P4P Supporting Gender Diversity in Pregnancy
[00:00:00] Dr. Alicia Power: It's Dr. Alicia here. I'm very excited for today's podcast. We talk to Trystan Reese who is sharing his story about his trans pregnancy, but also more around the medical side of testosterone and fertility. He also shares some tips and tricks for us as care providers to create a more inclusive space for all people but especially those who identify as being gender diverse. Really excited to get into this and we'll start the podcast right after this quick reminder.
[00:01:18] Dr. Alicia Power: Tristan, thank you so much for joining us on the podcast today. I am really excited to learn from you. I am on a journey of, I don't know, humanity in medicine, whether that's cultural, becoming more culturally aware, more trauma informed, and also learning more about how we can support people, whomever they identify as especially in pregnancy, because it's such a vulnerable time at the best of times, and let alone, if you're having any kind of challenges, societal, mental challenges, physical challenge, it just adds to the picture. So I'm really excited for our conversation today. I'm very excited to hear your speak at our upcoming Perinatal Health Summit on November 4th. So if anybody has listened to this and hasn't signed up, make sure to sign up for that. And why don't [00:02:00] we just start by you introducing yourself and telling our audience a little bit about who you are and why you do the work that you do.
[00:02:06] Trystan Reese: Of course. I'm Tristan Reese. I use he/him pronouns. I'm joining you from Portland, Oregon in Canada's, I don't know, meaner, older brother, America down here. I don't know what the right analogy is, but that feels right today. And yeah, I run Trans Fertility Co, which is an online resource for trans, non-binary, gender non-conforming community members to help us understand what's possible with our bodies. Yeah, and I'm a gestational parent myself, although my baby is now six and he keeps telling me I'm not your baby anymore. Which is like...
[00:02:40] Dr. Alicia Power: You're always the baby. My baby's nine.
[00:02:43] Trystan Reese: I say the same to the 13 year old and she's oh my god. Yeah. And so I do this work because obviously I have the personal experience. I've been a transgender man for 20 years. And I think like you, it sounds like pregnancy is [00:03:00] so unique in that it is so physical, it is medical, it's also emotional and cultural, and for some of us spiritual. So it just sits at so many rich, vibrant intersections that the work is never boring. It's always so exciting. And also, I think the way that we treat people who are pregnant is symbolic of what our culture values. And if I can be a part of helping our culture strengthen its commitment to marginalized people, I definitely want to do that.
[00:03:33] Dr. Alicia Power: I love that. How we treat pregnant people. It's a kind of representation of what our societal culture is. I love that. Wonderful. You are willing to share your story with us, which I think is such a blessing. So why don't you tell us a little bit about your story with your six year old baby. They grew up so fast. It's incredible.
[00:03:51] Trystan Reese: I just embarrassed myself. I was at the coffee shop yesterday with, and there was a lady there with a tiny baby and I felt myself say, [00:04:00] enjoy every moment. It goes so fast, which is so trite, but it is also true.
[00:04:05] Dr. Alicia Power: So true. Yeah. What is it? The days. What is it?
[00:04:09] Trystan Reese: The days are long...
[00:04:10] Dr. Alicia Power: the years fly by or whatever.
[00:04:13] Trystan Reese: Yeah. Yeah. Absolutely. Yeah, Leo began really as a dream, an actual dream I had at the nighttime, not a daydream or a fantasy, but I never wanted children. I certainly never as a transgender man, actually before I even knew I was transgender, I never wanted kids of any kind. And I certainly never wanted to be pregnant. But when I was 25, I met the person, the man that I would later go on to marry, and maybe after our first date, I started to have dreams about a baby, which, the rational part of me is like, that's just the ancestral chemicals, that are like, procreate, save the human race, but it didn't feel like that at the time, it felt like, oh my gosh, there is a [00:05:00] possibility of creating new life, with someone else.
[00:05:04] And as a transgender man in my community, it's not uncommon for this to happen. So it happens mostly outside of the awareness, I think, of more, people who are not in our community, but transgender men have been happily having babies for, now almost 23 years. Most people do that, again, a little bit more quietly, but there's even data dating back now about 10 years. There's medical studies, research on transgender pregnancy that, that finds that, testosterone does impact ovulation while you're taking it, but once you stop, much like any kind of other hormonal birth control, ovulation should and typically resumes, at which point there doesn't seem to be long term deleterious effects on the uterus, egg quality, quantity, labor pregnancy experiences, labor outcomes, postpartum experiences. Postpartum's a little sketchier, we just don't have enough data, that's one of the like, [00:06:00] one of my top three things that I'm pushing for more info on.
