What it means to be an Inclusive Practice

I occasionally get questions about the Inclusive Practice graphic on my website, so I wanted to take a minute to explain it and highlight why I see this designation to be important. We're on the heels of Pride Month, after all.

First off, what do all those color combinations mean?

Put simply, the above color combinations are the flags of the LGBTQIA community.  The most common flag associated with this community is the rainbow flag (left), though because many feel it to only designates gay and lesbian folks, other communities created flags with their own unique color combinations.

This flag represents bisexuality. These are people who feel romantic and/or sexual attraction to two genders. I have worked with many bisexual folks, and while it is not always relevant when they're in a heterosexual relationship, my clients feel they can comfortably disclose this intimate detail about themselves if they are aware that I am an LGBTQIA-friendly provider.

This flag represents the transgender community. A transgender person is a person whose gender differs from the gender they were assigned at birth. For example, a trans man may have been "DFAB", or designated female at birth. Many trans men can become pregnant and some choose to do so. Some nurse their babies and others choose not to or cannot. I am proud to be in a growing community of birth and lactation professionals that have educated ourselves on helping transgender folks meet their infant feeding goals.

This flag represents the genderqueer and non-binary community. Some folks do not identify with a specific gender, or their gender does not fit the typical man/woman binary. Non-binary folks often use gender neutral pronouns such as they/them. Many can become pregnant and give birth, so being knowledgeable about this community is a must for an inclusive birth and breastfeeding professional.

Speaking of non-binary folks, a pansexual is a person who experiences attraction to all genders. They dislike the term "bisexual" because of the implication that there are more than two genders. Again, this is not always a relevant issue for birth workers, but this community is important to include in your awareness base!

An intersex person is a person born with reproductive or sexual characteristics that do not fit the traditional male/female binary. Contrary to popular misconception, most intersex people are able to become pregnant, though modification surgeries to "assign" a sex during infancy often interferes with future fertility. Many if not most intersex people resent this cosmetic modification because they were not given a choice in the matter.

Asexuals are people who do not experience sexual attraction, or experience it very selectively. Many asexual people experience romantic attraction, and therefore do become pregnant and start families with the people they love.

The final flag is the only one that doesn't really "fit" in the LGBTQIA acronym, though it's relevant to doulas. Non-monogamous folks (also called polyamorous) have multiple romantic relationships with the knowledge and consent of everyone involved. A doula very often becomes acquainted with the intimate details of their clients lives, so being aware of diverse relationship dynamics is important. Especially if your client will be accompanied by more than one romantic partner!

In other words, this graphic is meant to signify that I have a great love and respect for diversity! Because no two families look alike, it is important to me to designate myself as an inclusive doula and lactation consultant. Indeed, I enjoy working with pregnant folks and their families regardless of sexuality, gender, or family structure. Additionally, I am committed to being aware and knowledgeable of the unique issues affecting each community.

For those who have asked, yes you are more than welcome to use the above graphic on your business page! I only ask that you educate yourself about each community and know that being an "inclusive provider" means committing to a lifetime of learning and never making assumptions. The experience of one person is not the experience of everyone within that demographic. The best practice is to listen first and echo language. If you're unsure, just ask! A few examples of questions you might ask:

• "What are your pronouns?" (Don't assume based on how someone looks or sounds.)
• "How should I refer to you nursing your baby?" (If you're working with a trans man, he might use "chestfeeding" or simply "nursing" instead of "breastfeeding.")
• "How should I refer to your partner?" (This goes for everyone! Just because someone is married doesn't mean they use terms like husband or wife.)

Sadly, most doula trainings are severely lacking in these topics, so I'm providing some resources to help you educate yourself on the diverse family below:

The Next Family - The leading resource for gay parents, single parents, and city dwellers
World Professional Association for Transgender Health
Milk Junkies - Breastfeeding and parenting from a transgender perspective
Professional Organizations on LGBT Parenting - HRC
More than Two - Resource for non-monogamous families

And a few for your LGBTQIA clients and their families:

Find an LGBTQ Care Provider - Breastfeeding Network 
Overview of Lesbian and Gay Parenting, Adoption, and Foster Care - ACLU 
Trans Parenting Support Group - Web-based community
Family Resources - Family Equality Council
The Basics of Inducing Lactation - Breastfeeding without Birthing
Breastfeeding Inc - Resources from lactation specialist and LGBTQIA ally Dr. Jack Newman
Peaceful Beginnings of the Triad* - Inclusive clinical lactation support for all kinds of families in the Piedmont Triad of NC

*Full disclosure: I am one of the lactation consultants at Peaceful Beginnings.

