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Sam Guido gave birth to his first baby three nights after Roe v. Wade was overturned. His physicians did not recommend misoprostol, a substance used in medical abortions, to help with contractions because they were unaware of what was still legal.
That was yet another setback and another indication that Guido’s labor was out of his hands. Guido had no desire to give birth in a hospital because he was terrified of being there. They have experienced the same misunderstanding and discrimination in health facilities as some trans people in the United States as transmasculine and nonbinary people. However, Guido’s apartment was very small, a home birth was simply not an option, and neither health insurance nor midwife care were covered.
Otherwise, Guido enlisted a select group of friends and relatives to support them in the hospital. As they welcomed his child, T, into the world, the medical team made sure that the other transgender individuals in the room were respected. Guido requested that The 19th keep his daughter’s second name private.
He said, “They made sure everyone who entered the room knew that I was going to be ‘Papa,’ I was T’s ‘Papas,’ and that the language they used to describe me and my body was appropriate.”
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This article is one in a series on American childbirth. We looked at how transmasculine people, Black Southerners, first-time families over 35, and people trying again after lost pregnancy locate pregnancy in our healthcare system. Read their tales.
T is currently 17 weeks old. Guido is appreciative of the little things that come with being a parent, like watching T learn to give high fives and blow kisses as she develops into her own individual more and more each day. He and his partner Joey both had siblings growing up, and they consider them to be some of the most significant relationships in their lives. That kind of unique relationship is what they want for T. Guido and Joey have therefore been attempting to conceive a second baby for the past six months. It has been a beautiful and strange approach, but not without difficulty.
It’s taking longer than it did with T. Guido has been feeling continually like he is doing something wrong after witnessing one negative pregnancy test after another. Guido has stopped taking hormones, which some transmasculine people take as hormone replacement therapy, while trying to conceive. Without it, his hormone levels fluctuate, making it difficult for him to control his emotions. His period has returned, which is causing him severe gender dysphoria.
They do intend to conceive, yes. However, being pregnant puts you back in the healthcare system’s vulnerable position. Guido searched for a primary care physician in Janesville, Wisconsin, that was both safe and trans-affirming before T was born.
It entails taking the risk of being harassed by strangers when leaving the house in public while pregnant and appearing too much like a man.
It entails experiencing the same personal and economic upheaval as other couples who undergo fertility treatments that, for whatever reason, are ineffective.
However, Guido has also learned new aspects of their personality as a result of trying for another childbirth. It has brought them closer to their spouse as a heterosexual couple as they both explore what connection looks like while trying to get pregnant.
In the United States, being a transmasculine male is full of these two emotions: joy and pain. The 19th spoke with two transmasculine couples who were thrilled to have children but felt isolated and discriminated against in a society that still views men who are pregnant as unnatural and in the healthcare system that assumes all expectant women.
Guido’s most recent pregnancy demonstrated to them that being pregnant really felt affirming for them rather than hypomanic, as it does for some other transgender men. They frequently feel the need to defend those thoughts.
“When it came to conception, I was surprised at how little distress I felt.” “In a way that didn’t in any way, shape, or form challenge my gender identity,” he said, “it felt very natural to me.”
Instead, during his first pregnancy, Guido struggled with feeling unknown and alone. He was unable to discuss this significant aspect of his life with anyone other than his close friends and family. Another trans person in the gay post class he attempted to join felt uneasy learning about his pregnancy, while some queer people vehemently asserted that childbirth was an experience that only women had.
He couldn’t find anyone else who was like him.
It refers to you as “mama” when you pick up a pregnancy test. They claimed that
when you enter pregnancy support groups, you are joined by cis people and that everyone is staring at you strangely because you have a beard.
These incidents made Guido conscious of how alone they felt in rural Wisconsin as a transgender woman who was pregnant.
According to a 2019 report from the Movement Advancement Project (MAP), transgender people in rural areas typically have fewer resources and are more likely to experience risks of being out than those in urban areas. Discrimination can have a more significant impact and make hostility more intolerable when there are fewer accepting employers, physicians, housing options, and nearby LGBTQ+ areas.
