Homebirth and Race and Class - Page 4 - Mothering Forums

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#91 of 117 Old 07-25-2008, 01:35 PM
 
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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.
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#92 of 117 Old 07-25-2008, 01:38 PM
 
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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* $4000 expense, especially right when they've got all the other financial impact of a new baby hitting around the same time. If we had a lower income, this home birth (supervised by a trained, legal, certified midwife) would not be an option for us. UC is an option for everyone, but that's outside our (and perhaps most peoples') comfort zone.
ita. we pay 600$ 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.
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#93 of 117 Old 07-25-2008, 02:01 PM
 
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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.
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#94 of 117 Old 07-25-2008, 02:52 PM
 
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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.
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#95 of 117 Old 07-25-2008, 04:40 PM
 
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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.

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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#96 of 117 Old 07-25-2008, 06:10 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."
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.

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#97 of 117 Old 07-26-2008, 11:30 AM
 
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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.

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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.


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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.
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#98 of 117 Old 07-26-2008, 02:56 PM - Thread Starter
 
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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?"

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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.

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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.

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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.

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#99 of 117 Old 07-26-2008, 03:02 PM - Thread Starter
 
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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.

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#100 of 117 Old 07-26-2008, 04:08 PM
 
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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.

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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.

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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.


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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.

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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.


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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.

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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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#101 of 117 Old 07-26-2008, 04:35 PM - Thread Starter
 
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Once the medicalization of birth is addressed and homebirth is normalized, then we can begin to talk about it in terms of race and class.
I guess my radical upbringing has me questioning before the goal is even achieved, to insure equality in the fight and in the outcome.

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

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

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

Otherwise, I think we completely agree, really.

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#102 of 117 Old 07-26-2008, 06:14 PM
 
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I guess my radical upbringing has me questioning before the goal is even achieved, to insure equality in the fight and in the outcome.
I didn't have that kind of upbringing. I grew up in a rather mundane suburban house where both parents worked and we were all latch key kids. In some cases, it was to our benefit and in others it was to our detriment. There was no real thinking outside of the box. There were times that we had all sorts of luxury but then there were other times when I remember standing in line for commodoties and food stamps. My parents were so busy trying to survive that they didn't have the time or energy to be radical. They didn't care what the rest of the world was doing because they were trying to work and provide for 4 kids.

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

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I think that being well educated may not equal ease in navigating health care systems (who can navigate those at all??), but just an easier time finding things and having access in general to information - so whether there's talk on a message board or elsewhere, having the internet at home is a privilege that aids that, as does the ability to browse bookstores or take prenatal yoga (where I learned a lot) or any variety of ways in which information about home practitioners could be spread.
I can't get past this because of the librarian in me. I can buy that being educated gives you better access to information generally speaking. The problem that I am having is the fact that there is so much information out there that people choose to ignore. Or, they are just unable to find it because they don't know how or they just don't really want to. I don't know how many students/patrons my husband and I have helped in libraries that can't seem to find information even when we put it in a nice little package for them. I can call it up on the computer screen or find it in the book and point them to it but I cannot read it for them and make them comprehend it. That is up to them.

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

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

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

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

Yes, I think we do agree! I am really enjoying this conversation because I have been doing a lot of reading on midwifery and doulas. At one point in time, I explored the option of becoming a midwife or a doula because I feel like everybody should have the option of homebirth. If they choose to birth in a hospital, it should be because they put some thought in it.
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#103 of 117 Old 07-26-2008, 07:01 PM
 
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I have a black midwife who I ADORE : Her practice is all walks of life with the exception of the very upper class. She is a CNM and does accept insurances, including Medicaid. Some of the Medicaid policies in my state do over homebirth.

