Month: November 2024

Categories
Anti-Oppression Anti-racism work Equity Health Care intersectionality lactation LGBTQ2S+ surrogacy understanding bias

Reflections on Trans Inclusion in Birth & Lactation Support

Response re Inclusive Language

Miriam Main, one of the directors of La Leche League Great Britain (LLLGB) recently resigned because she objects to the organizational directive to be inclusive of all people who lactate, regardless of sex or gender identity. Her open resignation letter explaining her decision echoes much of the feedback we’ve heard in recent years from birthworkers who disagree with our use of language such as “chestfeeding”, “birthing person” and other terms aimed at ensuring that all people who birth babies and feed infants from their mammary glands feel included and supported with the resources required to meet their feeding goals. 

Her objections to trans inclusivity include:

  • Women cannot be physically and emotionally open with “men” present
  • Men will make LLL meetings unsafe
  • It might be dangerous for men to feed babies
  • Men feeding babies separates them from their mothers, causing damage to the mother-baby dyad.

November 20 is Trans Day of Remembrance. The day was founded in 1999 in protest of the murders of two Black trans women, Rita Hester and Chanelle Pickett. There is heightened tension regarding this day this year because of the US election outcome. Trans people in the US and elsewhere are deeply afraid that emboldened transphobes will be incited to violence. Further restrictions on trans people’s ability to access affirming care is likely coming. The inability to access gender-affirming care increases suicidality among trans people. While Main claims that she is not anti-trans rights, unfortunately, rhetoric like Main’s fans the flames of fearful and hateful myths putting trans lives in danger.

The Confusion About Main’s Objections

Main is against the presence of “men” at LLL meetings. Confusingly, she includes transmen and non-binary people in a list of types of “women” she has effectively supported at LLL meetings in the past as a leader. When she uses the term “men” she could be referring to trans men who gave birth to their babies or trans women using the lactation induction protocol to assist with feeding their babies. Through this confusing use of language, Main appears to be asserting that trans men are “women” and that trans women are “men”.

Main’s view is rooted in an idea called “gender essentialism”. This is the belief that there are two genders, that gender and sex are the same, and that the characteristics of the genders are an innate, hardwired aspect of our biology. While many people subscribe to this normative view, there is a growing body of evidence that it is scientifically inaccurate. Since the dawn of recorded history, in cultures around the world, there have been people who don’t fall into the binary sex and gender categories of “man/male” or “woman/female”. Many cultures have acknowledged more than two genders. Now science is catching up with these age-old lived experiences. 

Main’s statement recirculates several myths that we as birth workers need to dismantle:

Women Cannot be Physically & Emotionally Open with “Men” Present

Main argues that it would be impossible to maintain the open, honest environment of LLL meetings if men were present. How could women feel comfortable talking about things like chapped and mangled nipples, or nurse in front of others if men are present? Main doesn’t realize it, but she answers her own question. She notes that breastfeeding is “the great leveler”. She observes that LLL group participants put aside differences regarding race, religion, income, politics, and sexual orientation. They are united in their shared goal of feeding their babies from their bodies. Whether participants are cis women, trans men, or trans women they are all dealing with chapped nipples, sleepless nights, and internal and external pressure to use bottles. Imagine the world we’d be living in if we developed our ability to focus on what we share rather than what divides us.

Men Will Make LLL Meetings Unsafe

She also fears that women may not feel comfortable coming forward about domestic violence if men are present, noting that 1 in 4 women have experienced intimate partner violence. A Canadian study of trans people conducted in 2019 found that 3 in 5 trans women had experienced intimate partner violence. Contrary to some of the rhetoric surrounding the recent US election, trans women are not usually the perpetrators of violence. They are in the population that is at increased risk of experiencing gender-based violence. Cultivating the erroneous belief that trans people are a source of violence is a significant inciter of violence against trans people. This needs to stop immediately.

Damage to the Mother-Baby Dyad

The letter raises safety concerns that are fear rather than fact-based. She posits harm to mothers and babies caused by ripping babies from their mothers’ arms so that men can feed them. Like much of what is fueling the current trans panic, this is a total red herring. Babies are not being ripped from their mother’s arms so that men can feed them. In the case of trans men, they are usually the gestational parents of their babies. Non-gestational parents with breast tissue can induce lactation. This includes cis women, trans men, and trans women becoming parents through adoption, surrogacy, or their partner carrying the baby. The protocol to induce lactation is rigorous, involving high doses of hormones and domperidone for several months before the birth. In cases where nursing is shared between a gestational and non-gestational parent, this is with the consent of both parents. For anyone who has fed a baby with their body, it should be easy to see why sharing the load of this labour might be desirable. 

