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Working with Non-Binary Folks in Birth, An Assignment

This was originally an assignment in a midwifery course. I've shared my thoughts here in hopes it helps other birth workers serve all birthing people with dignity and thoughtfulness. To read the PDF of the assignment, click here.

Transgender Birth Orange County

Case Study 1

Part 1: You have begun offering well-person care in your practice some years ago, but until now, you haven’t had the opportunity of serving a trans male for a pelvic with pap. Chris called to schedule with you for 2 weeks from now.

[if !supportLists]a. [endif]What are the special considerations you have?

To begin with, I’d want to make a conscious effort to shift pronoun usage if my typical clientele included primarily people who prefer she/her pronouns. I’d want to remember going in to ask about pronoun choices. I’d also need to look over my documents and forms prior to the appointment to ensure they were inclusive and left room to chat about the experiences, needs, and values of a trans man. I would want to inquire with Chris as to the preferred environment for the appointment as well. I expect privacy would be of primary concern for Chris, so offering the option visit in-home might be beneficial even if I typically work in a clinic or office setting.

Part 2: While you were in the exam with Chris, you mistakenly refer to him as female while examining his cervix. You can tell he tenses and seems uncomfortable.

b. How could you have prevented this situation from happening?

Reviewing any information given to me by Chris, prior to the exam, would have been helpful. If I did not provide space to chat about preferred pronouns, that could easily have led to a mix-up as well. Taking a few moments to clear my head and prepare for this individual appointment, apart from the last appointment I had, might have helped keep me present with Chris. I want to add here, though, that mistakes happen. I may not always be able to prevent using the wrong pronouns or referring to someone in mis-gendered terms; this is the result of an entire life full of societal norms being pushed via every institution, form of media, and entity I’ve encountered. Even those with the best intentions get it wrong and offend others. I believe the key is to staying open to learn and correcting the mistakes we do make.

c. What would you do in the future to avoid it with future clients?

Making a plan for the appointment ahead of time, which could include writing down my clients’ preferred pronouns, would probably be helpful. I could review it as the appointment went on to ensure I was covering everything and honoring the client’s identity. Especially in cases where anatomical terms themselves could be triggering, I would want to ask open-ended questions right up front; this way, my client has an opportunity to share which terms are okay, share any preferred terminology (i.e. chest instead of breast), and can learn that I am a midwife who aims to provide flexible and individualized care.

d. What will you do right now in the moment to correct the situation?

Apologize, immediately. Then, allow room for the client to express any concerns and choose to either continue or discontinue the exam. I would want to make sure the client is comfortable with me as the care provider all the way through the exam and appointment in total. I think it would look something like this: “I’m so sorry; I understand that my use of an inaccurate pronoun might be upsetting or hurtful. I recognize that your preferred pronouns are he/him and will do my very best not to repeat my mistake. Would you like to take a break from or stop the exam?”

Case Study 2

A student comes to you that is non-binary and prefers the pronoun they/them/their but isn’t sure how to present to your clients and is also not positive they are willing to come out to the community at large. You recognize the delicate process of coming out and do not want to rush them. You also recognize that some of your more conservative clients may not feel comfortable. You have to decide if you will allow clients to refuse to have a student that is in the LGBTQ+ community and still remain under your care (just as you will have to decide if you allow them to refuse to have a student of color and to remain under your care). Identify ways to manage this circumstance (assume for this discussion that you made the decision to include the student in your practice).

This is an easy answer for me. I would never allow clients to remain under my care if they were not okay with having a non-binary student in attendance. I intend to set up my midwifery practice as obviously supportive of LGBTQIA+ people as possible. Considering that, along with my own identity as a genderqueer person, I can’t imagine a scenario where someone would sign up for services with me without the understanding that they would be working with non-binary people. Even now, as a doula, my consultations with families often include a discussion about pronouns and the spectrum of feminine and masculine energy as it relates to how I doula people. No matter the identity of the student or the clients, I always introduce people with their preferred pronouns should that be their wish-and I know whether it is their wish or not because I’ve asked that specifically.

As for the student midwife, I’ve given this a lot of thought because I will probably be this student soon in my own community. I would want to chat with my student about some potential scenarios or challenges that might occur when working with conservative-leaning people. I think trouble-shooting and giving examples could help the student decide what they would and would not be comfortable with. I’d also allow room for each individual client to have a different relationship with my student if that’s what was needed. Perhaps the student would feel okay sharing about their non-binary status and asking for their preferred pronouns to be used with some clients, while not wanting to address it at all with others. This would definitely be an ongoing conversation between me and the student to make sure they feel as safe as possible in their learning environment.

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