I am board-certified music therapist, birth doula, and postpartum doula serving the Salt Lake City, UT area. I specialize in Music Therapy Assisted Childbirth, an evidence-based music therapy technique that helps laboring mothers incorporate music into their birth to promote a calmer, gentler and more empowered birth experience.
2017 brought the UDA our very first blog, and it has been an honor to be part of this inaugural team of bloggers. I have had the privilege of being 2017’s “Diversity Doula.” In this role, I’ve had the chance to bring you monthly blog topics that highlight marginalized communities and diverse voices. Finding a wide variety of monthly bloggers and topics has been fun and informative, and I appreciate this opportunity. I’m excited to see what blog posts next year’s Diversity Doula will publish!
Below are links to the 10 Diversity Doula blog posts that have been published in 2017. If you haven’t read them yet, now is a great time to check them out!
Thanks again to the UDA board for trusting me to be your first-ever Diversity Doula blogger. I’m excited to see what blog posts next year’s Diversity Doula will publish!
Beth Hardy, PCD(DONA), SCMT, MT-BC is a birth doula, postpartum doula and board-certified music therapist, serving clients in Salt Lake City, UT. Beth specializes in Music Therapy Assisted Childbirth, and also offers traditional birth and postpartum doula services. She loves working with all families, including LGBTQ+ parents, adoptive parents, and single parents. Beth can be found at her website, Facebook or Instargram.
Learning More About the University of Utah’s Volunteer Doula Program
In the spring of 2013, I took Kristi Ridd-Young’s three-day doula training workshop, which inspired me to start supporting women in labor. However, I knew it would never be full-time work for me. So, after learning about the University of Utah’s Volunteer Doula program, which was just getting started at the time, I got involved.
To volunteer for the program, doulas need a basic doula training (either from the U of U’s Volunteer Doula training directly or from another reputable outlet). New volunteers also have to be approved through the U of U’s Volunteer Services Program, which encompasses the doula program and many other volunteer programs throughout the hospital, more onboarding trainings, paperwork, an update on a few crucial vaccines, and an orientation in Labor and Delivery. After going through these steps, I began volunteering twice monthly—sometimes more.
The volunteer program was a great way for me to gain experience as a doula (during times that worked for me) and to help support women who otherwise would not be able to have a doula.
What the Program Is, and What it is Not
What It Is
It’s a great resource for women who otherwise would not be able to have a doula. While the intention is to help support those women who don’t know about doulas, don’t have labor support, and/or would are not able to pay for a doula, any woman laboring at the U of U hospital can request a doula if one is available.
It’s a great learning opportunity for new doulas to gain experience. The doula volunteers at the U range from some of our most experienced doulas working in Utah to brand new volunteers who don’t know much about childbirth or doula work (but are quickly learning!)
It’s a program that helps empower new mothers who may not even know that doulas exist. Young and single women are often offered doula support. Doulas then can help support these women in listening to their bodies, making choices that work best for them, and giving birth in a way that feels best to them. I’m convinced that this support can be life changing for some women, especially those who previously have had very little choice or support in their lives.
What It Isn’t
It isn’t a substitute for hiring your own doula. If you know you want a doula, you should hire a doula. While the volunteer doula program at the U has a doula on call or scheduled for many shifts throughout a month, there are plenty of times that are not covered. There is no guarantee that a volunteer doula will be able to come to the hospital when you go into labor. Another common scenario is that the volunteer doula is unavailable because she is working with another woman who is in labor.
It isn’t a guarantee your assigned doula will be a good match for you. Since you cannot choose your doula in advance, it’s possible that the volunteer doula who happens to be on call will be a wonderful, loving match (in my experience, most doulas are), however, it is possible that the on call doula is not a great match for you. Your personalities might clash, or you might get a weird vibe, or any other tangible or intangible aspect of the human relationship could make the connection great, or…not so great. (You can always ask the doula to leave if you no longer want her support.)
It isn’t a guarantee that you’ll have an experienced doula. While it’s true that every volunteer doula has some basic training, you never know how much experience your volunteer doula might have. She could be on her first shift and yours could be the first birth she’s ever attended. Or, you could get connected to an experienced doula. Experience levels in the volunteer doula program vary widely.
The University of Utah Volunteer Doula Program can be contacted at email@example.com, and questions can be sent to that email address, as well.
Sheri Rysdam, PhD Sheri Rysdam teaches college writing and yoga. Her scholarship is rhetoric, including feminist medical rhetorics. She works as a doula in the Salt Lake City area, where she focuses on supporting young women with limited financial resources. She writes at www.sherewin.com.
Seventeen years ago, when my first child was born, I had no idea that his birth would lead me to learn a new language, meet some really amazing people and come to love a whole new culture. When my son was 16 months old we found out that he was moderately to severely Deaf. This information gave our family the wonderful opportunity to learn American Sign Language.
