The white homebirther's burden

The white woman's burden is never ending. Now, apparently, it is the white woman's task to teach her unfortunate sisters of color how they ought to give birth.

Let's presume for a moment that the self-proclaimed "midwives" (CPMs) of the Big Push for Midwives aren't simply interested in cynically plundering the Medicaid coffers and take them at their word:

A report released by the CDC today found a 29 percent increase in home births from 2004 to 2009. The rate of home births among non-Hispanic white women underwent a dramatic increase, while the rate for women of color decreased or remained stagnant, a trend that reflects racial and ethnic disparities in other areas of maternity care throughout the U.S...

Barriers to out-of-hospital maternity care include ... laws or policies in all but 11 ... states that deny Medicaid coverage for home births managed by Certified Professional Midwives.

The fact that women of color don't choose homebirth is portrayed as an "ethnic disparity" in need of remedy. Never mind that women of color might actually be pleased with their own choices for childbirth. Or perhaps --- here's a mind-blowingly outrageous idea --- women of color ought to be the ones whose views are respected and emulated. No, it's far more satisfying to pretend that women of color don't know what they really want until they are "educated" by their white sisters.

The blogger at Balancing Jane is typical:

... [T]he women who are likely to choose home birth are more likely to be highly educated, married, and white. In other words, the women who choose home birth are the ones who benefit the most from privilege in our society. To me, this means that these are the women who have the greatest access to information and the greatest ability to go against societal standards for birth through informed self-advocacy. ...

Of course, that presumes that the women who choose homebirth are actually educated and they're not. They are distinguished primarily by their gullibility. Most of what they think they "know" is factually false and their personal experience is so limited that they have no idea what childbirth is like when you don't have immediate access to high quality medical care.

Therefore, Jane fails to consider an equally plausible alternative explanation:

Women of color might have no interest in the fads that preoccupy privileged white women. Possibly they have more important things to worry about. For example, they may have medical problems and risk factors that privileged white women do not have to contend with.

As Janelle Harris writes on The Stir:

... I can’t hop on this bandwagon that homebirth brings black women closer to our African heritage. I’ll immerse myself in a native language, I’ll shell out a few grand to fly to the mother continent and trace my Guinean roots. Heck, I’ve already dedicated thousands of dollars and thousands more hours studying our history for a master’s degree in African-American studies.

But if and when I ever find myself pregnant again, I’ll have my baby in a hospital, thank you very much. If something goes haywire — Lord forbid — I want all the bells and whistles of modern science by my side to save me or my child.

Harris points out:

I agree that we come from a society that likes to overtreat and overmedicate us for every bitty thing. But most of Black women’s issues lie not in the hospitalization during labor, but the health risks we suffer leading up to childbirth...

The Amnesty International report on maternal mortality emphasizes this point:

The US government’s failure to ensure that women have guaranteed lifelong access to quality health care, including reproductive health services, has a significant impact on the likelihood of having a healthy pregnancy and delivery...

Insufficient access to quality health care services over a woman’s lifetime means that women are entering into pregnancy with health conditions that are untreated or unmanaged. This poses added risks for both the woman and her child. For example, women who become pregnant with uncontrolled diabetes are more likely to have a miscarriage or develop pre-eclampsia.

But it is not simply that women of color suffer from lack of access to the technology employed to treat women with pre-existing medical problems and complications of pregnancy, the factors most associated with high rates of maternal death. Many women of color don't have the same interests or priorities of white women who choose homebirth. Indeed, lower income women of all ethnicity don't have the same interests and priorities of the relatively well-off women who choose homebirth.

That's not surprising. Homebirth is like following Martha Stewart. It's delightful to bake your own bread when you know that you don't HAVE to bake your own bread if you don't feel like it. Similarly, it seems delightful to privileged white women to avoid the hospital when they know that they don't HAVE to avoid the hospital if they change their mind. For other women, who don't have routine access to high quality medical care, who have medical risk factors, whose home is not a domestic paradise, who have enough unmedicated pain in their own lives that setting themselves the "goal" of enduring more pain without medication is unfathomable, homebirth is an affectation they have no interest in emulating.

I don't presume to speak for women of color. They can speak for themselves without my help. And frankly, I don't think the white women of The Big Push for Midwives actually care about women of color beyond seeing them as the way to secure access to Medicaid reimbursements. Nonetheless, I think the assumptions behind their publicity campaign are demeaning and wrong. It seems impossible for them to imagine that women of color are the ones who are truly "educated" about the reality of childbirth, and that privileged white women ought to be emulating them.