May 2017
Mother's Day: LGBTQ Focus
Happy Mother's Day!

Whatever this day looks like for you and your family (or however you wish it would look), we honor and celebrate your motherhood. We are so privileged to serve the diversity of moms that we do--young and older, first-timers or more seasoned mothers. We all bring such variety to the role of mother, but the common thread is what unites us--we care deeply for our children, and we are upfront about how challenging that may be, especially with a perinatal mood or anxiety disorder.

This month we especially honor the LGBTQ moms in our midst. We have an Provider Corner interview with Kristin Kali, a licensed midwife who specializes in LGBTQ family-building, including fertility services. We also hear from Rowan, a mom and a trans man who shares his experience of motherhood and his perinatal mood and anxiety disorder. We highlight new research about lesbian non-birth mothers and their transition to motherhood.  There is a great list of LGBTQ preconception, pregnancy, and postpartum resources. And importantly, our Parent Corner takes an honest look at Mother's Day and how we can handle our complex feelings about it.

We hope your day is special, in whatever way works for you and yours.
In This Issue
Parent Corner
The Truth About Mother's Day

Mother's Day does not mean anything. I will repeat that. Mother's Day does not mean anything. Yep. That's what I wrote. I know some of you are thinking, but it's my day! And if that's your experience--yay! But for those of us who are over the pressure of having the perfect Mother's Day or for you new moms who have enough going on right now, let's just treat it like any other day. No expectations. The truth is when you have young children there isn't a whole lot of predictability or much opportunity for time off for any parent.
Of course I think it is important to spend time telling moms how awesome and important they are--EVERY DAY! I also don't think we can expect our loved ones to live up to the expectations of a greeting card-perfect Mother's Day. Nor should we feel like how we spend our Mother's Day has anything to do with how well we mother. How your family does or does not celebrate you on Mother's Day says nothing about you or your family. We're all doing the best we can and that is enough.
Some moms really want to spend the day "momming' with their brood. Some moms just want a damn break already. Many of us fall somewhere in between. If you want something then take matters into your own hands, Mamas. Do you want breakfast in bed? You might have to buy all the ingredients, email your partner a recipe, and remind your family in the morning. Although you'll probably also have to be explicit if you don't want to clean up after. Do you want time for yourself? You might just need to make arrangements to leave the house for an hour and trust that your partner, a friend, or a family member can take care of the family for a short time while you recharge. Do you just want to have a regular family day with no expectations? Let your family know you don't expect gifts or special treatment ahead of time. Enjoy the day any way that's possible! And then continue to enjoy the days after that and know that you are loved and appreciated and important.
Rowan, a Mom and a Transgender Man

