In Hypnobirthing we talk about how the language that we use makes a big impact to our mental state. How it can be useful to reframe words in a more positive way, for example, using the term 'surge' instead of 'contraction'.
Lately in the birth world there has been a lot of discussion about language, what language we should be using (or not) to refer to various groups of people, namely the LGBTQ+ community. There’s been some confusion where people thought the terms 'woman' and 'breastfeeding' were deemed no longer acceptable - actually the LGBTQ+ community just want additional terms to be used, such as 'birthing person/birther' and 'chestfeeding', as not everyone who births identifies as being a woman or thinks of themselves as having breasts. Considering the Oxford English dictionary changes over time and new words and phrases get added, I personally feel there is space to include extra language to ensure that everyone feels included. One argument against this is that it erases all that women have fought for in terms of equality. I disagree wholeheartedly with this. Louder for those at the back, we're not getting rid of the term 'woman' or 'breastfeeding'! We’re just using new language in addition. You may think this is a trivial thing, but not acknowledging that people other than women give birth is damaging. What does their maternity care look like if their viewpoint is not taken into consideration?
I consider myself to be an ally to the LGBTQ+ community. I have LGBTQ+ friends who have raised families, and hate to think that the care they received would be any different to my own or anyone else, based purely on their gender or sexual orientation. We know this to be the case however here in the UK, from not having an adequate box on various forms (i.e. not just male or female - other countries such as Canada are now including a third box to denote neither male or female) to being denied access to IVF treatment on the NHS in England unless you have undergone 6 rounds of private treatment (compared with 2 for a heterosexual couple). Shockingly, across all Health services 'One in four LGBT people (23%) have witnessed discriminatory or negative remarks against LGBT people by healthcare staff' and 'One in seven LGBT people (14%) have avoided treatment for fear of discrimination because they are LGBT' *1
And in case you were thinking this only affects a small proportion of the population who want to start a family, consider these statistics:
'Half of 18 - 24 year olds do not identify as completely heterosexual' - Kinsey report from YouGov poll 2018
'77% of LGBTQ+ "Millennials" (then aged 18-35) are either already parents or considering having children' - LGBTQ Family building survey 2019
More and more people are 'coming out' and rightly living their lives as their true selves. Right now, LGBTQ+ folk are accessing maternity services up and down the country, wondering if their care providers will understand them and support them on their journeys to becoming parents.
Where it gets complicated is the argument that to give birth, you implicitly have 'female' physiology (a uterus, a vagina etc) - irrespective of how you identify yourself. The issue with this is that the term 'female' is so synonymous with being a woman, and the LGBTQ+ community refer to the sex being 'assigned at birth' (assigned by a health professional based on a number of factors outlined below. An LGBTQ+ person may not identify with being female themselves, despite appearances).
As well as actively listening to LGBTQ+ people to better understand their perspective and experiences with maternity services, what does the evidence based research say? Is it true that we neatly fit into female and male physiology?
Actually, no. A percentage of the population actually exists on a spectrum. If you looked at a city the size of London, maybe about 100,000 (around 1 in 80) people will have some form of 'intersex' (or DSD - Differences in Sex Development)*2 whereby there is a sliding scale of whether you are 100% male or female. This could be very minor, and it may be something that you're not aware of at all. Equally, it could be very pronounced in terms of physical appearance. The sliding scale works on a number of levels - whether there are XY chromosomes or XX chromosomes, external presentation of genitalia (vulva or penis), whether or not a uterus is present, whether there are ovaries or testes, and the hormones that are being produced (oestrogen or testosterone).
You could argue that this only affects a small percentage of the population. But considering DSDs could go undiagnosed for some time, or sometimes there is no evidence of any variance externally, there may even be a larger proportion than we know of that forms part of these figures.
No doubt more research is needed, but these studies show it's not as black and white as being 100% either male or female. We exist on a spectrum, and our hormones play a part in how we perceive ourselves and our identities. As society rightly becomes more accepting of the LGBTQ+ community, and more people acknowledge their true gender and identity, it is imperative that we change the discourse on maternity care for these people. That can only happen if they are (in the words of an open letter written by LGBTQ+ birthworkers in response to the misinformed rhetoric circulating in the birth world) 'given a seat at the table'.*3
I will finish with this quote:
'Being male or female is about so much more than our biology. It's about who we feel we are and how we live our lives.'*2
I couldn't have written this article without the invaluable help from Caroline, The Little Birth Company's LGBTQ+ Peer Supporter, and fellow hypnobirthing instructor at Pride & Joy Hypnobirthing.
1*'LGBT in Britain Health Report, Stonewall, 2018
2*'Me, My Sex and I' - BBC, 2010
3* Open Letter Statement - https://www.queerbirth.com/