Week 25: Privilege While Pregnant

Week 25: Privilege While Pregnant

I knew I had a find a way to have a healthy birth—despite what the statistics were telling me.
— Dani McClain, The Nation (link below)

I’m not going to lie to you…I walk into every prenatal appointment the same way: feeling excited, thrilled even. I leave my appointments eager for the next, feeling validated, supported and full of joy. This is not what I expected when I found out I was pregnant.

My first two prenatals at a medical office were filled with silent, pulsating anxiety and worry leading up to the scheduled appointment time. Then, they were followed by discomfort, confusion, and let-down when I was done. In short, I felt unfulfilled after each appointment at a time when words like "unfulfilled" and "confusion" should especially be avoided.

And sure, these appointments were early in my pregnancy which fosters its own anxieties and fears that later-term appointments may not, but I don’t believe it is that simple of an explanation.

And for that reason, for the past few weeks as I approach my third semester, when I let my guard down, I catch myself thinking about the experiences of other women. Lamenting that more cannot have this same experience and thereafter wondering what is the real reason why more aren’t on board.

This is where I need to check myself or at least step outside the conversation path and say, I know there are clearly PLENTY of well educated, feminist, financially secure, open minded women out there who choose to approach their prenatal care, pregnancies, labor and birth in the same way as the rest of the 98.5% of women who do this. I acknowledge that my decision only accounts for about 1.5% of births that occur in the U.S. (the number of planned births outside a hospital is probably lower still). To assume that most who choose this are somehow misinformed or ignorant or lazy is NOT my motive.

Based on trends over the past few years, I CAN claim that more women are now choosing alternative ways to assist them with their pregnancies and birth such as enlisting the help of a doula, opting for natural labor techniques, and overall challenging what has become the status quo, because they recognize that the status quo isn't exactly that great either. The key to this happening lies in one single word that some of us may take for granted: choice

Something as simple as having a choice is a privilege that many women in our country do not know they have, and many don't even HAVE.

And so, this is why it is so important to talk about privilege with regards to pregnancy.

Privilege has become one of those loaded terms lately. In certain circles, it can be wielded as an insult, as a way to undercut someone “man-splaining” you during an intellectual conversation, or as a way to divide or separate experiences between friends of difference circumstances. A quick dictionary search defines privilege as a special right, advantage, or immunity granted or available only to a particular person or group of people.

Immunity.

Advantage.

Special right.

In the past, at least under my vocabulary, this word was used more to describe those living a charmed life in a mansion, who drove expensive cars, had maids and butlers, went to private school, bought only designer everything. These people were mythical figures I rarely was exposed to. They were not in my vortex. To be called and one day accept that I am a privileged person would have been such a baffling concept to me ten years ago. Such a dense word can really spiral this conversation in so many directions, but for the sake of focus and brevity, I’ll stick to how privilege influences pregnancy, from prenatal care to postpartum experiences for women.

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To date, all of my prenatal visits have been one full hour about me and my baby. There have been some minor testing and the necessary measurements and questions, but the bulk of it has been celebratory, sisterly, encouraging and safe. My questions are validated and given their proper time. I’m offered multiple options and always am given the time and ability to choose what is best for us (me, my baby, and my husband). When things may be more complicated, we are directed to resources to seek out the full scope of research or opinions to guide us in our decisions.

One example lies in the way in which I could test for gestational diabetes. I never knew there were multiple ways to get this test done and that I can actually decline it altogether if I don’t think I need it and don’t have any warning signs present. While I have ultimately decided often the more “standard” route when it comes to blood work, vaccines, and testing, I have appreciated the time spent deciding for myself why these are the best way for us to go personally. This helps me feel comfortable with what is being done to my body and my baby. I feel a part of the process and ultimately feel in control of the process.

Privilege: an invisible package of unearned assets that I can count on cashing in each day,but about which I was “meant” to remain oblivious.
— Peggi McIntosh

By contrast, I cannot tell you how many times even a standard pap exam can leave me feeling like so much was done to me that I don’t understand and that I had no part in the process. I just was there and told what was being done to me, usually as it was being done. Think about how many times this happens during teeth cleanings. During so many of these occasions, I never thought to stop and ask questions or about what and why things were being done. When I have stopped and asked questions in the past, I’m often given hurried answers or handed pamphlets. I am not entirely faulting the practitioners. For many reasons, doctors do not have the same amount of time to spend or cannot say certain things without the fear of legal repercussions perhaps.

This does make me question this medical system which has been and continues to be so heavily criticized for practically any and all reason. Why then is it so taboo to question and criticize our healthcare system’s approach to prenatal care, women and birth?

I thought this week’s focus would take a different turn but perhaps I’m saying enough already and my privilege is showing on its own.

  1. I can afford (while not extravagantly) to have a midwife and home birth and all the extras we feel necessary to partake in as we prepare (nothing but maybe some blood testing is covered by or insurance...not true for most people with PPOs by the way). 
  2. I am educated enough to know how to access, interpret and sort through the data and information I needed to make the decision for myself, and continue to do this with the many small (and large) decisions we have to make throughout this process. 
  3. I am physically and mentally healthy, able-bodied with no conditions that prevent me from taking this route. 
  4. As of now, my pregnancy has been normal and without any complications or risks. 
  5. I am a white woman. I know other women like me (white, college educated, healthy, of certain means) who have gone through this process before me. I am not ignorant to the fact that nearly all the women I have met in the pregnancy groups, classes and circles I surround myself with are white. I am comforted to see women like me who are able to do this. This makes the path much clearer for me to imagine for myself. [This fact also upsets and challenges me to think about what implications there are to make about the lack of diversity in this option for women. Maybe this option isn't really an option to everyone.]

All of the above outlines my privilege and how my privilege is shaping my pregnancy and my prenatal care and ultimately my labor and the birth of my child, his newborn care, and my postpartum experience. These privileges are setting me up to lead a certain life as a mother and setting my child to lead a certain life of his own.

I cannot help but, especially in the current social climate we are in, think about women who do not have any these privileges (and the many others I didn’t even get into). What implications are there to make about the lack of diversity I identified above in the home birth/birth center option? In all other areas of life, when I find myself in a place with such a high percentage of white people present, I infer that the place, circumstance, or group is one of privilege, that it is an "unearned asset" not available to people of color.

Where does that leave everyone else when they go into labor? Where does that leave their children? How can we not think that this doesn’t contribute to the cycles we so readily talk about when it comes to socioeconomic gaps and racial inequality? Can we agree that a white woman in North County San Diego who has a midwife is not getting the same prenatal care as a black woman at a free clinic in South Los Angeles? If true, can we agree that one of these woman’s care is likely more focused and tailored to the well being of BOTH mother and child? What does this do mentally and emotionally to the woman and how does this influence the way she feels about her pregnancy? Her labor? Her child? Herself? Clearly, I'm giving two extremes, but I'm not out to lunch here identifying this potential problem. Even Serena Williams' birth story is getting a lot of attention about not being listened to when she had something to say about her health, her body, her pregnancy. 

Like I said, I just want to stir the pot and churn with these questions related to medical care during pregnancy for women. With the main question being, are women given their due importance when treated during and after their pregnancies? Further forward, are women of color, particularly black women, being given their due importance when treated during and after their pregnancies? This topic can boil over easily and become convoluted so I will leave you with this:

 
In certain parts of the country, particularly the Deep South, the rates of mother and infant death for black women actually approximate those rates in Sub-Saharan African. In those same communities, the rates for white women are near zero.

Even nationally, black women are four times more likely to die during pregnancy and childbirth than white women. Four times more likely to die. They’re also twice as likely for their infants to die before the first year of life than white infants, and two to three times more likely to give birth too early or too skinny — a sign of insufficient development. Native women are also more likely to have higher rates of these problems than white women, as are some groups of Latinas. For the last decade as a doula turned journalist and blogger, I’ve been trying to raise the alarm about just how different the experiences of women of color, but particularly black women, are when it comes to pregnancy and birth in the US.

Even middle-class black women still have much worse outcomes than their middle-class white counterparts. The gap actually widens among this group. And while access to care is definitely still a problem, even women of color who receive the recommended prenatal care still suffer from these high rates.
— Miriam Zoila Perez, TED Talk (2016)
 

Further Reading

I read this essay at some point during my Teach for America tenure that I am glad I was able to find from memory and with the use of Google. The section titled, "The Daily Effects of White Privilege" includes a pretty compelling list of conditions that people of color likely CANNOT count on on a daily basis. 

White Privilege: Unpacking the Invisible Knapsack

NPR has been doing a series called Lost Mothers: Maternal Mortality in the U.S. which investigates recent findings that reveal the U.S. has a higher maternal mortality rate than most developed nations. Below are some of the articles published as part of their investigative series:

 U.S. Has The Worst Rate Of Maternal Deaths In The Developed World

Focus On Infants During Childbirth Leaves U.S. Moms In Danger

Many Nurses Lack Knowledge Of Health Risks To Mothers After Childbirth

Nearly Dying In Childbirth: Why Preventable Complications Are Growing In U.S.

The LA Times is also chiming in on this issue, looking more closely at African American women:

The quiet crisis among African Americans: Pregnancy and childbirth are killing women at inexplicable rates

http://beta.latimes.com/nation/la-na-global-black-midwives-20171026-story.html

And in 2016, Miriam Zoila Perez gave a TED Talk on how racism is dangerous for pregnant women:

How racism harms pregnant women — and what can help

To close, here's one black woman's feature on her attitude on this topic when she herself was pregnant:

What It’s Like to Be Black and Pregnant When You Know How Dangerous That Can Be

And here's a great article following Serena William's birth story:

What Serena Williams’s scary childbirth story says about medical treatment of black women