Navigating U.S. pregnancy care as a transgender man

Written by Kayden Coleman

When I began my transition over 13 years ago, the thought of having one child — much less two — was the furthest thing from my mind. That nonexistent thought became an impossibility when I began my medical transition and was informed by my doctor that the use of testosterone would render me infertile after prolonged use. For me, that was perfectly fine. My main and only concern was feeling happy and at home in my body. And, if I am being honest with myself, even when I identified as female, I never wanted kids. I didn’t grow up envisioning myself with a family of my own. 

I am a Black, gay, transgender man and seahorse dad. I gave birth to my first daughter on January 9, 2014 — four years after beginning my medical transition. Six years later, I gave birth to my second child on July 21, 2020. Neither pregnancy was planned. I am a same-gender-loving man; I am attracted to and date male-identified people. While the logistics of how I have sex is really no one else’s concern, one should be able to deduce how I was able to conceive due to the fact that I found out about both of my pregnancies — rather than planning them. 

"Despite knowing my sexual history and practices, no one suggested a pregnancy test. I found out I was pregnant on my own."

With my first pregnancy, I didn’t find out I was pregnant until I was five months along. It’s not because I wasn’t going to the doctor — I absolutely was. I was in and out of the doctor’s office with symptoms like extreme fatigue, unexplained weight gain, and frequent urination. My provider at the time was also a transgender man. Despite knowing my sexual history and practices, no one suggested a pregnancy test. I found out I was pregnant on my own. 

When my pregnancy was confirmed, I was referred to an OB-GYN who knew literally nothing about how to care for me as a trans person. I was constantly misgendered, subjected to uncomfortable jokes at my expense from the nursing staff, and always had to be on guard and ready to defend myself. My blood pressure was constantly elevated and as a result, I was induced due to preeclampsia. 

"I didn’t feel like I had autonomy over my own body and experience."

I was admitted into the labor and delivery unit at the hospital in Philadelphia, PA. Upon arriving, I asked if it would be possible for me to have a C-section. I told them that I couldn’t imagine myself giving birth vaginally. I was told that I would not be able to have a C-section because it was too risky and because “all of the women on the labor and delivery unit would prefer a natural birth.” For five days, I was connected to a magnesium drip and unable to get out of bed or eat solid foods. To make matters worse, at any given moment there were upwards of 10-15 students in my room observing me. I felt like a lab rat. It was extremely uncomfortable and I didn’t feel like I had autonomy over my own body and experience. 

Finally, on the fifth day, the doctor came in and told me what the plan would be: They were going to continue to try to induce me. It was at that point that I had a complete nervous breakdown. I couldn’t take it anymore. I called the doctor back into the room and told her, “I know you said that all of the women on the labor and delivery floor would prefer a natural birth, but I don’t know if you’ve realized that I am not all of the women on the labor and delivery floor. At this point, either you cut this baby out or I will. Your choice.” 30 minutes later, I was on the operating table. But it was too late. The damage was done. 

My experience left me irreversibly traumatized, and I connected that trauma with my daughter. As a result, I suffered from severe postpartum depression, anxiety, and post-traumatic stress disorder. I spent the better part of two years just trying to be okay and found it nearly impossible to connect with my child. I was so focused on not giving in to the desire to take my own life — and, with little to no support or postpartum care, it was extremely difficult. 

"Transmasculine people are one of the most understudied and overlooked marginalized groups."

As you are (hopefully) already aware, Black cisgender women experience the highest mortality rate in the U.S. during childbirth. According to the CDC, in 2020, non-Hispanic Black women experienced 55.3 deaths per every 100,000 live births. That number is 2.9 times the mortality rate for non-Hispanic white women. The question is, how do transmasculine individuals — specifically Black transmasculine individuals — fare? We don’t know: Transmasculine people are one of the most understudied and overlooked marginalized groups in maternal health research. 

Only recently, thanks to the growing visibility of transgender people, has the topic of transmasculine pregnancy become a part of the conversation. Increased conversations (mainly in politics, with more and more legislation attempting to hinder access to affirming care) have compelled providers to want to learn more about our unique experiences. This has led to more attempts at including transmasculine people in pertinent studies — with the goal of being able to provide safe, equitable care. 

So, why does any of this matter? As a Black trans man who has had to navigate medical birthing spaces in the U.S. twice, I am living, breathing proof that a lack of education will almost always lead to traumatic, life-altering experiences. Childbirth is supposed to be a joyful experience regardless of a person’s race and/or gender identity. And what’s more — the experience a person endures during their pregnancy and childbirth will likely directly affect their postpartum experience. 

What needs to change?

1. Education is key. The very first step to providing safe, equitable care for transmasculine individuals is educating yourself. The best way to do that is to hire a qualified transmasculine person to provide training for you and your staff. It is also extremely important to remember that not every experience is the same. Different intersecting identities require different approaches to care. A Black transmasculine person’s experience will likely differ greatly from someone who is non-Black due to things like racial biases and systemic racism.

2. Representation matters. Using inclusive language (i.e., "birthing people," "gestational parent," etc.), using inclusive imagery, and making sure that your intake forms are inclusive as well are all ways to show transmasculine folks that a practice or organization is a welcoming, safe space. Small changes make a huge difference. I know that for a lot of people, change is scary. There is also the politics surrounding inclusive language/imagery — people feeling like including trans and non-binary people in the conversation is erasing women/mothers. But inclusion does not equal exclusion. There is a seat at the table for all of us, and all of us deserve quality care and representation. 

To my transmasculine community…

If you are currently pregnant or are considering taking the pregnancy journey, arm yourself with knowledge. Know that your body is yours and that you have complete and total autonomy over your pregnancy and birth. 

My biggest piece of advice is to hire a doula. A doula provides emotional prenatal and postpartum support and can help by being a buffer between you and potentially problematic providers. If at all possible, have as much community and familial support as possible. 

Don’t let society or anyone else convince you that you are undeserving of the life that you have envisioned for yourself. We all deserve happiness, and no matter the political climate, that’s not up for debate.

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At Millie, we strive to go way beyond the limits of the traditional maternity care system. Our goal is to provide care that reflects and honors the many facets of our patients’ identities, backgrounds, and experiences. That means equitable quality care for patients of all races, ethnicities, genders, sexualities, belief systems, and insurance status. No matter what, we’ll put you and your needs at the center of your experience. Because Millie means better maternity care for all — and we’re deeply committed to making sure that becomes the reality.