Collaboration can be cool

I am almost done with this part of reviewing the chapters for Our Bodies, Ourselves. I was really happy that I was able to recruit some help from trans activists, a disability activist, and a female sexual dysfunction activist with whom to discuss some of the material, to help make it more inclusive. I am also passing on some resources to the editors of websites I find useful that deal with size acceptance, including size acceptance in pregnancy, women of color and lactation, and the like.

Although these topics can tend to be difficult, I am happy I have had a mostly wonderful experience reaching out. Spending time in progressive communities, and finding blogs and websites on these issues in the past helped me work with existing relationships that I was very grateful for, and I built a new bridge, too.

Being an ally can be a good thing, and can be really gratifying and worth it. I know it can be potentially irritating for members of these groups to point out obvious things to people like me (e.g. If you don’t have to mention gender, don’t mention it! When in doubt, leave it out. It’s easier than it seems. Pregnant woman Pregnant patient. See how simple? Edited to add: I in no means want to imply that a physiologically normal birth should be medicalized with unnecessary interventions. My chapter dealt with medical procedures and medical conditions, but the changes I made did not use the term “patient”. It was a quick example with an unintended backlash below.)

But, as an activist / advocate / rabble rouser myself, I don’t want to just complain, and I am sure I am not alone. I want to discuss issues with people who want to improve our culture together. No, I don’t feel like educating everyone all the time, and everyone doesn’t feel like being educated all the time. But there’s a great middle ground where we can communicate with each other. It’s a great place.

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30 responses to “Collaboration can be cool

  1. I like that sentence “I dont want to just complain.” It shows me you want to do something. Which is of the uttmost importance.

  2. Yehudit

    I don’t want to replace pregnant woman with pregnant patient, even it makes pregnancy more “gender inclusive”. How many trans female-to-male pregnant “patients” are there?

    In contrast, there are a vast number of pregnant people (almost all of them identified as women, in gender terms) who do not want to be treated like “patients” – because pregnancy is not a medical condition. This strikes me as a much more important question in childbirth politics than trying to pretend that childbirth is not a women’s issue.

    • MomTFH

      That’s an interesting point. When I trained at a birth center with licensed midwives, they preferred the term “client” to “patient” for the same reason.

      I have actually known of a handful of trans men who have been pregnant. I don’t think that using a gender neutral term is about pretending pregnancy is not a women’s issue. I think it is more about thinking about language and inclusion. I am going to be an ob/gyn, so I will most likely refer to my patients as patients, since that is the common nomenclature. However, I don’t plan on medicalizing physiological birth. “Pregnant person” would work as gender neutral without substituting a more medicalized term, though, if that is also a priority.

  3. Yehudit

    I agree that language is important, and I’m staggered that a future ob/gyn who hopes to not to medicalise physiological birth is happy with the term ‘patient’ (merely because it is normative) but regards gender inclusive language in relation to the pregnant state as a priority. If, in the desire for gender inclusive language, you make women invisble in discourse on pregnancy (pretending that pregnancy is happening to some ungendered ‘person’) then understanding the politics of birth and maternity care makes no sense at all, since it is so thoroughly entangled with gender relations and the fact that it is women who are childbearers. The fact that a very tiny number of trans men (do we have figures for this?) have used very recent reproductive technology to become pregnant doesn’t change that.

    • MomTFH

      Yehudit, welcome to my blog.

      I think you are missing the point of my post, and my point of view. Not that I don’t think you have valid points. I just think you are directing your ire at an ally.

      In fact, the chapters I helped edit did not deal with pregnancy. I used that as a nonspecific example.

      And, the book is Our Bodies, Ourselves. I don’t think substituting a few unnecessarily gendered words from the two chapters I reviewed is going to somehow abandon women and feminism. The book is published by the Boston Women’s Health Collective and is considered to be a cornerstone of feminism in our country. Again, ally, not enemy.

