Kristin Kali, LM CPM, is a licensed midwife who provides care for “all families, all family structures, genders, and orientations,” with a focus on LGBTQ families through her practice MAIA Midwifery & Fertility. What’s unique about her practice compared to conventional medical/fertility clinics is the focus on a normal, healthy pregnancy and fertile parents (who probably need outside help in the way of donor sperm); this is different from much obstetrical care, which is designed around problem pregnancies, focusing on infertility, she says. Kristin spends a lot of time with clients in the preparation for pregnancy–nutrition, exercise, vitamins–things that many heterosexual couples do after they are pregnant, but here that planning starts before conception. “You can’t really say that you specialize in LGBTQ [care] if you don’t provide these services preconception,” Kristin emphasizes.

In her practice, conception is usually achieved by IUI (intrauterine insemination) with donated sperm. The sperm needs to be carefully tested for sexually transmitted disease. This process can be expensive and emotional for the couple involved. “It’s hard to access care in the mainstream medical system that will be sensitive and supportive of that.” She says she counsels on interfamily dynamics and the whole issue of testing the sperm. “I have breadth and experience to do that in a way that normalizes it,” she says.

She stresses that her focus in midwifery is to support families that are being created, so it’s not just the clinical care, but also emotional support. That means “creating the village that helps to create that child.” To that end, MAIA has a special PEPS group specific to LGBTQ families. (General PEPS outcome evaluations show that a majority of PEPS participants feel less isolated, more confident and competent about their parenting skills, aware of parenting resources in their community and neighborhood and well connected with people who support them as parents.)

The MAIA PEPS facilitators go through standard PEPS training (the general format, topic ideas, and so on), but additional meeting topics that are specific to LGBTQ families are covered. Twenty-seven families have come through this special PEPS program in the past year.

About the greater Seattle area, Kristin says it’s a community that’s very accepting, generally positive with lots of “mixed” spaces. You see this especially in “integrated” parenting groups–“parenting is a great equalizer,” she notes. Most of her clients won’t see direct homophobia in these groups. “But what’s lost [in the integrated groups] is the very unique experience it is to conceive as a queer person or trans or genderqueer person,” she points out. These experiences–such as getting pregnant with donor sperm but not because of infertility–are not reflected and centered in most parenting groups. Other issues that are unique to LGBTQ families include: homophobia from extended family; wanting to seek out donor siblings; not being out, especially as a trans person. “What families gain by creating queer/trans-specific parenting community allows a deeper level of being held in the fullness of what that experience is. It’s like walking into a room and not having to explain yourself.”

When it comes to emotional adjustment during and after pregnancy, Kristin sees many of the same things in her LGBTQ clients as she does in her heterosexual clients: body changes, not sleeping, etc. But there are some unique challenges, too: how much money it takes to conceive; navigating breast- or chest-feeding (sometimes both parents want to feed the baby with their body); partners not genetically related to the child and the response of the culture to that; and generally feeling like they are on the “edges.”

There are unique challenges to trans parents, she explained. “Culturally, lesbian and gay families have benefitted from progressive social movements, but we still have trans people being told they can’t use the bathroom in public.” For a trans man, for example, it may be physically dangerous to appear pregnant. For a trans woman, becoming a mother may be an affirmation of their gender as a woman, so if they are not able to carry a baby or become pregnant, it might feel like a loss. Kristin says that’s why she feels so strongly about focusing on this population, and wanting trans people to have sensitive care.

As for what providers can do to better serve LGBTQ clients, Kristin offers these concrete points:
Get training. If you’re going to serve LGBTQ people and it’s not a group that you normally serve, get some education so you have some context. This includes training on pronouns. She says she encourages providers with ALL clients to make things universal. Start out by saying “Hi, I’m Kristin, and I use she/her pronouns.” This is critical on the intake forms, too. Don’t assume “mom/dad”–use “parent.” Ask clients if they have specific word preferences when it comes to their bodies. For example, trans men may feel feminized if “breastfeeding” is used; they may prefer “chestfeeding.” Trans women, on the other hand, may want to identify with “breasts,” not “chest.” Use neutral words, like “parenting” and “genitalia,” for example.
Take responsibility for educating yourself. Do not expect your client to educate you. Also be aware of asking questions out of curiosity rather than to provide good care.
Open the door to let families share the totality of their experience. If you don’t create a space that ensures people are understood and held, they won’t share themselves. Assuming that someone “is no different from everyone else” may sound inclusive, but it may in fact be dismissive.
Make sure you are paying attention to the experience of non-gestational lesbian mothers and trans mothers. Those groups are typically not fully validated.

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