Maternity

Getting pregnant in the United States as a transgender man

Transgender men can get pregnant. Here's what they wish more people  understood.

When I began my transition over 13 years ago, the thought of having one child — much less two — was the furthest thing from my mind. That nonexistent thought became an impossibility when I began my medical transition and was informed by my doctor that the use of testosterone would render me infertile after prolonged use. For me, that was perfectly fine. My main and only concern was feeling happy and at home in my body. And, if I’m being honest with myself, I never wanted children when I identified as female. I didn’t grow up envisioning myself with a family of my own.

I’m a seahorse dad, gay Black man, transgender man. I gave birth to my first daughter on January 9, 2014 — four years after beginning my medical transition. Six years later, I gave birth to my second child on July 21, 2020. Neither pregnancy was planned. I am a man who identifies as the same gender and enjoys dating males. While the logistics of how I have sex is really no one else’s concern, one should be able to deduce how I was able to conceive due to the fact that I found out about both of my pregnancies — rather than planning them.
“Despite knowing my sexual history and practices, no one suggested a pregnancy test. I discovered I was pregnant by myself.” With my first pregnancy, I didn’t find out I was pregnant until I was five months along. I absolutely went to the doctor, so it’s not because I didn’t.

I was in and out of the doctor’s office with symptoms like extreme fatigue, unexplained weight gain, and frequent urination. My provider at the time was also a transgender man. Despite knowing my sexual history and practices, no one suggested a pregnancy test. I found out on my own that I was pregnant. When my pregnancy was confirmed, I was referred to an OB-GYN who knew literally nothing about how to care for me as a trans person. I was constantly misgendered, subjected to uncomfortable jokes at my expense from the nursing staff, and always had to be on guard and ready to defend myself. My blood pressure was constantly elevated and as a result, I was induced due to preeclampsia.

“I didn’t feel like I had autonomy over my own body and experience.”

I was admitted to the hospital’s labor and delivery department in Philadelphia, Pennsylvania. Upon arriving, I asked if it would be possible for me to have a C-section. I told them that I couldn’t imagine myself giving birth vaginally. I was told that I would not be able to have a C-section because it was too risky and because “all of the women on the labor and delivery unit would prefer a natural birth.” For five days, I was connected to a magnesium drip and unable to get out of bed or eat solid foods. To make matters worse, anywhere from 10 to 15 students were observing me in my room at any given time. I felt like a rat in a lab. It was extremely uncomfortable and I didn’t feel like I had autonomy over my own body and experience.

On the fifth day, the doctor finally showed up and revealed the strategy: they would keep trying to induce me. I had a complete breakdown of the nervous system at that point. I couldn’t take it anymore. I brought the doctor back into the room and informed her, “I know you said that all of the women on the labor and delivery floor would prefer a natural birth, but I don’t know if you’ve realized that I am not all of the women on the labor and delivery floor.” At this point, either you cut this baby out or I will. Your choice. After thirty minutes, I was on the operating table. But it was too late. The harm was already done. My experience left me irreversibly traumatized, and I connected that trauma with my daughter. As a result, I suffered from severe postpartum depression, anxiety, and post-traumatic stress disorder. I spent the better part of two years just trying to be okay and found it nearly impossible to connect with my child. It was extremely challenging because I had little to no support or postpartum care, and I was so focused on resisting the urge to kill myself. One of the most understudied and overlooked marginalized groups is transmasculine people. As you are (hopefully) already aware, Black cisgender women experience the highest mortality rate in the U.S. during childbirth. Non-Hispanic Black women will experience 55.3 deaths for every 100,000 live births in 2020, according to the CDC. Non-Hispanic white women have a mortality rate that is 2.9 times higher. The issue at hand is how transmasculine people, particularly Black transmasculine people, fare. We don’t know: Transmasculine people are one of the most understudied and overlooked marginalized groups in maternal health research.
Only recently, thanks to the growing visibility of transgender people, has the topic of transmasculine pregnancy become a part of the conversation. Increased conversations (mainly in politics, with more and more legislation attempting to hinder access to affirming care) have compelled providers to want to learn more about our unique experiences. This has led to more attempts at including transmasculine people in pertinent studies — with the goal of being able to provide safe, equitable care.

So, why is any of this relevant? As a Black trans man who has had to navigate medical birthing spaces in the U.S. twice, I am living, breathing proof that a lack of education will almost always lead to traumatic, life-altering experiences. Childbirth is supposed to be a joyful experience regardless of a person’s race and/or gender identity. And what’s more — the experience a person endures during their pregnancy and childbirth will likely directly affect their postpartum experience.

What should change? Education is key. The very first step to providing safe, equitable care for transmasculine individuals is educating yourself. The best way to do that is to hire a qualified transmasculine person to provide training for you and your staff. It is also extremely important to remember that not every experience is the same. Different care methods are needed for intersecting identities. A Black transmasculine person’s experience will likely differ greatly from someone who is non-Black due to things like racial biases and systemic racism.

Representation matters. Using inclusive language (i.e., “birthing people,” “gestational parent,” etc.), using inclusive imagery, and making sure that your intake forms are inclusive as well are all ways to show transmasculine folks that a practice or organization is a welcoming, safe space. Small changes make a huge difference. I am aware that change scares many people. There is also the politics surrounding inclusive language/imagery — people feeling like including trans and non-binary people in the conversation is erasing women/mothers. But inclusion does not equal exclusion. We all have a right to a seat at the table, and we all ought to receive high-quality treatment and representation. to my community of transmasculine men… If you are currently pregnant or are considering taking the pregnancy journey, arm yourself with knowledge. Know that your body is yours and that you have complete and total autonomy over your pregnancy and birth.
Employing a doula is my most important piece of advice. A doula can help by acting as a buffer between you and potential problematic providers, providing emotional support throughout the pregnancy and after the birth. If at all possible, have as much community and familial support as possible.

Don’t let society or anyone else convince you that you are undeserving of the life that you have envisioned for yourself. That we all deserve happiness is undeniable, regardless of the political climate.

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