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ChAPTER 2 Failing to See the Danger Conceptions of Pregnancy and Care Practices among Mexican Immigrant Women in New York City Alyshia Gálvez Rosa migrated from Puebla’s state capital three years before becoming pregnant and seeking prenatal care at Manhattan Hospital.1 I asked her if she planned to have anesthesia during labor and delivery. While her husband massaged her back, she told me she did not. Alyshia: ¿Y anestesia por qué no quiere? Rosa: No sé, me gustaría sentir a mi bebé. Pienso que para eso se arriesga uno a tener bebes. Si no, ¿qué . . . qué chiste? [Alyshia: And why don’t you want anesthesia? Rosa: I don’t know, I’d like to feel my baby. I think that is the reason that one risks having babies. If not, what is the point?] In New York City, babies born to native Mexican women have lower rates of low birth weight and infant mortality than do many other groups, in spite of a greater incidence of the risk factors associated with these problems—a phenomenon known as the “birth weight paradox.” However, as such women continue to live in the United States, this cultural advantage wears off, and birth outcomes begin to resemble those of other similarly situated socioeconomic groups. Based on an ethnographic study involving just over one hundred women in a public prenatal clinic at Manhattan Hospital as well as sites outside of institutionalized medicine in New York City, and in Oaxaca and Puebla States, Mexico, I argue here that Mexican immigrant women often share a view of pregnancy as something they are well equipped to accomplish successfully, without any special intervention.2 Even while they enthusiastically seek what they view as a modern, technologically advanced model of prenatal care (see Howes-Mischel, this volume; cf. Smith-Oka, this volume ), they demonstrate some immunity to the view commonly held by providers: that pregnancy and childbirth are inherently risky and to be successful require the management of skilled medical personnel and assessment and mediation of risk factors. The rise in unfavorable birth outcomes with longer residence in or nativity in the United States may be not a biological problem but an epistemological one, 37 in which women are slowly convinced of the riskiness of their own reproduction and come to behave in ways that erode their cultural advantage. In the interchange at the start of this chapter, Rosa reveals a view common to the participants in this study. Most women interviewed expressed disinclination toward pain medication during labor, as well as a generally negative view of the use of medications, some fetal diagnostic tests, and routine interventions during pregnancy and delivery. Although providers praise Mexican patients for their purported stoicism and docility during pregnancy and labor, I found that many women I interviewed had pronounced contrary views about some of the protocols of prenatal care and labor and delivery that are routine in contemporary biomedical settings. While many of the women in the study eagerly embraced the prenatal care they received, viewing it as more modern, humane, and advanced than the care they might have been able to access in Mexico, they did not unquestioningly consume prenatal care but actively rejected some central components of it. The patterns evident in the aspects of care that women critiqued and rejected reveal certain commonly held ideas about pregnancy and an agentive approach to health care consumption. As I describe some of the contentions over risk between the biomedical model of care provided in Manhattan’s clinic and the norms and expectations of many Mexican immigrant women, it will become apparent that even while Mexican immigrant women are enthusiastic about accessing what they view as a modern and technologically well-equipped hospital, entrance into this mode of care does not erase their deeply rooted understandings of pregnancy and childbirth as something they were born to successfully accomplish. On the contrary, their epistemologies of pregnancy indicate that they negotiate the care they receive in the hospital under certain suppositions about their own abilities to have a healthy pregnancy and successful labor and delivery. These suppositions may be protective and may partly explain the birth weight paradox. Nonetheless, they complicate the relationship between prenatal care providers who follow a medicalized perinatal script and Mexican immigrant women who have their own ideas about what constitutes a healthy diet, views on chemical pain relief and the consumption of medicines during pregnancy and childbirth, and opinions on cesarean section and other increasingly routine...

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