Let me just begin by stating a few things that folks must not seem to understand about my position regarding hospitals and birth. My position is first and foremost informed by being an Afro-Latina woman born and raised in the Bronx who has experienced firsthand micro-aggressions and neglect on behalf of the healthcare practitioners that are and have been available to my community. Before transforming into a birthworker, I already had strong feelings about the aspects of the American medical system that now drive me up a wall. What has further driven my rage has been the fact that 99% of the women I have assisted in childbirth and reproductive health matters identify as women of color. I have experienced and seen firsthand the abusive, dismissive, and otherwise neglectful treatment they have received. So, when I am stating my position that explicitly supports and favors midwife managed prenatal care and home birth, it is based on my personal experiences; the statistics, studies, and articles so many of y’all seem to cling to as evidence is just extra to me because y’all still argue what’s best. Also, the argument about safety is null and void because hospitals are not inherently safer. If they were, the maternal mortality rate in the United States wouldn’t be rising. Alright then? Great.
Before getting to the birth, let’s just start with prenatal care. it is common that women who are receiving care from the medical system are unsatisfied by their healthcare providers. The usual length of appointments are about 15 minutes and feel inpersonable, only checking vital signs but having no real time to hold space for the pregnant mother. I’ve come across cases of downright neglect, disrespect and abuse in the stories told to me over the last couple years. In comparison, homebirth midwifery care, hospital-based midwives, and some ob-gyns who practice a holistic model of care have made expectant mothers happier more often than not. As a doula, I have experienced the ability to fill in the void for women that their care providers are leaving. To further compound the issue, the chances of Black and Latina women receiving quality care are slim due to the socioeconomic barriers they often face.
When I was training in the birth clinic over a year ago, I noticed the difference in dynamic between patient and client. For me, when someone is treated as a patient, the healthcare provider assumes authority and absolute knowledge over the sick or care-seeking person. There can be a sense of infantilization that occurs in which the person is treated like a child, experiencing at times condescending attitudes and tones of voice. Whereas, when regarding someone as a client, there is a different feel to it. Combined with the midwifery model of care that places women at the center of their care and assumes the woman is the primary person responsible for her health, treating someone as a client brings the implication that the person is ultimately the accountable one for achieving optimal health. It can be argued that our collective inability to respect birthing women as capable adults stems from our parentalistic and patriarchal society; both ideologies combined imply that women are subservient, infant-like and unable to make sound decisions. Racism also promotes a similar treatment.
I am not surprised but I am deeply concerned not just for the physical experience women are having in hospitals but also for their emotional and mental experiences in prenatal care. Unfortunately, even mothers who are aware of homebirths and midwives have barriers that prevent them from having this care. One barrier is finances. Many mothers are unable to afford homebirths or doulas for hospital births on the budgets they live on or because their insurance doesn’t cover it. Midwives are then faced with the options that come with that: taking substantially lower compensation, serving more clients than they may feel comfortable with to support themselves, dividing their clientele on a sliding scale or turning down clients who just can’t afford it. In addition to finances, mothers face the potential barrier of unsupportive friends and family. Homebirth is still seen as primitive and dangerous. They could be forced to either shroud their birthing plans in secrecy to avoid stress or reluctantly birth in a hospital because they need to avoid being ostracized or losing relationships. For marginalized people, such as recent immigrants, losing relationships may mean a loss of livelihood or stability on some level. In an idealistic society, all mothers and all midwives would find it easy to work with each other without being encumbered by capitalist demands.
There is nothing inherently wrong with medicine and doctors. As I often explain, the art of healing and curing people and their illness is the root of the medical profession. What we understand as the medicinal arts and system today in contemporary society has roots in indigenous methods of healing. Nearly if not all medications have a plant base or hormone that exists in our natural environment or in our internal chemistry; the medicinal properties of plants have long been proven by traditional healers in cultures uncorrupted by imperialism or colonization. Furthermore, the presence of physicians and doctors were documented in Ancient Egypt, as well as the role of medicine men and those skilled in dealing with the supernatural. The presence of midwifery is also found in antiquity, sometimes the professions being interchangeable. I bring this up to say that my rage is not against the medical profession but rather the abuse of human rights and of technology and interventions. My rage is directed at the patriarchal and parentalistic attitudes that permeate the medical system, and how women and those most vulnerable bear the brunt of these ideologies.
In “Women and Nature: The Roaring Inside Her”, it speaks at length about how man has separated themselves from nature and by default women. What struck me most is how the hate and disrespect women stems from a mistrust and fear of nature and because women are close to nature in ways men are not (i.e heightened intuition, knowledge of plants, ability to birth, etc), we are subjugated and objectified in the same way our natural environment is. Women are constantly denied the wisdom of their bodies throughout their lifetimes and particularly when it comes to their reproductive health. Midwives are denied the respect of their worthy professions because its essence is antagonistic to a technocratic model of care in birth. Steps to rectify the severe imbalances include a dismantling of patriarchy, a reevaluation of patriarchal attitudes in the medical system and a return to trusting our natural environments and nature. We remain at a crossroads with our reproductive and maternal health where we are experiencing high rates of maternal and infant mortality and a host of other grievances. It is our work to restore the respect that mothers and midwives deserve in this country and world.