Three and a half years ago, I became a Doula and with my fluency in American Sign Language, I have had the blessing to support several Deaf families. For the most part, birth is birth, weather you are Deaf or hearing, but here are some unique differences that I hope will help you support a Deaf or Hard of Hearing client.
Lighting: Lighting is SO important. As a hearing person, I rely on background and environmental sounds for context and social cues, which means lighting can be low, yet I still have the ability to communicate effectively. On the other hand, a Deaf client relies heavily on their vision for communication, context and social cues, so, proper lighting is very important.
Visual Field: For me, a hearing person, I don’t need to see your face in order to communicate with you. But a Deaf client must have face to face communication. If they can’t SEE you, then they cannot understand you.
A Deaf client must have face to face communication. If they can’t SEE you, then they cannot understand you.
Working with an Interpreter: Some Deaf clients will hire an interpreter and that is great. For you this means making room for the interpreter to be face to face with your client. It means speaking directly to your client and not to the interpreter.
Facial Expressions/Body Language: Facial expressions and body language are a very important part of American Sign Language. Did you know that in 1972 Dr. Albert Mehrabian published a book called, “Nonverbal Communication”? In this book, he broke down typical spoken communication into three categories; spoken words (7%), tone of voice (38%), and body language (55%). In American Sign Language, the percentage for body language is much higher. What we say with our facial expressions and body language are easily and quickly deciphered by Deaf people, because these are such an integral part of American Sign Language.
Dress: What you wear can have a great effect on your client. If you wear a shirt with lots of bold bright colors or a shirt with abstract/crazy patterns, your Deaf client will find it very hard to focus on you without becoming distracted or fatigued. Imagine if you had to look at bold bright colors or crazy patterns all day. Your eyes would fatigue quickly and you would have a difficult time wanting to look in that direction. Please stick to solid, not too bright, shirts. Your Deaf client will appreciate this.
Cochlear Implants/Hearing Aids: Some people in the Deaf community have a Cochlear implants or hearing aids and some do not. Most of the time, at least for the clients I have worked with, these devices are not worn during labor, but they may want them on as soon as baby is born. Having them off helps to tune out the world and focus on the task at hand.
Lip Reading: Some Deaf do, and some Deaf do not lip read. It is not a universal skill that everyone in the Deaf community has. If you are working with someone who prefers to lip read, and you know this because they have told you, PLEASE DO NOT change the way you move your lips and DO NOT over enunciate. This will make it nearly impossible to read your lips.
Texting/ Video Relay/ Paper & Pen: There are many ways for the hearing and Deaf communities to communicate directly. Most Deaf people love to text or instant message. Some prefer video relay. Video relay is a service where a hearing person can call a relay center and an American Sign Language interpreter will video relay the interpreted call. And lastly there is good old paper and pen. Because most Deaf people have grown up and have been educated here in the United States, they can read and write in English fairly well. Do not let the lack of an interpreter stop you from communicating with people in the Deaf community. As a community, they will appreciate your efforts to communicate with them.
Do not let the lack of an interpreter stop you from communicating with people in the Deaf community. As a community, they will appreciate your efforts to communicate with them.
American Sign Language/ S.E.E. Sign/ Total Communication: Not all signs are created equal. American Sign Language is an official language, with its own rules, syntax and grammar. S.E.E. Sign, stands for Signing Exact English. S.E.E. Sign uses a sign or gesture for each English word. S.E.E. Sign is not a language but has been used to teach English to deaf or hard of hearing children. Total Communication uses American Sign Language signs at the same time as spoken English. This is hard to do and be true to both English and ASL. Find out which method your client prefers and then try to learn a bit in that method. They will appreciate your efforts.
Big “D” Deaf: As you may have noticed, when I refer to the Deaf community, I always capitalize the “D”. Deaf (with a capital “D”) refers to embracing the cultural norms, beliefs, and values of the Deaf Community. Not everyone who uses American Sign Language claims to be Deaf. If you are not sure, just ask.
I teach a six week ASL course for birth workers. This class covers commonly used birth terms. If you are interested, please feel free to contact me for the dates of up-coming classes.
Sariah Price received her doula training through DONA International. She has experience with home birth, hospital induction, epidurals, non-medicated, hypnobirthing, and c-sections. Sariah’s goal as a doula is to support, encourage, educate and enable her clients as they bring new life into this world.
I love working with Spanish-speaking clients, and clients from all communities. There is so much for us to learn from our clients; we learn about their birth customs and traditions, and it’s just fascinating. In many countries, birthing women don’t have many options regarding their birth choices. This is especially true if they are giving birth at a public hospital, where partners are often not even allowed in the labor room. As humans and as women, we have the right to feel empowered, and the right to have the birth experience that we want and deserve to have.
As humans and as women, we have the right to feel empowered, and the right to have the birth experience that we want and deserve to have.
I am a birth doula and a lactation educator born and raised in Mexico.