Get Yer Freak On. Doula's Orders

The first thing people do when they find out you're a doula (other than asking what the heck that is) is tell you their birth stories.  Which I love, but they very often end with, "So then I had a c-section, and did I really need one?"  Um, I dunno.  I wasn't there, and if I was, I wouldn't exactly have the authority to say.

The second thing people do is ask about some old wives' tales surrounding birth.  The favorite of mine is always, "Is it true that having sex can bring on labor?"  And let me tell you, the answer is yes.
But why?

Oxytocin, the so-called "love hormone," is at least partly responsible for three distinct physiological events in a woman's reproductive life: orgasm, labor, and breastfeeding. As a sex-positive doula and lactation consultant , you might say that oxytocin is my homegirl.

The female orgasm was once thought of as relatively inconsequential to the reproductive process.  In fact, some fertility specialists have even suggested that orgasm "dilutes" a woman's chance of becoming pregnant.  Au contraire, says a bulk of new-ish research that essentially reaffirms what lay-health workers have been saying for years: orgasm increases your chances of conception.  See, when a woman orgasms, her body releases even more vaginal secretion than she does when simply "aroused," helping to lubricate the sperm's path to the egg.  Additionally, the oxytocin released via orgasm contracts the uterus, lowering the cervix (the "neck" of the uterus) and making the uterus more accepting of a fertilized egg (ever wonder what that tight feeling in your lower abdomen was?).

So oxytocin contracts the uterus.  Hence, it may help tip your body into labor.  But the wonder-hormone's job isn't over when the placenta is delivered.  Oxytocin is also responsible for the milk "letting down" during breastfeeding.  See, when a woman first lays eyes on her baby, she's essentially OD'ing on oxytocin, as is baby.  That's the love hormone doing its job.  Baby will hopefully find her/his way to a nipple and begin suckling.  When the nipples are stimulated, oxytocin is released from the posterior pituitary gland, contracting the tiny myoepithelial cells inside the milk ducts, forcing milk out of the breast and into baby's mouth.  That oxytocin release is still doing it's job "down there," helping mama's uterus to clamp down post-delivery, thus reducing risk of excessive postpartum bleeding.

I mention the connection to breastfeeding because oxytocin is also released with nipple stimulation.  Women who enjoy nipple stimulation during sex may enjoy it for a number of reasons, but physiologically it's because that burst of oxytocin contracts the uterus (which essentially puts interior pressure on the clitoris and, well, you get it).  In other words, if you enjoy nipple stimulation, include that in your labor-inducing sex practice.  Otherwise you can just turn on your breast pump when you're finished, and you will probably get many of the same benefits.

If a woman is having sex with a man, he may play a labor-inducing role as well.  Semen contains prostaglandins, autocrine hormones that help to soften ("ripen") the cervix.  A softer cervix makes the fertilization/implantation process more likely, but these hormones work the same when a woman is already pregnant.  The low dose of prostaglandins in semen alone aren't likely to induce labor in a woman who's not yet term (which is why care providers don't warn against sex during pregnancy unless a woman is at risk for preterm labor), but the mild softening in a term mama might just be enough to tip her into labor mode.  As an added bonus, his penis hitting against the cervix may indeed induce some mild (but not earth-shattering) uterine contractions.

Captain Obvious moment: I generally don't recommend the prostaglandin method if a mama is in a relationship where she's at risk for a sexually transmitted infection.  The last thing she needs is to be infected with an STI right before a baby comes through her vagina!  If infection is a concern, sex with a condom still contains the benefits of oxytocin and cervical pressure.  Masturbation is a safe and effective alternative for women who don't have a partner (or just simply don't want to engage in partner sex).  Again, oxytocin is stronger than prostaglandins!

So yes, good sex can in fact induce labor.  In other words, if you're trying to get labor started, just get yer freak on.  Doula's orders.

 

Lauren Guy

CD(DONA), IBCLC

 

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