Homebirth and Race and Class - Page 2

[annakiss]

Originally Posted by Arwyn

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.

Yeah, that's true. sigh.

[Arwyn]

Originally Posted by nashvillemidwife

We're saturated with home birth midwives here also, and 3 of them in my immediate area are black, including my partner. There is another that is retired.

Well you rock. Portland, for all its awesomeness, is the whitest city in the US, and that may be represented in its midwife population. Still, I've seen in photos dozens of midwives from the area, and they've all been white. How accessible is that going to feel to the nonwhite population?

I've also seen tons of ads for midwives in the "Green Living" spaces (ReDirect Guide, Green Living fairs, etc), and none on billboards or bus stops downtown. Although, I'm also not in that demographic; I don't know that the birth centers don't also attend the low-cost baby fairs or have pamphlets in the county clinics.

[Arwyn]

Originally Posted by holly6737

Online, though, that's a different story. I think you'll find all kinds of people online who homebirth. The audience is much larger.

Although this is getting less true, one can make the argument that the very fact they're "online" represents a significant privilege.

[annakiss]

Originally Posted by Arwyn

Although this is getting less true, one can make the argument that the very fact they're "online" represents a significant privilege.

I agree. Most of the country doesn't have computers at home. Discovering something like MDC, for instance, takes some effort to some degree. The population online I think is definitely different than and less reflective of the general population.

[GOPLawyer]

Originally Posted by annakiss

But how do we access that information? If we are in survival mode due to limited resources or limited mobility (literal and figurative), how do we access information that is hidden from view in the mainstream?

Getting rid of the ACOG would be a great start. lol And I do think the info is becoming more and more available. It's just not an overnight process. The ACOG and the like wouldn't be in such a panic if it weren't.

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.

By talking to them as women and not as a "poor woman" or a "less privileged woman".

All women deserve to know about HB and I think it is important that we talk to women of every class, race, privilege etc. If someone were focusing on me because I was X race or X class, I would definitely tell them to take a leap.

Drop the classifications and just talk woman to woman.

[GOPLawyer]

Originally Posted by Arwyn

Although this is getting less true, one can make the argument that the very fact they're "online" represents a significant privilege.

Both internet access and books are free at the library.

[annakiss]

Originally Posted by GOPLawyer

By talking to them as women and not as a "poor woman" or a "less privileged woman".

All women deserve to know about HB and I think it is important that we talk to women of every class, race, privilege etc. If someone were focusing on me because I was X race or X class, I would definitely tell them to take a leap.

Drop the classifications and just talk woman to woman.

I don't think that doesn't happen when referring to a one-to-one basis, but to contrive to address the general population and to specifically increase access for poor/underprivileged women would most certainly be just that - contrived - and the conversation would not be the same.

Advocacy and activism in regards to homebirth is largely focused on the privileged few who can afford it, at least in my area. I know that there are some programs in New Mexico, for instance. Additionally, I think that CNM practices have a certain high ratio of those on assistance as well as those searching for a better experience - due to their accepting medicaid. But that's in the hospital.

[annakiss]

Originally Posted by GOPLawyer

Both internet access and books are free at the library.

That doesn't mean that access is precisely open in the same way as to those with internet at home. As I said, I think that finding this information requires some digging, not just the internet.

[laohaire]

Well, I definitely think that HB in current times in the United States is largely a domain of educated people, at least middle-class. I'm sure there is a subclass of very poor women who have unassisted or perhaps midwife-assisted births for financial reasons or perhaps some other reasons.

I would think that for most of the middle and upper class, the choice to birth at home with a midwife is NOT a financially-motivated one. For people with some level of heath insurance (even if Medicaid), it is more expensive to pay a midwife out of pocket than the go to the hospital.

Do women of privilege try to shut out poorer women in the homebirthing community? Perhaps. If that is the case, I would imagine it is due to the social pressure applied to all women to birth in hospitals under the care of OBs - middle- and upper-class women who homebirth feel already on the defensive and want to distance themselves from the poor women who home birth for real or perceived reasons of finance or ignorance. Thus middle- and upper-class women may try to gain validation by separating themselves from poor homebirthing women.

