Welcome to It’s Complicated, stories on the sometimes frustrating, sometimes confusing, always engrossing subject of modern relationships. (Want to share yours? Email pitches to email@example.com.)
Recently, while my partner and I were waiting for our labor-prep class to begin, the teacher came up to us and apologized in advance for using the phrase “you guys.” I must have looked puzzled, because she explained that she was from Chicago. “You know how Mike Ditka says ‘you guys’ all the time?”
If she was trying not to misgender us, she was way off. I didn’t care at all if she called us “guys” — my partner, who’s nonbinary (but is fine with she/her pronouns) calls herself a guy all the time — but I definitely minded the constant use of “mamas,” “moms,” and “ladies” to refer to the pregnant people in the room. My partner’s the one giving birth, but I’m the one who will go by “Mom” when our kid is born. The teacher seemed to realize that something about her pre-apology didn’t quite fit, but my partner doesn’t pass as male, so either the “trans” light didn’t flick on in the teacher’s head, or she had never encountered a nonbinary pregnant person before.
With a spouse who is about to give birth, I’ve got a lot of dad worries. Some are pretty typical for a soon-to-be-parent: We’ll run out of money and have to live under a bridge, the best person I’ve ever met will die at the hospital, we will never have sex again. But as a queer femme with a nonbinary partner, I’ve got some extra things to obsess about, especially when it comes to birth.
The worrying really kicked into high gear when we started a series of birth classes at the hospital. One of the handouts we received was a sheet of paper with a photo of all the hospital’s delivery doctors. Our regular OB/GYN, I was dismayed to see, was not among them.
It wasn’t just that we wanted someone familiar: When my partner and I were initially on the hunt for an OB/GYN, we chose her specifically because she was the only doctor we found whose online profile mentioned a specialization in LGBT issues. Her sharp haircut also reads queer.
“Nice overalls,” she said to my partner at our first visit, the queer sartorial head nod. We’ve spent eight months getting to know her, but she won’t be delivering our baby.
Except for her, though, we’ve had no indication that anyone in our Northern California hospital chain has experience with queer or trans people giving birth. We are always the only queer couple in birth class, and we’ve never seen anything but straight, gender-conforming people in the waiting room or in the birth-prep videos. In class, the nurse showed a picture of condoms and explained we’d all need birth control, even while breastfeeding. (“Otherwise, you get Irish twins!” she said.)
All of which is to say that I’m not wild about the idea of having to teach hospital staff LGBT 101 when my partner goes into labor. I want this to be an experience that feels safe, and a doctor making stupid assumptions about gender could throw that feeling of safety off entirely. And in a long labor with multiple shift changes, I might have to explain “birthing person does not identify as a woman but it’s okay if you use she and her pronouns” many times.
Sometimes when I envision the birth, I picture myself as a delivery-room monster, hyped up on adrenaline, yelling at the strange new doctor to stop calling my partner “Mommy.” Then my partner’s cervix closes up because she’s nervous that I’m yelling, we all get sent home from the hospital, and she gives birth in the back seat of the car because she’s become so much more relaxed, away from those jerks. In my imagination, this is the point where I cut the cord and lift the baby to the sky in triumph: “See! We didn’t need you in the first place! Now you won’t have to charge us $10,000 for the birth!”
But I know it’s wiser for me to focus on preventing that scenario. One way might be for us to create a birth plan that specifically requests LGBT-aware doctors and nurses. There’s a space on the hospital’s template form to write down your “cultural traditions.” Okay. Our cultural traditions include nude gay beaches, a lot of glitter, and rejecting the gender binary. Is that the place to explain that my partner doesn’t identify as a woman? Should we give them our VHS tape of Gender Trouble and ask them to watch it in advance?
That’s tempting. But it’s also possible that a long, detailed birth plan might actually make this experience worse for us. A 2016 study found that while birth plans do increase patient satisfaction, that’s only true if they don’t include too many demands. You might like the burger better if you add bacon, but not if you require the bun toasted and the sauce on the side and the meat cooked not even a second past minimum-rare. If you’re extra picky, you’ll be extra disappointed.
What does that mean for people like us, whose “cultural traditions” are politicized? Some nonbinary and trans people avoid hospitals altogether, paying for trans-friendly midwives and doulas. We can’t afford that. I am grateful to have decent health insurance at all, especially since LGBT people are less likely to be insured.
In practice, it means that we work within the confines of a system that doesn’t always seem to want to make room for us. I spent the class mentally translating the teacher’s gender references into something that made sense for my partner and me. (An especially tough task when she announced that partners had a special power: “Semen can get labor started!”) It’s a thing queer people do all the time: When we watch a movie or hear a song about straight romance, we find a way to pretend it’s a queer one. It’s why queer people are among the oldest fanfiction writers: We’re used to imagining ourselves in places where straight people can’t.
But birth isn’t a movie or a song; it’s one of the most intense experiences of anyone’s life. The teacher told us she hoped the class would help us avoid “trauma,” which is not uncommon: About 9 percent of people have diagnosed PTSD after birth. The advocacy group Postpartum Support International cites “feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery” as a contributing factor in birth trauma. Our teacher wanted us to be prepared to make thoughtful choices so we’d avoid that powerlessness, instead of white-knuckle panicking at the hospital.
The problem is that in this context, powerlessness isn’t something you can overcome with enough prep work. A Latino co-worker told me he and his wife decided to have their second kid at home after a white hospital nurse joked about how much their kid would like tacos. Black maternal mortality rates are alarmingly high in the United States, across socioeconomic lines.
Racial bias directly affects patient-doctor interactions and leads to worse health care for people of color, including during labor and delivery.
My partner and I are both white, so we won’t face racial bias at the hospital. But I am worried about navigating the institutional power dynamics of birth. If I’m too demanding — “Can you call her by her name, please, instead of ‘Mama’?” — I could get dismissed or laughed at or ignored or avoided, affecting my partner’s care. If I’m not insistent enough, it could have real medical consequences: Like a cat sensing the spot she’s picked out to have kittens isn’t safe anymore, her body can lock up and reverse dilation if she doesn’t stay relaxed, leading to a more difficult birth. It’ll be my job to help her stay calm, making calculations quickly on her behalf. But here’s one I haven’t been able to figure out yet: Is feeling understood during labor too much to expect? Or is it an essential part of good medical care?
I hit a jackpot with my spouse: I get to spend my life in a relationship where gender doesn’t dictate what chores we do, or how we spend our time, or how we have sex. But we are extra vulnerable in an institution like a hospital. All I can do is hope that when we show up on labor day, someone who gets us shows up, too.