Language around childbirth — mom, maternity, breastfeeding, motherhood — may seem universal. But it can also be hurtful. When pregnancy is treated as a heterosexual or cisgender experience, lesbian, gay, transgender, non-binary and queer families can be left feeling othered, excluded or diminished. At Rainbow Doula DC, which its founder says is the only queer-specific doula collective in the Washington, D.C., area, parenthood is far from binary.
Kelsey Carroll founded Rainbow Doula DC in October, disappointed that the material in her own doula training failed to use gender-inclusive language or acknowledge LGBTQ families. The experience got her thinking about a queer birth space, a hub not just for queer parents, but queer doulas.
“I learned that there are lots of queer providers and lots of queer doulas, but no sort of central space for all of that to be functioning from,” said Carroll, who identifies as queer. “I wanted to form a doula collective that would let queer expecting folks know that they can come to Rainbow Doula and any person they interact with is going to respect their pronouns, respect their lived experience, and, in some ways, share their lived experience.”
While Rainbow Doula DC works with all types of families, there’s a specific focus on LGBTQ parents and their partners. Gendered language is intentionally absent from the collective’s website and social media, as are color palettes awash in shades of pink and blue. Photos of couples of diverse gender identities and sexual orientations are plentiful.
“It’s about being in a space where you feel seen, it’s about being in a space where you’re given a choice and being in a space where the way that you move through the world is respected,” said Sara Fatell, a doula who works at the collective.
Unlike midwives or obstetricians, doulas aren’t medical professionals; they’re advocates, coaches and providers of emotional support. Inclusive language plays an important role in making childbirth an empowering experience. “Expectant mother” might apply to some people, but designations like “birthing parent” recognize and respect that not everyone who gives birth identifies as female, or with any one gender at all.
“Rather than putting our own judgments and way of doing things on the birthing person,” said NyShayla Williams, another doula with the collective, “we make sure that we’re providing them with tools and creating a very safe space where people are able to just be.”
Katie Shepherd can relate. A sex and trauma therapist who lives in Alexandria, Va., Shepherd identifies as bisexual and felt a kinship with Rainbow Doula DC. While initially drawn to working with a doula because she sought a calming presence during birth and someone to communicate with doctors on her behalf during labor, Shepherd said she felt particularly supported knowing that the doula collective respects all families, regardless of their sexual orientation or gender identity. She contacted Carroll last fall after learning about the collective from a friend.
“I loved the idea that there could be somebody there to hold that emotional space and be the expert guide in the room,” Shepherd said. “When I think of doula work, it’s really about space holding. I think there’s a lot of parallels with therapy because of that. Someone is there, focused on you and your experience, and validating that experience as it’s happening.”
With the coronavirus pandemic upending birth plans around the country, Rainbow Doula DC has had to rethink how to best support clients virtually, through prenatal Zoom calls, added prep work for partners and live birth support over video or speakerphone. Shepherd’s third trimester coincided with Virginia’s stay-at-home order, meaning that her labor and delivery, like so many other aspects of life these days, didn’t go as planned.
Carroll, who served as Shepherd’s doula, wasn’t present at the hospital — at least not physically. The Alexandria hospital where Shepherd gave birth adjusted its visitor policies in light of the pandemic, permitting one visitor per patient. In Shepherd’s case, that was her partner. If he had shown any symptoms of coronavirus when he was screened at the hospital, Carroll would have taken his place in the delivery room instead.
“My mom is so sweet, she bought me an iPad so that we would be able to basically bring Kelsey into the room with us,” Shepherd said. “I still wanted that presence with me somehow.”
Shepherd’s water broke on a Sunday evening. She texted Carroll shortly afterward.
Carroll remained on-call via phone, text or Zoom for the duration of the labor. When Shepherd’s contractions ramped up the following morning, Carroll talked Shepherd and her partner through breathing and position changes using the iPad by Shepherd’s bedside. They disconnected if Shepherd needed to rest, but a quick text was all it took to bring Carroll back into the room in real time.