At the time I gave birth to my first child, I didn’t know I had any options besides what the OB told me to do. Due to the language barrier, I struggled with not being able to understand everything that was going on in the room when my son was born. He was having a hard time breathing immediately after birth, and I wasn’t able to follow all that was happening. Since that moment, I told myself I was going to do something so others who do not speak English as their first language can be supported during these amazing moments in their lives. I wanted to help women during birth, using the language they can understand and feel most comfortable with.
I wanted to help women during birth, using the language they can understand and feel most comfortable with.
In addition to my work as a doula, I also interact with many pregnant women as their breastfeeding counselor, and 50% of the women I serve are Spanish speaking. I enjoy asking them where they are from and how women usually birth in their countries. It is fascinating to learn how each country has different ways of viewing and responding to birth.
I remember one specific mom who was Venezuelan. She shared with me that in Venezuela, it is common to have planned c-sections around 38-39 weeks of pregnancy. She was interested in other options and ended up hiring me as her doula. It was a challenge to help her family members who were in the labor room be more open to what this mom wanted. I tried to help them understand that everything she was going through was a normal part of labor and birth. She had the great support of her husband, and even though her family may not have all been on the same page, there was so much love from every single one of them.
Another experience I was able to be part of was the time a young woman became a mom for the first time. She hired me as her doula and planned to have a water birth. She was one of the most empowered moms I have ever seen, and also had her husband’s amazing support. While we were in the bathtub with her, her sweet mom was in the dark delivery room praying for the wellbeing of her daughter and first granddaughter. She had brought a quartz necklace from Mexico that a Catholic priest had blessed with holy water, and put it on her daughter’s neck. It was a very spiritual and loving moment to witness.
Helpful Spanish Words and Phrases for Doulas
Here are some words that might help you when working with a Spanish-speaking client:
Dar a luz (to give birth)
Now some phrases that you can use during labor for support:
Lo estas haciendo muy bien! (you are doing great!)
Relaja tu cara y tu mandibula (relax your face and your jaw)
Tu cuerpo sabe como dar a luz a tu bebe (your body knows how to birth your baby)
Eres una guerrera (you are a warrior)
My experience working as a doula for women from other countries has been very satisfying. I am grateful that they have allowed me to be part of their birth experiences, teaching me so much from their country and their own family traditions in the process. I wouldn’t want to be doing anything else; being a doula is my passion. Each birth has taught me something different, and I am certain I will be learning so much more as I continue on my doula journey.
Jennifer Riggs is a birth doula and lactation educator in Salt Lake City, UT. She is available by phone at (801)657-6773 or email at firstname.lastname@example.org, and is more than happy to provide support and advice to any mom or doula.
Author’s note: I recognize that the topic of transgender parenting, and transgender people in general, can be divisive and hard for some people to understand. It is my hope that by writing about the topic of transgender pregnancy, parenting and breastfeeding in this post, other doulas, birth workers and parents will have a greater understanding of– and empathy for– the transgender experience. And hopefully, we can all come to see that in so many ways, we’re all in the same boat, just doing our best to get through this crazy journey called parenthood.
“People are different from each other. It’s astonishing how few respectable tools we have for dealing with this fact.” – Eve Kokofsky Sedgwick, Epistemology of the Closet, 1990
I recently had the pleasure of reading the memoir Where’s the Mother?: Stories from a Transgender Dad by Trevor MacDonald. Trevor is a transgender man who became pregnant and birthed a baby, and even went on to breastfeed. (note: many transgender people prefer to use the term “chest feeding” when referring to feeding their babies, but Trevor uses the term “breastfeeding” throughout the book, so that is the term I will use in this post.) The book chronicles Trevor’s journey as he transitions from female to male, including taking hormones and getting chest surgery. Eventually Trevor meets Ian and gets married, and together they decide to start a family. The decision to have a baby is huge for any family, but Trevor and Ian have added societal expectations to manage, such as the idea that all babies are born to female-identified people.
To give you a glimpse into Trevor’s journey, I’ll share with you Trevor’s own words that he shared at the first La Leche League meeting he attended:
“My name is Trevor. My baby is due April 17th. I am able to be pregnant because I am transgender. That means I was born female, but I transitioned to male by taking hormones and having chest surgery. When we decided to start a family, I went off the hormones to become pregnant. I don’t know how much I’ll be able to breastfeed because of my surgery but I want to learn as much as I can and do my best.”
Transgender Pregnancy and Birth
Although we may not hear about it often, there are transgender men all over the world who are quietly starting families, getting pregnant and having babies. Some of you may have recently seen the posts and articles online about Trystan and Biff, a gay couple in Seattle. Trystan, a transgender man, got pregnant and gave birth to a beautiful baby, and they have been very open about sharing their journey. If you haven’t followed their story, I highly recommend starting from the beginning and listening to their four-part series on The Longest, Shortest Time podcast. You can also check out their Facebook page, where they share links to articles about their pregnancy, videos, and personal stories.
