Episode 40 - Kristin Liam Kali: Community Support in Queer and Trans Conception

Liam (they/them) is a midwife whose mission is to support and serve underrepresented and marginalized folks on their conception, pregnancy, and parenting journey. Queer, trans, non-binary, people of the Global Majority, single, and poly parents are uplifted in this conversation. In this episode you will find the importance of inclusive information, education, and access to affordable supplies.

[ID: A beige background and orange semi-circle. Text reads: The Intersectional Fertility Podcast Episode 40: Kristin Liam Kali @midwiferymaia and Josie Rodriguez-Bouchier @intersectionalfertility.]

Check out Maia Midwifery's website, and follow them on Instagram.
You can find Liam's book Queer Conception: The Complete Fertility Guide for Queer and Trans Parents-To-Be here.
You can also find products mentioned in this episode here.

Episode Transcript:

Disclaimer: This is an automatically generated transcript edited to be more readable. It may not be 100% accurate.

[00:00:00] Josie: I am Josie Rodriguez-Bouchier, and this is the Intersectional Fertility Podcast, where ideas and identities intersect to deepen our understanding of fertility and ultimately our whole selves.

[00:00:32] Kristen Liam Kali, Licensed Midwife, is the owner of Maia Midwifery and Fertility Services, an author of Queer Conception, the Complete Fertility Guide for Queer and Trans Parents To Be. They have supported thousands of LGBTQ plus parents through fertility and preconception care, in-home insemination, prenatal care, childbirth education, delivery in homes and birth centers, postpartum care, lactation management, and parenting groups. 

[00:01:04] A devoted advocate for queer and trans families everywhere. Liam also serves as a speaker and consultant, educating physicians, midwives, and childbirth professionals in culturally sensitive and clinically appropriate care, including the widespread use of gender inclusive language.

[00:01:30] All right. Welcome back to the podcast everyone. And Liam, welcome. 

[00:01:35] Liam: Thank you very much for having me. 

[00:01:37] Josie: Yeah, so will you share with us your pronouns and where you're joining us from today? 

[00:01:42] Liam: My name is Liam Kali and I use they/them pronouns. I am in Seattle, Washington, and on Duwamish land and land that's been tended for generations by Coast Salish people.

[00:01:55] Josie: Cool, awesome. So I would love to know about your background and story. I know that you've supported thousands of queer, trans, and non-binary folks to become parents, and you've trained hundreds of midwives and childbirth professionals to serve the queer and trans community, which is so incredible. How did you start doing this work and what inspired you and drew you to it?

[00:02:19] Liam: Hmm, well, I had a baby. I had a baby with midwives in 1995. So that introduced me to midwifery and the process of going through that time of life really underscored for me how much we need each other. Growing up white in very, very white spaces and community, like just the deep enculturation of individualism was something that did not at all serve me as a new parent. 

[00:02:55] And so here I am 22 years old with a new baby and having this epiphany of, oh, this is the work I can do. I can, I can become a midwife and my path as a midwife will always include building community among the families that I serve.

[00:03:20] I was not out at that time. I had an unplanned pregnancy. And just that deep level of self knowing that happens for so many of us going through childbirth, but also, Being a parent of a little, of a tiny little human makes us really kind of reevaluate who we are and how we function in the world.

[00:03:42] And so, pretty quickly, I was like, oh, okay. I'm queer. Then by the time I went through midwifery school and they had the extent of education around queer family building, queer pregnancy was like in this class where we also did a section on teen pregnancy. And like all these like tiny little cohorts and so the lesbian pregnancy I had I was like, okay, I'll do that one.

[00:04:09] Number one, it was called lesbian pregnancy. And basically I could, I could put together about a 10 minute presentation. So I went to the instructor and I was like, yeah, 10 minutes is not gonna cut it. And she's like, this is her response. "Oh, just talk about the garden variety lesbian."

[00:04:26] So I was like, okay, my work is cut out for me here. So that's my background and what drove me to do this. But then yeah. Getting into it, it's like, well, I can figure out how to midwife queer families and most of what I need to know to do that was not even addressed in midwifery school other than this is how the ovulation cycle works.

[00:04:58] And how do I inform other providers about how to care for our community well? And so that's when I started doing a lot of training for doulas, childbirth educators, midwives around queer and trans family building and how to use inclusive language. And the feedback that I've received, at least in the community of licensed midwives is, wow, you really, like single-handedly pushed the needle forward by doing this.

[00:05:28] And I was like, great, because I'm really exhausted now. I did that kind of advocacy work for like about four years and the last go round was, I went to a Lamaze conference in West Palm Beach. During the election season where Trump was being elected. So to be in West Palm Beach at that time and in a very mixed crowd.

[00:05:56] Just like the obtuse questions that I was fielding, not even behind the podium, but like, they had these little round table discussions and I was like, oh my God. I felt so pigeonholed and marginalized and like, really? You're gonna ask me this question? Can you just like, Step out of your own perspective for a second? And hear what I'm telling you about how our families go through this process completely differently than anyone else and don't have the benefit of all the cultural validation infused every step of the way. 

[00:06:33] So this is my point, is take off your glasses and put on mine for a second. Just take this in. So anyway, I think anybody that does this sort of work, the emotional labor involved means that it's a time limited thing. So I'm doing that all differently now.

[00:06:48] But at the time, in terms of answering your question about how I came to the work of training other providers, right now it looks like continuing to model. I've written a whole book that's inclusive about conception, it really can be done. And training midwives to do IUI. 

[00:07:09] So that in home and or outside of a fertility clinic that's not for us. How can people access care that is more appropriate, that is affirming and that's more appropriate cost for what you actually need. Less money, but the trick of midwifery is that it's generally, it depends on the type of midwife and all that, which we won't get into, but in general, midwifery care is something that costs less and gives you so much more.

[00:07:39] And if we could just like unlock that secret, then families would be so much better served. 

