- Learning the Hard Way: Lessons on Gender and Power
I can honestly say that I would not be who I am today if the birth of my first child had not been such a disaster. Every birth story is about transformation; mine is about the transformation from being a reproductive health activist and associating seeking ob/gyn care with agency and autonomy, to recognizing the coercive power of our institutions and the state over those giving birth. But my birth story starts years before I became pregnant, and hasn’t yet ended.
As a young feminist coming into adulthood in Texas at the dawn of the internet age, seeking information about sexual and reproductive health felt transgressive and empowering. After the stigmatizing and frightening abstinence–only sex education, it was exciting to have access to a resource where I could learn about methods of contraception, STIs, and self–care for common complaints. Women who came before me had Our Bodies, Ourselves; I had online forums and DIY websites. I took pride in feeling responsible for my body, and every chance to put my feet in stirrups and ask questions about my health felt like an opportunity to claim adulthood.
Then, I became pregnant.
In the moment, the timing was inopportune, but not unwelcome. Now living in New York with my then–fiancé, I was in my first semester of law school. We got by on a small fellowship stipend and student loans so that I could follow my dream of defending women’s human rights, and their right to sexual and reproductive health. It wasn’t a great time, but it never is.
In my naïve vision, prenatal care and birth would be just like the rest of the reproductive health care I received from a combination of university health services and feminist reproductive health centers. I’d visit conscientious professionals who would explain things to me; I’d do my own research, ask questions, and make decisions that would be respected. This was 2006 and I was used to being uninsured, but I was unprepared for care as a Medicaid recipient.
My options were circumscribed from the beginning. I live in an area with exceptional access to health care providers, but the only place that took Medicaid through my managed care organization was nearly an hour away by bus. Appointments were done by cattle–call, so a 9:00AM meant showing up at 8:30AM to be seen for five minutes at 11:00AM. I often felt dismissed and scolded; my questions were unwelcome. I hated that everyone called me mami. Finally, after being yelled at for not submitting to a test that had never been scheduled or even offered to me, I vowed I wouldn’t let anyone treat me that way again, even if it meant catching my own baby alone.
I cashed in my educational privilege and, through a medical student friend connected to a well–known midwife who had been her college thesis supervisor, I found a homebirth midwife who agreed to accept me as a client late in the second trimester. She was warm and steadfast, with the aspect of a woman who, in a Dickens novel, might be outfitted with a very large ring of keys. She told us about how she came to homebirth midwifery after decades of being an L&D nurse, and reminded me of the people who chose to work in reproductive health clinics in the hostile heart of Texas out of love for helping women make the best choices for them. I had found my match.
I benefitted yet again from the unearned privilege of living in a state where public insurance (ostensibly) covers births regardless of where they take place. The reality of getting approved was much more complicated. I struggled for months with often nonsensical insurance bureaucracy, spending hours at a time on the phone navigating a byzantine process to get approval for a homebirth. [End Page 200] Despite the fact that my midwife was a certified nurse–midwife and already an approved Medicaid provider, case managers and utilization review officers were shockingly uninformed about what a home birth entailed, questioning my...