      I think you are making the common mistake that there is a finite quota of activism and advocacy out there, and if I am advocating for more trans and intersex inclusion, somehow there isn’t enough room for woman or person – centered maternity care.

      Also, I am not pretending that any pregnant person is gender neutral or ungendered. My language in a sentence my be ungendered if it is more appropriate, but I will respect every single patient or person or client or whatever you want to call it, and I will let them tell me where their interest lies when it comes to gender presentation, pronouns, and the terminology they are comfortable with. I won’t tell them they are ungendered, or women, if they are not.

      I am staggered that you would go on my blog and somehow say this one post means I don’t understand or value feminism, or that I am making women invisible. This is actually part of the underlying reason I wrote this post. I was, IMO, pretty harshly rejected by one group I reached out to for what I thought was a bogus reason. It wasn’t in the area of advocacy they were known for. Funnily enough, they thought I wasn’t a strong enough trans advocate. Instead of discussing this with me and giving me the benefit of the doubt, they rejected all ties with me. Funnily enough, when I talked to actual trans advocates, they praised me for being a conscientious ally, and were thrilled to help me with the project.

      I am about as strong a non-medicalized feminist ally someone like you is going to find in a future ob/gyn, (I am saying someone like you based on what I am reading here and comment you posted on another blog that I read recently.) I am staggered that you would attack a strong, pro-choice, feminist ally over prioritizing trans inclusion in one post, and somehow make it into me not being a feminist or not promoting women-centered, demedicalized maternity care. You don’t have to sacrifice a marginalized group to save another marginalized group.

      Inclusion is not about prevalence. And, it is not finite. Honestly, I think that’s a poor argument in your favor, anyway. Do you know how many women want a homebirth in this country? Probably less than 1%. How many women do you think would be troubled by being called a “patient”? I would think it would be probably about the same % who may consider themselves genderqueer, intersexed or trans.

      I prefer the term patient to client, since I think client focuses on a financial relationship. I like the doctor / patient relationship, since I think it fundamentally contains a lot of ethical obligations when done correctly than a service provider / client relationship. I think of a physician as a teacher, its original definition, not as a paternalistic controller of a patient’s health.

      Anyway, I meant it when I said welcome. Just do me a favor: look around a little bit. Let me know if you think I am somehow trying to make women invisible in the discourse on pregnancy.

  4. Yehudit

    No ire intended. But I am genuinely staggered that your argument that patient is just fine is based on the fact it is normative amongst your (future) peers.

    I don’t think you are (on evidence of other writings) trying to make women invisible in discourse on pregnancy. Which is why your comment in the opening post “Pregnant woman (scored through) Pregnant patient. See how simple?” (and the assumption that the latter is preferable to the former) is so surprising.

  5. Yehudit

    In the UK, pregnant women are not patients – or at least, not by virtue of pregnancy. So, maybe this is a cultural difference. The fact that most women in the US are not troubled by being considered (and treated as) patients may not be unrelated to standard of care in the US, no?

    • MomTFH

      It may be. Rates of midwife attended birth are 10% or so, and the majority of that is in the hospital. Our homebirth rate is lower than that in the UK. The rest are physician attended births, and if you’re in an area like mine, it will be an ob/gyn, not a family practitioner.

      I have never heard a woman object to being called a patient here. We did use “client” in the birth center where I trained as a direct entry midwife (which is not a designation you have in the UK, as far as I know), but it was the midwife who was the director who had a problem with the term patient, not the women themselves. (I feel OK using women there, because I didn’t encounter anyone who didn’t identify as a woman who delivered there).

      Otherwise, it’s pretty common to hear patient, especially when discussing the hospital based labor and delivery that is the norm here. Not the ideal, but the norm.

      • I use the word patient in order to know who is the person seeking care. If you have a room full of people and some of them are pregnant, who is the patient? In the United States I think we also feel there is a patient provider relationship. IT is just not the same if you call it a person provider relationship. The patient provider relationship has certain understandings that are not spoken. Like if the person involved is my patient, then I have a duty to them to advocate for them, to care for them and safe guard their health and wellbeing. Just not the same when you say person-provider relationship. I don’t feel that pull of duty. Perhaps that is just me.