In the forward to “Where’s the Mother?,” the author shares that “Obstetrics and Gynecology [published a report] in which researchers interviewed forty-one transgender males who had given birth ‘after transitioning from female to male gender.’ Similarly in Barbara Walters’ interview with [transgender man Thomas] Beatie, who has given birth to three children, California midwife Stephanie Brill reported that she is aware of at least forty cases, and the number is increasing…Numbers of this kind suggest that underlying the television specials and magazine cover stories, there exists a quiet groundswell of social change, which has mostly been hidden from view.”
“Obstetrics and Gynecology [published a report] in which researchers interviewed forty-one transgender males who had given birth ‘after transitioning from female to male gender’…Numbers of this kind suggest that underlying the television specials and magazine cover stories, there exists a quiet groundswell of social change, which has mostly been hidden from view.”
The Breastfeeding Journey
Reading the book, one of the questions that kept popping into my mind was, “how can a person who has had chest surgery to remove their breast tissue go on to breastfeed?” As I continued to read, I learned that there is a difference between a woman getting a mastectomy to entirely remove the breast, and a transgender man getting chest-contouring surgery. Male chest-conturing surgery actually leaves some of the breast tissue intact so that it looks like pectoral muscles, and the nipple is carefully preserved. The type of chest surgery that Trevor had actually kept many of the nerves and milk ducts directly underneath the nipple and areola intact. Therefore, when Trevor attempted to breastfeed his baby, there were milk ducts there to produce milk. Trevor also explains that “…pregnancy hormones drive the body into high gear, developing more breast tissue and sometimes healing milk duct injuries, a process called recanalization.”
The entire second half of the book is dedicated to Trevor’s journey through breastfeeding. Even though he had some milk ducts still intact after his surgery, there were far fewer than there would be with a typical breast. Also, his breast tissue was drastically reduced, so there wasn’t much there for the baby to latch onto. He used an at-breast supplementer and fed his baby donor milk along with whatever milk he was able to produce himself. Finding and procuring donor milk can be tough for any new parent, and Trevor and Ian had the added hurdle of needing to explain their family structure to all the potential donors, and facing potential prejudice or harassment in the process. They used known donors, friends-of-friends, and the Facebook group Human Milk 4 Human Babies.
Reading this book was eye-opening, educational and informative. Trevor gives the reader a personal, intimate glimpse into his pregnancy, birth and breastfeeding experience as a trans man. Where’s the Mother?: Stories from a Transgender Dadis a great read for all doulas who are interested in learning more about the transgender parenting experience so they can be better informed and open-minded with all of their clients.
Birthing and Breastfeeding Transmen and Allies Facebook group. This group welcomes anyone trans* identified or with strong ties to the trans* community, as well as allied health care providers or other professionals interested in contributing to the group.
World Professional Association for Transgender Health An international, multidisciplinary group of professionals devoted to promoting evidence-based care for transgender, transsexual, and gender variant people. WPATH publishes standards of care and ethical guidelines. Website includes a searchable database of care providers who are WPATH members. The group holds a biennial symposium for sharing new research and ideas.
LGBTQ Parenting Network Toronto-based group that does advocacy, education, support, etc. for LGBTQ parents. Website includes an astonishing number of useful articles, reports and links for queer parents (topics range from sperm donation to birth registration and legal issues to single parenting).
La Leche League International Breastfeeding support and information. LLLI holds chapter meetings all over the world, as well as maintaining excellent web resources and books.
Human Milk 4 Human Babies Global breast milk sharing network. Operates on a model of informed choice, and is completely commerce-free.
Research paper on Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity
Article: The Midwives Who Help Trans & Non-Binary Parents Give Birth.
Article: Gender Identity: Transgender Dad, article on Breastfeeding Today
Article: Chestfeeding Through Dysphoria, article on Doula Trainings International
Beth Hardy, SCMT, MT-BC, PCD(DONA) Music Therapist | Birth Doula | Postpartum Doula Beth is a birth doula, postpartum doula, and board-certified music therapist. She serves families throughout the Salt Lake City, UT area, and loves working with all families, including LGBTQ parents, adoptive parents, and single parents. Learn more about Beth at www.HeartTonesDoula.com.
As doulas, it is important for us to continually learn and expand our knowledge base, so that we can provide the best, most well-informed care to our clients. One area where many doulas would like to get more training is the area of LGBTQ+ cultural competency. Below are several useful online trainings and websites for doulas who would like to learn more about serving clients in the LGBTQ+ community.
This is a 7 hour web-based course. This course explores the diverse nature of LGBTQ family structures and examines issues that commonly arise for gestational parents, nongestational parents, and in relationships from conception through early parenting.
This course offers guidance for creating a welcoming and affirming practice and CEU’s through the American College of Nurse-Midwives or the Midwifery Education Accreditation Council (7 contact hours).
