Natural childbirth and white privilege

Marie Antoinette midwifery

Avital Norman Nathman, writing in The Frisky, succumbs to what is apparently an irresistible urge among natural childbirth advocates to exploit the tragedies of women of color to advance the agenda of privileged white women. In doing so, she reveals the white privilege at the heart of natural childbirth advocacy.

In Mommie Dearest: Mom Issues That Deserve Media Coverage In 2015, Norman Nachman asserts that mothers:

More stories on our broken birthing industry. I wrote a little bit about why I champion midwifery care here before. And I’ve gone even further, looking at the larger issues surrounding midwifery care in the US. I would love to see more stories in the mainstream delving into these issues and challenging the current status quo when it comes to maternal health in the US. There is something substantially wrong when we have the costliest maternal health care in the world, and yet we rank 60th out of 180 when it comes to maternal mortality (and are one of the few countries where these rates are increasing). So, yeah. More focus/air time on this, please.

But our “birth industry” is not broken and her focus on maternal mortality is not an example of the failure of modern obstetrics, but a glaring example of white privilege.

What is white privilege? According to The Southern Poverty Law Center:

White skin privilege is not something that white people necessarily do, create or enjoy on purpose. Unlike the more overt individual and institutional manifestations of racism described above, white skin privilege is a transparent preference for whiteness that saturates our society. White skin privilege serves several functions. First, it provides white people with “perks” that we do not earn and that people of color do not enjoy. Second, it creates real advantages for us. White people are immune to a lot of challenges. Finally, white privilege shapes the world in which we live — the way that we navigate and interact with one another and with the world.

It is white privilege (in this case the belief that everyone is white, middle class and has easy access to healthcare) that allows Norman Nathman to expropriate the tragedy of maternal mortality (which disproportionately affects African-American women) to advance the agenda of natural childbirth advocates, a group that is almost exclusively Western, white and relatively well off.

White privilege means that Norman Nathman neither knows nor cares about the reality of maternal mortality in childbirth. If she bothered to learn about it, she would be quite surprised.

1. Race, unfortunately, is a risk factor for maternal mortality. Women of African descent have disproprotionately high rates of maternal mortality, even when socio-economic status is taken into account. Black women are more than 3X as likely to die in childbirth as white women and women of other races. We don’t understand why this is so, and its exploration merits intensive research efforts and research dollars.

2. Women of lower socio-economic status are more likely to die in childbirth.

3. Women with pre-existing chronic medical problems or serious medical complications of pregnancy make up a large share of women who die in childbirth.

4. The US has a higher proportion of women of African descent (and, therefore, a higher risk population) than most of the countries that have better maternal mortality rates.

5. Too many American women die in childbirth because we don’t have enough high risk obstetric specialists and high risk obstetric ICUs (intensive care units).

White privilege allows Norman Nathman to ignore the fact that the US maternal mortality rate reflects a population that is blacker, poorer and lacks access to high tech lifesaving care. White privilege allows Norman Nathman to imagine instead that the problem is that we aren’t spending more resources to spread the birth “experience” preferences of wealthy, white childbirth activists. Norman Nathman is the white privilege version of Marie Antoinette who, according to the apocryphal story, responded to learning that the poor were rioting because there was no bread, with the utterly clueless, “Let them eat cake.” Norman Nathman responds to learning that too many American women die in childbirth with the utterly clueless, “Let them get midwives.”

It is morally grotesque and reeks of privilege to suggest that midwifery is the answer to the problem of women dying in pregnancy of heart disease, kidney disease, eclampsia, and other serious complications. Natural childbirth advocates need to check their white privilege, stop imagining that everyone is white, middle class and has easy access to high tech healthcare, and, most importantly, stop expropriating the tragedies of black women to serve the agenda of privileged group of white women.

94 Responses to “Natural childbirth and white privilege”

    • Guest
      January 6, 2015 at 8:36 pm #

      And what kind of physician is she? One who obviously has no idea that the WHO does NOT set the ideal c/s rate at 10-15%. One who is a specialist in history but not obstetrics. One unaware that IUFD increases in AMA mothers?

      Also, why was she on Mag? Pre-eclampsia? And I was under the impression that post partum hemorrhage is associated with uterine agony and prolonged labor, NOT prolonged exposure to pitocin.

      Would love for our OBs and CNMs to comment on this…

      • Guesteleh
        January 6, 2015 at 9:29 pm #

        She’s an asshole. 40-year-old primigravida with gestational diabetes and she’s throwing shade at all the professionals who busted their asses to keep her and the baby alive. And she’s a medical student! WTF

      • Ash
        January 6, 2015 at 9:49 pm #

        “They wanted to start magnesium
        for suspected preeclampsia, a potentially
        life-threatening complication of pregnancy, but couldn’t prove whether I
        had the
        condition because the baby’s head was causing bleeding
        from my bladder.” From the full article in Health Affairs (there’s a little link below the Washington Post text)

        • Dr Jay
          January 9, 2015 at 4:49 pm #

          The bleeding could be from PET/HEELP– or it can be sign of a stalled labor. Either way, it’s not a good sign. And they don’t start MgSO4 unless you have PET or are delivering a significantly pre-term baby (for neuroprotection). You can “prove” a dx of PET with high bp/proteinuria/deranged urine and blood values such as a high protein creatine ratio, high urate, and deranged LFTs (in later stage). It’s not like we routinely use a diving rod or the runes or anything, so I’m not sure how she thinks that her team was undecided. It’s pretty cut and dried (at least in our unit).

