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Homebirth and Race and Class - Page 5

post #81 of 117
I'm sorry I haven't read the whole thread. But the midwife I almost went with does homebirths exclusively. And 90% of her clients are low-income and very racially diverse. Hospital births are very expensive. And she is trying her best to give women regardless of their background the best prenatal care and birth possible.
post #82 of 117
I do want to discuss this but will have to organize my thoughts as well as read the whole thread.
will post later
post #83 of 117
Thread Starter 
I want to clarify some things. First - the thread title. When discussing privilege in a social context, historians use the phrase, "Gender, Race, Class." It's a bit of a joke among the history PhDs I know - any paper these days is "Any Noun and the Any Noun of the Any Location: Gender, Race, Class" because as historians, everything must be examined through the lenses of everyone, which is an attempt to undo the whitewashing of history and get a more complete sociological perspective. So I was using that phrasing not to point out race as a determining factor, per se, but the issues of race and class related to homebirth. Or more specifically, to consider the concept of the white/christian/heterosexual privilege as it relates to, well, everything.

This is what I think: In this country, and largely in Canada as well, from what I understand, racism and classism are so pervasive and so a part of the capitalist system that the privilege that largely extends to the "elite" or the middle class is significant compared to the experiences of the non-white and poor. Now, non-white and poor is not a group in and of itself that has much in common except for the oppression from the capitalist machine. That's the connecting factor that determines non-white and poor as a group. And come to think of it, it should really be non-white and/or poor. This is a statistical truth: the segments of the population that are the poorest are largely people of color and women.

So of course the women who can afford homebirth are going to be primarily comprised of white women of some education from the middle class. What the true elite do is of no concern to me because they largely operate outside of the capitalist machine (or rather, on top of it), though their choices do eventually trickle down. Just takes awhile, usually. The people for whom homebirth is cheaper than hospital birth and have enough access to information to choose that are, I would assume, rare.

I can see that poor immigrant families would also comprise a fairly noteworthy portion of the homebirthing population due to the prominence of homebirth the world over. I would not expect it to comprise a large portion of immigrant families, however.

Mostly I just wanted to ask the question. None of the answers here really surprised me. It always seems that people want to deny privilege at all costs and struggle against it with anecdote after anecdote. There is a blogger who is fiercely radical who talks about birth and issues of racism and classism and I find it very very interesting, though I can't say I totally understand. How could I? I'm privileged.
post #84 of 117
Anna- so when I went to the midwives of color conference in Phoenix- the majority of the mws who came were CNMs who do not do home births, we even had nuns from some islands come - Mabel was a presenter and she is a CNM now-- so there are several issues I know that from my blue collar poor family that I have not achieved their aim for me to be a "professional" and be more than they are and have more than they had. Like it or not the issues are where is the success and the money at- money to pay for services that you qualify for and money as a provider to be successful. Locally the county hospital who employed midwives and had basically a midwifery run unit had a 5% epidural rate, the billing department messed up for a couple years in a row to the tune of maybe 9 million dollars of lost revenue to the hospital/county they closed down the midwifery unit--- the billing department folks still have jobs- now the mws are all out of jobs, and the women who were well served by mw are now out of luck - at the same time that they were having a 5% epidural rate the other hospitals were at about 70-80% now they are 90%, meds taking the place of good supportive care--- care for the poor is all about some type of 3rd party reimbersment - payment for services rendered -- in our state the % of birthing women who qualify for medical financial aid is high I don't remember right now 70% or higher average in the metro areas less and rural more.
the professionalization of midwifery moves providers out of the class of the clients they serve -- in other countries where mws have maintained their primary provider status it is basically a votec job 2 years of basic post highschool, pre-nursing studies and 1 year of mw study- something like being a car mechanic that cnms have to have masters and moving toward doctorates in this country is crazy and how do you pay back an education like that? not by doing home births for $500 or less... so mws who are not LMs who are clandestine make up the majority of mws of color who still do homebirths that I have met or worked around, or even some of the plain mws I have met who do not have much education are also unlicensed - but with birth certificate issues-many clandestine midwives are doing less births, how do you prove your child was born in the US?
here in Az LM can be medicaid providers IF they have malpractice insurance (right in the medicaid contract) and if they can become an official provider for an HMO that has received a medicaid contract-- waivers can be filed if you can show need and .... it is a long process and takes time and money, to say that organizing putting together monies and hiring a savvy lawyer and then being able to continue to pay for the ongoing work toward that end is just what it is--- some LMs would actually gain and others it would make little to no difference to their practice -- our state has less than 1% home births and given the population base we should have numbers similar to NM

so don't know if this targets or addresses what you are after but thought I should knock something out before I just let it slide--
post #85 of 117
Currently in our culture access to homebirth midwifery is racist and classist.