DTI is an organization that trains birth and postpartum doulas. They have a strong focus of training doulas who come from marginalized groups, such as trans doulas and doulas of color. They even offer scholarships to train doulas from marginalized groups, such as the Birth Workers of Color scholarship and the Trans Health Initiative scholarship to train transgender doulas.
This website focuses on “reproductive justice by and for queer and trans* people.” Thought the site appears to still be in its infancy, on their homepage the creators talk about hosting webinars, creating resource lists and care provider listings, and partnering with other queer and trans focused organizations. Keep an eye on this site or join their newsletter to stay in the loop about what they’re up to!
We hope these resources are helpful as you continually learn more about serving clients in the LGBTQ+ community!
Beth Hardy, PCD(DONA), SCMT, MT-BC is a birth doula, postpartum doula and board-certified music therapist, serving clients in Salt Lake City, UT. Beth specializes in Music Therapy Assisted Childbirth, and also offers traditional birth and postpartum doula services. She loves working with all families, including LGBTQ+ parents, adoptive parents, and single parents. Beth can be found at her website, Facebook or Instargram.
As a world traveler, birth and postpartum doula, and woman who has lived in various countries, I was ecstatic for the chance to review the book, Birth in Four Cultures written by Brigitte Jordan, an anthropologist, then later expanded and revised by Robbie Davis-Floyd. This piece is a cross-cultural study of how women bear children, and is a reminder of the complex layers that make up a community of people and how they dynamically apply their approach to the childbearing year.
The book is split into two parts: Childbirth in Biosocial, Cross-Cultural Perspective and Authoritative Knowledge in Childbirth. Each part plays an important role in understanding the birth systems in the Yucatan, the United States, Sweden and Holland. Under a microscopic view from Jordan and associates, they paint a thorough description of each of the four social-medical traditions around birth, and although each varies drastically from the rest, the comparison that Jordan draws is highly complex due to the cultural differences that shape each community.
Often times we as birth workers, expectant parents, and community members look at our current techno-medically driven system here in the United States with high regard. At the same time, some circles desire a less techno-medically driven approach. In a country with high infancy and mother mortality rates, we want the healthiest practices and best outcome for our clients and loved ones. How do Americans compare to alternative childbirth systems that are successful, when culturally we aren’t the same? What is missing from our current American structure? How can the American culture start to achieve better birth experiences and outcomes? How has the child-birthing system in United States changed over time? Lastly, how can we as Americans encourage this system to evolve, when we are on the inside looking out?
In a country with high infancy and mother mortality rates, we want the healthiest practices and best outcome for our clients and loved ones. How do Americans compare to alternative childbirth systems that are successful, when culturally we aren’t the same?
As Jordan puts it, “As a life crisis event, birth is everywhere, a consensual shaping and social regulation–the particular pattern depending on local history, ecology, social structure, technological development, and the like.” Simply put, it’s not that easy to change a system that has developed throughout medical, social and political histories, thus creating socio-medical norms. In each of the communities Jordan analyzed, she discovered that populations accept varying experiences of how we birth. Consequently, when implementing change, we need to “appreciate the systemic structure of childbirth practices to then rationalize how procedures are justified to begin with.”
Also, where we in the United States are more technologically developed than others, we tend to be viewed as more “advanced.” With our technological advances we are held as an example to teach those more “primitive” than our own. When we have other cultures looking to us as an example to work toward, why should we feel the need to change? Are we relying too much on our technological systems, rather than listening to our childbearing mothers? Due to technology, we disregard the biological cues that occur, then placing our mothers in a compromised condition. Could this be the reason our mothers and children are falling short of a better outcome?
Due to technology, we disregard the biological cues that occur, then placing our mothers in a compromised condition. Could this be the reason our mothers and children are falling short of a better outcome?
Jordan’s book offers an informative, well-rounded display of the current birthing systems, their strengths, short comings, and what this means for the evolution of birthing practices around the world. While reading this book, I was reminded of all the magical places I have lived and explored, the people I have met, the new traditions I have embraced, partially making me who I am today.
As I continue through my doula journey, it is critical to understand the social, spiritual, and medical reasons behind specific birthing practices, and to respect the authentic cultures in which these practices developed. Often times, because our cultures differ so greatly, I’ve seen when implementing foreign birthing practices in the US, the practices become distorted and void of their original intent. This conundrum occurs in similar ways when advanced medical technologies from the US are transferred to adolescent countries that lack the resources and technological infrastructure to support them. At a time when cultural appropriation is circulating frequently in conversation- I implore all those reading to dive deeper in a critical examination of the successful, customary practices being carried out in America today and honor the origin of these traditions and it’s peoples.
