Families: A Guide to Trans Pregnancy and Birth

Speaker 1 [00:00:09] Hey, fam, it’s me, Imara. Welcome to the TransLash Podcast, a show where we tell trans stories to save trans lives. Now, as we all know, for far too long, the representation around who can have kids and what parenthood looks like and even whose bodies are seen as capable of giving birth have excluded our community. But trans people have always been parents and today, right now, in 2025, despite everything that’s going on, more of us are reclaiming childbirth and biological family building on our own terms. So today, we’ll talk through each step of the process, from adjusting hormones during pregnancy to creating an affirming birth plan to building a larger network of support and care. Guiding us on this journey today is midwife, advocate, and author, Mireya Goodman.

Speaker 2 [00:01:00] I feel really passionate about creating a space where queer and non-binary and trans folks can feel at home when going through this family building process.

Speaker 1 [00:01:10] But before we get into that illuminating conversation, I wanted to make sure that you know about our other show. It’s called The Mess, Imara’s guide to our political hellscape. It’s where I share my analysis around the most important news stories that you need to know and just kind of throw back and let loose so that you can hear a lot of shade in the process. You can access it by signing up for a Translash fam subscription and Apple podcasts for only $4.99 a month. Now with that… Let’s start out as always with some trans joy. Building a family is a deeply personal and complicated journey, and for trans people, having an affirming support system can make all the difference. Based in Baltimore, Moss the Dula is dedicated to creating inclusive spaces where all parents feel seen and safe. Their queer-centered, full spectrum services are designed to help advocate for parents through all kinds of reproductive and family-building experiences. Beyond their work, Moss is also an educator and consultant. Including public speaking, training, and resources for birth workers and institutions. Here they are to share more about their practice and how they’re fostering trans joy through family building support.

Speaker 3 [00:02:48] So many people who embark on the parenting journey have these experiences that really change their understanding of their own gender throughout the process. And I think this is because like so much of gendered expectation is coded onto and packed into parenthood roles. You know, I know a lot of people who have gone on hormones after becoming parents. Is really fun to support and really cool to see. It’s just this like threshold experience that really allows people to step into themselves in a different way than other points in life, I think.

Speaker 1 [00:03:23] Moss the Dula, you are trans joy. Now, do you know someone like Moss who embodies trans joy? Well, if you do send us an email at trans slash underscore podcast at trans slash.org and make sure to include their name, contact information, and why you think they should get a shout out in a future trans joy segment. And with that, let’s get into my conversation with Maria. I’m so happy to get an inside look into the process of building a family with Mireya Goodman. As a licensed midwife, Mireya specializes in caring for LGBTQ plus families from pre-conception through the first year of parenting. They are the founder of Pregnant Together, a thriving online community for queer and solo parents. Mireya is also the co-author of Baby Making for Everybody, Fertility and Family Building for LGBTQ Plus and Solo Parents. Today, they’ll share their expertise on trans-inclusive fertility care, navigating pregnancy as a queer and trans person, and how we can build families on our own terms. Maria, thank you so much for joining us.

Speaker 2 [00:04:35] Thanks for having me. I’m happy to be here.

Speaker 1 [00:04:38] So first of all, what does trans-inclusive fertility care look like and how is that different than fertility care overall?

Speaker 2 [00:04:47] Trans-inclusive fertility care, there’s some different medical approaches depending on people’s body parts and whether or not they’re taking gender-affirming hormone therapy and some things that are relevant to the trans community that aren’t necessarily common practice in like the fertility clinic world and really acknowledging also the different social and emotional challenges and joys that trans people and non-binary and queer people experience in their lives and bring to the family building process. So I work as a midwife, I work primarily with people that have uteruses, but also with everybody who’s growing their families in creative ways and supporting people to do that in ways that are both accessible, gender affirming, and in line with their radical vision of the world.

Speaker 1 [00:05:46] So when couples come to you, and it could be, you know, so many different combinations of couples, I can’t even really do all the combinations in my head, but

Speaker 2 [00:05:55] So many.

