Homebirth and Race and Class - Mothering Forums

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#1 of 117 Old 07-22-2008, 01:07 PM - Thread Starter
 
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How does everyone feel about homebirth as a domain of the privileged (not necessarily wealthy, mind you - privileged as in referring "to special powers or 'de facto' immunities held as a consequence of political power or wealth. Privilege of this sort may be transmitted by birth into a privileged class or achieved through individual actions.")?

Do women of privilege seek to keep this to themselves? Do they seek to spread the love? Are there ways in which that might be accomplished?

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#2 of 117 Old 07-22-2008, 01:32 PM
 
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History has shown the opposite to be true.

IME, homebirth stretches across such boundaries.

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#3 of 117 Old 07-22-2008, 01:35 PM - Thread Starter
 
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Allow me to clarify - homebirth in the US. Currently.

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#4 of 117 Old 07-22-2008, 01:39 PM
 
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Even more so then.

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#5 of 117 Old 07-22-2008, 01:40 PM - Thread Starter
 
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Really?

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#6 of 117 Old 07-22-2008, 01:44 PM
 
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Really.

Especially considering that the "powers that be" are trying *very* hard to outlaw HB midwives, HB VBACs etc.

Further, every single HBer I know/have come across etc. would LOVE to share the HB love.

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#7 of 117 Old 07-22-2008, 01:48 PM
 
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I may be wrong, and I've seen no research on this, but I would guess that planned homebirths, just like nursing past a year, would be more common among the reasonably well educated. Is that what the OP meant?

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#8 of 117 Old 07-22-2008, 01:51 PM - Thread Starter
 
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Of course that's what I meant. I even offered a definition of privileged. I don't mean the upper-most echelon of American social class. I mean the privileged. As in it's not at all available to the poor, really.

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#9 of 117 Old 07-22-2008, 02:02 PM
 
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So, by your last post, you are referring to level of monetary wealth. Again, HB is enjoyed by both rich and poor. I would even go so far as to say that HB is more prevalent in the less affluent communities. Hospitals are not exactly cheap and HB midwives are not exactly rich.

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#10 of 117 Old 07-22-2008, 02:03 PM
 
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More than availability, necessarily, I think that the 'underprivileged' (for lack of a better term) disproportionately bear any negative consequences - involvement of CPS, for instance. Of course, that's not in any way limited solely to birth, sadly.

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and Brigid Eleanor (11/20/08)
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#11 of 117 Old 07-22-2008, 02:11 PM - Thread Starter
 
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So, by your last post, you are referring to level of monetary wealth. Again, HB is enjoyed by both rich and poor. I would even go so far as to say that HB is more prevalent in the less affluent communities. Hospitals are not exactly cheap and HB midwives are not exactly rich.
This is exactly the conversation I didn't want to have.

It's not just monetary wealth, it's also issues of race, but class is a more determining factor, though of course class is interrelated with issues of race. Class can include levels of formal education as well. I am currently on assistance for insurance and qualify for food stamps, and yet my husband is getting his PhD - we're middle class even though we don't have cash in the bank necessarily. We enjoy a middle class lifestyle because we have family that is middle class, have good credit, and can work the systems we participate in pretty well due to our education. So it's not cut and dried poor or not poor.

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

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

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#12 of 117 Old 07-22-2008, 02:18 PM
 
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More than availability, necessarily, I think that the 'underprivileged' (for lack of a better term) disproportionately bear any negative consequences - involvement of CPS, for instance. Of course, that's not in any way limited solely to birth, sadly.
I would agree with this.

The shift from homebirth as "that thing poor people do" to "that thing movie stars do" is a very, very recent one, however -- one of the few places traditional midwifery was preserved for a long time was the rural South, in African-American communities.

I know some formerly underground midwives working in the upper South (in a state that now allows CPMs), and I believe their clientele were mainly lower income, working class, as were the midwives themselves. Midwives were white; don't know about all the clients.
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#13 of 117 Old 07-22-2008, 02:22 PM - Thread Starter
 
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I would agree with this.

The shift from homebirth as "that thing poor people do" to "that thing movie stars do" is a very, very recent one, however -- one of the few places traditional midwifery was preserved for a long time was the rural South, in African-American communities.

I know some formerly underground midwives working in the upper South (in a state that now allows CPMs), and I believe their clientele were mainly lower income, working class, as were the midwives themselves. Midwives were white; don't know about all the clients.
I agree. However, the relative surge we're currently experiencing, along with the back-to-nature movement of the late sixties and seventies (spawning Mothering magazine, for instance) is one that is most certainly a thing of privilege.

Of course I think that so is the obsession with parenting minutiae and the associated act of having 15,000+ posts on mothering message boards. ahem... :

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#14 of 117 Old 07-22-2008, 02:24 PM
 
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i am non-caucasian and "underpriviledged" wealth-wise, and i am having a homebirth. the women that i've met at my midwives' practice have been a very diverse mix economically, socially and racially.
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#15 of 117 Old 07-22-2008, 02:26 PM - Thread Starter
 
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i am non-caucasian and "underpriviledged" wealth-wise, and i am having a homebirth. the women that i've met at my midwives' practice have been a very diverse mix economically, socially and racially.
Where are you? That has not been my experience at all.

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#16 of 117 Old 07-22-2008, 02:27 PM
 
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This is exactly the conversation I didn't want to have.