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

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

However, I am now in a more well-to-do area, highly educated but people still don't consider homebirth as an option; they tend to be consumed by fear or very comfortable with the hospital protocol. However, we do have pretty decent breastfeeding rates. There's a small counter-culture here that does a lot of natural parenting, including homebirths and we also have some great homebirth midwives to serve our area. Within this counter-culture homebirths are normal and as this counter-culture begins to spread, more are considering this option who may have otherwise thought it to be impossible.
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#104 of 117 Old 07-26-2008, 09:59 PM
 
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I can't get past this because of the librarian in me. I can buy that being educated gives you better access to information generally speaking. The problem that I am having is the fact that there is so much information out there that people choose to ignore. Or, they are just unable to find it because they don't know how or they just don't really want to. I don't know how many students/patrons my husband and I have helped in libraries that can't seem to find information even when we put it in a nice little package for them. I can call it up on the computer screen or find it in the book and point them to it but I cannot read it for them and make them comprehend it. That is up to them.

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


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

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

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

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

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

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

Shay

Mothering since 1992...its one of the many hats I wear.
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#105 of 117 Old 07-27-2008, 09:19 AM
 
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2. Nearly every other country in the world requires less education for professional designations such as Doctor, Midwife, Attorney, Pharmacist, etc. than then US does. For instance, in the rest of the world getting your full MD is a Bachelor's-level credential requiring from 4-5 years of study total, not a 4year undergrad + 4 years of Medical school. Getting your law degree is also a 4 year undergraduate level credential, instead of 4 years + 3 years of law school. So yeah, of course a midwifery program is considered a 2-4 year undergraduate degree... it fits in with the way they look at education in general. Also, tuition in most other countries is subsidized by the government and in some cases, free.
Where did you get this bit of info? I am currently living and working in a university town with a huge international population. One of the main comparisons that my acquaintances and I notice in our discussions is that the U.S. requires LESS training and education than other countries for professional designations. I am referring mostly to European nations.

Bear in mind that the educational system in the US differs vastly from the educational systems in European countries in general. Many of these students graduate from "high school" with what is considered at least equivalent to an Associate's Degree (or higher). My partner, who is European and works in academia, considers the U.S. educational system to be sub-par in comparison to what's available in Europe...and I must say, after having been exposed to these two sides of the world, I agree with him.
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#106 of 117 Old 07-27-2008, 10:45 AM
 
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While we're talking privilege,

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

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

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

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#107 of 117 Old 07-27-2008, 08:31 PM
 
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Where did you get this bit of info? I am currently living and working in a university town with a huge international population. One of the main comparisons that my acquaintances and I notice in our discussions is that the U.S. requires LESS training and education than other countries for professional designations. I am referring mostly to European nations.

Bear in mind that the educational system in the US differs vastly from the educational systems in European countries in general. Many of these students graduate from "high school" with what is considered at least equivalent to an Associate's Degree (or higher). My partner, who is European and works in academia, considers the U.S. educational system to be sub-par in comparison to what's available in Europe...and I must say, after having been exposed to these two sides of the world, I agree with him.
Check out the British Medical Association at www.bma.org.uk, the New Zealand Qualification Authority at www.nzqa.govt.nz, or basically any University in the UK, Australia, New Zealand or Canada. Like I said, my husband is looking into going either to PA school or Medical School, and we'd like to expatriate, so I've been looking into this pretty intensely.

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

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

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#108 of 117 Old 07-27-2008, 09:25 PM
 
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so you are asking for solutions-
I mentioned our state midwifery association is working toward re-instating our medicaid status- via hiring a lawyer- we have had donations, as well as some interesting fund raisers like a concert, and art auction, as well as some straight up donations-- a good lawyer is costly but priceless ....

