Photograph by Benjamin Loeb, Courtesy of Netflix
Pieces of Woman, starring Vanessa Kirby, was released on Netflix in January after having generated plenty of hype as it moved across film festivals last Fall. The sheer abundance and variety of reactions it has since received from critics and audiences alike, as well as the nature of the subject matter, made us want to watch for ourselves and give you our take on the story. We’re not film critics, so that’s not what we’re here to do, don’t worry. We do, however, want to address how the film portrays home birth, loss, and pregnancy and postpartum experiences in case you’ve been grappling with that yourself.
To over-simplify a complex story, the film follows Martha Weiss (played by Kirby), through an unexpectedly tragic home birthing experience and the resulting grief that ripples through her family following the death of her baby. If you haven’t seen the movie, we do want to warn you that the initial scenes are very difficult to watch, and it may be triggering for some viewers. We’ll be talking about some strong themes regarding pregnancy and birth complications, loss, and grief as thoughtfully and respectfully as possible. You do not have to watch the film to follow along with this post, but if you have seen it we would love to hear your thoughts in the comments below.
Now, without further ado, we watched Pieces Of A Woman (so you don’t have to), and these are our thoughts:
To reiterate, the initial scene of Pieces Of A Woman (POAW ) that covers Martha’s home birth is hard to watch. Birth is an incredible feat of the female body and there is such beauty in its raw power, but knowing the direction this movie takes while you are watching it unfold makes for a heart-wrenching 24 minutes (yes, we counted…). If you’ve seen the movie or just read the onslaught of reviews we feel it’s most important to set the record straight on topics related to birth plans, home births versus hospital births, and unexpected complications so we’re addressing those in turn below.
When it comes to birth plans…
Your motherhood journey is going to come with a lot of decisions, some seemingly bigger than others. One of those key decision points is where and how you’d like to give birth. In POAW, Martha and her partner decide on home birth, assisted by their midwife, which we later find out is met with disdain from the more ‘traditional’ views of her mother.
Just like any well-laid plans, birth plans rarely (if ever) go 100% according to what women might envision or expect. But that doesn’t mean you shouldn’t make a birth plan! The opposite is true. A 2012 study published in the Journal of Perinatal Education found that a woman’s recollections of her birth experience were more influenced by her level of “choice and control [of her birth plan]… than to the individuals present in the birthing room or the particular interventions that were chosen or necessary”. Over the years, outlining a birth plan has become central to maternal wellbeing and preparation for childbirth, and the most critical role healthcare professionals can play in this regard is providing women with as much credible information as possible to help them make an informed, empowered decision.
Our top takeaway on birth plans: your birth plan is your own. It’s not your partner’s, not your mother’s, not your doctor’s or your midwife’s. Making an informed decision about your medical care is an important step that should be completely thought through, and this also means having a backup plan (and possibly even a backup plan for the backup plan).
When it comes to home births vs. hospital births…
Home births have been on the rise for years and with the current pandemic causing concern over hospital safety and changing policies, midwives seem to be getting more interest in them than ever before. The majority of people still choose hospitals or birthing centers for their birth plans but for some, home births offer an appealing alternative. Of course, there are pros and cons to each.
About 1% of births (35,000) happen at home each year in the United States, and around 25% are unplanned. In the UK, about 2% of births happen at home per year, on average. The majority of home births are opted for by women who have already had at least one child. Regardless of where you give birth, you’re less likely to experience interventions, maternal morbidity, and neonatal morbidity or mortality if you’ve given birth before.
Recent studies show that compared to hospital births, “planned home births are associated with a lower maternal infection risk, fewer maternal interventions, and vaginal and perineal lacerations” (American Journal of Obstetrics & Gynecology). That means a planned home birth might mean a lower chance of labor induction, episiotomy, and C-section delivery. However, this again is not a “one-size-fits-all” situation and home births come with some necessary precautions to keep both mother and baby healthy.
The American College of Obstetricians and Gynecologists (ACOG) recommends that women curious about home births should know the following:
- Whether or not you are a good candidate for a home birth. Although a home birth might sound appealing, it’s not the best fit for every pregnancy. Research shows there are similar perinatal mortality rates between planned home births and hospital births when “women have a singleton pregnancy between 36-42 weeks, no pre-existing maternal conditions, no serious diseases developing during pregnancy, labor is spontaneous or induced as an outpatient, and is not being transferred from another hospital“. If these criteria are not met then there is a higher risk of perinatal death. That’s why having multiples, a previous C-section, or improper fetal placement is seen as a direct complication for home birth by the Committee on Obstetric Practice.