    • Samantha06
      January 6, 2015 at 8:57 pm #

      I saw this post earlier today… a woo-infested midwife I used to work with posted it on FB…. I call BS on a lot of it….

    • Amy Tuteur, MD
      January 6, 2015 at 11:23 pm #

      No, I hadn’t seen it. I’ll check it out.

    • Elaine
      January 6, 2015 at 11:45 pm #

      She was being induced for 2 days and is surprised that the doctors were starting to recommend a c/s? DUH!

    • MLE
      January 7, 2015 at 12:35 am #

      “The nurses would rush into the room in a panic and say, “We’ve lost the baby!” My sister, who was keeping me company, found this hilarious, and when they left she would say to me, “I know where the baby is,” pointing to my basketball-size belly.”

      Hahahaha isn’t death amusing?!?

    • Dr Kitty
      January 7, 2015 at 4:35 am #

      “We got the vaginal birth that epidemiological data suggests was safer for us both”…except that the actual data of a baby born flat and requiring resuscitation contradicts that statement.

      TBH, the entire piece reads like she was terrified of a CS.

      She was having haematuria, had GD, was a 40year old primip being induced…who eventually delivered a baby that had clearly not tolerated labour well.

      None of that suggests that VB was “safest”.

      • Elaine
        January 7, 2015 at 9:08 am #

        I think she is confused about the idea of avoiding a c/s for the sake of future pregnancies. Maybe if she wanted 6 or 8 kids making sure she doesn’t have a c/s would be a good idea. But she’s 40. She’s not having 6 kids; it’s going to be a stretch to have 3. I wonder if she is in denial about that too.

    • RKD314
      January 7, 2015 at 9:20 am #

      I found this very annoying, and then I read the original article. The picture there was a bit different. There are still points where I’d disagree with the author, but certain others are presented in a clearly distinct way: for example, the author specifically points out that there is no recognized “ideal” csection rate, that the idea is outdated.

      I think that there are a few valid points here. First of all, I don’t see a problem with a patient preferring not to have surgery. The author states that if it was necessary, she wouldn’t have a problem with the csection, but she didn’t want one she didn’t need. I don’t see that as being unreasonable. It’s also not clear to me that she was arguing against a section that really was necessary; there was not a consensus amongst the doctors in her care team. To me it’s problematic that as a patient she was sort of kept in the dark; that she had a care provider that didn’t seem much interested in actually assessing her need for a section (the doctor who didn’t bother to check how dilated she was); that the delivery team did not seem to be prepared when the baby came.

      Certainly there is a lot wrong with the article as well. For example, she makes much of the fact that several of the doctors who thought she should get a section, had not physically evaluated her, but had rather only been presented with details of the case. She presents this as if to say that they were unqualified to make judgements. However, she has no problem with her doctor friends making judgements, despite the fact that they also haven’t evaluated her, and certainly carry more bias towards her desires. And of course, the anecdote about “I know where the baby is!” was just terrible.

      • Ash
        January 7, 2015 at 11:23 am #

        I felt as if the article was missing some key points of interest: for example, as an ethicist, she knows that it’s not all black and white as “women got rushed into surgery they often didn’t need.” We know that some women who get c-sections wouldn’t necessarily have a catastrophic result if they delivered vaginally. Some babies with non-reassuring heart tones will be fine, some babies that have mothers with amniotic sac rupture longer than the author will be fine. That doesn’t necessarily mean that a C-section is not a reasonable option. For example, as the author noted, at one point the OR was really tied up with other procedures–so had there been an emergency situation, her procedure may have been delayed. A patient and provider may decide that it’s not best to wait until everyone (the entire hospital team and her friends on the phone) decide that it’s an “urgent clinical reason for cesarean”

        IMHO the author’s story, as an ethicist, would have been more interesting had it focused on this:

        If a doctor I trusted, instead of one I didn’t
        know, had suggested a cesarean forty-eight hours into my labor
        induction, I
        might have agreed.” Author clearly didn’t trust one of the MDs described in the article. As a professional dealing with palliative medicine and ethics, how do you advise patients with whom you don’t have trust? No physician only has patients that likes them and trusts their decisions. So as a physician, how do you A) build trust, especially in a time pressured environment, and B) provide good care when the patient doesn’t trust you?

        • RKD314
          January 7, 2015 at 3:39 pm #

          Yeah I agree with you completely. And I feel like the article, although it raises some relevant points, is more problematic than helpful, overall. Especially because the author is a physician, I’m sure it will be misused to defend all sorts of irresponsible choices.

    • fiftyfifty1
      January 7, 2015 at 9:50 am #

      40 yo primip with supposed gestational diabetes and yet she describes needing to go on insulin in the FIRST trimester. GDM isn’t tested for in the first trimester. Sounds more like she has DM2.