Many "natural family living" choices have this kind of dichotomy. There are mothers who cosleep because they feel is the best and safest way for their children. They want to differentiate their choices from the perception of poor women who don't want to buy a proper bed for their kids, and who (so the stereotype goes, anyway) live in filth, do drugs, and so on.

Likewise, there's the families who choose not to vaccinate due to research and proactive choices. And the public perception has, up until very recently, lumped them in with poor families who "don't bother" to take their kids to the doctor, who don't want to spend the money on shots for kids, and so on (now persception has extended to include a new category of "autism-fearing nuts" ).

Certainly, race and class have a HUGE, HUGE impact on the birthing choices and experiences of women, whether we're talking about home birth or not. And yse, I suppose there must be some manner of rejection from some classes in order to differentiate their "alternative" choices from the choices (or non-choices) of the poor.

[soso-lynn]

I have to agree with you, annakiss. The vast majority of people who choose homebirth or birth center birth here in Montreal (where it is free and covered under our universal health care) are older, white, middle-class, university degree holding people. In my view, there are many reasons for that. Here is the few that come to mind right now (I usually like to think such theories througha little bit more before presenting them to world, but still):

1. The middle-class enjoys the immense privilege of being able to do things differently. The poorer, less educated often do not know about their options. Even here where it is free, people have to go out of their way to get a midwife and need to do it very early in pregnancy to not end up on a waiting list (they have to know what they will do before getting pregnant). In the US, there is the money and insurance issue.

2. There is also the upper classes for whom it might be a little harder to do homebirth, not because of access but because of conventions, reputations and other lovely things that come along with being part of an elite. In order to have a homebirt, one must almost become an activist. The rich might not want to do anythignthat might affect their business of freindships while the poor or uneducated will most likely not be taken seriously and face more potential repercussions. I have an almost finished university degree, I am able to afford having hundreds of books on the topic, have constant access to the internet and, perhaps most importantly, can come off as very smart because I know big words and can afford professional or at least not poor-looking clothes. I can deal with CPS or whatever, sould that arise. Other people who, say, are on welfare and do not talk in an 'academic' kind of way can be terrifed of CPS.

3. The issue of race. In the Canadian context, race issues are closely tied with immigration. Most non-white people are first or second generation immigrants. They have a lot of added pressure from society to conform to the norms. A white person who homebirths is presumed to have legitimately thought it through while an immigrant is considered to just be following their native (primitive) customs or being irrationally afraid of doctors. In the US, the race issue is very different. I won't get into that right now.

4. Age. There is this whole trend of women who only have 1 (sometimes 2) children and wait until they are in their thirties. Those women already fit the description of being educated, white-ish, married. They also have the kind of confidence and acceptance tha younger moms do not. I was 19 when I was pregnant and the reactions I got to "I am homebirthing" were vastly different from the reaction older women got. Our society treat any un-married, before the age of 25 pregnancy as unplanned and reckless.

A lot of what I talk about is about society's perception of women who choose to homebirth and I think it is an extremely important factor. People have easy access to information and feel they have the options that society has already apporved for them. A young pregnant woman who is not married will feel obligated to at least acknowledge abortion, while a 'privileged' woman will have to acknowledge the existence of midwives.

I know that there is also a different kind of trend, rooted in 'hippy' culture as well as religious communities where homebirth is popular. I think this is a different thing than the current homebirthing 'trend' we see in mainstream society. I also know that 'real' trend is hypermedicalized, elective induction and c-section births, but that does not mean there is only one trend. And I do not mean trend as in fashion or fad, I mean trend in the statistical sense of the word. The middle-class is largely responsible for setting norms of behaviour and birth is not different.

[soso-lynn]

Wow, I missed a whole lot while eating and writing my post.

