Pregnancy After Transitioning Study

I’ve written before about the increase in information, resources and stories about trans pregnancy. While we know a lot more now than just a few years ago because trans folks having babies are getting together to share info, there is still a lot to learn about the experience. 

A provider who is queer, doula and midwife friendly asked me to share this call for participates in a survey about transmasculine pregnancy experiences. If you’re interested in participating, see below. 

Pregnancy After Transitioning Study (PATS)

PATS Anonymous Survey – Online Information Sheet

We are doing a pilot study about transgender men’s’ experiences with pregnancy.  This study aims to better understand how to best assist female-to-male transgender individuals who may want to become pregnant as well as how to counsel about pregnancy and possible birth outcomes. The data collected in this initial unfunded pilot study will offer some guidance to transgender men, and their healthcare providers, who are pregnant or interested in becoming pregnant.  The results from this study will support and guide the development of future outcome-oriented clinical research in this area of intense growing interest and importance

This study is an anonymous online survey of people who identify as transgender men (assigned female at birth with a transmasculine/ transmale/ female-to-male gender identity) and have been pregnant and delivered a baby.  If you self-identify with this population, then we would like to invite you to participate in this study.

If you choose to be in the study, you will complete a survey. This survey will help us learn more about transgender men (assigned female at birth with a transmasculine/transmale/female-to-male gender identity) who have been pregnant and completed the pregnancy.  The survey will take about 20 minutes to complete.  The questions will relate to your experience with fertility, conception, pregnancy, and birth.   To be eligible for the study you must be over 18 years old and have completed a pregnancy within the past 10 years.  You can skip questions that you do not want to answer or stop the survey at any time. The survey is anonymous, and no one will be able to link your answers back to you. Please do not include your name or other information that could be used to identify you in the survey responses.

All study results will be made available to the community through the Center of Excellence for Transgender Health at the University of California, San Francisco. The mission of the Center of Excellence for Transgender Health is to increase access to comprehensive, effective, and affirming health care services for trans and gender-variant communities.  More information can be found at http://transhealth.ucsf.edu

Questions? Please contact the study coordinator Lexi Light (415-206-6453LightA@obgyn.ucsf.edu).  If you have questions or concerns about your rights as a research participant, you can call the UCSF Committee on Human Research at 415-476-1814.

Being in this study is optional. If you want to participate, click this link to start the survey: http://bit.ly/PATStudy

Additionally, the researchers at the Center of Excellence for Transgender Health (CoE) at UCSF are doing research that is designed to lead to better programs for transgender people. They want to know if you wish to learn more about their research studies or if you may wish to participate in any of the studies that may be appropriate for you. By clicking this second link & filling in your contact information, you will allow qualified professional people on the staff of the CoE to contact you in the future to ask if you want to participate in any studies.  You will be entering your contact information into a different survey, completely separated from the above anonymous survey.  You have no obligation to actually participate in any study.

By providing your information, if a study on transgender people needs subjects, you may be contacted to ask if you want to participate. You do not have to participate. You may withdraw permission to be contacted at any time by contacting the CoE.  If you do not provide your information, there will be no penalty or loss of benefits to which you are otherwise entitled. 

Participation in research may involve some loss of privacy. However, your contact information will be handled as confidentially as possible. Access will be limited to the data manager and the researcher organizing the study and will require a password. No information will be used for research without additional permission. Your contact information will not be shared with anyone outside the CoE.

There will be no cost or payment to you if you sign this form.   If you have questions now or later, you can talk with the study researcher about any questions, concerns or complaints you have about this study.  Contact the study researcher(s) Dr. Jae Sevelius at 415-597-9183.

If you wish to ask questions about the study or your rights as a research participant to someone other than the researchers or if you wish to voice any problems or concerns you may have about the study, please call the Office of the Committee on Human Research at 415-476-1814  

If you agree to be contacted in the future, please indicate your preferred contact information on the following form https://redcap.ucsfopenresearch.org/surveys/?s=sHwkt3

 

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Review: What Makes a Baby

What Makes a Baby Book Trailer from Cory Silverberg on Vimeo.

A few months back I got a lovely email from Cory Silverberg telling me about a new book that he authored: What Makes a Baby. After a very delayed email exchange (I’ll admit I am often sloooowwww to respond) I received a copy of this lovely book in the mail.

The promises made in the trailer above definitely deliver. It’s an amazing specific yet unspecific story that helps tell the tale of where babies come from—all the modern and queer possibilities included. It does an incredible job of being inclusive of all genders and bodies. It also tells a birth story that includes the possibilities of a c-section and a vaginal birth, of midwives and doctors.

I’m not an expert on kids books, or what works when teaching kids about sensitive subjects like this one, but I’m happy to have this on my shelf for future use with family and friends.

The book is now available for purchase. A readers guide and more are available here.

ACOG says labor should begin naturally—When will medical practice change?

In my latest column at RH Reality Check I talk about new guidelines issued by ACOG regarding scheduled c-sections. They were addressing the practice of scheduled c-sections that have been producing pre-term deliveries, with a particular push-back on the  reasoning of a baby being too large to be born vaginally.

