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Mon Nov 16 2020 00:00:00 GMT+0000 (Coordinated Universal Time)
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Unfortunately, much of our healthcare system and resources for aspiring and new parents are designed around more “traditional” assumptions around family structure and gender norms, that often don’t reflect the true nature of families today. As a result, transgender parents and their unique needs are missing in the family support conversation all too often.

Cleo is committed to supporting all individuals through the many diverse paths to parenthood and ensuring inclusive, culturally supportive care and guidance, filling in the gaps in the healthcare system. Cleo Family Guide and Specialist Becky provides support for Cleo members who identify as transgender. We spoke with her about her experience, the importance of inclusive care, and the resources available to transgender parents.

Becky, can you tell us about your background and work as a Cleo Guide and Specialist?

I am a certified birth and postpartum doula, childbirth educator, a Certified Lactation Counselor, and early childhood expert. I focus on supporting individuals and couples through pregnancy or preparing for a new child, infant and toddler development, positive discipline, and early childhood education and diverse ways of learning. Inclusion and social justice are the guiding principles in all areas of my personal and professional life.

Prior to joining Cleo you were the lead educator for a doula training program and created a curriculum focused on inclusion, including best practices for supporting transgender individuals on their path to parenthood. Can you share a bit about your role as a Family Guide at Cleo and how you think about inclusive support for members and transgender members, in particular?

As a Cleo Family Guide, my role is all about acting as an advocate for our members to help connect them to resources in their local community or to online resources to help them navigate their family planning, pregnancy, or parenting journey. Sometimes members just need that person to help filter the information they are receiving and help them navigate everything. But more importantly than that, for many Cleo members, it is about having that other voice and support to help back them up when they feel like maybe something with their care isn’t quite right.

In my conversations with Cleo members who are transgender, a lot of what we focus on initially is to figure out and define what their overall plan and goals for their care are and think about how we can help them achieve their goals and ensure they are receiving culturally competent care. For example, figuring out how they want to be identified by their care providers in terms of pronouns and other language such as chestfeeding versus breastfeeding. We talk through how members can be self-advocates and what that looks like. What kinds of things do they need to pre-empt before appointments and before new medical team providers are added to their birth plans, such as alerting the team on pronouns before an appointment.

For transgender individuals building families, and for transmasculine individuals who are navigating pregnancy, it’s also really important for them to have another advocate or person on the ground who can help them with this self-advocacy.

Birth or any of the key moments in conception, pregnancy, feeding, etc. are important times to receive clinical care and you don’t want an individual to have to keep feeling like they have to explain or justify themselves. I want to help them address any uncertainties proactively upfront so they can get the care they are looking for.

What is the current state of resources to support transgender individuals who are aspiring parents, pregnant, or parenting infants?

For any individual, when they become pregnant they need to make decisions related to where to get care, where to get childbirth education, where to shop for clothing and what to wear during pregnancy, infant feeding information, and a lot more topics. For a transgender individual, they need to do additional navigation to understand whether these resources or care is culturally competent.

In some of the major cities we might be able to find a handful of providers who can provide culturally competent care, but in many cases, it's going to be a matter of getting a doula or an advocate or ally. It’s important to have someone who can actually help create that space for the transgender individual with conversations that are preventative so the care team knows to expect a transgender indivudal, pronouns, and more. With pregnancy there are so many words that describe the body and the body processes that are also gendered and these kinds of preventative conversations can alert the care team about words that may be triggering for the individual or simply aren’t used by them to describe their own body,so they can plan communications accordingly and help the individual feel supported and safe.

It's pretty rare to find childbirth classes, information, online articles, and books that are culturally competent in this way. Most of these resources have very gendered language. We can help find the best fit for local or online resources that affirm and welcome all kinds of families.

One of my roles as a Cleo Guide is to help do the work to find these inclusive and culturally competent resources and share these with the families. I want to be the filter for them to take some of that burden off. And when certain evidence-based articles or publications are written in a gendered way I can give a heads up before sharing an article. The other great thing about being at Cleo is that when I can’t find resources that are culturally competent to share, our team can create new ones.

What are some of the risks that you have seen for transgender individuals who don't experience culturally competent care?

There are certainly aspects of the transgender pregnancy and parenting experience that can be incredibly difficult but many take for granted, such as finding clothing for pregnancy, resources that are written to speak to them and their journey, but most importantly, there is a question of safety.

When we look at the urgency of this issue, it's big because we're looking at life and death. Transgender people are much more likely in our culture to commit suicide and to have violence against them, as well as receive clinically sub-standard medical care.

Our lived experiences and our lived stress carries into how we then go into any new medical situation. If someone has had challenges with healthcare providers before and feeling safe, then they may enter any new situation with fear which takes away from being able to focus on the medical care and support you need at that moment. If every interaction is triggering, that can also be a risk that keeps people from seeking care when they need it. Biases on the part of the healthcare providers can factor into how they care for an individual, and can lead to dangerous situations.

Many people are not used to seeing someone who presents as masculine pregnant. There are often safety concerns for these individuals throughout their pregnancy journey, not just within the clinical setting.

I do have hope that this can improve for transgender patients. Not too long ago it was a really difficult experience for lesbian couples to navigate pregnancy and parenting together (not to say that it still can’t be). Sometimes only the mother giving birth was allowed in the delivery room and the female partner was not or would struggle to adopt the baby to be an equal parent under the law. Some of that has changed and improved in recent years.

What are your thoughts for better support for the transgender community and family building in the future?

I am happy to be at Cleo and know that there are employers who are passionate about supporting working families and are making a resource like Cleo available to all employees, no matter how they are building a family. I also think it is important that Cleo is available for the employed individual and their partner or an additional support person in their life. It is a lot to ask a transgender individual to navigate this all alone and I appreciate that I can also help empower their partner or friend to be an advocate for them along their journey.

There are certainly organizations and advocacy groups that are doing great work to create better resources and training to make the healthcare experience and journey safer and more helpful for the transgender community. We have a long way to go, but I am happy to see more resources and conversations around this important topic.

Helpful resources for transgender parents and their advocates: