The Privilege of Avoiding the Beaten Path

A friend of mine from college mentioned as a guess for why there are relatively few birthing options in El Paso considering the size of the city, that it could be due to the poverty of this place. For a metro area of two million, for there to be only two birth centers (one of them a midwifery school, an outstanding, extremely low-cost option) and three midwives who do home births (most of them actually out of New Mexico), those are low numbers. I would expect to find something more similar to the Seattle metro area, which has over half a dozen birth centers, and at least a couple dozen midwives in private practice for home births. The low numbers here are staggering. My friend astutely pointed out that pursuing any of these options requires a pretty serious deviation from the beaten path, and that poor people who have always been poor, are very used to just being, as she accurately put it, "herded through the system". She has one hell of a good point, and it even shed light on a lot that has boggled my mind for years.

In my limited understanding of systems for the poor (I received WIC when Erin was a baby) it is very much "Toe the line; Do this; Now do that; We know what is best for you." If you say, "I think this is better." that idea is completely poo-pooed. Now someone like me, or anyone else who's had a baby whilst otherwise filling the role of a starving college student, can take that sort of thing with a grain of salt, and realize that these people are just going by the book, and using arbitrary guidelines which apply to most people, but if they don't apply to us, it's really not that big a deal to go in a different direction as long as it's substantiated by real facts (or guidance from other reputable sources). For people who are not just temporarily poor, who have always been poor, and even have been poor for generations, it's different. They seem to internalize this concept that they have to do what the system says or something bad will happen. Therefore, they end up herded through the system in a lot of ways that are of far more consequence than being issued the right number of vouchers for milk, cheese, grits, and pinto beans.

Maybe this "poor mentality" along with our city's population's widespread poverty, combine to make the wonderful alternative birthing options we have here, quite underused. It's crazy. Coming from a state like Georgia, where birthing options are so few (homebirth is illegal, and there is only one independent, non-hospital-owned birth center in the entire state. We were lucky enough to live only an hour from it, so Orren could be born there) to come to a state like Texas, where birthing options are limitless from a legal standpoint, it's just weird to find that everyone still thinks doctor, hospital, and all that comes along with it. Nationally, about 1% of women give birth in non-hospital settings each year. In this city, I'd estimate that it's less than .1%. Maybe it's because they don't know that they can.

Another thing that occurs to me is that there seems to be this rich/poor dichotomy when it comes to birthing. Since Texas Medicaid will not pay for scheduled c-sections (how awesome is that?!) the public hospital here in town has roughly a 12% c-section rate, which is pretty close to what the World Health Organization thinks is the true necessary rate. Of course, the public hospital is NAS-TAY, too. It's in a great part of town to go if you want to get shot, and the whole place is dirty and smelly. You don't want to have a baby there. Funny enough, you'll probably come out of it better than you would birthing at any of the private hospitals, most of which have c-section rates hovering right around 40% (is that not staggering?). Taking this into account, if you had a c-section, it means you're well off enough to have insurance. Natural birth, with few interventions if any (because they're stingy about those at the public hospital, too... as they should be) is what the poor do. This may be another local cultural factor for why the options we have legally available to us, are so underused. It's like how a lot of people think breastfeeding and cloth diapering are for poor people, even though celebrities are doing both in droves.

OK, but back to the poor mentality. It explains a lot about why so many military dependents just accept the crappy Army health system's dole, and won't go out and change it. What demographic in the US population is very disproportionately represented in the ranks of our military? The poor, of course. To these wives, the Army's medical system is just another system to get in line for, and when confronted with the option to change it, they wouldn't even know where to begin. Therefore, when someone like me, says, "Hey, I haven't dealt with that BS you're complaining about in years. Go on Standard like me. It's great. I have at least 10x the choices available to me as anyone on Prime has." they RAIL at the possibility, tell me I'm the stupid one.

This also applies to schools. When I sit in the parent pickup line at Erin's school in the afternoons, I've often joked that it's "the big obnoxious SUV show". I'm amid Hummers, Cadillacs, Lexuses, and others, but all the most gas guzzling ones made. My little red Chevy sticks out like a sore thumb (but I'm cool with that. I drive a small car on principle. I can't rationalize consuming enough resources to transport an entire platoon when I have a family of 5 or fewer.) The people who seek out any route aside from the standard public school, seem to tend toward being rather well off, or at least solidly middle class. Remember, the poor are disproportionately represented in the military, so when I say, "If your kid's school is that bad, take them out of it and find a new one!" there's a pretty good shot I'm talking to someone who has never even considered that there is any option accessible to them aside from whatever crappy public school they might be zoned for (and in this city at least 90% of the public schools are total crap) so when they tell me I'm crazy, it's because it really does sound like a crazy idea to them.

Living far from the beaten path is something I've always taken for granted. It's just the way things have always been for me. It is a privilege, though. Only people who have never been poor, at least in the theoretical sense (which has nothing to do with being poor in the financial sense) ever seem to know it's an option. The others, they continue along their well worn path, which is full of potholes and booby-traps that they never see, but the rest of us do, and that path looks just fine to them at the end of the day. It seems sad from where I sit, but it doesn't seem that most of those who are stuck on the beaten path really see it that way. It is an interesting difference in perspective.