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What it’s like to be a midwife for queer and trans parents

Queer people have been having families for as long as there have been queer women, but in recent years, there are more resources and different methods to build families. The most conventional options-having babies at the hospital, high incidence of medical interventions all throughout the pregnancy and birth-remain the ones that people know the most about. There are a lot of ways that people can have families-including less medicalized options-that people may not have a lot of information about!

We are discussing these options not to shame or belittle anyone for making more conventional choices, but the opportunity to discuss what one practitioner finds valuable about midwifery and home birth in particular. She’s an old friend of mine, and I (and most of my siblings) were born at home, back in the ’80s when fewer people were doing that. It’s something that has a special significance for both of us.

On a recent visit, I interviewed an old friend of mine, Tel Viehmann of Taproot Midwifery, formerly of Long Beach and recent transplant to Sacramento. Tel is a licensed certified midwife, the kind that has had medical training and a lengthy process of certification, (thousands of hours clocked, and hundreds of births attended) but sought this training specifically to do home births rather than a certified nurse midwife, who you might meet in a hospital.

AfterEllen.com: What do you do and why?

Tel Viehmann: So, I’m a licensed midwife, which means that I help folks with their pregnancies and births, usually outside of the hospital. It also means that I do a lot of fertility work. I do inseminations with folks in my office or at home. I’m also certified in the Arvigo Techniques of Maya Abdominal Therapy. What this means is I do work on people’s pelvises and abdomens externally that helps with fertility and overall health of the reproductive and digestive organs.

AE: If someone was considering a midwife, what would you want them to consider?

TV: When you think about the type of provider you pick, think about the care setting that that’s going to be in. As a licensed midwife, I’m not working for a corporation or a hospital; I’m working for my clients, and I’m my own boss, which means I get to set up my practice however I want to. What that effectively means, is that when people come and have appointments with me, it’s at least an hour long, and my care is customizable and unique to their individual needs.

Frankly, when you think about, vulnerable populations having babies-queer and trans folks-you may want to have extra time for your care provider to get to know you to understand your perspective and make sure that they’re providing really excellent care.

It’s important not only that they’re understanding your gender pronouns but also, what do you want to call the bodily processes that you’re doing? What do you call your body parts? When I spend so much time with someone throughout the course of their care, I can hold that space for them. You don’t get that in 15 minutes with an OB or half an hour with a hospital/CNM midwife. I think lots of people would like to provide that space, but because of the structural challenges in providing hospital-based care, you just don’t get the freedom to do that.

From there, choosing a care provider who may be queer or a straight ally-you’ll want to do some interviews. The thing to think about midwives, in general, is that they have really big hearts, and want to serve vulnerable populations. But that doesn’t mean they’re serving vulnerable populations-POC, queer folks, trans folks-well.

I have worked with midwives who wanted to work with these clients, and welcomed them into their practice, but then expected their clients to give them a Gender 101 or a Queer 101 talk and start at the very beginning.

Having a baby or doing an insemination is not the same thing as going to get your elbow checked out, or your busted nose checked out. It is an incredibly personal intimate time. It is a time when [care providers] need to hold that space and care for folks, and it’s more important to do that when folks are pregnant.

AE: So, you focus on serving queer and trans clients in your practice. Tell me about that!

TV: I love getting to serve my community and knowing that I’m doing it very well. When it comes to fertility and insemination, most folks if they’re not seeing a midwife are seeing a medical endocrinologist. Those places tend to be set up to serve straight folks who have been trying for years and years and have infertility issues, which is why they’re going to see an infertility specialist.

Certainly, there are queer and trans folks with infertility issues, but most of the time people are not getting pregnant because of lack of easy access to sperm. When you go see a reproductive endocrinologist you get set up on a path of a what they normally use for a high-risk pregnancy. You start in this very medicalized model-when you may not have a pregnancy that is any more high-risk than anybody else’s.

You get shuttled right along this very medicalized model, and very intensive and medicalized follow-up early in the pregnancy, frequent ultrasounds, hormones. Typically, this is treatment that we would give to somebody who has had frequent miscarriages and infertility issues in the past, but that doesn’t apply to most of my queer population.

