“In the end, it all comes down to the baby’s need to nurse, so I nurse her. She doesn’t know I’m trans, but understands that when she’s tired, sad, or hungry, there’s no cure quite like breastfeeding. [My son] was the same. And I’m his Dada. He has never—and I’m sure never will —call me by the wrong pronoun.”
But what about everyone else?
A transgender Dad embarking on the journey of pregnancy, birth, breastfeeding, and parenting can be endlessly confronted by stares, curiosity, hostility, and confusion over language from coworkers, strangers, and birth workers. Culturally competent doulas can and should take the time to listen to the experience of transgender parents, to learn why they may make the choices they do about care providers, birth locations, and which procedures and interventions they may want to decline if possible.
Trevor MacDonald’s soon-to-be published book Where’s the Mother is a wonderful place to start, and is eye-opening for new and seasoned doulas alike. Doula Trainings International will be adding Where’s the Mother to our required reading list for certifying doulas and highly recommends that current DTI doulas read it as well for continuing education.
Trevor is a transgender father raising children with his male partner in a small town in central Canada. Even after years of hormones and chest contouring surgery and publicly coming out as a man, he chose to become pregnant with his children and nurse (even tandem nurse!) them with the help of exhaustively procured donor milk and his own milk. While much of his situation is unique and groundbreaking, there is also much that birth workers and parents of all genders will find familiar, such as the struggle to drive cross-country with a crying newborn, the wakeful nights spent worrying if you’re making the right choices for your children when those choices take so much from you, the thrill of watching your first baby grow into a proud older sibling, even the sphincter law at work during labor when a birthing person feels fear or discomfort.
Trevor carefully recounts the ways in which pregnancy, birth, and chestfeeding can produce cognitive dissonance for a trans man in a world where the narrative focuses so much on femininity and a woman’s strength and parts, when even your most well-meaning friends and colleagues can revert to female pronouns when in the presence of a pregnant body, and when some of the best prenatal yoga and meditative preparation focuses on a female identity. As birth workers, we clearly have the ability to change the narrative here and make sure we are not assuming that anyone looking for birth support is a woman or even a woman that identifies with our cultural definition of femininity. We could have clients of many different genders, or clients that do not identify with gender at all, and we
can support them fully by examining our own preconceived ideas about what it means to be pregnant, birthing, and lactating.
Where’s the Mother will be available May 24, 2016. You can pre-order it now at Amazon.
DTI’s Interview with Trevor MacDonald:
Did you have a particular audience or audiences in mind when writing this book?
I wrote this book primarily for the well-intentioned ally—someone who wants to be supportive of LGBTQ families but maybe doesn’t quite know how to do that. This could include health workers such as doulas, or friends and family of transgender individuals. Of course, I also wrote with transgender and non-binary people in mind, particularly those interested in starting a family some day. In my writing, I tried to share as honestly as I could what my experience of giving birth and breastfeeding as a trans person has really felt like.
I also aimed to write a great story. I enjoyed the process of trying to craft a compelling narrative that any human could relate to on some level. My experience is particular as a transgender person, yet every parent has to make decisions about how to birth and feed their baby, and every parent goes through the challenges of adapting to life with a newborn. To some extent, everyone who becomes a parent must negotiate a shift in their identity.
In the epilogue we learned that you moved to a more rural area near the town you were living in. Has that been a different experience than living in town in terms of community reactions to your family, pregnancy, and nursing?
Yes and no. At our place in the country, we have much more privacy than we ever did in the city. I enjoyed this especially at the end of my pregnancy, when it felt so freeing to be able to take off my shirt in the sunshine without any neighbours watching. On the other hand, we have also started to connect with our local rural community. We visit a playgroup in a nearby town and have attended the local library program for pre-schoolers. Both in the city of Winnipeg and in the country, we’ve met people from all walks of life, including other queer folks, highly religious yet supportive families, religious and socially conservative families, and everything in between. We also continue to spend a lot of time in the city with friends who still live there. There is so much diversity in both places that it is difficult to generalize. I think there is an exaggerated stereotype about rural communities being monolithic, but the truth is that LGBTQ people live everywhere. I have found that what I see reflected in local rural newspapers seems different from my actual experience of my rural community.
I found it fascinating that after some disconnecting experiences with your first set of midwives, you did not call your care team while in labor with your second baby and also did not hire a doula. Was this a conscious decision? How did it change your labor experience?
I didn’t make the decision ahead of time. I tried to stay open to whatever might happen, and I had planned to call the midwives. However, in the moment, I realized I didn’t want to do it. I believe I would have made a different decision if my labour had progressed differently or if I had not felt the baby moving as much as I did during labour. I did notice that I absolutely couldn’t stand being watched, even by my partner. As a result, I think my labour felt much more like my own. I did not feel distracted by others and I was able to do my job.
Is there anything you would want to tell a doula working with a transgender client in terms of language used, specific support needed, or situations where more sensitivity might be needed? How might this doula advocate with their client for respectful care in a hospital setting where there may be many care providers coming in and out?
It is commonly understood that pelvic exams in general can be challenging for transgender clients, and I think it is safe to extrapolate that the same may be true during pregnancy. It certainly was for me. I experienced less gender dysphoria when I felt more in control of who was touching my body and when. A doula could ask their trans client if they have any concerns about experiencing gender dysphoria during birth. Together, they might be able to create a plan for the doula to be able to educate care providers in this regard.
In terms of language, I think it is always best to ask open-ended questions like “what is your pronoun?” instead of making assumptions. With permission from the client, a doula can share this information with care providers.
I was very interested to read that you had met Ina May and had learned so much to prepare for your first birth from her books. The latter is clearly an experience many share. After reading the letter she signed in response to the MANA Core Competencies changes, and you writing an article in response, did you ever have a chance to speak with her again to clarify her position?
I have tried to reach out to Ina May through a mutual friend, but unfortunately have not heard anything back. I would be interested in having a conversation with her some day.
I was curious why you chose not to make your experience with becoming a leader in La Leche League part of the story since that is something that has received such widespread attention. Has that story already been told?
I think so. As you say, the story received widespread attention. I wrote about it on my blog, and it was covered by media around the world. In this book, I wrote about my personal experience as an individual with my local LLL group. I wanted to keep this narrative intimate, about my in-real-life experiences rather than those that have been told so much in the media.
Besides changing language to be more gender inclusive on their website, marketing materials, and educational materials, what other ways a doula might make potential trans clients feel more welcome?
Tell them to read Where’s the Mother? 
In all seriousness though, I think it can be helpful to let a client know that you have invested time in learning about transgender individuals’ experiences. Maybe you have a trans friend or relative who you have supported, or you’ve read some good blogs or research articles. If so, share that information right away with your new client to let them know you’ve considered the topic before.
More about Trevor MacDonald can be found at Milk Junkies
DTI is proud of our Trans Health Initiative, and has begun awarding scholarships to trans doulas for the 2016 year.