[00:07:47] Josie: Interesting. Yeah, totally. And gosh, I've had so many thoughts pop up with everything that you just said. One was, patients of mine that tell me that they have to pay for all these services before every IUI.

[00:08:02] And one of them is a pregnancy test to make sure that they're not pregnant. When they have no access to sperm. So it's like they're just being funneled through this system that is not at all made for queer folks. And then also, one of my questions to you is gonna be, do you feel like you're literally the only person doing this work?

[00:08:22] Liam: I really do. And less and less so. I think that there are a lot of midwives who will do IUI because the procedure itself is, pretty straightforward for anybody that knows their way around the gynecoid pelvis and that knows how to do sterile technique.

[00:08:47] But as more and more people are doing that, they're finding that, oh, actually that means I'm gonna get all these other questions about timing about fertility, and it's not in our training programs. And midwives that have busy birth practices soon realize that when someone's ovulating, like you gotta go take care of them.

[00:09:11] You can't just say, I'm at a birth and I can't be there. Like, you need to have backup. So it is a whole other aspect of practice. And when I used to just teach midwives how to do the IUI procedure and pretty soon I was like, no, because they're gonna get all these other questions.

[00:09:29] So now I'm doing it as a whole, like, here's what you didn't get in school that you really need to know if you're gonna be doing preconception care and inseminations for people. And so that's going well and there's more and more people who are providing this care. So I'm no longer the only one.

[00:09:48] And I'm hoping that having access to this book also means that even without taking a class from me, that a midwife could pick up this book and get what they need to get kind of everything up to a wash procedure. You know, that's, that's not in the book. And how to do an IUI isn't in the book, but all that background stuff, that's not just procedural skills is there to be found.

[00:10:12] Josie: Yeah, nice. Yeah, I mean, you're right. It's almost like they do need to be on call to be ready for that ovulation window. So it's almost like being on call for birth, but being on call for the conception process. That's such a good point. Well, I was gonna ask if you had always specialized in fertility and serving the queer and trans community, or did one come first? It sounds like they were kind of simultaneous. 

[00:10:38] Liam: Well, as a new birth worker in the late nineties, early two thousands, I was doing childbirth education. I was doing doula work, and that was for all families. And really developed a very strong interest, I'm always drawn to where there's a gap.

[00:10:58] And in that work what I found was really missing was attentive and consistent care around establishing lactation. And that remains the case. I think I was able to affect some change among the birth community where I lived at the time, which was also Seattle. I just left and came back.

[00:11:19] But yeah, people still aren't getting good care around lactation. It's moved a little bit, but not a lot. So yeah, it wasn't until even the group facil- I've led groups for parents for 25 years as well. And so initially it was all everyone. But, because I'm a queer person, it was very clear that that was gonna be a safe space.

[00:11:43] But then since I've been a midwife, my work really has focused on queer and trans folks. And that being said, I still care for cis hetero folks. Whether it's people who come into my practice for their midwifery care during their pregnancy. Either that or cishet folks who need assisted conception, but don't wanna go into a clinic.

[00:12:05] So I still serve those folks, but it's the mirror or the negative image. In film speak of like, okay, this is what it looks like to really center queer and trans folks. And that means that the hetero folks who come through need to be cool with that.

[00:12:25] So I only get the best straight clients. And if not, they don't stick around for too long. And that's okay too. There's so many other providers for them. 

[00:12:35] Josie: Totally, totally. I love that. That's awesome. Yeah, I'm wondering, would you talk a little bit more about Maia Midwifery and what it is and what it's meant to you and your community? I love, I'm very familiar with Maya Midwifery and I send folks to your website all the time. 

[00:12:52] Liam: Thank you very much. Yeah, well Maia has actually been around since the early nineties. It was founded in the Bay Area and I took over the practice in 2006. Traditionally the same thing. Like, okay, if you're really gonna serve queer folks, then you need to be doing preconception care because our pregnancies begin in the initial decision making process. Around selecting a donor, if there's more than one uterus in the family, who's gonna carry and different things like that. 

[00:13:23] So Maia has always been focused on preconception and fertility care. And the other thing that I also found resonated with me as a student midwife, looking for where I was gonna practice and things like that was that Maia also did a lot of classes in groups and I was like, okay, this is home for me.

[00:13:45] And there was no other practice at that time doing that. It's always, separate folks are doing that kind of thing. And it's just continued at this point, when I joined the practice in the early 2000s, we were doing phone consultations for people in other parts of the country and then Zoom came along and so I remember in 2010 I did my first online support group. 

[00:14:16] I had this, it was a group for solo parents. And I will say I also work with solo parents by choice of all orientations. So that's another crossover where that happens. Basically folks that are marginalized in the childbearing process.

[00:14:30] So at this point we, me and a couple other people that help me out. We have everything from, you can come for preconception care that I provide via telehealth. I can order labs in all 50 states. If there isn't a provider in your area, I can work with you from a distance.

[00:14:54] I can do everything but the IUI procedure. And I can help you navigate how you're getting your IUI provider to do the insemination at the right time for you. And so sometimes that means like, when this or this fertility sign comes, you're gonna call the clinic and tell them quote, I got my positive.

[00:15:16] Tell them what they wanna hear. That you get scheduled at the time you need. So I'm doing that as an individual provider. But then in terms of the community support, the education piece, I have a fertility and family building program with support groups for solo parents by choice, BIPOC solo parents by choices coming down the pike real soon.

[00:15:42] Queer and trans families and queer and trans folks who are doing IVF. So we currently have those four different support groups. They come and go over time, but those are pretty much the ones that I think are gonna keep moving forward. 

[00:15:57] And then once folks are pregnant, you can be in a program that provides information, everything from how to cope with nausea, to thinking about the gestational diabetes screening and what that means and how to interpret it in a way that's not super fear-based.

[00:16:17] Like this is information about your body and this is what you can use that information for. So, trauma informed, anti-racist, body positive, fat positive info. And then the childbirth education, so that information all written gender inclusive. So nobody has to wade through this super binary gendered stuff.