      • lawyer jane
        January 7, 2015 at 11:15 am #

        Don’t forget the pre-eclampsia necessitating magnesium as well.

        I’m surprised she doesn’t actually understand what risk is – her whole argument seems to be that her vaginal birth turned out ok (blue baby and hemorrhage aside) – so obviously there was no need for a c-section. How illogical.

        Also, I wished that she had gone back and interviewed her doctors to ask them about the risks they feared and why they were considering a c-section for her before she concluded they were just out to cut her.

        • Ash
          January 7, 2015 at 11:39 am #

          Agreed . Author is in a privileged place as a physician–her doctors may have been willing to have a longer debriefing of the clinical situation than what they could fit into a normal postpartum visit.

          It seems that the author did not want C-section to be discussed at all unless it was an emergency. Example–at a prenatal visit with the MFM doc that the author dislikes, the MD says “I hope you go into labor on your own,” she said, “because if we induce, the chance of a c-section is 50 percent.”

          Author i “I was deeply unsettled, worried that she was already planning my cesarean”

          Reality check needed here. MFM doc was right to tell her about the possibility of getting a C-section, and asking if she’s done a pre-op visit with anesthesiology, so she’s better prepared if it’s necessary. But the author doesn’t want to hear it.

      • RKD314
        January 7, 2015 at 11:24 am #

        In the WaPo article the part in question reads “my pregnancy was complicated by gestational diabetes”, whereas in the full article in Health Affairs (see link below from Ash) it says “my pregnancy was complicated by diabetes”. So either the WaPo editor made the change, or the Health Affairs editor did.

    • Felicitasz
      January 7, 2015 at 2:34 pm #

      Whoa, I did not expect a tsunami of answers like above (or below, however disqus feels it today), but I am reassured to see that I was not the only one whose eyebrows went up.

  1. dbistola
    January 5, 2015 at 11:20 pm #

    LOVE this! Is there any way to ensure that this writer sees this?

    • dbistola
      January 5, 2015 at 11:21 pm #

      oh wait, durr, just saw below!

  2. Elaine
    January 5, 2015 at 8:58 pm #

    First italicized quote has a repeated “champion midwifery care”.

    • Amy Tuteur, MD
      January 5, 2015 at 9:24 pm #

      It was in the original and I didn’t notice it. I fixed it.

  3. Amy Tuteur, MD
    January 5, 2015 at 8:57 pm #

    Avital Nathman responds:

  4. no longer drinking the koolaid
    January 5, 2015 at 5:54 pm #

    AA teen diagnosed with chronic hypertension at 16 y/o. Pregnant at 24 and develops superimposed preeclampsia. Emergency C/S at 32 wks.
    Yep, real thing. Saw it just last week.

    • January 6, 2015 at 11:55 am #

      You’re saying that the Brewer Diet wouldn’t have helped?

      • no longer drinking the koolaid
        January 6, 2015 at 12:24 pm #

        I know you are being facetious, but even if Brewer worked, there are the questions of access to the food needed (food deserts) and the costs involved. Not too many fully stocked groceries in inner city Detroit.
        Perhaps that is an area that needs to be addressed. The midwives who don’t believe in modern medicine can put their focus on helping women to set up urban farms, teach them canning and preservation, and how to use fresh and preserved foods. A few chicken coops for the fresh organic eggs.
        However, the issue may also be that a working stove is needed in the home, along with pots, pans, and cooking utensils.
        I used to work visiting nurse and would go out to do the new mom visits. Not unusual to see a bare mattress on the floor for sleeping, baby slept in the car seat, and a card table and a couple of folding chairs for eating a meal.
        It is a whole lot easier to blame the hospital system for over intervention and mistreatment rather than to solve the problem of poverty and women having transportation to the clinic for prenatal care. Of course the midwives could offer to do prenatal visits at the woman’s home.

        • January 6, 2015 at 12:28 pm #

          I an being facetious, but only because we all know that many alt-need people would try to recommend it in all sincerity. I live in a fancy suburb with disposable income and a flexible schedule and I’m not sure I could keep that diet up for 40 weeks.

          • no longer drinking the koolaid
            January 6, 2015 at 12:33 pm #

            Yes, they would, and w/o understanding the problems women would face in trying to comply.

        • staceyjw
          January 6, 2015 at 6:40 pm #

          Fix the problems with poverty? Help the poor?

          And that is not even talking about the problems that stem entirely from white supremacy…

          But seriously, most of the problems in America, from maternal health to crime, and all the things in-between, could be fixed in part (or whole) by eliminating poverty. Whether you wanna increase wages, welfare, or both, inequality kills, and drains us of so much as a society goes. And YES, we can do it. Its not even difficult logistically, only politically.

          (But I guess billionaires need another jet, because while we cut SNAP, we gave them 5 billion ion tax cuts….)

  5. FormerPhysicist
    January 5, 2015 at 4:52 pm #

    Is there intensive research happening on the causes of racial disparity in maternal mortality? Does anyone know of any charities that specifically support this effort?

