gender

New resource: Trans Birth

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This came across my inbox a while back and looks like a great resource for people interested in trans friendly birth providers.

Trans Birth is a directory created to connect trans* and gender non-conforming people and their families to midwives, OBGYNs, and doulas who provide welcoming care to our communities.

A few years back I wrote about what my friend (and midwife-in-training) Chula Doula called the “Trans Baby Boom.” We’re seeing way more resources and conversation about the experience of pregnancy and childbirth for the trans and gender non-conforming. I don’t think it’s a new phenomenon, it’s just one that getting a lot more visibility as the issues facing the trans community get more attention.

Check out the website, and if you are a trans-friendly provider, you can request to be added to the directory.

Pregnancy After Transitioning Study

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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 (415-206-6453, LightA@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

 

American College of Nurse Midwives urges quality care for trans and gender variant people

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Anyone else feel like it really is a tide that is turning these days? The American College of Nurse Midwives issued a statement in support of working towards quality, competent care for trans and gender non-conforming people. Woo-hoo! While it may seem like this is a no-brainer, it’s actually a big step in the right direction for ensuring that trans people can find medical care that doesn’t try to pathologize trans identity, and hopefully someday with providers who understand the needs of trans folks.

From the statement, issued in December of 2012:

It is the position of ACNM that midwives:

  • Exhibit respect for patients with nonconforming gender identities and do not pathologize differences in gender identity or expression;
  • Provide care in a manner that affirms patients’ gender identities and reduces the distress of gender dysphoria or refer to knowledgeable colleagues;
  • Become knowledgeable about the health care needs of transsexual, transgender, and gender nonconforming people, including the benefits and risks of gender affirming treatment options;
  • Match treatment approaches to the specific needs of patients, particularly their goals for gender expression and need for relief from gender dysphoria;
  • Have resources available to support and advocate for patients within their families and communities (schools, workplaces, and other settings).

That all sounds great to me. It’s actually a really fabulous statement, much more comprehensive and far-reaching than the one issued by the American College of Obstetricians and Gynecologists last year. It addresses the need for education about transgender issues in midwifery education, and even the fact that it enumerates the different identities: transgender, transsexual, gender variant, gender non-conforming, is a big step that I haven’t seen many other medical bodies take.

This is my favorite part:

As many as half of gender variant individuals report having to educate their health care providers about their health care needs, but gender variant people do not by default have unique or complicated health issues. Most members of this community require the same primary, mental, and sexual health care that all individuals need. The most important thing all midwives can do to improve the health care outcomes of gender variant individuals is to use their skills to provide care that is welcoming and accessible.

Amen to that. I would say the same thing for doulas.

It’s really incredible to witness the strides being made, while still acknowledging the serious barriers and often really challenging conditions that trans people face in the United States. A longform journalistic article I wrote for Political Research Associates was recently published, and in it I explored a new ad campaign run by the DC government that tries to address discrimination against transgender people by promoting trans respect and awareness. It was a pleasure to interview the many folks involved in working to improve conditions for trans people–it’s clear just how much incredible activism has been happening, primarily led by trans folks themselves. But it was also a reminder of how far we have to go, and how trans and gender variant people face serious discrimination in pretty much every area of life. You can read the article here.

Lastly, another new resource from a group I used to work for, The National Latina Institute for Reproductive Health, about creating health care that is inclusive of trans and gender variant Latin@s.

h/t Claudia Booker for the ACNM link

Transgender Day of Remembrance

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Today is Transgender Day of Remembrance, where those transgender people who have passed on, whether due to violence, discrimination or suicide are remembered and honored.

Last week was also Transgender Awareness Week, organized by Fenway Health in Massachusetts.

I’ve been working for weeks now on a long article about the transgender community, so I’ve been knee deep in interviews and research about transgender people in the United States.

It’s depressing, to say the least. Experiences of discrimination are frighteningly widespread. Health disparities abound. Violence is a common fact of life.

But there is also much resilience, much hope, much strength in the transgender community. There is much knowledge that the arc of history bends towards justice, and that the transgender struggle lives in all of us who understand how ideas of gender limit all of us.

I wrote about discrimination and transgender health disparities last week at RH Reality Check, which you can read here. The discrimination that transgender people face impacts their health in serious ways, and when race is factored in, the disparities are even greater.

But on this day of solemnity and remembrance, let us also remember perseverance and strength. For every person who has passed on, there are many more who are thriving and surviving.