It’s a beautiful paradigm shift when people come to see me so that I can help them get pregnant. We can do it in my office and have it be very business-like, or we can do it in their home, and they can light all the candles and say all the prayers they want and have it be incredibly intimate and sweet. I feel passionate about helping people create their families in the least intrusive way possible.

I also love working with my fertility clients when we are successfully able to create a pregnancy, and then they continue with me through their pregnancy, birth and postpartum. People don’t always choose to do that, but when they do I have this wonderful opportunity to get to know them really well. It’s so important to me to work with folks in a way that sees all of them, sees their family, never screws up their gender pronouns, respects the names they use for their body parts. I feel like when you start with a provider, often you are starting at a negative, and at a deficit of trust. I do my best to start at more of an even playing field with my clients.

They assume that if you’re queer, they also assume that you’re gender-competent, and that’s not always true. I don’t think it’s a given. Even folks say they’re queer friendly, it’s not a guarantee that folks will be trans or queer friendly. Even if a provider is queer, it’s not a guarantee that they will be trans-friendly.

In my own family, my partner gave birth to our daughter just about three months ago. We interfaced with the medical system in a way that we were not anticipating due to some health issues that have been resolved. Going through this experience with my family has made it really personal and present how good the care is that midwives are able to provide that looks at the whole person.

We were in the NICU with our daughter for nine days due to a heart condition, and it wasn’t until seven days that anybody asked us what parenting terms we preferred and what we wanted to be called. I go by Baba, and everybody was calling me Mama, and most the time I smiled and nodded-because when your kid is sick, you don’t want to have a conversation about your gender.

Providers kept asking “Who is the parent?” What they meant was, who gave birth to the baby, but all the same, it felt really intrusive and disrespectful to the relationship I have as a parent to my daughter. I cannot imagine doing that from the very beginning of prenatal care, and having to go in with that defensive stance.

Another thing that happened due to bureaucratic missteps. My partner had given birth to the baby, but without asking someone registered that I had given birth to our baby. That has screwed things up for her already! Whenever we interact with any kind of social service agency, people think we’re trying to pull a fast one on them, because nobody bothered to ask who have given birth to our baby, and administratively and bureaucratically things are set up in a very heterosexist way.

AE: Do you have anything to say about queer folks working with a sperm donor and considerations that they should have?

TV: So first of all: I’m not a lawyer, this is not legal advice. I always recommend my clients see a lawyer, or check out their local LGBT center, often they have free legal clinics or recommendations. If you are trying to get pregnant, there is a real difference in your legal whether you use a known donor-fresh sperm from that person vs. going through a sperm bank. The law assumes that if a guy goes and donates sperm to a sperm bank, it assumes that he is fully aware and not intending to parent any children that may ensue from his genetic donation. Whereas it gets into a lot more gray area with a known donor.

In California this last summer, a law was passed if you’re planning on using a known donor, as long as you have a signed contract that is notarized and the law gives some good examples of legal language it wants you to use. As long as you have that signed before the first insemination attempt, then you are set in terms of having the same legal protections as someone who went to a sperm bank. However, this varies so much state by state I really recommend folks check out what are the laws are in their state. My recommendation is that whenever you have a known donor to have some kind of contract notarized.

If you are in a state where there are not a lot of legal protections, go see a lawyer and have them draft that language with you.

Then, once you have the baby, I think it’s a very good idea to get a second parent or step-parent adoption. Hopefully in the next decade that will get worked out so that same-sex parents don’t have to go through the process. There’s a lot of controversy and debate in the queer community about whether or not you need to do that. My strong opinion and recommendation is to pursue a second parent adoption, even though it’s costly and even though it’s terrible to have to adopt your own kid. Here in California they have waived the need to do a home visit, is my understanding. But if you ever leave the state, if you ever want to leave the country, I really recommend it as a precaution. The state is set up in a way to privilege heterosexual married couples, and has not caught up yet.

AE: How do you talk with queer couples about navigating any complicated dynamics around who is the gestational and who is the non-gestational parent?

