give birth. Normal birth is in danger of being lost, along with its significance in a woman's emotional and spiritual evolution. ('If I can do that,' one home birth mother says in the film, 'I can do anything!')

The Business of Being Born points out that western women spend more time researching car purchases than they do birth. 'Designer birth' is threatening to overtake normal birth, with women duped into perceiving major surgery as benign. It has even been suggested that the term 'c-section' is more accurately termed 'open uterine surgery', as few are aware that the uterus is taken out of the body during the procedure.

Glossed over in lowest common denominator pregnancy manuals such as What to Expect when You're Expecting ('caesareans are nearly as safe as vaginal deliveries'), the risks are disturbing. According to the film, the infant death rate during caesareans is twice that of vaginal births, and babies delivered by c-section have been shown to suffer more respiratory illnesses. And then there is the depiction of births on television and in movies, which is almost always agonising and gory. Epstein has said that before making the film, her images and association of birth were miserable on every level.

'My birth experience was horrible,' says Epstein, who became pregnant two years into filming and underwent an emergency caesarean. 'The idea of having post-traumatic stress disorder [PTSD] after a difficult birth is new, and I had all the hallmarks. I absolutely did not feel as if I'd had a baby. I absolutely felt as if I'd been hit by a car. Recovering from major surgery, being separated from my baby ... it really could make you totally psychotic.'

In The Business of Being Born, author and obstetrician Michael Odent says few obstetricians know what birth can actually be like - how peaceful it can be, how beautiful and how triumphant. 'We are completely lost,' he says. 'We have forgotten to ask the most simple questions. What are the needs of a woman in labour?'

Fevered in his denunciation of home births, the average obstetrician has never witnessed one - which is, as one specialist says, much like a geographer describing a country he has never visited.

Ina May Gaskin, who has been lauded for reviving the art of midwifery in the US, has long lobbied to restore birth not only to women, but to its social importance. In the film, she comments on high rates of infection and mortality in countries with doctors in favour of elective c-sections, and how the mortality rate in appropriately supervised home births is significantly lower. Her book, Spiritual Midwifery, was responsible for triggering Lake's awareness.

'Instead of treating birth as something I needed to schedule into my very hectic life and do it in the most painless way possible,' Lake says, 'I became inspired about it. Before making this movie, I approached birth exclusively as a matter of pain management - how can I avoid pain at all costs. You have to be inspired by birth. Read about it. And don't approach it from just a medical perspective. Address it from a psychological perspective, and from a spiritual perspective.'

Lake, who has, along with feminist author Gloria Steinem and TV host Rosie O'Donnell, volunteered to raise US$7 million for a birthing centre in Manhattan, is not alone in her attempts to teach women that birth is not cancer. International specialists agree that the technology and costs currently devoted to normal pregnancies need to be siphoned into pregnancies with real problems. In first world countries with high home birth rates - the Netherlands at 30 per cent, for example - women refer to doctors only in the event of complication and the infant mortality rate is negligible. Obstetricians, many in the documentary conclude, should deal with complicated pregnancies, and midwives should handle the rest.

The result? Better birth experiences, better health budgets.

Epstein and Lake have been in talks with the UN about infant mortality rates (2 million babies die in the first 24 hours of life each year) and the improvement of global maternity care. There have been discussions about Lake's viability as a spokeswoman for safe motherhood, and offers for a related book are being considered. Epstein and Lake suddenly glance over at their driver, who is waiting to escort them out. 'We need to respect the process of birth,' she says as they stand to leave. 'We need not to be numb to it; we need to be interested enough to partake in it. This isn't some trivial episode we're discussing; this is the introduction to human being.'