Destiny S. Olsen, a DONA certified Birth & Postpartum Doula, Registered Hatha & Trained Prenatal Yoga Teacher, loves aiding families towards a healthier, more enjoyable lifestyle. She lives in Salt Lake City with her partner, Taylor Lake and two cats, Downtown and Kiki. In her spare time she loves exploring, yoga and tending to her eclectic animals in her wildlife habitat. You can find Destiny on her website, Facebook, Instagram, and Meetup.
Rixt A. Luikenaar, M.D., FACOG board certified in obstetrics and gynecology, has been providing exceptional healthcare both locally and abroad for over 15 years. She holds numerous awards and continues to receive significant recognition for her work with people of color and the LGBT+ community. Dr. Luikenaar began offering transgender healthcare including hormone therapies, primary care, and preventative care in 2011, which she is continuing to provide at her clinic, Rebirth OBGYN. Dr. Luikenaar works tirelessly to make sure that all people receive the respect and care they deserve. I personally learned much from her and hope you enjoy our interview!
Before we get started with the interview, here is a list of terms that may be helpful as you read this post. These were taken from the PFLAG National Glossary of Terms:
Transgender: A term describing a person’s gender identity that does not match their assigned sex at birth. This word is also used as a broad umbrella term to describe those who transcend conventional expectations of gender identity or expression.
Cisgender: A term used to describe an individual whose gender identity aligns with the one typically associated with the sex assigned to them at birth.
Transition: A term used to describe the process—social, legal, or medical—one goes through to discover and/or affirm one’s gender identity. This may, but does not always, include taking hormones; having surgeries; and changing names, pronouns, identification documents, and more. Transgender people may or may not decide to alter their bodies hormonally and/or surgically to match their gender identity.
Non-Binary:A term used to describe those who view their gender identity as one of many possible genders beyond strictly female or male.
LGBT or LGBT+:An acronym that collectively refers to individuals who are lesbian, gay, bisexual, or transgender. May also include the letters Q (for Queer or Questioning) I (for Intersex individuals), P (for polyamorous/polygamist) and A (for Allies).
Gender Reassignment Surgery: Medical interventions used as part of the transition process to affirm one’s gender identity. Also sometimes called gender-affirming surgery, or sex reassignment surgery (SRS).
Interview with Dr. Luikenaar
What led you to be interested in working with transgender individuals? I am from the Netherlands, and in my last year of residency in OBGYN (in the US) I spent a month in the Netherlands with a doctor/sex therapist that treated transgender patients and they intrigued me. During my time in practice at the University of Utah I realized there was nobody caring for these patients and I felt like taking on the LGBTQ community just as I take on any minority (refugees, Latinos, Native American patients, etc). Interestingly, after I opened my clinic my youngest child, born female, said from the age of 2 that he is a boy. At age 5, all girl clothes were thrown out, and he wanted to be “Alex” and “him” from age 7 on. So we have socially transitioned him into a boy. He is now 10 years old (no pressure there, he knows he can be Sophia anytime he would want to).
During my time in practice at the University of Utah I realized there was nobody caring for these patients and I felt like taking on the LGBTQ community just as I take on any minority (refugees, Latinos, Native American patients, etc).
What services do you provide? My training is in obstetrics and gynecology; I provide any service related to obstetrics and gynecology but I have had a lot of training in primary and preventive care, and offer transgender hormone therapy and postoperative care after gender reassignment surgery. I perform gynecological surgery from ablations, tubal ligations, to laparoscopic-robotic hysterectomies.
What specialized training have you had? I did my residency in Obstetrics and Gynecology, and am board-certified. I am self-trained in transgender health, however the World Professional Association for Transgender Health (WPATH) has started a certification program for providers and physicians. I also spent two weeks with the Gender Team at the Vrije Universiteit in Amsterdam (a transgender center that has worked with transgender children and adolescents since the 1980’s). They provide a multidisciplinary approach to transgender health care and are very well known for this.
How is working with transgender people the same or different from working with cisgender people? If you are used to treating all people equally it is not that hard. Just remember you treat the anatomy that is present and ask for their preferred name and pronouns. Especially in the beginning of transition or if they are non-binary it is better to ask than to presume.
What are some of the unique needs of transgender people? No unique needs, they just want to be respected. There is a 70% depression/anxiety rate among transgender people, and they are still discriminated overall. They often don’t have insurance or have poor insurance, are often fired from their jobs, and some teens/adolescents are still kicked out of their homes or disowned by their parents. Again, treat the anatomy that is present in primary and preventive care, follow WPATH/Endocrine Society guidelines and discuss fertility/sexuality/contraception depending on their sexual preference. Also, most providers/physicians see gender as a binary; (i.e., you are a man or a woman) and many LGBTQ people don’t think of it this way. Instead, gender is thought of as an “infinity,” a “spectrum” and there is no end and no beginning. Many find themselves somewhere on the spectrum but do not necessarily identify as a transgender man or transgender woman. It is always best not to assume anything, and ask for clarification on people’s preferred pronouns.