TV: Everybody is so different! I have clients for whom it is very cut and dry about who is going to be the gestational parent, and who is not. Sometimes that is a very firm thing in a relationship.

Sometimes I have folks who both very much want to be pregnant at some point, and I think that process is difficult because sometimes. I often have folks in that situation based one who’s going to be the GP based on age. It gets complicated when there’s not an external factor.

Talking about it a lot as a couple, and with your midwife can be really valuable. What I can help folks do is go through some thought experiments about what life will be like, because when folks are trying to have a baby they’re very much in this right now kind of moment, and it’s hard to think about the future. What’s it going to feel like when my partner is pregnant? What’s it going to feel like when my partner is giving birth and breastfeeding? What will it be like a couple years past childbirth?

Having a real commitment to honesty and communication and being vulnerable when unexpected thoughts and feelings that come up, knowing that it was going to get uncomfortable sometimes, has been the most helpful for me and my partner.

Sometimes the situation comes up of someone who very much wants to become pregnant struggles and sometimes can’t. In this situation, the partner less enthusiastic about becoming pregnant sometimes is able to get and remain pregnant. In that situation, it’s common for feelings of resentment, feeling not good enough, like there’s something wrong with my body, all come up during pregnancy and translate into parenthood. When those things come up, therapy, community and getting lots of support are very important.

AE: What can people expect if they decide to work with a midwife and plan for a home birth?

TV: We work with low-risk pregnancies, so just for people to be aware, that’s why we can give birth at home instead in a hospital. They come see me for an hour at least in my office once a month until they’re 28 weeks pregnant, and then every other week until they’re forty weeks pregnant, and then once they’re 36 weeks, and then once a week until the baby is born.

I do offer all the same tests and procedures and all that that you would in any maternity care setting-if you went to see an OB or CNM, all the same blood draws and swabs and all that. I can’t send you down the hall to my ultrasound tech-I would have to refer you out.

One of the things that I think is really special about midwifery care is that informed care is at the core of what we do and I don’t make decisions for people. So if people want to refuse a gestational diabetes screening, or if they want to do it so that they’re not drinking the nasty glucola drink that you get in the hospital. If they want to do a food based smoothie, I have several options in my care that they get the same care but we get to customize it for them.

Anytime I offer a test or a procedure we’re going to talk in depth about what that test or procedure is, and why some people want to do it or not want to do it. But if for example in their last pregnancy they had gestational diabetes, and everyone in their immediate family had gestational diabetes, we should probably do the test! But we’re going to talk about it.

My care is really customizable-when it comes time to have your baby I come to your house, it looks like I’m moving in. I have all the same emergency equipment they would have at the hospital-I have oxygen, I know how to resuscitate a baby, I have the medications for post-partum hemorrhage, and IVs, and antibiotics, and we can suture at home-you’re just at home.

So if you want to walk around, if you want be in the shower, if you want to be in the birth tub, if you want to eat or drink, really I think that as much as we can have an uninterrupted physiological labor, that really is a safer labor and a safer birth, without unnecessary interventions. The less fear we can introduce, the more we can help folks feel really safe and comfortable, and let them do what their bodies are going to do, he better. We wind up with safer and happier births, and happier and healthier babies.

After they give birth I stay for three to four hours, we help clean up their house so it doesn’t look like they had a birth in their house, I cook them a meal, or my birth assistant does. I make sure that everybody’s safe and happy and we do a whole head-to-toe newborn exam. Mostly, though, we’re cleaning up and tucking people into bed and making sure that they’re bonding, and that feeding is getting a good start.

Then I see people a lot post-partum, this is where I feel like midwifery really excels-when you have a baby in a hospital, you might stay for 24-48 hours and then go home, and your baby sees your pediatrician all the time, but you don’t see your OB for another six weeks. If you have a midwife, I’ll come back and see you one day after your birth, three days, seven days, all in your home, and then you’ll come back to my office at two weeks and six weeks making sure that feeding’s going well, checking everything out, seeing if there is any post-partum depression, and addressing any concerns you have.

Maria Turner-Carney is a therapist and writer who lives in Seattle. You can follow her work at seattlefeministtherapy.com/blog.

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