[00:16:40] Childbirth education is included, lactation education is included. And then people go through the program with other people at the same point in pregnancy. Those folks are spread all around the country. We even have some folks in Canada and then after the birth, We come together and share birth stories in a facilitated space.

[00:17:00] And then I do weekly lactation support clinics. And then there is a set eight week series of weekly meetings where new parents are coming together, sharing highs and lows from the week I do Q&A with those families. So there's like a healthcare provider that you can ask these things and get answers, and then I facilitate a discussion.

[00:17:21] And that's all focused on queer and trans folks. And then I have a simultaneous program for solo parents that is kind of up and coming. I've just had a huge place in my heart for solo parents by choice. And so I'm hoping that we are able to generate enough interest that we can really fill a program that's specific for solo families. 

[00:17:44] Josie: Totally, totally. Oh my gosh. When do you sleep? 

[00:17:49] Liam: Good question. I mean, I've been doing this stuff for a long time, so a lot of it what we've done is just kind of like put it in a different package. As technology improves and things like that.

[00:17:59] But yes, I'm definitely, as I age and I'll turn 50 here in about three months. Yeah, that question of like, how much can I do in a day has got a different answer now than it did a couple years ago. 

[00:18:15] Josie: Right, right. Wow. Well that's incredible. I'm just thinking of all the people that I know personally who could benefit from so much of that that you're offering.

[00:18:25] How do people join the support groups, get that support from you? Like is it all on the website? 

[00:18:31] Liam: It's all on the website. Yeah, basically the website is divided into fertility, family building, and pregnancy and parenting. So if you're making your baby, you're gonna go to fertility and family building.

[00:18:45] There's either clinical care, I do consultations for family building, so if people wanna just like talk it through during that decision making phase. And then the groups, and then when people are pregnant, it's all in the group model. In fact, what I can say is I'm not catching babies anymore.

[00:19:01] That's what makes this all possible. A few years ago I decided, you know what, I'm spending all this time one-on-one with families, which is deeply valuable and I hate to let it go, but you know what, I could actually really serve a whole lot more people if I wasn't up all night at births.

[00:19:19] And doing all that intensive postpartum care. Cuz as somebody who believes strongly in lactation, I'm not just seeing people at six weeks, I'm like going their houses every day. At this point, if somebody lives close and I can do that, I still do, but for the most part, I am serving people in a group model once we're into pregnancy zone.

[00:19:39] Josie: Nice. Yeah, that makes sense. And just so listeners know, it's maiamidwifery.org. Is that right? 

[00:19:45] Liam: Dot com. Dot com. And Maia is M A I A Midwifery. 

[00:19:49] Josie: That's right. Okay, cool. And I'll include that link in the show notes for folks. 

[00:19:52] Liam: Thank you. 

[00:19:53] Josie: Yeah, of course. So I would love to shift gears and talk more about your incredible book that you've written. I have it right here in front of me. It's so wonderful and I just wanna thank you, first of all, for writing this book. This is so hugely needed. I kind of can't believe it exists. What an incredible resource for queer and trans folks who are trying to conceive.

[00:20:20] And I'm just so curious. How long did it take you to write this book? It seems like must have taken a while. 

[00:20:26] Liam: We are in 2022 now. I wanna say, I wanna say it was 2018, unless I figured it out and put it in the acknowledgements, cause there's something in there about that. I was like, okay, I'm gonna do this. And so I went to Alaska.

[00:20:40] My friend who lives there part of the year was raised there had a sailboat and he's actually the donor for my youngest child. That's how I know him. That's, of course a whole other story. But anyway he like, put me in a boat for a week anchored outside of Sitka, Alaska with some groceries and some bear spray and kayak. 

[00:21:04] And I sat down and I wrote, and I wrote and I wrote, and then I wanted to come in town and turns out, gosh, the library in Sitka, Alaska just looks right out over the water. So I had this little writing retreat, and at the end of it, I thought, okay, well I've got it 80% written. 

[00:21:20] Oh my God I so did not have an 80% written. Like, that was just my initial download from my brain with no internet connection. So then I thought, okay, I'll finish it this year. I'll go ahead and utilize the health sciences library and get all the data in there and everything.

[00:21:38] And as it turned out, no way, I didn't have time for that. It kept getting pushed to the back burner and then I thought, okay, well if I announce it to everybody that I'm doing this, then I'll really have to do it right? So I put it in a newsletter. And one of the newsletter, my practice newsletter, there's somebody in the community who had subscribed to my newsletter who is in publishing with a local publisher here in Seattle called Sasquatch Books.

[00:22:08] And so Hannah reached out to me, said, "Hey, how about we talk about us publishing your book?" And I was like, well, I was gonna self-publish because then maybe I would make some money for all this work writing the book. But the truth was, I wasn't getting self-published. And the barrier was knowing what was on the other side of writing it. In terms of actually getting it out. 

[00:22:30] And so as it turned out, really what that relationship ended up being was I needed somebody to midwife me as a writer. And to hold all of those pieces that actually, okay, white person, get outta your silo and know that other people can help you.

[00:22:48] Yeah, just letting that in. And so once I was signed up with Sasquatch, everything was laid out for me. I had a deadline and I had support in terms of content editing as well as copy editing and all that other stuff. So that focus time period was about a year. It was the ended up being the first year of the pandemic.

[00:23:11] I don't necessarily recommend writing a book during a pandemic because I was really isolated. And I couldn't just go to a cafe and write, you know, still couldn't. So that part was added to the trudging through kind of feeling. But once, once the manuscript was submitted, other than some editing, it's been over a year from the submission until the release.

[00:23:39] And so this quiet year of knowing that it was all there, but I couldn't give it to people was really hard. I think four years is probably all told how long it took, but I think I ended up using very little of that initial content. I think I really rewrote up pretty much everything in 2020. And then 2021 was the, the rest phase. And then it's out. May, 2022. 