For those of us who’ve been tuned into the maternity care debate, these kinds of change of practice or philosophy from a group like ACOG seem like a huge turn around. So huge, that at first I thought the whole thing was a hoax.

But, thankfully, it’s not. ACOG is actually urging providers to “let nature take it’s course.” Similarly, they just released new findings regarding the impact (potentially negative) of pitocin use on newborns.

For those of use who’ve been pushing back against rising c-section rates and pitocin use for a long time, this is a victory. But the challenge remains that history tells us it will likely take a long time for these recommendations to actually influence medical practice. In my column I use the example of episiotomy to illustrate this lag:

Unfortunately, it could take years for these changes to go into effect. Just look at the history of episiotomies. In the 1950s and ’60s, episiotomies, a cut in the perineum (the region between the anus and vagina), were recommended as routine practice during labor. At the time it was believed that an episiotomy was preferable to the natural tearing that is very common during vaginal delivery, and that the straight incision of an episiotomy was easier to repair. A 2012 Huffington Post article outlines this history, and how the practice came to dominate by the 1980s, occurring in more than 60 percent of deliveries.

It was only then that clinical trials were conducted to examine the impacts of episiotomy in comparison to natural tearing, and the results were staggering:

Clinical trials conducted in the ’80s and ’90s found that episiotomy cuts can, in fact, turn into even deeper lacerations during delivery, damaging the area around the rectum. Then, in 2005, a sweeping review published in the Journal of the American Medical Association found no benefits to routine episiotomy. A year later, the American Congress of Obstetricians and Gynecologists issued new guidelines, saying that episiotomy during labor should be restricted because doctors had previously underestimated the risk of bad outcomes later on, such as painful sex and possible incontinence.

Decades after those clinical trials, and seven years after the new ACOG recommendations, it’s unclear exactly how the new recommendations regarding episiotomy are being implemented. In 2005, the year before the ACOG recommendations, a study in the Journal of the American Medical Association (referenced in the Huffington Post article) estimated that 25 to 30 percent of vaginal deliveries still involved episiotomy. The 2010 National Hospital Discharge Survey reported that roughly 320,000 episiotomies were performed in the United States that year.

So this is both good news, and a call to action for all of us. As consumers, advocates and doulas our efforts have contributed to these recommendations, and we must remain vigilant to ensure that they get implemented. We can share these recommendations, coming from the Association tasked with governing Obstetricians, with providers who may be reluctant. And we can keep the pressure on. It’s a long battle, but I’m heartened by these incremental signs of progress.

Read the full column here.

Pro-choice pregnancy and the politics of language

I was inspired to write my latest column for RH Reality Check because of a number of emails I’ve gotten over the years with various questions about the issue of the language we use to talk about pregnancy and it’s impact on pro-choice politics.

From the column:

As a blogger and a doula, I think about this question of language a lot. What language to use when talking with people I’m supporting during their abortions? What about when supporting someone with a miscarriage? Should I use different language in one scenario over the other? How about when I write about these issues? If we call it a baby at only eight weeks, does that compromise our right to access abortion?

For me the answer is no. The reason that abortion is a decision best left to individuals who are pregnant is because it’s a complicated ethical and personal choice that one can only make for themselves. While there may be a lot of science regarding fetal development, when hearts beat and nervous systems are developed, there is no right answer when it comes to when life begins. It’s a question and a choice that every individual person has to grapple with for themselves. The same is true for the language of pregnancy and birth.

I do my best to mirror the language of the people I’m working with. If they call it a baby, I’ll call it a baby. If they call it a pregnancy, or a fetus, or a itty-bitty bundle of joy, I’ll do the same. Nothing about these language choices denotes anything about what choices should be available to pregnant people—it simply denotes how that individual person sees themselves and their pregnancy.

Read the full piece here.

Responding to the home birth debates

My latest column for RH Reality Check is up. With some serious hesitation I decided to respond to the conversation about the safety of home birth started by Michelle Goldberg recently at the Daily Beast. It’s been really challenging to see how polarized these conversations are, how vast the divide is between what feels like two camps: the home birthers (who are assumed to hate hospitals, obstetricians and people who use either) and the hospital birthers (who are assumed to hate midwives, home birth and people who use either). It feels like the potential for debate and rational dialogue is minimized because of this polarization. Maybe I shouldn’t be surprised by any of this. Anyway, my response is excerpted below.

A recent heated dialogue between journalists Michelle Goldberg and Jennifer Block about the safety of home birth has been the latest in a recent media flurry about the rise in home births reported by the CDC in January. A New York Times Magazine profile of Ina May Gaskin, arguably our nation’s most famous home birth midwife, was just one of the most mainstream of the recent articles, and seems to have stirred up much scrutiny of the practice.

I feel compelled to dip my toe into the conversation, if only to try and steer it in a different direction. The source of the back and forth between Goldberg and Block centers on this question: “Is home birth safe?” It’s not a new question; in fact it has been debated since the beginning of obstetrics and hospital birth at the turn of the 20th century.

