Homebirth and Race and Class - Page 3 - Mothering Forums

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Old 07-23-2008, 01:26 PM
 
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I am kinda lost with this topic.

I am low class, poor, no insurance, white, no real education past high school......and I had a homebirth

I did have interent. So that makes me priveledged? Hmmm....I guess I am a bit lost.

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Old 07-23-2008, 01:50 PM
 
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I am kinda lost with this topic.

I am low class, poor, no insurance, white, no real education past high school......and I had a homebirth

I did have interent. So that makes me priveledged? Hmmm....I guess I am a bit lost.
There are always going to be those more privileged than you, as well as far less privileged. Just by living in the US you are fairly privileged, wouldn't you think?

I am privileged to be able to...is a statement that we used to hear fairly often, and it was something you acknowledged, maybe even a source of pride in some cases. Now we seem to want to deny that we are privileged, because we feel like the word is being used to deny that we have problems, regardless.

My mother lived during the Great Depression, her mother died from meningitis at a young age, the children were all split up and sent to different relatives, some of them were abusive, and then my mother's favorite aunt killed herself. They were dragging the river for her body while my mom was at school. My aunt, to this day, is a very hard worker. She cleans move-out houses for money, even though she is almost 80 years old. People ask her why she still works so hard, she says when she was a child and was sent to live on a farm, she was told if she wanted to eat, she had to work. She knew she liked eating, so she worked hard, and she still does. In any event, my mother knows she is privileged, knows now how more privileged she was than others. Although I think in some ways it makes her less tolerant, because there are things that are unacceptable to her no matter how bad things are, and a lot of us don't see it the same way.

But I think of privilege as being aware of how your own situation is not comparable to another's, and you can't just say, "I did it, so you can do it too."
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Old 07-23-2008, 02:36 PM
 
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There are always going to be those more privileged than you, as well as far less privileged. Just by living in the US you are fairly privileged, wouldn't you think?
I agree that there is always going to be somebody that has more than you and somebody that has less than you. Sure, somebody might think they are privileged because they live in the U.S. At the same time, somebody else may view living in the U.S. negatively and would not view it as a privilege at all. The word privilege is not a neutral term.

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I am privileged to be able to...is a statement that we used to hear fairly often, and it was something you acknowledged, maybe even a source of pride in some cases. Now we seem to want to deny that we are privileged, because we feel like the word is being used to deny that we have problems, regardless.

Often times, when someone is referred to as being privileged it is usually a loaded statement. The intended meaning is usually, "Shut up, you don't know what you are talking about because you have X or Y or Z." In this case, it almost seems as if you are saying that because you have Internet, you don't qualify to consider yourself part of X group. Heck the homeless person that is dying on the streets can be considered privileged because they are alive so it is really a matter of perspective.

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My mother lived during the Great Depression, her mother died from meningitis at a young age, the children were all split up and sent to different relatives, some of them were abusive, and then my mother's favorite aunt killed herself. They were dragging the river for her body while my mom was at school. My aunt, to this day, is a very hard worker. She cleans move-out houses for money, even though she is almost 80 years old. People ask her why she still works so hard, she says when she was a child and was sent to live on a farm, she was told if she wanted to eat, she had to work. She knew she liked eating, so she worked hard, and she still does. In any event, my mother knows she is privileged, knows now how more privileged she was than others. Although I think in some ways it makes her less tolerant, because there are things that are unacceptable to her no matter how bad things are, and a lot of us don't see it the same way.
I am not sure what this adds to the conversation about homebirthing and race/class. I have family members with similar stories. My grandfather didn't find out his real name or real identity until he married my grandmother as a result of being broken up because of disease killing family members. I have similar stories of people working their butts off to eat today (single moms that feed their kids by picking up coke cans on the side of the road). There have always been and always will be people that are struggling to survive while the rest of us sit on our computers talking about them like they no longer exist and are a thing of the past or don't exist in this country.

