I am nonbinary. I was assigned female at birth, but my gender is neither male nor female. When my ex-partner and I were trying to conceive our first child, I had not transitioned yet and was still identifying as a woman. We were a same-sex lesbian couple searching cryobanks for the perfect sperm donor. I was ready and excited to have children, but the idea of pregnancy terrified me—repulsed me, actually—but my then-partner was excited to carry a child, so we shopped for sperm. I joked that the idea of lesbians needing sperm to start a family was like Superman needing kryptonite to thrive. Obviously, the need was because of biology; gender and sexual orientation didn't matter, nor do they need to be defined when it comes to conception. Babies are made one way: sperm fertilizes egg.
The primitive desire to start a family is universal, and while some view "modern" families as endearing, many folks struggle to make space for gay parents in a heteronormative world. For transgender and nonbinary people, the hardest part of pregnancy is not growing a healthy baby; it's convincing people that they can.
Transgender men (men who were assigned female at birth based on their biological sex) and nonbinary folks like me (those who don't identify as either male or female) can and do get pregnant. When talking about reproduction, reproductive rights, and gynecological health, transgender folks deserve the same inclusive and affirming care as cisgender folks. That starts with language.
Updating Pregnancy Language
During the trying to conceive (TTC) stage and then the pregnancy and birth stages on the way to becoming a parent, all I and any other gender-nonconforming person notice are labels. Books, hospital clinics, doctor's offices, and all of the internet wormholes I used to try to learn about best conception, labor, and delivery practices were written for and about cisgender, straight couples—specifically for women and mothers and their fathers-to-be husbands. I had to change the language in my head as I studied the ins and outs of pregnancy and how to be a supportive birth partner. It was and still is a word puzzle to try to switch pronouns and gender, relationship status and roles.
Stefanie LeJeunesse, childbirth educator and lactation counselor, agrees. "Changing the language around pregnancy and birth is not difficult; in fact, it's one of the easiest ways to improve [affirming baselines]. Using accurate terms like 'pregnant parent' and 'breast/chest feeding' does nothing to diminish the magic and honor of guiding a new parent through their pregnancy, labor, and birth."
Before coming out as transgender man, David Minerva was living as a woman in a lesbian relationship. Unlike my own very loud knowledge of the body dysphoria that pregnancy would have caused me, Minerva tried to ignore it when he became pregnant. He hoped being pregnant and delivering a child would help him sink into the idea of womanhood. It felt like a final effort to try out what he thought it meant to be a woman. But what he found was more discomfort. At first, it was hard for Minerva to understand why his pregnancy experience made him "bristle."
"I was deeply uncomfortable with how cis-normative the whole culture of pregnancy was. Phrases like 'pregnant women' and 'expectant mothers' made my skin crawl and made me feel wrong," says Minerva.
Being in a building for "women" during childbirth felt oppressive and made him think of his transgender male friends who were pregnant. It made David think of himself too. The gendered language, assumption of gender, and default terms used by nurses and doctors that referred to all birthers as women and moms made him feel excluded and unwelcome, like he didn't belong, even if the medical providers were warm and caring.
Building an Inclusive Health Care System
Jenna Brown, who uses they/them/theirs pronouns, is a queer full-spectrum doula, radical educator, and founder of Love Over Fear Wellness and Birth. Their website is affirming and welcoming, and as a nonbinary person, I felt safe and seen while navigating the descriptions of their services and how they provide inclusive care. While I have no desire to become pregnant, my hope is for all transgender and nonbinary folks to receive the type of care Brown provides.
LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual and many other identities) inclusive services can be universal, but Brown says they need to go beyond one-time trainings and a rainbow sticker on the window. To fully serve the LGBTQIA+ community, especially transgender parents and parents-to-be, continued education is a must.
"The needs of trans, nonbinary, and gender-nonconforming gestational and non-gestational parents are subjective and dynamic. Providers should also be prepared to shift their practice to one that is more person-centered," they explain. "Additionally, providers should be aware that any person that their patients interface with (receptionists, nurse practitioners, lab techs, etc.) should also be trained and engaged in ongoing education in order to maintain a safe environment."
A safe environment for transgender and nonbinary folks comes back to language and having allies who will not only use gender-neutral terms but who will also include all genders in conversations about reproductive health and rights.
Minerva spoke about a situation I often find myself in. He says, "It gets exhausting whenever conversations about reproductive rights and healthcare come up, because every single time there are cisgender women who swear they're my ally, and then they're all 'women women women.' Or even say things like 'if men needed abortions they'd be easy to get.' And it makes me want to scream. I know men who've had abortions! And nonbinary people too."
I feel the same way. And it always feels a bit intrusive or like I am trying to take away someone else's repression when I point out that that abortion rights are not just women's rights, nor is access to birth control or fertility treatments.
I had to have a mammogram done recently, and I was very uncomfortable being placed in a women's only space to have a women's procedure to prevent what is usually considered a women's disease. Because I am nonbinary, I hated being shoved into that female box. While my biological sex is female, my identity is not. I am a person, with a chest that needed to be screened. I have a uterus and a vagina that need gynecological preventative care. Yet, in order for insurance to cover these services, I need to bill them as if I am a woman. Many insurance carriers won't recognize the need for transgender men or nonbinary folks to receive what their company deems are women's health care needs—and pregnancy and postnatal care often falls into this category.
Regarding insurance companies, Brown sees the opportunity for providers to be advocates for their transgender and nonbinary patients. "Providers and care networks do have the voice and influence to change the way that insurance companies code patients and procedures," Brown says, "but it will take collective effort to make bigger-scale changes."
They also mention that providers who are committed to be allies to the queer community need to call for changes in the way electronic health records are built. The software, programs, and any tool used to collect information needs to be able to accommodate genders beyond the binary. This allows folks to be addressed by their preferred or chosen name and pronouns. This level of respect sets the stage for respectful and trusting conversations necessary when it comes to someone's health. It also validates who we are at our core.
Transgender man Freddy McConnell recently lost his case to have himself listed as his child's father on the child's birth certificate. McConnell has been living as a man for years but used his reproductive organs to become pregnant and give birth in 2018. McConnell is legally a man, yet because someone else believes pregnancy equates to motherhood, he was not allowed to claim his identity as his baby's father.
Other transgender men like Trystan Reese have also been publically sharing their pregnancy stories and are doing their part to change the narrative when it comes to pregnancy and parenting. Reese says, "Just because something has always been one way, that doesn't mean that's the right way or the best way or even the way that serves the most number of people. I would invite people to just see the many ways in which family has evolved over time."
I am aware that these changes will not happen quickly. But I am confident that a cultural shift will move language forward into more inclusive and nonbinary space. And with more mindfulness, folks will start to accept what was once considered impossible as normal. Transgender and nonbinary pregnant parents will be just another example of the beauty and wonder of childbirth, parenthood, and family.
Editor’s Note: Parents strives to be inclusive of all parents, regardless of gender, so going forward, we’ll aim to use inclusive language to refer to pregnant people and parents-to-be, and will work to update existing pieces with outdated gender references.