UCLA

This dissertation is a comparative ethnography of the life and worlds of the high-risk pregnancy when wealthy and poor in Los Angeles, California. The study design is a case comparison of high-risk pregnancy and prenatal care at the extreme ends of the socioeconomic hierarchy: my field sites are “the Boutique,” a private high-risk prenatal treatment center catering to upper and upper middle-class clientele, and “the Satellite,” providing a “one-stop shop” for publicly insured pregnant women. The comparison controls for health care provider orientation and training, as a rotating cast of physicians practice at both field sites. I find the biomedical classification of the high-risk pregnancy hangs together through a disparate web of risk for the wealthy and poor, attended through different forms of care delivered across settings. Empirical findings examine the divergent ways risk is constructed or produced in clinic, the differing temporal natures of the high-risk pregnancy for the wealthy and poor, and the unintended consequences of cutting-edge technology within the setting of elite prenatal care. Although the base assumption is that privately purchased care means better care, I uncover a surprising finding—poor women receive comprehensive, holistic care that surpasses the sometimes fragmented and overmedicalized prenatal care wealthy women receive. Yet this better care also has a punitive aspect: poor women do not receive care that respects their privacy and always attends to how the broader socioeconomic landscape, rather than how individual behaviors, influences outcomes. Furthermore, the Satellite represents an island of comprehensive care within a treatment landscape defined by a lack of access and availability to high-risk prenatal care for the publicly insured. This study reveals that socioeconomic stratification produces distinct forms and procedures of the high-risk pregnancy, occupying differing realms of the biological and biomedical, economic, political, and social —and thus make up “two Americas.”