[00:24:15] Josie: Wow, okay. Oh my gosh. Thank you so much for sharing that story cuz I, I love to hear the process of how books are born. I love that. And I love you describing that you had to be midwived. Like that book had to be midwived and you had to have that support. I love that. 

[00:24:32] Liam: Yeah. And there's some kind of metaphor about the donor, you know, being involved in planting the seeds. 

[00:24:39] Josie: Yes. That's totally in there. I love it. Oh, so cool. 

[00:24:45] So I love how, particularly how this book is organized for different phases of the fertility journey. I think that's so brilliant of the way that you chose to do that. Will you talk about that and how folks can use the book depending on where they're at in their fertility journey? 

[00:25:03] Liam: Yeah, sure. Really it's just born from 15 years of doing this work and knowing that people will start looking for resources. You know, either come into care or pick up this book.

[00:25:17] At different points in the process. And sometimes people feel like they're, on paper look like they're pretty far into the process. But if that process hasn't been informed from the perspective of donor insemination, from the perspective of queer family building, then pieces may have been lost.

[00:25:36] So what I decided to do was lay out the chapters so that somebody could pick this up at the very beginning. Starting with decision making, creating a timeline. I want people thinking about chapter two, Fertile Health for Every Body early in the process because the prep work that you do in a body preparing for pregnancy that starts at least three months before you actually try to conceive and putting it in terms of how the human body functions.

[00:26:06] We start to select that cohort of eggs that's gonna be matured about three months before we release them. So that's, that's why it all works that way. So I don't want people to wait for that piece. And chapter three, Lab Test and Fertility Evaluations, you know, get that early in the process to inform how you're preparing your body.

[00:26:29] Gamete Donors doesn't come until chapter four for a few reasons. One is a lot of people will start there and forget about the other stuff because like, "Oh, we're pretty healthy. We know who's getting pregnant here. We just have a missing piece." So we're gonna start thinking about this donor piece without thinking about preconception health and what an opportunity from a health perspective to be working on fertile health. 

[00:26:56] And, you know, donor insemination isn't easy. For some people. It works really quickly and pretty smooth, but for others it doesn't. And every cycle you try is financially expensive and emotionally costly. Even going down a pathway with a donor, if you haven't thought about fertility evaluation for your donor.

[00:27:19] Then it could mean, if your donor ends up being infertile, it could mean that you've done all these cycles without any chance of success. So I wanted to put that stuff before really diving into gamete donors. It is inclusive of all family types and routes to parenthood via pregnancy.

[00:27:38] So I've got a separate chapter on surrogacy because the considerations for surrogacy are very unique. However, families who are conceiving via surrogacy are also very well served by the gamete donors chapter. We go from the initial four chapters, making decisions, fertile health lab test, gamete donors.

[00:27:59] Then we're into methodology, so surrogacy or insemination. So insemination methods and timing is its own chapter and then, troubleshooting, I kind of lumped together with complicated conceptions. Because if you're already in the process, you already felt like you had things pretty dialed in, it's not happening, you might turn to the troubleshooting chapter.

[00:28:25] And then the very beginning of that chapter is kind of like, okay, let's regroup and make sure that really all these areas have been adequately covered. It's page one of the troubleshooting chapter, is your sperm source viable? So here's where like, did your known donor get a semen analysis?

[00:28:46] And then second question, are you having regular cycles and are you ovulating each month? Sometimes a fertility doctor will tell you that you're ovulating every month. If you get a positive on your ovulation predictor kit. But that's not always true for everyone. So here's really how you can reassure that you are releasing an egg.

[00:29:03] And then next question, what about timing? Is your timing spot on? So much misinformation about timing. Apps aren't accurate. There are new predictor kits on the market that are giving people the wrong information, or shortsighted, or inadequate, or inaccurate information. And then are you living a fertile lifestyle?

[00:29:25] Like here are the health components. Oh yeah, and there's one more. Have you completed all the lab tests and fertility evaluations? So all that, how people switch, you know, shift back. If the answer's no, then go back. So choose your own adventure model, and then it goes into more like PCOS, fibroids, endometriosis with some putting together medical approaches and conventional approaches, all evidence-based. 

[00:29:51] There is a separate chapter on the IVF process. That's chapter eight. And I decided for the IVF chapter, what I found was that in the families that I work with who are doing IVF, what comes up over and over and over again is just that element of not understanding that every step of the way is a trial and error.

[00:30:18] There's very little anticipatory guidance that's given to people going through the process. And what that means for queer and trans folks as well as in this time that we're living through. So many of us have experienced trauma in life, and so many of us have experienced trauma in healthcare contexts.

[00:30:45] Yet we need this high tech fertility medicine in order to reach parenting goals and family building goals. So my intention is that people can get information in a way that is not marginalizing, but that is in every way affirming. But I decided to lay out the IVF process so that people would understand this is what that process is, this is what it looks like, and here's where things can go not as expected.

[00:31:14] And that that is actually useful information. Like, okay, this didn't work, so we're gonna do the next thing. I think most people wanna know like, okay, what's gonna be the "if then." Because if I'm gonna step into this, I wanna know what's coming next after that. If anything happens. 

[00:31:32] So it's a whole anticipatory guidance chapter, and then there's a chapter on coping with cycle attempts. So kind of like looking at the mental health aspects of the process. A separate chapter on miscarriage, so you can turn to that if you need it. You can skip it if you don't. And then I could not in good faith put this book out without including the information about lactation.

[00:31:57] Because it is such a missing piece for folks. So what I decided to do with the last chapter in the book is put in info about early pregnancy. So many times people in early pregnancy start to feel like pregnancy has rendered them incapable. Because it's so physiologically takes over your body.

[00:32:21] And so many symptoms of pregnancy mean that we can't do the things we could do before. I wanted people to really have a solid understanding of like, no, it's not that you can't lift the groceries, it's that you're building a human. So let's validate everything that you are doing, doing nothing but sitting there.

