Home birth for women of color/low income women to solve health care disparities

[newlycrunchy]

I'm warning everyone that this is really long lol. I am a woman of color who is debating whether or not I should try a home birth when I decide to try for another child or if I should find a way to advocate for women of color and low-income women to have more control over their birth experience in the hospital. I was treated so poorly at the hospital where I gave birth that it has inspired me to do something about it so other women don't have to experience what I did. I am thankful that my LO was born healthy without any complications, but I felt so degraded by the hospital staff. The nurses and doctors who helped in my labor and delivery were extremely dismissive, unresponsive, and down right rude. I felt humiliated when I left. I'm not one to blame everything on racism, but I am convinced that my poor treatment was a result of my ethnicity.

I've noticed that most of the stories, debates, information on home birth focus on white, middle-class, and older women. These are typically women who are in the best position to advocate for themselves, be treated by more experienced health care professionals,  and to be treated with more respect (even though that is not always the case) than women of color or low-income women.

I'm really encouraged by reading the stories about positive home birth experiences and how empowering and calming it can be for a woman to labor in the comfort of her own home surrounded by a midwife that she personally selected and to be in the presence of friends and family. Many low-income women have little choice in an Ob-gyn or CNM. A lot of times that have to go to a "clinic" where they meet with whatever doctor who is available that day, and often it is a resident who has very little experience. Then, you go to the hospital and whoever happens to be on call that day delivers your baby. These women are often robbed of the ability to form a relationship with a health care professional to feel more comfortable during labor. They also may be at a disadvantage when it comes to  advocating for what they want since they may be stereotyped by hospital staff.

Although I think home birth can be really positive, I've read a TON of blogs where they talk about how horrible and irresponsible it is to have a home birth because of all the risks involved. Reading those blogs has terrified me.

So, my questions are: How safe is home birth? If more women of color or low-income women were able to have home birth, would that helped to decrease the negative mother and infant health outcomes faced by women of color? I understand that there are many serious and potentially life-threatening risks with home birth, but what I want to know is it any safer for poor women/women of color to have a baby in a hospital where they might be disrespected, treated by inexperienced Ob-gyns, and not given the highest quality of care than to have a home birth?

Thanks for reading!

[BamaMama22]

I am so sorry for your poor experience and the disrespect and mistreatment you endured.  You are not alone.  There are many women who feel the need to improve birth for women regardless if the birth happens inside or outside of hospitals. 

You need to read about the amazing work of black midwife, Jennie Joseph and her tremendous safe track record: http://jenniejoseph.com/.

You cannot rely on blogs to verify or deny the safety of home birth.  You have to go by peer-reviewed medical studies.  I encourage you to view these studies (available on the More Information and Resources tab at www.alabamabirthcoalition.org):

CMAJ, August 31, 2009

BJOG, April 15, 2009

BJOG, June 18, 2005

One thing to remember is that the riskiest home births are those with no trained attendant present.  It is important to have a trained midwife present to address any rare complications that could occur by providing life saving first response and appropriate transfer to obstetric care.  There are links to information about the training, professional organizations, and and core competencies of midwives on that More Information and Resources tab: http://www.alabamabirthcoalition.org/more-information-and-resources/. 

I encourage you to become involved with the International Center For Traditional Childbearing--http://www.ictcmidwives.org/.  The International Center for Traditional Childbearing, Inc. (ICTC) is a non-profit African American centered organization located in Portland, Oregon. 

You may also find the following organizations helpful:

http://www.choicesinchildbirth.org/

http://www.sistamidwife.com/#/black-midwifedoula-directory/4559947642

http://www.improvingbirth.org/

Much love!

[Homebirth Kits]

Hello

I've just read your post and felt really prompted to reply as even though I'm from the UK, there are so many women having unsatifsfactory experiences in hospitals here too and it is so disheartening to hear how this goes on in other parts of the world.

