It has not been a good few months for women’s health, particularly in Texas. Austin NOW has been out there doing what we can. I represented us at the giant headache that was the Women’s Health Program hearing, and THAT’S four hours of my life I’m never getting back. Ugh. The Texas Tribune says “spirited testimony,” I say a bunch of really brave women sharing their personal stories, some brave policy makers speaking the truth, and a bunch of anti-choicers out-and-out lying. For hours. It was a hot mess, y’all.
But! There is some good stuff happening. Not long before the WHP horror show, there was another Health and Human Services Commission hearing about whether Texas Medicaid should cover midwifery and birthing centers in a way that makes that choice tenable (that is to say, should reimburse providers adequately and not burden them with a lot of red tape). As a policy nerd, I say abso-frickin’-lutely. Poor women should have choices in their health care just like everyone else. Midwifery and birth centers are perfectly safe for most women and in fact are the standard in most other places in the world. Midwifery and birthing centers offer a warm, welcoming environment that many women prefer.
And just from a raw numbers perspective, midwifery is a BIG win. Over 60% of the births in Texas are covered by Medicaid at about $13,000 each, including pre- and post-natal care; the same services provided by a midwife cost about $6,000. The budget nerd in me likes that math, y’all. High quality care at half the price? Awesome.
I learned a lot at this hearing. I got to meet some really amazing women – nurses, midwives, doctors, parents. Extra love to all the activists from Mamas of Color Rising, a fantastic local group that does advocacy on these issues. (Check out this great op-ed they got into the Statesman the day of the hearing. Nice job.) I got to hear the personal testimony of so many young mothers of color who said that doctors often made ugly assumptions about them and treated them with disrespect because they were young, poor, and women of color. That’s awful. Unsurprisingly, they felt disinclined to return. That means worse prenatal care for them, if they could find another provider at all, because it is really, really hard to find health care providers that accept Medicaid these days. Considering that the US has embarrassingly bad rates of maternal and infant mortality (we are 50th in the world in maternal survival, and the numbers are staggeringly bad for women of color – seriously, Amnesty International considers us a human rights violator over it), we have got to do more to provide not only competent but respectful prenatal care for all women in the US.
No word yet on the rules changes, but I have to say, I felt so empowered and energized by all these folks who spoke so passionately about women’s health, about race and class and human rights, who were engaged and informed and just incredibly inspiring! Hooray!
I spoke in favor of the rule changes HHSC was considering to make it easier for midwives and birthing centers. My testimony is below the fold.
Hi, my name is Carrie Tilton-Jones, coordinator of the Austin chapter of the National Organization for Women, and I am testifying in favor of genuine Medicaid coverage of midwifery and birth centers. Because I’m a graduate student at the LBJ School of Public Affairs with a specialty in women’s health, I am very familiar with the facts – that midwifery and birthing centers are a safe choice for most women, with outcomes similar to hospitals, that many women find them a more supportive, welcoming choice, and that this kind of care is cost effective. Here in Texas, with about 60% of our births are paid for by Medicaid, we always have a delicate balancing act between smart fiscal choices and offering the best possible care and respect to patients. With hospital births costing over $12,000 and the average birth center birth costing half that, offering Medicaid recipients the choice to labor at birth centers makes excellent fiscal sense.
But that’s not what got me out of bed this morning.
I came here today to share my experience watching my godchild be born under a midwife’s care at a birthing center.
I’m fortunate to have had a best friend for more than 25 years. We’ve known each other since we were 9. Because we both grew up in difficult circumstances, we were frequent roommates in our young life. We think of each other as sisters. She gave birth to all three of her children at the excellent birthing center attached to Baylor Hospital in Dallas. And she was so grateful for the warm, sensitive, capable care she received, she is now studying to be a nurse-midwife herself.
I was there for the birth of Veronica, my goddaughter. I was the fourth person in the world to hold her, after the midwife and her parents. I gave her her first bath, scared half to death and with slightly trembling hands, under the patient supervision of the midwife. I feel a deep bond with Veronica, too deep to articulate, one that I expect will last the rest of our lives. Had Veronica been born in a hospital, I might not have been able to be there. What is unique about midwifery and birthing centers is the family environment they provide – both in terms of the physical comfort of having real beds and couches and in terms of their allowing people not related by blood, and as many people as the mother wants, to attend and support laboring mothers. For those of us who grew up a little on the margins, whose family trees have some broken branches and some grafts, and for people who grew up in foster care, for survivors of domestic violence, the most important people in our lives are probably not those related by blood. Birthing centers honor those connections.
And those chosen family members, that sense of extended family and community, has been vital to my sister’s children. Unfortunately, they lost their father in a car accident earlier this year. And while nothing can fill that hole in their lives, those of us who love them are doing our best to patch it over. And it means the world to me and to Veronica for me to be able to say to her, I was there when you were born, just like your mom and your dad, and I will be here for you until the day I die, just like them.
Thank you for the opportunity to offer my testimony. I encourage HHSC to approve these rule changes and offer choice in birthing options for women on Medicaid.