[00:32:44] This is what's happening in your body. This is why your body's freaking out in these ways. And how about I give you that information without, feminizing it. And making it appropriate for everybody. It not only affirms folks who carry pregnancies, who are not women or don't identify with a feminine language, but also expectant parents who are female identified and not pregnant.

[00:33:10] Because that kind of like, Female focus on pregnancy is really marginalizing to women who are expecting children and are not carrying the pregnancy. 

[00:33:19] Josie: Right, right. Totally. 

[00:33:21] Liam: So I do that and then talk about midwifery care so folks know about that. And then I rewrote the lactation induction protocols that everybody's been using for lactation induction.

[00:33:35] The Newman Goldfarb protocols are super wordy and and those words are specific to cishet folks. And the one study we have on trans-feminine lactation induction or lactation induction for trans women is one case presentation. So I put that material, I put that data together and laid it out in a way that is easier to follow, that is not so wordy.

[00:34:06] The Newman Goldfarb stuff is so wordy. And I organize it in a chart titled Physiology of Human Lactation. So there's like, this is on the left hand side, this is how l lactation occurs in the human body. And then you find the column that pertains to you. In bodies with ovaries and pregnancy is one column, in bodies with ovaries, but without pregnancy is another column. And then in bodies without ovaries or pregnancy is another column.

[00:34:38] Whoever you are, if you wanna induce lactation, here's how it happens, and here are the guidelines. And then I had to, the very last thing is I really go over latch. Even my editor who had already, she gave birth a couple years prior to that and her partner was pregnant and expecting at the time that we were going through this, she was like, "Oh my God, I wish I'd had this when I, even just the latch stuff. When I had had a baby." 

[00:35:10] I don't know why it's still so hard to find this information, but it really is, and I get a lot of good feedback about my approach to how I teach Latch. There probably should be a pregnancy book, but so many people are gonna pick this up. Yeah. And if it works, then they're gonna need this, so I have to have this in.

[00:35:27] So I think they expanded my page count. But I'm happy with what's there. Like what I really like could not have people leave the door without getting right. Is in that last chapter. 

[00:35:37] Josie: Totally. Oh my gosh, that's incredible. What an incredible body of work that you've created and yeah. Really a legacy. I mean, this is really gonna change so many lives. It's just incredible. Yeah, totally. So many things, thoughts that I had and one was that most of my patients and folks that I work with feel so frustrated that they're not given any sort of clear roadmap through the IVF process.

[00:36:05] And that everything is just one step at a time and they don't really know where they're going and everything's a surprise and they're like unable to plan well, I mean, all of it. It's just, it's so frustrating for them.

[00:36:19] Liam: It just feels like being a ship tossed in a storm. And it's not fair at all. And for all that money you're spending, you should get more than that. Like come on. 

[00:36:30] Josie: Yeah, exactly. So that's incredible that you've included that. 

[00:36:34] Liam: Anger and, and frustration are great motivators. 

[00:36:37] Josie: Yes, exactly. I agree. I agree. 

[00:36:42] Liam: As is love. You know, like sandwich that all together and then boom, here comes a book.

[00:36:49] Josie: Yeah, and the other thought I had was that when I'm working with patients who then become pregnant, I always have tell people, I'm like, take your to-do list, cut it in half, and then cut it in half again. Cause they feel so frustrated that they can't do everything they were used to doing. And they feel like they're not being as productive as they used to be. And I always tell them, you're being the most productive you've ever been. In your whole life. 

[00:37:11] Liam: Yes, and value rest. Value taking time when you need to. Even just looking at it from a feminist perspective, like culturally, women still make less money. And come home and do the housework and the childcare. So like, don't take that on. Don't take on this idea that you're supposed to just add a pregnancy, add a baby to a preexisting platform. 

[00:37:39] The entire platform needs to change, because if you do it the way that corporate America wants you to, you're just gonna get ground up in the grist mill, none of it is for you, it's for capitalism. Like, just let that go. 

[00:37:53] Josie: Exactly. It's like a reframe of anti-capitalism basically, people have to. 

[00:38:01] Liam: Exactly. Reexamine it. Queer it up. We know how we know how to do this as queer folks. This is not the time to assimilate into what the broader culture is telling you to do. Like this is the time to dig in your heels and queer this too. 

[00:38:16] Josie: Totally, oh my gosh. 100% agree. So I would love to, if you could talk a little bit about what are some of the gaps or barriers that queer and trans folks are running up against in their fertility journey. I know we've kind of talked about some, but if you have more to say about that and how does this book provide that solution? 

[00:38:34] Liam: I think there's a huge information gap and a lot of misinformation. Don't buy a hundred dollar Mosie Baby plastic syringe. It's a total ripoff and it's not a queer own company. So, you know, these folks are out to take your money. I've got a $1 plastic syringe on my website that'll do that for you.

[00:38:57] I'm not making money off my $1 classic syring. I just want it to be available. Same thing with ovulation predictor kits. You know, don't spend a whole lot of money on something that's gonna lead you astray, like your body has the information you need. So I think that there's a huge information gap.

[00:39:16] That's totally why I wrote the book. I think that there's also a gap around money that people are spending in the conception process. And I think that it makes people spend a whole lot more money than they actually need to. But also when folks don't have that money, I see people cutting corners in ways that don't actually serve them.

[00:39:43] In a couple of different regards, one is legal protections for the family. If you find a donor on a website, it is not a known donor. It is a live donor, but you don't know this person. You don't have a history with them. And you are just like taking their word at face value.

[00:40:04] I had somebody the other day who said, well, we didn't make a legal contract with the donor that we found on an app because he's an attorney. Well, if he's an attorney, then he would know that you each need your own separate legal counsel. And you need to have an agreement. And I do address that in the book.

[00:40:24] A known donor isn't always what we're thinking it is. And clinically speaking, your time to pregnancy and therefore the money you're spending in the conception process, it can be contained and limited by making sure that you're inseminating at the right time. And just because you're in a clinic and they say they're timing everything for you, air quotes.