That's my opinion, anyway.

It's the same thing with midwifery education, IMO.

If you look at attachment parenting per se, it's a largely white, middle to uppermiddle class phenomenon.
post #86 of 117
Quote:
Originally Posted by annakiss View Post
I want to clarify some things. First - the thread title. When discussing privilege in a social context, historians use the phrase, "Gender, Race, Class." It's a bit of a joke among the history PhDs I know - any paper these days is "Any Noun and the Any Noun of the Any Location: Gender, Race, Class" because as historians, everything must be examined through the lenses of everyone, which is an attempt to undo the whitewashing of history and get a more complete sociological perspective. So I was using that phrasing not to point out race as a determining factor, per se, but the issues of race and class related to homebirth. Or more specifically, to consider the concept of the white/christian/heterosexual privilege as it relates to, well, everything.
You definitely cannot argue that sexism, classism, and racism are still very much alive and well and are very pervasive. I guess the problem that I am having with this conversation is the fact that there are so many variables to consider. I also think that we need to clarify whether we are talking about homebirths with a trained/professonional midwife versus homebirth with an unlicensed midwife or with no assistance at all. All you have to do is look at the Unassisted birth forum to see that there are women in this country that choose an unassisted birth. I have been trying to find some more facts/information to bring to this discussion but the big problem is that it seems that most of the information that I find lumps all types of homebirths together (planned/unplanned/etc.) so it is difficult to get a clear picture of what is actually going on.

Quote:
Originally Posted by annakiss View Post
This is what I think: In this country, and largely in Canada as well, from what I understand, racism and classism are so pervasive and so a part of the capitalist system that the privilege that largely extends to the "elite" or the middle class is significant compared to the experiences of the non-white and poor. Now, non-white and poor is not a group in and of itself that has much in common except for the oppression from the capitalist machine. That's the connecting factor that determines non-white and poor as a group. And come to think of it, it should really be non-white and/or poor. This is a statistical truth: the segments of the population that are the poorest are largely people of color and women.
I am with you on this.

Quote:
Originally Posted by annakiss View Post
So of course the women who can afford homebirth are going to be primarily comprised of white women of some education from the middle class. What the true elite do is of no concern to me because they largely operate outside of the capitalist machine (or rather, on top of it), though their choices do eventually trickle down. Just takes awhile, usually. The people for whom homebirth is cheaper than hospital birth and have enough access to information to choose that are, I would assume, rare.
This may be true to some extent but I think one of the confounding variables is the fact that homebirth and insurance laws vary greatly from state to state. In some states, Medicaid will cover homebirths and it becomes a matter of preference. In some states, the requirements to get on state aid are so strict that you can't work at all so that if you have any sort of job it becomes cheaper to pay for a midwife out of pocket. In a state where homebirth is illegal or made almost impossible by legislation, it is not a matter of race or class but a matter of the law.

Quote:
Originally Posted by annakiss View Post
I can see that poor immigrant families would also comprise a fairly noteworthy portion of the homebirthing population due to the prominence of homebirth the world over. I would not expect it to comprise a large portion of immigrant families, however.
Actually, I would think it would be just the opposite. I would think that a poor immigrant family would want to go to the hospital because a lot of women die in childbirth around the world. I was looking at a website yesterday that said that in underdeveloped countries every minute a woman dies in childbirth. The site is http://www.safehands.org/ I am not sure what it brings to the discussion but if you consider that some people have that as part of their background, I can see why homebirth wouldn't be considered even if it were available.

Quote:
Originally Posted by annakiss View Post
Mostly I just wanted to ask the question. None of the answers here really surprised me. It always seems that people want to deny privilege at all costs and struggle against it with anecdote after anecdote. There is a blogger who is fiercely radical who talks about birth and issues of racism and classism and I find it very very interesting, though I can't say I totally understand. How could I? I'm privileged.
For some people, this discussion transcends race/class/privilege. I think you are not getting the answers that you think you should be getting because each state deals with birth and insurance differently. If you want to discuss it on a state by state level, then you might get a little better input. Racism and classism are very pervasive and they are huge barriers for a lot of stuff. It is not that people can't do things because they fit into a certain group. They can't do it because the preferred groups tell them they can't or make it so difficult to even try that they give up.

My sister that works doing outreach at a community college gets so mad at her coworkers because they ignore certain groups. If anyone from a certain group comes in, they blow them off or tell them that they can't. My sister's coworkers act like those characteristics (color, poor, whatever) might accidently rub off on them or something just by being in their company. They don't even want to deal with them and would rather lose a student than encourage certain people to attend college. It is like they want them to remain uneducated so they can stay on their pedestals. The people my sister works with are pretty average middle class people.