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Breastfeeding while trans

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Last week for my column at RH Reality Check* I wrote about Trevor MacDonald, a Canadian trans man and father who made headlines for being rejected as a La Leche League (LLL) leader.

In response LLL is reconsidering their policy that leaders must be breastfeeding women because Trevor, in fact, is breastfeeding his son.

I’ve talked before about how few resources exist about trans pregnancy and parenting, so the positive side of this controversy is that more people know about Trevor, his experience and the resources that exist (some he’s created) about breastfeeding for trans parents.

Trevor, despite having had top surgery, has been able to breastfeed his son using his own milk and an at-breast milk supplementation system  supplemental nursing system which is basically a thin tube that is connected to a bottle but is attached next to the nipple so that the baby can latch on to the nipple and the tube at once. This promotes the bonding that comes along with breastfeeding, but also allows the parent’s milk supply to be stimulated by the baby sucking, along with additional nutrition from the supplemented milk (Trevor has been getting this milk through donations from other breastfeeding folks).

Now I’m not a breastfeeding expert, and I can’t honestly remember much about what was covered on this subject at my doula training, but I’m surprised that this is the first I’ve heard about this. Both the fact that some people can produce breast milk post-top surgery, and that there is a way to supplement with other milk that isn’t a bottle.

I can imagine that the at-breast supplementation system might be tricky to use, and some folks would prefer the ease of the bottle. Related question: can you use the at-breast system if you are supplementing with formula?

While I’m not glad that Trevor was rejected as a LLL leader (and I hope they will come around and see that anyone who is breastfeeding should be welcome) I am glad that his story has brought attention and resources to the question of breastfeeding while trans.

For more information, visit his blog or join the facebook group he created for trans parents and allies.

I’d also love to hear from folks, doulas or otherwise, who have experience working with trans parents who chose to breastfeed. Other resources? Tips? Leave them in comments or email me (radicaldoulaATgmail) and I’ll post more later on.

Update: Trevor sent along the link to this fabulous post with tips for breastfeeding for trans folks.

*Transgender is misspelled in the title of the column, which was an error made by the Editor. I’ve contacted them to ask them to fix it, but have not heard back.

New column: Preparing for the trans baby boom

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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.

Philadelphia Trans Health Conference

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I’m heading to Philly tomorrow to attend the Philadelphia Trans Health Conference. I’m part of an exciting panel:

Trans & GNC centered Midwifery and Full Spectrum Doula Care (miscarriage, abortion, birth, adoption)

Saturday June 2nd, 5:30pm – 6:50pm

Room: 102A

We all know that the trans and gender non-conforming (GNC) community has needs when it comes to pregnancy, birth and reproductive health. This workshop will introduce participants to the midwifery and doula models of care, and discuss how trans and GNC midwives and doulas are working to improve care for our communities. While this workshop will be centered on pregnancy-related care, the health care models we will be talking about can be applied to any type of health care. We will present information and resources on options for midwifery and doula care that may be ideal for trans and GNC people. This workshop will discuss how empowering health care experiences can transform our lives and facilitate deep healing.

I attended the Philly Trans Health Conference two years ago, and was part of a panel about parenting for trans folks. I was the birth worker/doula voice, and I’m so psyched that this year there are enough birth workers attending to have a whole panel just about midwifery and doula care!

If you’re in the area, come! It’s a free conference, and a really incredible space for knowledge sharing about trans and gender queer, gender non-conforming health.

If you are going to the conference, and are a birth worker, a few of us are trying to organize an informal meet-up. I’ll post details here once I have them, but you can also email me at radicaldoula@gmail.com.

PTHC birth worker meet-up details: After our midwifery and doula care panel, come by for an informal gathering of birth workers attending the conference. 6:50pm, Saturday June 2nd, Room 102A. Hope to see you there!

ACOG issues statement urging OB-GYNs to treat transgender patients

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This may just be the only time I praise ACOG. I’m not a huge fan of the way they treat midwifery care and home birth, but this is good news for trans health. From my post at Feministing:

The American College of Obstetrics and Gynecology has come out with a new statement for their members: it’s time to prepare to work with transgender patients.

“To address the significant health care disparities of transgender individuals and to improve their access to care, ob-gyns should prepare to provide routine treatment and screening or refer them to other physicians, according to The American College of Obstetricians and Gynecologists (The College). In a Committee Opinion published today, The College also states its opposition to gender identity discrimination and supports both public and private health insurance coverage for gender identity disorder treatment.”

