Guest post by Shelly Nelson-Shore from the US
The #NotNeurotic series is published in partnership with BetterYou, whose sponsorship enabled me to pay Shelly, and four other writers from under-represented backgrounds, for their contributions. You can find more information about BetterYou, and their new Madeleine Shaw range of family health supplements, at the end of this post.
In theory, the world of pregnancy, birth, and postpartum life is shifting away from gender essentialism. More and more, we’re seeing stories of trans and non-binary people giving birth – not just binary trans men, but non-binary people across the spectrum of gender presentation.
But, despite all of this, in practice there’s still an assumption of womanhood or an identification with womanhood in all aspects of healthcare related to pregnancy and birth.
Being the parent who carries, births, and feeds has so much gendered language built into it that it’s taken as default: transmasc parents have had to go to court to be listed as something other than a “mother” on birth certificates, and trans and non-binary pregnant people have to specifically seek out trans-literate birth and lactation professionals to avoid being misgendered (or, worse, refused care completely).
Advocating for increased inclusion of trans men and non-binary people in conversations about reproductive health is often met with dismissal and even vitriol, especially on the internet. While health professionals are slowly catching up to the understanding that not all people who become pregnant and give birth are women, the scaffolding of prenatal and postpartum health remains grounded in the sexual binary and female-focused language.
As a non-binary parent who doesn’t present androgynously – meaning that I “read” as female – I accepted that I’d spend my pregnancy in gendered spaces and have to deal with a certain degree of gendering from the medical staff I saw throughout my pregnancy and birth. What I didn’t anticipate, despite doing as much front-loaded work as I could manage with my therapist, was how exhausting that experience would be.
I came into my pregnancy as a “problem patient”: even before I got pregnant, I was fat, had multiple chronic pain disorders, and was a queer assault survivor with a big “GET EXTRA CONSENT” note on top of my chart. The thought of adding one more thing – especially something that would require my doctor and her PA to police their language around pregnancy and gender – just felt like too much. I was already prone to anxiety and defaulting to “whatever’s easiest for everyone else” – what was one more thing? I could manage conversations about motherhood, and maternal health, and female bodies, and dozens of other throwaway comments that assumed an identity I didn’t hold.
Before I even thought about getting pregnant, I had been in and out of reproductive justice and advocacy spaces for over ten years as an educator, peer advocate, and clinic escort. I knew the impact that implicit bias and microaggressions among medical professionals – even those who were well-meaning and unaware of the problematic aspects of their words or behavior – could have on the health of someone’s pregnancy, birth, and postpartum care. But my education primarily centered around racial microaggressions and a lack of equity for people of color, particularly Black birth parents.
While I knew, in theory, that microaggressions could be related to sex and gender as well, it didn’t occur to me until midway through my pregnancy that the assumption of my gender identity was taking a toll. My anxiety amped up before every appointment. I rarely had any dysphoria related to my genitals (as opposed to my chest, which I had to stop binding during pregnancy), but found that I had to be repeatedly reminded to relax during any pelvic exam, as if my body was actively trying to shy away from additional reminders of the literally invasive gendered nature of prenatal care.
In an attempt to balance out some of the gendered input and care I was receiving, I intentionally found a trans-inclusive doula to support me during labor and delivery. She was an incredible resource, and made a huge difference in acting as a counterbalance to the way the doctors and nurses involved in my delivery approached me: she was attentive to my pronouns, avoided the casual use of “mom” and “mama” (to this day, I don’t understand the tendency of labor and delivery nurses to default to calling pregnant people “mama” – I have a name! It’s right there on my chart! You can use it!) and didn’t attach gendered terms to the processes of my body.
The difference in emotional energy I felt myself expending when she was the only provider in the room, compared to when the obstetrician or nurses were there, was something I didn’t even process until I was neck-deep in therapy, several months and a hearty dose of postpartum suicidality later.
My birth ended up being a traumatic experience unrelated to misgendering. But it wasn’t until after my diagnosis of postpartum depression and anxiety (a new and colorful addition to my pre-existing diagnosis of “regular” depression and anxiety), and my therapy sessions with a trans-inclusive and trans-positive postpartum psychiatrist, that I was able to draw connections between the lack of agency I felt in the process of my labor and delivery, and the lack of agency I felt throughout my entire pregnancy to be able to advocate for trans-informed care.
Spending my pregnancy silencing and censoring myself led me to a place where I was constantly second-guessing and mistrusting my reactions and feelings. Ultimately, that mistrust of my own gut feelings led me to fail to advocate for myself during labor.
More than a year later, I feel a sense of imposter syndrome when I talk about the role that misgendering had in my experience of pregnancy and birth. When I hear horror stories about people who have been ignored while miscarrying, or who have had to desperately advocate for care while postpartum, I feel ashamed of the intensity of my reaction to my well-meaning healthcare providers who weren’t actively being gender-inclusive in their approach to care.
But when we talk about bias in healthcare, especially when it relates to pregnancy and postpartum care, part of the conversation does have to be the ways in which even well-intentioned providers can still perpetuate systems of silencing and (cishetero)normativity that can lead to distress, trauma, and, yes, negative health outcomes.
I was much luckier than so many other people – I have a healthy son, my fertility is intact, and I was able to find a team of health providers to help me lay the groundwork for more self-advocacy and gender affirmation in any future pregnancies. But no amount of individual planning can make up for an industry that assumes pregnancy comes with womanhood and that giving birth makes someone a mother – and the terrible, throat-tightening anxiety that comes with the fear of speaking up.
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