- Potential risks and benefits, as found by scientific evidence. Although ACOG believes the safest place for birth is at hospitals and accredited birthing centers, every woman still has the right to make that decision on their own and she should be informed about the risks and benefits of that choice. Home births are associated with fewer maternal interventions than hospital births, but they also have “double the risk of perinatal death and triple the risk of neonatal seizures” in the United States.
- Availability of proper care and consultation. A midwife whose education and licensure meet the International Confederation of Midwives (ICM) Global Standards for Midwifery Education and access to consultations are shown to help reduce risks of adverse outcomes. Midwives assist with home birth more often than hospital births, and research shows that “care led by midwives is linked to fewer interventions during childbirth“. This could be a certified nurse-midwife, certified midwife, or midwife that meets the educational and licensure standards set by ICM. Planned home births attended by “midwives without this certification have higher maternal and neonatal morbidity and mortality rates“.
- Access to safe and timely transportation to a nearby hospital. In case something unexpected does happen, you want to be prepared. In the United States, about 23-37% of women having their first birth at home need to be transferred to the hospital during labor, and about 4-9% of women who have already given birth before need to be transferred to the hospital. Research shows increasing the distance from the nearest hospital increases the potential risk for adverse outcomes, so knowing how you can get to the hospital and how long it will take is an important part of being prepared.
It’s important to note that not all women fall under the same categories for risk, as there are pervasive racial disparities linked to maternal health complications. Women are 2 to 3 times more likely to die from pregnancy-related causes if they’re Black, American Indian, or Alaskan Native. Many of the deaths related to pregnancy are preventable, but have been persistent for years and continues to happen across the country. Talk to your doctor about what risks you have due to factors like your race, age, and conditions. Together you should create a birth plan that limits and reduces your risks of adverse outcomes as much as possible, and makes you feel comfortable.
A final point to note is that the American Academy of Pediatrics also recommends that pregnant women giving birth at home should be at least 37 weeks pregnant (as less than 37 weeks’ gestation is technically considered premature) and that each woman has a healthcare team of at least 2 people — one of whom must be responsible for the health of the newborn.
In POAW, we don’t have any context to understand Martha’s situation in regards to the 4 consideration points outlined by ACOG above, but there is only one midwife present at her birth. What is also clear is that when there does appear to be fetal distress the decision to transfer to the hospital becomes muddled.
Our top takeaway on home births vs hospital births: the decision as to where you would like to give birth is part of your choice as the woman, but this must be weighed with your particular circumstances, medical conditions, or potential complications. Communication in this regard should be clear and straightforward, and we always urge you to take the medical guidance of your healthcare professional. At the end of the day, everyone’s goal is a healthy, happy mother and baby.
When it comes to dealing with the unexpected…
Complications, stillbirth, and maternal and infant loss are devastatingly real. But what’s more common are healthy pregnancies and deliveries. There are always going to be “what if’s” and unknowns and it’s normal to experience anxieties related to childbirth; but focusing on proactivity, informing yourself, and preparing for alternatives will help you feel more in control of whatever situation that comes your way. Remember, the only moment you have control over is right now, and that’s why we are such big proponents of mindfulness and using your present moment to regain feelings of control and calm your stress response. It can be such a powerful tool in your labor process.
When unexpected complications and loss do occur, the emotional turmoil that follows can be devastating. Coping with unfair tragedies is such a painful part of life, and that grief process looks different for every person. We’ve spent this entire post talking about the first 30 or so minutes of the POAW film, without having touched on the remaining 3/4 of the film where you see the crippling toll that grief takes on Martha and her family, as well as her own path to healing.
While a lot of reviewers have given flack to the portrayal of grief and the aftermath of this tragic situation, it urged us to take pause. We know this is a movie, but it calls out to real experiences suffered by many women and families. How can you bottle up that kind of grief experience into 90 minutes of a Hollywood film? You can’t. And we don’t expect this movie to encompass postpartum loss and grief in its entirety. That could never give it justice because no one knows someone else’s grief; we don’t get to say what it should or shouldn’t look like. And that’s the last takeaway we want to leave you with…
If you’ve experienced a loss, our hearts go out to you completely. We see that pain and we know no one can take it away or feel it in the same way as you. Please know that you deserve all the time you need to move through it, and only you get to decide what that looks like or how long it takes.
If you have seen Pieces Of A Woman or if you’re on the fence about watching, please share your thoughts, comments, questions, or concerns below. We’d love to have this conversation with you.