    • January 6, 2015 at 11:56 am #

      This would be a good cause for the March of Dimes to take up, but I wonder whether they would be called out as racist.

      • Somewhereinthemiddle
        January 6, 2015 at 1:05 pm #

        Better to allow WOC to go on dying without find out why than to do something that might be percieved as racist.

        • Lj
          January 12, 2015 at 11:53 pm #

          I wonder if it’s because African women have narrower pelvises.

          • Young CC Prof
            January 13, 2015 at 12:08 am #

            African women as in women living in Africa, who suffered from childhood malnutrition? Sometimes.

            Women of African descent living in the USA? Nope. The intersecting factors of systemic racism, poverty and lack of access to medical care unfortunately explain it all.

  6. GiddyUpGo123
    January 5, 2015 at 1:48 pm #

    It seems pretty obvious to me that a big part of the problem is that we don’t have universal health care in this country. When you’re a low income woman without health insurance, you don’t see an obstetrician because you simply can’t afford to do that. And when you don’t see an obstetrician during your pregnancy and you instead wait until you’re in labor and then go to the ER to deliver, your chance of having a poor outcome is probably a lot higher.

    • Medwife
      January 5, 2015 at 3:46 pm #

      I think even more than prenatal care is a need for pre-conception care. People come in pregnant with a list of uncontrolled health problems a mile long because until they’re pregnant, health care is very hard to get. Even once you’re insured, there’s that pesky primary care provider shortage to deal with. We do what we can, obviously, but there is a limit to how much you can quickly “fix” from a lifetime of poor health.

      • Young CC Prof
        January 5, 2015 at 3:56 pm #

        In some states, pregnant women who don’t qualify for Medicaid can still get access to prenatal care. Prenatal care ONLY. Preexisting or comorbid conditions are not covered.

        It’s better than nothing, but it sure isn’t good enough.

        • Dr Kitty
          January 5, 2015 at 4:42 pm #

          That makes NO sense.
          You cannot treat people as if they are nesting dolls, where each system and illness is isolated in its own box and has no effect on anything else. Biology doesn’t work like that.

          • The Bofa on the Sofa
            January 5, 2015 at 5:37 pm #

            You make the mistake in thinking that the people who are restricting the funding for Medicaid care about biology. All they care about is making sure they don’t pay more than they have to for those mooching crack whore welfare queens.

          • Dr Kitty
            January 6, 2015 at 2:54 am #

            But, as medwife says, it’s a false economy if you have to pay for NICU and lifelong care of a disabled preemie who was born early because you didn’t pay a few hundred dollars for his mother’s BP meds, inhalers, anti-epileptics or insulin.

            Again, I’m always horrified by how much drugs cost in the USA. Salbutamol is about £2 and even the expensive combo inhalers like Symbicort are only about £60 to the NHS, which shows that market economics is not the best way to run a health system.

          • ForgetfulGuest
            January 6, 2015 at 7:13 am #

            Same in Australia – Salbumatol is a few dollars (we pay $6 which is the concession price, but I think even at full price it’s still under $10, and you get two lots/400 doses for that), and the more expensive preventer my daughter is on is just under $50. I first found out how much these things cost in the US when a friend who lives there (and who is by no means poor) couldn’t afford asthma treatments for her daughter. Horrified is a good word. It must cause so many problems and costs in the long run…

          • Dr Kitty
            January 6, 2015 at 9:04 am #

            I had an American tourist (visiting Irish relatives) who ran out of meds.
            Even paying for a private prescription and full NHS list price the meds worked out cheaper in the UK than her co-pay alone…
            There I was apologising that she wasn’t entitled to free drugs and she was happy enough with the bargain she got!

          • atmtx
            January 6, 2015 at 11:17 am #

            It wasn’t asthma meds, but I had this happen too. I had to go to the doctor in a country with socialized medicine. We called in a favor with a friend of a friend whose doctor friend (did you follow that? It really was that convoluted) saw me for free. He didn’t like that the medicine would cost me $20, so he charged it to his department. In that country, there’s no copay for prescribed medicine. He did appreciate our “payment” of a bottle of liquor for his troubles 🙂

          • Young CC Prof
            January 6, 2015 at 8:21 am #

            Salbutamol used to be that cheap here. Then they phased out the CFC inhalers, and the drug companies managed to negotiate NEW PATENTS. It’s outrageous. The first inhaled steroid was licensed in 1976, and in the USA, they are all magically still patent-protected. Even the ones that don’t use HFA delivery systems. No one has any idea when this state of affairs will change.

            I have one friend who has insurance and doesn’t have enough asthma medicine, because her insurance only covers generics, and people in that situation aren’t eligible for prescription assistance programs.

            Everywhere else on the planet, most drugs are sold for a modest margin above manufacturing cost. Profits and new drug development money all come from American consumers, which is insane.

          • Guesteleh
            January 6, 2015 at 10:15 am #

            It’s the same mentality where people would rather jail drug users and pay the huge costs of incarceration and maintenance of a militarized police force instead of funding treatment. It’s crazy. The desire to punish overrides common sense.

