Tuesday, January 26, 2010

Birth Choices, Social Class, & Othering

For those not familiar with the term, "Othering" or "Otherism" is the process by which societies and groups exclude "Others" whom they want to subordinate or who do not fit into their society. The "Others" can be any group of people separated by polarizing members of that group from another by dividing the two into an "us" or a "them", with the ones doing the excluding and their peers and/or intended audience being "us" and  the group holding different traits or ideas, and who are often used as an abject of hatred, ridicule, or mistrust, being "them". It is typically used to support prejudice, and some of the most visible othering is that based on race, sex, religion, or disability, but it is also used in political and ideological debate, by labeling ones opponents as liberals/conservatives, "hippies", kooks, bigots, etc.

One thing I've found interesting as I've been pregnant and researching various options in childbirth and parenting is the amount of othering used, often by members of one's own social class, to discourage mothers from choosing alternatives. Sometimes, a reverse sort of othering is used to imply that a mother should make a different choice than is traditional in her family or culture, because that's what the dominant culture or the wealthy or upwardly mobile do, and to choose otherwise would mark her as poor, backwards, or otherwise link her with aspects of her culture seen as negative by those in power.

In my own life, most of the othering I've seen has been based on social/economic class and political views. My family is very conservative, so  have been told that I am being a "hippie" or "listing to a bunch of liberal crap", because I want to have a natural birth and follow mostly attachment parenting. The other tactic has been the typical "getting above your raising" argument that poor people use to hold other poor people down - ie, it's more expensive to raise a child naturally, only rich women hire doulas or midwives or consider homebirths, etc. A friend of mine faced the opposite pressure on the same issue - her family is from Mexico, and they saw a hospital birth with an OB as a sign of prosperity and mobility, so her mother was insulted by her choice to birth at home with a midwife, because she thought others would assume she was poor and backwards by not having a hospital birth. Another friend was talked out of childbirth classes or hiring a doula because her husband said it was something only "rich, spoiled, white women do".

The sad fact is that a lot of women who are already "othered" by the kyriarchy are already limited by access to fewer resources and by prejudiced assumptions against them, yet they are subject to even more othering by friends and family who label and criticize the choices that may be available to them. Women who are younger, less educated, members of ethnic or racial minorities, from lower income families, are overweight, or are single are already less likely to attend childbirth education, receive adequate prenatal care, or have health insurance. This means that they must choose a doctor who is covered under the care plan they can get, and are excluded from many private hospitals, birth centers, and midwifery practices. Even if they are aware of the options, many know that they cannot afford what medicare and many insurers will not cover, and if they try they are likely to encounter objections from people who see them as uneducated, ill-informed, or less deserving of complete care because of their background or situation

I realize that there is a huge difference in not being able to make a choice because you have no reasonable access to it [ie, it is available, affordable, and you have support] and because you have an option but are discouraged from taking it. Still, I think that neither problem can really be solved without addressing the other as well. As long as safe, proven options for childbirth are seen as the domain of certain privileged classes, then we will see access limited or denied to those with fewer resources. If more women who can opt for independent childbirth education, natural birth, and care by midwives or with a doula to assist, then we can help make it the "norm". hat commonality will play a big part in getting coverage from insurance companies, and hopefully from medicare and other programs for the uninsured. Getting doctors to be more educated and accepting of less medicalized births will also help those women who must choose from a list of  approved care providers to find someone who may listen to them and not be as dismissive of their concerns.

Finally, we as a community [of women, mothers, or just people] need to be careful to include everyone who wants to be included in advocacy work, and try to provide more access to those without it. It may seem like a small thing, but every little bit helps. We need to find ways to reach out and educate women who may not be online or aware of their options to the choices they have, and also to find ways to make it affordable for them. Midwives and doulas who work with medicaid, charge sliding scales, or volunteer in lower income communities are awesome, but a lot of women don't even know about them because of the perception that they are unaffordable.What I would love to see would be more women from lower income and minority backgrounds able to go to nursing school to be CNMs, or get certified as midwives or doulas, and as childbirth educators, and for more independent childbirth classes to be held in rural and low-income areas, even if it has to be done on a free or reduced fee basis. I'm not sure how to make any of this a reality, but certainly there are people out there who know of something already being done, or some place to start.

I'm not really doing much myself, I'll admit, other than just talking to people. I do know of one local doctor with a CNM who's covered under medicare, and who provides vouchers for a free childbirth class through the hospital, and I've told several people about them. After my son is born, I do plan to get certified as a doula, and as a childbirth educator, and one of the things I am going to try to do myself is hold classes at the community center and talk with WIC/medicare about offering free or reduced services for their pregnant clients. I'm also considering buying some professional grade birth pools [or hospital allows waterbirth, but you must bring your own pools & supplies] and offering rentals, using the income from that to provide them free of charge to the OBs/CNMS with medicare clients who request them.


  1. Very interesting insight into this issue! It's interesting how birth options are seen differently within different families. I wanted a home birth, but we could not afford it so I had the same doula for all three births, in a hospital (which insurance covered). I am a natural childbirth educator as well. My dad and stepmom thought I was crazy for wanting a homebirth... hippie-ish? Funny. Because of my tendency towards a natural parenting philosophy and lifestyle in general, people who don't know me well might assume that I am a "hippie liberal" (why do people generalize), but in reality I am extremely conservative. I just do what I feel is the healthiest and most beneficial for myself, my husband, and my children.

    I found you through SITS!

  2. This is a great post. I found it on SITS, but I'm so glad I did! I'm part of an online community that is supportive of various birth plans. It's from a Christian perspective, so if you're interested, I'd love to have you stop by. Women discuss this stuff ALL of the time, and it is really difficult. Pressure can be immense to choose one way or the other, and you're right that various "cultures" place a lot of stake in the specific decisions you make regarding child birth. Hopefully your husband is supportive and willing to help you out along the way, because that is probably the most important :-)

    Anyways, if you want to stop by, the website is: http://christianfamilyplanning.net
    All the best!

  3. Great post! I am so glad that I found your blog because I feel the same way about a lot of things, especially regarding birth choices in general...

    Stopin' by from SITS!

  4. Stopping by from SITS.
    Interesting post...Hope you'll stop by my blog too!


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