I think that giving more access to underprivileged people is a great thing to aspire to, but it does not resolve the deeper issues that lead to class, race, etc to be constant issues. Just like being able to go to work did not resolve oppression of women, being encouraged to homebirth will not resolve class issues. I think we need to get to the bottom of those at some point. I know it is not easy and all, but I think I have reached a point where discussing endlessly how to improve some people's condition in the same hegemonic system really makes my head want to explode.

[annakiss]

Originally Posted by soso-lynn

Wow, I missed a whole lot while eating and writing my post.

I think that giving more access to underprivileged people is a great thing to aspire to, but it does not resolve the deeper issues that lead to class, race, etc to be constant issues. Just like being able to go to work did not resolve oppression of women, being encouraged to homebirth will not resolve class issues. I think we need to get to the bottom of those at some point. I know it is not easy and all, but I think I have reached a point where discussing endlessly how to improve some people's condition in the same hegemonic system really makes my head want to explode.

Well, yeah. I think that improving access is still important, I guess. Not really feasible, precisely, but a good theory.

[soso-lynn]

Originally Posted by annakiss

Well, yeah. I think that improving access is still important, I guess. Not really feasible, precisely, but a good theory.

My cynicism is really getting out of control, I know.

[library lady]

Originally Posted by annakiss

You're over-simplifying it by discussing the relative wealth of hospital systems versus homebirth midwives. People who go to the hospital for birth can qualify for a large variety of assistance that helps pay for their bills. The working poor largely are not made aware of birthing alternatives and can pay off hospital bills for ages. Those who receive assistance can hardly afford the out-of-pocket cost of a midwife. Those who know about homebirth and want it largely can't justify the out-of-pocket cost of a midwife, regardless of whether they're on private insurance or none at all.

Access is largely limited to a select group - largely white, educated, middle class (or higher) women.

I haven't read the entire thread but I had to respond to this.

When I was pregnant with my first daughter, I did not have insurance. I went to the local health clinic but didn't qualify for medicaid or any sort of assistance. They had a discount plan that I could pay out of pocket that cost $2800 dollars. (DH ended up changing jobs to one that would cover the pregnancy. He ended up quitting his other new job because the insurance refused to cover it because it was a pre-existing condition by the time the 90 waiting period kicked in.) The only way I could receive any kind of prenatal care and a birth assistance without racking up serious debt was to pay for their stupid plan. This was 7 years ago so it was actually more than I paid for the birth of my 2nd daughter at home with a midwife 3 years later. When I found myself pregnant with #2 with no insurance, I refused to be subjected to the a**holes at a clinic and began my search for other alternatives. I think anybody that has a little bit of knowledge and perserverance can find out about homebirth. If you are poor enough to be on Medicaid, then you are pretty restricted to a hospital birth. If you don't qualify for Medicaid or other government assistance and don't have insurance, then a midwife is pretty much one of the few workable choices that you have.

I have found that the more money a person has the more likely they are to have a hospital birth. They see themselves as too good to put up with the pain and they are not stupid enough to put themselves at risk. A lot of people associate homebirth with weirdos that live on the fringes. I don't think race, class, or even money figures into it at all. I think the bottom line is education and the ability to see beyond what the mainstream has to offer.

[Arwyn]

Originally Posted by library lady

I don't think race, class, or even money figures into it at all. I think the bottom line is education and the ability to see beyond what the mainstream has to offer.

You don't think those two things have something to do with each other in this society?

[library lady]

Originally Posted by Arwyn

You don't think those two things have something to do with each other in this society?

They do but I think that too many people have this notion that just because you aren't of a certain race or a certain class that you are somehow too stupid to think for yourself and you need those that are of the preferred class or race to come and save you. I have a sister that works at a college and does a lot of outreach to very diverse populations. Time and time again, the people that want to open their minds and learn will whether they are rich or poor or pink, purple, black, or white. Just because a person has money or an education doesn't guarantee that they will be open to the idea of homebirth no matter how much you put it out there. In my sisters line of work, the biggest obstacle is getting people to quit listening to the rhetoric of "You are poor, you are X, you are Y, so you can't possibly do this stuff". You can lead a horse to water but you can't make them drink. Just because a person has access to something doesn't guarantee that they will use it. It might increase their chances of using it, but it will not guarantee anything. There are a lot more barriers to homebirths than race or class. The biggest barrier to homebirth is the medical profession.