          • Dr Kitty
            January 6, 2015 at 10:52 am #

            It’s not just the desire to punish. Prisons are businesses. If you changed from a “war on drugs” to harm reduction strategies based on the understanding of addiction as an illness you’d suddenly have several obsolete or massively scaled down and altered organisations ( the DEA just to start with).

            There are vested interests in perpetuating the “war on drugs”, even in the face of evidence that it is pointless, expensive and, in some cases, actively harmful.
            If the status quo is good for their bottom line, they’re going to lobby hard against change.

            The fact that being “tough on crime” wins votes contributes, but politicians would be perfectly capable of reforming drug laws in line with evidence despite that.

            This is where I sound a bit like a conspiracy theorist, I know, but the UK government has repeatedly ignored the evidence presented to them by their own scientific advisors, and since there are elections only every 5years, I refuse to believe it is solely about losing votes.

          • Guesteleh
            January 6, 2015 at 11:45 am #

            You are absolutely right about the profit motive and it’s not paranoid. But it’s depressing how easily the public falls into line. Scaring people is the best way to control them.

          • Roadstergal
            January 6, 2015 at 11:49 am #

            Oh, don’t even get me started on the War On Drugs. The money we pour down the drain, the cartels and gangs we support, the wholesale imprisonment of vast swaths of our population. It would be such a better use of money to just legalize it all and fund treatment centers for those who can’t use moderately.

            OT, I know, but this gets me SO mad. The scheduling of drugs in the US is so blatantly antiscientific and divorced from reality…

          • Medwife
            January 6, 2015 at 3:17 pm #

            They just gamble that more will fall into the camp that happens to not have the preemie, or IUGR baby, who needs NICU and long term care. Then they save that money. Even if it’s a slim majority, the insurance company usually comes out in the black, and that’s the goal. See, it makes perfect sense.

          • Liz Leyden
            January 6, 2015 at 5:35 pm #

            The New York Times is running a series on US medical costs. They covered asthma meds in 2013.

          • Medwife
            January 5, 2015 at 9:18 pm #

            Oh don’t I know it. It’s hard to talk about without swearing. My pregnant patient’s insurance won’t pay more than a pittance for a LABA to control her asthma. Those things are hundreds of dollars AFTER her insurance has covered their share. Way to save a buck guys. They’ll have to pay for her intubation at the ED once that happens. We are definitely trying to get on top of it before that happens but it’s, ugh. So dispiriting. They try so hard to support the fetus without supporting the mother. The fetus is the one with worth.

          • moto_librarian
            January 6, 2015 at 12:59 pm #

            I have good insurance. And I had to jump through a ton of hoops to get my nebulizer when I had a severe flare in November/December related to a terrible respiratory virus. Insurance will not pay retail pharmacies for them since they are classed as “durable medical equipment.” I work at a university with a sprawling medical center, but the closest place that I could pick up my Nebulizer and have it covered was 45 minutes away. If I did not have a car, I would have been screwed. I too was mystified by the run-around – would my insurance really prefer a visit to the ED and hospitalization, because that is where I was headed without adequate medication at home?

          • Elaine
            January 6, 2015 at 11:49 pm #

            I frequently get the impression that the different arms of the plan are managed differently and if they hold down costs on the drug benefit but the patient ends up in the ER, the connection is not made that the reduction of costs on drugs ended up driving higher costs overall. In fact, I’m pretty sure that money spent on medications almost always ends up saving more overall than the amount spent on medications.

      • Dr Kitty
        January 5, 2015 at 4:37 pm #

        Any medical consultation with a woman of childbearing capability can be used as an opportunity for pre-conceptual counselling.

        Neurologists should be doing it with their epileptic patients, endocrinologists should be doing it with their diabetic patients, cardiologists should be doing it with all their patients.

        Every woman with a chronic illness should be told the risks her illness pose to her health or the health of her baby, whether less toxic medications should be considered before she tries to conceive, whether she’ll need to stop or change medications during pregnancy.

        That should all come up, as a matter of course, during specialist appointments.

        In my experience, it doesn’t, and it becomes the responsibility of the woman to ask those questions.

        I find it very difficult, as a GP, when patients do the right thing and come to see me for preconception counselling, only for us both to realise that their condition is complicated and that treatment options need to be discussed with their specialist, not me.

        It really isn’t my job to tell a CHD patient which of her medications she should stop, especially if she has had four monthly visits at the heart clinic since birth, and no one there has considered it might be a good idea to ask her if she wants to have children one day!

        • Guesteleh
          January 5, 2015 at 5:08 pm #

          I worked for a hospital that provides long-term follow up to cancer patients. One of the most valuable things they do is create a medical record that the patients can bring with them to GP visits flagging all of the things that need monitoring–CVD (since chemo can damage the heart), secondary cancers, fertility issues, etc. It’s too bad that both specialists and GPs aren’t routinely asking their patients about these issues.

        • fiftyfifty1
          January 5, 2015 at 7:32 pm #

          That doesn’t seem to be much of a problem in the multispecialty group I work in. By and large, the specialists are doing a great job of this with women of childbearing capacity. The one exception is psychiatry, which is doing a terrible job which is too bad because mental health is probably the #1 chronic health condition I see in a young childbearing population, with the possible exception of asthma. The main problem is that the psychiatrists are stretched so incredibly thin around here.

