Ricki Lake & Abby Epstein on Birth, Midwives, & Business of Being Born

Once known primarily for her talk show and her role as Tracy Turnblad, Ricki Lake has become a flashpoint in the world of women’s health.

You can’t even think about getting knocked up these days without somebody recommending her 2008 project The Business of Being Born, on the state of maternity care in America. The documentary, directed by Abby Epstein and which Lake executive produced and appeared in frequently, is less an exploration than an argument, presenting the average hospital birth as an assembly-line experience where you’re hooked up to machines and dosed with pitocin to speed labor—whereas several homebirths are offered as empowering, joyful experiences which end in mothers blissfully clasping their viscera-smeared infants to their breasts. Those scenes are genuinely moving, but presumably there’s plenty of happy tears on the old-fashioned maternity ward, too. (Don’t even get me started on the segments about the “love hormone,” oxytocin.)

And thanks to that distinct point of view, the movie inspires strong feelings, both positive and negative. Natural birth and homebirth advocates recommend the movie enthusiastically, as an eye-opening introduction to what’s wrong with the way modern America does childbirth. Women deserve to feel more agency from this process, they say, not less. But mention homebirth around an American medical professional, and chances are she’ll get nervous as a cat. Obstetricians insist that when labor starts going wrong, it goes wrong very, very fast, and you don’t want to bet your baby’s life on making good time in your rush to an emergency room. And all this emphasis on birth as a powerful, life-changing, emotionally defining event can get a feminist’s hackles up real quick.

But it’s worth noting that the movie actually closes with Lake’s collaborator Abby Epstein’s own attempt at a homebirth—which ends in a dramatic late-night trip to the hospital, because she went into preterm labor and the baby was breech. It serves as a nice counterpoint to all the ecstatically successful homebirths that preceded it, reminding the viewer that sometimes, only a c-section will get the job done safely. And alongside cultural phenomena like Call the Midwife, the low-budget movie’s viral popularity has helped mainstream options like midwife-assisted deliveries, as well as encouraging doctors and hospitals to reckon with a generation of women who don’t want to feel like they’re strapped into some impersonal clockwork mechanism. Doulas aren’t considered solely for nutty hippies anymore. People don’t automatically assume you’re an anti-vaxxer if you mention shopping around for birthing centers. (Well, not everybody at least.) The movie has empowered and encouraged many women to approach childbirth feeling that they have the right to speak up, to feel some investment in and control over a process that is, let’s face it, objectively fucking terrifying.

More recently, Lake and Epstein have lent their birthing celebrity to The Mama Sherpas, acting as executive producers on the project by Brigid Maher. It’s a documentary about collaborative care, a model in which midwives and doctors work together in an altered hospital environment. It makes an interesting companion piece, exploring an option with wider applicability.

Then there’s Lake and Epstein’s work on the documentary adaptation of the controversial Sweetening the Pill, which has already gotten her compared to Jenny McCarthy. They’re laying hands on a third rail of modern feminism—hormonal birth control. In their successful Kickstarter campaign to raise money for the project, they suggest that “we are coming into a moment where many women are seeking more holistic and empowering forms of birth control” and point to new offerings from the tech sector, which afford women more advanced fertility tracking options. “Hormonal birth control often dominates the conversation, but, like a hospital birth or cesarean, it’s not always the best choice for all,” they add. But if you watch the trailer, there’s a distinct drumbeat of danger, danger, danger.

Nobody will support a woman’s decision to opt for alternatives faster and more firmly than yours truly. I bailed on the pill after my pharmacist switched me between generics a couple of times and I began to worry the initial adjustment period was making my innate anxiety spike temporarily (plus I hated taking the damn things every day, and my doctor didn’t like the looks of my blood pressure, anyway). But confirmation bias is nothing to fuck with—the book Sweetening the Pill has been heavily criticized, and the fact is, for so many women, some variety of hormonal birth control or the pill specifically is still the best, easiest, most affordable option. Decades of studies say it’s essentially safe, and it’s not like unintended pregnancy is risk-free. Then, of course, there are the pro-lifers always waiting in the wings, ready to seize on anything they can use for more effective scaremongering.