The more interesting thing to find out was whether or not your aunt had her kids at home or in a hospital. My 80 yo grandmother had all of ther kids at the hospital but her mom had some kids at home and some at the hospital. I am not sure but I have always found it interesting to talk to older family members about birth and kids and how things used to be done.

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But I think of privilege as being aware of how your own situation is not comparable to another's, and you can't just say, "I did it, so you can do it too."
You are right. You can't compare one person's situation to another and lump people together. That is why I am having a really hard time with the assumption that homebirth is related to race and class. It is lumping people together and claiming that because you fall into X category, it is not available to you or you are not as likely to do it. I can see arguments on both sides why falling into a certain category (rich/poor/black/white/etc.) would make you more likely to have a homebirth. I can see compelling reasons for anyone to have a homebirth just as I can see compelling reasons for anyone to have a hospital birth.
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Old 07-23-2008, 03:57 PM
 
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Where are you? That has not been my experience at all.
i'm in seattle. i don't know if it's my particular midwife's practice, because i'd think it would be EVEN MORE caucasian and priviledged. i don't know if you know much about seattle, but the city is very white and $. we definitely have lots of immigrants & minorities spread around the outskirts, so i think it's interesting that they'd find their way to the most "hip" neighborhood in the city for a midwife & homebirth!
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Old 07-23-2008, 04:08 PM - Thread Starter
 
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Often times, when someone is referred to as being privileged it is usually a loaded statement. The intended meaning is usually, "Shut up, you don't know what you are talking about because you have X or Y or Z." In this case, it almost seems as if you are saying that because you have Internet, you don't qualify to consider yourself part of X group. Heck the homeless person that is dying on the streets can be considered privileged because they are alive so it is really a matter of perspective.
That is not at all what I am referring to when I talk about privilege. I feel that it's important for me to constantly question the privilege I experience, to seek it out and recognize that I am not alone in the universe and that my behaviors can be detrimental to others if I am careless - this is why we make an effort to tread lightly on the earth, to be careful about how we buy the things we need (it's important, for instance, to think about the child who sewed a piece of clothing in order to remember not to support slavery, the people who died for diamonds, the way that the chickens were kept that are now propped on petroleum derived plates at KFC).

I feel that it's important to share those ideas with my children, which we do because that's what we value and it doesn't look like sudden lessons on permaculture or child-labor, but rather growing our gardens, choosing our purchases wisely, and letting them know why we do the things we do as we do them.

It's even why I choose to homebirth. I see birthing at home as a feminist act, always have. It's using my biology, my femininity as a tool for change by supporting a midwife, being empowered by a powerful act, and by sharing that with others to see that they are powerful and that the system sucks.

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You are right. You can't compare one person's situation to another and lump people together. That is why I am having a really hard time with the assumption that homebirth is related to race and class. It is lumping people together and claiming that because you fall into X category, it is not available to you or you are not as likely to do it. I can see arguments on both sides why falling into a certain category (rich/poor/black/white/etc.) would make you more likely to have a homebirth. I can see compelling reasons for anyone to have a homebirth just as I can see compelling reasons for anyone to have a hospital birth.
I think it's difficult to deny that certain groups of people have the most access to the information and resources necessary to step outside of their context, to deny the system, to rebel against the norm. Which is not to say that those within those socio-economic contexts will always do so or that those outside those socio-economic contexts will never do so. It's about a correlation, which tells a bit about how homebirth happens and how it doesn't. Or maybe how homebirth happens or doesn't tells us about the context it falls into. Either way.

The point is access. The point is recognizing and questioning, whether it leads anywhere or not, why the freedom to empower ourselves is so limited and so difficult.

Ultimately, it is about changing the system entirely, not just about providing access to all groups, because changing the system will lead to access and the real goal - empowered birth, regardless of the setting.