          • prolifefeminist
            January 11, 2015 at 2:44 pm #

            “The one exception is psychiatry”

            This, x1000.

          • Dr Kitty
            January 11, 2015 at 3:21 pm #

            Opposite here- I can get a same or next day appointment with a psychiatrist for someone I’m worried about, but would struggle to get a medical or surgical outpatient appointment within the week.

            That’s the legacy of the Troubles- big time mental health problems and high suicide rates necessitating very good psych services.

            Our perinatal psych teams are especially good.

    • demodocus' spouse
      January 5, 2015 at 9:03 pm #

      Sometimes a woman cannot afford to take time off work, either, especially toward the end when the OB prefers you come every week or two

      • Cobalt
        January 5, 2015 at 9:07 pm #

        Especially if using public transportation. The bus takes forever if you’re not talking a prime commuter route.

        • demodocus' spouse
          January 6, 2015 at 5:39 pm #

          I know that all too well. My insurance insisted I see the obs in their main office. I needed to take 2 buses plus a 15 minute walk, 90 min one way. Fortunately, I had a very kind (and retired) friend who drove me.

    • staceyjw
      January 6, 2015 at 6:54 pm #

      The care we have for poor/low income people is also variable, to the extreme. Where I live (OR), it is excellent, but where I was before this (TX) it was basically non existent.

      Medicaid is a fed program that is administrated by each state. In some states, Medicaid is part of the overall health care system, so patients have excellent access to all they need, just like someone with a private insurer would. In other areas, there aren’t enough docs, if any, to take Medicaid patients, and the ones that exist are low quality. Overall, it does a pretty good job for the poorest women, as far as medical care goes.

      Too bad we do not care one bit if that women has a safe place to sleep, or for her kids to live. Nope, we don’t care a bit about that.

  7. Amy M
    January 5, 2015 at 1:30 pm #

    Not only white privilege but (likely willful) blindness to the reality of midwife-led care. Laying aside the issues of why American maternal mortality is less than ideal, how’s that maternal mortality rate among midwives? I imagine that for hospital based CNMs, its low. But what about homebirth midwives? Just days ago, we were discussing a woman who bled to death at home. Granted, she wasn’t in the US, nor did she have a midwife, but what if one of the stellar US homebirth midwives HAD been with her? It’s not like they could have done a blood transfusion. Her odds of survival MIGHT have been increased if the hypothetical midwife thought to call an ambulance real quick, vs. stuffing a piece of placenta in the woman’s mouth or yelling at her to stop bleeding.

    I guess all? of the women who were recorded as having PPH in the MANA study survived, but we know that they left out some number of adverse events. Since it was voluntary, I’m sure that if a mom died on some MANA midwife’s watch, she wouldn’t go shouting it from the rooftops. And if the mom dies several days later, maybe from an infection related to the birth, or some other indirect reason, the homebirth community would NEVER hold the midwife responsible for that.

    I’m not saying that homebirth maternal deaths are making much of a dent in the overall rate for the US, but considering the third-world circumstances these women insist on giving birth in, and the fact that many of them are high risk to begin with (GD/T2D, pre-e, VBAC, previous PPH), the US homebirth maternal mortality rate can’t be good.

  8. Guesteleh
    January 5, 2015 at 1:20 pm #

    Amy, I appreciate that you wrote this, but I have a suggestion: is there a woman of color you can invite to write a guest post on this topic? I don’t think you’re off base here at all but I think it’s very important for blacks, Latinas and others to speak for themselves. Otherwise it can come across as whitesplainin’ even though I know that’s not your intention. I know there are black bloggers who are upset with you because they think you’re exploiting their race to advance your agenda with no real recognition or effort to address the issues they’re facing with access to the healthcare system, equal treatment, etc. Anyway, this is a very loaded topic and it needs to be addressed, but always step carefully and recognize that you may have blind spots you’re not aware of.

    • Amy Tuteur, MD
      January 5, 2015 at 1:50 pm #

      I understand your point, but I’m not aware of anyone else who writes about the intersection of pseudoscience and privilege, but even if I were, wouldn’t it be paternalistic of me to approach a writer assuming that if she were black she’d want to write about an issue that I’m interested in merely because she is a black woman?

      • Guesteleh
        January 5, 2015 at 5:11 pm #

        But there must be black women who are also speaking about this issue? I know there are many black women who are critical of mainstream feminism for focusing on the needs of a small group of privileged white women and ignoring the needs of poor women and women of color. And also black women writing about the crisis in black maternal deaths and prematurity rates. Though I will concede some women might feel condescended to if they are invited to guest post.

