As PRIDE month, which celebrates the LGBTQIA+ population worldwide, draws to a close, I wanted to end this month with an interview with Simon Adriane Ellis, MSN, CNM, ARNP, FACNM, the 2021 recipient of the Excellence in Leadership & Innovation Award (formerly named the Kitty Ernst award) given by the American College of Nurse-Midwives.  This award honors an exceptional, relatively new CNM/CM who has demonstrated innovative, creative endeavors in midwifery and/or women's health clinical practice, education, administration, or research. 

Simon Adriane Ellis is a queer, trans and non-binary Certified Nurse Midwife in full scope practice in Seattle, WA, USA. Simon’s clinical focus is on providing sexual and reproductive health services across the lifespan for people of all gender identities. They have clinical specialties in abortion care, LGBTQ family building, and gender affirming care for transgender and non-binary people. Outside of the clinic, their advocacy work has included serving on the board of two local reproductive justice organizations, coauthoring the Cedar River Clinics trans health toolkit, conducting original research on transgender pregnancy, and providing mentorship and training to students, clinic staff and healthcare providers. They are also the gestational parent of a very, very cute toddler. 

Simon exemplifies this award, through their consistent leadership skills, their research focus on an often overlooked population, their expertise on LGBTQIA+ reproductive health needs and concerns and their tireless compassion and desire to provide respectful and appropriate reproductive care to all who need it, regardless of their identity.

Sharon Muza: Why is it important to have health care providers who not only are experts in non-binary and trans reproductive health and provide gender-affirming care, but also have similar lived experiences themselves?

Simon Adriene Ellis: Cultural concordance matters. Trans and non-binary people are the true experts on our own health and needs. I think this is especially true in the realm of sexual and reproductive health, where we - at the most intensely vulnerable moments of our lives - are routinely seen as objects of curiosity, and are sometimes looked upon with disgust. Or we are just disbelieved - not just our words or our knowledge, but our whole selves, our very existence. That is a devastating feeling; it can be a dangerous or deadly feeling if it prevents you from seeking needed healthcare. And in the context of new parenthood, it can be incredibly frightening. I have had patients travel such long distances to see me, pay out of pocket to see me, change insurance to see me - that is unconscionable. Yes, patients should be able to see me if they want to see me. But they should have choice, they should have options, they should have access to healthcare providers who know their reality and are well equipped to anticipate and meet their needs. We need more trans and non-binary healthcare providers.

SM: Health care providers who refer patients to you speak about how the care you provide is “person centered midwifery care in a culturally congruent setting.”  Can you speak more about what this means to both you as a provider and the people who receive care from you?

SAE: When I heard that said about me, it brought joy to my heart. I think what my colleagues mean is that I am focused on compassionate, individualized care, I am committed to informed consent and patient autonomy, and my queer, trans and non-binary patients in particular can breathe a sigh of relief and just feel known when they come to see me.

SM: Are you able to share some current statistics about the number of non-binary and trans families who become pregnant and grow their families every year.  Are you seeing any trends in these numbers?

SAE: I would really love to share those statistics, but they don’t exist. The census does not yet ask questions about gender identity; the questions asked about parentage on the last census were confusing at best and - for my family - just didn’t feel answerable. There has been several studies in the past decade exploring parenting desire among trans and non-binary people; these studies have found that, just like their cisgender counterparts, many trans and non-binary people desire parenthood. To me, that is completely unsurprising. Historically we have experienced significant reproductive coercion and have been actively dissuaded from having children by the legal and medical systems, but that doesn’t mean anything about what we want and who we are - and many of us are parents or plan to be in the future. In the most recent version of the U.S Transgender Survey (2015), 19% of respondents (all age groups) were parents. Informally, I am a member of several Facebook groups for trans and non-binary people who are or plan to become parents - one of these groups, specific to people assigned female at birth and not inclusive of allies, has 355 members. Another one of the groups, which does include allies, has 1,700 members. So basically...we exist!

SM: Why is respectful care so important from a life-saving perspective for gender-diverse people? Are gender-diverse people at greater risk for poor outcomes compared to their heterosexual peers?

