Fact Check

Belaboring the Point

Published Oct 1, 2015

FACT CHECK:  Are transgender people demanding midwives and doulas drop the words "pregnant women" in favor of "birthing individuals"?

Claim:   Transgender people are demanding midwives and doulas drop the words "pregnant women" in favor of "birthing individuals."


WHAT'S TRUE:   In September 2015, the Midwives Alliance of North America (MANA) updated its literature to be more gender neutral where applicable.

WHAT'S FALSE:   Transgender people are forcing or demanding midwives or other obstetrics-based care providers remove the words "pregnant" or "woman" because they "promote trans hatred"; MANA's revisions were based upon the "offense" of individuals in the transgender community.

Examples:     [Collected via Twitter, October 2015]

Origins:   On 30 September 2015 the web site InfoWars published an article titled "Trannies Want You to Say 'Birthing Individuals' Instead of 'Pregnant Women,'" subtitled "The phrase 'pregnant women' promotes 'trans hatred,' according to transexual activists."

The article claimed unspecified transgender activists had pressured the Midwives Alliance of North America (MANA) to strike the phrase "pregnant women" from their lexicon because the term purportedly "[promoted] 'trans hatred,'" although claim was not supported by any proof that transgender advocates (or anyone else) had said anything of the sort:

Transexuals want you to use the phrase "birthing individuals" instead of "pregnant women" because, according to them, the latter promotes "trans hatred."

LGBT activists have already convinced the Midwives Alliance of North America to stop referring to their clients as "women" and "mothers" and instead call them "pregnant people" and "birthing individuals" so transexuals won't get offended.

Numerous midwives protested this language change, calling it an attack on women in an open letter they wrote to MANA.

In response, one transexual activist called the open letter "highly offensive" to transexuals because it "denies" their gender and "implies the care provider decides the identity of the client."

That article referenced a 15 September 2015 Huff Post Parents blog post titled "Transphobia in the Midwifery Community" (an article that never described "trans hatred" emanating from non-inclusive language), which maintained that critics had presented a false choice between midwifery's including transgender patients and "erasing" women's identities:

The Midwives Alliance of North America (MANA) formerly referred to clients as "women" and "mothers," but in 2014 changed some (but not all) language in its core competencies document to refer to "pregnant people" and "birthing individuals." The new gender-neutral language recognizes that some transgender, genderqueer and intersex individuals may require midwifery care and do not identify as women. Now, a group of midwives, including the revered Ina May, calling themselves Woman-Centred Midwifery is condemning the changes. In an Open Letter to MANA, the dissenting midwives write, "women are all but missing from the language" due to the "erasure" of the word "woman." Over 1000 people have already signed a response letter in support of MANA.

The authors of the Open Letter assert that only women have the ability to give birth, and that such capacity is what women should celebrate about themselves. The Open Letter questions "whether and how these [transgender, genderqueer and intersex individuals'] particular needs fit into the scope of practice for all midwives." In a nutshell, the open letter says that trans guys who give birth are not men; they are women because of their biology.

The above statement is highly offensive to trans individuals because it denies our gender. Also, it implies that the care provider decides the identity of the client, rather than listening to the client and forming a respectful relationship. It places a burden of conformity on all people who give birth.

In addition to the use of pejorative language (such as "trannies,"), InfoWars began with the premise that MANA altered its guidelines due to the pressure of "offended" transgender parents. (That premise was chronologically misleading, as the above-quoted use of the words "highly offensive" came after MANA's comments and the letter of response sent by some midwives were issued.) But the lack of any corroborating content (such as tweets, Facebook posts, or e-mails that would have been generated by these offended parties) cast the claim in an immediately suspicious light. Were there a large number of individuals in the LGBT community demanding such concessions, surely a single example tweet should be available to illustrate that purportedly popular position.

Some clarity was available through a page on MANA's web site titled "Overview of the MANA Core Competencies Revisions," dated 13 September 2015. In a section titled "Making Our Language Inclusive and Welcoming to All Who Seek Midwifery Care," MANA's own words painted a strikingly dissonant picture in contrast with claims that transgender advocates (not MANA) had ordered the linguistic changes which later became controversial):

MANA opted to revise the Core Competencies to reflect all of the clients MANA midwives serve. We received suggestions and additions which we incorporated. The revised Core Competencies were approved via consensus decision of the full MANA board.

