This was originally an assignment in a midwifery course. I've shared my thoughts here in hopes it helps other birth workers serve all birthing people with dignity and thoughtfulness. To read the original format of the assignment and/or references, click here.
A recurring theme in the Equity and Anti-Oppression course this term is that of the allostatic load carried by underprivileged groups. It is evident from multiple required reading and video sources that stress can have a long-lasting impact on the lives of the gestational parent, the fetus, and the generations that follow. For instance, Thomas et al. (2014), in Section II, identified chronic stress and stress during pregnancy for low-income families as impacting health factors such as obesity, gestational weight gain, and depression. In their study, 80% of the pregnant, low-income participants cited moderate or high stress levels with issues such as financial struggle, housing and job insecurity, relationship conflicts, and anxiety about pregnancy itself contributing to their stress.
The work of D’Anna et al. (2012) from Section II sheds light on another contributor to stress in pregnancy: citizenship status. These researchers studied the unique barriers to perinatal wellness that immigrants, who also commonly identify as low-income people, face in pregnancy. They describe a phenomenon whereby assimilation of Latinx immigrants into mainstream U.S. culture can negatively impact health. Wanting to understand the mechanism behind these findings, D’Anna et al. (2012) tracked hormone levels of pregnant people with Mexican heritage. Not only did the researchers find high cortisol levels in Mexican-Americans compared to white counterparts, they also note that those with higher rates of acculturation had higher rates of cortisol. These folks had higher rates of low-birth weight, preterm birth, and postpartum depression and had lower rates of breastfeeding (D’Anna et al., 2012).
As a future midwife in Southern California, these reports on the Mexican-American experience of pregnancy and birth are of interest because the population will make up a portion of my clientele. As the Race Forward video on Immigration Policy (2015) from Section I points out, the strong focus in America on securing the Southern border is guided by policies of ignorance and systemic racism; these polices have far-reaching implications beyond simply matters of residence. Since D’Anna et al. (2012) provided insight into how stress impacts this population’s outcomes, I was interested to learn what work is being done to combat the effects of immigration-specific stressors to improve health outcomes for Mexican-Americans. I chose low-birth-weight and neonatal mortality in the first year of life as the perinatal health markers because I have direct experience with these specific outcomes at or following birth in my role as a doula supporting undocumented Mexican families.
Perhaps one of the most critical contributors to stress during pregnancy is being without access to medical care. Healthcare coverage issues are tied to both the financial struggle and the anxiety about pregnancy itself that Thomas et al. (2014) identified as being major enablers of stress for low-income families. Researchers Swartz, Hainmueller, Lawrence, and Rodriguez (2017) set out to examine how having healthcare coverage during pregnancy can impact morbidity and mortality outcomes for Mexican immigrants. These researchers cite various reports that identify a link between a lack of prenatal care and higher incidences of low-birth-weight and neonatal mortality. This is important from a humanistic perspective as well as a socio-economic perspective. As the authors of this study note, babies of Mexican immigrants are U.S. citizens because they are born on U.S. soil; their lifelong health and the costs associated are greatly impacted by the access to and quality of the prenatal care their gestational parents receive (Swartz et al., 2017).
This study evaluates the differences between Emergency Medicaid and the newly expanded Emergency Medicaid Plus program in Oregon. While both are in place to meet the needs of those who fall into the intersecting identities of both low-income and non-citizen, Emergency Medicaid only covers life threatening and obstetric admissions situations. The expanded Emergency Medicaid Plus includes prenatal visits and postpartum follow-up with a healthcare provider, which means continuous access to preventative care is possible for this population. The results of this study are clear: when access to continuous care was covered, Mexican immigrants had higher rates of preventative healthcare utilization that led to better outcomes in multiple areas for the parent and infant (Swartz et al., 2017).
Though prenatal care is not shown in this study to reduce the rates of low-birth-weight infants, it is positively associated with a decrease in the rates of infants born in the “very low-birth-weight” and “extremely low-birth-weight” categories. Additionally, the rate of infant death within the first year of life was reduced by 1.01 per 1000 live births in this population; this is a reduction greater than that accomplished by the “Back to Sleep” campaign that took place over a period of 30 years (Swartz et al., 2017).
Participants of the study who were covered in the prenatal period also had more well-child visits, more health screenings, and greater utilization of vaccines than their counterparts, despite all children being covered by Medicaid programs. The authors hypothesize that this occurred because parents who consistently interact with healthcare professionals in pregnancy are more likely to remain connected to healthcare systems after birth (Swartz et al., 2017). Considering Hispanic folks are the least likely group to have health insurance in the U.S. yet face some of the greatest environmental health risks (Miller & Garran, 2017) this research by Swartz et al. (2017) bolsters proponents of healthcare and immigration reform policies that would better serve the health interests of Mexican immigrants and the generations of U.S. citizens that follow.
Amanda Cagle is a professional doula, educator, and student midwife located in Orange County, CA who offers comprehensive services to growing families and birth professionals alike. Amanda can be reached via email at email@example.com or through www.yourbirthteam.com.