Most providers/physicians see gender as a binary; (i.e., you are a man or a woman) and many LGBTQ people don’t think of it this way. Instead, gender is thought of as an “Infinity,” a “Spectrum” and there is no end and no beginning. Many find themselves somewhere on the spectrum but do not necessarily identify as a transgender man or transgender woman. It is always best not to assume anything, and ask for clarification on people’s preferred pronouns.
What should other OBs or midwives be aware of if they get a transgender client so they can provide the best possible care? I held a “grand rounds” talk for the Department of OBGYN at the U of U and the most important things that I shared were about the Affordable Care Act, and the AMA/ACOG Ethics and Committee Opinions that now say we cannot discriminate who we see. We have to treat these patients and learn about them. I think that learning about transgender health should be a continuing education requirement for healthcare professionals. We already treat many cisgender women with hormones. It is not that hard to extend this knowledge to transgender patients. Also, the ABOG (American Board of OBGYN) stated in 2014 that OBGYNs can now treat men in our clinics. Respect your transgender patients’ names/pronouns, and don’t make assumptions about who they have relationships with. Don’t assume anything, just ask. Don’t ask transgender patients about their genitalia if it is not relevant to the care you are providing. They get tired of explaining why they haven’t had “THE” surgery yet or whether they will ever want to. Some transgender men may want to preserve their fertility to have eggs frozen/transferred to a partner or may want to be pregnant themselves. There are also protocols for transwomen to breastfeed their babies. Uterine transplants so far have not been implanted in transgender women, but I know it is a matter of time; it will be done within the next 10 years. For most doctors, I simply advise to keep your judgements and presumptions at home, come to work to learn and ask questions. That’s what I advise students and residents and they love it.
For most doctors, I simply advise to keep your judgements and presumptions at home, come to work to learn and ask questions. That’s what I advise students and residents and they love it.
In your opinion, what are some of the ongoing unmet needs of the transgender community within healthcare, and how can we as doulas work to meet those needs? Respect, insurance coverage (two major barriers in healthcare), frank and honest communication, and don’t presume every patient is heterosexual and cisgender.
If you could tell other birth workers one thing to help them best serve the transgender community, what would it be? Be open minded, tolerant and involve partners and friends in the medical decision-making process. Many transgender people have created “alternative” families, which are made up of friends and other support people, not necessarily their biological family.
Thank you to Dr. Luikenaar for this interview. We appreciate you sharing your knowledge and expertise with the doula community so that we may better serve the LGBT+ community in Utah!
Tobie Spears is a certified birth and postpartum doula and board member of the Utah Doula Association. Learn more about Tobie on her website.
I have been called to attend two births of Muslim mothers in my time as a doula. I have found their culture to be very warm and welcoming, and I loved the experience I gained from attending Muslim families. This particular Muslim birth I attended was a very special experience.
The whole family came and waited and prayed in the waiting area while the mom labored. Everyone was very happy and friendly, and at one point they started a roster with guesses of birth weight and time of birth that was almost two pages long! Most Muslim births are all-female with only the birthing woman’s mother, mother in law, sisters, and other female family members present.
While this sweet mother did not choose to have an all-female staff, most observing Muslim women prefer to only birth in a location where they can guarantee no men will be present with the exception of the father of the baby. This can also exclude male doctors and nurses, so the birthing location is methodically thought out prior to baby’s arrival. Many Muslim women also prefer to stay very modest and covered throughout the birth experience, using sheets to cover their legs while pushing and minimal exposure of their pregnant belly.
While speaking to this family before the birth, they told me that the level of dedication to their religion dictates how the mother chooses to dress during birth. This mother was planning on letting her instincts and body lead and guide her during her birth and she wasn’t going to worry about remaining any more modest than she felt would be comfortable for her.
During birth it is normal for prayers to be spoken aloud for the mother to listen to as she labors. The prayers are quiet and meditative, and although I couldn’t understand what was being said, it was so beautiful and calming to listen to. My client’s mother in law was the one praying during this birth and she was so sweet, hugging me in celebration of new life.
After this baby was born, she was brought up to her mother’s chest and my client’s mother-in-law began to ‘read on’ the baby. I felt honored to witness this private rite of passage; sometimes this can also be referred to as an Adhan. Prayers and verses from the Quran are whispered in to the baby’s right ear and then again into the baby’s left ear so that it is the first words she hears. Many of these versus are fundamental and serve as a pivot point around which the life of a Muslim rotates, so it is very symbolically significant to be done immediately after birth.
It is culturally and religiously important for Muslim women to breastfeed their babies. They believe that eating specific kinds of dates called ratb help to improve breastmilk quality. The Quran also makes many references to the benefit of breastfeeding their children for two years. After birth, the women are given Cinnamon Tea to help the uterus shrink back to size, ease cramping and discomfort, and warm the mother. It is often used during periods for similar reasons. Cinnamon Tea is made with cinnamon sticks boiled in water, and then walnuts, sugar, and butter are put in it before drinking. I was so excited when I was offered some during my postpartum visit with this mom and I still think about the amazing taste and heat of that tea. It really cleared my sinuses!