MANA is keenly aware of the social determinants of health. There are many issues of disparities to marginalized communities, such as the disparities in pregnancy outcomes among communities of color, and culturally inclusive issues and language reflect our goal of creating a document that can speak to all the diverse communities across the nation who can benefit from midwifery care.

Whereas pregnancy, birth and breastfeeding are unique to the female sex, there are those who seek midwifery care who do not gender identify as women. Considering the national initiatives challenging health care professionals to provide gender neutral services and gender inclusive health care materials, we committed to a document reflective of these national trends and consistent with our values. In the process of crafting these revisions to our Core Competencies, many of the midwives involved found ourselves undergoing a paradigm shift and realized that many of these issues and practices apply more broadly to include other family members. Changing to gender neutral language reaffirms the midwives’ goal with relationship to the whole family system. Inclusive language helps us all learn to be more aware, sensitive and humble to the needs of each family system and the devastating effects of marginalization. No individual wants to be singled out or identified as "different" or less worthy. As long as a single client is excluded from the midwifery community, all clients are potentially vulnerable to discriminatory treatment.

MANA's guidance dwelled at length not about fear of activist bullies, but about the organization's commitment to provide care for all patients regardless of their gender identities. At no point did MANA's statement indicate that any transgender advocates demanded (or even requested) the changes. But the matter nonetheless proved offensive to some: on 20 August 2015, the web site Woman-Centered Midwifery ("a group of gender-critical midwives, mothers, and birth workers deeply troubled by the present cultural trend of enforcing socially-constructed sex-role stereotypes as the primary definitions of female and male") released an open letter denouncing MANA's pending policy language changes and urging the group "to reconsider the erasure of women from the language of birth." That letter (signed off on by prominent midwives such as Ina May Gaskin) maintained that the scope of midwifery remained far too narrow to encompass transgender patient care, and objected to an "[uncritical]" approach to the intersection of gender and obstetric care:

We believe that it is a mistake to define the experiences of pregnancy and childbirth though the lens of gender identity. The very few gender-identified males that have given birth or accessed an abortion have only done so because they are female-bodied people, and that scientific fact cannot be erased. We are allowing gender identity to be the primary way that we refer to one another, even for a biological process like birth. Pregnancy and birth are distinctly female biological acts; only women and female-bodied people can give birth ... Why would we now change the biological definition of woman because a tiny proportion of the population change their gender identification?

We wholeheartedly endorse inclusivity, which above all requires midwives’ provision of the particular care that transgendered people need. Toward that end, we see the need to gather more information on the ways in which body modifications, puberty blockers (Lupron), and long-term synthetic hormones may affect midwifery care in pregnancy and birth. Midwives are well aware of how body dysphoria can negatively impact pregnancy, birth, and breastfeeding. Before uncritically supporting gender transitioning, MANA should be calling for evidence precautionary to its long-term effects, especially in light of the younger and younger ages at which it is occurring. Before rushing into “inclusivity” we need to focus on the clinical needs of transgendered people and an open reflection of whether and how these particular needs fit into the scope of practice for all midwives.

In September 2015, the Canadian Association of Midwives (CAM) weighed in on the dispute between MANA and Woman-Centered Midwifery [PDF]:

We are aware of recent events in the United States and the claims of some that the important steps being taken to ensure that trans, gender queer and intersex people in our care and in our communities are not marginalized, denied or made invisible, are somehow undermining our ability to provide woman-centered care. CAM refutes this statement completely. We believe that it is critical for midwives to honour and respect all people’s right to self-determination and their right to receive health care that is free from discrimination, transphobia and prejudice. Women and women’s health care will not benefit by refusing to recognize or include the rights of others.

In short, it's true that MANA (and CAM) publicly affirmed the inclusion of all pregnant people (transgender and cisgender) in their scope of care. In response, some midwives registered an objection (characterized by some as trans-exclusionary radical feminism, or TERF) objecting to the changes. But no information supports the claim that transgender or LGBT advocates ordered or pressured MAMA into making the changes, and by MANA's description the decisions were based on their own standards of care, inclusion, and position on gender identity.

Last updated:       1 October 2015

Originally published:      1 October 2015

Kim LaCapria is a former writer for Snopes.