Homebirth can be a wonderful experience and some of the points you made are absolutely true, at home a women can feel more at ease in her own surroundings enabling the release of positive birth hormones such as oxytocin to be undisturbed, often leading to a quicker, calmer labour and birth. When a labouring mother feels, threatened or disturbed as many do as they enter an unfamiliar environment (such as a hospital), adrenaline (the fight or flight hormone!) is released which counteracts the release of oxytocin, which can slow down labour and often leads to interventions and/or complications.

However, as with any birth setting a homebirth is not risk free and I agree with the previous post that it is extremely important to research this option thoroughly before making a decision. The articles from the previous reply are a great start and I would also highly recommend www.homebirth.org.uk as a great resource of information.

Another recent research study that may be of interest can be found on http://www.homebirthkits.com/blogs/news/6660820-home-births-may-be-safer-than-hospital-births

I really hope that with your next birth you receive the support and care you deserve and that you are treated with the dignity and respect every woman should receive, regardless of their ethnic background or income.

All the best

Charmaine

[nilatti]

Well, I don't think I would consider hospital births particularly safe for women of color. A study came out over the summer that found that black women are five times more likely to die in childbirth than white women. I think that the kind of disrespect and lack of care that you experienced at the hospital is responsible for some of that appalling disparity (source: http://www.reuters.com/article/2012/08/03/us-more-minority-women-die-in-childbirth-idUSBRE8721B220120803)

As to home birth, I figure it's as safe for a woman of color as for a white woman. In my opinion, the skill of your birth attendant and the trust you feel you can place in him/her is as important, all other things being equal, as where you give birth. If you are having a low-risk pregnancy, many studies show that homebirth is as safe as hospital.

I'm a bit biased--not only did I have both of my babies at home, but I also grew up in a community where home birth was very normal. I knew probably fifty kids, growing up, who were born either at home or in a free-standing birth center. No one had any birth trauma that I'm aware of, and this was in a state where midwives couldn't be licensed and were delivering babies in my community illegally and with less training than they would have in a state where midwifery was legal and accepted. 

I wrote a bit more about the safety of homebirth in a blog post here: http://cinnamonandsassafras.wordpress.com/2012/10/13/homebirth-faq/

Whatever you decide for your next birth, I hope that you are able to find someone to attend it who will support you and treat you like a woman deserving of dignity.

[betts]

I am a homebirth midwife who has been happy to serve women of color who range from low-income to upper middle class. I have not found any difference in outcomes for the low-income women because they were very committed to having a healthy pregnancy and safe birth and did everything possible to achieve that. A healthy diet is oftentimes your best bet for lowering your risk factor and it is possible to have a healthy diet even if you are low-income as many nutrient rich foods are inexpensive.

I have been able to take care of women who have medicaid and I definitely believe that in most cases the care that they receive during pregnancy and birth exceeds what they would expect through the medical model. That is not to say that there are not excellent providers in the medical world who serve low-income women, but they tend to be overworked and pressed for time. My low-income clients receive the same care and attention as every other client in my practice.

The women who came to my care for the reasons you outline in your post have related to me that their homebirth was very empowering for them. In turn, I found them to be inspiring in their dedication to the birth option that they feel best suited both them and their families. You might enjoy reading Patrice A. London's book, Empowered to Give Birth Naturally. It is available on Amazon. 

Best wishes to you as you make this decision.

[newlycrunchy]

Thank you everyone who responded! I am going to check out all of those links and do some more research.

[Mom31]

This is something I think about a lot.  I had a hospital birth while married and then a home birth also while married and middle class.  I divorced and moved into low income and have had medicaid and can not believe the difference in medical care.

I have recently attended a meeting of women in the area made up of doula's and midwives and other birth professionals and women who are in support of better births and brought this up.  There was a young mother there who had a terrible story and it made me think more deeply about this exact topic.

I am glad you are sharing and looking into this.

[Vaske]

A few years ago, I was looking at state neonatal death rate statistics, and learned that being born in a hospital in Mississippi to a low-income mother of color with little prenatal care is far more dangerous for the baby than the average homebirth is.  I wish that some of the doctors who go on and on about the dangers of homebirth would instead go and do something useful and good there.

