When Morgane Richardson was training to be a doula, she began to notice gaps in the education she was receiving. As much as she was learning about supporting and advocating for her clients during pregnancy and birth, there was still a lot being left out.

“I started to realize we were really excluding the voices of gender non-conforming folks, queer, trans, lesbians, kind of the whole spectrum” of LGBTQ experiences, she told Rewire.News.

As a queer woman herself, Richardson wanted to provide the best possible care for LGBTQ families, but when she sought more specific training about supporting queer and trans people through pregnancy, she found that there was almost no information available in the New York City birth worker community of which she was a part.

So Richardson began discussing these issues with her doula collective, discovering that the birth world at large seemed to lack understanding about the unique challenges queer families can face. “Why don’t we see more queer families having home births?” she wondered, before realizing that the high costs of in vitro fertilization (IVF) or surrogacy mean queer parents have often burned through their savings getting pregnant, and can’t pay out-of-pocket for a home birth that their insurance won’t cover. As her expertise grew, Richardson was invited to give a talk about LGBTQ birth at the DONA International conference, developed a workshop curriculum, and now offers an in-person training for birth professionals who want to offer culturally competent care to their queer and trans clients.

The kind of education Richardson offers is increasingly in demand, so much so that she’s started offering a follow-up workshop for those who want to deepen their understanding of and advocacy for queer birthing parents. As legal protections for LGBTQ families have been strengthened in the early 21st century (despite recent attacks from the Trump administration), and assisted reproductive technologies have become more effective and accessible, parenting feels more and more like an attainable goal for queer people and our families. But just because we may be able to get pregnant doesn’t necessarily mean that the world of birth is welcoming to us.

When my genderqueer partner Charlie and I decided we wanted to have a baby, we realized quickly that much of the medical field surrounding conception, pregnancy, and birth was never intended to accommodate our family. The doctors who performed our intrauterine insemination referred to Charlie as “mama,” called our sperm donor “the dad” and didn’t acknowledge me as a parent at all. We hired a home-birth midwife for many reasons, but one was so that our daughter’s birth would be attended by someone who didn’t need to be reminded that Charlie uses “he” pronouns while he was crowning. The midwifery world is divided on the question of affirming trans men and genderqueer people through childbirth, but as caregivers with a measure of independence from the medical establishment, each individual midwife can tailor their care to the clientele they want. Our midwife, for example, was fantastically supportive.

Meanwhile, Melita Schwartz, a Denver doula and member of the Braving Doula Collective, says that doulas, who are not medical professionals like midwives but are specifically trained to provide emotional support to the birthing parent, can be especially helpful to LGBTQ people for this reason. “For an LGBTQIA person who may be estranged from their family because of homophobia or transphobia, having a doula who supports all of who you are can make all the difference in the world.”

But as Richardson notes, the difficulty of making a living as a self-employed birth professional like a doula or midwife means right now, the field is largely populated with people—mostly women—from privileged backgrounds. “You tend to see mostly cis women, white women, middle to upper class. It’s expensive to go to school, and it’s hard to have another job on the side, so a lot of doulas have a partner who can support them financially.”

That means people who are more likely to be financially disadvantaged, like women of color and LGBTQ people, are underrepresented in birth work, which in turn means that birth workers have to work harder to understand those people’s experiences. Too often, it falls to pregnant people and their families to do the work of educating their care providers, even while they are at their most vulnerable themselves. This may lead people from underrepresented groups to be less likely to seek midwifery or doula care. For Richardson and Schwartz, queer and trans competency trainings are a way to alleviate some of that individual burden for LGBTQ people.

Braving Doula Collective hosted its first LGBTQ training for birth workers on Saturday, March 10, for a small group of trainees including doulas and midwives as well as family therapists and attorneys. As a queer-owned and operated doula collective, Braving gets “a lot of requests from other birth workers to provide a space for learning around how they can be more inclusive to our community,” said Schwartz. The training covered vocabulary basics, microaggressions, and how to market a birth-related business so that it doesn’t inadvertently alienate LGBTQ families.

HB Lozito is the executive director of Green Mountain Crossroads, a Vermont-based resource for LGBTQ people in rural areas. They offer trainings to medical providers on how to treat trans patients with sensitivity and respect. When the local Green River Doula Collective began getting requests for resources on working with trans clients, HB partnered with a queer cis doula to offer a trans health-care training for birth professionals. “Folks of many different genders need birth-related care, and care providers must be able to meet all of our needs,” Lozito said. “Especially in our rural spaces where care providers of any kind are few and far between, everyone needs to be able to work with trans people!”

For these birth workers, developing more nuanced vocabularies for talking about pregnancy and birth is paramount to making LGBTQ clients feel welcome. “From intake forms that don’t include gender options other than male or female, to assuming that all birthing people identify as women, down to the very belief that birth is sacred women’s space,” Schwartz said, pregnancy care “for birthing people who don’t identify as women … can feel very exclusionary.”

During the workshop, she had attendees consider how they would respond to a variety of hypothetical situations during pregnancy and birth, such as a doctor asking a lesbian couple, “Who’s the real mother?” In that instance, one student suggested clarifying what the question is really trying to find out by saying something like, “Both of them are the mothers, but Jane is the one who’s pregnant.” While gaps in terminology like these may seem trivial to people who don’t face them daily, they can be painful and distracting during what should be a safe and supportive experience.

Lozito notes that what pregnant and birthing trans people want from their caregivers are largely things cis people take for granted. “Use the words we use for the parts of our body you’re providing care for; before asking us something [about our transitions or bodies] ask yourself if it’s unrelated to the care you’re providing; trans people are people, so give us the highest level of care you would provide any client,” they said. Perhaps the most heartening thing about trainings like these is that straight, cis birth workers are attending and taking notes—striving to offer the best, most inclusive care they can to LGBTQ families.

Richardson, who is now pregnant with her and her wife’s first child, is coming to understand the importance of this education from a new perspective: that of a future parent. “Reading so many books that referred to [my wife and me] as ‘dad’ and ‘mom’ was challenging and disappointing, and that’s where a lot of the workshops stem from,” she said. She’s hired a midwife who’s familiar with her work and is willing to learn more. Richardson also suggests that LGBTQ people planning to become parents consult with birth workers before trying to conceive, so that there’s plenty of time to determine whether a caregiver is compatible without the deadline of birth looming.

Much as the one-on-one support doulas and midwives provide can help overcome disparities in birth outcomes along racial and class lines, the push toward LGBTQ-inclusive birth work offers a path to allaying many of the fears queer and trans people feel about pregnancy. “In an ideal world,” says Lozito, “any person of any gender could work with any available care provider and be assured the highest level of care.”