Homebirth and Race and Class - Page 3

[frontierpsych]

I am caucasian. Not sure if I'd consider myself "privilged", I guess it depends on the context. I am a high school graduate in a happy marriage living below the poverty line. We do have health care, a car, and we can afford our groceries and bills (though not much else). I'm sure this means different things to different people.

[amydidit]

Originally Posted by annakiss

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.

I wasn't specifically speaking of wifi. The libraries here (and I've seen *cyber cafes* in other places) have computers available to use. Not just wifi.

I still am not sure I'm *buying* it though. At the library near there are all classes, all races, all everything there. People comfortable with computers, people who have no clue, etc. I think it's silly to say that internet = privilege. Even if your schools didn't have computers or computer classes, still the majority are aware they exist and are available in many places for free use. Sure, the more privileged have them at home and can surf whenever they want. But we're not talking about the quantity of time online (at least I wasn't). We're talking about having access to internet. Which everyone nowadays has.

[library lady]

Originally Posted by laohaire

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 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.

A lot of people that live in cities or the suburbs take internet access for granted. My parents cannot get high speed access where they live. So many sites are optimized for DSL that it makes it almost impossible for them to use the Internet. When we lived in Kansas, it was really, really hard to find places that offered more than dial-up and even then that was hard to get. The funny thing was that there were a lot of well-to-do people that didn't use the Internet or see a value in it. It was weird because it was like stepping back in time in a lot of places.

There are people near where I live that don't even have a phone so how in the world would they get Internet access? Whether you are rich or poor, availability of Internet is not an automatic. If you grew up without it because of being in a remote location, chances are that you aren't even going to bother going to the library to access the Internet. Let a person that isn't dressed according to the "right" standards come in a library with 3 kids and see how fast she gets treated like crap.

[amydidit]

Originally Posted by library lady

Let a person that isn't dressed according to the "right" standards come in a library with 3 kids and see how fast she gets treated like crap.

This I'll agree with, in some places only. Where I live that is certainly not the case. Not in the least. And again, I can only speak of my personal experiences.

[sharr610]

Originally Posted by annakiss

I agree. However, the relative surge we're currently experiencing, along with the back-to-nature movement of the late sixties and seventies (spawning Mothering magazine, for instance) is one that is most certainly a thing of privilege.

This is a really interesting conversation. I was a homebirth transfer and, yes, at the time, I was privileged by all definitions discussed here. At the hospital I was spoke to as if I was a child, talked to about how this would affect my food stamps(never on them and could have never qualified at the time) and lots o' social worker type people visits.
One of my midwives, who is also a medical anthropologist that specializes in US birthing practices says that this is normal in hospitals. Most of her clients are in academia. She had a transfer once for a couple where dad was african-american, mom was hispanic, both were professors at a local university. At the hospital, a translator was automatically dispatched and assumptions made about their ability to pay, being on welfare, etc.
Ok, so this isn't totally on topic, but its something I've thought about a lot. In the medical arena, for some reason, it seems its seen as a practice of the un-privileged.

[sharr610]

I think improving access to all populations is only going to happen two, or maybe even one of two ways:

1. Get the information out in the mainstream media. Ricki Lake on the View is a great start. Get her on Tyra, MTV and Oprah, all set. Make it cool!

2. Encourage critical thinking. I think this is an often unspoken aspect of the privilege you talk about annakiss. It can come with more education, as it tends to be encouraged more at higher levels of education. That does not mean that there are not families and lower levels of education that encourage this, but its a general trend.

In order to open things up, people need to feel confident in their own decisions and ability to think critically. And that, my dear, is a much more complex problem, IMHO...

[kJad29]

I'm an educated, middle class, AA woman and I do consider myself quite privleged. I am also planning a homebirth, breastfeeding, babywearing and being a SAHM. This was all due to my desires and also to my research. I think that when talking about race and class, it has a lot to do with like a previous poster suggested, the fact that there are quite a few underprivleged women who really trust doctors and the medical establishment. They don't question them because they perceive them to be more intelligent than themselves. You must remember that there was a smear campaign against the old AA midwives and immigrant midwives in the US to bring AA and other poor women to the hospital (In my opinion it was just more practice for doctors with what they considered less valuable guinea pigs). They convinced these women that they should be like rich white women and go to hospital to have their babies. What happened was there was a drastic rise in infant and maternal mortality and morbidity in the hospitals due to AA and poor women choosing to birth in hospital. A disparity that exists to this day.

