Not everyone who gets pregnant is a woman. Birthing and parenting can also extend to transgender, nonbinary, and gender-nonconforming people who were assigned female at birth but now identify differently.
Cora Beitel is a registered midwife who identifies as nonbinary and uses they/them pronouns.
“I’ve definitely encountered doctors and nurses who have misgendered people and have had trouble respecting people’s needs around their identity,” Beitel told the Georgia Straight in an East Vancouver café.
Beitel cofounded Strathcona Midwifery Collective in Vancouver about five-and-a-half years ago; it has since become one of British Columbia’s most queer-friendly midwifery practices. About three-and-a-half years ago, the clinic established a queer and trans parenting and pregnancy community group.
“With establishing that group, I think our clinic became more known for providing inclusive midwifery care but also focusing on more than just the medical care,” Beitel said.
Their expertise is in high demand. Last year, they spoke at the triennial congress of the International Confederation of Midwives in Toronto as part of a symposium about the lived experiences of queer and trans midwives and clients. In the past few weeks, numerous requests have filled their inbox.
Beitel doesn’t disclose their gender identity and pronouns during work unless they are caring for a trans or nonbinary client, as they don’t feel comfortable inserting that part of their identity into a job where their clients are the focus.
Gender-neutral language in midwifery has previously caused controversy. In 2015, the Midwives Association of North America changed its documentation wording from “woman” to “pregnant individual” or “birthing parent”. A group called Woman-Centered Midwifery circulated an open letter protesting the changes, arguing that “pregnancy and birth are distinctly female biological acts.”
Tracy Simpson, a midwife and former board member of the Midwives Association of B.C. (MABC), felt that something needed to be done. The letter, in part, prompted Simpson to propose a working group within MABC—called Gender and Sexual Inclusivity (GASI)—to focus on queer and trans needs in midwifery.
“As a queer and gender-nonconforming midwife…I’m more aware of the issues,” group chair Simpson said by phone. “It’s something that affects me personally.”
Beitel, who was previously part of GASI, understands where some of the resistance to inclusive language could be coming from.
“For a lot of midwives, it feels really important not to lose the word woman in the way that we talk about midwifery, because it feels like it’s really connecting to the history of the work that’s been done,” they said. Beitel thought that the word woman could still be included in documents so long as it was alongside inclusive language like client, family, or person.
Being gender-variant and pregnant can create challenges medically, personally, interpersonally, socially, and professionally, according to Simpson. “Being put in a position where they need to educate their care providers on how to take care of them, it’s a ridiculous position that trans folks are in all the time,” Simpson said.
GASI, which started in March 2017, is designed to advocate for queer and gender-variant midwives, clients, and children born to clients, promote inclusive models of care, and provide education to B.C. midwives at large.
In December, the committee organized a training session attended by more than 100 people to help midwives understand queer and trans health needs; B.C. has about 300 registered midwives.
Mel Mundell, MABC communications director and GASI member, noted that the event took place at B.C. Women’s Hospital. “There’s an example right there of gendered language and birth,” said Mundell, who identifies as queer and uses they/them pronouns.
Providing inclusive care goes beyond using the right words, though. Beitel said the physical space of a midwifery clinic is a key place to start—including knowledgeable administrative staff, diverse posters and images on the walls, a variety of library books detailing different experiences, and single-stall nongendered bathrooms.
In terms of care, Beitel said, providers need to ask open-ended questions, not make assumptions, and take it slowly.
“Within midwifery care, we have the opportunity…to really slow down and not rush through our appointments, not rush through physical exams,” Beitel said. “It’s really taking time with people’s health care and with their bodies in a way that’s honouring that there’s so much more at play than what you’re seeing in that moment.”
In hospitals, the change is slower: doctors and nurses often greet new patients with, “Is it a boy or a girl?” Beitel said this is a difficult question for people who don’t identify with the gender they were assigned at birth.
Institutional change takes time, but Beitel said hospitals are making steps. They think health-care workers are generally amenable to change if it means they are helping their patients.
“Health-care providers want to do well by people,” Beitel said. “It’s why we do this work.”