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Old 07-23-2008, 04:23 PM
 
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maybe if we all wrote to our insurance companies and to the state departments of health and explained that we desire and support insurance coverage of homebirths this might change something, making homebirth more affordable and widespead.
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Old 07-23-2008, 05:26 PM
 
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Both internet access and books are free at the library.
:Have you tried to take small children with you to the library to use the internet? I only do that if I am REALLY desperate. If I didn't have the internet at home I would not be able to go to the library to use it for recreation since I always have at least one child with me; particularly since I now live further from the library than I used to.

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Old 07-23-2008, 05:41 PM
 
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maybe if we all wrote to our insurance companies and to the state departments of health and explained that we desire and support insurance coverage of homebirths this might change something, making homebirth more affordable and widespead.
In my case, it would have to be 100% coverage in order for it to truly make a difference. The last time I had insurance, the copays added up to more than what it cost me to pay for a home birth and my midwife was a heck of a lot more understanding. I think everything dealing with health care needs to be affordable.
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Old 07-23-2008, 06:01 PM
 
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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.
This is a great point. We actually moved, well for a lot of reasons, but to this day, that main one was because we didn't want to give birth in our dingy little apartment far from a community that would give us the great aftercare we needed. I think to feel comfortable giving birth at home, you first need to feel comfortable at home!

S, mama to boy M(6/07) and baby girl R(7/10). We do all the good natural family living stuff!
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Old 07-23-2008, 06:31 PM
 
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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.
How so? I'm not white. What does that have to do with
my birthing choices?

What does race have to do with any of this and why
is it significant?


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Originally Posted by soso-lynn
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.
I've never been what anyone would consider poor; however my spouse is a different story. So I feel safe in saying that poor does not always equal less educated. People really need to throw that out of the window.

I went to private school all my life and guess what; there were rich people and poor people. Lacking finances does not always hinder ones ability to receive a "good" education.

Once again, we are back at this "I am so educated because I have money" arguments.

And by the way, just because someone is "educated" it doesn't mean they will make the same decisions as you. As this "educated" woman doesn't plan on breastfeeding. *gasp!*

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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.

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.
Exactly!
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Old 07-23-2008, 06:37 PM
 
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It's even why I choose to homebirth. I see birthing at home as a feminist act, always have. It's using my biology, my femininity as a tool for change by supporting a midwife, being empowered by a powerful act, and by sharing that with others to see that they are powerful and that the system sucks.
I agree that it is good to show others that they are powerful and have the power to choose what they want for their bodies. Yes, the system sucks. I am a bit confused though because it sounds as if you want people to home birth for political reasons or to make a statement. I think that is totally cool but I just don't like it when personal choice becomes politically motivated. I choose the things that I do because I think that I am doing what is best for my family. If my neighbor does something different, it is not because they are less powerful or are somehow inferior. They are just different. I am sure that I am not communicating what I mean correctly but I hope that some of what I mean is coming across somewhere in my ramblings.

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I think it's difficult to deny that certain groups of people have the most access to the information and resources necessary to step outside of their context, to deny the system, to rebel against the norm. Which is not to say that those within those socio-economic contexts will always do so or that those outside those socio-economic contexts will never do so. It's about a correlation, which tells a bit about how homebirth happens and how it doesn't. Or maybe how homebirth happens or doesn't tells us about the context it falls into. Either way.
Yes, certain groups do have more information and more access. I guess the problem that I keep having is the fact that just the other night I watched a PBS special on midwives/birth in Africa. Home birth is the default standard there. Women only go to the hospitals for complications or problems. I know that you are looking at just the US but I find it difficult to look at things in such isolation. I like looking at the bigger picture. If you look at home birth rates for the US, you can say that white women are more apt to have a home birth. I couldn't find a correlation with education. The following chart indicates that just over 50% of the women in 2005 have over 13 years of education. http://www.uptodate.com/patients/con...x/moms_who.htm

In that regard, you can generalize that in the US, educated white women are more apt to have a home birth. I am not sure why that is the case because that is not the case in other countries. In doing some research, it is interesting to note that the homebirth rates actually appear to be slightly declining. I found a report that provides stats for place of birth from 1990-2004. http://nchspressroom.files.wordpress...birthplace.pdf

It is interesting to note that homebirth rates are actually declining. When I looked at the report, I was looking at the number of women that gave birth in their residence. It went from being 25,923 in 1992 down to 23,150 in 2004. I think the report itself is a bit racist because it only considers Whites, Blacks, and Hispanics so I don't think it gives a complete picture. I was unable to find anything that linked place of birth to socioeconomic status.