[00:40:48] Doesn't mean that you're inseminating at the right time. So one example of that is, Not everybody ovulates 24 hours or 36 hours, whatever your clinic's telling you after you get a positive on your ovulation predictor kit. And similarly, if you're getting a trigger shot, if your body was just about to ovulate, it's not gonna wait because you got that shot.

[00:41:13] So I have people using ovulation predictor kits. I think that's a useful tool. Knowing that what that kit is telling you is it's giving you a yes or no answer about when your level of luteinizing hormone has reached a threshold that we know will trigger ovulation. And that does happen in a surge of luteinizing hormone.

[00:41:37] After that initial surge, your body's gonna keep peeing out that LH hormone, but it doesn't mean anything about your ovulation. What does tell you when you ovulate are your symptoms of high estrogen. Because your estrogen levels will continue going up until your egg releases, and then estrogen goes down, progesterone goes up.

[00:41:59] So all it takes is knowing when you get that positive, when your LH surges test frequently enough that you really know when it surges. I have most people test morning and evening, don't wait 24 hours. We need to narrow things down in a 12 hour window which I'll get to.

[00:42:18] So from the time you get a positive, track changes in your fluid, in your genital fluid should become watery, clear. Maybe stretchy, not for everyone, but it should go to something that you think sperm might be able to swim through. So nothing that looks like any various stage of Elmer's glue.

[00:42:39] We're looking for egg white consistency, water or egg white. So look for that to become more clear, more stretchy, more copious, and then go away. And same thing with changes in your cervix. If you're willing and able to put a finger inside your body and find your cervix and feel it.

[00:42:58] It will go from firm like the tip of your nose, medium like your chin. To really soft like your lips. In response to rising levels of estrogen and the cervical os, the opening to the cervix will open up. As the cervix gets softer, it makes that os open up, and then once ovulation occurs, the cervical os will close, it will become more firm again, and the fluid will go back to a cloudy, creamy, sticky, tacky consistency. 

[00:43:31] So what that means is, you look at the amount of time from the onset of your LH surge, that very first positive OPK, until you get your peak estrogen symptoms right before they went away. So if that's happening, if your peak estrogen symptoms are 24 hours after you're positive, then as long as you actually caught that positive, you weren't just testing once a day, but checking twice a day, then yeah. Your insemination 24 hours after your LH surge is gonna be accurate.

[00:44:02] But, some people release their egg 12 hours after that positive. So if you're in a fertility clinic and they're telling you to test your OPK once a day, and they're telling you to come in the day after you're positive, your insemination, if you're actually releasing your eggs 12 hours after a surge, your insemination's gonna be late.

[00:44:24] Every single time. And when you don't get pregnant, no problem. They've got IVF for you. For tens of thousands of dollars. So even just something like timing you're not well served in a clinic because they struggle, they can't take their glasses off expecting straight people with endless amounts of sperm in their bedroom at home.

[00:44:46] And that 12 hour window is about the fact that the egg only lives for 12 to 16 hours once it releases. And frozen sperm are not, they're like, they might live for up to 24 hours. They certainly don't span a number of days. And when IUI is done, it's most successful, your, your chances of success are highest the closer to ovulation you do that insemination. 

[00:45:14] And so we should be hitting ovulation within 12 hours. So that's why all of these things you need to check every 12 hours. So test the OPK twice a day, look at your fluid and changes in your cervix twice a day. I will say that not everyone can feel those changes immediately.

[00:45:33] It does take you know, some experienced fingertips of like right monitoring those changes. Most people that are going by feel will have a light bulb moment on that second or third month of, oh, now I understand what I'm feeling. You get a lot more direct and immediate information by looking with a speculum, which sounds scary to a lot of folks.

[00:45:56] And certainly if you have any kind of dysphoria or trauma in that part of your body, that's not gonna be feasible. However, if it is possible for you, a good quality, doesn't have to be high-end speculum, but like the ones from Amazon are not very good for self-exam. So again, I've made them available on my website, very cheap.

[00:46:17] 10 bucks. They're hinged, they're easy to use, and a flashlight in a mirror. And a little bit of you know, education, which is also in the book, then you could really, you can see it. And a lot of people are incredulous the first time they see it. They're like, why did nobody ever tell me this? My body is telling me when it ovulates every single month.

[00:46:37] I think that the, you know, that gap in care where you are living in a body that gives you this information every single month, yet you're spending hundreds and sometimes thousands of dollars for a clinic. It means that the repercussions definitely bleed over into access of care issues, let alone experience of care and how that's kind of like laying the ground for this transition into parenthood.

[00:47:05] Josie: Totally. Oh my gosh. And none of that stuff you can get from an app. 

[00:47:11] Liam: No, no. There's no app that, nothing that that tracks things twice a day. And, and your body's not a computer. It's not always gonna follow the algorithm, for the most part, the pattern with which your body ovulates.

[00:47:27] Will generally be consistent from month to month. It might shift in terms of what cycle day it happens, and there's always gonna be things that can offset that. Like if you were ill the first half of your cycle, or if you went to a wedding and had a few drinks that that can, you know, disrupt what estrogen's doing in the body during that time.

[00:47:47] So there are things that can, that can throw it off. And sometimes people have one pattern that happens in one ovary and another pattern that'll happen on the other side. At least that's what we're guessing. Not using ultrasound to determine that. But if there's a clear, like, oh, this happens one month, this happens the other month.

[00:48:05] But it takes a, you know, a month's time, you only ovulate once a month. And if you wait to think about this stuff once you're actually ready to try, it means that you might be spending money on sperm. And even insemination procedures that aren't timed appropriately. So it takes some, like getting that data ahead of time.

[00:48:26] And I will say that if you're using frozen sperm, your chances of success double by doing intrauterine insemination. You're not gaining very much by just doing an insemination, you know, DIY at home with a syringe if you're using frozen sperm. And the flip side is if you're using fresh sperm, then you don't need to be quite so precise.

[00:48:46] Those sperm will live in your body for three days, maybe longer. Success rates are highest when insemination are done 24 to 48 hours prior to ovulation with fresh samples. Where IUI, you wanna get it as close to the release of the egg as possible. So it's, you know, that's why there's a whole chapter on methods and timing in the book. 

[00:49:08] Josie: Totally, oh my gosh. Yes. And I'm also just thinking fertility clinics are not incentivized to correct that process to get more accurate because then they're like you said, "now we have no problem. We have IVF you can try instead." Where they can control all the factors. 

[00:49:28] Liam: Yeah. And they don't make a lot of money off of IUI. They don't meet their overhead. I've, I've had a doctor at one of the biggest clinics here in Seattle say, can I just send our people to you for IUI because this, it's not meeting our bottom line. And that's why they add, that's why they're doing an ultrasound at the time of your insemination.

[00:49:49] You don't need ultrasound at the time of insemination. They're doing it so they can bill you for it. 

[00:49:53] Josie: Wow, so much wrong with the system. I don't even know where to start. So I'd love to switch gears and talk about how queer folks can experience a better fertility journey. Can you offer any words of encouragement or advice for queer, trans and non-binary folks with wombs who are trying to conceive in the cshe world?

[00:50:14] As you know, it can be discouraging at best and harmful or violent at worst, especially for BIPGM, or BIPOC. 

[00:50:22] Liam: I mean, along the same lines of a lot of what we've been talking about, just know that the systems are not built to support you. Be careful how much faith you put in them and connect with other people that are going through what you're going through.

[00:50:34] Don't isolate yourself. I think that all of us have ways that we are able to just like get through things. And it sometimes it varies day by day. There are times when you just put your head down, get what you came for, just like get through it. There are times when we've got the spoons to, you know, take someone to task for the language they're using or whatever, and there are times that we.

[00:51:00] Bring an advocate. There are more and more people who are going into doula work that is focused on the fertility journey. A good doula will help you advocate for yourself rather than advocating for you. Because that ultimately it's disempowering to have someone else speak in on your behalf, except in those instances where it's not.

[00:51:20] And one thing is around gender and pronouns. That being said, some of us just go through the entire birth experience, you know, not wanting to, like, I just need to be in labor and have this baby. I don't wanna be dealing with pronouns, so whatever. If they call me, she, that's fine. But other people are gonna be like, no, that's gonna completely take me outta my zone and I need people to use the right pronoun.

[00:51:42] That sort of allyship. Of you know, having somebody help correct people's language when necessary, help bring in an element of trauma informed practice. So like having a doula there who can say, okay, the doctor's grabbing the speculum. Now is there anything that you need to say? Do you need a minute? Bringing that sort of assistance into the room and helping you remember the questions you were gonna ask, helping take notes on what the answers are.

[00:52:14] So remember that those folks exist reminding folks who want to serve queer and trans families, you know, birth workers, that this is a thing you can do, that'll be really useful. I'm trying to think of who's doing training for that right now. I think king yaa might be doing it in some of their trainings.

[00:52:33] I think Erika Davis might be doing some stuff. Although I think she's doing more postpartum stuff right now, but I don't wanna misspeak. Look up those folks, look up Erika Davis with a K and king yaa for training. I think that connecting with other folks who share as many identities with you as you can find.

[00:52:54] Even if you only end up identifying one or two people. Remember to reach out and create that baseline for yourself, because otherwise, if you don't, it can be so easy to just feel lost in a world that doesn't actually see you or meet you or serve your needs. 

[00:53:14] That when we connect with other folks that have identities, like ours or like our own, then we can really have a felt sense of that resonance, that layer of being able to like, let your shoulders relax and just be. Because that's the platform that will serve you through what everybody experiences as just a deeply, deeply vulnerable place physically and psychologically going through pregnancy, birth, and new parenthood.

[00:53:45] You wanna have that baseline to measure everything else against, because what ultimately ends up happening if you don't, is we end up turning it in on ourselves. We end up feeling like, why can't I do this? You know, why can't I do these things when I'm pregnant? Why am I struggling as a new parent?

[00:54:02] And the truth is, everybody does. It's just this big secret. So let's, let's make it not a secret. And recognize that actually as queer and trans folks you know, the, the more marginalized identities a person has, the more and more skills you have acquired for your own resiliency, for pushing back at the powers that be and creating your life in a way that actually serves you.

[00:54:32] It's never as important as it is during the transition to parenthood because it then ultimately, like you are the foundation for your family and for the worldview that you're creating for your child and, and their sense of self and self-worth. So, you know no big deal. It's not, it's not like you have to figure it all out from the very beginning.

[00:54:54] It will unfold. What you do need to figure out is, is creating community and creating a baseline that actually meets you where you're at and points out those skills and those elements of resiliency that you've created for yourself, have that validated and affirmed cuz nobody else is gonna affirm our permit for you in the, in the broad culture.

[00:55:14] Josie: Yes, yeah. Yeah, that's such a good answer. I love that. And besides buying your book, which I'm sure everyone will be doing after this episode, what else can queer, trans folks do to set themselves up for a successful conception journey? Is there anything left that we haven't talked about? 

[00:55:33] Liam: I don't, I don't know if this is the ultimate answer, but I'll tell you the answer that popped into my head. Which is get some support around your relationship. Your primary relationship that you're, that you're bringing this parenting dynamic into. And the same goes for solo parents by choice. Because that is, you are in primary relationship to yourself as a solo parent. And if you're in a couple or a poly family or even if you're just co-parenting with another individual, it's actually that relationship that is the foundation for your family.

[00:56:13] So, you know, we take our bodies in for prenatal care, take your relationship in for some relationship care. It's a excellent time to be in therapy if you are in a couple, or a partnership of some form, regardless of how many people are in it, establishe care with a therapist.

[00:56:33] And it also means that, or what that also entails is pregnancy is not just a physical experience. Which means that we don't just need care providers who care for the physical body, we need care providers who are caring for our mental health. And that goes for non-gestational parents as well.

