I have had bits and pieces of this conversation with Jess over the last few years and each time, I have felt something inside me shift and change. Some of this is the specifics of what Jessica is sharing - how we hold the pre-emergent life of a child-before-birth and how transphobia impacts that period - have changed how I approach those I love who are growing a descendant inside. And it’s also more than that: something about Jess’s thinking, about how they approach and unpack this concept of attachment, has also generally broadened my sense of what is possible when welcoming a new life into a community. I keep remembering the stories I heard growing up, stories about how we used to wait to name our children until they were a few months old or a year old because we weren’t sure they would survive, and I think that the remembering of the stories is probably wrong. I think that this is the excuse that we might have created for why we forgot what it is to wait for a newly born life to emerge and show themselves to us, their community, before forcing them into a gender or role or name box. From Jessica’s piece, this quote: This conversation is about the possibility of our children, and our willingness or unwillingness to embrace their full possibility. What willingness do we have to engage in ‘not-knowing’ in exchange for possibility? For the fullness of unconditional belonging and the protections of unconditional love? 

Much of the psychology of attachment feels like a western way of trying to get at the wound of disconnection. Sadly, attachment psychology often only focuses on human-to-human attachment, again centering the western wound of the isolated individual. Whatever it means to heal collectively; for those who have forgotten, to come back to experiencing and supporting the unconditional belonging of all life; this piece feels like it is touching on one of the pieces of this process. Reading Jess’s words feels like both claiming and remembering at the same time. Thank you, Jess, for being willing to write this so that I could share it here.

I came to midwifery 12 years ago, not as a parent but as a person deeply intrigued by the potential of how the de-medicalization of birth and death could position people to more readily engage in their own liberation. The lens of public health was important to me. I saw the way that medical systems, even when populated by really good people, systemically compromised bodily autonomy: targeting bodies based on race, class, gender and other categorical exclusions. I came to midwifery from feminism, craving a lens that wasn’t overtly misogynistic as was so blatantly evident in all the clinic settings that I had previously experienced. I was being called on by my community to accompany folks in their births, abortions, and other reproductive health experiences. My community was inviting me in. 

Modern midwifery is in a complex process of reclaiming traditional knowledge and carrying forward a model of healthcare based in relationship. It is deeply entrenched in the influence of white supremacy, and subsequently cis-heteropatriarchy, making it a difficult profession to enter for those not centered within the dominant culture.As my life drew me toward midwifery I felt much trepidation about my place in this profession as a gender non-conforming (GNC) person who presents on the masculine side of the spectrum.  During my apprenticeship I experienced some of the most intense inter-personal transphobia of my life and witnessed the way in which white, cis-women occupy propriety around this knowledge and role. Once licensed, I sought out a community who might be interested in working with this fragmented knowledge from a lens of liberation work. And I found this. I have had the gift of work alongside powerful BIPOC midwives, birthworkers and advocates who are scaling the steep climb of reclaiming birthwork from the clutches of colonialism-- both past and present.  I have seen a Birth Justice movement surge that is centering those most impacted by health disparities and obstetric violence and rejecting the complicit nature of white-dominated birthworker culture. Yet still among these transformational conversations about birth, bodies, survival and liberation I have felt something missing. 

During this last decade I have observed that conversations about gender inclusion in birthwork (and there are few) have been largely focused on semantics. It  usually focuses on how to make language more inclusive, such as how to use the right pronouns, terms, and labels so that Trans and GNC people ‘fit’ within the service model. This conversation is important. How we communicate about multiple experiences of gender, sexuality, relationship and roles is an essential building block to scaffold a conversation that acknowledges there are experiences outside of cishetero-normativity. However, my observation is that this intention around the words we use is both the beginning and end of the conversation about Trans liberation within the context of birthwork. In truth, I have abstained from the conversation often. I have braced myself in performing the exercise of  pronoun introductions in countless groups where I am the only visibly GNC person. I have wondered many times ‘what am I doing here’? 

Until recently, I have had difficulty articulating what I want and care about for Trans people in birthwork out loud. The vulnerability that I feel as the ‘only’ one in so many birth circles has made it hard to find community for this conversation to happen in a real way. I want to go deeper than a conversation about  the basic things-- the right for us to be seen and valued, to have access to basic human dignity and the right to healthcare that is not violent or stigmatizing. These are things we all deserve and that people of many identity intersections, certainly not just trans and GNC people, have yet to attain.

