Navigating pregnancy if you’re trans or non-binary

Pregnancy can be a challenging time both emotionally and physically. You may feel uncertain or anxious about what to expect and wonder how to navigate this heavily gendered space and speak up for your own needs and preferences. This is completely natural – and you’re not alone.

Here, we try to answer some of the questions you may have about pregnancy and birth.
 

Will hormone therapy affect my pregnancy or birth?

The small amount of research in this area suggests that prior use of testosterone makes little or no difference to pregnancy and birth. The progression of pregnancy and birth appears to be the same as it is for cisgender women, although more research is needed.

However, it’s important to pause testosterone while you are pregnant, as it can cause birth defects in your baby. If you plan to chestfeed after birth, you may need to hold off restarting testosterone until after you have stopped feeding, as it can reduce the amount of milk your body makes.

Can I have my antenatal appointments at home?

Yes, it should be possible to have your appointments at home if you prefer not to go to the GP surgery or hospital. If home appointments are not possible in your area, you could request an appointment at the beginning or end of the day when it is quieter, if that’s better for you.

If it’s your first baby, you’ll have around 10 antenatal appointments. Your first one, called the booking appointment, should happen before you are 10 weeks’ pregnant.

You can book your first appointment as soon as you find out you’re pregnant. Call your GP surgery to get a referral to the midwifery service.

Your scans will be done in hospital. You may find it helpful to take someone with you for support.

How do I share my language preferences?

Don’t be afraid to speak up about your needs and preferences – your midwife won’t know what these are unless you share them. You could write a list of preferred language that can be kept with your pregnancy notes.

Some hospitals offer continuity of carer, which means you can see the same midwife throughout your pregnancy. This isn’t available at every hospital though.

Staff at many NHS Trusts have received training on how to give appropriate care to pregnant people who identify as trans or non-binary. Some won’t have had this training, so they’ll need your guidance on language.

Can I change my midwife if things don’t feel right?

Yes, you can ask to change to a different midwife. It’s important to have a good relationship with your midwife so that you feel relaxed and able to be open and honest about any concerns you have.

If you don’t feel you’ve been treated appropriately, you can offer feedback to the hospital through their Patient Advice and Liaison Service (known as PALS).

I don’t feel comfortable attending antenatal classes. What are my options?

Antenatal education is important because it prepares you for birth and caring for your new baby. If you don’t want to attend an in-person class, there are lots of online courses available. You can choose a live online class where participants attend in real time or a self-paced, on-demand course that you work through on your own (or with your partner if you have one). Think about what would work best for you and what you’re comfortable with.

Whichever option you choose, be sure to choose a reputable course, run or created by qualified people.

Your midwife may also be able to provide 1:1 antenatal education for you. It’s worth asking.

Can I choose where and how I give birth?

Yes, you can, although it may depend on where you live and whether you’ve had any medical issues during your pregnancy or with a previous birth.

Your options include giving birth at hospital, in a midwife-led unit (if you live near one) or at home. Midwife-led units tend to be more relaxed and homely than hospital but they don’t have doctors, anaesthetists or neonatal facilities (if your baby needs medical care after birth) on site. If you’re having a straightforward pregnancy, giving birth at home is a possibility.

Think about your preferences early on and discuss them with your midwife. Write a birth plan explaining what you would like to happen during the birth of your baby and your preferred language. This can help you have a positive birth experience.

If you’ve had lower/genital surgery, you can discuss how this may impact birth with the consultant obstetrician.

If you prefer to give birth by Caesarean section, this should be possible.

Where can I find gender-neutral pregnancy clothes?

ASOS has a huge selection of pregnancy clothing with lots of gender-neutral options. Gap is another good bet with a selection of gender-neutral shirts, vests, jeans and joggers.

If sportswear is more your style, Adidas and Nike both have pregnancy ranges that include gender-neutral T-shirts, leggings, joggers, sweatshirts and jackets.

You can also adapt your existing wardrobe by adding a ‘belly band’ or ‘bump band’, which helps to cover the gap when your bottoms no longer go over your bump. Lots of places sell them and they are easy to find if you search online.

If you still have your breasts, you might want to consider a pregnancy bra – there are lots of plain, crop-top-style options available. If you plan to chestfeed, it’s worth considering one that doubles as a nursing bra.

I’m struggling emotionally. What can I do?

Pregnancy can be an emotional rollercoaster for anyone. Hormonal mood swings, feeling tearful and uncertainty about what’s to come are all part of the journey. For trans folks, this may be compounded by conflicting feelings and gender dysphoria, which may intensify as their body changes during pregnancy – although this is not the case for everyone.

Negative reactions from others, feeling the need to answer questions or to explain your situation can take their toll. In a recent study, one trans man describes how he “…had the feeling of coming out all over again. But now I was coming out as being pregnant and transgender. So I went through the whole process again”.

Your experience will be very personal to you, but it’s important to seek support if you need it. Talk to your midwife if you are struggling. Reach out to trusted friends and family who are able to listen and support you.

If you feel your mental health is deteriorating, talk to your GP.