In order to apply this to homebirth, you have to figure out whether or not people see homebirth as something done by the enlightened or the stupid. I know that is a crass way of putting it but I think that if people see homebirth as something that is done by the educated white people, then yes they will do whatever they can to keep all of the "others" from doing it. If it is seen as something done by weirdos and freaks, then they aren't going to care if the "others" do it because the "others" already stand out and don't fit in. I don't know if I am making an ounce of sense so please forgive me if I am not. Also, the other variable to consider is where the midwives come from. If they are from the typical educated white middle class household, then they will probably be less likely to extend their services to the disenfranchised because they can't stand the thought of dealing with "those" people for fear of getting their cooties.
post #87 of 117
Quote:
Originally Posted by mwherbs View Post
the professionalization of midwifery moves providers out of the class of the clients they serve -- in other countries where mws have maintained their primary provider status it is basically a votec job 2 years of basic post highschool, pre-nursing studies and 1 year of mw study- something like being a car mechanic that cnms have to have masters and moving toward doctorates in this country is crazy and how do you pay back an education like that? not by doing home births for $500 or less...
I think your analysis is a bit off here. Consider two facts:

1. Nearly every other country in the world has some form of universal and government sponsored or controlled health care.

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.

So yeah, this country's outlook on health care and education IS completely crazy. But it's not about moving Midwives out of being primary providers. It's about making Midwives more serious primary providers by requiring a level of professionalization and education that is in line with what is required of other primary providers like Nurse Practioners, Physican's Assistants and MDs. And it parallels the level of professionalization and education that is required to be a primary provider of any kind in countries that have saner education requirements and health care payment strategies than the US.
post #88 of 117
the stretch between the poor and professionalization is huge--
there are quite a few books written on the subject of professionalization of midwifery in England, and we are walking that same path and are trying to pass that up---

look at the worries about cultural differences and the mothering folks- most of us have been concerned about being judged by CPS for co-sleeping or extended breastfeeding-
same difference with inviting highly educated folks into our homes, or to be involved in our lives on any level--- from cradle to the grave, some folks who are transitional can bridge that gap-
---------------------------
i wanted to add this because it is important the use of the word nurse in the midwifery realm decreases their cred and value-
here is the basic requirements to be a Physician's Assistant- many times they have the same scope of practice as many NPs - like rx with doc supervision

"Physician assistant programs usually last at least 2 years. Admission requirements vary by program, but many require at least 2 years of college and some health care experience. All States require that PAs complete an accredited, formal education program and pass a National exam to obtain a license."
post #89 of 117
I don't think it can be said enough that you have to factor in insurance coverage when looking at the impact of class/income level on health care choices in the US.

My family has insurance through my husband's employer. It covers a hospital birth 100%, and I don't even have any copays for prenatal care or prenatal testing. On the other hand, they won't cover homebirth at all. We're opting for a home birth, which is $4000 out of pocket. There are LOTS of folks (middle class folks) who can't afford an *optional* $4000 expense, especially right when they've got all the other financial impact of a new baby hitting around the same time. If we had a lower income, this home birth (supervised by a trained, legal, certified midwife) would not be an option for us. UC is an option for everyone, but that's outside our (and perhaps most peoples') comfort zone.
post #90 of 117
I haven't read the whole thread yet so excuse me if this has been pointed out already. The word privilege *means* private law. Access to homebirth is one of the best examples of how privilege works. Because birth and parenthood exist in a weird limbo where the rule of law is not clear, there are multiple sets of rules for people depending on their status. The most important piece of the solution to this problem, imho, is creating clear public law that applies to everyone. We need to explicit legislate that no one may interfere with a woman's right to determine the location and course of her births (just as it should be explicit that parents have the right to direct their children's education, a similar issue). Increasing access is all well and good but without the legal underpinnings it's not going to really do the job.
post #91 of 117
Interesting. I think it largely has to do with the people you are exposed to. Caucasians have had more time to "evolve" where other ethnic groups are sort of 2 generations behind. Both my husband and I are african americans. He has his PhD in Chemistry and I have my Ms in Biology. I attended very great schoools (smith for undergrad and Brown for Graduate).

Despite this...everyone, including my husband, thought I was a loon.

I think most importantly, my education allowed me to be able to look out of the box...to explore things that are unknown to me. I am the first (and remain) only homebirther in my family or sphere of friends. Plus, I know what is best for me and I know what I want.

In these economic times, I would say that with all our education, that we aren't in the middle class. It seems that we are in the lower class...yikes.

