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Abby Epstein, The Business Of Being Born


After years as a theater director, Abby Epstein has transitioned into being one of the most important new female voices in documentary film. Epstein began directing plays in the 1980s in Chicago where she started her own theater company, Roadworks Productions. In the late 1990s, she relocated to New York to helm the highly successful Broadway musical RENT. Notable amongst numerous other credits is her involvement with Eve Ensler’s seminal The Vagina Monologues, which she directed during its New York run as well as its North American tour. Until the Violence Stops, her documentary about the global impact of Ensler’s play, marked Epstein’s move into filmmaking. It premiered at Sundance in 2004 and won an Emmy after screening on Lifetime.

Epstein’s second documentary, The Business of Being Born, also grew out of her connection to The Vagina Monologues, as it was instigated by former Monolgues actress Ricki Lake. Shocked at the results of her own research into the birth industry, Lake asked Epstein to make a film about childbirth. The resulting movie, The Business of Being Born, is a damning indictment of the American medical profession which reveals how it excessively and detrimentally intervenes in women’s pregnancy and labor. Characterizing hospital births as motivated more by the hospitals’ financial and legal considerations than patients’ wishes, or even best interests, Epstein’s film makes a compelling case for a return to traditional (and often safer) midwife-assisted births.

Filmmaker spoke to Epstein about the need to change the perception of birth practices, how her own pregnancy affected the film, and her childhood obsession with The Wizard of Oz.


Filmmaker: You spent a long time working as a theater director, so how did you get into documentary filmmaking?

Epstein: This was a really weird journey, because I did theater for a long time. I really loved it, but at a point it became doing all these Broadway shows 500 times in 20 different languages. I was doing that on the Vagina Monologues in New York, where I met Ricki.

Filmmaker: Was she acting in the show?

Epstein: Yeah, we were doing this thing where we had different celebrities come in and do the show for a few weeks at a time. She was one of hundreds of actresses I directed in the show, but we really hit it off and stayed in touch. I had proposed the idea of doing this documentary about how The Vagina Monologues really became a social movement and how the play had taken off and was getting performed in these strange corners of the world. I was going to be just the producer on the project, but then the filmmaker we had selected had a conflict and couldn’t do it and the playwright [Eve Ensler] said to me, “This is your baby, you should direct the film.” When I did the first film, it was a nice organic transition because I knew the material really well, and I knew what I wanted to say. I didn’t have great filmmaking tools, but I knew what I was doing in terms of covering and angles from a narrative perspective and it translated pretty well to documentary. It was a bit of a trial by fire.

Filmmaker: That film, Until the Violence Stops, was a real success.

Epstein: Yeah, it was premiered at Sundance and went on to have a really nice life. It was such a difficult process and so long and tedious that I didn’t want to do another documentary after that. I thought, “This was a great experience, but you can’t really feed yourself doing this.” I went back to theater and was also looking for more narrative [film] projects because I was missing working with writers and actors. Then this thing with Ricki came along and I [thought], “OK, I have to do another documentary because they’re so difficult and I sort of just started to figure out what I was doing on the first one, so I just need to do one more.” [laughs]

Filmmaker: These two movies have made you a prominent voice in feminist documentaries.

Epstein: It’s funny, because my world before this was directing really heavy testosterone shows like Rent, Hedwig and the Angry Inch and a lot of tough, British dramas. There wasn’t anything too feminist about it. The reason that I wanted to do this film was that I’m really moved by stories of empowerment, people who are suppressed and marginalized and how they find their voice. As women, I think we’re still on a journey in this culture to undo a lot of negative work and empower ourselves and find our voices. I’m not a women’s studies person, but with the birth film, once I got into this topic and realized something was being taken away from women, that really stirred me up.

Filmmaker: In terms of the people who are repressed and marginalized, in The Business of Being Born that group is essentially all American women, and it seems an incredible challenge to affect significant change.

Epstein: Especially with this particular topic, [because] I think people who consider themselves feminists (as I certainly did) are completely ignorant on this. I mean, I worked on The Vagina Monologues for three years and was traipsing all over the world and going to Africa to fight female genital mutilation, but I didn’t know what a midwife was. I had no idea. I didn’t know there was real gender politics involved in childbirth at all. I didn’t know the history of it. The problem of this topic is that a lot of women who need to go out and advocate for change and more education are just not even aware that this is an issue. People know about rape and sexual abuse, but don’t really know about what happens in childbirth.

Filmmaker: When you coincidentally became pregnant, was it easy for you to put into practice what the movie was proposing, namely that midwifery and homebirths were the way to go?

Epstein: [laughs] It was terrible, it was my worst nightmare. My editor [Madeline Gavin] kept saying, “I really think you should shoot your story,” and I was really fighting her, saying, “No, this isn’t that kind of movie. Who cares about the filmmaker?” I had a difficult time making up my mind [about whether to have a homebirth] because I was interviewing from so many different perspectives every day, but ultimately I knew what I wanted. It wasn’t necessarily studies that I’d read or experts that I’d interviewed [that affected me], it was going to someone’s house and watching them giving birth in their living room and filming it and sitting around with them afterwards and ordering breakfast. It was this amazing energy, and for a woman it really helps to witness someone else doing that to believe that your body can do that. One of the reasons that I wanted to make the film was seeing the footage of Ricki’s birth. I was so blown away — I’d never seen anyone give birth like that.

Filmmaker: It’s so rare that someone as well-known as her would allow such a personal experience to be seen in a movie.

Epstein: I know. When I first saw the footage, I was just so moved by it, and thought it was so gorgeous and powerful and evocative. But there was a point in the editing process where I had to tell Ricki, “We’re not sure where to put your birth…” She was kind of relieved, and at one point it was really not going to be in there but then we found a place for it.

Filmmaker: The footage of all the women’s homebirths is very powerful, partly just because it is so totally unlike how we usually see birth on screen, with women flat on their back with their legs in the air.

Epstein: That was the intention, because that was what was most moving and surprising to me. We filmed a lot more births than are in the film, but the ones that we put in I felt we were the ones that showed [a different perspective], like that it could be a very sexy experience too. When we were at one of the homebirths, I remember thinking, “Oh my God, the neighbors are going to think we’re watching a porno in here!” because there was this moaning all day and she and her husband were in the tub. I’m not a conspiracy theorist, but I think you don’t you see [natural births] because there is a strategic effort to keep this information somewhat suppressed.

Filmmaker: Certainly a huge amount of money is made by the medical propagating the image of women incapable of giving birth simply.

Epstein: In every field, it’s very easy in this society to convince women that they’re not fit enough, not young enough, not pretty enough. Their bodies are never up to the task, their bodies are not fit for what they’re really made to do. It’s a psychological headtrip that women have bought into hook, line and sinker. There’s already so much fear around this issue anyway that if anybody feeds you any more fear, it’s impossible to find your footing and your confidence.

Filmmaker: You were planning to have a homebirth, but ended up having complications and having a very early Caesarian section birth, all of which we see in the film. How easy was the decision to include that footage?

Epstein: I honestly felt that this wasn’t a film like Super Size Me, a filmmaker going out there like “I’m now pregnant, so I’m going to explore my maternity options,” or “I’m going to do this homebirth live on camera.” Because I started the movie as a sceptic on the outside of all of these issues, it was hard it figure out how to use my story. Ultimately my editor and I decided that we should shoot my birth just to see if there was any value in it. At the end of the day, there was an honesty, reality and balance to it, and I felt we had to include it. Ultimately, this is the nature of birth: it’s this wild process, and sometimes it benefits from medical intervention and most of the time it doesn’t. I think it would be deceptive to create a movie that led everybody to believe that everybody could go home and plan their perfect birth in their bathtub and it would all work out like that, because it just doesn’t.

Filmmaker: This is a very important film in terms of changing women’s perception of childbirth, so what do you hope this movie can achieve?

Epstein: I would really hope that we are exposing a lot of misinformation. At most of the screenings I have attended, I think it has really inspired people to look at birth in a completely different way: not as a scary medical event where you just try to cope the best you can and survive it with as little pain as possible, but as a potentially incredibly transformative and sacred rite of passage. This is not a medical experience, it’s a spiritual experience, it’s an emotional experience and something that people throw away too easily. I think the film reminds you of something that you sort of knew somewhere deep inside but has been covered up by layers of fear, layers of politics and legal issues. People are fed up of seeing the more sacred experiences in our lives by constantly corrupted by these bottom line policies. I think when you see that in relation to babies, it’s horrifying.

Filmmaker: What was the first film you ever saw?

Epstein: The Wizard of Oz. I got sort of obsessed with it: I started to write spin-off series and I created these whole sequels about where the wizard would take off in his hot air balloon and where the wizard would land. I think it was a huge source of imagination for me. I ended up directing musical theater and going into all that, so that film had a huge influence.

Filmmaker: What’s the most embarrassing film you’ve watched the whole of on an airplane?

Epstein: It’s not on a plane, but sometimes I like to watch The Devil Wears Prada. [laughs] It’s the kind of film that’s totally for teenagers and you’re watching it and you’re like, “Oh my God, this is so formulaic and silly,” but you have to watch it to the end.

Filmmaker: Finally, what was your cinematic epiphany?

Epstein: I think it was sex, lies, and videotape. When I saw it, it was a revelation to me. I had been working in theater at that point and directing a lot of plays that felt exactly like that movie, so for me it was like, “Oh, this is what I’m interested in.” I’m interested in small, intimate human stories that take place in a few locations and are dialogue-driven and character-driven, and at the time that movie was really such a departure. It was not all these fancy filmmaking tricks and all of this technical wizardry, it was something so simple and small about it. It made the whole film world suddenly feel within my reach.

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