Their statement specifically addresses the gynecological needs of transgender men, who may still require cervical and breast cancer screenings, as well as other gynecological (and even obstetric) care.

“We need to make our offices settings that treat all patients with respect,” said Dr. Buyers. The College offers ob-gyns suggestions on how to create an office environment that is welcoming to transgender patients. For instance, asking patients their preferred name and pronoun, posting non-discrimination policies, ensuring confidentiality, and offering sensitivity training for staff are all steps that signal acceptance and let patients know that they will be treated with dignity. “We want the transgender community to know that we, as ob-gyns, care about their health.”

I hope that their members follow this important advice.

While not a widely addressed topic, folks in the birth activist community are starting to address the needs of trans and gender non-conforming people in health care. The fact that ACOG has gotten on board shows just how far we’ve come. The advice ACOG provides for their members applies to us as doulas as well, and we’d go far by simply implementing some of their recommendations also.

Happy Coming Out Day!

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Today is National Coming Out Day. While the holiday doesn’t get a ton of attention, it’s an important reminder that visibility is a large part of acceptance. It’s well documented that those who know someone who is LGBT are more likely to support the fight for LGBT rights.

I’m working with a group called Basic Rights Oregon to spread the word about their new video series highlighting the experiences of LGBT people of color. As a Latina, I was excited to see this bilingual video included in the series:

There is also a video about the Asian Pacific Islander community and the African-American community.

Providing birth support to trans and gender non-conforming folks

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So I had a great weekend at the Philly Trans Health Conference. It was my first time attending the conference and I went to speak on a panel about trans parenting organized by an amazing genderqueer activist and new parent.

My favorite part of the whole weekend was when during my panel, I asked at the beginning of my comments for folks to raise their hands if they’d heard of doulas before. In a room of about forty people, almost EVERYONE raised their hands!! And this was not a doula/birth centered conference at all. I think that says a lot about how far doulas have come in recent years.

I met one other doula at the conference, Beagle, who practices in Asheville. And I met an awesome midwife, Abigail, who works in Gainesville. Abigail and I are plotting a workshop for next year’s conference focusing specifically on pregnancy and birth, and I would love to get a meet up of trans and gender non-conforming birth workers together.

I’ve gotten a few emails over the years from trans and gender non-conforming doulas or aspiring doulas. As providers, there are many questions to be answered about how we do our work as doulas and as trans/gender non-conforming folks. It can be tricky, when being a doula is in many ways not about us, to figure out how to make space for yourself and your identity with in a highly gendered and gender normative birth environment.

I’ve worried for a while that my gender presentation as a genderqueer person might make some birthing folks uncomfortable. I’m still not sure how I would deal with that, it’s yet to come up in my work.

But another big set of issues is providing support to trans and gender non-conforming parents. I think as doulas we can do so much to make sure that folks have the best experience possible. You don’t have to be queer, trans or gender non-conforming to provide care as a doula that is sensitive to these communities. Here are some ideas/things to think about when working with trans and gender non-conforming (TGNC) doula clients:

  • Asking about preferred gender pronouns is always a good start. Heck, even with folks that you don’t know identify as TGNC! It’s the assumptions that get us into trouble. Just because someone is pregnant doesn’t mean they identify as she/woman/mother etc.
  • As a doula, you could help the pregnant person strategize about how best to communicate preferences like language and pronouns to their doctor or midwife. If they were comfortable with it, you could even do some of the advocating/explaining/reminding. It can get tiring as a TGNC person to constantly be reminding and educating folks.
  • Pronouns aren’t the only important thing–the language we use to refer to our bodies is important too. TGNC folks often use language as a way to talk about their bodies in a fashion that reflects their identity. This might be hard for medical providers to understand or get used to, but as their doula if you respect this language it could make a big difference.
  • Unfortunately there isn’t much research out there about TGNC folks and pregnancy/birth. We don’t know much about the effects of hormone treatments like testosterone on pregnancy and fertility, or the impacts of chest binding on breastfeeding. Research as much as you can and see what communities exist for TGNC folks to share experiences and knowledge.

That’s all for now! One resource that was mentioned as somewhat helpful was The New Essential Guide to Lesbian Conception, Pregnancy and Birth. I haven’t checked it out but I recommend looking it up.

If you have experiences/tips to share about working with TGNC folks, please add in comments! I hope to write more about this issue in the future.