Navigating Gender Identity and Pregnancy

Trans and gender-nonconforming (GNC) individuals have carried pregnancies for as long as they have existed, despite that pregnancy is often branded as an experience that pertains only to cisgender women. 

Pregnancy care is feminized by pretty much any industry that profits from the experience such as stock images in pamphlets at OB-GYN offices, “maternity” clothing, or the term “women’s centers” for prenatal care. Cisnormative language around pregnancy isolates anyone who might not be cis, or a gender identity matching the one they were presumed at birth. 

For anyone, pregnancy causes tremendous emotional and physical changes. Whether you’ve been navigating your gender identity for long before pregnancy, or begin during pregnancy, the process can bring up a lot, though no two experiences are the same. “Pregnancy can trigger a complex interplay of emotions surrounding bodily transformations and their impact on sense of self and gender identity,” explained Rhiannon John, a Sexologist with Bedbible. 

For trans and GNC individuals, the constant gendering of pregnancy can create dissonance between authentic expression and societal norms around pregnancy, which can lead to a profound sense of discomfort and dysphoria, John said. 

Navigating gender identity and pregnancy includes making sure you have enough support through friends, family, community, healthcare, resources, and self-care for the process. 

There is no single experience

Navigating gender identity can encompass a wide range of experiences—from starting to explore your feelings about gender, coming out, receiving gender-affirming care, or social support—it’s a scope. Trans and GNC individuals may also become or choose to become pregnant at different points throughout receiving gender-affirming care, such as starting testosterone (T). The moment that pregnancy is the right choice for you is the right moment. 

There is no one experience for individuals navigating gender and pregnancy. No matter someone’s gender, the experience of creating and nurturing life can be deeply meaningful and transformative, John said. For some, pregnancy can be a positive experience that feels celebratory and affirming of someone’s gender experience. For others, it can create or exacerbate gender dysphoria, which is a feeling of unease or distress around gender.

Pregnancy creates changes in skin, hair, bones, and hormonal fluctuations, among others. Sometimes, the physical experience of pregnancy creates dysphoria. It’s significant to note that not all trans and GNC individuals who become pregnant have gender dysphoria. 

Resources for finding an affirming provider

Medical settings can be hostile places for trans and GNC folks. There are barriers to finding affirming care that exist in the forms of intake papers, pronoun assumptions, or the use of binary terms for body parts. There is a clear need for the medical world to shift its practices and advance training to meet the needs of gender-diverse individuals. Finding an affirming provider who is not only well-versed in pregnancy experiences across genders, but someone who you can trust throughout your prenatal care can be meaningful. 

• World Professional Association for Transgender Health (WPATH) is a network of professionals committed to transgender health care. The site includes standards of care and a directory to find providers. 
• The LGBTQ+ Healthcare Directory
• OutCare Health Directory

Finding support

While it can make all the difference to have an affirming doctor, depending on where you live, and other systemic barriers such as insurance, this is not always accessible. Unfortunately, trans and GNC individuals face hostility, stigma, and discrimination from healthcare providers. The Center for American Progress reports that nearly half of transgender adults experienced discriminatory experiences with a healthcare provider. 

It can be tough to predict how your individual experience will go with a doctor. Having a support person to advocate for you can be a lifeline. Your support person can step in, and ensure providers use affirming language and do the educating so you don’t have to. A support person could include a partner, parent, friend, or a gender-affirming doula or midwife. 

“It can be helpful to seek out classes and services that are either private or specifically designed for the queer and transgender community in collaboration with a midwife, doula, or doctor,” John said. 

Self-care and community-care

Isolation can be a common piece of navigating gender identity and pregnancy. Finding community support where people have shared experiences, whether that’s online or in-person, can be helpful. Reading books about others’ experiences with gender-diverse pregnancy can serve as a useful reminder that you’re not alone in whatever you feel. 

“As a support network, it is essential to prioritize the needs and desires of the pregnant person. This can mean actively seeking out and providing resources and information that are inclusive and affirming of trans and gender non-conforming individuals. It can also mean creating a safe and supportive environment where the pregnant person can express their feelings and needs without fear of judgment or invalidation,” John said. 

For anyone navigating pregnancy, self-care is essential. Make sure you’re giving yourself lots of love during this time, eating nourishing foods, and getting enough rest. For any emotional pieces that may come up around gender or parenthood, it can help to work with a therapist. If it’s hard to find an affirming therapist in your area, online resources like Pride Counseling, or directories like National Queer & Trans Therapists of Color Network, and the LGBT-Affirming Therapists Guild can be useful. 

Having a plan

It can be helpful for trans people, nonbinary individuals, gender-expansive, and gender-nonconforming folks to have a birth plan set in place, as it can empower people to actively participate in their own birthing process and make decisions that are congruent with their identity and well-being, John explained. 

Your plan can include self-care that you will practice postpartum, who your support team will include, and terms providers should use or avoid. Though birth plans can change, creating one can help you feel a sense of agency and communicate your wishes and non-negotiables to your team. A birthing plan can also create a sense of safety by making your intentions clear.

All pregnancy experiences are unique and full of ups and downs. Ample support through friends, loved ones, and community during this time is essential.