      • fiftyfifty1
        January 5, 2015 at 8:02 pm #

        Ah, the intersection of privilege and pseudoscience. ..I don’t think that the privileged have more woo than the non-privileged, it’s just that the woo of the privileged is more privileged than the woo of the non-privileged. That is, one of the privileges of being privileged is that your nonsense always gets *taken seriously*. I think about anti-vax, NCB, healing touch,homeopathy etc. If white people like it, it gets taken seriously, even to the point where many Universities/med schools have CAM departments. White people even have the privilege of giving their white seal of approval to certain non-white woos (e.g. TCM) and then these will be taken seriously and disseminated also. But the woo that isn’t white or white approved/appropriated doesn’t get taken seriously. It doesn’t even get considered something as fancy as “pseudoscience”, it’s just called stupid ignorant nonsense. You don’t see Med school CAM departments lecturing on the wisdom of using Vick’s Vapor Rub for [insert any ailment here] or writing a grant to get funding to study drinking pickle juice for CHF exacerbations, because it’s poor Latinos and AA’s who endorse those beliefs.

        • SporkParade
          January 6, 2015 at 2:45 am #

          Hmm, yes and no. There is this weird irony where white people prefer non-white woo these days. When my Eastern European great-grandmother did cupping, it was primitive. When Chinese people do cupping, it is legitimate (I guess because Asian people are magical?). Also, c.f. that Mexican cloth thing for late pregnancy/labor.

          • Dr Kitty
            January 6, 2015 at 5:57 am #

            The only Irish woo I’m familiar with involves wearing holy medals, Traveller ladies who have “the touch”, a general belief that some form of alcoholic beverage will cure whatever ails you, rubbing warts with potatoes before burying them in the garden in moonlight, flat 7-Up will cure all gastrointestinal ills and sudocrem cures all skin complaints, and that nettle soup is good for the blood.

            I’m pretty sure that hipsters have absolutely no interest in any of that apart from the nettle soup.

          • Mishimoo
            January 6, 2015 at 6:56 am #

            I had stomach bugs so often as a child that I can’t drink 7-Up as an adult, hot tea instead of alcohol, and it was zinc + castor oil cream that ‘fixed’ every skin issue.

          • Dr Kitty
            January 6, 2015 at 10:59 am #

            Yup, zinc and castor oil cream goes by the brand name Sudocrem here. My patients will put it on ANYTHING- cuts, burns, rashes, bruises, funny looking moles, athlete’s foot- you name it!

            “I’m sorry for wasting your time doc, but I got worried when the Sudocrem didn’t clear it up” is a fairly common opening gambit.

          • Mishimoo
            January 6, 2015 at 5:56 pm #

            I found that out when I looked it up, and had a bit of a laugh because we do have sudocrem but I’ve always heard that it doesn’t work as well as the generic.

            Hydrogen Peroxide 3% seems to be replacing it as a cure-all now.

          • SporkParade
            January 7, 2015 at 2:09 am #

            Hey, the flat 7-Up trick works. Also, my doula recommended I drink nettle tea to reduce water retention and hopefully bring down the weight estimate of the fetus so that I wouldn’t be automatically signed up for a C-section. (I didn’t take the advice, having decided that shoulder dystocia is infinitely scarier than C-sections.)

      • sdsures
        January 10, 2015 at 4:22 pm #

        You’d probably get criticised no matter which decision you made.

    • lawyer jane
      January 5, 2015 at 2:09 pm #

      this is a hard issue because there are plenty women of color who are also into NCB or otherwise crunching. And arguably, some crunchiness (such as breastfeeding benefits for infant health) theoretically stands to benefit POC more than white people. And while home birth is not the safest alternative on average (for all the reasons people who follow this blog know well), I find it entirely possible that a high-touch, well-trained homebirth care MIGHT produce better outcomes for women of color, who otherwise get crappy care. But the irony is, why should women of color forgo modern medical care just to get good medical care? Anyway, . I think what’s important to remember is that women of color might see NCB as an alternative to a system that is not serving them, and in some cases they may be right.

      As for the issue of privilege and speaking for others – I think that it’s right for Dr Amy to call out the white privilege (and Western privilege) of obsessing over “interventions” while our brothers and sisters suffer here and across the world for lack of basic care.

      • Amy Tuteur, MD
        January 5, 2015 at 2:35 pm #

        In addition, I don’t see myself speaking to or for women of color in this post. I’m a white woman calling out another white woman specifically for using the issue of American maternal mortality, which disproportionately affects black women, to advance the agenda of a small group of privileged white women.

        • Guesteleh
          January 5, 2015 at 5:13 pm #

          Point taken. But I think of someone like Dreah Louis and how she’s been treated by the white homebirth community. It’s a terrible thing and I give her a lot of credit for speaking out about it.

        • staceyjw
          January 6, 2015 at 6:59 pm #

          This is the job of (a white) ally- to educate others (whites) about the privilege we have and how that effects others. We should not expect for the oppressed to educate us.

        • S
          January 7, 2015 at 11:55 am #

          I have to say, i really appreciate the nuance with which you’re discussing racial topics these days.

      • The Computer Ate My Nym
        January 6, 2015 at 8:57 am #

        Hispanic women who breast feed have an increased risk of triple negative breast cancer, the hardest to treat and most deadly form of breast cancer. The initial studies showing that breast cancer went down with breast feeding were all in, you guessed it, non-Hispanic white women.