[00:06:05] But yeah, so I, I did some. research after I had some dreams. Of course, I didn't tell my partner because it is very weird after one or two dates to say, Hey, I had a dream we had a baby. So I, I had the presence of mind not to share that with him, but on my own, and I actually remember sending my dad an email because my father was a physician for many years. I said, dad, I have had friends who've had babies. Yes. I'm curious about what the options are for me. Can you send me any studies you can find? And he went into some academic literature and sent me what he had but then that project got put on hold because my partner and I became parents in a totally different way, which was we took in his niece and nephew, his sister's kids needed a place to stay.
[00:06:52] So we became parents overnight to a very traumatized one year old and three year old. And we were just [00:07:00] supporting them for a couple of years. And then as that settled down, the dreams came back and I finally had to have the conversation with my partner. And that was, that kicked off the journey of pregnancy, miscarriage, pregnancy again, live birth. That became my delightful child who is now six and not a baby.
[00:07:19] Dr. Alicia Power: Lovely, lovely. And I love that. You really went into the research a little bit to understand what your options were, because I think, I know, so I have a few colleagues, friends who I work with who are gynecologists, and they often get referrals for for trans men around kind of surgical options, and I don't know that there's a lot of, there's probably a lot of information out there, and you probably know all the information, but like anything for many of my 40 year old female patients, they don't know about perimenopause, which is like, everybody knows about perimenopause is my assumption, right? Because I'm so entrenched in that, right? But for people who aren't, or for people who haven't done those deep dives, [00:08:00] there's so many different options based on what your goals are, right? Whether it's as a transgender male in fertility, whether it's as a 40 year old in perimenopause, but you need to actually be able to understand what the options are to make an informed choice for yourself, right?
[00:08:14] And if our care providing team is not well versed on that and able to discuss the options, then what do patients, what do clients, what chance do they have at making the right choice for them? So I love that you took that on yourself and educated yourself and obviously you have a great supportive resource with your father, but I feel like you probably would have figured that out in another way, if he wasn't there. So I think that's such an important thing. And so today we were going to talk a little bit about that the transgender, like the transgender kind of care and options and also talk about some tips and tricks for us as providers to support humans, in whatever way feels comfortable for them, because I think a lot of people don't want to, as a [00:09:00] provider, don't want to make mistakes, don't want to make people feel bad, but we're all going to make mistakes. My theory is, do your best not to, and if you do, apologize for it, own up for it, and learn from it. Would love to for you to share your information.
[00:09:12] Trystan Reese: I mean, I often use the Brené Brown quote that our goal is to get it right, not to be right. And I think that's particularly difficult for physicians and other providers because there is a culture of almost the sort of like deification of physicians of Oh, well, you are always right in everything. And I think to do well and get ahead as a physician, you have to have that aura a little bit and that's gendered right. I do anecdotally see that approach a little bit more in male physicians than female physicians. I think that an unfair burden is placed on men in leadership that they should know everything I think they are penalized if they show vulnerability. I think, of course, the unfair burden is [00:10:00] placed on women to prove that they are actual experts at what you know, so there's a burden on both sides, but if we can access that part that is, I'm really excited to support you. I'm really humble about the ways that you may need something unique that I haven't offered other people, then that's going to be great.
[00:10:19] So yeah, excited to talk about it. The first thing that I think about is thinking about the ways that a hormone transition, a hormonally driven transition is going to impact fertility. And I know you work, mostly with pregnancy, prenatal OBGYNs. We're not talking about urologists, right? So we won't talk about transgender women or people who were assigned male at birth, who may have been born with testes whose bodies currently, or in the past have produced semen and sperm. Okay, we won't talk about that, but that's a whole. really fascinating area of medicine. But if someone's going to go on testosterone, it's important to remember that not every transgender person takes [00:11:00] hormones, right? They don't have to, you don't have to take this many hormones to ride the transgender ride. No, we don't have that litmus test. But many do, 80 to 90 percent of transgender people do take hormones, right? And what we know about testosterone, the data tells us, and I always remember this phrase, that testosterone is a dose dependent ovulation suppressant. What my job basically is, is I take fancy medical and academic language and I translate it so that the average trans person can understand it, right? So what I usually say is, what that means is if you take it in the right dosage for your body, it should stop ovulation. That's why testosterone causes amenorrhea. Is that the right pronunciation? So many of these words I see written down more than I hear spoken. Is it perfect? No, because that if if you're taking the right dose, that if is doing a lot of work and I don't know what trans health looks like in [00:12:00] Canada because I do my work mostly in the U.S., some in the U.K., but in the U.S., at least in Oregon, nearly any medical provider can prescribe testosterone. A nurse practitioner can, a holistic or naturopathic doctor can, right? And that is so that we don't have huge barriers that prevent trans people from accessing care. Unfortunately, sometimes it does mean that a provider who has the passion and the interest in it doesn't always have that very advanced medical knowledge to back it up. So they're not always checking. Okay, let's start with this dose. Has your period stopped? Yes or no. Let's run your labs at the beginning and end of your cycle. There's not always that level of attention to detail. Not to mention the fact that trans people skip shots. Same as anybody. Same as anybody.