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The point is access. The point is recognizing and questioning, whether it leads anywhere or not, why the freedom to empower ourselves is so limited and so difficult.

Ultimately, it is about changing the system entirely, not just about providing access to all groups, because changing the system will lead to access and the real goal - empowered birth, regardless of the setting.
I completely agree that the whole point is access. One thing that keeps coming up for me is what is hindering access. Is it the cost that hinders access? In some cases, it is cost prohibitive. In other cases (such as mine), it is the only affordable option. Is it lack of education that hinders access? Perhaps. I don't think that you can identify a single source that prohibits access. As a librarian, one of the things we try to identify is barriers to service so that they can be removed. In some cases the barriers are so pervasive that you have to tackle them one at a time from within. Like you say, the entire system needs to be changed and it needs to focus on personal choice rather than you need to do X because somebody else thinks that is what is best for you.

I hope I have made some sense after being interupted a bazillion times.
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Old 07-23-2008, 06:41 PM
 
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This is a great point. We actually moved, well for a lot of reasons, but to this day, that main one was because we didn't want to give birth in our dingy little apartment far from a community that would give us the great aftercare we needed. I think to feel comfortable giving birth at home, you first need to feel comfortable at home!
Yep, with my first daughter, I didn't have a home because the house we bought to bring our new baby home to had been destroyed by a flood the month before she was born. The time I was in the hospital with her allowed me to forget that I didn't have a home. We hadn't even gotten our insurance payments when she was born. I have since had two home births and am planning on a 3rd but you couldn't have paid me enough to have a home birth with my first.
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Old 07-23-2008, 07:26 PM
 
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How so? I'm not white. What does that have to do with
my birthing choices?

What does race have to do with any of this and why
is it significant?




I've never been what anyone would consider poor; however my spouse is a different story. So I feel safe in saying that poor does not always equal less educated. People really need to throw that out of the window.

I went to private school all my life and guess what; there were rich people and poor people. Lacking finances does not always hinder ones ability to receive a "good" education.

Once again, we are back at this "I am so educated because I have money" arguments.

And by the way, just because someone is "educated" it doesn't mean they will make the same decisions as you. As this "educated" woman doesn't plan on breastfeeding. *gasp!*



Exactly!
I think it has been clearly stated throughout this thread that education and financial means are two different things.

Just because we can come up with examples of non-white people who do X, Y or Z or poor people who are very educated or uneducated people still capable of fighting for their opportunity to homebirth does not mean those things are irrelevant. It is a fact that our society is based on 'othering' certain groups and those categories shape the lives of many people. Saying that black people are oppressed and generally have less access to information and opportunities than white people is nothing controversial. Saying that non white, middle-class bodies have been assaulted by medicine a lot more is not something I just made up. In theory and in your individual life, race has nothing to do with anything, it does not even exist. But socially, it is a reality and society shapes the meaning of it. Currently, society says that white, middle-class women have much more agency over their bodies than poor OR black OR uneducated women.

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Old 07-23-2008, 07:33 PM
 
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I think it has been clearly stated throughout this thread that education and financial means are two different things.
I don't think so or people wouldn't keep bringing education and then using the word poor in the same sentence.

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Saying that black people are oppressed and generally have less access to information and opportunities than white people is nothing controversial.
It depends on who you say it to.

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In theory and in your individual life, race has nothing to do with anything, it does not even exist. But socially, it is a reality and society shapes the meaning of it. Currently, society says that white, middle-class women have much more agency over their bodies than poor OR black OR uneducated women.
Actually that's not true. In my life, race has a lot to do with a lot of things; yet I try not to focus too much on it because I get angry that I have to be seen as a "RACE person" instead of a "person" . In fact, the only time I bring it up is when someone else does....