  6. Yehudit

    Just because it is helpful for YOU to consider the woman as a patient, in the context of the patient-provider relationship (incidentally, you might want to read Mavis Kirkham (ed.) “The Mother-Midwife Relationship” to rethink that framework) doesn’t mean that it is the appropriate term to use in OBOS. Not everything the pregnant woman does or thinks about is in the context of that relationship.

    For example, take this paragraph (at random) from OBOS Pregnancy and Birth:

    “Many people like to touch big pregnant bellies, and sometimes they do so without asking permission. Most of the time, people’s intentions are loving and they are reachingout toward your belly because seeing it has brought them joy. However, it is your body and you have the right to decide who can touch it. Women have very different feelings about this.” [followed by quote from woman about her feelings of having people touch her bump]

    Would this paragraph by improved by striking women in this sentence and replacing it with the gender neutral “patients”?

    • MomTFH

      No, I would say “people”. My sons also don’t like being touched without permission. It is a human right to your own body, not a unique right of pregnant women.

      I know what you’re saying, but I think trans inclusion is more important.

      • Yehudit

        In THAT paragraph, substituting “people” makes it very difficult to understand – you’ve got the “many people like to touch” and then you’ve got the “People have very different feelings about this”, so it becomes unclear whether the “people” in the latter sentence are the touchers or the touchees.

        Of course, there are ways around it by totally rewriting the paragraph, and I applaud your committment to trans inclusion. I just think your initial assumption that ‘patient’ is preferable was ill thought out. TBH, gender neutral language is the least of it in relation to trans inclusion in OBOS Pregnancy and Birth. (e.g. there is barely mention of assisted conception, and none in relation to people outside heteronormative relationships. There is a the tiniest nod to the existence of lesbian mothers, but nothing that actually addresses any specific needs of lesbian mothers). Will changing every “woman” to “person” resolve that?

        • MomTFH

          I am not sure what else will be done in the chapters I did not review. I certainly added more than just some (very little, actually) gender neutral language. It’s not a tiny nod, it was just a small example (that wasn’t even truly representative) I gave in what I hoped was going to be a fluff post on collaborating with other allies. I didn’t say we replaced the word “woman” in every instance in the book, or even that gender neutral language was our main tactic in making the book more inclusive.

          I suggested adding information on cervical cancer screening post vaginoplasty, cervical cancer screening for trans men, breast cancer screening for trans men and women, more precise language on the spectrum of intersexed genitalia, finding a practitioner who was experienced with surgical transition, and quite a few other suggestions. The trans activists I was working with who actually saw my suggestions seemed pleased.

          Even though the sentence you are referring to on touching bellies was not one I was part of reviewing, I will touch on it one more time. BOTH groups of people have different feelings about this, so I am not seeing the problem here. Yes, the whole paragraph can be rewritten even better. I hope whoever works on that chapter thinks about it.

          I also have told you a few times that I heard you about the medicalization issue, which I understand is YOUR priority, and is often mine, but is NOT WHAT THIS POST IS ABOUT (for the fourth time!). It wasn’t supposed to be a “well thought out example” that encompassed demedicalizing pregnancy, it was just supposed to be an example of replacing gendered language with non gendered language. I really don’t want to hear that you don’t like that example again. Got it.

          I meant it when I welcomed you to my blog, but I have to say I am getting sick of bickering about this issue. Yes, substituting the word “patient” for “woman” is obviously not always the best thing, and I never said it was. In fact, I never did it in the review process, I just used it as an example in this post when discussing gendered language, not discussing pregnancy.

  7. Yehudit

    Or…

    “For some women, this latent phase of labor last for many hours or up to twod days, with regular strong contractions that slowly efface the cervix….When you hear of labors that lasted for days, the women involved spent the bulk of that time in latent-phase labor, not active labor.”

