All About a Birth (Juno and Knocked Up)

So, like just about everybody else, I loved Juno.

Ellen Page’s stunning performance made the movie. Rarely in a movie is someone so sassy yet not only sassy. Sassafras, like irony, is often one-dimensionally hostile; wit is used to say “don’t tread on me” and spare the audience further character development, especially with teenage characters. But Page and director Jason Reitman — both of whom deserve the Oscar for which they were nominated — make Juno MacGuff smart and vulnerable in the same breath. She is sassy because the wants to be, because she’s a know-it-all, even because she is vulnerable. That juxtaposition is one of the only real things in the movie, but that is enough to power the audience’s suspension-of-disbelief through the rest of the “fairy tale,” as one New York Times op-ed writer calls it.

But Page isn’t why I left feeling so good, nor is the film’s quicker-than-life humor, which certainly made me laugh. Because so did Knocked Up, and I left that movie feeling kind of sour. But the movies’ treated their pregnancies very differently, and I think therein lies the rub. I agreed with one; I found the other objectionable, at least partially offensive.

Juno all-but-ignores that teenage pregnancy is at the center of the story. It is fair target for jokes, but not for any serious discussion. But pregnancy and birth in general are portrayed positively. Juno with her belly is no less attractive than without it. In fact, Bleeker wants her more than ever when she is so big she looks like she’ll pop. (I have to admit, I was rather confused by his absence for 98% of the movie and can only guess that it is so emphatically Juno’s story that there is no room for him in it.) In Juno, pregnancy and birth are both perfectly natural. It is how we deal with that nature, intended or not, that matters (and I don’t mean Juno’s choice not to have an abortion).

That was not the case with Knocked Up, where pregnancy seems to invade not only Allison Scott’s life (she gets turned away from the club she rocked a mere six months before), but her body. And it is a hostile takeover. I left Knocked Up feeling good about people – it was a feel-good movie, after all – but the icky portrayal of how those people come into the world pissed me off.

I’ve become increasingly aware of Americans’ ambivalent, even dysfunctional, attitudes toward birth. Nowhere is this more evident than in the CDC’s statistic that in 2004, nearly one in three babies was delivered by cesarean section. The rate of birth by c-section rose 46 per cent between 1996 and 2004. That’s astounding. (Incidentally, the same report shows that the rate of birth to teenage mothers has fallen to the all-time low of four percent of all births. Seven-and-a-half times as many babies are delivered by cesarean section as are born to teenage mothers. Of course, the social costs of these two events are apples and oranges, but at least the costlier one is headed in the right direction. Perhaps that is why Juno was able to all-but-ignore teen pregnancy.)

Allow me to editorialize: Clearly, a lot of babies are being delivered by cesarean even when there is no medical indication for the surgical procedure. Why any doctor would agree to cut open someone’s belly without a damn good medical reason is beyond me. I’m sure if I went into the hospital and cheerfully requested an appendectomy, I would be refused.

In part, this growing trend is the result of the increased medicalization of birth over the past century. (Although I can’t find the data to pin down an exact date, I’d hazard that most American baby’s were delivered at home until the 1950’s, although many or most might have been attended by a doctor before then. Until after the Depression, most rural residents lacked access to a hospital and during the Depression, few could afford a hospital birth, anyway.)

A second factor in the increased rate of c-section could convenience for the mother and doctors. According to my father, who works as an epidemiologist, some data suggest that doctors may prefer cesareans as a way to gain some control over their schedule. One can see that might also appeal to certain groups of women, too.

So how do Knocked Up and Juno figure in? There could be a third factor: ambivalent or negative attitudes toward birth resulting from unfamiliarity or misconception. For which, of course, I would hold media representations such as Knocked Up partially responsible.

Part of the issue is that our experience with birth is becoming increasingly mediated by the media. In a rural economy, as existed in much of this country several decades ago, everybody would be introduced to birth on the farm; the success of the farm depended on it being a regular event. When (human) birth happened at home, a girl might also attend the birth of siblings, nieces or nephews, or neighbors, even if she was just there to hold the mother’s hand or run for a glass of water. As families become smaller and our society more urban (conditions that have existed at least since World War II, if not earlier), people experience birth less personally and more through media representations, until at last they experience it themselves. By that point, it is the media that have established what to expect from a “normal” birth.

Often in a movie, birth is the climactic event in which multiple layers of tension collide, exacerbating the harrowing effects of complications and substandard medicine. OK, so perhaps I tailored that description to Knocked Up’s climactic scene, and I can’t deny that from a narrative perspective, birth is a good climax. But such births are hardly typical. On the contrary, most births, especially when the mother and child have been receiving prenatal medical care, proceed without complications.

I’m not saying that giving birth is a piece of cake; all but the most miraculously easy births (of which I hear mine was one) are painful and physically and emotionally exhausting. Some have complications. Birth is a big deal. But, as pioneering midwife and hippie-commune co-founder Ina May Gaskin points out, the human body is physiologically designed for birth to work (it is an evolutionary necessity). But, she continues with great medical detail, as with anything else, excessive anxiety will make birth more difficult; if people expect a hellish experience, they will be more likely to get it. Which is why the overabundance of Knocked Up- and Robin Hood-like birth scenes is problematic.

Juno’s labor is not a walk in the park, but neither is it the end-of-the-world. Instead, Juno’s crisis comes when she learned of her child’s adopted family’s impending dissolution. She is scared for her child, that the adoption won’t proceed, and that her faith in humanity has been misplaced. It is an emotional crisis that Juno is able to overcome, and to grow from. All that other stuff? There’s nothing inherently wrong with it.

To me, that feels more like life.

PS: I know I’m not ever going to give birth, and so I have either the luxury or burden of a purely theoretical relationship to this subject. For the record, however, I’d like to say I have a very strong feeling that I am missing out.