When I was still an apprentice I attended a prenatal where the sex of the baby was being discussed by the midwife and parents. The dad joked ‘we don’t care if it’s a boy or a girl, we just want one or the other’.  That comment had a deep effect on me. Is it true? Would you only want one or the other?  Would you reject this baby if you knew they might not follow those rules? This is a reality I have seen and known.

I’ve carried that fear with me through midwifery. That maybe the possibility of a child, like me or so many that I love, was unthinkable. That it would be better to assume that it is not possible.

I believe that the deeper struggles that Trans people are engaged in are actually not yet seen or acknowledged through the lens of Reproductive and Birth justice. We have barely scratched the surface of the conversation about our belonging, as adults, within a practice that is rooted in a foundational human experience--whether it is one that we experience as individual bodies through giving birth or, as a collective, by being born. And already I want this conversation to go deeper. I care that we reclaim a space for ourselves for our natal belonging--our right to exist -- and acknowledge that right for those who are yet to come. That we make the space of attachment big enough to include those of us that do not follow the rules of gender, as it is often expected by our parents, families and communities.

So often the narrative around Trans people is one of correction-- being in the ‘wrong body’ or having a ‘mismatch’ between sex and gender. Some of the time this narrative is rooted in a conversation about how Trans people can self-actualize-- whether through language, clothes, medical transition, or other means. However when we view this language through the limited verbal vocabulary and vast emotional language of children and babies we are messaging only what ‘doesn’t fit’ or ‘isn’t quite right’, transferring the burden of transphobia directly onto them for their failure to conform.  I want our belonging to begin when we begin. I do not want our belonging to be delayed until we have been decoded and then become eligible to belong.

The way our expectations of binary gender informs our attachments with our children are constantly on display during the tender times of gestation and early childhood. I have been a part of countless discussions where we, or more often parents with me as a witness, construct ideas of who their children will be through the lens of their assigned sex and gender. Parents talk in sweeping assumptions about the ways that child’s sex will or will not complete their family’s circle of relationship.  In fact, the conversation of sex and gender may be considered ‘nuetral territory’, a respectful way to engage someone about their pregnancy without asking overly personal questions. Babies have full wardrobes before they are born based on their presumed gender, and even animals that are somehow associated with being a boy or a girl. We are so eager to attach to our children and invite others into that attachment that we piece together their identity with the little information we have and enthusiastically encourage others to do the same. 

Transphobia and ableism are set up in much the same way prenatally, through the myth of typicalness, and the intense conditioning around this myth. The idea that we can only set up love and belonging through the expectation of categorical sameness. Typicalness is a concept used as a hierarchy of value-- those who act, appear, or perform as typical (non-disabled, able-bodied, cis) are accepted and included while those who fail to be typical (by birth or through developmental trajectory) are separated, ostracized, medicalized and even seen as less lovable.

As a midwife, I often talk to parents about how genetic testing can delay attachment; how these tests, seemingly harmless and without physical risk, create a profound uncertainty within how we see our unborn children and thus our willingness, and sometimes ableness, to attach. I think of presumed gender in the same way. When we assume we know something about our children because of their anatomy, we use this as a primary basis with which to attach to our concept of them. We create a set of rules that is deeply embedded in this most foundational attachment that some, if not many, children will break by their (our) very being. 

For most Trans and GNC people our identity is not passed to us through our family of origin and thus not typically reflected within this context by our parents, caregivers or siblings. Instead, if we are lucky, we learn that we share identity with others when we become part of a larger community, usually as teens or adults. For this reason, most of us are born into aloneness in a gender-expansive identity and we quickly learn that our bodies and spirits do not follow the rules. 

We know that birthworkers have a powerful impact on supporting the process of attachment and bonding between parents, caregivers and children. We know how much protecting birth as a physiological, relational, and spiritual function of the body affects the ability of families to form strong, nourishing bonds before, during, and after the birth process. These are the tenants that brought me to midwifery: that by protecting birth we protect ourselves, our families and our communities from the ongoing cycles of disrupted attachment that perpetuate so many of the patterns of harm that we know. 

Through observing the creation and expansion of family countless times, I have come to believe that attachment is perhaps the most powerful resource that we can have access to. When attachment is interrupted, withdrawn or not formed, there is no ready replacement for this resource. Although we know that attachment alone cannot prevent the impacts of structural violence, without it-- our vulnerability multiplies exponentially and we cannot as readily gain access to protection, recovery and healing from personal and intergenerational wounds inflicted by structural power. 