Regardless of the exact nature of the situation, it’s safe to assume that anyone showing up to feed a baby at a La Leche League meeting is a parent to that baby. That’s really all that should matter.

It Might be Dangerous for “Men” to Feed Babies

She asserts that it might not be safe for babies to be fed by a “man”. She cites no evidence of any safety concerns. This is because there is none. Aside from universal precautions regarding substance use or infectious disease, If milk comes from your nipples, you can feed it to a baby. Where supply is inadequate to meet the baby’s nutritional needs, this can be addressed as it would be for anyone. We all know how frustrating and overwhelming supply issues can be. Parents experiencing this challenge need more compassion and support, not less.

There’s no reason to believe that trans lactators are at increased risk of under-supply or babies that are failing to thrive. In response to Main’s open letter, IBCLC Ashley Pickett has shared some helpful research. She notes that “When people take hormones, they can still breastfeed. It hasn’t been shown to be dangerous. Many AFABs [assigned female at birth] are entering menopause, and breastfeeding while on HRT [hormone replacement therapy]. Some trans women have taken estradiol and domperidone and their breastfed babies thrive.”

The potential for trans women to lactate and nurse is a new phenomenon, and as such, bound to raise concerns. Ashley Pickett, IBCLC addresses this with the best available evidence also. She cites two articles showing no cause for concern at this time:

https://pubmed.ncbi.nlm.nih.gov/37138506/

https://pubmed.ncbi.nlm.nih.gov/7462406/

Drawing from the articles she cites, she also provides evidence to allay fears that hormones are crossing over into the milk supply and causing harm to babies:

“Spironolactone is poorly excreted into breastmilk and there are no reported adverse effects on infants.

Cyproteone Acetate (used for [male to female] transitions as well as more commonly for acne and hirsutism, alopecia, etc) in people [assigned female at birth] transfers at 0.2% of the parental dose. However, in trans HRT uses high doses. Switching to an injectable Estradiol Valerate may be enough to elevate estrogen and not require an anti-androgen, and safely breastfeed. Breast development would remain, but she may grow some unwanted hair.

GnRH treatment has been used in postpartum contraception for decades, and in this time, has been shown to be as low as undetectable in milk and up to 1-2 micrograms per feed at max. The amount ingested had no biological activity in the infant (would be destroyed in the gut before entering the system). When taken throughout pregnancies, as it has been for many many experiencing fertility care since the 1990s, there has been “no specific hazard observed” among newborns exposure.”

 ~

The REAL issue

Evidence has nothing to do with Miriam Main’s underlying fear. It is the same as that of our members complaining about our use of gender-inclusive language. She is afraid that she and her fellow cis women are being erased from spaces that should feel like home. While this fear is an understandable conditioned reaction to change, it is unfounded. Cis women continue to comprise the majority of people who birth and lactate. Our use of inclusive language is an action to begin opening the door for trans and non-binary people who birth and lactate to receive affirmation and support. For cis women reading this, take a moment to imagine what it would feel like to walk into an LLL meeting knowing that there will probably not be anyone else in the room who is like you, but you need help feeding your baby all the same. Would you be brave enough to walk into that room? Would you be grateful for any gesture that made it a little easier?

Letting trans folks in doesn’t erase us as cis women. It is not usually presented this way, but trans inclusion and acceptance create more freedom for cis women. As we dismantle rigid, binary gender constructs and break down boundaries regarding what a “woman” can or should be, we are all freer to express ourselves authentically. I was raised in a family of women who couldn’t leave the house without “putting their faces on”. Now, I wear makeup when I feel like it. I speak truth to power without hesitation because I’m not limited by the belief that being a “woman” requires passivity. Every day I engage in numerous actions that I take for granted that would have been unthinkable for a Black woman a century ago. I owe a huge debt of gratitude to racialized trans ancestors, like Marsha P. Johnson and Sylvia Rivera, who started the Stonewall Riots, and with them, the queer liberation movement in North America.