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

also in states where midwives are legal I know that there are still midwives who do home visits- grant writing and providing out-reach at home care even if the women you care for do not have a home birth is one way to improve the situation for many women without prenatal care as well as educate them about birth, choices , self-care and midwives (this is how CNMs found their way in originally) and there are still many places where there is need as well as grant money-- finding someone who is grant savvy is probably key,
actually I have read over many of the title V reports in different states and there are ways to use those reports to your advantage as far as knowing where the problem areas are so you can tailor proposals to what they recognize as problems- this can also help with licensing as well.
Personally I would like to get on the local mobile health van and do out-reach prenatals that way-
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#109 of 117 Old 07-28-2008, 07:33 PM
 
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you know I wanted to add another solution I have run across- someone had a non-profit set up so that people could make tax deductible donations toward supporting a home birth for moms who could not afford a midwife.
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#110 of 117 Old 07-29-2008, 08:48 PM
 
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It seems to me that the first thing to do here is to advocate for laws stating that insurance companies and Medicaid must cover homebirtha at the same rate they cover other births. I gave birth at home and paid $200 total (ins co picked up the rest). I don't know what I would have done had I lived somewhere it wasn't covered--probably not had a HB.

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

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#111 of 117 Old 07-29-2008, 11:35 PM
 
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This is really simple and so not as much of an educated response as some of you have posted here...

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

Just a thought.
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#112 of 117 Old 07-30-2008, 08:23 PM
 
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How many black midwives do you know? Hispanic? Asian? I know of several black midwives, and Midwifery Today makes a point to showcase native midwives from Central and South America, but in my area, which has a saturation of homebirth midwives, I can think of none who are not white and more or less middle class.

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

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

But bugger me if I can figure out how I, a middle class white daughter of MD/PhD parents, can make help that happen without being accused (rightly) of colonialization, of trying to tell "those pitiable women" how to live and what choices to make.
Ive just read the first page of replies so far but wanted to comment that the homebirth midwife im using is black! She has been catching babies for over 20 years and when I went into her office for my first visit there was one India patient, another white patient (im also white) and I remember he commenting that she was uninsured, and there was a black patient...so I dont know, I felt encouraged by what I saw! That homebirth isnt just something for the "white middle class".
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#113 of 117 Old 08-03-2008, 04:29 AM
 
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Check out the British Medical Association at www.bma.org.uk, the New Zealand Qualification Authority at www.nzqa.govt.nz, or basically any University in the UK, Australia, New Zealand or Canada. Like I said, my husband is looking into going either to PA school or Medical School, and we'd like to expatriate, so I've been looking into this pretty intensely.

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

While your husband is right that the US educational system is sub-par, and while as far as what they've learned students in other countries may already have the equivalent knowledge to an associates degree, the fact is that we require substantially more formal butt-in-chair schooling for our professional degrees than most other nations.
So, if I'm doing the math correctly, then it all works out to about the same numbers of years of schooling and training when it comes to obtaining a Doctor of Medicine degree (or equivalent, depending on the country).

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

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

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

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

Wikipedia has some sources: http://en.wikipedia.org/wiki/Doctor_of_Medicine
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#114 of 117 Old 08-03-2008, 01:47 PM
 
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I think this is much ado about nothing.

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

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

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

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

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

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

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

Get ready. It is on its way.

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but if you want to spread the word about homebirth/NFL then give a local OB/pediatric office a subscription of mothering mag. It will sit out on the table and people will read it. You can even pick a low-income type clinic.
You are in California. Do you know if Mothering has a Spanish Edition? That will make the biggest dent there. The upper class on the West side already has Mothering in Wild Oats and Whole Foods.

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#115 of 117 Old 08-04-2008, 11:44 AM
 
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well yep, Applejuice I agree, my grandmothers both had home and hospital births- my maternal grandma had 15 kids and IF they had the money at the time she went to the hospital. Family did ask if we needed money, when we had our first homebirth. So deep associations with poverty.
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#116 of 117 Old 08-04-2008, 04:15 PM
 
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I find the speculation that homebirth is slanted towards a higher class to be laughable.

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

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

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

Mama to expecting Babe 2
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#117 of 117 Old 08-04-2008, 04:23 PM
 
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This could be considered a shallow response but I think homebirth really has to do with the "life education" that one chooses to have.

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

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

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

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