However, trans people frequently experience bias in healthcare, regardless of where they reside in the United States. According to the 2015 U.S. Transgender Survey, this includes being denied insurance coverage for regular physical or sexual checks that are still considered to be women’s health problems, such as Pap smears and mammograms. Others may instruct their health professionals about transgender care in order to get the right care. They are frequently asked intrusive questions.
According to Kellan Baker, executive director and chief learning officer of D.C.-based LGBTQ+ health care provider Whitman-Walker, the nation’s health system is woefully unprepared to treat transmasculine patients. Accessing quality care becomes even more challenging for transmasculine women who are pregnant, especially for those who experience gender dysphoria during childbirth, he said.
Because of ignorance, individuals assume that trans people would never want to become pregnant. Or, as Baker claimed, people mistakenly believe testosterone to be birth control.
Healthcare professionals frequently believe that trans pregnancies don’t occur or, if they do, that their practice is unaffected by their rarity. According to Baker, this results in specialists who are unable to provide patients with the proper treatment.
“It can be fatal,” according to Baker, “when people don’t have the proper tools to fully understand the health care needs of trans people.”
That threat is made evident in a 2019 study published in the New England Journal of Medicine. A 32-year-old transgender man went to the emergency room with excruciating abdominal pain, only to learn several hours later that he was pregnant, much to his surprise and the surprise of the medical staff. There was no fetal heartbeat at that point.
When the person was admitted to the ER, he was properly identified as a man. However, his treatment was not in line with his actual needs or physiology. His high blood pressure was assumed to be hypertension, and his symptoms weren’t treated as an urgent situation of pregnancy-related abdominal pain.
Guido’s most recent pregnancy demonstrated to them that being pregnant really felt affirming for them rather than dysphoric, as it does for some other trans men. (Photo by Jamie Kelter Davis for The 19th)
Kayden Coleman, a queer Black transgender man, experienced the same lack of knowledge among health workers regarding transgender people and the type of reproductive health care they require during his first pregnancy in Philadelphia in 2013.
Coleman didn’t realize he was pregnant for five months in part because of the medical staff’s ignorance. He didn’t go through the same symptoms that most cisgender women would. He lacked breasts, so increased tenderness was irrelevant. He also didn’t experience morning sickness. He only felt tired, so his doctor assumed he wasn’t pregnant.
“My general rule is that you can become pregnant if you’re having sex with someone who has a penis that doesn’t detach. And you ought to be investigating,” Coleman added. “You cannot trust your health professionals.” At the time, his personal physician was a transgender person. He still hadn’t considered the possibility that Coleman might be pregnant. He said, “We’re kind of on our own out here.”
Coleman enjoyed taking pictures of his chest and sharing updates as his first pregnancy progressed once he began receiving care. He didn’t experience any gender dysphoria because he wanted to be as outward as possible.
He claimed that “ten years ago, there was no picture of Black pregnancy for trans men.” “I thought we needed more of that. I guess I offered my services as a gift.”
Because of how Coleman was treated by health personnel, birth was traumatizing. He claimed that he wasn’t taken seriously. He was mistreated by medical professionals after being induced, and they disregarded his calls for a C-section until he experienced what, according to him, was “a psychological breakdown.” He struggled with postpartum depression, anxiety, and post-traumatic stress disorder after the birth of his child Azaelia.
He didn’t feel truly helped and supported until he met a nonbinary doula through a queer Philadelphia-based Facebook group. They provided Coleman with a level of comfort and understanding that was far superior to anything he had experienced in the doctor’s office, and they provided logical explanations of his situation.
“I was unable to be left alone with my child without experiencing a panic attack. But she assisted me in getting through that as well,” Coleman said. She looked after Azaelia so Coleman and his ex-husband could relax and guided him through the typical postpartum depression experience.
When I was feeling like I wanted to end my life, he said, “Just her explaining all the aspects, like the PTSD and all that, helped tremendously for me to be able to talk myself off the edge.”
About 1 in 8 women with a recent delivery have experienced postnatal depression, according to the Centers for Disease Control and Prevention, which only monitors how some cisgender women experience the problem. There isn’t much comparable data on the birthing experiences of trans people, and the scant research that has been done has largely ignored trans women and nonbinary people in favor of White people’s experiences.