Speaker 1 [00:05:55] You know, it could be a cis person and a trans person, two trans people, right? It could, there’s lots of different combinations of couples who could be coming in and as you say, lots of different body types, including people who are intersex, by the way, who we never include in the conversation, sadly. Um, when a couple comes to you and says, we want to build a family. We’ve tried to build a family before in some way, but it hasn’t worked. What are the things that you advise them when they come through your door? What are things that these couples need to think about? Because one of the sort of urban legends out there is that for some reason, if you’re a trans person and you’ve been on hormones for a while, that you just can’t have kids, right? Like the sterilization myth that, you know. Conservatives and Christian nationalists love to seize upon as a reason why trans people aren’t valid is because you can’t quote reproduce close quote. What do you say when these couples come in and maybe come in with these ideas and stereotypes in their heads?

Speaker 2 [00:06:57] Yeah, such a good question. I just want to say like I really see queer and trans family building as a reproductive justice issue. Like every human has the right to grow or not grow our families in whatever ways that we choose. And you know, specifically when it comes to trans family building, you’re totally right. There’s a story in our culture that has medically been disproven that after taking gender affirming hormone therapy. People can’t use their gametes, so sperm or eggs, to grow their families. And we’ve seen through research that people can and do go off of gender-affirming hormone therapy to use their own sperm or egg to create a pregnancy. Trans men are, some of them are choosing to get pregnant and give birth. And the research shows that there is no higher risk medically. For a trans person experiencing pregnancy than a cis person, the challenge really often comes through society and prejudice and things that people experience. And of course, whenever somebody is considering possibly going off of gender affirming hormone therapy to grow their family, it’s a really huge decision. There can be a lot of. Challenging psychological experiences that come up as a result of that. And so important to really understand all of the options, first and foremost, and then get mental health support and community. So one of the things that I do is I run a super sweet online community called Pregnant Together for queer folks and solo parents to come together and support each other, of people who are. Deciding to go off testosterone so that they can resume ovulation and try to conceive and all sorts of different family building experiences that are not reflected in our society. You know, when you look at the family building world, it is so intensely heterosexual and so intensely cisgender, pregnancy is so feminized. And I feel really passionate about creating a space where queer and non-binary and trans folks can feel at home when going through this family building process.

Speaker 1 [00:09:18] Can you talk a little bit about sort of the range of options that are out there that I think are important for people to conceive? So for example, someone comes in and says, you know, we’ve tried standard and chorus. We both have been off hormones or one partner has been off of hormones. Again, the variety of ways that people are together and work to have kids. You know, I think that most people think that about IVF or other types of, those types of fertility, medical practices that are widely known. But there are also ones that are not as widely known, right? So people can have help in boosting sperm count or the same thing with egg count. And there’s a range of things before and after IVF that can be done to help the process of conception. Can you just talk a little bit about that? Cause I think that again, like we think in very narrow ways, popularly about fertility and what is possible. Bit. There’s so many options now and I think we just want to give people a sense of what those are.

Speaker 2 [00:10:22] Absolutely. Yeah, thanks for asking that question. I mean, so I’ll go into the biological ways that people often grow families and that’s kind of more my area of expertise. But before going into that, I do also want to acknowledge that people and queer folks in particular have forever creatively formed families in biological and non-biological ways through adoption and fostering to adopt and just like… Extended family and extended community. So there are so many examples that we have in history, and we will always form our families in creative and beautiful ways.

Speaker 1 [00:11:02] And oftentimes those things, by the way, they go hand in hand, you know, so. Absolutely. You know, for example, Miss Bager has a biological kid and then has infinite number of other children throughout her life. So I think that like, we want everyone to know that when we talk about this, we are speaking expansively about family, but in this case, talking about biological conception.

Speaker 2 [00:11:23] And it’s all interconnected, and we need all different forms of family.

Speaker 1 [00:11:26] 100 percent.