Our doula, who I am struggling to pay, did say something very interesting to my husband. She cannot break into the African American Community. There are many reasons why that is...but African Americans are not exposed to these types of services. They ask...what is a doula...just as I did. But, I can see the benefits...and many just see the $$$$. It's the way it is. I think it's just time. A few more generations...more knowlege. I will pass along my knowlege to my children so that they are exposed to things I wasn't exposed to. After a while...it becomes a norm.
post #92 of 117
Quote:
Originally Posted by SiobhanAoife View Post
I don't think it can be said enough that you have to factor in insurance coverage when looking at the impact of class/income level on health care choices in the US.

My family has insurance through my husband's employer. It covers a hospital birth 100%, and I don't even have any copays for prenatal care or prenatal testing. On the other hand, they won't cover homebirth at all. We're opting for a home birth, which is $4000 out of pocket. There are LOTS of folks (middle class folks) who can't afford an *optional* $4000 expense, especially right when they've got all the other financial impact of a new baby hitting around the same time. If we had a lower income, this home birth (supervised by a trained, legal, certified midwife) would not be an option for us. UC is an option for everyone, but that's outside our (and perhaps most peoples') comfort zone.
ita. we pay 600$ a month pre tax towords our insurance plan and the fact that it may not cover our 3000$ homebirth just sucks to put it lightly. to change this legislation is going to have to take place forcing insurance companies to cover homebirth. until then it will be the people who can afford the extra out of pocket expense.
post #93 of 117
Quote:
Originally Posted by arismama! View Post
ita. we pay 600$ a month pre tax towords our insurance plan and the fact that it may not cover our 3000$ homebirth just sucks to put it lightly. to change this legislation is going to have to take place forcing insurance companies to cover homebirth. until then it will be the people who can afford the extra out of pocket expense.
That won't happen as long as you have groups like ACOG and others actively speaking out about the dangers of homebirth and the safety of hospitals. If homebirth/midwife laws were consistent from state to state, then it might be easier to get something passed that would secure a woman's right to choose homebirth. I think that is one of the main reasons that I keep coming back to the fact that race and class are only part of the equation. If everything else were equal, then yes that would be a valid claim. In some places, it isn't even available for the average person because of restrictions. The person that could afford to circumvent local laws or go to another state is problably outside of the realm of this discussion anyway.

Off topic rant: The thing that irks me even more about insurance is the fact that paying for a homebirth out of pocket is about equivalent to all the copays for the doctor and hospital. When I had my first daughter at the hospital, I thought I had good insurance but they wanted to bill me an additional 1200 for the pediatrition and NICU stay and that was on top of all of the other copays. It infuriates me that I have to pay outrageous insurance premiums and get such crappy coverage and it seems to only be getting worse. My husband worked at one job where he got a raise every year but his take home pay actually went down because the insurance premiums went up all the while the actual coverages went down.
post #94 of 117
yeah i dont think there would be so much disparity in homebirth access for people in low income families and people of color if insurance covered any type of birth. in many states if you are low or even middle low income your family can get state health insurance for a very low cost but you cannot usually get homebirth covered by this.

and yes insurance in general is going way up with less coverage and less benifits and more out of pocket expenses. having had both private and public insurance through the same insurance company, medica, my experience was that publicly funded insurance through the same carrier was so much better in covering basic services. there are such better programs offered than are offered to paying customers, which I am glad of because low income people probably need these extra services more than I do now but its a bummer to spend 10s of thousands a year on insurance for your family and not have the services you need be paid for.
post #95 of 117
I would love to round up CarolynnMarilynn or one of the other Ontario midwives and get their input on how having universal coverage of homebirth has affected its demographic. I think that having easy, bureaucracy-free medicaid coverage (not like in Oregon with its whole wait until you are quite pregnant then sign up for the open card, yadda, yadda nonsense) and private insurance coverage might help.


One other thing, with the system as it currently stands, though. Homebirth is a special thing, the not-default, takes an effort sometimes. (For example, there are at least 7 homebirth midwives in my town and only 2 are listed in the phone book.)

I grew up in a working-class household (and sometimes my working-class manners are a barrier between me and my upper-middle class clients, but that is another story). It was drilled in my head again and again that I should not try to do anything special, ask for anything special, or expect anything special. I think that the sense of entitlement that women have when they seek out homebirths is a result of middle-class values. It would be completely contrary to my working-class cultural upbringing to walk into a CNM clinic in a hospital-based practice, go through the appointment and toss aside my paper gown and say, "This is not good enough for me. I deserve better!" I think this is something I share with a lot of working class women.

I serve women who skew toward more diverse and poorer than my surrounding county, but I think that is just me. If you take homebirth midwives as a whole around here, they do tend to overwhelmingly serve the white middle class (but not the hyper-rich, which is fascinating to me). Even though I do serve a lot of poor women, if you dig a little deeper you see middle-class backgrounds a lot of time, regardless of race. About 50% of my clients are on medicaid (despite the fact that medicaid doesn't pay me) but amongst them are a lot of students, recent grads, recent immigrants, beginning farmers, etc. Middle class, just temporarily poor. When I serve truly poor women who have come from poverty and are living in poverty long-term, it is almost always because of some kind of extremely abusive or negligent care on the part of an OB or because of past trauma.

