Homebirth and Race and Class - Page 6

[annakiss]

Originally Posted by library lady

Once the medicalization of birth is addressed and homebirth is normalized, then we can begin to talk about it in terms of race and class.

I guess my radical upbringing has me questioning before the goal is even achieved, to insure equality in the fight and in the outcome.

Fwiw, I was on medicaid for both my births and am on Medicaid currently. I never sought Medicaid coverage for the one homebirth I paid out of pocket for (the other I went through my mom's CNM practice and she helped me and paid the assistant on my behalf) because I didn't even think it was possible (or worth the hassle!). My husband is currently working on his PhD. I come from a family where three of my parents have master's degrees. I don't have any degree, but consider myself pretty well educated, all things considered.

I think that being well educated may not equal ease in navigating health care systems (who can navigate those at all??), but just an easier time finding things and having access in general to information - so whether there's talk on a message board or elsewhere, having the internet at home is a privilege that aids that, as does the ability to browse bookstores or take prenatal yoga (where I learned a lot) or any variety of ways in which information about home practitioners could be spread.

As far as I can tell, the culture of the (largely white) middle class and educated aids this in a way that I don't think exists elsewhere. Even shopping at Whole Foods or making choices to buy green - questions about health and environment are largely in the domain of the privileged and that's where we find this related information about homebirth. Certainly that's how my doula clients find it...

Otherwise, I think we completely agree, really.

[library lady]

Originally Posted by annakiss

I guess my radical upbringing has me questioning before the goal is even achieved, to insure equality in the fight and in the outcome.

I didn't have that kind of upbringing. I grew up in a rather mundane suburban house where both parents worked and we were all latch key kids. In some cases, it was to our benefit and in others it was to our detriment. There was no real thinking outside of the box. There were times that we had all sorts of luxury but then there were other times when I remember standing in line for commodoties and food stamps. My parents were so busy trying to survive that they didn't have the time or energy to be radical. They didn't care what the rest of the world was doing because they were trying to work and provide for 4 kids.

Originally Posted by annakiss

Fwiw, I was on medicaid for both my births and am on Medicaid currently. I never sought Medicaid coverage for the one homebirth I paid out of pocket for (the other I went through my mom's CNM practice and she helped me and paid the assistant on my behalf) because I didn't even think it was possible (or worth the hassle!). My husband is currently working on his PhD. I come from a family where three of my parents have master's degrees. I don't have any degree, but consider myself pretty well educated, all things considered.

You have more of an advantage than most because your mom has a CNM practice.

Originally Posted by annakiss

I think that being well educated may not equal ease in navigating health care systems (who can navigate those at all??), but just an easier time finding things and having access in general to information - so whether there's talk on a message board or elsewhere, having the internet at home is a privilege that aids that, as does the ability to browse bookstores or take prenatal yoga (where I learned a lot) or any variety of ways in which information about home practitioners could be spread.

I can't get past this because of the librarian in me. I can buy that being educated gives you better access to information generally speaking. The problem that I am having is the fact that there is so much information out there that people choose to ignore. Or, they are just unable to find it because they don't know how or they just don't really want to. I don't know how many students/patrons my husband and I have helped in libraries that can't seem to find information even when we put it in a nice little package for them. I can call it up on the computer screen or find it in the book and point them to it but I cannot read it for them and make them comprehend it. That is up to them.

Librarians are notorious for unintentionally censoring information because they don't know that the information exists. Most librarians don't know that they need to include a better variety of books on child birth. They think the books like What To Expect When You Are Expecting are the norm and don't even realize that the "other" kind are out there. My husband has done a great job of trying to make sure that these types of books are on the shelves but most librarians are clueless. In general, the Internet is a great place to find information but by design it is flawed and you have to know the correct vocabulary in order to find it. I didn't know that my parenting style was called AP. I stumbled upon it in a search on something different yet related. Once I found the correct vocabulary, a whole new word opened up for me.

For any of you reading this, if your local library only has mainstream pregnancy and parenting books, talk to your librarian and tell them that other options exist and that they need to account for that in their collections.

Originally Posted by annakiss

As far as I can tell, the culture of the (largely white) middle class and educated aids this in a way that I don't think exists elsewhere. Even shopping at Whole Foods or making choices to buy green - questions about health and environment are largely in the domain of the privileged and that's where we find this related information about homebirth. Certainly that's how my doula clients find it...

Otherwise, I think we completely agree, really.