When we look at experiences like homelessness, participation in street economies, and joblessness and the way queer and Trans people (especially youth) are disproportionately represented in these experiences we see people who are not accessing the protections of attachment and belonging. When we see an epidemic of violence toward Trans Femmes (particularly those who are Black, Native and POC), we should not ignore a legacy of disrupted attachment untethering people from protective structures. Our lack of attachment to Trans and GNC bodies is dangerous, even fatal. Trans bodies so often do not get claimed within our own families, communities and larger identity groups (race, faith, culture)-- we are left out of the circle of belonging that connects us back to those who were meant to protect us from the beginning: from birth. Our existence ends up as a liability for those around us who are our primary attachments, an uncomfortable anomaly that is often more easily disposed of than integrated. Our bodies are irreconcilable with the prescribed roles that are offered to us in early childhood, often forcibly disengaging us from the relationship and care that is meant to ferry us through the vulnerability of childhood and accompany us beyond. Our bodies have prescribed meaning and value when we can be easily aligned with our assigned sex/gender, despite being problematic for everyone. When these rules are broken by the appearance of Transness (atypicalness) there are not relationship scripts available to parents to situate themselves or their children in the comfortable belonging of cis-heterosexism. 

I want us to realize how much we are setting up patterns of harm for Trans children before they (we) are born; how much we are excluding even the possibility of their (our) being. We could impact this so positively if we wanted to, even just by believing in the possibility of Transness, rather than setting up the lie of deviation. We could set up belonging, but we set up rejection instead. 

I know what it feels like to perform a lie in exchange for recognition. Being unrecognizable in plain sight to the people who know you most intimately, often parents and caregivers, is a rupture of attachment. Attachment is deeply impacted when children are not acknowledged in their authentic expression of self or even discouraged from this expression entirely and instead asked to perform disingenuously. In the child-mind, the preferences of parents and caregivers is painfully obvious, even without the impacts of overt transphobia that GNC children typically experience. As a Trans parent, this realization has altered my sense of reality and opened up a chasm of grief that I feel desperate to transmute for my children and future generations. 

My isolation as a Trans midwife has felt heavy as of late. Although the community of birth workers that I have known has always been deeply dominated by cis-people there is something about the progressive doubling down I have seen around transphobia that has enhanced my sense of despair. There is often this fear that by including Trans people, cis-women will be decentered and forgotten. There is a sense of scarcity around who can give birth or attend birth. Too often, there is a lack of acknowledgement of the way that lateral violence from cis-women towards Trans people continues to serve the patriarchy and hurt all of us. I say this even while recognizing that it is difficult to hold the complexity of the magnitude of harm that has occurred/is occurring toward cis-women in the context of birth with the simlutaneous truth that sex and gender essentialism is hurting us and our children. The road forward is filled with a recognition of how these patterns intersect and how we have been set up against one another. 

There are many places where you can read about and debate the realness of gender construction. This is not that conversation. This conversation is about the possibility of our children, and our willingness or unwillingness to embrace their full possibility. What willingness do we have to engage in ‘not-knowing’ in exchange for possibility? For the fullness of unconditional belonging and the protections of unconditional love? This is the work of undoing transphobia within birthwork. 

I want to see birthwork expand past the scarcity that has been inflicted through constructed gender and colonization. We could use birthwork not only to improve experiences and to empower birthing people but to also invest in the liberation of each being coming into life, in their mystery and potential; in their natal belonging and entitlement to unconditional love whoever they may be. Here is a place where we can transform the terror of the unknown into excitement for the vast range of possibility.

Jess F Gutfreund LM, CPM, IBCLC, MSM  (they/them)

I am a white non-binary trans person born and raised in Cincinnati OH. My work life has emerged at the intersections of social justice, healing work and anti-racism practice. Midwifery brought me to rural New Mexico and has kept me here for much longer than I initially expected. I live in Tiwa and Tewa country and have been influenced and mentored immeasurably by the communities of Northern NM that have taken me in and offered me a place to learn, collaborate, grow and become so much of the person I am today. I have been a licensed midwife for 12 years and accompanied hundreds of families in the process of giving birth. This work has extended into the development of a community birth place, policy work to transform the conditions of rural healthcare access, participation with building a Birth Justice movement and training birthworkers from New Mexican communities, among other things. In recent times, I have stepped back from full-time practice to provide administrative support to Breath of My Heart Birthplace and work on the structural barriers to effective community birth models that seek to serve low-income communities of color and other populations deprioritized by current health systems.  Queer family has also rooted me in this geography, where I am grateful to be accompanied by chosen family members and raise my 2 children in community with folks who are doing the work of living our liberation politics through the relentless joy and exhaustion of parenting.  Jess F Gutfreund (they/them) and jfgoodfriend@gmail.com