If we let go of the fear of erasure, we can invite in the potential for trans people to enrich birth and lactation spaces. We may discover that the experiences of trans people add an important perspective on issues affecting all of us who experience gender oppression and gender-based violence. Community support and mutual aid are not finite resources. We don’t have to worry that by making space for trans people, cis women will be squeezed out. There is room in the circle for everyone.

 

About the Author

Keira Grant

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.

Categories
community Equity intersectionality

Response to the Consensus Statement on the Management of Intersex Disorders

intersex families

[vc_row][vc_column][vc_column_text css=”.vc_custom_1731959260366{margin-bottom: 0px !important;}”]This year, in the course of my prenatal and birth support work, I had the occasion to read The Consensus Statement on the Management of Intersex Disorders published in 2006. Now eighteen years old, the Consensus statement is still used by medical teams to guide ethical decision-making regarding the medical care of intersex newborns, infants, and young children. 

Given this, doulas should be familiar with this Statement and ready to provide informational support to parents that is free from stigma and based on current evidence, including the stories of intersex adults. There are numerous concerns with this statement from a health equity and intersectional social determinants of health perspective. Many issues arise from how dated the document is. There are four problem areas with this statement: 1) Guidance on Terminology, 2) Guidance on gender assignment, and 3) Lived experience of intersex people not valued as evidence 4) The Kenneth Zucker controversy. 

Guidance on Terminology

The term “Intersex” is used in the article title, however, in the article body it lists “intersex” as potentially pejorative alongside several outdated and offensive terms. It then goes on to advise providers that “Disorders of Sexual Development” is the preferred term. This differs from the position of advocacy groups by and for intersex people, who counsel their audience that “intersex” is the term they prefer. 

Intersex conditions are numerous and diverse. Framing all of them as disorders discounts the reality that many intersex people are able to have sexual relationships and children without ever needing medical intervention. The universal use of the term “disorder” insinuates that all intersex people have something “wrong” with them that needs to be corrected. This is simply untrue. Some intersex conditions can cause issues with the ability to eliminate urine, in which case this must be treated as soon after birth as possible. Other conditions may impact fertility, and sexual functioning, or increase the likelihood of having cancer later in life. None of these issues need to be treated during the newborn phase and parents should be encouraged to focus on bonding with their baby. The blanket use of the term “disorder” and the fear it is apt to inspire in parents does not support the measured and stigma-free approach to decision-making that is best here. 

Guidance on Gender Assignment

Unsurprisingly given the statement’s age, concepts like non-binary identity and gender-open parenting are not entertained. The Statement positions it as a given that parents will be deeply disturbed if they are not able to assign a gender to their baby at birth. It promotes making a gender assignment as quickly as possible after birth as the way to alleviate parental anxiety. Much of the pressure to diagnose and treat early that it advocates is rooted in the belief that parents need guidance on how to assign gender. The statement then offers guidance on what gender should be assigned to people with certain conditions.

The idea that each individual is the most qualified person to identify their gender is never considered. According to the statement assigning gender is strictly the purview of the parents, in this case, guided by medical experts. 

Earlier this year, I wrote about the concept of “gender-open parenting” and how and why it is enacted. This approach to parenting is guided by the belief that each individual has the right to assert and express their gender as free from external pressure as possible. Gender-open parenting is a wonderful option for parents of an intersex child to consider. Gender formation and expression happen in early childhood. Anecdotally, most children who have been raised gender open have self-identified their gender by the time grade one is over. At this age, most medical complications will not have arisen, and most medical interventions are still on the table. From the standpoint of promoting bodily autonomy and informed consent, parents should be encouraged to defer decisions about gender assignment and non-urgent medical intervention until the child can be a part of those conversations.

The Lived Experiences of Intersex People

More recent research on intersex people has found that many intersex adults have extensive medical trauma from repeated examinations and in some cases multiple surgeries during childhood. Moreover, many intersex adults attest that the surgeries they endured were cosmetically motivated, medically unnecessary, and in some cases harmful to their sexual functioning and/or fertility. Still, other intersex people whose parents forewent medical interventions state that they are happy, functional adults. 

This qualitative evidence from intersex adults needs to be viewed as legitimate evidence regarding how intersex people should be cared for in childhood. I’m not sure how much qualitative evidence from intersex adults existed in 2006, but if there was any, it wasn’t included in the statement. 

