Jul 15 min read

Gender Identity and Pronouns in the Hospital During Birth

Updated: Jul 18

lgbtq family at pride celebrating with a rainbow flag, two queer adults and their children

What is the issue? Feel free to skip this section if you already know

Getting medical professionals to respect patients’ pronouns is one important aspect of a larger struggle against the cisnormativity ingrained in much of medical research, education, norms, and practices. Particularly when it comes to childbirth, many long-held associations between childbirth and womanhood make it difficult for trans and non-binary people to get adequate counseling before pregnancy and appropriate care while pregnant or giving birth. Undone research and untold stories add to the unnecessary difficulty of receiving perinatal care. Examples of issues include:

Bioessentialism, "only women can give birth," and lack of understanding the difference between assigned sex and gender
Lack of research on anyone outside of the heteronormative structure (including single parents by choice, queer and trans birthing people, and adoptive parents)
Lack of exposure and training
Inclusivity being used as a political tool and re-contextualized as "controversial"

Ways people have gone about gender presentation and pregnancy

Regardless of how someone chooses to hold their trans and/or non-binary identity alongside their identity as a pregnant person, some grounding principles will not change based on others’ perceptions or how you choose to respond to them.

Grounding principles:

Not unique, not other, not an anomaly - no birthing experience is the same, but there are so many people in your corner regardless of if there are a few individuals, for lack of a better term, who try to make you feel like a diversion from the “usual” (and, in fact, anywhere from 24% to 54% of TGE people want to have children; although that range highlights the need for further research).(1)
You can feel differently about your own body and childbirth than you may be perceived. However, it is also completely valid to feel your gender identity and pregnancy are at odds with each other. Here are some people’s experiences quoted in research articles:
1. “Pregnancy and childbirth were very male experiences for me. When I birthed my children, I was born into fatherhood.”(1)
2. Another person noted, “‘I didn’t feel dysphoric in my body, I felt dysphoric in the language used to talk about my body.’”(2)
3. Some trans men felt like their pregnancy represented a purpose for the body they have. In contrast, other men felt disconnected from the fetus and their body.(2)
No matter how you go about it, your gender identity and the fact that you are creating a life will not change

There are several ways that people have chosen to go about their pregnancy, recognizing the gendered perception people might have of them. There is no right way or better way, and feelings about what path works for you can change moment-to-moment.

That said, here are three ways that people commonly report going about being pregnant and expressing their gender identity:

Passing as a pregnant woman: people who chose this route reported feeling safer and experiencing less overt transphobia. Additionally, they were able to enjoy the social support and affirmations they may not have had if they had chosen to conceal the pregnancy. However, it was often associated with increased gender dysphoria. For example, “Hoffkling and colleagues (2017) found that some pregnant transgender men hated being in public settings because they knew they would be read as a cisgender woman.”(1,2)

Hiding the pregnancy: people who chose this route saw that it decreased the likelihood of transphobic discrimination, but did not allow them to hold both identities of their gender and being pregnant. Additionally, people may have missed opportunities for social support and affirmation around their pregnancy.(1,2)

Holding both identities visibly: people who chose this route appreciated that they could hold both identities and reported feeling “internal happiness,” but were at a higher risk of transphobic discrimination.(1,2)

Often pregnant people end up doing some combination of all of these, including waiting to see who their provider is before deciding whether or not to disclose information.

How can a doula help?

A doula, particularly an LGBTQ doula, can help navigate the gendered environments someone might encounter along with being a familiar presence who you know understands your identity and wishes. During prenatal care, this can include talking through how you are feeling about becoming pregnant relative to your gender identity. They can also share similar experiences and TGE-specific knowledge with you to combat the isolation, particularly “informational isolation,” that is commonly reported.

For care in the hospital, a doula can help you decide how you want to interact with providers, including if you want providers to use correct pronouns, not gender the baby, or use certain anatomical language. These plans may change given the burden of having to correct providers while needing to focus on…giving birth, and doulas can be there to help you through those changes. Some physical actions that doulas can take to help include writing pronouns on the whiteboards in hospital rooms, or adding a sign to the door with your correct pronouns. Additionally, full-spectrum doulas often provide care after childbirth, providing additional time to debrief and unpack any gender-based harm that occurred.

Some topics you may discuss with a doula might include:

Past experiences with gender dysphoria
Past experiences with medical professionals
Mapping a social support system
Language to advocate for in the hospital, including pronouns
Ways to check in with yourself as you go
What interventions you want or want to avoid (ex. trans people who had previously used testosterone were more likely to request a cesarean)
How to talk to a provider about developing a plan for safe cessation of testosterone before becoming pregnant
Where, and with whom, you want to give birth (ex. “research also suggests that a disproportionate number of TGE people seek care from a midwife instead of a physician and decide to give birth in a community setting — at home or in a freestanding birth center — rather than a hospital.”(1))

“The same elements that threaten holistic care for pregnant and birthing folks also perpetuate violence against trans, queer and non-gender conforming people. These systems include, but are not limited to, profit-based, industrialized medical care, colonialism, sexism and patriarchy. When gender-nonconforming folks are also people of color, low-income or disabled folks, they disproportionately experience discrimination. As a result, we are committed to promoting the additive use of gender-neutral language in traditionally woman-centric movements (birth and reproductive justice) because doing so disrupts those systems and supports gender liberation.”

MANA (Midwifes’ Association of North America) (3)

Note that midwives, working in both birth centers and in homes tend to spend a lot more time with their clients and therefore get to know their clients more deeply. Many TGE people find that this allows for more space to be known and a higher likelihood of their gender identity being respected.

Others’ experiences and advice: