Episode 56 - Sara Ceiba Flores: A Radically Expansive Approach to Queer and Trans Family Building

Today we're bringing back this highly enjoyed episode featuring Sara Ceiba Flores. Sara is a queer, multi-gendered, Two-Spirit human, Registered Nurse, Certified Nurse Midwife, and Nurse Practitioner. They have an immense amount of experience in the world of birth, learning from multiple sources and from experience.

In this episode, Sara and Josie discuss the term "queerception" and its origins, as well as the impacts of the biomedical industrial complex on queer, trans, and non-binary folks who wish to conceive. They also discuss ways to protect and cultivate joy and pleasure throughout the conception process and beyond. Along with exploring the deeper aspects of the topic, Sara offers practical advice for those seeking to conceive.

[ID: A beige background and orange semi-circle. Text reads: The Intersectional Fertility Podcast Episode 56: Sara Ceiba Flores @reclaimmidwifery and Josie Rodriguez-Bouchier @intersectionalfertility.]

Follow Sara on Instagram, and Follow ReClaim Midwifery & Healing Service.

Email them at reclaimhealers@gmail.com. 

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] Hello, friend. I am so excited for you to hear this episode today, and I'm gonna get to that in just a second. But I wanted to check in first and let you know that the Intersectional Fertility merch store is open for Pride month, which is upon us. I can't believe it's almost, that we're in May, and that next month is June.

[00:00:53] It is like blowing my mind how fast this year is going. But I wanted to let you know, because last year I didn't let folks know about the merch store with all these amazing Pride T-shirt designs until the month of Pride, until June, and some of these designs will take a few weeks to get to you. So this year I'm more on top of things and reminding folks to get in there now this month of May, and so that you can have your Pride designs and time for pride next month.

[00:01:26] And of course, we all know that Pride is every month, all year, right? So yeah, if you haven't checked 'em out yet, they're incredible. I've been working with the most talented design team and their studio is called Don't Be Jealous Studio. They are incredible and they've designed all of my graphics and branding and logo and all of the merch in my merch store as well.

[00:01:47] So you can go to my website, intersectionalfertility.com and just click on shop and that will take you to the official merch store and you'll find some incredible designs on all kinds of different, not only t-shirts, but also crop tops and tank tops, hoodies, kiddo t-shirts, all sorts of options there.

[00:02:08] And then lots of colors to choose from as well. These are wonderful t-shirts. They're definitely my favorite in my closet, I wear mine all the time, not just in June. If you get one, let me know what you get. Tag me on Instagram and show me what you ordered or let me know, I would love to see. So I wanted to make sure you knew about that.

[00:02:27] And then, yeah, this episode is the top downloaded episode of the Intersectional Fertility Podcast. This episode is really the most popular episode for a reason. It kind of exemplifies, you know, one of the main reasons I decided to do this podcast, it really is such an incredible episode and resource for queer, trans, non-binary folks who are trying to conceive. Sara is just amazing, an amazing person as you'll see in this interview.

[00:02:59] So, I hope you enjoy today's interview. And just a little fun facts about the podcast that I found out today when I was going through the episodes, I found out that the Intersectional Fertility podcast is downloaded in 58 countries, which I thought was so cool. And we've also reached 15,100 downloads. So that also feels really good, you know, being such a new podcast.

[00:03:23] I think we're about just over two years old now, so, thank you all so much for making that happen and for listening and being such an incredible supporter of the Intersectional Fertility podcast and this work that I'm doing. So I'm just eternally grateful to you and all that you've done to help me do this work, to bring this work into the world.

[00:03:43] So thank you. I hope you enjoy today's episode, and I will talk to you again soon.

[00:03:57] I am so honored to introduce you to my guests today. Sara Ceiba Flores, is a queer, multi-gendered, two-spirit human. They sprout from their ancestral homelands of Honduras, Ireland, and Scotland by way of their birth land, occupied on a Anishinaabe territory today known as Detroit, Michigan. Sara is a midwife and the legacy of healing people, and plants, who preserved and passed on indigenous sacred technology.

[00:04:27] They're also a registered nurse, certified nurse-midwife, and nurse practitioner by way of the cis-heteronormative racist education model that they're determined to disrupt. They serve as a midwife and preceptor at a busy hospital and occupied Huichin in the Bay Area of California. Additionally, they have a midwifery and healing practice for their community, based on barter and trade called, ReCLAIM, which stands for Resisting Colonial Legacy and its Impact on Medicine.

[00:05:01] Through ReCLAIM, Sara provides preconception, fertility, pregnancy post-birth care, IOI counseling and services, limpias, and herbal medicine to their QT BIPOC community. Sara has experienced joy and community accountability as co-author of Freeing Ourselves: A Guide to Health And Self Love for Brown Boys; being a founding member of the Healing Clinic Collective, which provides free traditional healing clinics throughout Huichin; and being a member of the Intergalactic Council of Midwives, a council that enhances the spiritual fortitude of midwives.

[00:05:41] They are a parent, who queer-ceived twice at home via IUI, a home miscarriage-er, a home live-term birther, a homebody, and a homie to some who they love dearly and queerly.

[00:06:04] Sara, thank you so much for being on the podcast today.

[00:06:07] Sara: Hi, thanks for having me.

[00:06:10] Josie: I am so honored to have you here today. I have learned so much from you, and this is just a really special episode for everyone listening. I'm so excited. Okay. So diving right in, will you introduce yourself and share with us your pronouns and where in the world you are visiting us today?

[00:06:31] Sara: Sure. My name is Sara Ceiba Flores and my pronouns are expansive. Today, they/them resonates. I joined from occupied Leisholaloni land in the village of Huichin also called the Bay Area, California.

[00:06:52] Josie: So I really want to dive into your story and your background. Will you share a little bit about what led you to birth work? And how you came to focus on specifically serving the queer, trans, and BIPOC community?

[00:07:05] Sara: Sure. This was a lot of fun for me to think about. I really appreciated the question. I am going to be 44 in a few weeks and I started on my journey of what I would consider reproductive justice work, when I was 16 years old. So I’ve done this work for the majority of my life, more than half of my life.

[00:07:36]  And I really came into what could be called birth work now, but at that time, and in 1993/94, what I was really focused on was body autonomy in what I knew at that time as the feminist lesbian community. I had the privilege and honor of meeting folks at a really influential time in my life as a teenager, who understood the importance of empowerment of our bodies and they happened to identify as lesbians.

[00:08:10] And those women introduced me to Sweet Honey in the Rock. Sounds like you know who they are, and many of your listeners probably know who they are. Powerful, black, dynamic musicians, organizers, activists, some of whom are queer. And I also was introduced to health guides that were written by feminist lesbians.

[00:08:43] And I just thought it was the sexiest most exciting thing to have a speculum in my hand and look inside my own body. And then, I thought, Ooh, I want to help other people get this lit up about our bodies. And in that excitement I came to really find my place also as - never lesbian, that word never stuck, but it was before queer was a term that was in my world.

[00:09:16] So I just went with gay. But I was out, I knew I was gay. And I felt like body autonomy would be the way in which I could express my activism around my queer identity. And pretty quickly thereafter, at age 17, I learned about midwifery, about being a midwife and I learned about midwifery through books in the library. 

[00:09:46] This is pre-access to the internet, folks. I mean, there might be people who had access, I did not. And I saw books with midwives in the books. They were all white cis midwives attending what appeared to be cis-het births. And I thought, Ooh, there's gotta be more to this.

[00:10:13] This looks good, but I bet it would look better if it was really queer. And I've never stopped since. I never stopped. And I became a midwife, an aspiring midwife at that point. And I identify as a midwife, which is an important distinction I think, because I know there's a lot of folks who identify as birth workers, and I really respect that. But, I identify with the term midwife, and I've been doing it now, for all these years.

[00:10:49] Josie: Wow. Amazing. I love that story, especially about Sweet Honey in the Rock. That's so cool. That's awesome. And then there's a word that you taught us. So, how I was able to be introduced to you and your work was through a course that I took by king yaa, who's a birth worker called, Birthing Beyond The Binary, and Sara was one of our teachers. 

[00:11:13] And Sara, you taught us a word, that is your word, called, queerception. Will you explain that word to our listeners and where that came from?

[00:11:25] Sara: Sure. I'd love to even in sharing the little bit of my story that I just shared, I feel like that was the inception of queerception. Because to me, queerception, it's a play on the word conception.

[00:11:43] And conception can be thought of as the beginning of something new. And so, even from the beginning of my journey into reproductive justice work and midwifery, it was queerception from the moment I had an understanding about body autonomy. It was inherently linked with being queer. And I think that has set my path, in and that, I didn't have to then, try to understand body work through a cis-het lens and then try to reintegrate myself as a queer person into it. 

[00:12:24] I always was a queer person, understanding body work, and health and autonomy, through the lens of my queerness and my community who asked for services. So then, as the years progressed I've had the honor to support a lot of folks through fertility work, and through them wanting to imagine ways in which they would either build family or not build family.

[00:12:55] And I found that a lot of the work that I was doing in conversation and consultation was helping people dismantle the cis-het lens of family building and try to find a place in it. And then, I saw that absolutely follow through when there was a pregnancy, and then the journey of pregnancy, and then a birth. 

[00:13:22] The ways in which the many challenges, and obstacles, and traumas, of interfacing with the cis-het norms around birth. It just impacts us every step of the way. So I really wanted to introduce queerception as part of my work, and share it with folks. So that from the moment we're even envisioning, how we would build families, how we wouldn't choose to build families, how we would take care of our bodies, how we would welcome in children, and not welcome in children. 

[00:13:55] We could have a way of knowing that centers our autonomy and our sacredness as queer people, that we were purposefully removed from the web of family building, but that's not the way we were designed to live as humans. We were always an integral part as queer people in family building, pre-colonial times. 

[00:14:24] And so, queerception is this way of knowing, that re-centers our queer experience as the authorities on our lives and our bodies. And I think it also actually has a lot to offer folks who are maybe not queer, around radical expansiveness on thinking about how they could maybe build families or not build families in ways that are not pre-prescribed.

[00:14:55] Josie: Yes. This is something that has hugely profoundly influenced my work was listening to you talk about this concept. And what I loved was you talking about how queer folks were purposely removed. And so, that there's no really need to be “inclusive”. It's not like it's this thing, that's oh, let's be nice and be inclusive for all the queer folks.

[00:15:25] It's no, no, this was actually set up this way, to be exclusive. And not only were queer folks originally a part of this conversation, but they were leading it also. So yes, this was sort of a big aha moment for me, when I heard you talk about this for the first time.

[00:15:52] Sara: That's right. And I would also just add to how we don't need to be inclusive, that I don't want to be invited to that party. I don't want to be added to the cis-het Eurocentric, patriarchal, biomedical, industrial complex ways of thinking about our bodies. Nope, no, thanks. Actually there's a whole ‘nother lens in which we can come to talking about how we would build families.

[00:16:22] An example for me, I have been pregnant twice. And the first time I miscarried and that was a beautiful experience. And then the second time I carried my child to term and gave birth, and my child is healthy and I'm so grateful. And in the journey of fertility, I really brought in queerception to the lens of how I moved forward in conceiving. 

[00:16:52] And I had these visions of my egg - because I have eggs in my body- that my egg was such a high power femme diva, in full drag, which is not my gender identity at all. But my egg was super juicy and just really in the legacy of some of the beautiful queens I've been around, in my life.

[00:17:23] And it was, what does my juicy, queen, diva, high power femme egg need? And listening to that voice, which was usually in some type of acapella, Mariah Carey singing voice – again, not at all how I walk through the world – but so damn queer. And so, so removed from tracking ovulation in this patriarchal linear way.

[00:17:53] Josie: Yes. Oh my gosh. Yes. You just touched on so many things that I want to talk about more. When you said that, I just remembered a dream that I had when I was pregnant with my oldest kiddo. I didn't know her yet, obviously, but I had this dream that she had painted her nails bright red, and she just slid out of my uterus and was just, jazz hands.

[00:18:22] Sara: Yes.

[00:18:23] Josie: Now, knowing her, I'm like yes, that matches. She's a Leo, she's very flamboyant in a lot of ways. So anyway.

[00:18:31] Sara: I love that. So cool. 

[00:18:34] Josie: So one of the things I wanted to talk about was something that you just mentioned, was the biomedical industrial complex.

[00:18:41] This is something that I wrestle with a lot in my work and in my life personal life. And I'm just wondering what your thoughts are on that, and how your background, or even your ancestry, or gender has influenced your work around dismantling the biomedical industrial complex, and all the harm that it's caused and is causing? If at all. If those things have influenced that work at all.

[00:19:07] Sara: Yes. Yes they have. And I appreciate the framing of the question because I wouldn't really even be able to comment on the biomedical industrial complex, and my relationship to it, without talking about my ancestry. So I am a mixed person.

[00:19:25] My father is Mayan from Honduras, from Central America. And I'm first-generation on his side. And on my mother's side I'm third generation here on Turtle Island. She is from Irish, Scots, and German ancestry. So in my essence, I carry the ancestry of the peoples who have resisted colonization, and the colonizer.

[00:20:02] And I'm also a mixed person in terms of my gender identity. I identify as multi-gender, and I identify as someone who isn't on the binary. And I also have mixed training and education around my midwifery. So I'm a lifelong student and lifelong learner of traditional midwifery practices that come through my ancestral Mayan lineage.

[00:20:35] And I'm a lifelong learner of plant medicine and traditional plant healing. And I also carry degrees from Western Medical Education. I'm a registered nurse under Registered Nurse Practitioner, and I'm a Registered Certified Nurse Midwife. So everything about me is an alchemy of bringing together multiple threads and braiding them into my lived experience.

[00:21:12] So my relationship with the biomedical industrial complex also is this mixed relationship. And as a midwife, I practice as a home birth midwife, as a birth center midwife, and as a hospital midwife. So I also have these different practice settings in which sometimes, I'm working very much outside of the biomedical industrial complex, and other times I'm working very much inside.

[00:21:42] Even when I'm inside, my daily mantra is, I am in this place, but I am not of this place. And, still, I am in that place at times. So I feel like my relationship with the biomedical industrial complex is almost less focused on a dismantling, although, I do resonate with that word, but more about coming into right relationship with folks having access to all modalities of healing, at whatever time in their lives they need access.

[00:22:24] Josie: I can relate so much to everything that you just said. I also am a mixed person, with my ancestry, and I also have mixed training as well. And I also practice in different scenarios where I'm in it, but not of it. For sure. So yes, that really resonates. I also wanted to talk about, also dive into just some really specific, helpful info for folks who are queer and trying to conceive. Queer, trans or non-binary.

[00:22:59] So will you walk us through some different options that are available for queer, trans and non-binary folks to conceive? And also specifically, like what the differences are between fresh and frozen sperm, and things like that?

[00:23:15] Sara: Sure. Well just also you bringing back the concept of queerception to this question, the options are limitless, as limitless as we are. There's so many different ways to form family and there's so many different constellations. And sometimes something starts off seeming like the way that it's going to go and then there's a transition point, and then there's an expansiveness, and then maybe something leads to something else.

[00:23:47] So I wouldn't say anything that I'm sharing is advice for a person to start at this point, and think it's going to lead to point B and then point C. I would really visualize it more as a spiral, or in my tradition of Mexica ancestry of the atecocolli, the conch shell that spirals in. And so, I really think that's an important framing because it is the linear Western colonial patriarchal legacy that makes us think we're supposed to march along in a particular way to create family.

[00:24:31] Josie: Totally. 

[00:24:33] Sara: And what are you going to do? On one level, you just have to start somewhere. So, an egg is needed from a body and sperm is needed from another body. And I think folks identifying where those, whose bodies are those, and where that egg and that sperm are going to come from, are actually really important pieces.

[00:25:01] And identifying, maybe, is that going to mean somebody who somebody knows. Asking a friend, a relative for eggs or asking a friend or relative, community member for sperm. Or using your own. So those are the options. You either ask somebody or you use your own. And when you ask somebody that can also be through purchase, through a sperm bank, or through working with a surrogate who has eggs.

[00:25:35] And just demystifying that alone, I think is a really important initial step. And also, asking oneself, even if the person has the egg or sperm, would they want to use their own? There's not a reason you have to do it any one way. That's the beauty of queerception. So when it's figured out, where are these elements going to come from, at least has a starting place. Again, it might change. Then I think what I hear people ask a lot is, how are you going to get those two things together?

[00:26:15] How are the egg and the sperm going to meet? And I have the true privilege of having seen people do so many different things. It really has blown my mind. And one example that I just want to share, about how I've seen people really vary how the sperm and the egg meet. Is that we understand that there's a need for a warm environment for the egg to become fertilized and then grow. Which many people call the womb, or the uterus, or the baby holder.

[00:26:51] There's lots of different words. But I don't think that that has to mean that that person who's carrying a baby growing in their body, has to even identify with being pregnant. I think that that is an important piece of just understanding that, that might just be where a baby grows inside of a person's body. And that's where the baby's growing.

[00:27:14] But it doesn't have to just mean that that person wants to get pregnant, or identifies as pregnant. And so, that piece is really been a gift to me, by working with trans men, who are really ready to be dads, can't wait to be dads, and happen to have a place for a baby to grow inside of their body. But don't identify as pregnant people at all.

[00:27:42] And then the sperm, which I often will think of as swimmers, because that's a real important role of sperm, is to swim. You asked what's the difference between the different ways of getting sperm into a body, and how does that work? Well, I also have a very queer vision of these super non-binary gender expansive swimmers.

[00:28:12] This is just how I think of it and how I think I was able to receive sperm into my body. They really have a role of cooperation with one another. They really need to work together, and they have a long journey. And so, they usually would have packed snacks on their way. They have a backpack full of sugar, glucose.

[00:28:38] They have a backpack full of protein bars. They have all these snacks, which is seminal fluid, it's like the liquid that they're in. And it's one way to conceive, to just have sperm in their liquid, with all their snacks, put inside of another person's body. Either with direct deposit, through one person's body, directly into the other person's body. Or through somebody putting those sperm into a cup with the seminal fluid. 

[00:29:10] So, the swimmers into a cup and then using a needleless syringe with that into another person's body to swim inside. Or the swimmers can go inside of a cup, a diva cup, you can buy online, or there's cervical caps for this purpose. They can go inside this little cup, and then the cup can be put into the person's body. 

[00:29:34] There's strap ons that have internal needleless syringes that the swimmers can go in and then you can push a little plunger, and then they shoot out the end of the strap. And they can go into another person's body that way. And I bet there are things I've never even heard of, that are another way. But that's how you get the swimmers into somebody's body with all their snacks packed, and ready to roll. 

[00:30:05] And they'll live for a couple of days that way, usually. Another way that people conceive is to take the seminal fluid, the liquid away from the sperm. And that's done with a process of washing the sperm in something called a centrifuge. Where it spins really fast and it separates the liquid from this sperm, and that can also be done at home. 

[00:30:29] Everything I already said could be done at home. But it can be done at home with just a little bit of understanding about safety. It does take a special type of syringe that needs to be sterile, and it requires a speculum to see the cervix, usually. And then, those sperm can be put directly into the area that folks may call womb, uterus, baby holder, other words, that muscle.

[00:31:03] And when that happens, those sperm only live for a shorter period of time, like 12 hours maybe. And that is what people refer to as intrauterine insemination. That's how I conceived, personally. And then, I know I'm speaking quickly and giving generalizations, but then, just the other way that sperm and egg would meet would be with IVF, In Vitro Fertilization, which I think, you know, a lot about. 

[00:31:35] And then the sperm and the egg are introduced to each other outside of the body and then placed into the body already in their process of fertilization. So, I use the language I'm using intentionally, which is not meant to strip the humanness from it, or strip away the emotion, or the spiritual pieces of it.

[00:32:00] But, I hope my message is to demystify the fact that it's not about gender, it's not about our sexual identity, our gender identity, about how we plan to parents on the other side, who will be called dad, mom, baba, whatever terms that we're going to be used. It's about really taking away the fact that most of us were taught this through a completely cishet model. And I really want us to just strip that language away.

[00:32:35] Josie: I love it. I love that. It feels so relaxing to hear you talk about it, because there's no triggers. For me, that's how it feels. And I also loved what you said about someone, because pregnancy is such an identity, isn't it? And so, I never thought about that before, how it could really try to eclipse someone else's identity of who they are, but can really try to encroach upon that.

[00:33:08] Yes, that makes a lot of sense. And then also, I was just thinking too, to kind of clarify, to the first part that you talked about when the swimmers have their snacks, that's fresh sperm right?

[00:33:19] Sara: Yes. Thank you. 

[00:33:21] Josie: And then, when they don't have their snacks, when they go through the centrifuge, then that's washed sperm? Is that right?

[00:33:29] Sara: Correct.

[00:33:30] Josie: Okay, cool. And then one of those can be frozen?

[00:33:35] Sara:  They can both be frozen.

[00:33:37] Josie: Oh, they can both be frozen. Yes, totally. Okay. I just wanted to clarify on that. Because, like you said, that's a question I get asked all the time, is where to start? And people always want to, I think, very understandably want a linear sort of roadmap of, where do I begin, and how do I get to that point B?

[00:33:59] Sara: And I do, I get it, but also, I really hold this piece because I'm a midwife, this is my belief system, from what I have witnessed over 25 years of seeing the journey of pregnancy, I think it is a disservice to folks to falsely introduce a linear narrative during the conception time, that will not be present during the pregnancy time, and the parenting time.

[00:34:32] It's not going to be there once a baby's forming in first trimester, and hormones are taking over. And fast forward to a labor and a birth, which is not linear, then a baby's sleep cycle, which is not linear, then chest feeding, breastfeeding, bottle feeding all the different things. And, because we have an opportunity to be intentional with our parenting often, not always, but we often have the opportunities as queer people to be intentional.

[00:35:06] We are falsely falling into this idea that intentional equals linear. And then my clients, my queer clients, my trans clients, they really often are falsely set up then. For the pregnancy to also follow the way that they thought their app about their ovulation, was supposed to keep going. And it's because already the Kool-Aid was drank about a cishet model during the conception.

[00:35:41] And so, then when you come out on the other end, you have your baby and people are saying homophobic ass shit to you like, who's the real mom? Or all this stuff, you're so thrown off because in the beginning you're like oh, I thought we were going to be just like everybody else.

[00:36:00] We got pregnant just like everybody else. Actually, no, we're not just like everybody else and that's our gift. That's our strength. That's sacred, that's beautiful. And so, we don't have to conceive in a cishet linear model either.

[00:36:10] Josie: Yes, I love that. The fact that many times queer folks do have that opportunity to be so intentional. And yes, the conception process is so different, or can be different in a good way.

[00:36:27] Yeah, I love that. And that reminds me too of, so I treat a lot of my patients in the beginning part, when they're trying to conceive, and then also throughout their pregnancy, and then sometimes I treat them postpartum as well. And I also use that opportunity to say, okay, let's talk about boundaries now, while you're in the conception process, because that's going to come up over and over and over again with all sorts of things.

[00:36:58] But as a parent and having good boundaries, and especially around other people's thoughts and feelings about how you should be parenting and all of that. So I love that metaphor of just starting now, with the fertility process of just using that as a smaller version of what's to come.

[00:37:21] Sara: That's right. 

[00:37:22] Josie: Yeah. 

[00:37:22] Sara: And we might talk about this, in future questions that you may have, but I feel like I want to just mention right now. That one of the pieces that I think makes us get more in our frontal lobe, more intellectual, more forward-facing with our journey with fertility is that sex is often removed from the conversation of how we conceive as queer folks.

[00:37:49] And I'm all about bringing the sex back to the conversation, if that's what's resonant for folks. There's lots of people who, that's not going to be their journey and I respect that. And I don't even mean it has to be sex with somebody else. But either finding that pleasure in one's body, finding that pleasure with somebody else.

[00:38:13] When I conceived with intrauterine insemination, it was my partner in the room, myself, and my midwife, all in my bedroom. I didn't really feel that sexy with my midwife, even though my midwife was also queer. My midwife's a good friend, but, it did kind of take the mood away a little bit. But I had figured out already, that if I could feel sexy in myself, I could feel juicy.

[00:38:40] I could have sex. I could orgasm before my midwife got there, and be all in that energy of what I was calling in from my sacred body. Not for my child, because I wasn't conflating that sexiness with the conceiving piece. That's also a beautiful part of being queer, is you can pull those pieces apart if you want.

[00:39:07] But as a way of grounding myself in my body, and taking myself out of my frontal lobe, and releasing some oxytocin and the hormones that help with conception, I just really feel like we have to talk about that more, and make more space for people to have whatever would make them feel centered in their body. And help them not only be on spreadsheets and apps and OPK tests. And all that's important, but it's not actually the only important thing.

[00:39:35] Josie: thing.

[00:39:36] Yes. Yes. Oh my gosh this is something that all my patients struggle with is, de-medicalizing the process of conceiving. Because it becomes a whole other form of stress that we have to address, is the actual process of conceiving. Yes, I do want to dive more into that. But first, I want to just go back a little bit and talk about some of the more specific stuff.

[00:40:09] And then, I want to go back to that pleasure piece of it. So a question I get, or I'm wondering too, if for trans masculine or non-binary folks with wombs, who are on T, what is your advice on how to approach conceiving? Something that I learned from you was that this is a process that shouldn't be rushed, necessarily. Because coming off of gender affirming hormones can be potentially scary or even life-threatening.

[00:40:40]  So, if you could talk a little bit about that, what would you advise folks?

[00:40:47] Sara: Sure. Well, I want to say first, that I am not a person who is transgender. I don't have a lived experience of being trans. And I therefore, also acknowledge that while I did share what I shared with you, I didn't come up with that.

[00:41:08] I learned from trans men, specifically, and I listened to trans men tell me what was going on for them, during their pregnancy. So, all credit and honor goes to them. And I am humbled and grateful to be able to continue to witness, specifically, some of my very closest friends, but definitely even clients, who have shared a lot of their more vulnerable experiences with me.

[00:41:41] And I would say for folks who are listening, who might be birth workers, or acupuncturists, those who provide services for folks who are wanting to conceive, the first advice I would give is listen to the folks you're caring for, because they are going to say what they need. And then, we are in service of that.

[00:42:05] So people who have hormones that they choose to take outside of their body, because they affirm their gender identity, who need to take those hormones to survive, who want to take those hormones, they are the authority on their hormones and they know what they need. And what I've heard time and again, is that it does actually need to be acknowledged as a potentially life-threatening situation to decrease gender affirming hormones in order to conceive.

[00:42:39] Or in order to produce eggs to freeze for later, or in order to produce sperm to freeze for later, or to donate. So, just content warning for everybody listening. And for us, I do need to talk about genocide. And I do need to say that there is intentional genocide that has tried to stop transgender people from living. Especially Black trans women.

[00:43:22] And there's intentional genocide that is ongoing, to try to create obstacles for trans people to be in their autonomy around their bodies. So changing gender-affirming hormones needs to be at the pace of the person who is going to have the lived experience of what it's like to have a change in facial hair, voice changes, curvature of their body, start bleeding again.

[00:43:59] That's a big one, to have blood come again. There's a lot of changes that will come, and so, some folks need to just go real slow with that. And I think building systems of support as part of the conversation. Can somebody go from working outside of the home to working inside the home?

[00:44:22] Can somebody go from needing to commute on public transportation to getting rideshares? Or can crowdsourcing be done to help with financial support for folks? Because, if they literally need to essentially, hibernate for the time in which they need to change their gender-affirming hormones to survive, to live, then, it's those of us who don't have that lived experience, it's our obligation to actually rally in support and leverage the privilege we have.

[00:44:55] And so then, as people might feel comfortable to decrease their hormones little by little, or do it quickly, if that's what they choose. It actually is from what I've observed and been told, the most complicated piece of it is the social aspect. And the internal narrative that then comes up when their body is not in conjunction with how they view themselves.

[00:45:28] And so, that can be really disorienting, and confusing, and triggering, and activating, from past traumas. But on an internal hormonal blood level, it's actually pretty quick to go from taking T, to not taking T, and then having a cycle that involves bleeding and ovulating. Based on the person's age, though, that's what I think is more shocking to folks, than whether or not their body is going to go back to this type of cycle.

[00:46:08] That might not have been a cycle that was affirming to them in the past. If their body doesn't go back to that cycle, I've had a lot of conversations with people who went on T, in their twenties, now they're in their late thirties and they're like wait, what's up? I don't bleed the same way.

[00:46:27] And maybe they're tracking their cycle through ovulation predictor kits and seeing that, maybe they even conceived in their twenties, and it's not happening like that for them in their late thirties. So there's a piece that has to do with age, that I think is a really important part of setting expectations.

[00:46:48] And then, the same thing for folks who may change gender-affirming hormones to ovulate. I'm sorry, I've been talking about ovulation, but to release and be able to give sperm, or have access to sperm, that some of it is about age, although less so when it involves sperm. And then the other piece I would say is when changing gender-affirming hormones, it is also okay to go right back on those hormones.

[00:47:22] I've learned from trans men that I've had the honor of working with, the first time that I worked with an aspiring dad who miscarried, when I checked in with him about his questions, what he was going through, he was like, “oh my God, I'm so glad I gave myself my first dose of T, as soon as I started bleeding.”