“It was really helpful having her there to suggest some things that wouldn’t have occurred to me,” Shepherd said of Carroll, who also encouraged Shepherd to vocalize during some of her later, more intense contractions. “I think I was feeling self-conscious about making noise,” she added, and Carroll “was really validating about like, ‘No, that feeling sucks, and it’s helpful to allow yourself to make noise.’”
While Shepherd was initially nervous about how a doula’s services would translate via virtual, versus in-person, support, she felt she got what she needed during labor and delivery. She gave birth to a baby boy in June. “I think it’s about consistency during an experience that’s so unpredictable,” she said.
Policies are in flux at hospitals nationwide, with many allowing birthing parents only one support person. A client of Carroll’s who identifies as transgender and non-binary has already requested Carroll’s presence with them when they go into labor, not their partner’s.
“For this person in particular, they have a lot of trauma behind their connection to their body and their connection specifically to their reproductive organs,” Carroll said. “I think that they’re anticipating needing really trained and expert support for their birth.”
Every client at Rainbow Doula DC is treated with a trauma-informed approach to care, Carroll said. Certain procedures and sensations during pregnancy and birth can be especially triggering for someone with a history of abuse or trauma, like vaginal exams or procedures used to induce labor. Rates of sexual assault and hate-motivated violence are disproportionately high within the LGBTQ community. According to a 2015 survey by the National Center for Transgender Equality, nearly half of approximately 28,000 respondents reported that they had been sexually assaulted within their lifetimes. Sexual assault was even higher among transgender people of color, disabled people and those who have experienced homelessness or engaged in sex work, the survey found.
Carroll said she always offers to explain the type of touch that might be expected during labor or delivery procedures, either in preparation or in real time. She also asks every client for their permission before she applies any touch herself, such as gentle massages for pain management (“For a person who has experienced trauma, that quick second to ask if something is okay means everything.”). Plus, she asks if they have a history of trauma that they feel comfortable sharing. For transgender people in particular, the physical and hormonal changes that accompany pregnancy can intensify gender dysphoria — feelings of severe anxiety, distress or discomfort when someone feels disconnected from the gender they identify with and their physical body.
In the early stages of labor, Carroll also holds a quick debrief with her clients’ medical team to set the stage for creating a welcoming space in the delivery room. This often involves discussing preferred pronouns and any alternatives to “mom” or “dad” they’ve chosen with their partners. Using incorrect pronouns, refusing to acknowledge preferred pronouns or making assumptions about gender identity can place an added burden on parents who may already be feeling vulnerable. With so many of Rainbow Doula DC’s services conducted virtually during the pandemic, it’s more difficult to ensure these needs are being met.
“It puts the onus back on the partner of the birthing person, or perhaps the birthing person, to gather everyone together,” Carroll said. “The whole point of having a doula and an advocate in the room is to take that burden off of the people who are focusing on birth.”
Before the pandemic began, Rainbow Doula DC had also been offering postoperative support for caesarean and gender-affirming surgeries as well as postpartum help, including house calls and overnight stays with new parents in the throes of disrupted sleep and new feeding routines. The collective also offered support for breast-, chest- and bottle-feeding or induced lactation. These services are on pause for now, until it’s safe to gather again.
Carroll has since created a series of online workshops for those giving birth who have had to suddenly adjust their birth plans due to the pandemic. One such workshop, DIY Doula: Tips and Tools for Partners, offers suggestions for comfort measures meant to relieve pain (hip squeezes, pressure point work) in addition to breathing and visualization techniques. It’s designed for partners who need a little extra help before they feel ready to offer labor support without a doula by their side.
“Having a person in the delivery room who’s confident, who feels a little bit more secure and like they’ve had some more preparation can be really, really important,” Carroll said. “That type of energy is palpable.”