        • Roadstergal
          January 6, 2015 at 6:08 pm #

          Can you post the link? I’m interested in that study.

    • Neya
      January 5, 2015 at 9:52 pm #

      When I was in grad school, I got plenty of “pre-conceptual counseling” – or reasons why I should NOT be getting pregnant – from my GP. I was married, in my mid-twenties, extremely healthy, with a BMI of 19, running marathons, doing martial arts, and getting a PhD in engineering. In fact, my main reason to go to a doctor were martial arts injuries. Still, my hispanic last name seemed to my doctor carte blanche to assume that I was going to accidentally get pregnant and that he needed to insist on me staying on birth control. It was frustrating. I can see how that kind of experience could turn some people away from medical professionals, if they have nothing to use for comparison. I am very fortunate to have many relatives who are doctors and to have had the opportunity of seeing them at work. But, I can tell you that being hispanic sure puts you at risk for doctors to do your family planning!

      • RKD314
        January 7, 2015 at 9:57 am #

        Wow. I am just dying to know, did you ever tell that doctor off?

    • Brixguest
      January 5, 2015 at 11:56 pm #

      I appreciate when white people explain white privilege to other white people. Some people are really resistant to hearing it from a brown person. I just had to unfriend someone because of her insistence that it doesn’t exist and her subsequent attempt to justify trivializing the deaths by lynching in this country’s history (a whole nother story). I have always been middle class so I’m not really familiar with the prenatal and birth healthcare challenges of low income minorities in this country. But I know about privilege and racism. Income does not guard you against those.

  9. Karen in SC
    January 5, 2015 at 12:45 pm #

    Generally, when you look at those global statistics around maternal (and neonatal and even infant) mortality, you see that that countries that rank above the US are countries with socialized medicine.

  10. Dr Kitty
    January 5, 2015 at 12:30 pm #

    I read the most recent MBRRACE report on maternal mortality today. Sobering stuff.

    MBRRACE has concluded that since 11% of maternal deaths were caused by flu and almost 25% by sepsis, priorities for reducing maternal mortality are ensuring universal uptake of flu vaccination in pregnancy, and training staff in the early recognition and treatment of sepsis.

    The UK has halved direct maternal mortality in the last 10 years, while indirect mortality hasn’t fallen.

    The issue isn’t so much healthy women dying from pregnancy related causes, but sick women who get pregnant and worsen because of the extra stress pregnancy puts on their bodies and psyches.

    • Sarah
      January 5, 2015 at 1:13 pm #

      It’s great news that we’ve halved direct mortality, though?

  11. Young CC Prof
    January 5, 2015 at 11:40 am #

    This was my recent forehead-slapper moment about white privilege.

    I was listening to a (childless middle-aged) man try to give a lecture about the supposed evolutionary basis of gender differences, and he sounded completely clueless. It wasn’t that he was sexist, in fact he was clearly in favor of equal rights. He just didn’t seem to realize that, when women made different choices than men (on average), it might be because they were responding to different needs, circumstances and experiences, rather than because they had different biological drives.

    The practical needs of women were invisible to him, simply because it had never occurred to him to ask whether they were different from his own.

    And then I switched a few words around in that thought, and said, “OH!”

    • MaineJen
      January 5, 2015 at 10:10 pm #

      Mine was when I got pulled over for speeding on the way home from work one night. In true comedy-of-errors style, my driver’s side window refused to go down (old car, cold night), so I had to crack the door open and laughingly apologize to the officer that my window wouldn’t open. I then spent a few minutes digging in my purse for my license and in my glove box for my registration.

      …I’m not the most organized person.

      He laughed with me, reminded me of the speed limit in town and let me go with a warning.

      Thinking back on Ferguson and all of the recent demonstrations regarding our police forces’ differential treatment of black vs white, I found myself thinking about how much SCARIER that encounter would have been, were I a black man. What would have happened when I opened the car door?

      I get it.

      • Life Tip
        January 6, 2015 at 12:24 am #

        Not quite as scary but similarly, I was recently at a store with my young daughter and I gave her something to hold while we were in line. She got tired of holding it so she stuck it in my bag. I didn’t even notice. As I went up to pay, the woman behind me very nicely told me that she thought my daughter might have put something in my bag. Both the women working the register and the woman in line were laughing, saying my daughter was cute, “kids do the darnest things”, etc. There seemed to be no suspicion whatsoever that I might have intended to steal anything. If I was a young woman of color with young children, would the situation be the same?

        My first roommate in college was not white. I remember going to a rather expensive clothes store in the mall with her for the first time and the saleswoman at the store watched us like a hawk, followed us around and acted like we were wasting her time by opening a fitting room. That had never happened to me before and it was so eye-opening.

      • namaste863
        January 6, 2015 at 12:56 am #

        Errrrrr, I see your point, and this very thought has occurred to me on more than one occasion. Take, for example, the young football player at UNC who crashed his car, started knocking on doors to phone for help, and was then shot dead by the police in a dreadful misunderstanding. Being a 5’0 blonde, blue eyed female, I know I am far less likely to be faced with this (And let’s be honest- short skirts and crying helps

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