The same could be said about breastfeeding. When formula first came out it was out of necessity because more women were working outside the house, then it became the thing that only rich and privleged people did. The poor in turn wanted to emulate that standard and started formula feeding. You can even see in the modern breastfeeding culture that now mostly women who can afford to stay at home for extended periods or indefinitely and have pumps breastfeed for longer than poor and disadvantaged women. There are some women in poor communities that don't even consider breastfeeding because in the last few generations it was looked down upon as only something that poor women did.

What it really boils down to is changing the culture. Now it's standard to have your baby in the hospital and give your power away to the doctor or midwife rather than doing the reasearch for yourself, and to feed your baby formula and whatever against your biology thing that may come up simply due to the fact that it's considered the poor person's thing to do. You can go to any ghetto or poor neighborhood and see people with expensive shoes, cars, and other material things just to have the appearance of wealth and privledge. It's a bit deeper than just saying that now only middle class white women do this or that. It all started with middle class white women, and now the reverse is happening.

I hope that made sense.

[library lady]

Originally Posted by sharr610

In order to open things up, people need to feel confident in their own decisions and ability to think critically. And that, my dear, is a much more complex problem, IMHO...

:

Exactly! I feel like nobody is encouraged to think critically. It doesn't matter what your race/class/socioeconomic status is. Critical thinking is not encouraged. From day one, kids are taught to trust their superiors. You must obey your parents, then teachers, then college professors, then your employer. Along the way, you are taught to trust doctors and anyone else in the helping professions without questioning them. If you question authority, you are seen as rebellious, a hell-raiser, trouble maker, etc. Having a homebirth requires that you question everything that you were ever taught about birth and doctors. I know my family never talked about birth in a natural sense. I was the first in my family to homebirth and breastfeed for an extended period of time. I have seen super priveleged/super intelligent women choose a hospital birth because that was seen as the safest/most logical option.

[Belleweather]

This is an interesting discussion for me particularly, because I have had two out-of-hospital births (one at home, one in a free-standing birth center) which were paid 100% by Medicaid, which is state health insurance for the poor.

I am caucasian, married, and very well educated (we qualified for Medicaid because I was in Law School when I was pregnant the first time, and had just graduated and was unemployed the second time). My midwives were also mainly caucasian and well-educated CNMs. But there was a substantial community that grew up around the practice I delivered with, and the new mamas group was VERY diverse as far as race, class and ethnicity. Our group included an attorney, a zookeeper, new immigrants, single mothers with no resources, GLBT couples, students, older mamas, and people of many different races. I can't say that was completely representative of the clientel of the practice, since it was only the people who could be arsed to come to the new mamas group, but I do think it says something about the practice and it's commitment to diversity.

Now that happened for two reasons: firstly, the midwives were able to attract sufficent patients with means or insurance to pay their fees that they were able to also take patients on Medicaid or in need of payment assistance -- because let's be honest, Medicaid's reimbursement rates suck, and if they were seeing just medicaid patients they'd have problems meeting their expenses. Part of that is that they made a commitment that it was important to them, and part of it is that the community that grew up around the practice does active fundraising to help subsidize the care for women who can't afford to pay the full rate.

The other reason is that midwifery is legal in our state. CNMs can attend homebirths and can practice mostly independently and prescribe. Medicaid is mandated on a federal level to cover midwives, but if midwives aren't legal or allowed to practice outside a hospital, then you can't have Medicaid coverage for homebirth. Also, our State Department of Health and Human Services lists homebirth midwives in their provider directory and will refer people to them as registered providers, which makes a big difference if you're a lower-income person on Medicaid and want a midwife-assisted birth, or are just looking for someone to birth with period, because you can see that as an option.

So yeah. I don't think Tyra or Oprah or Ricci Lake or anyone else has very much to do with making midwifery available to people outside of those who have economic privilege. My experience on the ground has been that it MUST be far more grass-roots and at the same time far more political.

[library lady]

Originally Posted by sharr610

1. Get the information out in the mainstream media. Ricki Lake on the View is a great start. Get her on Tyra, MTV and Oprah, all set. Make it cool!

I was thinking about the idea of getting it out in the mainstream media but then I got to wondering how that would really help. If it got people to asking questions, that is great and wonderful but if it got people to do homebirth because that is what is being shown on the media then it is no different than going to a hospital. People need to be making informed decisions and use critical thinking whether they are giving birth at home, a birthing center, or a hospital.