Here is my birth fantasy. Midwives who are able to practice freely at home and hospital. Small practice groups, small client loads. Every woman gets a midwife to labor at home with her. When she gets to late active labor, those who have not already asked to go to hospital or made a definite plan to stay home hear, "Hey, you're doing great. We can finish this birth right here if you want and then we can tuck you into your own bed when you're done, ok?" If she says no, then midwife goes to hospital and they finish the birth there. If she says yes, they call in assistants and finish at home. I think that not only would the homebirth rate go up with a system like this, that the intervention rate at the hospital would go far, far down.
post #96 of 117
Quote:
Originally Posted by mwherbs View Post
the stretch between the poor and professionalization is huge--
there are quite a few books written on the subject of professionalization of midwifery in England, and we are walking that same path and are trying to pass that up---

look at the worries about cultural differences and the mothering folks- most of us have been concerned about being judged by CPS for co-sleeping or extended breastfeeding-
same difference with inviting highly educated folks into our homes, or to be involved in our lives on any level--- from cradle to the grave, some folks who are transitional can bridge that gap-
---------------------------
i wanted to add this because it is important the use of the word nurse in the midwifery realm decreases their cred and value-
here is the basic requirements to be a Physician's Assistant- many times they have the same scope of practice as many NPs - like rx with doc supervision

"Physician assistant programs usually last at least 2 years. Admission requirements vary by program, but many require at least 2 years of college and some health care experience. All States require that PAs complete an accredited, formal education program and pass a National exam to obtain a license."
I'm very well aware of the requirements for a PA program, since that's the program my husband is currently applying to. PA programs are moving almost universally to being a Master's degree credential, meaning that they require a 4 year BA or BS PLUS anywhere between 1000 and 5000 hours of direct patient contact health care experience in some other setting (like a CNA, Pheblotomist, EMT, etc.) Even the few programs that award an undergrad degree are 5 or 6 year training programs with a full BS and then a year of PA training and a year of clinicals.

I guess I just really don't get the idea that highly educated people are a threat. First, because let's face it... CPS workers are not really well known for being highly smart or educated. And secondly, because education doesn't always equal class privilege. And thirdly, because people who are educated are more likely to be able to understand cultural and class difference as actual difference, rather than being someone doing it "wrong" or "badly" who needs to be brought to the light. Or the attention of the authorities.
post #97 of 117
Quote:
Originally Posted by library lady
I also think that we need to clarify whether we are talking about homebirths with a trained/professonional midwife versus homebirth with an unlicensed midwife or with no assistance at all. All you have to do is look at the Unassisted birth forum to see that there are women in this country that choose an unassisted birth. I have been trying to find some more facts/information to bring to this discussion but the big problem is that it seems that most of the information that I find lumps all types of homebirths together (planned/unplanned/etc.) so it is difficult to get a clear picture of what is actually going on.
Exactly. I was waiting for someone to point that out.
It's like we are acting as if homebirth is some new
sort of luxury item, please. Women have been giving
birth at home since the beginning of time.

Quote:
Originally Posted by annakiss
It always seems that people want to deny privilege at all costs and struggle against it with anecdote after anecdote.
I for one am not denying anything. I am asking why
race adds value to this discussion of the overall
goal is to educate women- period.

Besides, if I spend my life shouting "privilege! privilege! I can't get ahead because of my race and gender" people don't take that too well. "Oh those [RACE] only want handouts! Nothing is free. Just work hard like everyone else. Lazy!" Oh but if someone else says it because they feel so bad and want to help my supposedly underprivileged self then it's ok. Just something I've noticed.


Quote:
Originally Posted by library lady
In order to apply this to homebirth, you have to figure out whether or not people see homebirth as something done by the enlightened or the stupid. I know that is a crass way of putting it but I think that if people see homebirth as something that is done by the educated white people

Yup, it's hard for people to have a well rounded discussion
if it always (no matter what) goes back to - these poor minorities
and their undereducated, underpriveliged, selves need our help
because we are white and we know better than they do.

Then someone has to add "well I am a minority and I agree".

Great. Now tell me how this helps spread the message
that women have a choice to birth at home. IF THEY WANT.

I think we also forget that what is best for you isn't
best for Jane Doe. You can "educate" until the cow
comes home but when it comes down to it there will be women-
black, white, brown, yellow and in between- who still prefer
to give birth at a hospital.
post #98 of 117
Thread Starter 
Quote:
Originally Posted by library lady View Post
You definitely cannot argue that sexism, classism, and racism are still very much alive and well and are very pervasive.
Did you mean to use "cannot?"