    If you change women to “patients” in that para you are no longer addressing pregnant women, but providers. (And practically inviting women to show up at the hospital at the first contractions….after all, they need to fulfill their patient role….)

    • MomTFH

      “For some, this latent phase of labor…” “When you hear of labors lasting for days, most of that time was spent in latent labor, not in active phase labor”

      See how easy it is? It’s not really about pitting one group against another. I know you have a specific advocacy you want to talk about, but it isn’t really the focus of this post. This post is about how allies can work together, not about how their needs are competitive.

  8. Hey, it’s all about me. Didn’t you know that?

  9. Yehudit

    haha! Of course!

    I don’t mind so much if we talk about patients amongst ourselves (and especially with Obs, I expect it) or even with women in the clinical context (though it is not my lingo). But in a popular book, the raison d’etre of which is to normalise and demedicalise women’s health issues? Seems a bit strange to me….

    • MomTFH

      I understand, but you are not looking at this issue from an intersectionalist point of view. The book demedicalizes women’s health issues with its content, not by the repeated use of the word “woman”. ACOG’s pregnancy books are full of gendered words and pictures of women, but if they still medicalize pregnancy and birth, we are sacrificing trans inclusion for no benefit.

      I hear your priority, but it is not the focus of this post.

      • Ursula L

        The problem, I think, is the movement you made from non-medicalized to medicalized.

        Moving from a non-medicalized gendered term to a non-medicalized non-gendered term would be a step forward. It’s an ally change, bringing from one group in without harming the other.

        Moving from a non-medicalized gendered term to a medicalized non-gendered term is, at best, a step sideways. Instead of acting as allies, it prioritizes the inclusion of trans over the problem of healthy pregnant people (mostly women) being pushed into the role of “patient.” Sick people are patients. And treating healthy people as if they’re sick, just because they’re pregnant, is used to justify all sorts of medical interventions. Which you know, and write about a lot.

        Working with allies doesn’t and shouldn’t mean that you put the allies needs ahead of your own. It means collaboration and not working at cross-purposes.

        Also, have you seen this: http://breastcrawl.org/ ? I think it might be up your alley.

        • MomTFH

          Thanks, and welcome to the blog.

          Not only have I seen the breast crawl video, I used it in a neonatal class for midwifery students I was teaching. Love it.

          Look, if we were arguing about medicalized vs. nonmedicalized terms, that would be a valid point. But we’re not. I already said “person” would have worked also. I am not sure why you felt the need to re mention that. I not only read that argument, I think I addressed it.

          This was a hypothetical example that wasn’t reflective of what I did in the chapter, which was a chapter on medical procedures. I really doubt suggesting that saying gendered terms don’t need to be used in all cases is going to change the medical aspect of a pap smear or a mammogram. I would hope anyone who has read my blog, and read all my responses on this post (which I welcome you to do) wouldn’t think that I need 20 comments on this post to make me think of birth as a less medicalized process. As I said before, ACOG can put the word “woman” and pictures of women all over their literature, but if there is still a medicalized treatment of the birth process, I don’t think one use of the word “woman” is going to counteract that.

          I already said, several times, that pregnancy, medicalized and otherwise, is not the focus of this post. I am not sure what multiple comments about medicalized birth being somehow sacrificed with trans inclusion on the blog of someone who is a strong, vocal proponent of nonmedicalized birth (like me) is doing for your cause, other than making it seem like you have a problem with any other advocacy issue being brought up if it’s not yours, and that you won’t back down when it’s pointed out to you that we’re not discussing that issue.

          You are making assumptions about what I worked on that are not true. I did not review the pregnancy chapters. I already made that clear. The people who did are big proponents of physiological birth, homebirth, and midwives. The group behind the publication, the Boston Women’s Health Collective, is a very feminist organization. You are barking up the wrong tree.