Absolutely, nobody but the largely white middle class can afford to shop at Whole Foods or buy green. I know there was one whole foods type store that we went to that had tons of stuff about homebirth, etc. on the billboards and what not. We try but it is a huge struggle so we have to pick and choose. When we were starting out, there was no way we would even consider shopping in such stores because we couldn't afford it coupled with the fact that it never occurred to us that the way we had done things our entire lives was flawed or needed to be improved.

Yes, I think we do agree! I am really enjoying this conversation because I have been doing a lot of reading on midwifery and doulas. At one point in time, I explored the option of becoming a midwife or a doula because I feel like everybody should have the option of homebirth. If they choose to birth in a hospital, it should be because they put some thought in it.

[apelilae]

I have a black midwife who I ADORE : Her practice is all walks of life with the exception of the very upper class. She is a CNM and does accept insurances, including Medicaid. Some of the Medicaid policies in my state do over homebirth.

Like many things, I don't think it's so much a race/class issue. I think it really is more about knowledge and knowing your options and knowing others who have done it.

If you are young, poor, and black and have only been exposed to hospital births and do not know, why would you think to look outside? Just as I come from a poor, white area from birth, few people consider homebirthing and breastfeeding because they really are deeply undereducated about their options and the benefits of; and also everyone seems to do a intervention laden hospital birth and bottle feed, so why would they think to do anything differently?

However, I am now in a more well-to-do area, highly educated but people still don't consider homebirth as an option; they tend to be consumed by fear or very comfortable with the hospital protocol. However, we do have pretty decent breastfeeding rates. There's a small counter-culture here that does a lot of natural parenting, including homebirths and we also have some great homebirth midwives to serve our area. Within this counter-culture homebirths are normal and as this counter-culture begins to spread, more are considering this option who may have otherwise thought it to be impossible.

[shayinme]

Originally Posted by library lady

I can't get past this because of the librarian in me. I can buy that being educated gives you better access to information generally speaking. The problem that I am having is the fact that there is so much information out there that people choose to ignore. Or, they are just unable to find it because they don't know how or they just don't really want to. I don't know how many students/patrons my husband and I have helped in libraries that can't seem to find information even when we put it in a nice little package for them. I can call it up on the computer screen or find it in the book and point them to it but I cannot read it for them and make them comprehend it. That is up to them.

Librarians are notorious for unintentionally censoring information because they don't know that the information exists. Most librarians don't know that they need to include a better variety of books on child birth. They think the books like What To Expect When You Are Expecting are the norm and don't even realize that the "other" kind are out there. My husband has done a great job of trying to make sure that these types of books are on the shelves but most librarians are clueless. In general, the Internet is a great place to find information but by design it is flawed and you have to know the correct vocabulary in order to find it. I didn't know that my parenting style was called AP. I stumbled upon it in a search on something different yet related. Once I found the correct vocabulary, a whole new word opened up for me.

I have been wanting to jump in for several days but was really unsure where to go. I hear what you are saying as far as libraries but my experience living in both a major metropolitan area as well as a rural area is that the quality of libraries and what's available in them is largely impacted by the area they exist in.

I grew up in Chicago and at one point lived in a low-lower middle class Black neighborhood and the library was crap to say the least. I now live in Maine and here where towns only partially fund libraries and the rest is raised by the library itself, the quality of what is available is directly impacted by the socio-economics of the town. So in some cases even requesting books that are not there simply is not going to happen. I know there is inter-library loan but again certain areas don't have these books, so many books folks mention on MDC I cannot find anywhere near me.

As I have read this thread, I keep hearing folks say info is available and I say yes and no, there are huge portions of the population who don't have access to info. I used to teach adults here in Maine and had students who didn't have computers and the only access they had was at school. Even in my town, which is solidly middle class, if you didn't have a computer and could only use the library, you could only use it in 30 min increments. Hardly time to research these issues. This is a town of 16K and while the local coffeehouse and Stabucks have wifi that means having a laptop, there are no true internet cafes unlike in Chicago where I used to live and even those are costly.

When I got pregnant with my last child 3 years ago I spent hours online seeking info as far as homebirth eventually settled on midwife at a birthing center. A luxury that if you are busting your butt to survive you may not have the privilege, at the time I was finishing my masters so I had a fair amount of time to be online. 17 years ago when I was pregnant with my eldest had there been an internet, I would not have had the luxury of looking up info, I was too busy working and hoping I could pay rent.

