Natural childbirth, white privilege and denial


It’s no surprise that a privileged, white natural childbirth advocate would deny my claim that white privilege plays a large role in natural childbirth advocacy. I am surprised, however, by the weakness of her denial.

As the title of her piece, The Obstetrician Who Cried “White Privilege”, indicates, history Prof. Lara Freidenfelds considers my claim irresponsible.

In December of 2016, I wrote an essay for Nursing Clio called Nurse-Midwives are With Women, Walking a Middle Path to a Safe and Rewarding Birth. In the piece, I advocated that all women be given the option of delivering with hospital-based nurse-midwives … I only recently, quite belatedly, realized that OB-GYN Amy Tuteur had responded on her blog to my essay. She offered a belittling (and inaccurate) representation of my position on hospital-based nurse-midwifery, specifically invoking the specter of “white privilege.” Why? As far as I can see, it was an attempt to shut me down with highly-charged language that was intended to shame me and alienate those likely to be my allies.

Well, yes, natural childbirth advocates ought to be ashamed that in their privilege they imagine that what all women need is what privileged white women want. For better of for worse, Prof. Freidenfelds is a perfect example of white, pregnancy privilege.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Who wants to be accused of being a privileged white person? Certainly not a privileged white person![/pullquote]

As I’ve written before, pregnancy privilege is defined by 25 attributes:

1. My pregnancy is planned and wanted.
2. I am healthy.
3. I have health insurance.
4. I have a choice of healthcare providers and do not have to rely on a clinic.
5. I can access a hospital that has excellent statistics for neonatal and maternal outcomes.
6. I can be sure that the majority of my caregivers belong to my racial and demographic group.
7. I speak English.
8. I am married or have a reliable long term partner who is available to care for me when needed.
9. I have easy access to and can afford healthy food.
10. I can afford books on pregnancy.
11. I can afford to take childbirth classes.
12. I may have to sacrifice, but if I wish I can afford a doula or midwife.
13. I can hire a birth photographer.
14. I can afford weeks or months of maternity leave from my job.
15. I have easy, reliable access to the internet so I can share information with other pregnant women.
16. I can write well enough to create a birth plan.
17. I am not a victim of domestic violence.
18. I am not addicted to alcohol or drugs.
19. If I have older children, I have family or friends to care for them when needed.
20. I can create a baby registry on the assumption that I and my friends can afford to purchase new baby items.
21. I can afford a breast pump.
22. I have a job that offers both privacy and time to pump without loss of income.
23. I have a spouse or partner who is supportive of breastfeeding.
24. I don’t face a dramatically increased risk of premature birth.
25. I don’t face a dramatically increased risk of maternal death

Freidenfelds can correct me if I’m wrong, but suspect she scores close to if not exactly 25 out of 25 on the pregnancy privilege scale. And, like many beneficiaries of privilege, she’s in denial about her own privileged status.

Why? Acknowledging privilege is embarrassing, especially when you view yourself as speaking from a position of moral superiority.

My primary claim is that privileged, white women imagine that the childbirth experience that they want is what less privileged women need. I’ve analogized this in the past to sending sterling silver flatware to people dying of starvation.

To the extent that Prof. Freidenfelds engages with this claim, she deliberately misrepresents it (or, perhaps, misunderstands it).

Tuteur claims that nurse-midwifery could only possibly be appealing to middle-class white women such as myself, who she believes are inordinately attached to the idea that women might value a low-intervention birth experience, and therefore, when I advocate that nurse-midwives be available to all pregnant and birthing women who want them, I am cluelessly advocating from a position of white privilege. (my emphasis)

But that’s not my argument at all. I’m not talking about what is or is not appealing. I claim that nurse-midwifery is only appropriate for low risk women.

To use my sterling silver analogy, I would never say that fine flatware could only possibly be appealing to privileged, white women. Who wouldn’t want sterling silver flatware if they had plenty of everything else in their lives? But it is worse than meaningless for people who don’t have enough food to eat. Recommending midwives (specialists in low risk pregnancy and birth) to women who suffer inordinately from high risk conditions and complications is also worse than meaningless.

Freidenfelds also misrepresents my position on the safety of nurse midwives:

Tuteur will never accept evidence that any form of midwifery is safe. She is completely committed, at least publicly, to advocating for OB-GYNs at every birth, and no evidence of nurse-midwifery’s safety will ever be enough for her. That means that, at least as long as the evidence available to me supports the safety of nurse-midwife care for low-risk women, we will have to agree to disagree about the role of nurse-midwives.

That’s a bald faced lie. I’ve written more times than I can count that I always worked with certified nurse midwives, found them to be excellent practitioners and that the scientific evidence shows that they have a great safety record for low risk women. But by definition they can’t care for the most high risk women who are disproportionately African American, suffering from pre-existing medical problems and severe pregnancy complications. For example, the leading cause of maternal death in this country is cardiac disease. What, exactly, can midwives do to prevent cardiac deaths? Absolutely nothing.

That’s not the only thing that Freidenfelds refused to address.


The racist, sexist origins of natural childbirth advocacy.
The biological essentialism at the heart of natural childbirth advocacy.
The remarkable elitism of the movement that has only token representation of women of color and poor women.

Freidenfelds has nothing to say. She doesn’t deny any of that since it is all true; she simply ignores it.

How about the questions I ask in my piece?

What distinguishes midwifery from obstetrics? Is it truly a difference in outlook or merely midwives clawing for market share?
Should women be reduced to their reproductive organs and does reproduction mean the same thing to every woman?
Are midwives with all women or just privileged white women?

Freidenfelds doesn’t bother to answer these questions. As I noted in my original essay:

Natural childbirth advocates are overwhelmingly Western, white, and well off. Certified nurse midwives are overwhelmingly Western, white and well off. I find it quite shocking that in a country that struggles with high black perinatal mortality and high black maternal mortality, Freidenfelds doesn’t even bother to give lip service to the many women of color, women of other nationalities, and women with pre-existing medical conditions and pregnancy complications whose have no interest in and cannot be helped in any way by the philosophy of natural childbirth.

It’s almost as if these non-privileged women do not exist.

Freidenfelds writes:

As I explained in the essay, nurse-midwifery was originally developed to serve lower-income women who could not afford physicians’ fees. Midwives continue to disproportionately serve low-income rural and inner-city women, many of whom have difficulty accessing care otherwise.

And as I explained, that’s not true. While some nurse midwives prior to 1970 cared for poor women, they represented only a few hundred providers. Since then the number of nurse midwives has grown exponentially (now approximately 12,000) and there is no evidence they disproportionately serve poor women.

According to CDC Wonder, in 2016 African American women represented 16% of births attended by doctors and 13.5% of midwife attended births. CDC Wonder does not collect income statistics but it does collected statistics on maternal education. Women with a high school degree or less represent 40% of births attended by doctors and 37% of midwife attended births. In other words, midwives are LESS likely than doctors to attend births of African American women or poor rural/inner city women.



Freidenfelds concludes:

I do not accept Tuteur’s mis-use of the critical terminology of “white privilege.” Specious arguments based on claims about white privilege are pernicious because they weaken and discredit the concept.

I understand; who wants to be accused of being a privileged white person? Certainly not a privileged white person like Freidenfelds. She ought to present actual arguments debunking my claims instead of misrepresenting them or ignoring them. The fact that Freidenfelds cannot suggests she ought to check her privilege.