Working with LGBTQ+ Clients

In the year 2018, it’s pretty safe to say that most folks have heard the acronym LGBTQ+. We may know that it means lesbian, gay, bisexual, transgender, and the “Q” portion is frequently interpreted differently – some people say it means “questioning”, but I came up knowing it to be “queer” to encompass the other alphabetical identities like intersex or asexual/aromantic. We may inherently know what the acronym and words mean but do we, as birth workers, truly understand what it means to be part of this community?

I always knew that the identity of “girl” assigned to me at my birth was not right for me. As a child, I was a tom-boy, but still also liked traditionally feminine things like carousel horses. I also knew that I wasn’t a boy. I didn’t have the language to understand what I was feeling or that it even really had a name. I had heard of (at the time) LGBT but given my deeply religious upbringing, I did not actually know what it meant. It was not until I moved into a house with several lesbians and queer people that I even knew there was such a thing as more than one gender or began to comprehend what it meant to be transgender. I came out as genderqueer, which is on the trans spectrum, at 19 and really began to explore what that meant for me. Heck, some days I am still figuring that out.

So what exactly does that have to do with birthwork? Well, as I came into my identity and eventually my passion for birthwork, sex education, and general reproductive knowledge, I found myself and my fellow LGBTQ+ counterparts left out. So many texts are written from deeply gendered and heterosexual perspectives. That isn’t to say that there is anything wrong with being proud of and celebrating cisgender womanhood (which means having been assigned female at birth and identifying as a woman). Certainly, there is a great deal of beauty and wonder there, but what about those of us who fall in the inbetweens or don’t fit the molds of traditional womanhood and manhood? What about those of us whose families aren’t shaped the same way heterosexual families are? We exist and we are having babies, creating our own unique family units.

Just as the birthing realm has the potential to be harmful and violent to straight cis women, it is the same or worse for queer and trans people and families. Our identities do not exist in a vacuum. It is important for birthworkers to be informed and inclusive of people of all identities. Depending on where you live, knowledge or acceptance of and around varying gender identities and sexual orientations may be seriously lacking. When doulas, midwives, and educators have the knowledge and acceptance of things that may be outside of our own identities (or even when they are a part of them), we create safe space and room for those people, just as we do for our straight cis clients.

We want to make our clients feel as safe and supported in their pregnancy and birthing process as possible, so how do we do that? First, we start with the basics. It is important to know which hospitals and birthing centers are open and supportive of people within the LGBTQ+ communities. I personally keep a list of resources for folks who may fall into marginalized categories (such as people of color, differently abled folks, etc). For said people it can be hard to connect with others who have not shared our experiences, and that can be isolating and make us feel as if we aren’t able to be fully honest with care providers. If there are not any resources indicating local care providers that are allies, call providers and ask. Knowledge is one of the most powerful tools in our kit. Of course we will not know everything and that is okay, but the more information we have, the more we can pass onto our clients.

Secondly, when it comes to clientele, ask them questions! As I said, information is key. However, this is not a space to ask prying and potentially harmful questions, such as the state of a trans person’s genitals. For most people, these sorts of questions can be triggering and come off as transphobic. When interacting with our queer and trans clients we let them take the lead. Listen to the language they use and if you aren’t sure, then ask. Ask how a person refers to their relationship, if they have one to another person. Don’t be shy about getting to know the terminology trans and nonbinary people use around their bodies. Not every person refers to their anatomy the same way a cis person might. Some do. Some may understand that in a medicalized setting (like a hospital) their body may get referred to by scientific names (ie: vagina, uterus, breasts, etc). Queer and especially trans identities are very unique to each person’s life, particularly with the amount of outwardly transphobic rhetoric even within the feminist and LGBTQ+ communities.
A third thing birthworkers can do when working queer and trans families and birthing people is have conversations with the hospital or birthing center staff (only if you’ve been given the go-ahead by your client – sometimes people may not feel safe or comfortable being “out” in certain contexts). Explain that your client(s) are queer or fall somewhere on the trans spectrum and they wish to use a specific pronoun, or that they wish to have the way they feed their baby referred to as chestfeeding versus breastfeeding. These things, to cis people, may seem very small, but for people within the LGBTQ+ community they can mean a lot. Language plays a key role in all of our lives, whether we realize it or not. The way we speak and whether or not we remember to call someone lesbian instead of gay, or use they/their pronouns instead of she/her, really do play a huge part in a person’s life.

A note: you will make mistakes, but it doesn’t have to be a big production because that makes everyone feel uncomfortable. Correct yourself and keep going, but don’t expect people to always correct you when you mess up. Not only can it be emotionally exhausting to constantly point out being misgendered (referred to as one gender identity when you are another), but sometimes it can begin to feel uncomfortable or even unsafe.

Along the same lines, another thing birthworkers can do it amend the language they use on their website and resources. Instead of always using “woman/women”, refer to your potential clients as a “birthing person/people”. Instead of “breastfeeding”, you could talk about feeding options (bonus: this one also doesn’t exclude folks who decide to bottle feed their babies). These blogs by Inspired Birth Pro and can help you get started.


 To put it into perspective, you would want your care providers to know you and the information about what makes you tick, right? It is our responsibility as birthworkers to make sure that everyone we agree to work with feels safe, secure, and ready to make that transition into parenthood. It goes back to the golden rule we learned in elementary school. Treat others how you would want to be treated. Create the safety and space for birthing people you would want to feel for yourself. It sets people up for success in both labor and postpartum. When our clients succeed in their birth plan and feel safe in those moments, it is a success for us as birthworkers because even if you don’t know or understand queer and trans people we still exist. We are having families and we have the right to feel seen, safe, and comfortable. Access to good and well-informed natal care is not a privilege and it is not reserved just for the elite among us. If anything, those of us who exist in marginalized communities need it more now than ever and as doulas we can be the ones to support that is needed.

Danie is a labor and support doula specializing in queer and trans families as well as the owner of the self-care company Of Earth + Salt, which offers self-care products and services. When not supporting birthing people and their families and doing work with OES they’re usually cycling around and taking photos of their friend’s pets.

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