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Friday
Dec042009

Stuff White People Like: Talking About Birth

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I intended to post the comment I left on Pamela’s blog (She’s blogging again!) a few days ago prefaced with something like “Please critique fiercely. Send it to a sociologist or a picky friend. K thx.” I’ve had it in the queue along with some historical stories of interest and after this conversation, which is still going, I’m posting it now.

 

Pamela, I have so many ideas that I’ve been sitting with for over a year. I’m reluctant to dig in because, well, among other reasons I really don’t want to come across as a white woman defining and speculating on the experience of people of color.

The one thing I have arrived (it’s a theory in work) at is that white privileged women are more likely to shocked by medicalized birth, not solely because they came in with preconceived notions that it should be different, but because it’s a window of time in which we are profiled, discriminated against, told our bodies are defective and insufficient, our rights to bodily autonomy are repeatedly violated and there doesn’t seem to be any way of navigating and changing “the system.” It can be a microcosm of the societal oppression of females, which many of us felt we previously had some control over because of education, privilege, whatever.

As an emergency service or if used for personal preference (i.e., preferring an anesthetized birth), the medical birth system is great. It fails in its desire to control the births and bodies of ALL women, using drugs and procedures to standardize and expedite the birth process, and it ultimately places the self-interest of the physician or hospital above that of the patient as evidenced by the collective justification of hundreds of thousands of unnecessary “medical” procedures performed each year on women who are not told the real reason for their cesarean/induction/augmentation/intervened upon birth.

While I can’t speak to the experience of the women of color in the medical birth system, I feel somewhat comfortable speculating that the reason why white women speak up so much more often is because we were more likely than women of color to be raised with the idea that our bodies are not broken, defective or property of anyone else… or at least that’s what we’d convinced ourselves until we got pregnant. When we come face to face with someone arguing otherwise without any solid scientific evidence to fall back upon or trying to get us to throw in the towel before even trying, it’s really disgusting. I personally don’t mind trusting medical authority, but it had better be backed up by data and facts, not anecdote, personal preference, opinion, a half-baked appeal to the authority of “the system” (as in “it’s just the way we have to do things”) or plain-old demanding compliance with the established patriarchal value system.

That’s what I arrived at after my hospital experience of refusing unnecessary meddling disguised as prophylaxis or “preventative medicine.” I walked away thinking about how much harder it probably would have been to negotiate for a regular old vaginal birth if I hadn’t been (any or all of the following) white, middle class, educated, English-speaking, insured, average-weight, neurotypical and able-bodied. Wouldn’t it have been harder to self-advocate if I didn’t come in with a heaping helping of privilege on my side?

 

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Reader Comments (90)

Very interesting points. As Women Of Privilege, birth may be the first, even only, time in our lives where we experience oppression. Do we therefore get angrier about it than Women Of Color, or are WoC so used to being trodden on that they don't get as upset? Maybe both?

December 4, 2009 | Unregistered CommenterJill

I think it is a wonderful and brave post examining privilege.

I trained at a birth center with a great racial and ethnic diversity of patients, including a 30% Medicaid population in a poor, mostly black part of South Florida. I also cannot speak to anyone's individual reasons for choosing to deliver at a free standing birth center,especially not a woman of color, but I know I was surprised (since I am privileged and assumed most of the patients would be middle class white women like myself) and pleased at the diversity.

I know I may be inaccurate in making this suggestion, since I am speaking from my point of view, but it seemed to be that more women of color, especially the ones who had Medicaid, expressed about seeking midwifery care for better treatment prenatally, and the white women expressed more concern about having autonomy over their birth process. I think it may be very well be that women of privilege may be more likely to feel the right to autonomy over their births and are shocked by the lack of autonomy in medicalized birth process. And, women of color and poor women may tend to get poorer treatment prenatally from providers.