Under Obamacare, it is going to be easier to open birth centers and pay midwives under Medicaid.  That might be a good direction to take your advocacy.

[Buzzbuzz]

"So, my questions are: How safe is home birth? If more women of color or low-income women were able to have home birth, would that helped to decrease the negative mother and infant health outcomes faced by women of color? I understand that there are many serious and potentially life-threatening risks with home birth, but what I want to know is it any safer for poor women/women of color to have a baby in a hospital where they might be disrespected, treated by inexperienced Ob-gyns, and not given the highest quality of care than to have a home birth?"

I believe that the safety of a home birth is directly proportional to the skill of the health care provider and the risk status of the woman giving birth. 

However, for any home birth one must recognize that they are in a resource poor environment (the home) and that certain events (severe PPH, AFE, uterine rupture, etc., etc.) are either not survivable at a home birth or chances of survival are substantially reduced.

"...safer for poor women/women of color to have a baby in a hospital where they might be disrespected, treated by inexperienced Ob-gyns, and not given the highest quality of care than to have a home birth?"

Also, don't forget that abuses can happen in the home as well -- google power birthing for example (incredibly painful and damaging manual dilation of the cervix -- a number of women have complained of their midwives using this technique without their consent).  

[studentDr]

Originally Posted by newlynatural 

Thank you everyone who responded! I am going to check out all of those links and do some more research.

you definitely sound highly intelligent and educated I can't see how a hospital could treat you that way just because of color. in our hospital al of the patients are respected, and most of them are low income and uneducated. it is a great public hospital. we have lots of indigenous patients who are treated with respect, and other patients. over here you would be classed as an upper class educated patient which you are, not by your color.

you should become a doctor or something !

[MeepyCat]

StudentDr, I get that you mean well, but the way you're coming across is very dismissive of the OP and her experience. You even hit a point where you manage to imply that, if she was treated badly, it must be her own fault for non-racist reasons.

I can just about promise you that there are patients at your hospital who would credibly claim to have received bad treatment and poor care because of irrational prejudices from the staff, or because of institutional structures that make assumptions out of fit with their lives. There always are. You don't improve anything for anyone by noting that the problems you have aren't the same as other problems, far away.

[studentDr]

oh no

I was just really surprised that she was treated like that, it's horrible

in Australia at our public hospital no one would treat her like that

and she sounds very intelligent

maybe over where you are you don't have nice public hospitals and they are all private ?

I have a number of African, Indian and aboriginal friends who are doctors and they are like her, highly intelligent and highly respected.
Edited by studentDr - 12/8/12 at 6:41am

[MeepyCat]

StudentDr., let's tie it back to what there is here:

The OP describes an experience of OB care that's pretty common to women in the United States, particularly women on Medicaid (the government-funded health care option for low-income women):  Their prenatal care is handled "in clinic" and they see a different doctor or midwife every time, often (especially if low-income) a resident rather then a full-fledged doctor.  Residents cycle in and out of clinic service much faster then women go through pregnancies.  Some residents are genuinely interested in OB care, and do excellent work, others are just checking off this requirement and really don't give a darn.  Residents are prone to suddenly losing interest in their current work when longer term job offers come through at the end of the academic year, or to not having all that much interest in the first place.  Quality of care and quality of charting varies.  Different doctors with different opinions give different answers to the same women when she asks the same questions.  Doctor A may tell a patient that *of course* the hospital supports VBAC, and natural birth is absolutely the best option for her and her baby; next month, Doctor B may opine that she's a *horrible* candidate for VBAC, and it's very dangerous anyway; the decision about whether or not the woman gets a trial of labor will, in practice, be made by Doctor C, who sees her at 37 weeks, or by whatever doctor (D? Q?) happens to be on service when she actually goes into labor.  Being really intelligent has no impact.  I've seen my medical records, and they include notes that mention how personable and engaging I am, and how great an understanding I have of my condition, my baby's condition, and the current state of the relevant medical research.  I cannot tell that these notes made any impression at all on the next doctor down the line.