[guestmama9904]

from personal experience homebirth is in my opinion not as accessable or feasible financially and socially to the less financially fortunate. i was 19 when I became pregnant with my DS, now 6.5 and I was working part-time for a low wage and in college. I then dropped out of college to work and save money so that I could stay at home at least for my baby's first 3 months of life. I saved about 3,000$, which combined with the now defunct "at home childcare" subsidy through the state, foodstamps and free healthcare through medical assistance in MN, and my son's dad's income was enough to help my son get his first year of life at home with his mom.

long story short the 3000$ I saved while working was just slightly more than what most homebirth midwives here in MN are charging so I had the choice of either having a free (state health insurance covered) hospital birth and being a stay at home mom, or having a homebirth with a midwife and having to go back to work as early as 6 weeks post partum.

perhaps accross the country there are cheaper midwives or areas where people cannot get free health insurance if they are very poor and therefore choose homebirth because it would be cheaper than a hospital birth with no insurance, but here in MN where I live all the midwives I called, and I called near a dozen, charge at least 2,500$ and also here in MN we have a fairly good state health insurance system where even moderately low income folks can get insurance for cheap. i know many homebirthin mamas here but they are all "priveliged" in some ways, be it class, race, education, the family they were born into ect. and they are all white.

oh and another huge thing is whether or not homebirth midwives can be covered by insurance. with our midwives my DH and I are seeing right now, whom are certified and licenced but NOT CNMs, we have to pay 3000$ and then at 6 weeks post partum they will attempt to get insurance to cover the care they gave. they stated that maybe half of their clients get some financial reimbursment but we certainly should not be holding our breath.

[plantmama]

Some ideas on making homebirth more available to those with low incomes and less resources in general:
Donate your books on homebirth to your library- where I live the public library is well used by every different sort of person in the community and it is a diverse community.
Always support legislation to make homebirth more affordable. I've heard that in Vermont they just made a law that homebirth be covered by insurance.

I've also had home birth partially covered by medicaid, yay!
I think if home birth becomes more common among the middle and upper classes it will "trickle down" to the lower classes. I guess because upper and middle class practices get more media attention, are more socially acceptable?? Don't know this for sure, but I feel like I've read this as an economic theory?
I'm very sensitive about my social status as a well educated middle class white woman (must be that darn liberal arts education) but I never hesitate to proudly proclaim my son's homebirth. It is one of the things I am most proud of. I've had women of all races, from all different social classes warm up to this, in short I've never had a negative response from some one in my own age range which is wonderful to me.

[kJad29]

Originally Posted by library lady

I was thinking about the idea of getting it out in the mainstream media but then I got to wondering how that would really help. If it got people to asking questions, that is great and wonderful but if it got people to do homebirth because that is what is being shown on the media then it is no different than going to a hospital. People need to be making informed decisions and use critical thinking whether they are giving birth at home, a birthing center, or a hospital.

:

[library lady]

Originally Posted by plantmama

I've also had home birth partially covered by medicaid, yay!
I think if home birth becomes more common among the middle and upper classes it will "trickle down" to the lower classes. I guess because upper and middle class practices get more media attention, are more socially acceptable?? Don't know this for sure, but I feel like I've read this as an economic theory?

I don't know why but this struck me as funny. My sister is a single parent and she is always joking about how a lot of the stuff she has done to save money is now considered posh and is part of the in thing. Now, she doesn't do this stuff because she is poor, she does it because she is being Green. It's funny how the poor can do stuff for ages and people look down their nose at it, yet when the middle and upper classes pick it up, it becomes cool. Is this something that has truly trickled down or has it trickled up?

All of the research that I have done was done in the past so my recollections may be a bit off. Once upon a time, homebirths were for everybody. I have read mixed information about the involvement of doctors and hospitals. I think I recall reading that in Europe, they had birth rooms were built with an eye towards charity. Most women gave birth at home unless the homes were too small and dirty. I seem to recall other accounts where the elite went to hospitals and the poor stayed home. I seem to recall that one book I read indicated that a lot of the women tried for witchcraft were actually midwives and their knowledge of birth and women was seen as some kind of weird magic because it wasn't scientific enough.

With the proliferations of hospitals, the elite moved into the hospitals and left the homebirths for the poor. Rather than let them do things differently, they had to insist that the poor go to the hospital too. When the poor did it, it was horrid but now that the supposedly privileged are doing it, it is okay? I have read so many different books about the history of midwifery and I find it funny that homebirths are now for the elite when historically they were for everybody. I wish I had the time to do some research.

[barefootpoetry]

: THis is a really fascinating discussion and I see a lot of good points being debated. Awesome!