Speaker 2 [00:11:27] So my advice changes depending on who I’m talking to, what organs and gametes people have, right? So we do see in the research that estrogen is not supportive to sperm health. And one of the things that I think is really important is that everybody be offered before any type of medical transition an opportunity to store and freeze gametes. So I work with a lot of people that store sperm before starting gender-affirming hormone therapy. IUI is a great option, so it’s something that I do for people at home. Depending on the state that you live, that might be a wonderful option, and there are a lot queer and queer-affirmative midwives that can actually go to your home and do an intrauterine insemination. So taking previously stored. And washed sperm that’s been frozen at a sperm bank. And then we defrost it and we do the insemination at home, maybe in your bed. If there’s a partner, I’ll often place the catheter inside the uterus and then the partner will be the one to push the syringe down to actually do the inseminations. So that can be a really wonderful option for a lot of queer folks. Whether that sperm came from somebody’s body in the relationship or is donated sperm. You know, I also support people a lot through the process of choosing donors, choosing an egg or a sperm donor and what all of that entails. There are also a lot of vitamins and supplements that have been shown to improve sperm count for folks that have decided to go off of gender affirming hormone therapy or just want to boost their. Sperm count. There are some supplements that can be supportive as well to people with ovaries. The research around fertility is complex and it’s hard to focus on queer and trans bodies because so much of the fertility research we have is based on heterosexual couples who are actually experiencing infertility. So we don’t always know if that research applies to queer folks. There are some great options for at-home semen analysis tests, which can be great for people who want to use their own sperm to create a pregnancy or potentially a donor, a directed or known donor that they know in the community, it can be helpful to get that sperm count analyzed before starting the conception process, especially if you’re a trans man or trans masculine person. Going off of gender-affirming hormone therapy to try to conceive, we want to ideally reduce the amount of time it will take to get pregnant as much as possible because I work with a lot of trans men going through this process and there have been studies that show it takes about three or four months off of testosterone to resume ovulation to be able to get pregnancy and people generally return to their fertility rates Pre. Starting gender-affirming hormone therapy. But what I hear often in community is that it’s hard to go off of gender- affirming hormone therapy, it’s like there’s certain feelings and experiences that people sometimes can go through again that don’t necessarily feel gender-afirming. And so I think the mental health piece is really important to get that support around with a therapist and community.

Speaker 1 [00:15:08] Just to pick up on that point, what support do you recommend for people who are going off gender-affirming care in order to have a biological family? What kind of support do recommend for them, you know, not only therapy, but do you a recommend support groups? Are there tools that partners can use to stay in communication? Like, what are the things that can support in that?

Speaker 2 [00:15:33] Yeah, great question. Definitely a therapist who has some experience working with people going through this. I know Folk’s Health is a good resource for people in the U.S. Wanting some mental health support, especially around that going off of gender-affirming hormone therapy process. So in my online community, we have monthly support groups for trying to conceive, for pregnancy, queer parenting. We’ve got a lot of different things that people can meet monthly over Zoom. And then post in the threads like, hey, this is what’s happening, did anyone else experience this? Support around different fertility treatments or just like the mental and emotional process. We also have a non-gestational parent support group, which is a great place for the person who’s not carrying the pregnancy. And so many resources, one thing that. I like to talk about too is the possibility of inducing lactation. So anyone with breast tissue can actually induce lactation and nurse their baby. It is a commitment or it requires commitment and taking medications and herbs and pumping, but that can be a really affirming and bonding thing for trans women, trans mothers to go through when they’re. Growing their family. So that’s something that I’m not a lactation consultant so I don’t specialize in it, but I have worked with people who have gone through it and do recommend as much as possible finding an affirming lactation consult in your area to help you through that.

Speaker 1 [00:17:14] Okay, and then we’ve done all these things, right? Let’s say in this imaginary world, we’ve did all the things. And in this scenario, we’re gonna say it’s a transmasculine person and transfeminine person, but you know, lots of different possibilities out there. They’ve now gone through this process. They’re pregnant. One person is, you know preparing to lactate. The other person is pregnant. What are the supports that trans couples need during pregnancy that’s… That’s different. We understand that there are things that have to happen in terms of monitoring the health of everybody involved, and okay, so we assume that that’s happening. But what else on top of that, and then what are the barriers that trans people can have, even in accessing those basic services around people who are comfortable with you and will treat you as a person and not as an object?

