Pregnancy

Pregnancy is something that some people choose to do, and some of those people are trans. For some people, of all genders, pregnancy is an important part of their lives, and for others there is less of a connection to the idea. There’s no right or wrong way to want to be.

Being pregnant is also not a thing that women can do, it’s a thing that people can do. Being pregnant or the ability to become pregnant doesn’t define your gender in any way, only you get to do that.

“There’s nothing inherently feminine or womanly about conception, pregnancy, or delivery. No body part, nor bodily function, is inherently gendered. If your body can gestate a fetus, and that’s something you happen to want — then it’s for you, too.”

Kaci, a 30 year-old trans man, Healthline1

It’s important to note that, while trans people have been getting pregnant and giving birth for as long as there have been trans people (hint: a very long time), very little research exists about the ways hormones and trans bodies function during and after pregnancy, and the research that has been done is often on very small numbers of people.

Currently, it is still not possible for people without a uterus in Australia to get pregnant. The science is developing overseas, including several successful uterine transplants in specific circumstances, but it is likely to be quite some time before this is an accessible and available process in this country.

Pregnancy is the term used to describe the period of time in which a fetus develops inside of a person’s uterus, from conception until birth.

A pregnancy lasts an average of 9 months (40 weeks), which is often divided into three periods called trimesters.

During a pregnancy, the body undergoes a lot of changes to prepare for and accommodate a growing fetus, which may include swelling around your body. changes to your hair, skin and bones, and lots of hormonal shifts.

There are a lot of different ways to approach becoming pregnant. Depending on the people and bodies involved, getting pregnant might involve inserting donor sperm, having receptive sex with a partner, or IVF treatment through a clinic.

If you are using a form of birth control, it’s important to have a conversation with your doctor about what stopping or removing that might look like, and to check in about any side effects and the length of time it may take for it to stop working. It’s also important to note that testosterone alone is not always an effective form of birth control, and it can be possible to get pregnant while on testosterone. It’s worth having a conversation with a trusted doctor about what conception, pregnancy and hormone use look like for you.

Trans person who are pregnant have many of the same challenges as other pregnant people, but an important difference is that they are experiencing pregnancy in a world and society that views it as something that women do, and can struggle to adjust language, expectations, and interactions to suit.

Research to date has shown that having been on testosterone in the past does not affect the chances of a healthy pregnancy or birth. A 2013 study found that there was no “significant differences in pregnancy between those who did and didn’t use testosterone. Some participants did report hypertension, preterm labour, placental interruption, and anaemia, but these numbers were consistent with those of cisgender women2.“ This has been backed up by a 2019 cohort study which wrote that “outcomes can be excellent even if testosterone therapy has already been initiated3.”

Researchers have also found that conception may be possible even before starting menstruation again. Healthline writes about a 2013 study that “found that most respondents were able to conceive a child within six months of stopping testosterone. Five [out of 41] people conceived without having first resumed menstruation.1”

It’s important if you are pregnant or planning on becoming pregnant to stop taking testosterone, as it is teratogenic, which means it can cause problems with the development of a fetus. If you are planning on becoming pregnant or are at all concerned that you may be pregnant, talk to your doctor about what stopping testosterone for a while might look like.

When thinking about your birth, finding a midwife or doula that you trust and want to work with can help a lot. They can help assemble the rest of your care team and do the work of educating others so you don’t have to all the time.

They can also help coordinate other potential care needs, such as:

• Helping other medical staff use affirming language

• Accompanying you to other appointments, clinics, pharmacies, and more, so you do not have to be in gendered medical spaces by yourself

• Finding you waiting rooms and spaces that are not gendered, or where you won’t be questioned or uncomfortable

•  Entering spaces and clinics through alternative routes

• Helping set up or find private prenatal classes

A lot of trans parents report that one of the most important parts of pregnancy is not wanting to feel like an object of curiosity or negative attention. Working with your midwife, doula, or GP to find classes and services that are either private, or queer and trans specific can be a great way of helping to alleviate that feeling. Rainbow Families also run an antenatal and postnatal class a few times a year in Sydney, which you can find more about here.

Having a birth plan in place is recommended for everyone, and is especially important for trans people. Some trans people would prefer to opt for a c-section rather than a front hole/vaginal birth, and you’re able to request that prior to labor. Talk with your midwife, doula, or medical professionals about your options and your comfort levels.

There are several private Facebook groups for trans parents and carers which you can join for more anecdotal information and support from others going through the same process as you, which you can find by searching for “birthing trans groups” or similar.

Chestfeeding (or breastfeeding) is something that almost everyone is able to do, regardless of their gender.

“Trans men, trans women, and non-binary individuals may choose to breastfeed or chestfeed their babies. You do not need to have given birth to breastfeed or chestfeed.”

La Leche League international

For people whose top surgery has consisted of a bilateral mastectomy, chestfeeding may be difficult or not possible at all, and it’s a matter of talking to a trusted health professional or doctor about your options. People who haven’t had top surgery or have had a different form of top surgery may be able to chestfeed. It is also important to talk with your health professional about how to safely bind following pregnancy and chestfeeding, as some complications can arise from binding immediately afterward.

Many people who were not pregnant, including trans women and non binary PMAB people, are able to chestfeed using the ‘Newman-Goldfarb protocol’ and with the help of a medical professional and some hormonal medication, which you can find more about here and here (please note this link uses gendered language to talk about pregnancy and chestfeeding).

A trans person who is pregnant or has given birth may also choose to suppress lactation, for a range of reasons. This is also possible with the help and support of a health professional. For more information, check out the links at the bottom of the page, and Rainbow Families’ fantastic resource Breastfeeding, chest feeding and human milk feeding: Supporting LGBTQIA+ Families.

Experiences of parenthood for trans people may differ in some ways from that of cis people.

This may be due to societal expectations around gender roles, bodies, and who may have carried a pregnancy, general transphobia, and gaps in health provision and support groups for trans people (Eg. A new mothers group that doesn’t allow men or non-binary people, even those who have recently given birth).

Many trans people find that having even a small community of trans, or LGBTQ+ people around them during their parenting adventures can help take the load off of being the only people like them they know, especially if they know other LGBTQ+ parents who they can share stories and care with, and introduce family members. See our page on community groups for more information about how to put together a group like a parenting group.

Rainbow Families’ guide to being a trans parent offers a wonderful diversity of stories and can be found here.

There is no one right way to be a parent to a child, or to work with other parents, friends, family, and community to support the young people in your life, but being a trans parent means nothing more than what it says on the tin - you have the same opportunities to learn, change, grow, make mistakes, find joy, and seek support as anyone else.