But I fail to see the correlation between race and home birth or why it's even important to bring up race in this instance if your goal is spreading awareness.

Furthermore, my main point is that just because one has this view that they are more "educated and enlightened" it doesn't mean that their decisions will work for everyone.

Tell all the rich, poor, middle class, and everyone else about home birth and that doesn't mean they will want to do it. Still, I think women should know about their choices.

So....

If you want to help, then as someone else said, drop the labels, leave race out of it, and spread whatever message you want to spread.

Instead of "let's educate all these unfortunate minorities about their options" you'd probably get further with "lets educate ALL women about their options".

It just takes the hint of elitism out of it and makes it more welcoming which in turn will make people less defensive and more receptive.
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Old 07-23-2008, 07:43 PM
 
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My mom was a homebirther, and many of her friends were as well. I have three friends IRL who have birthed at home.

My mom sought a HB MW because she couldn't afford to access the mainstream medical system. My parents depended on my dad's construction work, and when he injured himself and she discovered she was pregnant, she went to a MW. The MW in her area had a policy of, "Pay me what you can afford." My parents paid her $300 in the early 1980s.

Most of my mother's friends were also HBers, and most of them were also poor, lower class, non-college educated. In fact, one couldn't scrape up anything to pay a MW, so she called over two of her friends who had collectively had 11 children, and they helped her.

Two of my three IRL friends have had HBs because of lack of insurance and not wanting to pay $5K+ to a hospital. One IRL friend is who I would classify as upper middle class, and is a well-educated white woman who interviewed many MWs before choosing the perfect one.

These two groups chose to birth at home for vastly different reasons. One group because they couldn't afford the regular medical care system (admittedly, there was a bit of a natural, back to earth mindset there as well), and the other was a purposeful setting out to choose the optimal birth experience, including paying $5K out of pocket for a MW.
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Old 07-23-2008, 08:12 PM
 
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But I fail to see the correlation between race and home birth or why it's even important to bring up race in this instance if your goal is spreading awareness.
Exactly. I don't know why I am obsessed with this thread but it has really struck a nerve with me. I fail to see race as a hindrance or a barrier to being able to have a home birth. Statistics say that white women in the US have home births more often than others but it does not provide any sort reason behind it. If you want to look at is from a strictly statistical standpoint, it stands to reason that the majority of people having homebirths are white women. Why is that the case? That is due to the simple fact that if you look at the US as a whole, the majority of the population is WHITE. According to the 2005 Census at http://www.census.gov/population/www...mic/RACEHO.pdf you can see that 82.2% of the population is white. If you want to extrapolate further, 90% of them have high school diplomas or higher. http://www.census.gov/population/www...Attainment.pdf

From a link I provided in another post, a little over half of the women that have homebirths have 13+ years of school. Thirteen years is about equivalent to a high school diploma. So of course, it can be said that the majority of people that have homebirths are educated white women. In order for the assumption of race and class to be validated, you would have to break it down and see if the percentage of white women having homebirths is roughly equal to the percentage of women of another race. Only then can you make the assumption about race.

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Furthermore, my main point is that just because one has this view that they are more "educated and enlightened" it doesn't mean that their decisions will work for everyone.

Tell all the rich, poor, middle class, and everyone else about home birth and that doesn't mean they will want to do it. Still, I think women should know about their choices.

So....

If you want to help, then as someone else said, drop the labels, leave race out of it, and spread whatever message you want to spread.

Instead of "let's educate all these unfortunate minorities about their options" you'd probably get further with "lets educate ALL women about their options".

It just takes the hint of elitism out of it and makes it more welcoming which in turn will make people less defensive and more receptive.
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Old 07-23-2008, 09:34 PM
 
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You want to know how I found out about midwife care?