December 4, 2009 | Unregistered CommenterMomTFH

Definitely have noticed a higher expectation among my "white privelliged" clients than my "in some way oppressed in general" clients. So, my Maori, PI and Asian clients as well as my teen mums and socially marginalised clients, have lower expectations generally than my thirty something well educated white clients. Having said that, their expectations are more that they won't fight. They just assume that whatever they want to do, be it medicallised or non medicallised, will happen. It might get them yelled at some, but, at the end of the day, they will make it happen. So, a marginalised Maori woman who wants a home birth... well, she is as likely not to mention it till I offer it as an option, and then say, "Oh, yeah, I am having one, I was just going to call you at the last minute." Where my highly educated white clients will come in at thier first appointment and say "I Want to birth this baby at home in a pool, and nothing you can say will change my mind. What do you think of THAT!" And epidurals, at the other end of the spectrum... when they come up with a marginalised PI client who wants one she will say "I just want to know that you will get it for me. i am not really interested in all that stuff" when I try to give her informed choice info. My White educated clients, again, come in at their first visit, saying "I need to know you are not one of THOSE midwives who will trick me out of an epidural. If i ask for one, I want it, quick smart." I wonder if it is less a difference of colour, and more one of social position. Because, I have had well educated Maori/PI clients present me with birth plans five pages long, and White Mum's who look at me like I am insane for asking what they have in mind for thier birth. I think colour is less the issue these days, and that in fact socio economic status and privellige are the biggest issues.

December 4, 2009 | Unregistered CommenterAnna

Thank you for opening this discussion. I've struggled with these thoughts myself, and how class issues affect other related issues, particularly breastfeeding.

Interesting observation from MomTFH on the differing priorities of the two groups. Much food for thought.

December 4, 2009 | Unregistered CommenterDou-la-la

Socioeconomic privilege give some of us the time and space to speak up. We can find time to use our internet connection, electricity and computer to write about birth. Philosophizing, theorizing, exploring ideals and debating birth, infant feeding, parenting, diet, exercise, medication and more is most likely an exclusive practice in developed countries.

I think it’s safe to conclude that the women of Sierra Leone, even those with a laptop and an internet connection, do not blog about making childbirth a better experience. One in eight of those women die while during pregnancy or giving birth from a variety of reasons, one of which is lack of access to emergency obstetric care.

Similarly, people who are starving aren’t analyzing protein-carb-fat ratios. They just want food.

“Just be grateful that you and your baby are alive” doesn’t totally fly here and yet so. many. people. continue to divert attention from the many improvements that need to be made to our U.S. maternity care system by using what amounts to my mom’s old “There are starving children in Africa. Eat your canned peas” line. I am grateful and I remain reverent of necessary and wanted procedures, but I wonder what could be.

December 4, 2009 | Registered CommenterJill

Socio-economically speaking, my state's cesarean rates are highly in favor of the underprivileged. The richest county in our state has the HIGHest cesarean rate, while the hospitals/practices who take mostly medicaid patients (read: WoC) have the LOWest cesarean rates. I know this is the opposite of what many states see though.

In fact, one of the most "VBAC-friendly" midwifery practices in our area is a low-income clinic in the Austin area of Oak Park.
Why is this? The place is a dump, but scarred white women with excellent insurance flock there when they want a VBAC.

My thought has always been that the low-income hospitals simply aren't going to throw unnecessary interventions at a woman because they can't afford that nonsense. Of course, with my nice "white-people" insurance, I got a whole big buncha unnecessary and damaging services provided to me.

Also, in my experience, WoC (at least in the Chicagoland area) seem to put up with birth interventions MUCH less than their rich, white counterparts. The first person I knew in real life to have had a planned home birth was a woman of color. I believe that WoC grow up thinking their bodies are the cat's pajamas, and nobody is going to tell them they can't do something. Whereas most of the women I know who drink the "my pelvis is too small" koolaid are white girls who have always been made to feel that their bodies are messed up in some way. First we're all too fat, then we're all too "teeny" to birth. I honestly have very few friends of color who sit around crying over some body dysmorphic disorder. In black culture, shapeliness is celebrated. It's not so in our oppressed white "privileged world".

