Navigating the Complexities of Giving Birth as a Poor Person in America

Throughout American history, poor women faced significant challenges in accessing safe and affordable childbirth. Before the advent of modern medical facilities and obstetricians, midwives and community support played a crucial role. However, with the high mortality rates among pregnant women and infants, the medical establishment transformed childbirth into a business, charging substantial fees for "emergency services."

Pre-Modern and Community-Based Childbirth

Traditionally, midwives and community women were the primary caregivers for pregnant women. Their roles extended beyond mere physical assistance; they were also seen as essential members of the community, performing their duties as a "Christian duty." These midwives provided local support and care for pregnant women, often charging a fee in exchange for their services.

Without access to modern medical facilities, complications during childbirth could be life-threatening. For many poor women, the options were to attempt a home birth with the support of community midwives or government-sponsored care, or face the risks of complications and potential death.

The Evolution of Modern Healthcare

The establishment of hospitals and the advent of obstetricians marked a significant change. The higher mortality rates under midwife systems necessitated a shift towards trained medical professionals who utilized forceps and other medical interventions. This transition paved the way for a commercial healthcare system, where specialized medical services were provided with substantial fees.

However, even with modern medical facilities, the financial burden of childbirth remains a significant challenge for poor individuals. High medical bills can deter people from seeking necessary care or can result in financial strain.

The Personal Struggle: A Case Study

For many families, managing the financial aspects of childbirth is a daunting task. One case in point involves a mother whose fifth child was born prematurely, resulting in an extended stay in the neonatal intensive care unit (NICU). The associated costs were overwhelming, prompting her to return to work immediately after her hospital discharge.

After years of saving small amounts each month, a family managed to gather sufficient funds to cover the expenses. However, the experience highlights the difficulty of affording childbirth, even with efforts to save and budget.

Employment and Insurance Benefits

For some fortunate individuals, employment can provide access to healthcare benefits. For instance, some corporate employers, like Petco, allowed former employees to retain health insurance benefits temporarily during the birth of a child. The case of a woman who was terminated from her job due to a high-risk pregnancy but retained insurance coverage until her son's birth underscores the complexities of employment and insurance policies.

Wedding and union arrangements have also become a means for some individuals to gain better insurance coverage. In one instance, a woman married her boyfriend to gain access to his union laborers' insurance, which proved to be highly beneficial. The combination of her former employer's insurance and her new partner's union insurance meant no out-of-pocket expenses for the birth and subsequent medical treatments, including consultations with two perinatologists, an OBGYN, and epidurals in a private room.

Laws and Policies Affecting Childbirth

Legal arguments often arise around the termination of pregnant employees. Many argue that it is legally permissible to terminate an employee for extended absences, citing policy exceptions for FMLA and state-specific regulations. In Missouri, for instance, pregnancy is not considered a disability or an illness protected by FMLA. Thus, employers are legally within their rights to terminate employees for extended periods, provided they follow company policies.

Government Support and Medicaid

Government programs such as Medicaid play a crucial role in providing healthcare to low-income families. In the case of the woman who lost her job, despite legal barriers, Medicaid covered her son's healthcare needs for many years. While private insurance through employment was chosen initially, the state's refusal to enforce child support meant that Medicaid bore the financial burden for the child's medical care.

The complexities of accessing affordable and safe childbirth are multifaceted, involving legal, financial, and social dynamics. Addressing these challenges requires a comprehensive approach that considers both individual circumstances and systemic changes in healthcare policy.