SAE: There is a good deal of research which supports that trans and non-binary people are at greater risk for poor health outcomes compared to their cisgender peers. This is because of transphobia both in healthcare and outside of the healthcare setting. Murder, for example, is a terrifyingly common experience for trans and non-binary BIPOC people, particularly trans women. Parents of trans and non-binary people lose their children to murder, to death by suicide, to preventable illness. Healthcare is not the only place where we need sweeping change to protect the life and dignity of trans and non-binary people, but it is a critical space in which to do this work. Respectful care prevents death by suicide. Respectful care prevents healthcare avoidance. Respectful care allows for cancer to be detected and treated. Respectful care allows for reproductive autonomy, which saves lives. It is important to remember that it is transphobia and not being trans or non-binary that is responsible for health disparities and deaths in our communities. We’ve always known this, but research on mental health outcomes in trans and non-binary children who receive appropriate support from their families and communities has proven it.

SM: I know you work closely with and appreciate the value of childbirth education for pregnant people.  How can perinatal educators make sure that any gender diverse families have access to resources appropriate for their needs during the childbearing year as a member of the LGBTQ community.  What information should they be sharing with all the class families?  Note: Educators should be sharing this information with all their families so they can access what they need, as people may keep their LGBTQ status private.

SAE: I absolutely value childbirth education, and I want all my patients to have access to it! The first thing I think that all childbirth education providers should do is check the language on their website, handouts, materials, etc. to ensure that it is gender inclusive. This is the first thing your LGBQ, trans and non-binary patients will look for. Including images of diverse families (diverse in all the ways!) in handouts, materials, artwork, etc. will also send a clear and welcoming message. The other really critical thing for trans and non-binary folks in particular is to offer access to individual classes - either by offering this yourself or by posting information on your site saying who in your comminity is offering individual care. For myself and my partner, there was just no way we would even consider sitting in a room full of cisgender, straight families to get childbirth ed. We wouldn’t be able to let our guards down, get comfortable, and receive the education we were seeking. So we did individual classes. 

SM: Look into the future for a moment and dream big.  What would you like to see for people who are choosing to grow their families as a gender-diverse parent, so that they will have what they need to do so safely and with respect?

SAE: I want for us to feel safe and full of hope accessing whatever it is we need to grow our families, through whatever route to parenthood is the right fit for us.

For those of us who seek pregnancies for ourselves or want to conceive pregnancies with our partners or chosen co-parents, I want us to have affirming and evidence-based fertility preservation care, pre-conception care, insemination care, assisted reproductive technology, prenatal care, childbirth education, intrapartum care, doula care, postpartum care, and mental health care. I want insurance to cover our fertility care needs regardless of our gender identities or the anatomy of our partners. I want single payer healthcare and affordable healthcare for all! I want us to receive excellent care, always. I want us to not be othered in our pursuit of parenthood. I want there to be amazing, ethically-generated research to help guide our reproductive life planning. I want our healthcare providers to be up to date on that research, and to provide us with accurate information in a compassionate and approachable way.

Then, I want us to move about in the world feeling confident that we will be understood as parents. I want the parenting names we or our children choose for us to be honored, I want our kids to feel that our families are secure and protected, I want our kids to be free of harassment and bullying and inappropriate questions. I want us to be free of violence so that we can continue to parent our children. I want us to feel free of the threat of losing our parental rights because of transphobia. I want us to be able to travel freely without the fear of our parenthood being challenged or our children being taken from us.

I want the definition of family to be big enough and beautiful enough to hold us and our children.

Simon Ellis has been a colleague of mine for more than a decade and my community and the larger world are better for the contributions that they have made to reproductive health care.  I say from the bottom of my heart, Simon, I want the definition of family to be big enough and beautiful enough to hold you, your family and your chldren too!

Resources for professionals to share with parents

• The Transgender Health Care Toolkit
• Queer Parents Network
• Queer Liquid Gold - Focus on bodyfeeding
• Birthing and Breast or Chestfeeding Trans People and Allies

Papers authored by Simon Adriane Ellis

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