The following story is a guest post by Edie (that’s Eeeeeedie not Eddie) who is a Midwife, and a communications, media and journalism student. It was originally posted over on her most excellent read at: EDIE115.
It probably wouldn’t happen very often but if you are a health professional who cares for people during pregnancy and birth ie; a Midwife or Doctor, you may come across a transgender man who is pregnant.
This can be really challenging for people who may not have come across transgender people or issues. This is a guide to maybe help you in that situation. You’re welcome.
So firstly a bit of trans 101.
I’m writing this from a trans male perspective. So this means this person was born and assigned female at birth. It has become clear over the years that they are not female and in fact male. They have probably seen psychologists, psychiatrists and doctors and started on testosterone. This will have changed their appearance and voice to a certain extent, depending on where they are in their journey. They may have had family issues and massive discrimination or bullying or they may have a massively supportive family and network and have done very well. Just like anyone they will have had challenges in life but their story is their own and it may not be the same for everyone. Do not presume that things are the same for everyone. People are people and are in all sorts of different places with stuff.
Being transgender is not a choice. It’s not a fad. It’s a very real normal phenomenon and there are many transgender people in the world. You have probably come across many in your life, serving your coffee, driving your ambulance, doing your accounts etc.
There has been much discrimination towards transgender people over the years but there has also been a wave of understanding and support of late too. Many Doctors and healthcare staff have been interested in this area and although there is still not enough support and training around this it is encouraging.
Despite that, transgender people are at a far higher risk of suicide and violence than anyone else.
Trans men generally take some form of testosterone. It’s unusual but they can still sometimes get pregnant.
Now if you are a trans man then you are a man. This is how you identify. This might be hard for people to get their heads around because they are going ‘What??? Vagina???’. Stay with me on this. Some men have vaginas. Yup. Not everybody who is transgender has gender reassignment surgery. So there are trans men having Pap smears etc.
If someone identifies as male then they are male. It’s actually an act of violence to misgender someone.
Pregnancy can be a very welcome thing for some trans men. Some trans men even plan it. Because they can. It can also be an unwelcome thing and bring up huge gender dysphoria (feelings of distress around their body). It can be challenging.
So as health professionals we have to be very aware of this. We provide care to everyone whilst respecting their dignity, their worth. Dignity is probably the MOST important aspect of this discussion.
Practically this would be my advice….
You are given a transgender male to look after in pregnancy or birth.
Sit down. Have a conversation. Please DO!!!
It doesn’t need to be the elephant in the room. I mean it might be so obvious it would be weird to ignore it. I would probably say… Hi (person) ….find out their preferred name, they may not have their preferred name on their Medicare card. Sometimes it’s hard to change that stuff so if you go in saying ‘Hi Susan’ to someone with a beard they are going to think you are a complete dick. For good reason! So find out the name!!!! And the partners name.
Then you could simply say…. my name is blah and I understand you are 31 weeks pregnant and this and that is happening. What we plan to do is… I also understand that you are transgender. What are your preferred pronouns?
It seems a weird question to say to someone ‘What are your preferred pronouns?’ But do it. Do. Anyone who is transgender will totally appreciate this and think you are the shit! Also ask their partner. They may not be trans but they might.
Then add… I am here to look after you and I can assure you that you are going to have the very best care from me. Then smile. You may find then that there is a palpable relief in the room. The trans person is now more relaxed, feeling they are going to be cared for well. The elephant in the room has fucked off and now you can just get on with the job at hand. With some considerations, I’ll get to that.
You probably don’t need to peruse any kind of transgender chat after that. You certainly don’t want to be asking questions about…. When did they become transgender, personal questions etc. This would make you a massive dick because firstly it is none of your business, secondly you are there to do a job. If you are the midwife, obstetrically there will not really be a difference in what you are doing to what you always do. There have probably been many chats about challenges etc with other people like social workers and support people and Doctors. You don’t need to do that bit. You probably just need to do your job in a sensitive way. If you feel that you may be asking questions just out of curiosity then please check yourself and stop.
You could just check in on family stuff though. Just a quick how’s stuff there. They may not want certain family members in the room. If you notice misgendering by the family or calling the wrong name etc you could then lose that family member from the room. Be an advocate. Look after your patient. You could help out a lot like that.
It’s very important to check with the person what they are comfortable with regarding examinations etc. Some trans men will choose to have a cesarean section for birth but some will not. You may have to be extra sensitive around things like examinations, ask permission ( I know you do that anyway), maybe be extra checky with what is okay. Maybe be extra ninja like with your placing of sheets etc during examinations. Maybe don’t use the word vagina. You don’t have to.
Maybe let the person lead in the words they want to use. Some trans men say chest feeding. Maybe listen and pick up on cues. I know it’s hard because we automatically say a lot of things. But maybe think about that.
You might need to concentrate a lot not to use the wrong pronouns or words. I’ve got faith in you! You can do that! Extra concentration!
You might make a mistake and use the wrong word or pronoun. Apologise immediately. You will be forgiven. If you genuinely have this persons best interest at heart and are clearly doing your very best to do the right thing you will be forgiven. Form that amazing midwife / person relationship we are all so good at.
If you are assigned to a trans man and you are not comfortable with it or your own personal views come into it in a negative way then please unassigned yourself. Please go and find your team leader and let them know it’s not your jam. Then go home and research about it and educate yourself.
Hopefully then your team leader will find someone who will be the most amazing person in that situation. It IS a little bit special treatment and it bloody should be. It’s not something we come across every day and if we need to put measures in to make sure that the right health professionals are looking after these people then we should. Transgender people are often treated badly by health professionals. It causes so much damage. I’m all for putting special measures in.
If you have really bigoted views about this. And you might have,even if you think you don’t. Then step out.
If you think it’s okay to have conversations in the office about transgender people in your hospital and say negative bigoted things to pass away the night shift hours then please check yourself. There may become people who work with you that have transgender relatives or kids. There are eyes and ears everywhere.
And if you are really struggling with it maybe find someone who can help to educate you.
Maybe come and find me.
We can have a chat.
It’s always better to chat with someone about things you don’t understand than to join in gossip. You might get called out. I might come and speak with you.
This is a great learning experience. As health professionals we want the best possible outcome for our clients. We have values. Dignity is a massive one. Do your profession proud.
Thanks to V for the drive by check of this article. I am aware that as I am not transgender myself I will pass stuff like this by someone who is.
Read here for more information on nursing care of the Transgender and LGBTIQ patient.