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  • Writer's picturemisha

Nonheteronormative Exclusion In Midwifery (TERFy Bullshit)

(CW: transphobic quotations from birthworkers)

“I am a midwife, which means I am with women and I only provide care for women. If you say you are a man, then find another care provider.”
“I do not care what you say that you are; if you have a uterus and vagina, you are a woman, not a man or otherwise.”
“I do not provide care to men, because I am a midwife.”
“I do not understand how someone can claim to be a man and come to me pregnant and asking for prenatal care.”
“I would never provide care to a transman.”

These are actual things that midwives and other birthworkers have said concerning nonheteronormative clients.

The word “midwife” means “with woman”. It is undeniable that myself and most other #midwives are indeed with women. A lot. Though some of us have found or will find ourselves with folks who are not women. Providing these clients with compassionate, appropriate care is important and what all of our clients deserve, regardless of what #gender they identify with, what #pronouns they prefer, or who their partner(s) is.

For me (and many other #birthworkers), if you are a #pregnant person, regardless of your gender expression, gender identity, or sexual orientation, I am going to provide you competent and compassionate care that is within my abilities and skill set. *Period.

*I really have nothing else to say about this matter. I am only concerned about assisting babies making their Earthside arrival and honouring and caring for the human beings that have nourished them along the way.


“I will not change the language that I use in my practice as a midwife, because midwifery is about mamas, motherhood, women, and breastfeeding.”
“This whole trans thing is out of control! Now I am not supposed to say woman when talking about birth, because apparently ‘men’ can now have babies.”
“Women have enough problems having the kind of births they desire and deserve without a bunch of liberal radicals trying to be politically correct and change how we, we women, can talk about birth.”
“Transgender people are asking for too much when they want midwives and women to start saying ‘pregnant/gestating person’ instead of ‘mother’.”
“If pregnancy and birth are no longer sacred times and experiences for women only, then what the hell is the point of feminism?”

Again, these are actual things that midwives and other birthworkers have said concerning nonheteronormative clients in reaction to a request for and a move towards using more inclusive language in the world of birth and midwifery care.

The people that are saying these kinds of things are not just the usual suspects (religiously conservative and/or right wingers). No, these are “feminists” (some of which call themselves 4th wavers, which seem to share the often racially bigoted and trans-exclusionary radical feminist views of 2nd wavers) who are saying that using more #inclusive language in the world of #midwifery and #birthwork is demeaning of women (read: women born women) and actively erasing the struggle of the female where birth and maternity care are concerned. The same people who are all about inclusive language in all other areas of life…


Some say that they are willing to address trans men by their masculine or gender neutral pronouns, but that they will not change their language concerning #birth when talking to these same individuals. For instance, the following sentence should not have to be changed according to naysayers: “When a woman is in active labour it is best to not ask her a lot of questions, as it can distract her from going deep within herself.” For the rest of us, it seems like a no-brainer to say the follow: “When a person (or client) is in active labour it is best to not ask them a lot of questions, as it can distract them from going deep within themselves.” The difference? Just changing the subject and pronouns to be inclusive of folks that are not “women”  or “she/her”.

Let’s do another sentence; one that is traditionally more “feminine” or “women-centred”: “When a woman and her husband hire a midwife, they are seeking a kind of care that is woman-centred or family-centred.” How incredibly hard is it to simply say, “When a client (or person) and their partner hire a midwife, they are seeking a kind of care that is client-centred or family-centred.”?


There is something about this “4th waver” mentality that I just can not wrap my brain around. There seems to be a thread of essentialism about what it means to be female (or a woman): boiling it down to having a uterus and being able to give birth. Clearly, plenty of females are born without a uterus and many more women and others with uteruses are unable to conceive, let alone give birth.

The message I get from “4th wavers” is one that sounds something like this: “We (as women-born women) feel threatened by the hypothetical erasure of ‘our struggle’, so we are going to throw a huge-ass fit in an effort to continue to erase the struggle of other marginalised peoples.” One could easily boil that down to, “We 4th wavers are bigots.”

Let’s look at it another way.