I don't know but overall I have to say Annakiss is on the money, I am on the board of a local group in our state that deals with these issues and we have discussed ad nausem how to make midwives and homebirth more accessible to WOC and low income women and I do know a factor is money. Coupled with the fact so many of these women are not informed and its a hard task to get the information to them but our group faces the barrier of money. Our services cost and even on a sliding scale for truly low income women they cannot afford classes and workshops on birthing choices.

I won't say race is a single factor because I am Black but I do think race and class factor into why homebirth is not as prevalent with certain demographics.

Shay

[misswerewolf]

Originally Posted by Belleweather

2. Nearly every other country in the world requires less education for professional designations such as Doctor, Midwife, Attorney, Pharmacist, etc. than then US does. For instance, in the rest of the world getting your full MD is a Bachelor's-level credential requiring from 4-5 years of study total, not a 4year undergrad + 4 years of Medical school. Getting your law degree is also a 4 year undergraduate level credential, instead of 4 years + 3 years of law school. So yeah, of course a midwifery program is considered a 2-4 year undergraduate degree... it fits in with the way they look at education in general. Also, tuition in most other countries is subsidized by the government and in some cases, free.

Where did you get this bit of info? I am currently living and working in a university town with a huge international population. One of the main comparisons that my acquaintances and I notice in our discussions is that the U.S. requires LESS training and education than other countries for professional designations. I am referring mostly to European nations.

Bear in mind that the educational system in the US differs vastly from the educational systems in European countries in general. Many of these students graduate from "high school" with what is considered at least equivalent to an Associate's Degree (or higher). My partner, who is European and works in academia, considers the U.S. educational system to be sub-par in comparison to what's available in Europe...and I must say, after having been exposed to these two sides of the world, I agree with him.

[CorasMama]

While we're talking privilege,

Originally Posted by GOPLawyer

Both internet access and books are free at the library.

Approximately 20 million Americans are non-literate. How many more are not literate enough to appreciate reading enough to go to a library? And how accessible are libraries to many rural and urban working poor? (Hint: these answers are not promising.)

Statements like the above quote really chap my hide. It presents the problem as though, if "they" would only go to the libraries, "they" would have access to all the resources "we" do, and since "they" don't, it's not "our" problem.

Also, if you don't know that certain information/practices even exist, how would you go about finding it? And what would possess you to do such a thing? For instance, I learned today about Dvorak the keyboard layout. It makes total sense, and I'm going to look into maybe using it. But I would never have thought to look it up and investigate Dvorak keyboard layout had I not heard some friends talking about it (and some of the benefits.)

[Belleweather]

Originally Posted by misswerewolf

Where did you get this bit of info? I am currently living and working in a university town with a huge international population. One of the main comparisons that my acquaintances and I notice in our discussions is that the U.S. requires LESS training and education than other countries for professional designations. I am referring mostly to European nations.

Bear in mind that the educational system in the US differs vastly from the educational systems in European countries in general. Many of these students graduate from "high school" with what is considered at least equivalent to an Associate's Degree (or higher). My partner, who is European and works in academia, considers the U.S. educational system to be sub-par in comparison to what's available in Europe...and I must say, after having been exposed to these two sides of the world, I agree with him.

Check out the British Medical Association at www.bma.org.uk, the New Zealand Qualification Authority at www.nzqa.govt.nz, or basically any University in the UK, Australia, New Zealand or Canada. Like I said, my husband is looking into going either to PA school or Medical School, and we'd like to expatriate, so I've been looking into this pretty intensely.

The UK MD Qualification requires a 5 year undergraduate course, and then a 2 year residency/clinical course plus post-graduate training in a specialty. The US MD Qualification requires a 4 year undergraduate course, then a 3 year medical school course, then a residency that can be anywhere from 2 years (for a GP/Family doc/Internist) to 7 years and beyond for surgery or anesthesiology.

While your husband is right that the US educational system is sub-par, and while as far as what they've learned students in other countries may already have the equivalent knowledge to an associates degree, the fact is that we require substantially more formal butt-in-chair schooling for our professional degrees than most other nations.

[mwherbs]

so you are asking for solutions-
I mentioned our state midwifery association is working toward re-instating our medicaid status- via hiring a lawyer- we have had donations, as well as some interesting fund raisers like a concert, and art auction, as well as some straight up donations-- a good lawyer is costly but priceless ....