[00:47:45] And he was so happy to go back on his T. And that piece, I think is an important part of holding space for it. Whether it's from miscarriage or somebody does conceive and they carry a baby and then they give birth. I have been there, the placenta has come out and somebody has given themselves T right there.

[00:48:08] They were ready. And so, having a conversation about it, being safe to go right back on gender-affirming hormones as well.

[00:48:17] Josie: Totally. That's so important. Yes, but that makes a lot of sense. And you started kind of going into this next question that I wanted to ask you too, a question I get asked a lot, that has more to do with the age piece.

[00:48:29] So folks want to know whether or not they should look into freezing their eggs, which as you know, can be super expensive and a pretty invasive process, or if they'll be able to safely and effectively lower or eliminate their gender-affirming hormones later to conceive down the road.

[00:48:49] Or if you have an opinion on that, what would be better? Because I know age does play a part in, like you said, especially with the eggs as opposed to the swimmers.

[00:49:00] Sara: Yes. Well the truth is, yes. There's just pieces to this that are, I think kind of set a little bit just in our ways of being in our bodies. Which I'm hesitant to even use the word biology, but there's just some scenarios that I don't know work arounds for, that our eggs begin to age.

[00:49:25] And so my simple answer to the question is yes, if there is a way and if it's speaking to a person to try to look into ways to actually save their eggs for the future. Yes. By all means let's put the queerception framework on it. Let's not just immediately say, oh, but it's going to be too expensive, and it's going to be too invasive.

[00:49:56] Let's just look into it. Let's just look at our options. Let's just think about what might be out there for us. Let's demand some shit from the biomedical industrial complex to make it more accessible. So, let's keep that as a yes, if it is a full body enthusiastic yes, from the person who's asking the question. And let's hold space for the reality that it may not be accessible. They may look into it and they'll be like, oh, I don't want to do all that.

[00:50:24] That's not what I had in mind. So, okay. Then does that mean, maybe we want to set some sort of a flexible working timeline of then a year from now, two years from now? Is that the time to lower hormones? Because also, a conception journey, it would be really normal if it took six months to 12 months to conceive.

[00:50:49] So I really just try to talk to people about all the options. I wouldn't want to say no, don't even look into that. Because I have met a few people through various creative funding opportunities, and through something that came up for one person once with their insurance, because of some other health issues, that they were able to save and store their eggs. 

[00:51:13] And if that's not going to happen, let's have a frank conversation about a timeline. And also a frank conversation about how far somebody would want to go on the journey of fertility. And spend some time maybe thinking about, if somebody wants to do fresh home insemination. Do they want to try that for three to six months, then IUI if they don't conceive with that first step. 

[00:51:39] Intrauterine insemination for three to six months, while also doing herbs, while also going to acupuncture as well. Also, doing everything else that resonates with them. Then, do they want to have a timeline for three to six months for IVF?

[00:51:58] Then do they want to have a timeline for adoption, fostering? I really try to have people be as expansive with their thinking about the journey from the beginning, so that it's not a giant curve ball when you realize, oh, wow here I am, 38 years old, not ovulating, like I thought. Or money's running out or time is running out.

[00:52:25] Josie: I love that. I love the expansiveness of that way of thinking. And again, that's the gift of queerception, is thinking about it in a more expansive way. I love that. Okay. Let's see. I want to switch gears a little bit and talk about joy and pleasure, to wrap up. 

[00:52:45] So, when you talk about, and we kind of already went here. But if there's something else you wanted to say, or if you have any stories, or anything that you want to share about ways that folks can more actively or more intentionally bring joy and pleasure back into the experience of conceiving. If you have anything more to share there? And if not, no worries. We can also just go on to the next question.

[00:53:10] Sara: Well I guess I'll share a story because it taught me a lot in my early days of doing in-home insemination services. I was working with a couple who both had eggs in their bodies, and had used the sperm bank to buy a frozen, washed sperm.

[00:53:34] And we were in their bedroom and the person who was planning to carry was laying in the bed. And then, the partner was really interested in my role. How was I getting the sperm inside of the catheter? And what's a speculum? And what are you going to do with all that?

[00:53:57] And great, I was really excited that they were excited about it. So I pretty much checked in with the couple, and was okay, how about, I'm just like a fly on the wall? I'll show you how to do everything, but I'm just here, if you need me. And they were really excited about that. So we did a practice run, actually just with water inside of the catheter, not injected into the other person's body. But to just make sure that the partner knew how to draw it up.

[00:54:28] Because just a real side piece, in case folks are wondering, sperm from the sperm bank frozen, it's going to cost you $700 to $800. So you don't want to just go playing around and just spill it. So, they were feeling comfortable and they approached the partner, a little kissing happened, a little I love you, calling to the baby. And they got ready to do the insemination.

[00:54:55] And, for those of us who either place IUD or do inseminations, we know that there's a feel when the long catheter hits the very top of the uterus, or the womb, or the baby carrier place. It's a very gentle feeling. But we know we're right at the top. It's like a feedback in our hands.