All that’s to say: Lake has become a controversial figure. So when I got a chance to sit down with her and Epstein and ask a few questions, I tried to hash some shit out. Here’s our conversation, trimmed and lightly edited.

Cards on the table: I’m curious what you guys would say to somebody who’s planning to have kids in the next two years—

Lake: Like you, I’m talking to you!

Yeah, for instance. A hypothetical! Doesn’t want major abdominal surgery unless it’s absolutely necessary; wishes that midwives were considered an option that insurance took more seriously, but also feels a bit alienated by the culture around natural childbirth and around homebirth.

Lake: You feel alienated?

A little bit. And a conversation that’s about systemic issues has become this very personalized argument for a lot reasons that aren’t necessarily anybody’s fault. What’s fundamentally a question of, like, how do we get obstetricians to train other obstetricians differently, or how do we get them to work better with midwives, has become this question of “Well, I had a cesarean section and how dare you say…”

Epstein: Somebody just emailed that question into our last chat. Like, “I fought for my VBAC and how can all these people be getting cesarean sections?” And we said, “We really need to embrace all women’s choices.” It gets very judgy and weird.

What do you say to that woman if she were for instance sitting in front of you? What do you say to the woman who’s like, “I don’t fucking know!”

Lake: I think it is possible for any woman to have the experience that she wants. It’s about advocating for yourself. There are so many options. I think what the film has done is started a conversation and whether some people find it a time to be judgment about, “my experience was better,” or whatever, I think it’s great that the information is out there and it is getting better. The consumer has been informed about the options that they have in hospitals and protocols are changing because the consumer is demanding it. I mean, yes, there is still so much work that needs to be done with insurance companies and the laws are such in areas of this country that midwives are not, they have to have supervision in California for instance. There’s this law that’s in—where is it now, it’s now in the Senate, right? AB 1306. It’s this ridiculous law, that’s basically, it’s like, just, you know, writing in one sentence so that they have to have supervision by doctors. It’s like a Catch-22—no doctor is going to say, or be there, for the birth. You know? It’s just, it’s ridiculous. And things are changing and I have high hope that you will have that experience that you want.

Epstein: And whatever it is you want—that’s the other thing, too, is that I think it’s always been, you know, whatever is empowering for you. Whatever feels like it’s the birth you want. And if that’s the person who wants to schedule a cesarean delivery and they’re informed and they’ve been told they have options and these are risks and these are benefits and they’re like, “Well that’s good I choose that surgery,” great. There will be women who want to be drugged up to the gills and women who want to be a hot tub of water. It’s ultimately, I think, you know, what was hard—I think what moved us in the beginning when we made the movie were the women who kind of went in so uninformed and then were like cattle to the slaughter. Do you know what I mean? And then only woke up afterward and they were traumatized by their experience. You know, that’s what’s been sort of the norm—this kind of blind trust in, “I’ll just go along and if I do everything the doctor says everything will be great.” And it’s all happy-happy because everything about pregnancy and birth in this country and babies is, like, happy-happy! There’s no dark side. Which, believe me, there’s a huge dark side to everything about having children. We can both tell you.

Lake: Get ready, when they graduate high school they’re really pleasant.

Epstein: And from birth and postpartum. I mean, postpartum is so difficult. I mean, it’s difficult, you know?

Lake: Breastfeeding, it’s all really hard.

Epstein: It’s all challenging.

Lake: And amazing! And amazing. I mean, it’s amazing and I relish that time. Getting nostalgic about fourteen years ago—I loved, pregnancy was so amazing to me. I wish I wanted more children, to raise more children. I loved being pregnant so much. But it’s such hard work. But yeah, to go back in time and to experience that all over again, it’s amazing. But it is—there are a lot of obstacles and there are so many women that are so judgmental about everything. “What, you’re gonna work?”

