Are you trying to decide whether to give birth at home or in a hospital? You are not alone. In the United States, approximately 35,000 births (0.9%) per year occur in the home. Three-quarters of these births are planned and attended by a midwife. Rates of homebirth vary across Europe, with some of the highest numbers of women choosing homebirth in the Netherlands (16.3%), followed by Denmark, Sweden, England, Slovenia, Ireland, and Scotland. Netflix’s recent film, Pieces of a Woman, may seem like a great way to learn more about home birth. Regardless of where you plan to deliver, I would advise saving Pieces of a Woman for a time when you are not expecting or in your childbearing years.
Martha (Vanessa Kirby) and Sean (Shia Labeouf) are a white couple living in Boston who choose to have their first child at home. Just seven minutes into the film, Martha goes into labor. Unfortunately, the couple’s baby tragically dies minutes after being born. The audience is left as devastated and shell-shocked as Martha and Sean. Viewers must pick up the painfully sharp pieces of relational shrapnel to find some direction in the meandering plot. This is not an entertaining task as the couple spirals out of control in waves of self-destructive grief. The film’s cinematography, directing, and acting are top-notch. Regrettably, they don’t outweigh the risk of possible vicarious trauma watching the film could cause for expectant audiences.
A Story Born From Personal Tragedy
Real-life partners Kornel Muncruzcó, a Hungarian-born director, and Kata Weber, a writer, lost their own child during childbirth. According to Weber in an interview with the Independent their grief and the stigma of neonatal loss drove them to want to explore healing from:
“[T]hings that are so hard to talk about… the tragedies that are no one’s fault… the things which are not under our control, like losing a child…which goes absolutely against the circle of life.”
Weber and Muncruzcó did not talk much about the depth of their grief. Years later, Muncruzcó discovered some of his partner’s journal that she had titled “Pieces of a Woman.” These fragments broke the couple’s silence. They used these journal entries to first write a play, set in Poland, before developing the screenplay set in Boston.
The drama is also loosely based on the case of a Hungarian midwife activist. Hungary only legalized home births in 2010. Midwives around the world have long fought against misperceptions and a lack of understanding of their medical expertise. In many parts of the world, midwives are medically-trained health care professionals. Midwives (depending on their training) can deliver babies in hospitals as well as at home. Pop culture and the media do not always portray midwives accurately. Unfortunately, Pieces of a Woman does a disservice to midwives or homebirth with its portrayal of a home birth gone wrong.
That Labor Scene
Pieces of A Woman does not waste any time getting to the heart of Sean and Martha’s tragedy. In the first thirty minutes of the film, we watch Martha give birth in real time. As any midwife or ob-gyn will tell you, this is extremely fast and unrealistic for any first-time birth. Even though it is a masterpiece from cinematographic and acting perspectives (filmmaker Muncruzcó shot the entire scene in one take without any cuts), watching this film should not be on your pre-baby prep list.
Thirty-two-year-old actress Vanessa Kirby has never given birth herself, but you would never guess that from watching her labor on camera. From belching and vomiting in early labor, breathing through contractions in her tub, to the almost catatonic state of transition, Vanessa Kirby nails it. She reportedly shadowed an ob-gyn and attended a live birth in preparation for her role. Many in the film industry are already whispering about an Oscar nomination for her in this role.
During the chaotic labor, a backup midwife (played by Molly Parker) arrives late because Martha and Sean’s primary midwife is detained at another birth. The midwife desperately tries to get Martha to stay still in one position long enough to listen to the baby’s heart rate, but as is revealed later in court, she only listens for the baby’s heartbeat three times from when she arrives until delivery. While the baby is born alive and the couple experience a few devastating moments of joy, the baby rapidly (in a matter of seconds) stops breathing and dies before EMTs are able to save her.
Besides not checking on the baby frequently enough during labor, some midwives also note that the birthing equipment the homebirth midwife brings with her is woefully inadequate. As one Canadian midwife commented: “We carry the equivalent of level-one hospital equipment with us: anything and everything you would need up to the point of a cesarean section or vacuum or forceps. We have IV equipment, oxygen, and very extensive training in neonatal resuscitation. Our skills are much beyond what is ever shown.”
When Things Don’t Go According to Plan
Pieces of a Woman is a visual depiction of many pregnant women’s nightmares. That is why watching it while pregnant, could be too upsetting or anxiety-producing. We all logically know that things can go wrong during labor and delivery. Bad things can happen whether we give birth in a hospital or at home.