Speaker 2 [00:18:07] It’s so important to take the time, and this is easier said than done, especially depending on where you live. But it’s so to take time to find affirming providers. We did a panel on trans and non-binary, trying to conceive pregnancy and parenting, and Tristan Reese, who is a trans man who carried his youngest child, I think seven or eight years ago, talks about what questions he asked. The health care providers in the office that was assigned to his insurance about, you know, making sure that there’s someone who was actually excited to work with him, who understood, you know who had experience working with trans people who could honor his experience as a trans man, his pronouns, his relationship with his partner, certain questions that can be helpful to ask not only medical providers, but also the administration staff because you You may find a wonderful provider in office, but then the receptionist is like cold and unfriendly and just as much as possible. And I know it’s a huge privilege as a trans person to have affirming healthcare. It shouldn’t be a privilege, it should be a right, but unfortunately the reality is that it can be hard, hard to find, especially in the family building world. So taking that time. To find affirming providers, I think especially for trans folks and queer folks having a doula. So that’s somebody who is trained in interfacing with the medical system, but who’s really on your team, who can help you navigate talking to these providers and kind of be a buffer for you. Sometimes, they can even be the person who. Goes in and helps make sure that the staff is prepared to care for you and your family. Duelas, I mean, there are now transition duals, there are fertility duals. There’s birth duals postpartum duals having people in your corner. And I know folks that find very creative ways to pay for this, you know, instead of a traditional baby shower doing, you a community call for doula support or midwife support and getting creative about setting up your support systems. One thing I also recommend for trans people growing their families is actually to print out photos of other trans parents and put them up in your home. Like there’s, we are inundated in our society by heterosexual cisgender images of… Parenting and family building. And so we need to actively counteract that. So actually printing out those photos and putting it up and reminding yourself over and over that there are other trans folks, there’s other queer and non-binary folks that have done this, that are doing this, that you’re not alone. And then a lot of people find a lot of support through the online spaces. So in Pregnant Together, or people have used Facebook group. Given the political situation, more and more people are moving away from Facebook, but there’s still a lot of creative ways that people find each other on the internet. It’s a really important thing to build that community because I often hear from folks, all of our friends who are parents are straight and all of our friends are queer or trans are not having children. We need to come together with our community around this experience.

Speaker 1 [00:21:50] Yeah, I mean, I think that one of the things that makes all of this so sort of tricky to navigate is that the world of fertility and OBGYN and all the rest of it is very heavily gendered, right? They really see things in a very restrictive. It’s not only gender roles, but it is various specific gender roles. It’s a very interesting way of approaching. The entire situation, which can make it feel sort of alien and sometimes hostile to trans people. And so I think you pointing to people to try to figure out the people and the places that will be less that, if not that at all, and of doing smaller things to remind yourself of the variety of things, you know, of getting outside of the very restrictive gender binary in which they operate.

Speaker 2 [00:22:44] Yeah, absolutely. And you know, this applies to everyone, no matter your gender, sex or sexuality, when growing your family. I think a lot of this can be actually like a practice for parenting, like the intense gendering doesn’t stop. It happens to the young people, it happens to parents and so finding the ways that you can in your own home and in your home community and the places where you’re accessing care, feel affirmed, feel empowered and authentic as the parent that you are and want to be. Like those are skills that will help you through the parenting journey.

Speaker 1 [00:23:28] Let’s talk about we’re now at the end of the process and the person who’s giving birth is ready to give birth. I’ve heard so many different experiences of actually people of all genders in the process of giving birth in hospital and how at certain points that can be really dehumanizing where at a certain point, medical professionals just stop listening to you. Like they’re not actually paying attention to the things that you’re saying. I know certain instances where that’s, you know, almost cost people their life, to be perfectly honest.