Epstein: Oh, God, that’s really—the hyper-mommy moment that we’re in. It’s nauseating. This kind of super parenting weird moment in time, which, it’s the same thing as like, if you’re going to play into that shit when you’re pregnant, you’re doomed. You can’t get caught up in that shit. Do you know I mean? If you want to give your kid Captain Crunch and watch fucking TV while they eat breakfast, great! You know what I mean? They’re really going to grow up and be just as good a person as if you’re making quinoa and reading them Shakespeare in the morning. It’s fucking disgusting, I think.

It’s like, the shaming of the mother, it’s all this, like, you’re not good enough. And I just think, you know, it’s all very complicated and ultimately I think everyone, you want to have an empowering experience. you want to have a pleasant experience. you want to feel as in control as one could feel.

Lake: Of your body, be respected—

Epstein: You want to feel respected. You just want to feel respected, and listened to, and I think that’s the difference. And then if somebody you respect comes over to you and says, “This ain’t going well. This baby ain’t coming out.” Then you’re like, okay, fine. I trust you, let’s go have the surgery. And it’s not traumatizing. It’s totally different than if you’re with strangers and you feel like you’re at the mercy of strangers and you’re being coerced into some kind of an outcome. And I just think, that’s, women who are informed and respected and that can happen with OBs. It’s just not black and white. It’s not like, midwife good, OB bad. There are midwives who are really pushy and opinionated.

Lake: And have a schedule, and aren’t available when you’re in labor.

Epstein: Oh yeah, and women break up with their midwives and switch because they’re like, “She was too bossy,” or “She was too this.” And I think it also depends—look, after I had my c-section, which was in the movie, and then I wanted to try to have a vaginal, everybody was like, oh, are you going to do it at home? I’m like, no. Oh are you going to use a midwife? And the truth is, I used a high-ranking O.B., because I knew that would have the pull to get me my VBAC, and that’s the only reason I got my VBAC. Because he was able to tell everybody, nah, give her another two hours.

For our readers who aren’t as familiar with The Business of Being Born and the background, tell me a bit about how you got into this. Because at this point it’s activism, basically. You do a lot of women’s health projects. How did you get onto this path?

Lake: Well, I did a talk show for a really long time that was mostly about nonsense. It was a great thing and it was amazing and it was a phenomenon and it was like the voice of a younger generation. It was great. But after September 11—which, I was living in my West Village apartment and watched it all go down—and I had kind of an epiphany where I felt like, if i live through this day, where can I make a difference? I really had that kind of come-to-Jesus moment. Where can I make a difference? I’m this high-profile person, I did a lot of movies, but what do I stand for? What do I believe in? And I thought about it and I was like, okay, AIDS and cancer. And I’d had this profound, life-changing in so many ways birth experience two months before 9/11 in my apartment and I loved my midwife. I wanted to be a midwife. And I felt like that wasn’t necessarily being—women didn’t know about this option, really. It wasn’t being talked about. So I got kinda the bug on birth and birth options and natural birth and so that’s where I thought I could make a difference.

I didn’t know it was a documentary at that point. But Abby and I had worked together on The Vagina Monologues, she directed me in it, so she and I connected years later when I was in LA and I was like, I have this idea. So I gave her a couple of books, I gave her my birth video that I’d never watched, my homebirth. That’s really how it happened. We basically funded it ourselves and it was three and a half years and we didn’t know she was going to get pregnant, we didn’t know what happened during the birth was going to happen. None of it. It was so serendipitous how it all came together and became a balanced film for the most part. It definitely had a point of view but it wasn’t as rah-rah homebirth as we were planning because of her outcome. I think the gift of the film, because I was so mainstream and because my celebrity is so—

Epstein: Well, that was a blessing and a curse.

Lake: It was a blessing and a curse—why do you say that?

Epstein: I think your celebrity was a blessing and curse for a documentary because it’s very hard to integrate a celebrity. Because documentaries are usually about real people, about unknown people. And I think when the film first came out, before people saw it—do you remember? they were like:

Lake: “I Saw Ricki Lake’s Vagina!”

Epstein: “She’s exploiting the birth of her child for notoriety.”