* I also think that bringing legality to every state is a good place to focus *

also in states where midwives are legal I know that there are still midwives who do home visits- grant writing and providing out-reach at home care even if the women you care for do not have a home birth is one way to improve the situation for many women without prenatal care as well as educate them about birth, choices , self-care and midwives (this is how CNMs found their way in originally) and there are still many places where there is need as well as grant money-- finding someone who is grant savvy is probably key,
actually I have read over many of the title V reports in different states and there are ways to use those reports to your advantage as far as knowing where the problem areas are so you can tailor proposals to what they recognize as problems- this can also help with licensing as well.
Personally I would like to get on the local mobile health van and do out-reach prenatals that way-

[mwherbs]

you know I wanted to add another solution I have run across- someone had a non-profit set up so that people could make tax deductible donations toward supporting a home birth for moms who could not afford a midwife.

[loraxc]

It seems to me that the first thing to do here is to advocate for laws stating that insurance companies and Medicaid must cover homebirtha at the same rate they cover other births. I gave birth at home and paid $200 total (ins co picked up the rest). I don't know what I would have done had I lived somewhere it wasn't covered--probably not had a HB.

My experience is that HB midwives here serve people who are outside the mainstream in one way or another. This includes Muslim women, conservative religious women and/or homesteaders, and far-left, overeducated liberal folk who live poor partly by choice or inclination (this would be my category).

[janasmama]

This is really simple and so not as much of an educated response as some of you have posted here...

but if you want to spread the word about homebirth/NFL then give a local OB/pediatric office a subscription of mothering mag. It will sit out on the table and people will read it. You can even pick a low-income type clinic.

Just a thought.

[jlizgar]

Originally Posted by Arwyn

How many black midwives do you know? Hispanic? Asian? I know of several black midwives, and Midwifery Today makes a point to showcase native midwives from Central and South America, but in my area, which has a saturation of homebirth midwives, I can think of none who are not white and more or less middle class.

For whatever reason, homebirth does seem to be more prevalent among the privileged - privileged by class, race, education, or wealth. Which is not to say there aren't women who are poor, or of color, or with little formal education who have pursued homebirth, only that they are disproportionately underrepresented in the homebirth population.

I would love to see homebirth spread, accessible to all women. Who more than the underprivileged deserve the one-on-one personalized care of a homebirth midwife? Who more needs the empowerment of a natural birth?

But bugger me if I can figure out how I, a middle class white daughter of MD/PhD parents, can make help that happen without being accused (rightly) of colonialization, of trying to tell "those pitiable women" how to live and what choices to make.

Ive just read the first page of replies so far but wanted to comment that the homebirth midwife im using is black! She has been catching babies for over 20 years and when I went into her office for my first visit there was one India patient, another white patient (im also white) and I remember he commenting that she was uninsured, and there was a black patient...so I dont know, I felt encouraged by what I saw! That homebirth isnt just something for the "white middle class".

[misswerewolf]

Originally Posted by Belleweather

Check out the British Medical Association at www.bma.org.uk, the New Zealand Qualification Authority at www.nzqa.govt.nz, or basically any University in the UK, Australia, New Zealand or Canada. Like I said, my husband is looking into going either to PA school or Medical School, and we'd like to expatriate, so I've been looking into this pretty intensely.

The UK MD Qualification requires a 5 year undergraduate course, and then a 2 year residency/clinical course plus post-graduate training in a specialty. The US MD Qualification requires a 4 year undergraduate course, then a 3 year medical school course, then a residency that can be anywhere from 2 years (for a GP/Family doc/Internist) to 7 years and beyond for surgery or anesthesiology.

While your husband is right that the US educational system is sub-par, and while as far as what they've learned students in other countries may already have the equivalent knowledge to an associates degree, the fact is that we require substantially more formal butt-in-chair schooling for our professional degrees than most other nations.

So, if I'm doing the math correctly, then it all works out to about the same numbers of years of schooling and training when it comes to obtaining a Doctor of Medicine degree (or equivalent, depending on the country).

UK = 2 years of A-levels + 5 years of undergraduate medical degree + 2 years of foundational training + 3 years (minimum) to 8 years (maximum) of specialized training. (Additional years required, if one desires the graduate medical or research degree.)

NZ = 6 years of medical degree (including internship) + 1 year minimum of additional post-graduate training

CA = 4 years of undergraduate degree + 4 years of medical degree (including internship) + 2 years (minimum) to 7 years (maximum) of specialized training

Those are the only countries I looked into, although my guy (a research doctor himself) just informed me that in Germany, the process is more or less similar to the USA's -- except with different labels.