Stop me before I start quoting Sir-Mix-A-Lot. ;)

December 4, 2009 | Unregistered CommenterThe Feminist Breeder

The Feminist Breeder:

You know, I've experienced a lot of the same things that you have. In fact, in my law school I know a lot of women who have planned or will plan scheduled C-sections, simply to put them on the books. They're amazed that I just "let it happen whenever." On the other hand, I think that wealthy white women (WWW, if you will) are better able to access education and care and therefore more knowledgeable about how the system works and how to use it (or escape it). It's sort of a conundrum in my head.

Doctors/hospitals/etc. clearly don't want to "waste" resources on poor folks (WoC or not), but they are also the easiest to railroad because they don't feel they can or should stand up to the white coat.

Perhaps it is (and pardon me for "thinking out loud") that WWW are more likely *request* that sort of intervention (out of the group who requests it) while poor women/WoC are more likely to be *forced* into that sort of intervention? Mind you, both can escape it, although it tends to be a lot easier for WWW, perhaps leading to Amy's conclusion that the only people who want "natural childbirth" are WWW.

I feel very lucky as a (not exactly wealthy) white woman. While we are on military insurance, which does not cover homebirths, I can afford to pay for one out of pocket. I can afford the internet access that lets me pull down medical journals. I have the education to READ those medical journals and comprehend them. I can afford the books I read to help prepare myself. I can afford to turn down interventions because, as an apparently WWW, no one would suspect me of trying to "hide something." I can afford a homebirth in a state where the midwife isn't legal because I can afford a lawyer to defend us (and who would convict a WWW of anything that would put her kids in danger?). As a (not exactly) WWW, I was raised with enough "say WHAT?" in me that when I'm told that my pelvis may not be "adequate" I question the doctor soundly...before walking out the door to my next choice. I have that choice.

NB: It's late, it's right before exams, and I just spend hours keeping the kids from shooting the cats with Nerf guns, while the newest addition happily attempted to empty my bladder. If this comment does not make sense, feel free to ask questions - or send chocolate. I could totally do with some chocolate.

December 4, 2009 | Unregistered CommenterTara

I have also heard, and experienced, the other side of the coin: the underprivileged (low-income, Medicaid, possibly unmarried and/or young) recieving MORE interventions because the doctors know that the government will pay for them, or possibly because their "care" providers care less about them because they ARE "less" than them. It's been postulated by others and seemed to be what happened to me, even though I was being seen by what was touted as a low-intervention, natural-friendly CNM practice. I'm not sure how true this theory might be and if it is I'm sure it's not a standard for all as evidenced by posts above. I loathe the term "med-wife" but that is exactly what I got, even though other clients were treated well and had very good birth experiences. The difference? They were married, had private insurance, and were not 20 and looked 14. Correlation doesn't always equal causation but sometimes it makes me wonder - why was I the one who got shit on? I'm sure the reason why WoC have much higher maternal/infant mortality rates is due to inadequate prenatal care and bad environment/lifestyle, but maybe there is a bit of truth in the theory that they are not worth taking good care of because they are poor.

December 4, 2009 | Unregistered CommenterJill

This thought is coming at an interesting time as a WWoP, I'm applying to graduate school for researching birth issues. Let's hope that the professors reading my application, don't also read this post!

December 4, 2009 | Unregistered Commenterjenne

To all: an interesting and relevant article, I think: http://www.nytimes.com/2009/11/27/us/27infant.html?_r=1

Jill:
I had much the same experience with my son. I was 19, and with a midwife (covered by Medicaid) and interventions were pushed on me, and it didn't help that I didn't know better. Fortunately (???), it was horrid enough that I decided I was either having no more children or it HAD to be different. When I found out it could be different - and oh how different - it not only made me sad, but righteously angry. Informed consent? My "informed consent" for my induction was "if you don't do this now you and/or the baby will die, there's absolutely no risk to it, but you'll die without it." My son was born later that day, and still suffers the effects of iatrogenic prematurity, nine years later.

December 4, 2009 | Unregistered CommenterTara
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