Lake: There were some really nasty, nasty pieces. Jezebel would’ve gone crazy back in the day on that. But then we also had apologies written. It was unbelievable. We had, like, retractions. Once they saw the film, it was amazing.

Epstein: But it was kind of like on The Vagina Monologues. People would just write nasty things and they’d never even seen the play. With The Business of Being Born—”Oh, she had a homebirth and she’s naked and she filmed it?”

Lake: “Who does she think she is, she’s not a doctor!”

I watched it and I did really like that the ending, it included a full range—sometimes it goes really well…

Lake: By accident.

Epstein: And because we had that ending, we knew we could be a little bit more ideological in the first part of the film. We knew where it was going to go.

It’s nice when things are serendipitous like that! Get the ol’ Bob Durst “confession.”

Epstein: We didn’t quite get that.

Lake: I like to think we did.

But my career—I’ve been around for such a long time and this project, the fact that it’s being taught in colleges and universities, it’s part of the curriculum for women’s studies, ethics class, gender equality, nursing school—it’s fucking crazy that my little idea, post the apocalypse—it’s the most fulfilling thing I think I’ll ever do in my career because it was so personal. It was such a risk. I didn’t know it was a risk at the time, I just thought I really need to do this project. But it’s been the most amazing thing. And the fact that it came from the births of my two children—it’s really big.

Epstein: And it’s still going on. The fact that we just did these premieres of The Mama Sherpas in LA and San Francisco and like everybody showed up, in LA and SF. Every midwife, every O.B., every doula, anybody who was part of was just there and, like, paying homage to the fact that—

Lake: I’ve got to tell the story about the cop. We were having, like, a homemade spread before the reception. It’s so grassroots, these people. They have this homemade banana bread. So this burly guy comes up to me and he’s like “Are you Ricki? I just wanted to introduce myself.” His girlfriend, years ago, she wanted to be a midwife so she made him sit down and watch a movie. They weren’t even planning children or anything. It’s just a passion. So they watched the movie and the next day, he pulled someone over, he was working, and he pulled a couple over and she was clearly pregnant, and he was immediately like, “What kind of birth are you having? Are you aware that the c-section rate in hospitals is—” He started spewing out statistics.

Epstein: He started giving quotes about pitocin.

Lake: And he just said the impact it’s had on him and continues to have on him. And he’s not a midwife, he’s not in the field, he doesn’t even have children. But stayed with him. It’s such a cool, cool thing.

This was your personal project, very intimate, you said you didn’t know what you were even getting into. Are you surprised by the impact that it’s had? And what do you make of it?

Lake: Absolutely I’m surprised. I didn’t know that people would find this stuff interesting like I did.

I mean, I think the timing—I honestly wish I could package it and do it again. I do think with our other project, Sweetening the Pill, that is our next step or natural evolution of what we’re trying to do for women. I think it was just the timing. I think it was luck. And the public was ready to welcome this kind of information and look at birth a different way. That process, that right of process, really can be such a gift and such an opportunity. And that’s really what I got out of it, having my baby on my own terms at home. Which was my choice. It’s not a choice I would suggest for everyone, but that’s where I felt safest, and respected. That power that I felt during that nine-hour birth has stayed with me through every other experience of my life.

Epstein: And it was a real healing for you.

Lake: I mean I was a victim of sexual abuse as a child and to not have my body be violated in any way, to come to terms with my body image—hating my body for so many years of my life—to see what a miracle, what my body did in that moment. Still, it’s 14 years ago with my youngest—it was a miracle. And I know everybody can see it on the celluloid, but in that moment of her telling me to reach down and pull out your baby—it was badass. That is badass stuff.

Epstein: That is the moment, too—when she first approached me about doing the film, I really wasn’t sure, because I thought it sounded really boring. Because who wants to make a documentary about midwives? Come on. It sounds like 99-cent bins. And then she gave me some books, and then when she showed me that little clip that’s in the movie—which she literally showed me, like, on her camcorder, and when I saw that moment of the baby coming out of her—

Lake: [doing an impression of herself] “Oh my God! Oh my God! Oh my God!” When you saw me squealing.

