Queering (the) Inquiry

In the final post of our Birth Trauma takeover, Anna Nelson illustrates the potentials opened up through queering how we write, think about, and practice maternity care.

“I was so proud to be in the houses of Parliament to take part in the APPG on Birth Trauma, but I’m so frustrated at how gendered the final result is. I’m so glad we’re listening to women, but we should also be recognising that not everyone who gives birth is a mum and that trans and non-binary people who give birth are not only at risk of birth trauma, but at *higher* risk – especially if we experience multiple marginalisations. I’m at the launch [of the Inquiry] today and it’s hard to be here. One of the speakers today has said “We feel heard, we feel valued”, but I don’t. Sitting here in a space talking about birth, as someone who has given birth and experienced birth trauma I feel invisible, unseen and ignored. I’m quoted in the document, but even the title of the document either excludes or misgenders me.”

(Making Better Births, quoting Jacob Stokoe)

Trans, non-binary and queer people give birth

When I started drafting this post, I initially wrote that it was heartening to see trans, non-binary, and queer birthing people included in the evidence gathering process for the Inquiry into experiences of birth trauma in the UK (2024). However, the reality is this is not ‘heartening’ and should not be remarkable. Queer, trans and non-binary people give birth, just as cisgender and heterosexual people give birth. They, too, experience the harms enabled by the systems of oppression underpinning modern maternity care. Indeed, as Jacob Stoktoe emphasises in the above quote, they experience a particular risk of harm during maternity care and birth (LGBT Foundation, 2020). It ought not be notable that their voices were included in this Inquiry; it ought to be expected. 

‘Listening to mums’: silencing trans, non-binary and queer voices

That the Inquiry took an open approach to including transgender and non-binary birthing parents is obscured by the decidedly gendered language adopted in the Report itself. The title – “Listen to Mums: Ending the Postcode Lottery on Perinatal Care” – fails to give recognition to these contributors. As Camilla Rosan writes, “even in the paragraphs that focus on the birth experience of those who do not identify as women,” there is a failure to adopt accurate language (Rosan, 2024). 

A welcome inclusion in the Report is the specific section on the experiences of ‘same-sex partners’ (p. 55). However, the commitment to the inclusion of queer families is not matched in the language and framing of families which remains focussed on “the cisgendered heternormative model” (Making Births Better, 2024). The foreword of the Report, for example, states that “[this] Birth Trauma Inquiry is, in its simplest form, an attempt to break this taboo and share the stories and experiences of mothers and fathers” (p. 6). 

Language matters. Not only does it serve to invisibilise the experiences of trans and non-binary birthing people, and queer families. It also disrespects and undermines the identities, and dignity, of the members of those communities who participated in the Report.  In Stoktoe’s words: “I’m quoted in the document, but even the title of the document either excludes or misgenders me.”  Rather than giving voice to these contributors’ experiences, making them feel validated and heard, the Report risks further compounding some of the epistemic harm it seeks to ameliorate (Rosan, 2024).  

Undermining identity, undermining care

The failure to attend to the realities of trans, non-binary and queer people adequately carries symbolic and epistemic significance. But its harm goes beyond that. It poses a fundamental barrier to achieving the central goals of the Inquiry. The Report advances a set of recommendations aimed at working “towards a maternity system that is woman-centred and where poor care is the exception rather than the rule” (p. 9). However, maternity ‘care’ which does not respect and attend to the reality and identities of the people giving birth can never be anything but poor. The Report itself speaks to this to some extent, noting that where heterosexuality is assumed the “birthing mother” is placed in the position of “having to “come out” repeatedly to health professionals throughout the pregnancy, birth and postnatal period” (p. 61). However, the Report makes no such observations regarding assumptions about gender – assumptions which are prevalent across a system “structured around a heteronormative model of care’”, reflected in “the language used in information leaflets, online systems, and other written information” (Pezaro et al. 2022, p. 314). 

That this denial of identity necessarily and inherently undermines good care is captured powerfully by Woollard, Holroyd & Cull (2024): 

“How would you feel if you had just given birth and people kept calling you the wrong name, or got wrong central facts about your identity? Perinatal care covers pregnancy, labour, birth and the period immediately after birth. These are often times when we are at our most vulnerable.”

‘Queering’ our inquiry into harmful maternity care

According to Ledin & Dalton (2024), the practice of ‘queering’ means attending to the “centres and margins of social and cultural experiences in society, especially related to marginalised individuals and groups like transgender and LGBTQ+ people (Muñoz 1999), and to de-familiarise dominant paradigms and practices in the social world (Warner 1991; Butler 2006).” Queering the Report, and our broader inquiry into harmful maternity care and the systems which uphold this, goes beyond (the unquestionably important) task of highlighting the ways that queer voices were silenced. Queer scholarship seeks to destabilise the normative (Otto & Jones, 2023; Thomas, 2023). It provides us a “disruptive lens that challenges notions of the status quo” (Hrynyk et al. 2023, p. 953). Queering gives us permission to radically reimagine maternity care and our solutions to the current structural injustices which pervade it, while also constantly reminding us to think carefully about who is precluded by current logics and approaches. 

