Pregnancy and birth occupy a strange place in American culture. On the one hand, pregnancy and birth are seen as natural events that occur in most people’s lives, a given that most feminine-presenting people are expected to want wholeheartedly and without reservation. Those who decide not to have children are still seen as strange, unnatural, and perhaps event deviant. In fact, an entire culture (or perhaps counter culture) has risen up to give voice to this viewpoint, wherein childfree adults assert their right to not do what compulsive heteronormative culture insists we must do, which is grow up, get married, and pop out a couple of bouncing babies in order to live anything resembling a full and meaningful life. This trajectory was described as “straight time” by queer theorist and Columbia University professor Jack Halberstam, a nod to the compulsory aspect of our culture when it comes to idealized relationships between cisgender men and women. For queer folks, however, that trajectory is more complicated. Unlike the scores of cookie cutter rom coms, there are very few representations of queer partnerships that result in children and parenting. Yet pregnancy and birth are most certainly realities for queer folks of all genders, whether we’re represented or not.

“I was creating a queer family, placing a kid in an open adoption with a gay couple, which for me is an extension of my queerness. And literally NOTHING in modern medicine bears this in mind as an option at all.”

This is where doulas come in. For queer couples already facing marginalization in their lives and relationship before making the decision to become pregnant, the presence of a doula can be profound. “I became a doula in order to provide specific support for queer families,” full-spectrum doula Rachel Gellert says. “When I first stepped into the birth work world, I was a bit apprehensive — generally the language I was seeing was very cis and hetero-centric. I wanted to provide services that not only represented, but celebrated queer people and queer families.”

So what does queer-specific doula care entail? According to Rachel, there are a myriad of ways to be a doula that’s inclusive of LGBTQ+ identities and experiences, starting with the terminology included on her paperwork. Never assuming someone’s gender, and making the deliberate choice to include gender-neutral language on intake paperwork is one of the first steps that a doula can take to ensure their practice is queer-affirming. Rachel also makes a point of making space for clients to describe their families in open-ended ways. “I always ask my clients how they define their family!” Rachel says. ‘What do you plan on having your child call you?’ ‘Who is important in your lives?’ ‘Tell me more about your family…’ are some of the questions she asks them early on in the process. “This can be such a joyful conversation and is an important part of my prenatal visits.”

As a queer-affirming doula, Rachel is sometimes present before conception. There are many types of doulas, she says, and a fertility doula in particular might be present at impregnation, or even as a source of support before then. “Many queer folks make the decision that they want to start a family, but after a quick Google search, find themselves extremely overwhelmed and without any idea of where to start!” Rachel says. A queer-affirming doula will be familiar with the process, and can be an invaluable resource in navigating it. “Queer affirming doulas would be able to provide referrals, evidence-based resources, preconception health and wellness education, and, as always, a non-judgmental, supportive space to talk through your options.”

Queer non-binary playwright and life coach Mariah MacCarthy experienced the benefits of doulas services first-hand when they were pregnant. “My unique needs had nothing to do with my sexuality/gender identity (I didn’t know I was non-binary at the time), and everything to do with my being a birth mother,” Mariah says. “At the same time, though, my queerness and my birth motherhood are utterly intertwined; I was creating a queer family, placing a kid in an open adoption with a gay couple, which for me is an extension of my queerness. And literally NOTHING in modern medicine bears this in mind as an option at all.”

“I didn’t want to be treated like an alien,” Mariah says. They described how the nurses on staff were also unfamiliar with a birth mother who wasn’t a teenager navigating an unplanned pregnancy. “There were multiple times when nurses would see on my chart that I was placing the kid for adoption, and they would kinda stare at me like, ‘So, what does this mean?’ and I would have to say, ‘Don’t do anything differently, just treat me like any other mother.’” Mariah wanted to bond with the baby, hold him, nurse him. “I wanted to do all the mom-things, and hey were just very clearly not used to working with someone in my situation,” they recall. For Mariah, the doula they worked with was also a birth mother. “She was probably the first birth mother my own age that I ever met. So I felt comfortable opening up to her about what I was going through in a way I couldn’t with just about anyone else.”

Doulas who work with queer patients also must factor in how things like dysmorphia or dysphoria can impact pregnancy. According to Rachel, just being a safe and knowledgeable person to talk about such feelings can be a helpful part of a queer-affirming doula’s repertoire – doulas or other medical providers who aren’t well-versed in queer health issues perhaps wouldn’t be able to provide the same space for client’s experiencing dysphoria during pregnancy. “A doula is there to validate and listen and make sure that their client has all the external support that they need,” Rachel says. But she adds that it’s important for a queer-affirming doula to know what her limitations are; the role of a doula, after all, is not meant to take the place of a counselor or therapist, as the training and resources are different for both professions. Therefore, it’s important for a queer-affirming doula to know what their resources are, and when to make referrals for clients. Rachel says that she’s also a fan of group therapy or support groups. “What every person needs is going to be different, but having a space to talk to folks with shared experience can be so powerful. Even if there isn’t a band-aid fix, sometimes just having someone listen and say ‘me too’ can make a significant difference. This is why I believe finding queer/trans community through pregnancy and family building is so crucial.”