Epstein: For me, that was the moment where I was like, holy fucking shit. Because I’d never seen a birth that wasn’t screaming and blood and pain. Right? Because that’s all you see on TV. And there is this woman who is my friend, and I kind of know what a wimp she is. So seeing her do that—I was like, Oh my God. And then I started to think, if she could do that, maybe I could do that. For me, there was this ah-ha moment in seeing her birth that I thought let me know maybe this could be a film. I think that’s what happens, is people see the film and it sort of resonates inside them, in information the kind of know in their DNA but they maybe haven’t learned.

Because birth is something that used to be more communal. All the women would gather and you would see your sisters and your aunts, you would see other women in labors.

It’s not a mystery. By the time you’re doing it, you’ve seen it happen several times.

Epstein: And I think that’s huge. Because by the time I had a baby, I’d been at several births. And so it probably worked against me because I was overthinking everything, you know what I mean? But it normalizes it. And I think that’s been a big impact of the film, is taking that TLC thing out of it. It’s always bloody and screaming and awful.

I started watching the footage of women walking around during labor and I was like, “Oh, I get natural childbirth now.” I’m still not convinced that I want it, but like, I get that it’s doable.

Epstein: And you have to want it, by the way. You can’t just be like, “Oh, we’ll see how it goes!” You’ll just be like, “I’ll have drugs.”

I do want to go back that thing you said about it being a powerful experience. It’s obviously a very powerful experience for many women, and people testify to that, and it can really be a landmark event in your life. But I’ve also known women—you know how some people are baby people and some people aren’t and that doesn’t mean they want kids any less, it just means that they’re not baby people? Some people get really into birth and see Business of Being Born and want to be a doula. But some people, it just doesn’t speak to them.

As natural childbirth and this more empowered form of birth has become bigger, one of the offshoots has been a focus on trying to achieve this experience. And I’m curious whether we’re pushing back on one kind of pressure, but another is cropping up.

Epstein: I think it’s a very valid question. It’s totally a judgy mommy-war.

We were accused of that originally when the film came out—like, oh, you’re trying to make women feel bad.

Lake: I know my intention was not to make any woman feel bad about her choices.

Epstein: You can’t, I think breastfeeding is way more of an issue like that, because it’s in public. So when you whip out your little formula and start shaking it up—do you know what I mean? Or when you whip out your boob. Breastfeeding is, I think, everyone thinks it’s their business. At least birth is more private. You could talk of, like, I don’t know, privileged white women, about achieving a birth or whatever. But if you watch The Mama Sherpas, and you see what midwives really do on the ground, it’s giving women that have no money, don’t speak English—it’s saving those women from a very potentially traumatic and intimidating experience. That’s really what most midwives do, is work with women who don’t have means, who don’t have options. Traditionally, in a lot of settings, like when we were shooting at Mt. Sinai, anybody who walked in off the street got shoved with a midwife. You know what I mean? Honestly.

So there is definitely—I don’t think there’s a status about your birth, but this kind of speaks to—remember with Alanis and her homebirth, when we interviewed her for a follow-up? Alanis Morissette, right, who was one of these women who decided oh, I want that. Has this homebirth, totally, like, the baby comes out at 6 o’clock on Christmas morning with the mists rising. She was completely traumatized by it.

Lake: She had a really, really, really difficult birth.

Epstein: And she said, “And I think I would have been just as traumatized if I’d been shot up with drugs.” It was just a very difficult experience for her. It wasn’t transcendent. She had PTSD and postpartum. She’s been very vocal about it. Look at postpartum depression.

I think that it’s not always this groovy, transcendent experience. But I do think that we’re designed physiologically for it to be a tough experience, because I think parenting is fucking tough.

Lake: Yeah, a little precursor to what you’re about to ensue forever. Forever! It’s so hard. I’m just warning you. It’s so hard. And it doesn’t get easier.

“Ricki Lake Told Me Not to Have Kids!” Kidding, kidding.