Wikipedia has some sources: http://en.wikipedia.org/wiki/Doctor_of_Medicine

[applejuice]

I think this is much ado about nothing.

When my mother, the wife of a chiropractor, had her babies at home in the 1950s and 1960s and 1970s, people asked if she had us at home because we could not afford the hospital.

When Jesse Jackson spoke at the Democratic National Convention in 1988 as a Presidential Candidate, he talked about his mother delivering him at home in North Carolina because the family could not afford to go to the hospital. He was talking about how poor she was, that she could not go to the hospital like the rich whites did. Do you really think these people had their babies at home because of class and money?

There were plenty of black midwives throughout the South before the Medical Doctors made them illegal. Often, it was the only profession they could do.

Now in 2008, since most health insurance plans cover just the hospital, it is expensive to pay out of pocket for a home birth.

The fact of the matter is that people can afford the things they want if they decide they really want it. There are other forces that keep healthy women walking into the hospital to give birth: social factors - insurance companies that will not cover a home birth, hospitals and doctors that refuse to give backup service to home birth health providers, familial factors - families that tell awful stories and insist that women go to the hospital, spouses that demand that their wife go to the hospital; financial factors - as the insurance companies that charge exorbitant rates to families and give little choice in health care in return and will only cover a home birth.

People need to take responsibility for their life and its outcome into their own hands and demand that they have choices in matters that affect the quality of the way they live their life. Choices need to be made after being educated. Usually a person who is better educated knows that they have choices whereas the person who is not educated is easily cowed into giving in to unreasonable demands of their time and resources. There are more women in college now than men. Will this translate into women making better choices in childbirth? I do not think so. The healthcare system is even more stringent about how women give birth - flat on their back, chemically paralyzed and surgically delivered. This is a trend that began with women going to the hospital and is escalating now into a 100% surgical birth rate. ACOG is happy to oblige you.

Women with money are having their babies surgically and are opting for a tummy tuck afterwards. Do you think this will become part of a package delivery system in ten years under a government plan? I know of many husbands who would love it.

Get ready. It is on its way.

but if you want to spread the word about homebirth/NFL then give a local OB/pediatric office a subscription of mothering mag. It will sit out on the table and people will read it. You can even pick a low-income type clinic.

You are in California. Do you know if Mothering has a Spanish Edition? That will make the biggest dent there. The upper class on the West side already has Mothering in Wild Oats and Whole Foods.

[mwherbs]

well yep, Applejuice I agree, my grandmothers both had home and hospital births- my maternal grandma had 15 kids and IF they had the money at the time she went to the hospital. Family did ask if we needed money, when we had our first homebirth. So deep associations with poverty.

[claddaghmom]

I find the speculation that homebirth is slanted towards a higher class to be laughable.

The environment growing up from extended family, friends, school groups, etc was that homebirth is for poor, uneducated, backwards people. The assumptions are far fetched....one person even made the statement that homebirth happens because the woman is too stupid to know she is pregnant.

I'm still living in the same state, but have changed areas and I find the newer area to represent a higher class and a predominantly white population. The homebirth movement here is composed of the "rich" all-natural families. DH calls them the suburbia moms in their pink velour suits with a jogging stroller. For example, at the mall these ladies will use a sling and breastfeed, but that sling is handmade out of 100% silk and costs $300.

I remember trying to make a new friend and talking about water birth. This lady had an entire sunroom installed on her deck and two jacuzzis put in, because she couldn't decide which one she wanted to use for the delivery. She asked me what I was going to do and I was thinking, "Um, yep, I bought a $16 blow up pool at Target" hahaha

[janasmama]

This could be considered a shallow response but I think homebirth really has to do with the "life education" that one chooses to have.

For instance, I'm not college educated but my DH does make a decent living. We are definitely not poor. When we had our first homebirth we didn't make much money though. As a matter of fact we could have had a no-cost hospital birth but we chose to live simpler in other areas of our life in order to afford $2k for a homebirth b/c we believed in the benefit.

I have chosen to choose the lifestyle we live. You don't have to be well-off to not eat junk food...you just have to know how to read a label and choose to avoid fast food.

I understand that the 'brands' of health food can be expensive, I don't even buy many of them...but I do cook whole foods...Major supermarkets sell brown rice, fresh vegetables and other foods from scratch too.

I think for the most part, society is completely socialized into conformity that they don't believe or understand the benefits of natural birth/homebirth. More than it being a thing for the rich or poor, I think homebirth is a more of a choice for the 'thinker.'