Speaker 4 [00:24:04] Mm-hmm.

Speaker 1 [00:24:04] And so one that would seem to underscore the need to have an advocate, so you were talking about doulas, who that’s what they do. But I’m also wondering if you can talk a little bit about exploring the option that you represent, which is a midwife, midwifery.

Speaker 2 [00:24:18] Yes, absolutely. I do think that out of hospital midwifery is a really wonderful option for medically low risk birthing people. There have been studies that show that queer and trans people choose midwives at a way higher rate than the general population for exactly that reason, because it’s easier to find an affirming provider who sees you as you are and not really interface with the medical system. There are some important things to consider, out of hospital midwifery, we only take low risk birthing people. So if anyone has a history of high blood pressure or diabetes or health experiences that can potentially negatively impact your health or the health of the child, it is safer to be in the hospital because they have some higher tech tools than we can bring it home. We do bring many things. We bring medications for hemorrhage. We bring oxygen resuscitation supplies. I like to say that I bring everything that they have in the hospital, except an epidural and an operating room. There are some access issues. Most people are paying out of pocket for midwifery care and it depends on the state that you live and the restrictions around access to midwives. It’s a wonderful thing to consider. I’ll also share that, you know, there are a lot of trans men that I’ve worked with that are like, I want to plan a C-section. That’s how I feel most comfortable giving birth. And you know there are reasons that people either need to or choose to be in the hospital system. And even if you choose an out of hospital birth, if something during the birth comes up that is outside of the realm of normal and low risk, then we need to transfer to the hospital. So There is always a potential of needing to interface with that world and some people that are just, that’s the place where they wanna be. I think out of hospital midwifery is a wonderful option and also it’s not the only option and it’s important to be able to advocate for yourself or have people around you who can advocate for you in the Western medical world as well.

Speaker 1 [00:26:38] I’m wondering what are the special considerations for people who are doing it solo, a trans person who’s deciding to go through this entire process solo. Now, I think a lot of things that we’ve discussed apply with respect to doulas, emotional support, making sure you find the right provider, having a therapist, like a lot other things transfer to. Doing this solo because you can do this by yourself, right? But in addition to the things that we’ve discussed, what are the special pieces of advice that you have for people who will choose to go through this process solo?

Speaker 2 [00:27:18] There’s a really high percentage of the pregnant together community are solo parents or perspective solo parents. And I think that more and more people, more and queer folks are embarking on this path of solo parenthood because they know that they want to be a parent and that they may have a shorter window to be able to biologically become a parent if that’s what they choose, you know, than to find a partner. And so I’m seeing a lot of people do a lot of creative things, a lot of like solo polys, solo parents that are dating one or two people and also on their fertility journeys. It’s a really empowering choice. So for solo parents, there’s usually some aspect of the choosing a donor experience which can be complex depending on, you know if you’re looking for. An egg donor and a surrogate, if you’re looking for a sperm donor, deciding if that’s someone you know in the community or someone who is more anonymous through a sperm bank or an egg bank. And what I like to give for my solo parent clients is to set up your support system in layers. So to have like three different layers of support. And so, you know, without a partner, having one or two people that are closest to you who could maybe come with you to the fertility clinic, or to your doctor’s appointments, someone who you can call at 3 a.m. If you can’t sleep and you just need a moment of support. Thinking of one or 2 people who can be that inner layer and then three to five people. That you feel comfortable having around after giving birth or after the baby’s born. People that you comfortable being vulnerable around and who can support you, but maybe not your most vulnerable self. Maybe that’s reserved for that inner circle. And then a wider circle of people that can drop off food or walk your pet. It’s a really vulnerable time. It’s a vulnerable time to. Grow your family, to be expecting a baby, to be gestating a baby. It’s vulnerable in a lot of ways and so I like thinking about it in those terms of having those different tiers of support.

Speaker 1 [00:29:48] Yeah, it’s like mimicking the support network that you would optimally have if you had sort of a full spectrum of family and support around you, regardless of who you were, right?