[00:55:18] Which, another aside, I would say is the beauty of being a queer midwife. My hands have done so many things. My ability to know what my fingers feel like, what I've learned from fisting. For real, like my hands really have skills that when I try to teach straight midwives and cis midwives, I'm like, oh, you don't know what I'm talking about, because you never did that before.

[00:55:49] Josie: Totally. Wow, fascinating. Yeah, that makes sense.

[00:55:52] Sara: That's an aside. But so, the partner must have come up against this place, because I see them pushing a little bit on the syringe and it's not going easily. So I come over quickly, and I'm okay, hold on, pause. Let's see what's going on.

[00:56:07] And we both put our faces very close to this person's what they call, the vagina. And we're looking at the syringe and making sure we're getting it right. And the partner just got excited and just was too excited to wait even one more second for me to adjust. And they push in the plunger that has the sperm, but there's too much pressure.

[00:56:34] And so, the plunger, the syringe comes detach from the longer syringe, and we both get a face full of sperm. It just totally ejaculated in our face. My eyelashes were stuck together, because we were right there. This is pre-COVID. There's no mask. And we were all shocked. And then, the partner just said, whoa, I'm so sorry.

[00:57:07] And I said, “yes, that hasn't happened to me since my twenties. It's been a long time since I've had a face full of jizz. But that's kind of fun, I'm going to ask my partner to do something like that when I get home. I'm kind of missing that.” And we just all started cracking up. So I just offer that because, in those days it was early in my practice, and I was a little tense. I was a little nervous about, because, also, side note, it’s not like this is regulated by the state.

[00:57:41] So many of us doing this we're just working it out on our own, and figuring out how to do this. Nobody taught me how to do this in midwifery school because this is totally left out of education. So that just broke the ice. And I carry that story with me until now, about laughing at our mistakes, keeping it queer. And letting it be a place in which we allow for human error and the human experience in all of that.

[00:58:11] Josie: Totally. And what I love so much about that story is it's not only bringing more joy and pleasure to the experience, but humor. Which is also important to bring back into that experience. Because, like you said, there's so many unknowns, and curve balls, and things that can go wonky. And if you can't laugh about it, that's problematic as well.

[00:58:34] Sara: That’s right. 

[00:58:35] Josie: Yeah, I love that. I love that story. Oh good. I was so hoping that you were going to share that story, so thank you.

[00:58:45] Sara: You're welcome.

[00:58:47] Josie: Okay. So my last question for you is I'm wondering if you have any practices or rituals in place to bring joy and pleasure back into your life? I feel that this is so important for us as queer, and gender expansive folks, and especially people of color.

[00:59:03] Because along with our struggles and hardships comes, for me, at least this ecstatic experience of being queer and living in my truth. So, I feel we need to protect that, that joy and pleasure and insist on it. Not only during conception, but always. And I would just love to hear your thoughts on that.

[00:59:21] Sara: Yes. Thanks for asking. I did a little thinking before this conversation and actually my list was long. Oh, I was like, oh, I have so many things, putting the clippers to my head and feeling the buzz of shaving my head, is pleasure for me. Playing with my child is pleasure for me. Sleeping.

[00:59:40] But what I've really wanted to offer you and your listeners was something that came to me from you asking me to be in this conversation with you. What I have done is a somatic practice in which, I call it a full body scan. Where I check in, in a full embodied way from head to toe. It might take a couple of days, which is often why I don't get back to emails quickly.

[01:00:09] I'm sure folks who know me know it takes me a minute. But I'm doing a full body scan and looking for my enthusiastic yes. And also, being really open to my enthusiastic no. And I found an enthusiastic yes about being in conversation with you. And that brings me pleasure to have accessed the somatic teachings of my body. To actually know where I can give energy, where I need to hold back, where I can give less, where I need to have concrete conversations about boundaries. That brings me great pleasure and joy.

[01:00:54] Josie: Mmm, I love that. And I think that's such an important practice, for so many reasons. That comes up all the time in my practice of checking in with your body. Yes for enthusiastic yeses. Enthusiastic nos. I love that. Thank you. Well, thank you so much for being here today.

[01:01:15] This was just such an honor to have you, this was such a great conversation. I know my listeners are going to learn and gain so much value from this episode. Where can folks find you and support you, learn more about you?

[01:01:31] Sara: Thanks for asking. I am slowly coming out of hibernation with my personal, private practice, which is called, ReCLAIM.

[01:01:41] ReCLAIM stands for Resisting Colonial Legacy and its Impact on Medicine. And that is my midwifery practice. And you can find me on Instagram @reclaimmidwife, but you'll notice it's not a very active account and that's okay. I will totally respond if you send me a message. But that's part of my somatic practice of full body scan, is that I let my practice go a little more into hibernation, as I am more focused on being a hospital-based midwife right now.

[01:02:13] But now, I feel like there's reason to give a little more nourishment to ReCLAIM, and you all are part of that. And you're helping feed me. So thank you for that. And I'm happy to be in community.

[01:02:26] Josie: I'll put all of that, everything you just mentioned in the show notes. Thank you so much.

[01:02:32] Sara:  Thank you.

[01:02:37] Josie: 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. 

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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.