Radical Doula

This is a post that I wrote for Feministing a few weeks ago. I wanted to cross-post it here because this issue, of kids born with intersex conditions, definitely comes up for birth workers. While you may not have had this experience yet, it’s possible that one day you will be with a family when their child is born with an intersex condition. This could lead to all sorts of responses from the midwives or doctors you are working with–including the decision to perform surgeries on the infant.

It’s a huge issue, and one that is difficult to tackle in a blog post. But it’s one that I would like to keep writing about. Just as I talk about gender and the ways folks identify outside of the binary of male and female, there is also the biological fact of gender diversity, exemplified by folks who are born with intersex conditions.

At the moment of birth, when the doctor/midwife/practitioner wants to issue the hallmark phrase–“It’s a boy/girl!” if there is any confusion around this, it becomes a huge issue.

Maybe it shouldn’t be–and maybe one day we’ll move away from such a strong propensity toward gender categorization. In the meantime, we’re dealing with doctors who would rather employ experimental hormonal treatments in utero and perform radical medically unnecessary surgeries on infants than deal with gender ambiguity.

Obviously I have a strong opinion on the matter. The post below has more info, if you’re confused about what I’m saying.

This issue has been getting some major press lately (Courtney mentioned it the What We Missed yesterday) but in my opinion it’s being misreported.

Time has a good breakdown of the experimental treatment we’re talking about:

The early prenatal use of dexamethasone, or dex, has been shown to prevent some of the symptoms of CAH in girls, namely ambiguous genitalia. Because the condition causes overproduction of male hormones in the womb, girls who are affected tend to have genitals that look more male than female, though internal sex organs are normal. (In boys, in contrast, the condition leads to early signs of puberty, such as deep voice, body hair and enlarged penis by age 2 or 3.) But while the prenatal treatment may address girls’ physical symptoms, it does not prevent the underlying, medical condition, which in some severe cases can be life-threatening, nor does it preclude the need for medication throughout life.

Basically, this drug dex is being given to mothers while pregnant who have an increased risk of giving birth to a child with CAH, an intersex condition that affects the hormone levels in the body, and can produce ambiguous looking genitalia.

This story is being talked about as a treatment to prevent lesbianism. It’s not. It’s a treatment to try and alter the genitals of babies with an intersex condition to make them seem more normative.

First, some intersex 101. There are many conditions which fall under the intersex umbrella, and can result in a person having any number of conditions that might get them defined as intersex. These things could affect the way their genitalia look, how their hormone levels are, what their chromosomes look like, what their fertility is like.

Let’s get even more 101 for a second. Our gender and sex divisions are an ever shifting set of categories and definitions. We don’t have a good rubric that says this is what a girl is, and this is what a boy is, despite the fact that we plan our entire society around this division. Why? Because it isn’t that black and white. Not all people we call women have two X chromosomes. Not all men have an XY. Same thing for hormone levels, fertility, genitalia, secondary sex characteristics. In reality, our bodies are extremely diverse.

Intersex conditions are actually really common: 1 in 1500 people in the United States is born with one (Reporting on this is not very good, nor is tracking. This is a conservative estimate). The medical communities response to these folks has been to try and alter their bodies to fit the social norms–assigning them a gender identity (based on absurd rules I won’t even get into) and then doing all sorts of things to babies to make them fit this norm. We’re talking genital surgeries that eliminate the possibility of sexual pleasure, as well as all the other complications that come with these types of surgeries on children.

There are all sorts of resources about intersex conditions, these surgeries and the movement to fight back against them. The Intersex Society of North America is one place to start.

The doctor’s involved in these treatments are making the link between gender and sexuality–they are also talking about the affects this treatment has on the likelihood of the person to get married, have kids, etc. But at it’s core, this is not about sexuality folks, or lesbianism. It’s about trying to use medicine to make everyone’s bodies fit into one box or the other, male or female, with really narrow ideas of what each box can look like.

This is about using a treatment that is untested, likely to be harmful and has no medical benefit. The only benefit, argued below, is that the child might not have to undergo surgeries. Surgeries which are not medically indicated to begin with, but instead are used to mask the natural gender diversity that exists in our bodies. These surgeries are a way to alter the person, rather than have them deal with a society which falsely believes that the gender binary is a bright line. Or rather, have their parents deal with it as children.

The Time article continues:

Meanwhile, the possible benefits are clear: the treatment can spare young girls the potential psychosocial problems associated with having ambiguous genitalia as well as the ordeal of surgery to correct deformities later. “I see potential for benefits and I don’t see evidence there’s any negatives to this. There are lots of risks associated with surgery, and if this can prevent surgery, then it’s a good thing,” says Dr. Ingrid Holm, a pediatric endocrinologist at Children’s Hospital in Boston.Research has also suggested that affected women who were treated with dex in the womb show more typical gender behavior than other women with CAH; the latter group tends to behave more tomboyishly and express little interest in having children. New told the Wall Street Journal in 2009 that the treatment further spares parents the “terrifying prospect” of not knowing whether their newborn is a boy or a girl.

The Doctor quoted here is leaving out one huge option–leaving kids genitalia alone, whatever it looks like. Most of these folks have functioning parts, meaning they can go to the bathroom and even orgasm. These surgeries are really about conforming these kids to societies standards–dealing with the anxiety of living in a falsely gender binaried world. Parents are often told to never tell their kids about their condition–many only find out through medical records when they are adults.

Intersex activists are fighting to stop the practice of genital surgeries on babies, instead arguing that these procedures should be held off until the child is old enough to decide for themselves what they want for their bodies and their identities.

This is just further evidence that our falsely binary idea of gender is hurting us–it’s even leading us to treat fetuses with experimental drugs.

Cross-posted at Feministing.com