It's not just monetary wealth, it's also issues of race, but class is a more determining factor, though of course class is interrelated with issues of race. Class can include levels of formal education as well. I am currently on assistance for insurance and qualify for food stamps, and yet my husband is getting his PhD - we're middle class even though we don't have cash in the bank necessarily. We enjoy a middle class lifestyle because we have family that is middle class, have good credit, and can work the systems we participate in pretty well due to our education. So it's not cut and dried poor or not poor.

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

Access is largely limited to a select group - largely white, educated, middle class (or higher) women.
I can only go by the words that are written on the page. First it was political power, then it was wealth...just trying to pin down exactly to what you are referring. This last post was much clearer.

However, I still disagree. There are posts after posts of discussions about working w/ midwives as to cost, bartering etc.

As far as people being made aware that HB is an option, I think that applies to a vast majority of the population. It's a problem that, again, cuts across class, race etc.

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#17 of 117 Old 07-22-2008, 02:36 PM - Thread Starter
 
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As far as people being made aware that HB is an option, I think that applies to a vast majority of the population. It's a problem that, again, cuts across class, race etc.
But how do we access that information? If we are in survival mode due to limited resources or limited mobility (literal and figurative), how do we access information that is hidden from view in the mainstream?

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#18 of 117 Old 07-22-2008, 02:41 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.
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#19 of 117 Old 07-22-2008, 02:45 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.
We're saturated with home birth midwives here also, and 3 of them in my immediate area are black, including my partner. There is another that is retired.
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The only homebirthers I know of IRL are white. They are typically college educated and I'd say around middle class so far as lifestyle goes. I'm in NC, if that makes a difference.

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

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#21 of 117 Old 07-22-2008, 02:48 PM - Thread Starter
 
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But bugger me if I can figure out how I, a middle class white daughter of MD/PhD parents, can make help that happen without being accused (rightly) of colonialization, of trying to tell "those pitiable women" how to live and what choices to make.
Yeah, that's true. sigh.

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#22 of 117 Old 07-22-2008, 02:54 PM
 
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We're saturated with home birth midwives here also, and 3 of them in my immediate area are black, including my partner. There is another that is retired.
Well you rock. Portland, for all its awesomeness, is the whitest city in the US, and that may be represented in its midwife population. Still, I've seen in photos dozens of midwives from the area, and they've all been white. How accessible is that going to feel to the nonwhite population?

I've also seen tons of ads for midwives in the "Green Living" spaces (ReDirect Guide, Green Living fairs, etc), and none on billboards or bus stops downtown. Although, I'm also not in that demographic; I don't know that the birth centers don't also attend the low-cost baby fairs or have pamphlets in the county clinics.
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Online, though, that's a different story. I think you'll find all kinds of people online who homebirth. The audience is much larger.
Although this is getting less true, one can make the argument that the very fact they're "online" represents a significant privilege.
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#24 of 117 Old 07-22-2008, 02:58 PM - Thread Starter
 
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Although this is getting less true, one can make the argument that the very fact they're "online" represents a significant privilege.
I agree. Most of the country doesn't have computers at home. Discovering something like MDC, for instance, takes some effort to some degree. The population online I think is definitely different than and less reflective of the general population.

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#25 of 117 Old 07-22-2008, 02:58 PM
 
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But how do we access that information? If we are in survival mode due to limited resources or limited mobility (literal and figurative), how do we access information that is hidden from view in the mainstream?
Getting rid of the ACOG would be a great start. lol And I do think the info is becoming more and more available. It's just not an overnight process. The ACOG and the like wouldn't be in such a panic if it weren't.

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But bugger me if I can figure out how I, a middle class white daughter of MD/PhD parents, can make help that happen without being accused (rightly) of colonialization, of trying to tell "those pitiable women" how to live and what choices to make.
By talking to them as women and not as a "poor woman" or a "less privileged woman".

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

Drop the classifications and just talk woman to woman.

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#26 of 117 Old 07-22-2008, 03:00 PM
 
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Although this is getting less true, one can make the argument that the very fact they're "online" represents a significant privilege.
Both internet access and books are free at the library.

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#27 of 117 Old 07-22-2008, 03:04 PM - Thread Starter
 
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By talking to them as women and not as a "poor woman" or a "less privileged woman".

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

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

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

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#28 of 117 Old 07-22-2008, 03:05 PM - Thread Starter
 
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Both internet access and books are free at the library.
That doesn't mean that access is precisely open in the same way as to those with internet at home. As I said, I think that finding this information requires some digging, not just the internet.

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#29 of 117 Old 07-22-2008, 03:06 PM
 
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Well, I definitely think that HB in current times in the United States is largely a domain of educated people, at least middle-class. I'm sure there is a subclass of very poor women who have unassisted or perhaps midwife-assisted births for financial reasons or perhaps some other reasons.

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

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

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

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

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

Homeschooling mama to 6 year old DD.

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#30 of 117 Old 07-22-2008, 03:06 PM
 
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I have to agree with you, annakiss. The vast majority of people who choose homebirth or birth center birth here in Montreal (where it is free and covered under our universal health care) are older, white, middle-class, university degree holding people. In my view, there are many reasons for that. Here is the few that come to mind right now (I usually like to think such theories througha little bit more before presenting them to world, but still):

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

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

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

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

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

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

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