Planned home births are considered relatively safe under certain conditions. Nevertheless, the American College of Obstetricians and Gynecologists (ACOG) believes that hospitals and accredited birth centers are the safest settings for birth, not homes. The US’s largest professional association for ob-gyn’s has not come out with any professional statement on “Pieces of a Woman.” The American College of Nurse Midwives (ACNM) faults the movie for:
“perpetuat[ing] a common cultural narrative of homebirth as an unsafe choice and midwifery care as somehow to blame when tragic events occur. Over time and consistently, midwifery care practiced in an integrated system that supports interprofessional communication and seamless transition of care based on the needs of the individual has been shown to result in optimal outcomes.”
Midwives and homebirth advocates feel that the writer’s choice of home birth for the setting of the baby’s death takes attention away from the topic of childbirth loss. Viewers, as well as Martha’s mother, Elizabeth (Ellen Burstyn) and her partner Sean, are able to blame Martha for choosing homebirth rather than supporting her in her grief. In the most heart-wrenching line of the entire movie, an angry Elizabeth lashes out at her daughter when she says “If you’d done it my way, you’d be holding your baby in your arms right now.”
According to Manavi Handa, a Toronto-based registered midwife in her interview with Now Toronto Magazine, “The movie is about childbirth-related loss, and how much of a strain it puts on the family unit, and how different people respond differently. I think they did a really good job of showing how much grief affects the couple’s relationship. I almost felt like the home birth idea detracted from all of that. They were grieving about “the mistake” of home birth versus grieving the very real loss of a child.”
Professional midwifery organizations worldwide cite research demonstrating that home births for women with low-risk pregnancies are as safe as delivering in the hospitals. ACOG maintains that “although planned home birth is associated with fewer maternal interventions than planned hospital birth, it also is associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000).”
Debate continues between midwives and doctors partially because there too few high-quality, randomized-controlled studies looking at the safety of homebirths. Women and their families are left to try to make the most informed decision they can, balancing their desire for a home birth with their comfort with some degree of risk. “Pieces of A Woman” does not tell the story of Martha and Sean’s choice of homebirth, another point that leaves the viewer feeling confused and wanting to blame the victim (Martha).
The Complexity of Grief
In her depths of despair, Martha shuts out both the audience and her entire family. She desperately races back to grocery shopping, her job, and normalcy. She strips the nursery walls of ultrasound photos and breaks down the crib with an emotional coldness that alienates her family, her partner, and the viewer.
As a result, Sean (Labouef) runs down a predictable checklist of self-destructive behaviors to cope, including violence, alcohol, and drug abuse. Watching LaBouef throw the birthing ball at Mary’s head in a fit of anger reverberates with traumatizing reality given the actor’s current state of legal affairs. His ex-girlfriend (FKA twigs) accused him of perpetrating sexual battery, assault, and emotional distress in a Los Angeles courtroom in the fall of 2020.
As uncomfortable and depressing as it is to watch, Pieces of A Woman successfully unwinds the complexity of the human grief response. From Martha’s avoidance to Sean’s violence, the viewer is bombarded with sharp testimonies of grief’s power to unravel even the most intimate relationships.
Martha’s stubborn fight to come to terms with her loss in her own way brings some redemption to the film and relief for the viewer. Gritty Holocaust survivor Elizabeth, Martha’s mom, feels betrayed and angered by her daughter’s unwillingness to take the midwife to court or to charge her with criminal negligence. It is ultimately her mother’s betrayal that emboldens Martha to deliver her impassioned defense of her midwife in court at the end of the film:
This woman did not intentionally harm my girl. She only wanted to deliver a healthy baby that night. Do not think it is her fault…There might be a reason for what happened but we are not going to find it here in this room… If I stand here and ask for compensation and money, I am saying I can be compensated. And I can’t. It can’t bring her back. No money, or verdict, or sentences can bring her back … How can I give this pain to someone else, to someone who has already suffered? That is not why my daughter came into this world for the time that she did.”
In her soliloquy, Martha gives voice to what ACNM calls “the secondary trauma experienced by those providing care when unexpected outcomes occur.” In some ways, the viewer is struggling to process this secondary trauma a well.
To Be Saved For Later
“Pieces of a Woman” would not be at the top of any list of movies for expectant mothers to watch. If you are looking for some other suggestions of less-traumatizing movies about pregnancy and childbirth, The Pulse has already put together just such a list for your viewing enjoyment. Instead, save Pieces of a Woman for a time when your children are grown or you are no longer considering childbirth. You will be able to appreciate the film’s brilliant acting (particularly Ellen Burstyn and Vanessa Kirby) and the way it shatters taboos around pregnancy loss, neonatal death, and human grief. While “Pieces of A Woman” tells an important story, it is one to save for the right place and time.