Could you tell us about yourself and your family?
My funky little family consists of my son (Little Padraig), and my two partners (Big Padraig and Nic), and me. All three of us adults are some flavor of gender non-conforming--I am a trans man, Nic is non-binary trans masculine (identifies as masculine-of-center but not male), and Big Padraig is gender-fluid (identity and presentation shifts around the gender spectrum). We don't do "normal" in this family AT ALL, and it's kind of wonderful.
What was your experience with perinatal mood or anxiety disorders?
I mostly remember feeling frantic all the time. I was always terrified of what was going to go wrong. I would wake up 20 times a night to make sure my baby was still breathing. It completely freaked me out if he was out of my sight. Everyone and everything was a threat, and I had horrible intrusive thoughts about the people around me hurting him.
I also constantly felt like I was a failure. My son had a very severe tongue-tie that wasn't caught until he was almost two months old, so he had trouble gaining weight and was frequently ill. In my mind, it was all my fault--I wasn't trying hard enough at breastfeeding, I was failing to keep him healthy. These thoughts quickly degraded further--I thought that I was an awful mother, and that my son was better off without me.
What was your recovery like? What were the keys to your recovery?
There was this moment--I was sitting in the nursing chair in my lactation consultant's office and she was trying to figure out why Padraig wasn't latching properly. I was so frustrated and exhausted. She took him out of my arms to look in his mouth and I just started shaking and sobbing. She asked me, "How are you doing?" and it just all came out--that I felt like a failure, that I was scared, that I wasn't sleeping. She calmed me down a little, handed Padraig back to me, and stepped out to call my doctor. I remember hearing her tell the scheduler, "This is an emergency. We need an appointment today." I saw my doctor that afternoon. She wrote prescriptions for an anti-depressant and an anxiety medication, and gave me a referral to a therapist.
For me, the most important pieces were the medication, and getting connected with a great support group. The mothers I met there, the space that was created... it was amazing. There's no feeling in this world like feeling safe enough to talk about the scary stuff, and then realizing that you are not alone. After my first meeting, I felt like I could breathe again, like maybe everything really was going to be okay.
You had mentioned that gender dysphoria about being pregnant and breastfeeding played a role in your postpartum depression and anxiety. Could you explain a little more about that?
So, it's important to know that I did not identify as trans until my son was almost a year old. I always knew something was "off," but I didn't have the tools or language to describe it.
Everything felt so foreign and strange. I had always been very uncomfortable with my body, very disconnected from it. When pregnancy made my hips get wider, my breasts get larger, and I started to get a visible baby bump, everything just felt wrong. I was already uncomfortable with the "female" parts of my body, and pregnancy put those parts center stage. The expectation is that pregnancy is supposed to be this time where we take joy in all of the changes, and I just couldn't. I was stuck in a loop of feeling awful about my body, and feeling awful about feeling awful. I was worried that I didn't love my baby enough, that I wouldn't love him after he was born.
Then, when we had so much trouble breastfeeding, it was very easy for me to feel like it was my fault. I couldn't be present during breastfeeding; it wasn't a bonding experience at all. I felt like that was why it was so hard for Padraig, that he could tell I hated it so much. It all turned into more of the same loop; I'm supposed to feel this way, but I actually feel horrible, and I'm a terrible mom because this makes me feel horrible.
Is parenthood what you expected? Why or why not?
Haha--parenthood is not at all like I expected! It's so much harder than I thought it would be, but it's also much more beautiful, and interesting, and funny than I thought it would be.
What is your parenting "support system" like (people, family, online resources, groups, etc.)?
I am very lucky to have not one, but two amazing partners. We work as a team, which is great--Padraig is now 3½, and has seemingly endless energy. Big Padraig's parents live very close to us, and love spending time with their grandson, which gives the rest of us a break. My parents live a state away, but we talk/message/Skype frequently. I also have a great chosen family--people that have been an important part of my life, people who my son calls Auntie, Uncle, or Oontie (gender-neutral version).
What would you like providers--doctors, therapists, midwives, etc.-- to know about caring for a transgender pregnant person or parent?
First, most providers don't seem to realize that not all birth-giving parents are mothers, and not all are women. I know that 99% are, but for the rest of us, that assumption leaves us feeling very othered and alone. Also, there's a lot of inner-goddess, earth-mother kind of talk in birth communities. This can be really powerful for mothers that identify as female, but can be actually very damaging for those who don't. Motherhood/birth is not inherently feminine, which is great! We can reframe empowerment to be flexible, and fit each person individually, which is actually helpful for everyone.
The other is that providers need to be aware of the specific risks and struggles for transgender parents. The dysphoria that can accompany pregnancy can be devastating. Transgender men who give birth have to stop necessary gender-confirming hormones, which can make emotional/mental health struggles even more of a possibility.
What would you like fellow parents to know about being a transgender pregnant person or parent?
That even though my family looks very different from yours, we are probably more similar than you realize. Parenthood is parenthood--it's still potty training and runny noses and adventures and mischief and love. Also, when you hear my son say "My Mommy, he...," it's okay to ask (polite) questions! I would much rather field questions than suffer that awkward/confused look people get.
What's your ideal Mother's Day like?
If we are talking true fantasy land? I wake up to a clean house and breakfast--eggs over medium, fruit salad, 12-grain toast, coffee. Then all four of us go on an adventure--maybe a hike, or go to the beach, something outdoors but not super strenuous. We all come home muddy and happy.
Provider Corner
Interview with Kristin Kali, LM CPM, MAIA Midwifery and Fertility