My two cents is that sometimes class and education can be seperate - I consider myself pretty well educated, and I'm in the lower class (depending on whose standards you're using) - perhaps because the DRIVE to be educated can transcend any monetary boundaries. With my first child I was even poorer than I am now, and I considered myself educated...but about the wrong things. I read all the typical pregnancy and birth books and took all the classes at the hospital only to find out that OMG THIS TOTALLY SUCKS AND I NEVER WANT TO GO THROUGH ANYTHING THIS HORRIBLE AGAIN. Getting sent through the hospital wringer motivated me to seek out alternatives.

I really had no idea that the massive world of homebirth and birth activism in general even existed back then. Of course, it DID, and it was just as available to me then as it is now, but the point is that I had to seek it out, it didn't just jump in my lap like a copy of What To Expect. This information is not nearly as prevalent as I'd like it to be. I want the option of homebirth and midwifery (not just the hospital-based version) to be right there at the forefront for every woman when she is looking over her options for pregnancy and birth.

I suppose that I am not as horribly poor as some because I have managed to scrape together almost enough money for my MW's fee from every potential nook and cranny I could dig up, and I do have internet access that has blessed me with so much wonderful information. Without a computer, and without the agonizing yet still available means to gather funds, I would probably be scheduled for another C-section courtesy of Medicaid just like last time. And I don't really know how to stop that from happening to another mom like me. How do we get this information out there? How do we make homebirth more affordable? How do we let women know that a gentle, normal birth is their RIGHT, and reverse the thinking of "I'll just go to the hospital and do whatever the nice doctor tells me to"? That is an issue that transcends class, money, education, everything else.

[mustangtbn]

Originally Posted by sharr610

2. Encourage critical thinking. I think this is an often unspoken aspect of the privilege you talk about annakiss. It can come with more education, as it tends to be encouraged more at higher levels of education. That does not mean that there are not families and lower levels of education that encourage this, but its a general trend.

In order to open things up, people need to feel confident in their own decisions and ability to think critically. And that, my dear, is a much more complex problem, IMHO...

I agree that homebirth is more of a critical thinking thing than a privilege thing. The paradox is that while it can come with higher education, it can also be more completely squleched in the pursuit of higher education as well. I would say that, in comparison to the general population, probably a great many more of the homebirthers I know are college droputs, but of the type who are constantly reading and researching and learning on their own because that's what they enjoy doing.

A big part of the discussion here is how you define "privilege". Everyone seems to have their own definitions. Where I live, anyone who is privileged enough to be able to read can go to the local library and there are books there about homebirth. I know this because that is where I did a decent amount of my own initial homebirth research. This would unfortunately leave out a number of people who are illiterate, or who maybe don't have time to read, but by the same token, homeless people can and do go spend all day reading in the library, so this information is probably as widely available as it could possibly get.

Further, as a monetary thing, there are a number of issues around that as well. First of all, for uninsured people who don't qualify for medicaid, homebirth is a ton cheaper than hospital birth. For me, with insurance, it would probably still be comparable to pay out pocket for a MW as to pay the hospital, doctor, etc. Most MW have a sliding scale (some even down to cost) because they want to be able to help women who don't have much money. And for UCer's, it's very inexpensive to birth at home!

So, I don't think this is as easy as a privileged/not privileged/race/class thing. I think it's more about the person's own interest in birth, along with the luck of hearing about it somewhere, and then having the interest to think about it and blow off conformity.

[Kim919]

I think I would probably be considered lower middle class income wise(60-70K per year household income + benefits with our first baby on the way) but I think most people who looked at us would think we were probably even lower income then we are. We are against having debt, so we bought a very old house that needed a lot of work (and will have the note paid off this year - less then 3 years from when we bought it.) We both drive old vehicles that we paid for with cash, and we have no credit card or other debts. We could easily go buy a nice big house & two brand new cars and get some credit cards and make payments on everything and people would think we were higher class, but that is out of our comfort zone.

I do think if we were a lot tighter on money (especially if we didn't have a really good health insurance policy) it would have been more difficult to plan a home birth. I think we would have done it anyway, but it was really nice to have money not even be an issue in the decision.

As for people keeping home birth "to themselves." I do find myself avoiding talking about it, but not because I want to be part of some exclusive group of "enlightened" individuals that I would like to remain exclusive.

I occasionally, when the correct time presents itself (ie: what hospital are you delivering at?) mention gently that I plan to home birth. How I proceed after that in the conversation is based entirely on the response I get. If i'm greeted with negativity, I quickly try to change the subject. If the person seems interested, I'll continue talking about my reasons, etc. for as long as their attention span allows. I've yet to find anyone who is really interested or supportive (except my mom.)

So I guess basically I'm saying I don't think that home birth is exclusive to privilege, monetary or intellectual. I think that it tends to find its way to women with a specific approach and outlook to life in general who are able to appreciate the benefits that it has to offer. I think that outlook crosses social and economic borders in a very random way, and the fact that those woman are so few and far between might make it appear that they are trying to "keep it to themselves," when in fact they just coincidentally tend to be the same women who are not ones to push their belief systems on other people.

edited to add: Myself & DP BARELY graduated high school, we both grew up in very poor families, he didn't really even learn to read and write untill he was about 21. Neither one of us had any interest in collage. He is one of the smartest people I know, even gifted in certain areas, and I would like to think I'm not an idiot. I work at a desk job as a bookkeeper and he is a tree surgeon. We're not married & don't plan to get married, though we do have a domestic partnership for some legal protection. I thought I should add this for prospective.

[sharr610]

Originally Posted by library lady

I was thinking about the idea of getting it out in the mainstream media but then I got to wondering how that would really help. If it got people to asking questions, that is great and wonderful but if it got people to do homebirth because that is what is being shown on the media then it is no different than going to a hospital. People need to be making informed decisions and use critical thinking whether they are giving birth at home, a birthing center, or a hospital.

I absolutely agree. I think what I meant more was it starts a national conversation. By making it "cool," I mean, make it something interesting to talk about. Make it "cool" to make your own choice about birth.

[Viola]

Originally Posted by laohaire

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

I would agree with this, especially among the middle aged or older where computers were not a part of their schools when they were growing up. Issues with things like leisure time, access to jobs where you might use computers and become more familiar with them, access to utilities at home like electricity, phone service let alone cable or DSL or whatever. And even if you have an old computer that you got for free, knowing how to troubleshoot problems, and dealing with connectivity issues, etc, it doesn't seem like a person in that situation would have the habit of going to the library to research something online...if you did go, you might turn to more traditional methods. I think this may change as it seems more and more public elementary schools have computers and computer education, but time is still a big one.

[Viola]

Originally Posted by annakiss

How does everyone feel about homebirth as a domain of the privileged (not necessarily wealthy, mind you - privileged as in referring "to special powers or 'de facto' immunities held as a consequence of political power or wealth. Privilege of this sort may be transmitted by birth into a privileged class or achieved through individual actions.")?

I think it's sad, since you could almost look upon it as a type of cultural appropriation (maybe not the accurate term, but I can't think of what I mean, exactly). At one point, homebirth, even in the US, was not the domain of the privileged. Then as access to modern medicine and hospitals became more common, more and more of society could take advantage of these things, until it became a situation where choosing homebirth, denying hospital care to certain segments of the population would be seen as something to be put down by any right thinking, moral person. Now we've come in a circle to a place where often the people who are choosing homebirth are the ones who have a certain amount of power and privilege, at least to be taken seriously by the mainstream. They have to say, "Yes, we researched it and it is scientifically sound." And that is what bothers me, the most, I think, because when it comes to obstetrical care in this country, I feel like we've thrown the baby out with the bathwater in many cases.

However, I don't necessarily think homebirth is for everyone, and I think the best way to educate is by word of mouth. I think we need to work on a governmental level to make birthing choices and obstetrical care better for everyone, regardless of whether a woman gives birth at home, in a birth center or in a hospital

When I have talked about homebirth with less privileged than I, there was a resistance. And then finally what came out of it is, "I don't WANT to stay home, are you kidding? I want to get OUT of here, I want to go to the hospital and at least have some break." (I've also talked to at least one person for whom a hospital was not an option, because of her financial situation.) If you are talking to people who might be returning to work as soon as 2 days after giving birth, they may welcome the chance to get away from their home for just that little bit of time. We don't know what their home situation is like. The idea that one would give birth in their tiny, messy place (or that they would have to clean it and make it ready) without access to any pain relief or aftercare may not strike a person as empowering, it may feel precisely the opposite. So word of mouth, IMO, is the best way to really explain the benefit one might get, but you have to accept she is not going to feel the same way. That's why I would like to work on bettering birth choices all around.

I thought it was interesting when I was pregnant, and I was talking to my doctor about how I wanted a homebirth midwife, and she was really confused, and then finally suggested that if I wanted a midwife, I could use the clinic that they ran for the underprivileged. But the midwife wouldn't deliver me, the OBs have to do all the in hospital stuff.