Quote:
Originally Posted by library lady View Post
I guess the problem that I am having with this conversation is the fact that there are so many variables to consider. I also think that we need to clarify whether we are talking about homebirths with a trained/professonional midwife versus homebirth with an unlicensed midwife or with no assistance at all. All you have to do is look at the Unassisted birth forum to see that there are women in this country that choose an unassisted birth. I have been trying to find some more facts/information to bring to this discussion but the big problem is that it seems that most of the information that I find lumps all types of homebirths together (planned/unplanned/etc.) so it is difficult to get a clear picture of what is actually going on.
I don't the the UC rate is as great as it may appear here at all. It is certainly up and coming throughout the homebirth community, which I think is a result of two things - lack of access/affordability and over-medicalization of birth (in the hospital and out, whether "real" or perceived). Either way, the issues of lack of access and afforability remain relevant.

Quote:
Originally Posted by library lady View Post
Actually, I would think it would be just the opposite. I would think that a poor immigrant family would want to go to the hospital because a lot of women die in childbirth around the world. I was looking at a website yesterday that said that in underdeveloped countries every minute a woman dies in childbirth. The site is http://www.safehands.org/ I am not sure what it brings to the discussion but if you consider that some people have that as part of their background, I can see why homebirth wouldn't be considered even if it were available.
I wasn't clear - I was saying that there may be a certain percentage of immigrants seeking out homebirth that would seem significant - meaning even a small percentage - but that I didn't think that it would necessarily mean that immigrants at large would give birth at home. I figured it could go either way - either people wanted to experience hospital birth as the high tech privilege it is, or people wanted to maintain connections to their birth based on a history of birth as normal, depending of course on their experiences with birth in the past, etc.

Quote:
Originally Posted by library lady View Post
This may be true to some extent but I think one of the confounding variables is the fact that homebirth and insurance laws vary greatly from state to state. In some states, Medicaid will cover homebirths and it becomes a matter of preference. In some states, the requirements to get on state aid are so strict that you can't work at all so that if you have any sort of job it becomes cheaper to pay for a midwife out of pocket. In a state where homebirth is illegal or made almost impossible by legislation, it is not a matter of race or class but a matter of the law.

For some people, this discussion transcends race/class/privilege. I think you are not getting the answers that you think you should be getting because each state deals with birth and insurance differently. If you want to discuss it on a state by state level, then you might get a little better input. Racism and classism are very pervasive and they are huge barriers for a lot of stuff. It is not that people can't do things because they fit into a certain group. They can't do it because the preferred groups tell them they can't or make it so difficult to even try that they give up.

My sister that works doing outreach at a community college gets so mad at her coworkers because they ignore certain groups. If anyone from a certain group comes in, they blow them off or tell them that they can't. My sister's coworkers act like those characteristics (color, poor, whatever) might accidently rub off on them or something just by being in their company. They don't even want to deal with them and would rather lose a student than encourage certain people to attend college. It is like they want them to remain uneducated so they can stay on their pedestals. The people my sister works with are pretty average middle class people.

In order to apply this to homebirth, you have to figure out whether or not people see homebirth as something done by the enlightened or the stupid. I know that is a crass way of putting it but I think that if people see homebirth as something that is done by the educated white people, then yes they will do whatever they can to keep all of the "others" from doing it. If it is seen as something done by weirdos and freaks, then they aren't going to care if the "others" do it because the "others" already stand out and don't fit in. I don't know if I am making an ounce of sense so please forgive me if I am not. Also, the other variable to consider is where the midwives come from. If they are from the typical educated white middle class household, then they will probably be less likely to extend their services to the disenfranchised because they can't stand the thought of dealing with "those" people for fear of getting their cooties.
I don't think of the issues as one of othering at all, but I suppose there is that element. I think that due to the normalization of whiteness in this country, white middle class midwives are not likely to actively seek out ways to cater to poor or non-white women, even though they may not consciously fear or shun/avoid them. It's just a matter of what is normal and acceptable to them.

My whole point is that it probably isn't even an issue though because I don't suspect that there is a huge population of poor and non-whites actively seeking out homebirth due to the lack of access for everyone. I see this as especially a lack of access for poor and non-whites not because they are unable to find the information through any fault of their own, but because this information is not exactly walking around on billboards or television on a regular basis. Without the information out there, available as a viable option and not just a weird freaky one to the mainstream, how would anyone know about it, for one, and two, understand where to begin to find a care provider?

In general, it takes a lot to step outside the system - support from people who care about you whether actively regarding a specific decision or not is key. I imagine that living in an (nearly) inescapable cycle of poverty would not really lend itself towards bucking the system, though as George Orwell pointed out, they're in a unique position to do so.