You have a meeting with a potential client. They happen to be a trans man. This client’s given (or birth) name is Gabriella, but at the meeting they inform you of their trans status and that they prefer to be addressed as Anthony and with traditional masculine pronouns. There are a few different ways this can be handled:

  1. decry having the knowledge of how to care for a trans client and refer them to someone else

  2. accept them, their status, and ask any questions that you need to in order to better understand how to assist them if need be

  3. privately not believe in their status, because you just don’t believe in the concept of being transgender, but you accept them as a client and you address them as Anthony

  4. you accept them as a client, yet you insist on addressing them as Gabriella, because you only believe that females/women can give birth

If you fall into the last option’s camp, then there is absolutely no skirting around the issue that you are a bigot. Period. The 3rd option is not all that great, but at least you are making an effort to be respectful of someone with a reality that does not mirror your own. The first option is not the greatest, but at least you are not insisting on disrespecting someone or pretending that you accept them. The 2nd option is the only option that makes any kind of sense if your only concern is to take care of babies and the amazing human beings that gestate and give birth to them.

The 2nd option also allows for learning to take place. Maybe you have never offered care to a trans, genderqueer, or intersex person before (that you know of); there is nothing wrong expressing this information, but making it clear that you are willing to learn and do your best to honour your client’s journey.

It is that simple, folks. Anything else is over complicating a situation that only requires empathy and compassion. Anything else smacks of bigotry.


In my own personal practice as a queer and genderqueer/nonbinary trans midwife, I have done my best to create inclusive handouts and inclusive verbiage on my website. When I am hired by a heteronormative client (and their partner), I tend to use neutral and inclusive language, but attempt to add in more “women-centred” phrasing and #feminine pronouns when talking about birth, my client, and their care. However, when I have had nonheteronormative clients, I try my best to use neutral and inclusive language when speaking about birth and their care. As a rule, before I am privy to potential clients’ preferences and identities, I use neutral and inclusive language by default. Whenever I have been unclear, I default to the most inclusive language possible while listening and paying attention to how my client speaks about themselves, their partner(s) (if applicable), and birth and then I mirror that language back at them.

It is not rocket science. It is language being used in a way to honour the greatest amount of people possible.


The issue of erasure. Again, it feels very one sided by those who are 4th wavers or who sympathise with their sentiments. It sounds like and feels like, only "women-born women" are allowed to decide for themselves how they are talked about and how they relate to birth and anyone who is not a woman-born woman is not allowed to decide for themselves how they are talked about or how they relate to birth.

If you had a client whose name was Emily, but you thought that she looked like a Stephanie and you decided to call her that regardless of her protesting and reminding you that her name was Emily, you would have to expect some push back and anger from your client. You just do not go around calling folks by whatever name strikes your fancy. The same is true for gender and pronouns. Each person gets to decide how they identify and relate to the world and this right to self-determination does not erase women or the struggle of women.

If anything, it is my belief that by creating a more inclusive and competent culture in birthwork, MORE light will be shed on the very real struggle for all people who are pregnant and giving birth without further marginalisation of trans, nonbinary, gender non-conforming, queer, and intersex people.


If you would like to know more about how to create a practice that is more inclusive of all pregnant and birthing people, there are some wonderful resources that can be found here.


One more note about another aspect that further tries to muddy the waters and justify bigotry in birthwork: gender-abolitionists, which are what many 4th wavers call themselves. They seem to live and philosophise in a world similar to an Ayn Rand novel — that is to say, that in a perfect world, these theories could work, so let’s try to impose them on the imperfect world that we actually live in. The idea is to do away with gender and only base our beliefs and descriptions about males and females on biology and secondary sex characteristics. To essentialise what it means to be male/man and female/woman. That there would be no need for a conversation around inclusivity because being transgender would not be a thing that existed.

*Whether or not one believes that being transgender is a reality for people, it is not their place to tell people they think they are wrong for feeling they were born in a body that does not match with how they feel about their gender and gender expression — one can not know with absolution that they are indeed wrong.*

Anyone with any education in biology beyond high school level knows that sex is not so cut and dry. There is no ABSOLUTE scientific definition that allows for only males and females to exist. The variances on the spectrum of chromosomal differences, hormonal variances, and physical genital/reproductive organ differences and combinations is vast in and of itself. And insisting that someone born with certain sex or reproductive organs is a specific sex erases the very real existence of intersex people.

While I can get behind the idea that it would be nice to live in a world where there were no gender stereotypes and people could be free to express themselves in whatever manner felt authentic to them, we do not live in that world — yet. I believe that what is needed more than gender abolition is gender autonomy: the freedom to individually determine our socialization and expression around our sex.

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