Transphobia in the Midwifery Community

Trans, genderqueer and intersex people have been giving birth for as long as women-identified people have and we have also encountered oppression.
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Five years ago, as a transgender expectant parent, I eagerly read midwife Ina May Gaskin's Guide to Childbirth. I credit her work as having had a tremendous effect on my ability to birth at home in our western culture of medicalized birth.

Deciding on midwifery care for myself was easy. I knew that working with a limited number of care providers who would have the time to understand my unique situation and needs would be vastly preferable to five-minute appointments with a OB/GYN and subsequently labouring with hospital staff I'd never met before. The midwifery approach to care, in general, emphasizes informed decision-making and establishing a relationship of trust and respect with the patient. Midwives prioritize continuity of care, meaning that the client sees the same two or three care providers throughout pregnancy, labour and post partum. Longer appointments ensure the opportunity to develop a positive provider/client relationship.

My midwives communicated with the local hospital in case of a transfer, and the head of obstetrics agreed that my situation was "obstetrically normal." Since midwives care for medically low-risk individuals and they are able to establish a deeper relationship with their clients, midwifery was an ideal choice for a trans person like myself. I would not need to explain my trans identity during such a challenging time as labour, and the midwives could likely manage the medical needs of myself and my baby.

I've now had two wonderful home births, both under midwifery care, and have delved into advocacy and research around the issue of transgender individuals' reproductive care. Last year, I was brimming with pride when I was invited to speak alongside Ina May, the first midwife I ever heard of, at a birth conference in Québec. I took the opportunity to thank her for her incredible work and how it affected my own birth experiences. Imagine my surprise and shock, then, to see her signature on a letter, dated August 20, 2015, protesting the inclusion of trans, genderqueer and intersex people in midwifery care.

The Midwives Alliance of North America (MANA) formerly referred to clients as "women" and "mothers," but in 2014 changed some (but not all) language in its core competencies document to refer to "pregnant people" and "birthing individuals." The new gender-neutral language recognizes that some transgender, genderqueer and intersex individuals may require midwifery care and do not identify as women. Now, a group of midwives, including the revered Ina May, calling themselves Woman-Centred Midwifery is condemning the changes. In an Open Letter to MANA, the dissenting midwives write, "women are all but missing from the language" due to the "erasure" of the word "woman." Over 1000 people have already signed a response letter in support of MANA.

The authors of the Open Letter assert that only women have the ability to give birth, and that such capacity is what women should celebrate about themselves. The Open Letter questions "whether and how these [transgender, genderqueer and intersex individuals'] particular needs fit into the scope of practice for all midwives." In a nutshell, the open letter says that trans guys who give birth are not men; they are women because of their biology.

The above statement is highly offensive to trans individuals because it denies our gender. Also, it implies that the care provider decides the identity of the client, rather than listening to the client and forming a respectful relationship. It places a burden of conformity on all people who give birth.

The signatures of midwives held in high esteem in the birthing community are especially hurtful. Ina May's books have frequently been cited in an online support group that I run for trans parents. One transgender friend of mine scrolled the list of signatures and was sickened to see the name of his own midwife. He gave birth a few years back and subsequently transitioned. I cannot imagine how it would feel to see your midwife, who cared for you when you were at your most vulnerable, sign a letter that protests your right to a safe and welcoming health care environment. Further, a number of midwives of colour signed -- a particularly painful point, given that people of colour experience disproportionately higher levels of transphobia than white transgender individuals.

Arguments found in the Open Letter might at first seem vaguely familiar and even reasonable. The authors speak of the power of women's bodies and their life-giving abilities. They are careful not to write anything hateful in plain language about transgender people. Ultimately, they employ a false dichotomy by making a number of positive statements about women's bodies and abilities, and then implying that gender inclusivity harms these gifts. In fact, it is possible to be inclusive of diverse gender identities and celebrate the power of the female body.

Like the authors of the Open Letter, I do not wish to erase the word "woman," nor do I deny the life-giving power of women. Women are a group who have been and continue to be oppressed in many ways by a patriarchal society. This includes women having a terrible lack of control over their bodies during the birth process. I have deep respect for this struggle.

Yet, trans, genderqueer and intersex people have been giving birth for as long as women-identified people have and we have also encountered oppression. The Open Letter presumes that to be trans and to give birth is some new phenomenon of the last few years. Trans people giving birth are newly visible because today we are able to transition hormonally and surgically as well as engage our bodies in pregnancy, but there have always been people who identified differently from women whilst experiencing birth.

I believe those who wrote the Open Letter feel that they as women would be made invisible by the exclusive use of the words "pregnant individuals." They fear a future where they will not be allowed to write or speak about women in their own practices. For some, becoming pregnant and giving birth is a crucial aspect of their womanhood, not their personhood.

We do not need to choose between celebrating women and including people of all genders. Why can't midwives serve "women and people of all genders?" Organizations trying to grapple with respecting the feminist legacy of midwifery care while using inclusive language should be generous with their ink. Queer folks have done well to add more letters to our "alphabet soup" LGBTTQIA acronym. We can all handle a few more letters.

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