Beyond all that lack of information and viability, even when folks do manage to step outside the system, affordability becomes a huge issue. I don't think Medicaid sometimes covering homebirth necessarily means that people are going through the hassle to make that happen, primarily because just because they do, doesn't mean anyone knows about it. Same with any insurance really.

Certainly, homebirth being against the law is an access issue for everyone. I think that there are access issues for everyone anyway, but I'm imagining that because of how access to everything else breaks down socio-economically, that homebirth would really be no different. Ultimately I think the solution is to try to increase access which means education, outreach, convincing insurance companies to cover it (or alternately attaining universal healthcare), and improving the laws. I also think ACNM has a tricky stance on DEMs that is moving increasingly toward limitations and that really sucks too.
post #99 of 117
Thread Starter 
Quote:
Originally Posted by HisBeautifulWife View Post
Exactly. I was waiting for someone to point that out.
It's like we are acting as if homebirth is some new
sort of luxury item, please. Women have been giving
birth at home since the beginning of time.



I for one am not denying anything. I am asking why
race adds value to this discussion of the overall
goal is to educate women- period.

Besides, if I spend my life shouting "privilege! privilege! I can't get ahead because of my race and gender" people don't take that too well. "Oh those [RACE] only want handouts! Nothing is free. Just work hard like everyone else. Lazy!" Oh but if someone else says it because they feel so bad and want to help my supposedly underprivileged self then it's ok. Just something I've noticed.





Yup, it's hard for people to have a well rounded discussion
if it always (no matter what) goes back to - these poor minorities
and their undereducated, underpriveliged, selves need our help
because we are white and we know better than they do.

Then someone has to add "well I am a minority and I agree".

Great. Now tell me how this helps spread the message
that women have a choice to birth at home. IF THEY WANT.

I think we also forget that what is best for you isn't
best for Jane Doe. You can "educate" until the cow
comes home but when it comes down to it there will be women-
black, white, brown, yellow and in between- who still prefer
to give birth at a hospital.
I tried to clarify before that race by itself is not an issue. It's race and class together and the lack of access to, well, everything for those that are poor and/or non-white. It was just occurring to me that perhaps homebirth, and really, most of this middle class obsessing over parenting minutiae is a privilege and maybe those of us who have it should become aware of that fact. The subsequent questions in my OP were not my opinion, but simply questions. I don't deign to imperialistically assume that all the poor and people of color should want this and that I should help them get it. I just think it should be available to everyone.
post #100 of 117
Quote:
Originally Posted by annakiss View Post
Did you mean to use "cannot?"
I was trying to make the point that racism, classism, and sexism iare very much alive and well. People could argue that it doesn't exist but I think they would be wrong.

Quote:
Originally Posted by annakiss View Post
I don't the the UC rate is as great as it may appear here at all. It is certainly up and coming throughout the homebirth community, which I think is a result of two things - lack of access/affordability and over-medicalization of birth (in the hospital and out, whether "real" or perceived). Either way, the issues of lack of access and afforability remain relevant.
I completely agree. When discussing the UC rate as not being that great, I think you need to consider the fact that the homebirth rate isn't that great either. I have read a so many articles and I think I have seen them quote the homebirth rate in the US as being anywhere from 1% to 6% of total births. (I couldn't find the articles again.) In the land of MDC, it seems like homebirths and UC are so normalized that we forget that they are still a tiny part of the overall birth rate. Most people outside of MDC don't even consider homebirth worthy of discussion and look at you like a freak if you bring it up.

Quote:
Originally Posted by annakiss View Post
I wasn't clear - I was saying that there may be a certain percentage of immigrants seeking out homebirth that would seem significant - meaning even a small percentage - but that I didn't think that it would necessarily mean that immigrants at large would give birth at home. I figured it could go either way - either people wanted to experience hospital birth as the high tech privilege it is, or people wanted to maintain connections to their birth based on a history of birth as normal, depending of course on their experiences with birth in the past, etc.
I agree completely. I was just trying to point out that it could go either way too. I guess we were just saying the same thing in a slightly different manner.


Quote:
Originally Posted by annakiss View Post
I don't think of the issues as one of othering at all, but I suppose there is that element. I think that due to the normalization of whiteness in this country, white middle class midwives are not likely to actively seek out ways to cater to poor or non-white women, even though they may not consciously fear or shun/avoid them. It's just a matter of what is normal and acceptable to them.
I don't think that racism/classism/sexism is always a case of consciously choosing to fear or shun people. Like you said, it is just a matter of what is normal and acceptable. Anything outside of what they see as normal or acceptable is automatically feared. By default, the people that are different are treated differently.