Speaker 2 [00:30:00] Yeah and couples need that too. I was just doing a postpartum visit for a client earlier today and like I just was telling them humans never evolved to take care of a newborn just to adults like that is not it is too much and the way that we do it in our society is not sustainable so that advice really applies to anyone growing your family.

Speaker 1 [00:30:23] That’s right, that’s right. Lastly, I’m wondering if you can tell us how the nexus of where we are politically is impacting how you’re thinking about the creation for trans, queer, and solo families. The hostility and targeting of trans people, the targeting of control over your body regardless of who you are with respect to reproduction, aggressive state laws that are also happening. But at the same time kind of more queer and trans people than ever wanting to form families. So how are you thinking about the clash of those demands in this moment and how are seeing them and what advice are you giving?

Speaker 2 [00:31:10] When the election results rolled in, I personally felt this like renewed vigor for the work that I’m doing because I was like, oh, we need this more now. We need the representation, we the community, we need people who are like showing that this is possible. And so that is really important to me, that representation piece and that bringing people together. At the same time, It absolutely is affecting people’s choices and their physical safety in many different instances. When it comes to queer.

Speaker 1 [00:31:50] Where they can go.

Speaker 2 [00:31:50] Where they can go, literally where they can go, their access to care, whether or not they feel physically safe walking down the street. There’s some huge, real impacts that are happening right now for folks. When it comes to queer family building in particular, I think understanding your rights in the state that you live. So speaking with a lawyer who. Has experience working with protecting queer families. And there are some family lawyers that I’ve spoken to that actually recommend that if you are a trans couple, so a trans man and a trans woman, creating a biological child together, that actually I’ve heard from some lawyers that they recommend that both parents do a confirmatory adoption of their own child so that… They’re basically like double protected legally as the parent to the child. There are some extra considerations to protect queer and trans families that unfortunately we need to be thinking about. The LGBTQ Bar Association has a really awesome list of family lawyers that have experience working with queer families in different states across the country. So I send people to that place and then. I have some clients now who are going through reciprocal IVF. They’re an AFAB couple and they live in Texas and they made the choice to create their embryos in Washington State, not in Texas, because of the potential complicated access to IVF and fertility care and embryos and all of that. So people are… Making choices that they should never have to make because of the political reality. And yeah, finding ways through it as best that we can.

Speaker 1 [00:33:57] Thank you so much, Maria. I think that everyone listening is happy that you and your network has renewed vigor in the face of what’s happening because that’s clearly gonna be necessary because trans and queer and solo people are gonna continue to want to form families and have every right to do so as human beings and are going to need the help and support that everyone deserves in order to be able to help those dreams become a reality. So just thank you so much for joining.

Speaker 2 [00:34:27] Thanks for having me. This was a great conversation.

Speaker 1 [00:34:31] Thank you. That was midwife and advocate, Maria Goodman. Thank you for joining me on the TransLash Podcast. Now listen all the way through to the end of the show for something extra. If you like what you heard, make sure to go leave a comment on Spotify or a five-star review on Apple Podcast. You might just hear me read it out on the show. The TransLash Podcast is produced by Translach Media. The Transalch team includes Oliver Ash-Kleine and Aubrey Calloway. Xander Adams is our senior sound engineer and a contributing producer. The show gets to your ears with the help of our social media team, Including Morgan Asprey The music you heard was composed by Ben Draghi and also courtesy of ZZK Records. The TransLash Podcast is made possible by the support of foundations and listeners like What am I looking forward to this week? Well, you know, we all survived tax day, but I think, you now, actually the quiet on Easter Sunday, I don’t know about you, but I actually stay home. And it’s brilliant because it’s incredibly quiet. As long as I’m not trying to get brunch anywhere, it’s spectacular. So I’ll be running errands. I’ll going to the drug store. I will be going and doing all the things that no one else is doing because they’re tied up with Easter festivities. So. If you see me at CVS on Easter Sunday, you know why.