The statement does use statistical evidence drawn from intersex adults, using the gender identity held by the majority of individuals with specific conditions to justify assigning that gender to all infants with that condition. The Statement notes that gender may need to be reassigned if the initial assignment proves wrong. Again, the experts are to make this reassignment. The concept of the individual deciding their gender for themselves is not mentioned. 

Throughout the document, the intersex child is discussed as a passive bystander to their health care decision-making. This is not aligned with contemporary approaches and attitudes regarding the importance of client-centred and directed care, informed consent, and bodily autonomy that should be enacted in every part of the healthcare system.

Kenneth Zucker Controversy

The Statement is a consensus among international experts on the diagnosis and management of intersex conditions. The Canadian expert who contributed to the statement is Dr. Kenneth Zucker. His name will ring a bell for many members of the Toronto 2SLGBTQ community, especially trans people, parents of trans kids, and their allies. For many years, Dr. Zucker was the director of the Gender Identity Clinic at the Centre for Addiction and Mental Health (CAMH). Many trans youth and their parents have accused Dr. Zucker of harming them by gaslighting them about their gender identity and trying to convince kids who were certain that they were trans that they were wrong and that in his expert opinion, they were cisgender and should focus on being comfortable with the gender they were assigned. Following significant and sustained outcry from the 2SLGBTQ community alleging conversion therapy, Dr. Zucker was relieved of his duties at CAMH, and the Clinic was closed. He defended his practices, appealed this decision, and was eventually offered an apology and a settlement by CAMH.

The consensus statement manifests many of the concerns that were raised about Dr. Zucker’s ideology. They included:

  • The individual is not considered a valid authority on their own lived experiences and identity. 
  • Conforming to the gender you are assigned is the ideal outcome. 
  • Non-binary, genderqueer, agender, and genderfluid identities are not legitimized or even considered. 
  • Everyone must eventually conform to the box of “male” or “female”. 
  • Gender is something that is assigned to you, not something that you define for yourself. 
  • Having a child that can’t be easily slotted into one of those boxes is “disturbing” for parents.

On this platform, I have talked about how these beliefs are harmful to trans people. They’re harmful to intersex people too, especially in infancy. The pressure to rush to gender assignment, potentially reinforcing the assignment with surgical procedures, is driven by these beliefs. Intersex people are being physically and psychologically harmed as a result. 

~

For many parents, their child being diagnosed with an intersex condition will be the first time they have given any thought to the existence of intersex people. This is through no fault of their own. The gender binary is the dominant perception of reality. The lives of intersex people are shrouded in stigma and silence. As such, parents are highly vulnerable to accepting what they are told by medical experts at face value. The Consensus Statement is an excellent example of how medical guidance is not always objective. Our interpretation of “facts” is always mediated by our preexisting beliefs. 

Doulas have a vital role to play in helping parents understand where medical recommendations are coming from and unpacking the beliefs on which seemingly evidence-based recommendations rest. The B.R.A.I.N (Benefits, Risks, Alternatives, Information/Intuition, (do something) Now/Never/Not Now) model of decision-making is an excellent approach to apply. We can also reduce stigma by sharing stories of positive outcomes for intersex individuals. Role models and other resources can be found at Intersex Canada or InterAct: Advocates for Intersex Youth.

My social media post from October 28, 2022, offers guidance on specific questions parents should ask if their child is diagnosed with an intersex condition. A huge part of the magic of this work is the power to improve lives by being at the ready with unbiased, affirming, open-minded information and compassionate support. If we lead with compassion and inclusiveness, we can alleviate the medical harms currently happening to intersex babies and children. 

 

Keira GrantKeira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

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About Us Business Certification certification Members Mentorship Webinar

Recertification

Recertification

As professionals dedicated to excellence and impactful care, we understand that learning is a continuous journey and we’re so happy to invest heavily each month in newsletters, webinars, new courses, program updates and more to serve you as our alumni. This month’s blog shares an important reminder about staying relevant, effective, and confident in our roles: recertification.

When Doula Canada became an approved vocational school years ago, we undertook that for students to be able to use RESPs to pay for their education. One of the requirements of that program and of many other provincial and state doula associations was a requirement for recertification to be part of the organization’s standards. This requirement has been in place since 2017 when this was first introduced. See FAQ item posted here. This requirement however has not been enforced administratively and was up to individual doulas to submit their Continuing Education Units (CEUs). 

We’re now introducing a more formal way for us to track and support alumni with this process. 

