In recent years, midwives have expanded their scope of practice to include transgender men; that is, men assigned female at birth who have transitioned. Transgender men may still have female reproductive organs and be able to conceive, carry a pregnancy and give birth. Midwives have been mostly supportive of their transgender clients, including curricular units on transgender affirmative hormone care in their training, for example, and shifting the language of their documents from “mothers” and “women” to gender-neutral words, such as “pregnant people,” “patients” or “families.” But in the United States, these changes have not come without controversy. Some midwives (and others) believe that pregnancy and childbirth should remain “women’s space,” and see no reason to accommodate trans or nonbinary pregnant patients. Others are willing to open their practices but face constraining state licensure laws, which have conventionally restricted midwifery care to women only (ob-gyns in the US have only recently been allowed to expand their client base to include men ). Midwives and patients who seek changes face cultural as well as legal and medical obstacles. I put today’s controversies in historical context, tracing bitter disputes regarding various meanings and ideals of womanhood, motherhood and feminism and highlight a central tension in the contemporary construction of “gender dysphoria.”
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