Quote:
Originally Posted by annakiss View Post
My whole point is that it probably isn't even an issue though because I don't suspect that there is a huge population of poor and non-whites actively seeking out homebirth due to the lack of access for everyone. I see this as especially a lack of access for poor and non-whites not because they are unable to find the information through any fault of their own, but because this information is not exactly walking around on billboards or television on a regular basis. Without the information out there, available as a viable option and not just a weird freaky one to the mainstream, how would anyone know about it, for one, and two, understand where to begin to find a care provider?
You don't even have to be poor or non-white to face this dilemma. When we were expecting our first daughter, we had just gotten out of graduate school and DH got his first full time job. We did not have insurance and the insurance through his work had a 90 day waiting period. Even without the waiting period, they wouldn't cover the birth because it was a pre-existing condition. We applied for Medicaid but were rejected for making too much money. (Anybody that equates education with money is mistaken.) I had no idea where to go or how to seek out information about pregnancy or childbirth. I did what everybody does. I went to my mom, sisters, and others that had been in a similar predicament and was told to go to the local clinic, which is what I did. I have to add that my sisters are highly educated people. My oldest sister has a college degree and works at a community college. My middle sister has two master's degrees. I have a master's degree and my husband has two master's degrees. We are not uneducated people by any stretch of the imagination. We went to the clinic and had no idea how to find a care provider other than what was available through the local clinic/social services, which completely supports your claim that the information just isn't out there to be had. I didn't really have an excuse for not knowing because I am white, highly educated, and while we are no where near rich, we are not dirt poor either. I think we walk the line between lower middle class and poor. DH and I are both librarians so we really didn't have an excuse other than we just didn't know. Nobody had ever mentioned homebirth as a viable option and when researching childbirth the only books that most libraries have are the mainstream ones. When you do a google search on childbirth, you get the mainstream stuff. I didn't stumble across homebirth until I was looking for information on breastfeeding, babywearing, cosleeping, and other natural living things after I had my first daughter, which is part of what led me down the homebirth path.


Quote:
Originally Posted by annakiss View Post
In general, it takes a lot to step outside the system - support from people who care about you whether actively regarding a specific decision or not is key. I imagine that living in an (nearly) inescapable cycle of poverty would not really lend itself towards bucking the system, though as George Orwell pointed out, they're in a unique position to do so.
I completely agree. It just isn't poverty that makes it difficult to buck the system though. There are a whole host of things that make it difficult. I find that I catch flack for my decisions until I start spouting off my credentials and even then it doesn't guarantee acceptance. My MIL is a constant barrier to us stepping outside the system. It is a constant battle. If my family had taken the same attitude, it would have been very difficult for me to pursue a homebirth. That's not to say that I wouldn't have done it, but it would have been a lot more difficult and might have caused me to see thinks a little differently. I guess the point that I am trying to make is that medicalized births are so much a part of the system that it is difficult for anybody to step outside of the system regardless of race or class. I think sexism is more of a problem than race or class because doctors are typically male and prevailing culture has historically been paternalistic where the men come to the rescue of the weaker sex.

Quote:
Originally Posted by annakiss View Post
Beyond all that lack of information and viability, even when folks do manage to step outside the system, affordability becomes a huge issue. I don't think Medicaid sometimes covering homebirth necessarily means that people are going through the hassle to make that happen, primarily because just because they do, doesn't mean anyone knows about it. Same with any insurance really.

Certainly, homebirth being against the law is an access issue for everyone. I think that there are access issues for everyone anyway, but I'm imagining that because of how access to everything else breaks down socio-economically, that homebirth would really be no different. Ultimately I think the solution is to try to increase access which means education, outreach, convincing insurance companies to cover it (or alternately attaining universal healthcare), and improving the laws. I also think ACNM has a tricky stance on DEMs that is moving increasingly toward limitations and that really sucks too.
If I could have gotten on Medicaid and had all of my births paid for, I don't think that it would have been profitable to step outside of the system no matter how much I hated it. I know a lot of people that have been on Medicaid and given birth. I talk to them about homebirth and they are very open to the idea but there is no way that they could or would ever consider it for the very reasons that you mention. It is so easy to become entrenched in the system no matter how much you hate it. Education and outreach are very important but in order to have a homebirth you have to have a certain level of personal responsibility. Most people that I talk to are not willing to take that level of responsibility. They don't want to clean their house. They want to be separated after birth. They want the epidural. They want to blindly follow doctors orders. They take what the doctors say as gospel without questioning it. I have seen this among the rich as well as the poor. Our entire culture would have to be changed and birth would have to be seen as normal and not something that requires treatment. All of the news articles that I have read about the recent controversy over Ricki Lake have tons of comments that show just how pervasive the culture of medicalized birth is. 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.
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