[00:56:53] And when you're a solo parent, having a mental healthcare provider who really understands perinatal mental health, really understands the transition to parenthood and who can hold space for a person who's doing it on their own, while at the same time helping that person navigate what it is to ask for help in a culture that tells us, oh, you're not supposed to be able to do this on your own. 

[00:57:21] It doesn't mean that you have to then not accept help from anyone, it's that, no, you need help just as much as anybody who has one or more co-parents like we all need our village when we become parents and solo parents are no exception. The answer is, have some care for your mental health and for your relationship with yourself and with your co-parents. Going through this would would be my advice. 

[00:57:46] Josie: Oh my gosh, yes. That's an incredible answer to that, yeah. Last question. Something that I love to ask all my guests is, in Chinese medicine, our fertility is referred to as our essence.

[00:57:58] So the more we're able to get in touch with who we really are, or our essence, or what I call the Whole Self, the more access we have to our fertile potential and creative power. Do you have any personal practices or rituals in place that allow you to connect with your essence or your whole self?

[00:58:15] Liam: I will say that as a very young parent, I got pregnant when I was 21. I had a baby at 22. Even before coming out, I didn't have a lot of family support. And what I really felt like was you could open a book of parenting advice to find any answer you wanna find. And really it's about your gut feeling.

[00:58:41] And so I've always used my gut to guide my decisions around my parenting. You know, it's easy to get lost in your brain. But if you tap into that innate, embodied wisdom, that's always that it's, it's never gonna lead you wrong. Never gonna leave you astray. Because there's all these other opinions out there about like, what's gonna be right for you and what you know about yourself.

[00:59:05] And ultimately once you have a baby, what's gonna be right for your baby? Cause nobody knows your baby as well as you do. As I have gone into midwifery practice and I am now, you know, midwifing people over Zoom and across state lines and international boundaries, I find that as long as I am tuning into that embodied wisdom, not only about what I feel is right for the communities that I'm serving, but also what's right for me as an individual and what really can I take on and do well.

[00:59:42] And what am I energetically tapped into and staying connected with that is something that has, that consistently proves to be like, there is an energetic loop. If I have an aspect of my practice that I'm not paying attention to, it doesn't flourish. And as soon as I blow a little bit of energy into it, pretty soon here comes the, you know, people are scheduling or people are buying things from the web store.

[01:00:09] Like it really is an energetic exchange. And currently, I've put out this new platform for my program. Same programs I've always run, but it's on this new platform and I can't feel it. I've lost the pulse because I have other people putting that together for me. I'm showing up to do the groups, but I don't totally understand how this new platform works.

[01:00:35] So I'm currently like in this, this vulnerable, like I don't quite know how to drive this part. I know how to drive the car, but I know how to drive this car, and so I'm not totally in touch and so, like, my next to-do is to really get in and, and figure out that platform simply for the energetic loop to be coming back through. 

[01:01:00] Because it is a container and I'm holding that container. So if I don't have that embodied in me and I don't have the energy flowing where I'm really tapped into it, then it's not gonna land where I want it to land. And I think that that's, you know, the other thing that I will say about midwifery is obviously every midwife approaches their practice differently, but there is this term of spiritual midwifery that can, mean a lot of different things to a lot of different people.

[01:01:29] And the book, Spiritual Midwifery, we all, all now know Ina May is a homophobe, or transphobe, maybe a homophobe too, I don't know. But that there, there is potential. Within the field of midwifery to utilize that sort of energetic framework that we're trying to get our, that we're trying to also then be able to model and convey to parents to do that.

[01:01:54] And so not all midwives carry that perspective and carry that through their work. And sometimes it just has to do with, you know, healthcare contexts and what we have to navigate as providers. But it is part of the advantage of having some selection in the midwife that you choose and, understanding that there are different types of midwives and as we're all individuals, we're all gonna approach it differently, so, right.

[01:02:20] Yeah. You need to find a provider that's appropriate for you. Really think about what you're wanting out of your midwifery care and keep shopping around until you find it. 

[01:02:29] Josie: Yeah, totally. Ugh, Liam, I am just overflowing right now with gratitude and I've just learned so much from this conversation. I am in awe of everything you've done and everything you continue to do. It's just incredible. So thank you so much for being here today. 

[01:02:46] Liam: Thank you so much. I, I have found that, that putting this book out in the world, it really has, has hit home that this is a love offering. That I have this knowledge and I wanted to put it out in the world.

[01:02:57] And so, you know, comments like you just shared that appreciation is, is also landing really, really deeply right in here. And you know, I feel like, okay the need is being met and I can rest in that. So thank you and thanks so much for having me on your podcast.

[01:03:18] Excited to hear it and to have it reach more folks. 

[01:03:23] Josie: Absolutely.

[01:03:27] Y'all, I'm so excited to let you know that fertile registration is open. Fertile is a queer, trans, and non-binary centered five week online program for folks with wombs to reclaim power over their fertility journey and conceive using my Whole Self Fertility Method. Healthcare practitioners and community workers, you are welcome to join us and become certified in the Whole Self Fertility Method. 

[01:03:53] Head over to intersectionalfertility.com/fertile to check out all the program details and register now. Sliding Scale is available for all, and scholarships are available for Black, Indigenous, and People of the Global Majority. Join us, it's gonna be so much fun. I'll see you there. 

[01:04:13] Thanks for listening to the Intersectional Fertility Podcast. To get customized fertility recommendations based on your Whole Self Fertility Method element, join my mailing list at intersectionalfertility.com and get immediate access to my two minute quiz. If you like the show and want to hear more, tap subscribe on your favorite podcast platform, and please leave us a review. It really truly helps. 

[01:04:39] The Intersectional Fertility Podcast is hosted by me, Josie Rodriguez-Bouchier, and produced by Rozarie Productions with original music by Jen Korte.

All content offered through The Intersectional Fertility Podcast is created for informational purposes only, it is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.