Lake: I’m just giving you a disclaimer. It’s so hard. Yeah.

Epstein: But I’m saying the birth doesn’t necessarily mean, like—even your first birth, for example. That was a good birth. But you didn’t feel good. Right?

Lake: I mean, it was a success. Healthy baby, healthy mom. I was able to put my baby skin-to-skin right away, I had a vaginal birth. But looking back, which is why I wanted to have another experience and ultimately make a film about it, I felt like there were unnecessary interventions that were given to me just because I was on that assembly line.

Epstein: You felt like you were on that assembly line.

Lake: Yeah. But I was able to have a walking epidural, I could squat on the ground, which was cool.

Epstein: It was successful, right?

Lake: Yes. But it wasn’t what I wanted.

At the end of the day, we all want the healthy mom and healthy baby, period, over and out. But if you can be empowered in the process, if you can get in touch with your power, I think that can really stay with you forever.

Epstein: There’s no way to prepare psychologically. But I do think—and we’ve talked about this in our book. We have a book.

Ya’ll are very busy.

Epstein: But we have a whole chapter in our book about birth for survivors of sexual abuse. Because that’s a huge thing, and that will come up in your labor and rock the shit out of you if you haven’t dealt with it. That’s what labor’s designed to do—it brings you to your knees. It can be traumatizing, it can be empowering, enlightening. It’s more complex than we give its due in our culture.

That’s interesting though because you’re saying, a lot of the rhetoric is we’re designed to do it, we don’t need surgeons to do it, but then, it’s interesting what you’re saying there. There’s a tension there. It’s hard but we can do it.

Epstein: But it’s not in your control and I think that people who, like, planned their homebirth from day one—

Lake That’s me!

Epstein: No, but the first one.

Lake Oh, the first one, no no.

Epstein: I’m just saying, some of those people you’re always like, oh boy.

Lake: But I’m a control freak. I’m a total type-A Virgo. I planned both of my births, I got pregnant the first time I tried with both my kids, no miscarriage. But yeah, it is completely out of your control at the end of the day.

Epstein: Yeah, I’m saying, the first birth for you, you lost control of the story or whatever. And I’m just saying, some of those people, it almost makes you go, “Oh my God, they’re so going to end up in the hospital,” just because it’s hubris to think that you could just have a great meditation CD and it’s all gonna happen.

Lake: Hypno-birthing, check that out. I wouldn’t do that. I didn’t know about that.

Epstein: It’s, like, a spa experience.

Lake: It can be! For the select few. You can have an orgasm during birth. I don’t know anyone who has but it’s apparently possible.

Epstein: Yes, that’s true. I guess there’s a lot of power to putting out the possibilities and seeing these—people gave a lot of shit to Gisele in our movie because she was talking about her homebirth and comparing it to surfing or whatever. She makes it sound so easy. But you know what? She kind of manifested that shit. She was so in the zone, honestly. She’d trained for that mentally and I’m sure she—you can control the level of pain you experience, because if you’re primed for a terrifying painful experience—you know what I mean? I think there’s a lot of it that you can condition. Even my first birth when it went terribly and it was that emergency blah blah blah, I was never scared because I knew so much. I knew everything that was going on.

Lake: Her water broke in the taxicab. It did.

Was the cabbie cool about it?

Epstein: I don’t even know what happened. I just remember getting out and there was so much blood on his seat and I remember throwing him $20 to clean his cab.

So, Mama Sherpas. You’re the producers, not the directors, but tell me about your involvement and what you hope comes of it. It seems it’s a lot more, like, “Let’s have midwives working within the system.” Business of Being Born is obviously pretty homebirth focused, but Mama Sherpas looks more like it’s about “Let’s have midwives working with O.B.s in a hospital that’s more like a birthing center.” Tell me a bit about what the outlook is and what you hope to come of your involvement.

Epstein: I think we got involved with it just to help it get some exposure, initially.

Lake: Because midwives, there’s like a one percent homebirth rate in this country.

Epstein: Less. It might JUST be one percent.