Trans-inclusive health care is crucial because it is well known that trans men frequently experience loneliness, anxiety, and isolation during pregnancy. In addition to discrimination, stigma, and bias within the sexual health care system, trans men and women both have restricted access to gender-affirming fertility preservation services.
More can be assumed given the high Black maternal mortality rate in the United States—Black women are at least three times more likely than White women to die from a pregnancy-related cause—and the fact that Black transgender people and Black genderfluid people face even greater risks when seeking reproductive health care.
Due to the coronavirus, New York City was shutting down when Coleman learned he was pregnant with his second child, Jurnee. Due to increased pandemic restrictions, he had to manage health facilities without anyone else present to advocate for him. He was unable to take a doula to medical appointments as he had intended. Those sessions, he claimed, were angry.
Coleman was informed by a worker that he wasn’t welcome at the Brooklyn perinatal company because it was only for women. He claimed that although the worker previously apologized for trying to ignore him, he had to request documents from his physician that allowed him to be seen. He claimed that the ultrasound technician in that same company later stopped referring to him as the father of his child or using his proper pronouns.
In 2020, Coleman’s girls will appear in a family photograph in Gaithersburg, Maryland. Throughout his next pregnancy, Coleman believed that racism rather than stigmatization was a major factor in how he was treated. KAYDEN COLEMAN
Coleman had been misgendered before, so it wasn’t a new experience. But compared to what he had previously experienced, this was worse. He had no choice because of COVID-19. He was unable to simply locate a new ultrasound facility or maternal business.
Coleman believed that racism rather than transphobia was the primary driving force behind much of his treatment throughout his subsequent pregnancy, which included medical professionals regularly asking him if he wanted an abortion despite his declarations of joy at having another child.
He claimed that “their fear or their microaggressions toward Black men take precedence over their knowledge that I am male.” “Now that I’m the angry Black person, who knows what could have happened if I had lashed out or lost my cool?”
Coleman claimed that those encounters robbed him of joyous moments during his pregnancy that he will never be able to regain. He recalls feeling hurt, angry, and uncomfortable as he and Jurnee’s other father left an ultrasound session. And the incidents just kept coming.
“Here’s another one as soon as you’ve fixed the first one.” The office later came together, and the women there were even polite. But he added, “That was near the end of my pregnancy. The doctor was to be the next stop. I now have a completely new team that I must manage. And I have to deal with a whole different list of infractions.”
Following T’s birth, Guido even struggled, going through a brief period of postpartum psychosis followed by an eight-month-long depression. They began taking drugs for their symptoms, visited a therapist every week, and felt incredibly guilty for not paying their parents the proper amount of attention.
Their experiences with maternal mental health issues served as a reminder to them of how important it is for other trans people to have access to spaces created and managed exclusively for and by trans people. Actually finding reproductive health care in establishments that are familiar with trans people is challenging right now. Additionally, Guido had to inform his own health professionals about his basic needs while attempting to get help because he lacked trans-competent health care.
At their Wisconsin house, Guido holds his wife’s hands. Following the birth of his daughter, Guido even struggled, going through a brief postpartum psychosis followed by an eight-month-long depression. (Photo by Jamie Kelter Davis for The 19th)
They claimed that “My sex is inextricably linked to this fertility journey and is a non-removable component of it.” It’s now a very tough and personal process to navigate right now. I don’t really need more obstacles, though.
Guido has discovered a new postpartum support group for gay and trans parents in Madison, about an hour’s drive from his home, as he continues his quest to conceive once more. Every quarter
, the group gets together. On a bright, crisp Saturday in late October, he first joined them. The older children, who were 3 and 4 years old, played in the area while the people conversed and ate lunches that they had packed.
He experienced an emotional time during that meeting. It was the first time he had ever interacted with a trans parent who was also expecting. In addition to being understood for his transgender experience, he was also not being questioned about his lack of gender distress while pregnant. He and the transgender man he met, who had brought his own family, truly shared that knowledge.
It was just a relief to be able to say, “Oh, you get it. You’ve been there,” he remarked. When meetings resume in the spring, he’ll get up and hopes to run into other trans parents just like him.