Kristin Kali, LM CPM, is a licensed midwife who provides care for "all families, all family structures, genders, and orientations," with a focus on LGBTQ families through her practice MAIA Midwifery & Fertility. What's unique about her practice compared to conventional medical/fertility clinics is the focus on a normal, healthy pregnancy and fertile parents (who probably need outside help in the way of donor sperm); this is different from much obstetrical care, which is designed around problem pregnancies, focusing on infertility, she says. Kristin spends a lot of time with clients in the preparation for pregnancy--nutrition, exercise, vitamins--things that many heterosexual couples do after they are pregnant, but here that planning starts before conception. "You can't really say that you specialize in LGBTQ [care] if you don't provide these services preconception," Kristin emphasizes.

In her practice, conception is usually achieved by IUI (intrauterine insemination) with donated sperm. The sperm needs to be carefully tested for sexually transmitted disease. This process can be expensive and emotional for the couple involved. "It's hard to access care in the mainstream medical system that will be sensitive and supportive of that." She says she counsels on interfamily dynamics and the whole issue of testing the sperm. "I have breadth and experience to do that in a way that normalizes it," she says.

She stresses that her focus in midwifery is to support families that are being created, so it's not just the clinical care, but also emotional support. That means "creating the village that helps to create that child." To that end, MAIA has a special PEPS group specific to LGBTQ families.  (General  PEPS outcome evaluations show that a majority of PEPS participants feel less isolated, more confident and competent about their parenting skills, aware of parenting resources in their community and neighborhood and well connected with people who support them as parents.) 

The MAIA PEPS facilitators go through standard PEPS training (the general format, topic ideas, and so on), but additional meeting topics that are specific to LGBTQ families are covered. Twenty-seven families have come through this special PEPS program in the past year.

About the greater Seattle area, Kristin says it's a community that's very accepting, generally positive with lots of "mixed" spaces. You see this especially in "integrated" parenting groups--"parenting is a great equalizer," she notes. Most of her clients won't see direct homophobia in these groups. "But what's lost [in the integrated groups] is the very unique experience it is to conceive as a queer person or trans or genderqueer person," she points out. These experiences--such as getting pregnant with donor sperm but not because of infertility--are not reflected and centered in most parenting groups. Other issues that are unique to LGBTQ families include: homophobia from extended family; wanting to seek out donor siblings; not being out, especially as a trans person. "What families gain by creating queer/trans-specific parenting community allows a deeper level of being held in the fullness of what that experience is. It's like walking into a room and not having to explain yourself." 

When it comes to emotional adjustment during and after pregnancy, Kristin sees many of the same things in her LGBTQ clients as she does in her heterosexual clients: body changes, not sleeping, etc. But there are some unique challenges, too: how much money it takes to conceive; navigating breast- or chest-feeding (sometimes both parents want to feed the baby with their body); partners not genetically related to the child and the response of the culture to that; and generally feeling like they are on the "edges."

There are unique challenges to trans parents, she explained. "Culturally, lesbian and gay families have benefitted from progressive social movements, but we still have trans people being told they can't use the bathroom in public." For a trans man, for example, it may be physically dangerous to appear pregnant. For a trans woman, becoming a mother may be an affirmation of their gender as a woman, so if they are not able to carry a baby or become pregnant, it might feel like a loss. Kristin says that's why she feels so strongly about focusing on this population, and wanting trans people to have sensitive care.

As for what providers can do to better serve LGBTQ clients, Kristin offers these concrete points:
  • Get training. If you're going to serve LGBTQ people and it's not a group that you normally serve, get some education so you have some context. This includes training on pronouns. She says she encourages providers with ALL clients to make things universal. Start out by saying "Hi, I'm Kristin, and I use she/her pronouns." This is critical on the intake forms, too. Don't assume "mom/dad"--use "parent." Ask clients if they have specific word preferences when it comes to their bodies. For example, trans men may feel feminized if "breastfeeding" is used; they may prefer "chestfeeding." Trans women, on the other hand, may want to identify with "breasts," not "chest." Use neutral words, like "parenting" and "genitalia," for example.
  • Take responsibility for educating yourself. Do not expect your client to educate you. Also be aware of asking questions out of curiosity rather than to provide good care.
  • Open the door to let families share the totality of their experience. If you don't create a space that ensures people are understood and held, they won't share themselves. Assuming that someone "is no different from everyone else" may sound inclusive, but it may in fact be dismissive.
  • Make sure you are paying attention to the experience of non-gestational lesbian mothers and trans mothers. Those groups are typically not fully validated.
LGBTQ Preconception, Pregnancy, and Postpartum Resources