This kind of thing happens, I am sure, even in Australia.  It's not any one person's act of negligence or cruelty (although that does sometimes comes into play).  It's just that when resources are limited (as they always are) and need is great, some people get short shrift.  For any hospital, anywhere in the world, there is some population that is badly served by that hospital.  That population is usually low-income, and usually some form of minority.  The presence of doctors of from a variety of races and cultures, while a wonderful thing in itself, is not a guarantee of high quality or culturally sensitive care to every patient.

In general, I'm in favor of hospital care (as opposed to home care) for pregnancy and birth, because I believe that it's safer.  I understand, however, that some women don't feel safe or comfortable in hospitals, and I understand some of the reasons why. 

[studentDr]

we have a few public hospitals.

the one I was at was extremely friendly, the midwives and nurses were awesome .

we don't have obs and gyne as a requirement. residents take it because they are interested in it

students also see the patients , but they then present thepatient to a consultant

patients are seen by a multidisciplinary team which includes consultants, midwives, etc

and the patients are from all walks of life. of course the rich people go to private hospital. but if they have complications the rich people also come to this public hospital. I was even a patient at the hospital and I had no complaints. we have a very multicultural group of health care workers of high standards including friendliness.

the private hospitals look nice, but the consultants usually work both in public and private. and the private hospitals are very expensive. something like $1,400 per day.

I am coming to realise that it must be by expensive for people in america

[Mom31]

OP- I reccomend going to the local library or ordering some books online on homebirth.

I used to have a list- but no longer do...

Anything by ina may gaskin

there are quite a few books on homebirth.

My favorite birth book is Birthing From Within- which is not a homebirth book but just a very good book to read.

[dontVaccinateMe]

can we make a list

of the  and disadvantages advantages of home births ?

and advantages and disadvantages of hospital births ?

[Mom31]

It's all over- a list?

HMMM....

For everyone it will be different.
 

[newlycrunchy]

Again, thank you everyone for the positive input. I am very serious about improving the prenatal care, labor and delivery, and postpartum care for ALL women, but especially low-income women and people of color. I have even thought about becoming a certified nurse-midwife so that I can be the one who can start the change, but I don't really care to go to school for that long lol. I do understand that there are many risks to home birth, but something has got to change with how hospitals treat their patients.

[studentDr]

let us know if we can help in any way

my friend from Zimbabwe is going back home in her holidays to help out at the hospital. here parents are both nurses. I'm pretty sure they had formed a group that was going back.

also over here (maybe over thereto ? ) we have groups of doctors from private hospitals (especially hollywood - inaustralia) who go to places in need every so often and help out. ( eg they went to some remots place, I forget where exactly and took a whole pile of cervical cancer vaccines to vaccinate all the girls, I think another team is going to Africa somewhere to help the young girls with fistulas from childbirth) they probably wouldn't go to America but they may be able to help you out with contacts, how to organise things and get things.

oh someof these expeditions led by consultants and others are also advertised to medical students as electives, so if you get something up and running you might like I get them involved, this is key because they will likely return when they are qualified, and they have access to finances and hospital resources and also other contacts)

and it is common practice to make and sell scrub hats to help raise money. over here they sell for $5 to $10 . and people like helping out buying them and getting a cool scrub hat. I have a few and I buy them for my friends as presents. where I work they are just left in the staff room with an honesty jar, or at the front counter.

[erigeron]

Originally Posted by BamaMama22 

You cannot rely on blogs to verify or deny the safety of home birth.  You have to go by peer-reviewed medical studies.  I encourage you to view these studies (available on the More Information and Resources tab at www.alabamabirthcoalition.org):

CMAJ, August 31, 2009

BJOG, April 15, 2009

BJOG, June 18, 2005

I agree with the need to look at peer-reviewed studies. I'd add to be careful when looking at data from another country. The midwives there may be trained differently (homebirth midwives in the UK and Canada have a similar level of training to American CNMs, not CPMs).