[amydidit]

This is a very interesting discussion and one in which I don't feel anywhere near qualified to enter into. But I'm going to anyway.

As with anything else I believe it's possible that privelege could enter into it. Of course that's possible. But from what I've seen personally, I don't know if I completely agree that it's affecting homebirth as much as other aspects of life.

Now I admit, I don't know very many people here where I live, mainly only those I work with. I live in a poor town. That's just how it is. And of the women I work with (that are pregnant, of which there are a LOT) most are choosing to birth in a hospital. Why? I can't speak for all of them, but of the ones I've spoken too, it mainly boils down to believing in doctors. Not because of cost, or not knowing it's an option, etc. White, black, hispanic, etc. Only one other is interested in homebirth and she's not white.

Regarding midwives. The midwife I hired with DD2 is hispanic. So were several other midwives I've looked into. The midwife I've currently hired for this pregnancy, I'll be honest, I have no idea what she is. She's married so her last name gives no indication. She's a beautiful woman, and obviously not a woc. But she could be hispanic or even asian, I really don't know. Now I admit, in this are the other midwives I've looked into are mainly older white women. But I don't think that necessarily reflects the current state of being. Instead I believe that reflects previous priveldge. It's true that years ago there were many more priveldges (not to say there aren't now, but I certainly don't agree they are are prevelant as decades ago) for white women, and these women are now the midwives in the area.

As for internet access meaning priveldge. I don't believe that. Most libraries offer internet access for free now. As well as many coffee shops (where you can spend a dollar for a water and get online). Etc. There are plenty of places that people can get online, even if they can't afford it at home or live in an area where it's not yet available.

Yeah, I really have no idea what my ramblings would contribute to this conversation, but I just wanted to add my observations.

[NishaG]

I just wanted to chime in here. I am African-American, married with 2 kids and in my mid-thirties. I have done alot of research on homebirth and have decided that this is how I would like to bring my next child into the world.

I think what changed my mind is witnessing the various interventions on shows the A Baby Story and Birth Day.

No one in my family has ever had a homebirth, with the exception of my grandmother in the '30s. It seems the most normal and natural thing to do in the world.

However, I must add that I grew up in the Bay Area, near Berkeley, so my perception of what is normal is a bit awry, LOL!

[laohaire]

Originally Posted by amydidit

As for internet access meaning priveldge. I don't believe that. Most libraries offer internet access for free now. As well as many coffee shops (where you can spend a dollar for a water and get online). Etc. There are plenty of places that people can get online, even if they can't afford it at home or live in an area where it's not yet available.

Being in the habit of being onine is part of being middle or upper class. If you are poor, don't have a computer/internet connection, your high school didn't have computers or computer classes, your friends don't have computers - you're not likely going to be heading to the library to log on. While I understand and agree that it's possible to BE online without requiring a lot of money, I do think that it takes more than a dollar to do it - it takes comfort with computers and Internet, it takes personal time (if you are poor and have three kids are you going to drag them into the coffee shop for an hour while you research? whereas middle class people have the luxury of surfing at home while their kids play at home). It requires valuing the Internet to a certain extent as well. It requires being in a location with coffee shops (no coffee shops here have anything as worldly as an Internet cafe; I'm in a working class town) or a library with decent funding (might not be that common in, say, some parts of Missisippi Delta). I honestly couldn't even see through all the privileged assumptions myself, since that's my perspective too.

[annakiss]

Originally Posted by amydidit

As for internet access meaning priveldge. I don't believe that. Most libraries offer internet access for free now. As well as many coffee shops (where you can spend a dollar for a water and get online). Etc. There are plenty of places that people can get online, even if they can't afford it at home or live in an area where it's not yet available.

The other thing I'd like to add to what laohaire said is that just because there is wi-fi all over doesn't mean that people can access it. That requires a laptop.