Another part of queer affirming doula work includes recognizing that the common narratives around pregnancy don’t always fit for everyone – and are perhaps even more likely to be a difficult fit for clients of more marginalized identities in terms of their gender and sexuality. Pregnancy and birth are so often seen as “miraculous,” “joyful,” and “beautiful” experiences, perceptions that often overlook the pain, discomfort, and fear that pregnant people face throughout the process. “It is important to understand that the changing pregnant body will not be a positive experience for everyone. Some people might experience body dysmorphia and/or a wide range of difficult emotions during pregnancy. I’ve had clients share frustrations that just walking around as a queer pregnant person requires them to come out on a daily, if not hourly, basis,” Rachel says.

Similarly, because narratives about pregnancy and birth so often focus on images of a heterosexual family dynamic – a straight, cisgender pregnant woman, and a straight, cisgender male partner – queer clients are often met with scrutiny, disbelief, and rudeness from strangers who feel they have a right to all the information regarding how such an “unusual” pregnancy could possibly take place. “Most pregnant people face a barrage of invasive questions, assumptions, and comments, and for queer, trans, and non-binary pregnant folks these questions are often taken to a whole new level: How did you get pregnant? Why isn’t your partner carrying the child? Whose sperm did you use?” Rachel says. This is the result of the hypervisibility of being both pregnant and visibly queer. It can be experienced as violence or trauma for a pregnant person.

“What every person needs is going to be different, but having a space to talk to folks with shared experience can be so powerful. Even if there isn’t a band-aid fix, sometimes just having someone listen and say ‘me too’ can make a significant difference.”

In some ways, doula work – and obstetrics/gynecology more generally perhaps – is more of an art than a science. After all, as Annemarie Plenert wrote for The Establishment, “The only universal truth about childbirth is that the baby has to come out somehow.” There is a lot of unpredictability in delivering a baby, and part of a doula’s job during labor is to make that unpredictability as easy to navigate for the client as possible. For queer clients, this can mean intervening on their behalf if new and unfamiliar staff is suddenly on call — a not-infrequent occurrence during labor, which can last for several hours or even days. “In a hospital setting, a major difficulty is that you never really know who will be on staff when your client goes into labor. I have seen OB-GYNs, midwifes, and nurses who have provided my queer clients with amazing, loving, affirming, rock solid care,” Rachel says. However, she’s also seen the flip side of that, sometimes when the shift changes and unfamiliar staff are brought in. “Sometimes it’s ‘small’ things like a specific nervousness or an awkwardness in the room – which one of my clients referred to this as ‘homo-timidness.’ Sometimes, unfortunately, there are more harmful challenges, like inappropriate comments, invasive questions around pregnancy, bodies, and sex that are not medically relevant, lack of respect or regard for the couple’s relationship.”

Queer couples, too, have to face challenges that straight couples do not, such as if the non-birthing partner has to file paperwork in order to adopt the baby after the birth. The clients’ sense of safety is of utmost importance, especially during the high-stress, high-adrenaline, and high-stakes nature of labor and delivery for queer parents. “As a doula, it is essential that I am following my client’s lead. My role is to validate my client’s experience, support them in advocating for themselves, and help them pursue follow-up action if they choose.”

So how can clients recognize when a doula they might be interested in working with is specifically queer-affirming? What are some key attributes to be on the look-out for? First, Rachel recommends a face-to-face initial consultation, which some doulas will do for free, and others will charge a small fee for. “A good fit is important,” Rachel stresses. “Trust your gut!” If you get a bad or uncomfortable feeling from someone during your first consultation, she says, you should listen to and honor that voice. “There will be someone who will be a better fit for you.” And when browsing for doulas, make sure you pay attention to the web pages. Are queer couples specifically represented on their website and in their reference material? Are there quotes and testimonies from other queer families they’ve worked with before? Or are their queer-affirming services a throwaway line tacked into a bio without anything to back it up?

It’s important to do your research, and to do your research well; the relationship with a doula takes place over several months, under vulnerable circumstances, and is a very intimate one where you’ll want to have the right person on your side. For queer, trans people of color, this is even more important. For Black women in particular, pregnancy and birth are not so much the “miracles” they’re touted to be in our cultural lexicon, as they are potentially deeply dangerous and risky experiences. Black women are three to four times likelier to die in childbirth than white women. Even famous or wealthy Black women, like Serena Williams, aren’t immune from such risks, and experts say that racism – both systemically (widespread and embedded in U.S. culture), and specifically within the health care industry, is to blame for this shameful statistic. “The rate of maternal mortality for Black women in the United States is consistent across class lines and are a direct result of interpersonal, structural, and institutional racism in our healthcare system,” Rachel says. “But the Black Mamas Matter Alliance, SisterSong, and Ancient Song Doula Services are examples of incredible organizations leading the way” in recognizing and preventing health inequities for Black folks – queer and straight – in the process of family building.

Clearly, working as a doula is emotionally and physically demanding. But, Rachel says, it’s also some of the most beautiful and rewarding work she’s done, especially as a member of the queer community herself. “As a queer doula, I have found my work with queer families to be really healing — maybe part of that’s because I can see a version of what my own future family could look like, an image I definitely did not see as a kid.” In such a compulsively heteronormative world, where there are still so few depictions of queer families and queer love reflected back to us in mainstream media, working with queer people to build their families is a radical and transformative experience, according to Rachel. “I love the intimacy of working with queer couples. I love that I get to witness the strength of queer partnership at such an important moment in my client’s life. I love that I get to be there when a new life is born, but also when new queer parents are born. It is one of the most humbling feelings I have ever experienced. My favorite part of working with queer families is that I can often feel my queer teenage self in the room — as if she is watching and recognizing that queer joy and family is not only possible, but deeply beautiful and real.”

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