What does recertification entail?

Trust us when we say we want this to be EASY. No one wants a complicated and convoluted recertification process. We will require only 2 things for recertification: 15 CEUs and an up-to-date CPR/First Aid.

THERE WILL BE NO FEE FOR RECERTIFICATION AT THIS TIME. The earliest date we will require recertification is December 2025, one year from now.

Why is Recertification Important?

There has long been debate about many aspects of our profession, credentialing in general and of course the professional aspects of being a “profession” at all! As leaders who’ve been working in the field for over 20 years we’ve seen a LOT of change. Similar to modern midwifery, the doula profession has experienced a conflicting balance between wanting the work to be accessible for families but also wanting to maintain independence from the colonial and capitalistic aspects that formal regulation brings. Ultimately it always calls for a trade-off or balance of priorities, needs and desires. As we look to the United States and see more and more states covering doula services through Medicaid, the future is pretty clear: our profession is trending in the direction of expansion. This means more doulas and more coverage, and more structure.

How Can I Get CEUs?

Have you noticed that Doula School offers our alumni FREE monthly webinars? Each webinar is worth 1 CEU and they are hosted almost every month of the year! This is a cost effective way to get your CEUs. We also launch new courses each year, giving you the chance to learn a new skill AND gain valuable CEUs. And of course you’re always welcome to take courses from other organizations that offer something you’re wanting to learn about. We will also have other simple ways to get CEUs at no cost. We will be launching a recertification guide in the coming weeks and it will give you lots of information about how to get everything done. Please note that if you unsubscribe from our newsletters  you won’t receive important information about webinars or recertification notices. You can resubscribe here on the website.

When do I need to recertify by?

We are giving all students one year to complete these steps. You are welcome to submit earlier if you prefer (and are due for recertification) but it will not be REQUIRED until December, 2025 for those who certified before December 2022. 

If you certified after December 2022 then count 3 years from the time you certified for your due date. See more info in the FAQ about how to calculate your recertification period. 

 

FAQs

Why does Recertification Matter?

Staying Current with Industry Standards

The field we work in is dynamic and continually evolving. Recertification ensures you are up-to-date with the latest research, best practices, and trends. This not only elevates your own practice but also upholds the standards doula clients expect and deserve.

Strengthening Your Professional Skills

Recertification often involves engaging in advanced education, workshops, and reflective practice. These opportunities allow you to deepen your knowledge and refine your skills, ultimately making you a more effective and informed practitioner.

Building Credibility and Trust

Clients, peers, and employers value those who demonstrate a commitment to excellence and continued education. Recertification reflects your dedication and passion for ongoing improvement, reinforcing your credibility within the community.

Networking and Community Growth

Recertification often provides an avenue to reconnect with peers, share insights, and grow as part of a collective. This network is invaluable for support, growth, and even collaborating on new initiatives.

Adapting to Emerging Needs

As professionals, we serve a diverse range of needs that may evolve over time. Recertification helps us stay informed and prepared to meet these needs with competence and empathy.

Renewing Your Commitment to Excellence

Recertification is more than fulfilling a requirement; it is a reaffirmation of our shared commitment to providing the highest quality care and expertise to clients. We are here to support you every step of the way, with resources, guidance, and opportunities to make this process enriching and rewarding.

What is recertification?

Recertification is a way to ensure that our doulas and educators are maintaining their high level of knowledge and skills by showing proof of continuing education, even after their program is complete.

Why do we ask you to recertify?

We want to ensure that our doulas and educators are viewed as leaders in their field, and having organization-wide policies that show that our alumni are regularly continuing their education allows us to demonstrate our high standards. This policy also keeps us on par with other professions, such as Registered Nurses, Massage Therapists, Paramedics and Social Workers, which will allow us to keep moving the profession forward in recognition of the value of our work.

How often do I need to recertify?

We ask that you recertify every 3 years. You will receive notification when you are approaching your recertification deadline. If you graduated between January 1st and June 30th, your deadline will be June 30th of your recertification year. If your graduation date was between July 1st and December 31st, your deadline will be December 31st of your recertification year.

What if I don’t want to recertify?

If you don’t want to recertify then don’t! Quite simply there is nothing more ‘doula-y’ than doing what you want (after all, isn’t that what we help all our clients to do?). If you no longer feel value in certification or recertification then ignore our reminder emails and carry on!