Lake: But eight percent of births are midwives-attended. Most of that is in hospital. So we wanted to really feature collaborative care, midwives working well with obstetricians in the hospital setting, what women are able to get in this birth experience. We’ve got the natural progression of The Business of Being Born onto this. And it’s a really well-made film and I think women will learn a lot—women like you, who are planning that birth in two years.

And midwives are amazing. It’s an amazing profession, it’s very different than obstetricians. They’re there for those women through labor, not just at the end, catching the baby. and these women that we feature, these midwives, are just extraordinary practitioners.

Epstein: I think it’s just a very natural progression. Because we did get a lot of questions—because even in The Business of Being Born there is birth that’s in a hospital birth center with midwives, but for some reason people still thought it was a home birth, even though it says “Roosevelt Hospital Birthing Center.” It just didn’t play, and people didn’t really get it, because we just didn’t have time in that movie to hit all the notes. We just thought, great, since most women are going to birth in hospitals, this kind of demystifies it and I think it’s been helpful a lot of times for women to be able to show their partners a film. Because partners don’t like to go to classes and read books. You know what I mean? It’s a nice tool. “Oh, here’s why I want to use a midwife, “ and they watch it together and then the partner kinda gets it within 90 minutes. It’s like, oh, I see, that model of care makes sense. Because you have to do some work to find a midwife that takes your insurance, you know? It’s difficult. And I think that doulas have become really in vogue and popular and midwives are really still struggling. In New York it’s been really difficult. Things are terrible. Saint Vincent’s was a mecca of midwives. Not only did they employ so many midwives, but so many homebirth midwives used that as their backup.

Lake: And they supported Elizabeth Seton, the only freestanding birth center that was in Manhattan, that has since closed. There are less options in New York City.

Epstein: New York is tough right now. It’s very tough. Hopefully a movie like this will show a paradigm that institutions will want to emulate and women will demand—why doesn’t my hospital have it? And med schools, too. When we showed The Business of Being Born at medical schools, a lot of the med students would raise their hands and be like, why don’t we have a midwifery rotation? And they’d be like, “Ask the dean!” Med students are very young and open. It’s really important for them to also see this.

Tell me about Sweetening the Pill. I think a lot of young women are suddenly disaffected with hormonal birth control (I hated my pill!), so it’s an interesting project. How did you get involved?

Lake: Abby, you tell it, because you found it. Holly sent the book to us and Abby, it was sitting on her desk for six months and she was on a flight and she read it and she landed in L.A. and she was like, I think this is our next project. And the book is really in your face—I don’t know if you’ve checked out the book, but we’re going to be a little bit more balanced in the film. But it is something definitely worth exploring and me, who was on hormonal birth control for 20 years off and on, I took the morning-after pill once or twice, I mean, I’m someone that fucked with my hormones, and in hindsight looking at things that I’ve suffered from, I wish I knew then what I know now. With the new progestins, the changed generations of these things, they re-patent them. They’re getting more and more dangerous.

Again, we don’t want to, as Jezebel quoted us, we’re “scaring women off of whore pills.” I don’t think that’s the goal. The goal is to do what we did with birth, with The Business of Being Born, for birth control. There needs to be more options. We look at the pill, the pill has been around 55 or 60 years. It was an amazing breakthrough at the time, incredible for women’s independence and for their careers and to be able to control their careers. It’s amazing. But I think that there needs to be more options available.

My question with this is always: More people are turning to IUDs or even charting, but I’m hesitant to talk about it, because there’s an entrenched political movement in this country that is about restricting my options and I don’t want to play into their hands.

Epstein: But you can’t help that, and that’s the thing. We’ve had, like, the Catholics—and it’s just like, yeah, you don’t get what we’re doing. You just can’t really help that, because everyone’s gonna jump on you. But I think the bottom line is that we want more access to birth control. We want more women to have birth control that fits with their values and their lifestyle, and that’s not happening now.

Correction: A previous version of this post said that Epstein transferred to the hospital because her labor wasn’t progressing; in fact she went into labor preterm, and the baby was breech, necessitating the trip. This has been corrected.