Trans and Pregnant: How to Find Competent, Gender-Affirming Healthcare

Can pregnant trans men and nonbinary people find compassionate healthcare?

The answer is yes, of course. But it isn't always easy. However, transgender folks don't have to settle for being misgendered and misunderstood to have children.

Trans people need and deserve quality, compassionate healthcare. While this is true all of the time, it becomes especially important during pregnancy. Trans men and nonbinary or genderqueer people who become pregnant have just as much right to competent healthcare as anyone else, but they often encounter many challenges and barriers.

The assumption that only cisgender women have babies can make finding the right OB-GYN, midwife, or doula daunting. It's possible to find great birth workers who are ready to support trans parents. Trans people don't have to settle for subpar treatment or discrimination in the healthcare system.

Here are some tips and resources to help people find a supportive, trans-friendly team of providers to make their pregnancy and birth as healthy and happy as possible.

Decide what you're looking for

The first step is to know what type of provider and birth setting you want.

People with uncomplicated, healthy pregnancies have many options to choose from. High-risk pregnancies or certain medical conditions may require more comprehensive care at a hospital for the safety of the parent and baby.

OB-GYNs typically work out of hospitals or clinical settings. Some midwives attend births in hospitals; others go to birth centers; some help clients deliver at home. Doulas offer additional support to the birthing parent, whether in the hospital or elsewhere.

You can choose to work with one or a combination of these providers based on your needs and preferences.

The laws that regulate these differences vary from state to state, so do your research first. For the purposes of this article, we'll start with finding birth providers within the hospital system, which includes OB-GYNs and nurse midwives who attend deliveries in hospitals or birth centers.

Next, we'll focus on birth providers outside of the hospital system, which includes home birth midwives and doulas, whether or not the actual birth will take place in a hospital setting.

Make sure to check out resources for the LGBTQ community

Starting with trans-friendly recommendations can make the task of finding a birth provider much simpler.

To narrow the search, it may help to start with a list of providers using the resources in this guide for finding a healthcare provider who's an LGBTQ ally. Another helpful list of providers comes from the popular Facebook group Birthing and Breast or Chestfeeding Trans People and Allies.

You can also try reaching out to your local LGBTQ organization or clinic. Many have lists of trans-friendly businesses and healthcare providers, including birth workers.

Keep in mind that just because a provider considers themselves LGBTQ-friendly doesn't mean they're well versed in trans issues or treating trans patients. You may still need to vet them.

Online reviews can be helpful, but the best way to find out is to do your own research on the provider and call the office before making an appointment. Ask what services they can provide, the provider's experience, and any other questions that are important to you.

Finally, word of mouth is invaluable. If you know trans people in your area who have given birth or been pregnant, ask them who they went to for care and what their experience was like.

If you don't personally know anyone, you may be able to find a trans community in your area online. It's extremely likely that you'll find some people who have given birth there.

For midwives and doulas outside of the hospital, the ball is really in your court

When hiring a provider outside of the hospital system, you'll usually first contact them by email or phone. Make sure to be upfront about your identity and the treatment you expect right away. Don't be afraid to ask them questions about their experience with trans people.

Many patients also conduct an informal interview with independent midwives or doulas before deciding to work with them. This is a great time to get a feel for how they'll treat you as a transgender birthing parent. Also ask any other questions about their practice.

Just like the traditional healthcare system, the so-called 'natural birth community' does have its share of transphobia and gender essentialism. Make sure to exercise caution, but also know there are great people out there ready to help trans people have empowering births.

Only you can decide what and who you're comfortable with. Some providers might be trans-friendly in theory or in attitude but lack a lot of experience with trans people. You may have to educate them along the way.

For some people, this trade-off is OK if it's a provider they otherwise feel great about. Others may only feel comfortable with someone who's more familiar with trans people, identities, and language.

If you're hiring a midwife for a home birth, inquire about any assistants or apprentices. Make sure everyone is on the same page.

For in-hospital midwives and OB-GYNs, be prepared to navigate the whole hospital system

In-hospital providers present their own unique challenges. In many hospitals, you may see the same doctor or midwife for all of your prenatal care, but the birth is attended by whichever provider is scheduled for that day or available; the baby may come early or late (unless you have an induced delivery or scheduled cesarean section).

It's a good idea to inquire about the hospital's (or birth center's) policy on trans patients. Be wary if they don't have one.

Also call ahead and ask about the provider's experience beforehand. If you're able to tour the labor and delivery unit early on, that's another great time to ask questions and gauge whether or not the setting is right for you.

A little confidence goes a long way!

Whenever you encounter providers — whether it's for your first visit or you're in the car about to arrive at the hospital to give birth — simply call ahead and specify your gender identity and the pronouns you wish to be used.

Most people should be receptive. This reduces the chance of an uncomfortable encounter when you arrive to meet in person.

Trans people can and do have wonderful birth experiences with supportive healthcare providers. Don't be afraid to ask questions, advocate for yourself, and demand respect.