          If anyone really wants to know what actual change I was referring to (which was only one suggestion of many), here it is:

          “Even if you have already had a mastectomy, getting checked can be useful, because chest surgery does not remove all breast tissue, and there’s still a small risk of cancer. Transgender people, both male to female and female to male, may benefit from breast exams, too . Telling your health care provider your natal sex may help to make sure your risks are not neglected.”

          I had a problem with the terms female to male, male to female, and especially “natal sex”. What we ended up with was:

          “Even if you have already had a mastectomy, getting checked can be useful, because chest surgery does not remove all breast tissue, and there’s still a small risk of cancer. Transgender people, both trans men and trans women, may benefit from breast exams, too . Transgender individuals should try to find a practitioner who is experienced and sensitive to their needs, especially if they have a surgical history. Finding a practitioner that is aware and knowledgeable about your transgender status may ensure that your risks are not neglected.”

          See, the word “woman” and “man” are even in there. It was the “natal sex” reference and the use of the sex assigned at birth to define the transgender individuals (by using the term female to male instead of trans man) that we tried to edit. All of the medical terms in the actual passage remained the same. I suggested using the term “gender assigned at birth” to replace “natal sex”, but the advocate said – if you reread the sentence, most of the time you can rewrite it without the term. And, we could.

          In other words, you have to see the context before you know how much more or less medicalized one word change will be. In an entire passage on elective cesarean, I could call the woman a female goddess and argue it is her pro choice feminist right, and still have a medicalized view of birth.

          I am not going to argue that the term “patient” may be more medical than the term “woman.” In fact, my first reply said “it wasn’t a real example anyway, just a made up one, and you could use “person”.” I also explained why I like the term patient, since I think it implies an ethical contract that I respect. I would call someone showing up for a pap smear a patient, even if it was a well visit. This may be a topic for another post.

          But, what I want to know about this post: Why I am still arguing about this?? Have you read my blog? You say you have. Do you think you are teaching me to view pregnant people, women or otherwise, differently? Do you think this post is somehow sacrificing physiological birth advocacy?

          Do you think this is a valid point on a post about getting along with allies???

  10. lesbonurse

    Thank you for your work on trans-inclusion! As a provider who treats transgender patients in a community health setting, I promise you that every bit of bridge-building and ally-creating that you do is important. Have you considered providing cross-hormone therapy in your future practice? There is a huge need for sensitive, knowledgeable hormone providers.

    • MomTFH

      Thanks! I haven’t even thought about it, but I certainly wouldn’t have a problem with it. I am planning on being an ob/gyn. I don’t know what type of practitioner usually does that- I would have guessed it would have been an endocrinologist, but I suppose an ob/gyn could do it if well trained / informed.

    • MomTFH

      Oh, and you’re welcome! I am most certainly not doing it for pats on the back, but I love them when I get them.

  11. lesbonurse

    We all love a little praise once and a while!
    In my opinion, any knowledgeable and thoughtful doctor, NP or PA is qualified to provide cross-sex hormone therapy. The bottom line is that there are not nearly enough endocrinologists that are trained or interested in trans health to meet the demand. And endocrinologists are difficult for people to access, especially for patients that don’t have the money to pay for specialty visits. Several of my trans patients are on the very margins of society (limited income, limited english, limited insurance) and would be getting their hormones on the street if I wasn’t providing them with a safe, accessible option. I know of a GYN in my area who provides hormones as part of his private practice–I think it can be done. At the very least, you could be a safe and affirming provider for trans patients who need paps and other GYN procedures.
    Here is a link to a blog post that I wrote about the importance of trans-friendly providers: http://lesbonurse.wordpress.com/2008/11/15/transgender-day-of-remembrance/

    • MomTFH

      Thanks for the link! I will definitely check it out.

      I hope to reach out in whatever community I end up practicing in, to let LGBTI individuals know I am friendly, and hopefully knowledgeable. It may be harder to reach out to other marginalized groups, but I will do what I can to let advocates know I am an ally / practitioner.

  12. Pingback: Reply turned post, blogging civility style « Mom’s Tinfoil Hat

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