Each religion and culture has their own customs surrounding pregnancy and birth. It is not typical for Muslim women to have a baby shower, but women still can if they choose to, especially as Western culture finds its way into many aspects of day-to-day life. Often, after a Muslim child is born it is common for an aqiqah (pronounced ah-kee-kah) to be held a week or so after the baby is born to celebrate with close family and friends. Other than this celebration, the family stays in their home for up to 40 days while family and friends provide meals to them during that sacred postpartum time.
I still have so much to learn about this amazing culture and its people. Going into these births, I was very open about wanting to know how to best serve these families. I asked them to tell me as much as I needed to know so that I could support them with love and respect. I would advise anyone in a similar doula/client situation to do the same.
These families were so happy and willing to share their personal lives and culture with me, don’t be afraid to ask! If you have experience working with other cultures or specific religions, make sure that people know it! The second Muslim family contacted me for their birth because they heard that I had previously worked with other Muslims, and it was comforting to them. If you have specific experience, list that on your website so it’s welcoming for people of other cultures.
Many times, if you have multi-cultural experience it will lead to a more diverse clientele, not just more of the same culture you are advertising to. You are drawing in and welcoming all kinds of people by showing that you have a willing heart to serve those who have a different cultural background than you do.
Bonnie Baker is a birth doula, Hypnobabies instructor, placenta encapsulation specialist, bengkung belly binder, and fertility educator. She serves Salt Lake County and Davis/Weber County. Learn more about Bonnie at www.BellisimoBirth.com
Free to Breastfeed: Voices of Black Mothers by Jeanine Valrie Logan & Anayah Sangoele-Ayoka
As doulas, part of our role is to provide general information, tips, and help with getting our clients started breastfeeding. It is important for us to take into account the societal and cultural factors that could present possible hurdles for our clients who choose to breastfeed. That is why I was so excited to read Free to Breastfeed: Voices of Black Mothers. The book (available on Kindle or paperback) is a collection of stories, essays, poems, and email conversations from a wide variety of black mothers. They all share their unique experiences and perspectives regarding their personal breastfeeding journeys, with all the ups, downs, joys and challenges that most women who breastfeed eventually feel. The book is broken up into six chapters covering topics such as the legacy of breastfeeding, myths and barriers, troubleshooting problems, stories of empowerment, and the eventual ending of the breastfeeding relationship. The book ends with a collection of useful terms and resources, as well as profiles for each of the contributors.
The authors compiled all of the stories into this book to “act as a starting point for discussions within our communities, a steadfast support in those difficult moments, and a self-empowering guide when discussing one’s breastfeeding goals with family, friends, partners, and health care providers…because breastfeeding IS the revolution.”
The Health Implications of Not Breastfeeding, and How Black Mothers are Disproportionally Affected
Statistically, African-American mothers are the least likely ethnic group to breastfeed, and if they do breastfeed it is often only for a short time. The authors point out that there is a shortage of breastfeeding support groups specifically targeted to black women, as well as a “lack of trained lactation consultants, specialists, educators and counselors in black communities.”
The Center for Disease Control and Prevention reports that black women breastfeed at a rate of 54%, compared to white women at 74% (source). Black women under the age of 45 are also at a higher risk for developing breast cancer compared to white women, (source) and the authors point out “that breastfeeding not only reduces one’s risk for developing breast cancer, but risk is also exponentially reduced the longer one breastfeeds. This information is major for black women who die from breast cancer at a rate four times greater than white women.” (source)
Black Women and Breastfeeding: A Complicated History
With the clear health benefit to breastfeeding, as well as the emotional benefits of bonding with one’s child through the breastfeeding relationship, one may wonder why more black women don’t breastfeed. There is a complex history surrounding black women and breastfeeding, and for some women this plays into their decision not to breastfeed.
A “Wet Nurse” is a woman who is hired to nurse and sometimes care for another woman’s child. Wet nurses have been used throughout history, but the author tells us that wet nurses “are very significant to Black American history. Black female slaves were readily used as wet nurses for their owners’ children, often at the sacrifice of their own children.” Because of this, some black women feel a complicated mix of feelings around breastfeeding. The author of the blog post Breastfeeding While Black: Let’s Normalize It also shares more reasons why black women may not breastfeed, including “lack of general knowledge, few hospital resources, limited peer support, lack of family/spousal support, and insufficient maternity leave.”
What Can We As Doulas Do?
As doulas, each of us has the power to help black women in our communities breastfeed if they choose to. We can reach out to offer support, education, resources and help clear up myths and misconceptions about breastfeeding. We can connect clients with resources specifically geared toward black mothers, starting with the resource list below. Also, please share this blog post on social media to help spread the word about the need for more breastfeeding education and support for black mothers.