At a Catholic charity in the inner city of St Paul that has maternal care for low income/no income women. My mom dropped me off because I did not have a car at the time of my own. I went there because I could not afford a hospital birth. Thank God I did because that choice changed my life! My birth with a midwife and no intervention at a hospital downtown St Paul left me thinking "Wow. That was wonderful! We could have done that at home!"

SO next time we did. :

I had interent because I lived with family and came home to start researching birth options. I found out about water birth and ended up here at MDC.

Mama to 9 so far:Mother of Joey (20), Dominick (13), Abigail (11), Angelo (8), Mylee (6), Delainey (3), Colton (2) and Baby 8 and Baby 9 coming sometime in July 2013.   If evolution were true, mothers would have three arms!

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Old 07-24-2008, 06:12 AM
 
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Yes, certain groups do have more information and more access. I guess the problem that I keep having is the fact that just the other night I watched a PBS special on midwives/birth in Africa. Home birth is the default standard there. Women only go to the hospitals for complications or problems.
Just curious as to where they were in Africa? I'm in West Africa and, uh, yea, out in the middle of nowhere where the closest clinic of any kind is several hours away, its a given where you birth-home or the midwives house. If access to a clinic or hospital is available, its going through the same transformation here as it did in the states a while back. Its a status symbol to birth in a hospital, being held up by the fact that this is a country with HUGE infant mortality and infant morbidity rates, so they do feel safer in a hospital. We have a dear friend who literally went broke so that his wife could give birth in the hospital.

S, mama to boy M(6/07) and baby girl R(7/10). We do all the good natural family living stuff!
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Old 07-24-2008, 12:33 PM
 
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i really feel like the biggest thing stacked against moms who might choose homebirth is money, at least in most of the usa where homebirth midwives are not covered by insurance (generally speaking, i know some plans do cover if its a cnm and i know in a few states homebirth mws are covered, but not as a rule throughout our country). when i was recieving state insurance i payed 4$ a month for full coverage including dental in MN. granted MN has a more generous state health insurance program than many other states. my birth at a hospital, including DS's 5 day NICU stay was 100% covered, I did not pay a dime. if I had chosen homebirth I would have had to come up w/ 2500$-3000$, the average going rate here, for a home birth mw. I was 19 and this wasn't feasible for me. If homebirth had been covered by my health insurance plan I absolutely would have chosen that and most likely avoided a 2nd degree episiotomy, drugs and having my son taken from me for 4 days for a dubious never found illness.
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Old 07-24-2008, 12:53 PM
 
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Just curious as to where they were in Africa? I'm in West Africa and, uh, yea, out in the middle of nowhere where the closest clinic of any kind is several hours away, its a given where you birth-home or the midwives house. If access to a clinic or hospital is available, its going through the same transformation here as it did in the states a while back. Its a status symbol to birth in a hospital, being held up by the fact that this is a country with HUGE infant mortality and infant morbidity rates, so they do feel safer in a hospital. We have a dear friend who literally went broke so that his wife could give birth in the hospital.

It was Mozambiqu. Here is a link to the MDC discussion about it: http://www.mothering.com/discussions...d.php?t=932448
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Old 07-24-2008, 01:05 PM
 
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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.

Angela , wife to DH (Oct 1999), mother to DD (Oct 2008)
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Old 07-24-2008, 02:06 PM
 
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I do want to discuss this but will have to organize my thoughts as well as read the whole thread.
will post later
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Old 07-24-2008, 02:51 PM - Thread Starter
 
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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.

anna kiss partner to jon radical mama to aleks (8/02) and bastian (5/05)
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Old 07-24-2008, 05:34 PM
 
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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--
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Old 07-24-2008, 05:59 PM
 
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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.
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Old 07-24-2008, 06:34 PM
 
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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.

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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.

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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.

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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.

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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.
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Old 07-24-2008, 07:27 PM
 
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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.

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Old 07-24-2008, 09:01 PM
 
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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."
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Old 07-25-2008, 12:43 AM
 
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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.
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Old 07-25-2008, 07:55 AM
 
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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.
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