Unfortunately, though, it’s exactly the wrong question to which to be devoting so much air time. A scant share of all women giving birth in the United States do so at home. Despite the reported 29 percent increase in home births nationally between 2004 and 2009, fewer than one percent of births happen out of hospital. While home birth gets much scrutiny, particularly when wealthy white women are seen as forging a new trend by choosing it, the place where the majority of women give birth in the United States — the hospital — goes largely un-scrutinized.

Hospital births do get a lot of attention in birth activist circles (where I spend significant time, as part of my work at Radical Doula). Midwives and doulas will quickly recite the problems with hospital birth, e.g., why high intervention rates (c-sections, inductions) are bad for mother and baby. But outside of that arena, where it’s arguably most needed, the conversation is stalled.

Here is the reason this matters: we are in the midst of a maternity care crisis. I’ve said it before, but I’ll say it again: our maternity care system is broken. Why? Because our maternal and fetal mortality rates are worse than 40 other countries worldwide, despite the fact that we spend more money than anyone else on maternity care. And where is  almost all that care being delivered? In hospitals.

Read the rest here.

New column: Preparing for the trans baby boom

My latest column for RH Reality Check was published this week. An excerpt:

This shift in attention toward the issues facing trans and gender non-conforming pregnancy is indicative of a bigger shift overall — more and more trans and gender non-conforming people are giving birth. As Pati Garcia, a Los Angeles doula and midwife-in-training put it during our panel: “We’re on the cusp on a trans baby boom.”

Trans health as an overall field is still in its nascency. Our understanding of hormone therapies, gender reassignment surgeries, and much more is still being developed, so it’s no surprise that the field of pregnancy and parenting for trans people is also new and developing.

Within the needs of trans people in pregnancy and birth is the challenge of addressing what seems like an obvious connection: between pregnancy and femaleness. Trans people are often neglected in the arena of pregnancy and birth because of the strongly-held notion that only female-identified people experience pregnancy and birth. While not all trans people, whether they were assigned female at birth or not, can experience pregnancy (because of infertility or hysterectomy), some can and do, prompting the need for our pregnancy and birth providers to accommodate.

It’s not easy, as it’s a process that is intensely gendered. Everything from maternity clothes to the language of health care providers carries the assumption that the pregnant person identifies as female (and often that the other parent identifies as male). Language is an obvious barrier from the get-go: maternal health, pregnant women, all of the language associated with pregnancy and birth is gendered. From body parts to actors, all is coded in a way that would make a pregnant person who is not identified as a female feel uncomfortable.

Read the whole article here.

It was inspired by my panel at the Philadelphia Trans Health Conference, so big props to Pati Garcia (aka Chula Doula), Ryan Pryor, Abigail Fletcher and Lucia Leandro Gimeno, my co-panelists. It was an amazing conversation about trans and gender non-conforming centered midwifery and doula care. And the room was full! I love how many more people are focusing on these intersections, because there is much work to be done.

New column: More on maternity care and race

My second column is up at RHRC, an expansion on my thoughts about the new census numbers and maternal health.

The Center for Medicaid and Medicare Innovation just announced 43 million in funding for new approaches to prenatal care that address the problem of premature births — something that leads to much higher mortality rates, and a host of other complications for newborns. But once again it looks like midwifery will be kept out of this discovery process — the only eligible providers are those who see at least 500 births per year — something that few midwifery practices or birth centers do. These requirements are based on the desire for statistically significant findings, but they might just exclude those who can actually produce the results they are seeking.

It’s hard to imagine that a medical provider who is forced to carry a high volume of clients will be able to provide the care necessary to eliminate race-based health disparities. If Medicaid doesn’t make room for alternative, potentially life-saving maternal health models, we risk endangering the health of generations to come. The challenges are clear, what we require are the innovative solutions. Our nation’s health depends upon it.

I also owe a big thank you to Claudia Booker, who got in touch after I wrote this post, to talk with me about the challenges of making a living as a midwife who serves mostly low-income women of color. Much of our conversation didn’t make it into my column, but it’s an absolutely crucial conversation for us to have: how can midwives make a living and still serve low-income women? Medicaid, only an option in a portion of states, makes it extremely difficult to make a living and stay true to the midwifery model.

Without it, midwives have little chance of reaching women of color, and midwives who want to work exclusively with low-income populations will have to make a living through alternate means. Our providers have to make a living, and if they can’t make a living serving low-income women, we’re screwed.

Thank you Claudia, for pointing out that making midwifery accessible to communities of color also means making the midwifery profession accessible to those who want to serve communities of color. That’s going to require an innovative business model for midwifery.

One thing we talked about was having a diverse clientele–for each midwife to serve clients who can pay the full fees (either through private insurance or out of pocket) and low-income clients via Medicaid or a sliding scale.

The challenge, she said, is racism. Namely that it can be difficult for midwives of color to attract clients who can pay (who are more likely to be white), and these biases make it difficult for all midwives to have a diverse client base. She pointed out that we all want providers who look like us.

I have a lot more to say on the subject. For now, you can read my column, and stay tuned for more.