I\'m Summer, a mouthy, sarcastic bitch. I\'m passionate about natural birth, long term breastfeeding, and living naturally. I curse too much, love tattoos, and will some day be crushed to death by my book collection. I homeschool, dream of gardening, and swing to the left. 
Poverty And Childbirth
photo credit: Raphael Goetter
There is a great article up over at RH Reality Check called The Cost of Being Born At Home.
Current efforts to transform birth – offering women more options and preserving their decision-making – are not reaching low-income women. Birth activism draws attention to the ubiquitous media portrayal of highly interventionist births, the normalization of c-sections, and the lack of choice afforded to women by their doctors, whose hands, in turn, are tied by hospital policy and malpractice fears. The criticisms made by birth activists are accurate yet incomplete. Missing from these conversations is how low-income women – who suffer the worst outcomes for their babies, including lower birth weights and higher infant mortality rates – are making decisions about where and how to give birth.
A big point of the whole article is that even with changes made to insurance companies, low income women who have to use Medicaid or pay out of pocket. And when you’re choice is paying the electric bill or paying for a midwife you’re going to go with electricity. I get that, I do. Here in Oklahoma Medicaid will pay for a midwife if you choose a hospital or birth center, but not at home. Luckily there are a ton of midwives here who will work with a mom to do payments and generally don’t cost more than $2000, but even then that can mean needing around $200 a month to pay for the birth.
When insurance will mean you pay nothing to go to the hospital and do the typical birth thing it’s not crazy to see that a lot of low income women just go with the hospital. Or as one Midwife said:
“If Medicaid doesn’t start covering homebirth, any positive changes toward homebirth will not benefit poor women. They will have to choose between homebirth and food, and food will win every time.”
So what can we do? What can birth activists do to help poor women feel like they have a choice? Pushing insurance companies to accept midwives and homebirth is of course important, but it can’t end there. State insurances also needs to accept midwives as valid caregivers and the home as a viable place to give birth. And real, honest, education about choice needs to be given to all mothers, even the ones who can’t afford doulas and fancy childbirth classes.
I was lucky with Evan that my midwife provided Bradly childbirth classes in her service, so it was paid for. But there are many women who don’t even know that there are other options beside the standard hospital offered Lamaze classes. When I had Evan there were several times that despite being on the state insurance and knowing that they covered my midwife and freestanding birth center I still came face to face with Medicaid workers who A) had no clue midwives were covered, B) had no clue there were options outside the hospital, and C) and occasionally argued with me that it couldn’t cover what it did.
Still, having homebirth not an option makes it hard. Especially when the nearest birth center is an hour drive away. I’ve done that once, it’s not something you want to do in labor.
Homebirth is a choice, but it needs to be a choice that all women are able to make. Not just the ones who can afford to change their insurance or pay out of pocket. When fighting insurance companies to accept and pay for homebirth we need to remember to include the state insurance policies that many poor women have to use.
You know, this continues to just blow my mind.
Maybe being Canadian and havign something like this covered, but the thought of something as natural and indeed *human* as giving birth, that people are *charged* for it..
Well, I find that inhuman.
Andrea_R\´s last blog post..Quiz time
I agree, there needs to be a big push for state insurance to provide better coverage, education, support, and customer service to the lower income segment of the population. Maybe this is why Americans are so against the idea of socialized medicine – their only exposure to it is our inept Medicaid.
And btw, UC is completely free.
If anything, poor women need the care of a midwife EVEN MORE than middle or upper class women. They are the ones most likely to be nutritionally deficit, living in less-than-optimal conditions, possibly in an unhappy relationship, be depressed/stressed, and a whole host of other issues that can negatively affect birth. Midwives can help with AAALLLLL of that! And most of them are more than happy to accomodate a mom in payments…I’m sure most would rather get paid $50 a month for 2 years or barter services than turn a mom away.
I recently lobbied against a bill that would refuse Medicaid reimbursement for VBAC homebirths in VA. It was overturned, so there is definitely progress being made here, although it is pretty slow and small. We have a looooong way to go.
Jill\´s last blog post..Our Two New Boys
I just stumbled upon you post here. I seems to me that you had your homebirth convered by medicaid? Is that right? I am really interested in this. My husband lost his job in April and now I’m pregnant and yikes! Also, I don’t know much about homebirthing but is it possible to pay the midwife and homebirth fees out of pocket but do the testing and ultrasound stuff through medicaid or is that included in the homebirth fee? I need help!