Queer approaches to maternity care draw attention to the fact that “medicine has traditionally exerted a regulatory power over women, children, and…queer people” (Hrynyk et al. 2023, p. 953) and demands that we are attentive to the implications of that fact. It allows us a lens through which to illuminate and interrogate the unequal and harmful structures – identified in the posts throughout the Birth Trauma Inquiry series – which act as a barrier to safe, respectful and care-full maternity care for all. It draws attention to the intersections of discrimination which render maternity care particularly unsafe for certain people – drawing critical attention not only to transphobia and the erasure of queer realities, but also to systematic racism, ableism, classism and so on. 

This is important in the context of the Report, which poses the questions: “What does good maternity care look like?” (p. 65). The suggestions made in response to this question – e.g. “good quality antenatal education”, “listening to women” and obtaining consent (p. 66) – are not wrong (beyond the failure to adopt additive language) but neither are they novel, nor massively instructive regarding the actual steps to be taken. Queering these suggestions may provide a useful approach through which to flesh out the details of how to actually and meaningfully manifest these improvements in an equitable and inclusive manner. A queer approach can underscore the importance of ensuring the Report serves trans, queer and other marginalised birthing communities, and draw attention to the systems, norms and structures which need to be reimagined to facilitate these changes.

Importantly, taking a queer approach to maternity care and the regulation thereof gives us permission to move beyond ‘the way it is’ and to think radically and creatively about what could be when we let go of that “which has been ‘taken for granted’ or ‘naturalized’” (Otto & Jones, 2023). It seeks to enable better care for all birthing people by “deconstructing limiting constructs and structures” (Ledin &  Dalton, 2024), and in so doing creating space to reimagine and reinvigorate practices of care so that they better serve all birthing people (and the health care workers who support them). 

Conclusion

(Re)constructing a care-full maternity and birthing system safe for all who use it is an urgent task. Wholeheartedly including trans, queer and non-binary birthing people (and families) in the process is absolutely essential. Looking to queer theory to inform the process provides valuable tools to help us as we forge this essential path forwards. We must learn the lessons of this Inquiry as we move forward on that path, and do better to truly represent all people impacted by these harms. As Otto and Jones (2023) emphasise, “queering is a continuous process, a conversation on many levels as opposed to a blueprint that can be clearly defined”). The process will be messy, it will be challenging, it will undoubtedly be frustratingly slow at times – but it is essential.

About the Author

Anna Nelson (she / her), is a socio-legal researcher, with a primary research focus on the way that (gendered) socio-medical realities shape experiences of consent and care during labour and childbirth. She has a PhD in Bioethics and Medical Jurisprudence from the University of Manchester, and has worked as a Research Associate on a wide range of projects. Follow her on Twitter/X at @Anna_Nelson95 

References

All-Party Parliamentary Group on Birth Trauma. 2024. Listen to Mums: Ending the Postcode Lottery on Perinatal Care. 13 May. London.

Butler, Judith. 2006. Gender Trouble: Feminism and the Subversion of Identity. London: Routledge.

Hrynyk, Nicholas et al. 2023. Queer(ing) medical spaces: queer theory as a framework for transformative social change in anesthesiology and critical care medicine.. Canadian Journal of Anesthesia 70(6): 950–962. 

Kendall, Thomas. 2019. Practicing Queer Legal Theory Critically. Critical Analysis of Law 6(1): 8-22.  

Ledin, Chase, and Benjamin Dalton. 2024. ‘What are the queer medical humanities?’ The Polyphony, 11 Oct 2024.

LGBT Foundation. 2020. Trans + Non Binary Experiences of Maternity Services: Survey Findings, Report and Recommendations. 

Make Birth Better. 2024. “A mixed bag of emotions: the APPG published its report” Make Birth Better Blog, 17 May 2024 

Muñoz, José Esteban. 1999. Disidentifications: Queers of Color and the Performance of Politics. University of Minnesota Press.

Otto, Dianne and Emily Jones. 2023. “Queering International Law” Oxford Bibliographies, 26 May 2023.

Pezaro, Sally et al. 2022. “Perinatal Care for Trans and Nonbinary People Birthing in Heteronormative “Maternity” Services: Experiences and Educational Needs of Professionals.” Gender & Society 37(1): 124–151. 

Rosan, Camilla. 2024. “A personal reflection on the Birth Trauma Inquiry Report” The British Psychological Society, 17 May 2024. 

Warner, Michael. 1991. ‘Introduction: Fear of a Queer Planet.’ Social Text (29): 3-17. 

Woollard, Fiona, Jules Holroyd, and Mathew Cull. 2024. “How inclusive language can help to reduce birth trauma.” The Conversation, 21 May 2024.