I’ve always wanted to have a home birth. For a variety or personal and political reasons, I did not want to subject myself, my partner or my child to the perils of a hospital birth – not unless medically necessary. When choosing a new practitioner in Sacramento, I let my anxiety get the best of me. I searched and googled for an OBGYN practice that had a natural attitude towards pregnancy and birth. I finally came across the perfect practice. Their c-section rates were low, they had an all-woman staff, and they looked like they birthed babies at The Farm while on vacation. Done.
While perusing their website, I noted that they had two offices. One in a tony suburb and another in the city. Again, a perfect match. I could take the bus from work, and minimize my time in a car. I called the number for the city office and excitedly made my first appointment. After a few hours, they called me back and changed my appointment to the suburban office. Confused as to their method, I asked why.
“Well, that’s where our private patients go.”
I made the change resigning myself to the idea of a 25 minute drive to the suburbs, then I sat with their response. “That’s where the private patients go.” I thought I had made a mistake and choose a practice affiliated primarily with an HMO. So, I returned to their website and took a closer look at the insurance companies that they contract with. The list was extensive. Twenty or thirty companies. Nope, that wasn’t it. Embroiled in the trials and tribulations of relocating and starting anew, I marked my calendar with the updated address, and I put the strange comment aside.
On the day of my appointment, I was the first to arrive, yet they were already running 45 minutes late. The doctor didn’t believe me when I told her that I knew that I ovulated on November 14th. She questioned the efficacy of monitoring via ultrasounds, OPKs, and charting. All of them in tandem did not provide enough evidence for her that I did indeed ovulate on the 14th. Evidence-based medicine at its best. She was rough with the speculum, and was not forthcoming with any information on my progress, thus far. She also wasn’t one of the hippie midwives that are featured on the website. She definitely would not deliver babies at The Farm while on vacation. It wasn’t a good fit.
In scheduling my next appointment, I specifically explained why I wanted to have my appointments at the city office. It’s closer, I explained. I don’t have to drive 25 minutes to get there. They looked at me quizzically, and they said it again, “But, we have our private patients come here.”
“By private do you mean the opposite of public? As in your Medicaid patients?” I asked.
“Yes. We have all of our public patients go there and their appointments are scheduled on seven minute increments.”
A bit shocked and incredulous at the blatant discrimination, I put my foot down. “That’s where I want to go. I don’t want to drive to a suburb I would never set foot in otherwise. I don’t give a shit how the person next to me is paying for their care. And, you were 45 minutes late today, so it can’t get much worse.” I walked out with an appointment at the city office.
I probably would have changed caregivers anyway. I want to birth with a midwife, assuming that I don’t risk out. I don’t want to have a hospital birth unless it is medically necessary. I don’t appreciate the attitude and condescension I repeatedly get from OBGYNs. So, I probably would have changed caregivers anyway.
However, something must be said about the way in which this practice goes about providing healthcare. Repeatedly, I was told that they segregate based upon insurance coverage. To be clear, this is discrimination based upon socioeconomic status. In an era with a widening chasm of income inequality, segregating and providing a different quality of care for low-income women is not the answer. I recently finished reading Origins where the author neatly outlines an enormous body of scientific literature regarding the prenatal environment and its lifelong effects on individuals. As you can guess, low-income women need quality care to ensure their children are provided with a prenatal environment that will give them building blocks for a healthy life, not the converse. Additionally, the US maternal mortality rate has doubled in the past 25 years, and the rate for African-American women is three times that of white women. We are ranked 50th in the world in maternal mortality despite spending more on maternal healthcare than any other nation.
So, when faced with the prospect of receiving care from a practice that would find it acceptable to segregate by healthcare coverage, I took my baby and ran. When safely ensconced in a comfy chair at my CNM’s office, she casually asked me why I changed practitioners. I explained my aversion to the suburbs, the condescension, and the segregation. She then noted that they require their “public” patients to enter the practice from a separate door. I wish every woman, regardless of socioeconomic status, had the option to run.