MAIA Midwifery & Fertility
MAIA provides holistic, individualized midwifery care, creating strong families, empowered parents, vibrant pregnancies, and healthy babies. MAIA welcomes people of all genders, family structures, and orientations, with special expertise in queer and transgender family building, intentional single parenthood, and achieving pregnancy over 40. MAIA offers preconception care, home insemination, prenatal care, home or birth center birth, postpartum care, and lactation support.
  • Fertility and Conception Webinars
  • Queer Conception Support Group
Childbirth Education and Newborn Support
  •  Childbirth Class for LGBTQ Families
  •  PEPS Groups for LGBTQ Families
MAIA Professional Training
  • Providing Culturally Sensitive Care for LGBTQ Families: An online, self-paced course with 7+ hours of webinars and audio recordings. MEAC and ACNM CEUs available!
  • Caring for Transgender and Genderqueer Clients with Cultural Humility: A 90-minute webinar.
  • Midwifery Model Preconception Care Course: Online, self-paced educational                                  modules for practicing midwives.
  • Training and Consulting: Services for midwifery education programs, birth professional organizations, and private clinics.
  • Public Speaking: Book Kristin Kali, LM CPM, for your next conference or event.
Sacred Light Birth Services
Offering LGBT families the following specialty services:
  • Pre-conception Consultation
  • LGBT-specific Childbirth Education
  • LGBT Support Group Facilitation
    • Maybe Baby Support Group
    • Donor Support Group
    • Non-Gestational Parent Support Group
Sacred Womb Services
            Doula Services
            Postpartum/Post Loss Care
            Classes and Workshops
            Pelvic Health and Wellness
The Arvigo Techniques of Maya Abdominal Therapy
Root Down Healing Arts
Ishell Neville
Christine Coe
Nicole Donahue
Rebecca Bloom
Shannon Solie
Birth Doulas
Kelsey Henry
Erika Davis
Katie Spataro
Sharon Muza

Andrea Starbird
Open Arms Perinatal Services

LBGTQ Family Law
Cynthia Buhr
National Center for Lesbian Rights
Transgender Law Center
Lesbian Co-Mothers and Transition to Motherhood
A small qualitative study published in the March 2017 issue of Perspective, the journal of Britain's National Childbirth Trust (NCT), focused on the experiences of the non-birth mother in a lesbian partnership. The hetero-normative language used around pregnancy and birth was a meta-theme that arose within each sub-theme the researcher identified. For the purposes of this study, lesbian non-birth mothers are referred to as Lesbian Co-Mothers (LCMs).
Five main themes arose
  • Who am I? Beyond the mother/father binary: There is currently inadequate language to describe their new role. Insecurity and uncertainty as to mothering role vis a vis the birth mother can contribute to feelings of anxiety and depression.
  • Bonding and breastfeeding: The LCMs interviewed named worry about feeling less bonded to their infant than the breastfeeding mother. As is common in heterosexual relationships, there was some jealousy when birth mom was breastfeeding.
  • Support Communities: The LCMs in the study pointed to insufficient support from both extended families and the general lesbian community.  
  • Educating others:  Throughout the process of having a child, the necessity to explain who they are in relation to the baby arises repeatedly.
  • Emotional Health: Lack of support is a main contributor to postpartum mood and anxiety disorders. For this population, that is often compounded by homophobia and heterosexism, along with insufficient awareness that there is a deep emotional component for the LCM as well as the birth mother.
The author cautions that this was a small sample size and therefore the study offers insight and directions for further research, but is not generalizable.
For the complete article see:

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