The poor factor

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Money influences all, right?  So why should it not influence medical care (or lack thereof) while pregnant and giving birth?  Without socialized healthcare reform, a person’s wealth determines the access a person has to care providers.  Choosing the right care provider is possibly the most important decision a woman can make in determining the outcome of her pregnancy and birth.

Different providers also allow for different birth locations.  At least here in Texas, Medicaid will not pay for a home birth midwife, whether the midwife is a CNM, CPM, LM ,or whatever.  The Texas government does not support home birth, period.  Probably because the ACOG (American College of Obstetricians and Gynecologists) and the AAP (American Academy of Pediatrics) says home birth is evil!  Okay, not really, but they do not support it.  The ACOG’s stance on the issue of home birth is this:

“Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery. Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence.  Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.”

They then go on to say “The relative risk versus benefit of a planned home birth, however, remains the subject of current debate…  High-quality evidence to inform this debate is limited. To date there have been no adequate randomized clinical trials of planned home birth.”

So how on earth do they claim the risk of neonatal death is higher with a planned home birth?   The ACOG’s position on home birth really deserves its own post, so I will stop here.

Back to the AAP.  The AAP pretty much ditto’s the ACOG’s stance with this statement:

“The American Academy of Pediatrics concurs with the recent statement of the American College of Obstetricians and Gynecologists affirming that hospitals and birthing centers are the safest settings for birth in the United States…”

And just to clarify to all the people that think it is dangerous to give birth out of a hospital:

Home births have much better maternal outcomes, statistically, than hospital births, and the neonatal outcomes are the same.  A woman has a much higher chance of having a cesarean section (at least 300% higher) in a hospital rather than at home.  If I could have afforded it, I would have hired a home birth midwife.  Because I could not afford it, my birth experience was far from what I wanted it to be.

The fact that Medicaid does not support all safe birth locations irks me.  Why do they feel the need to limit options?  It is not right.  It is as if the government thinks the poor are not intelligent enough to make safe birth choices.  Being poor does not mean unintelligent.  Even a poor woman should have the right to birth where she chooses.  Of course that choice should be based on careful research, weighing options given a woman’s specific set of circumstances, and a resulting decision should be made carefully.  Researching  and preparing for pregnancy, birth, and caring for a baby seem not to be high on the list of priorities for most Americans, whether wealthy or poor.  But that is a different post.

I am not implying there is no place for hospital birth.  There certainly is a place for it, especially for high risk pregnancies, and unfortunate and unforeseen outcomes from normal, healthy pregnancies.  But there needs to be a choice.

Also, home births are cheaper!  Why wouldn’t Medicaid support home births, given the lower cost?  Home birth is around $3000, as where hospital birth is about $20,000.  A cesarean section in a hospital is $40,000!

Medicaid only paid for one visit from an LC (lactation consultant), which suggests that breastfeeding is not high on their list of priorities, either.  It is really so very common for women to experience problems breastfeeding in the beginning.  Easy access to LC’s is a must, especially because it is common for doctors and pediatricians to give bad breastfeeding advice.

In addition to the difference in providers determined by wealth, there is also a difference in postpartum support/help.  Someone who can afford a postpartum doula or has other help available has a lower chance of getting postpartum depression.  There is a correlation between the onset of postpartum depression and quitting breastfeeding.  Not to mention the postpartum experience is more pleasant for a mother who can just hole up in her bedroom for a couple weeks to feed, bond with her baby, and recover.

Giving birth is a significant life event and should be respected and supported.  The bottom line is that when a woman is poor, she has limited options.  Since the vast majority of Americans are poor, the vast majority of Americans do not have the range of options that, I believe, are necessary to give birth and take care of a baby properly, safely, and with less stress involved.  Having less stress associated with birth and the postpartum period contributes to better parenting, and happier, more sane citizens in the future.

So why are we throwing ourselves to the wolves?  Oh yeah, greed.  Greed of the wealthy to keep their money where they think it belongs, in their own hands.  Boo, I say. 


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