[00:12:51] Remember when the birth control pill was all we had, how many people like forgot and missed a pill, right? Didn't refill it, layer on lack of access to [00:13:00] care. If you go to the pharmacy and that pharmacist is transphobic, or they think that you're, it's drug seeking behavior and that's why you're asking for needles, it's not the right needles for drugs, sometimes that judgment is there, you might not be able to afford the out of pocket expenses that might cut, right? There are lots of reasons why the dose might not be right. Someone's skipping a shot. But it is possible for someone to conceive while they are on testosterone. The data shows that it is very rare right and this is a thing that when I was pregnant I couldn't believe how, I don't this isn't the right word and I apologize the right phrase, but I couldn't believe how dumbed down the information is by the time it gets to the patient. They're like Don't drink coffee. You can have one cup, but not two. You can have two cups, but not three. But what I'm making from my little crapping espresso machine is very different than Starbucks, and they're like with wine, they just like dumb it all the way [00:14:00] down. That same thing happens with testosterone. People get told if you're on it, you can't get pregnant. They're told if you're on it, you can get pregnant, and neither are really true, right? It is very rare that you will get pregnant if you are taking it correctly. It's a nuanced message, but that's what the data tells us. Yes, you could get pregnant on testosterone. Most people do not. But it does not look like there are long term negative effects from testosterone and the best study that I still go back to, even though it's like the very first one. So it's the oldest in trans health years, it's only 10 years old, of the people they looked at in this study who had been pregnant, had given birth within about 6 months, they had regained a cycle. If they had been on testosterone, they stop it in order to get pregnant. Three to six months, everyone had gotten their cycle back by six months. That's important because often people will come to me and say I was on testosterone. I [00:15:00] stopped. It's been a year and I haven't gotten my cycle back. I'm like, Oh my gosh, go see someone because it's not, it's probably not the testosterone. It's something else. You've got fibroids, blocked tubes, PCOS, exactly, which may be the symptoms of PCOS may be masked because guess what? You already have hirsutism. You've already got a beard because you are on testosterone. There's lots of other factors, but it probably wasn't the testosterone usage.
[00:15:24] Dr. Alicia Power: Exactly. And we say that in, right? So if you are cycling regularly before starting X contraception, right? X birth control, X whatever, then you would expect for your regular cycles to return after X amount of time, right? So same type of thing. You have to have had a normal cycle. You have to know you are ovulating every month. You have to, if, to have that same expectation post stopping testosterone, for example, right?
[00:15:50] Trystan Reese: Exactly. Yes. A lot of people though, do not want to be on testosterone, stop for a fertility experience, either pregnancy or egg harvesting.[00:16:00] And then have to go back on it because in a way, it's not de-transitioning, so we do not use that word, but in a way it's like you are undoing the menopause and then having to redo puberty again. It is very difficult. Medically, it's not dangerous, right? We, you don't even really have to titrate down testosterone because it slowly filters out of the system anyway. But regaining a cycle can be tough. The mood swings can be tough. You might have hair loss or hair gain. All of those normal, hormonal things, skin problems, acne, things like that. That's tough. A lot of people don't want to do it. And so that's where we get the conversation about fertility preservation that prior to starting testosterone, if you want that little insurance policy, if you want to hit pause on age, because age is still going to happen, whether you're on testosterone or not, you're still getting older, which we know is the number one determiner of [00:17:00] fertility, pretty much period, right? That's always an option. It's fewer than 5 percent of trans people use fertility preservation. It's invasive, relatively speaking, for people, who have, who are getting their eggs harvested, not so for sperm cryopreservation. It's relatively invasive. There's, you got, there's stirrups involved. Not everyone wants to do it. You may not want to postpone your transition. There are lots of reasons why people do not do it but...
[00:17:29] Dr. Alicia Power: I hear it's quite expensive, right?
[00:17:31] Trystan Reese: It's extremely expensive here, $15,000 to $20,000. Most transgender people do not have that money.
[00:17:38] Dr. Alicia Power: No concept of how much it costs in Canada, but I know it's private pay and probably at least a few thousand dollars, probably less than in the States, but probably still expensive, which is not insignificant, right?
[00:17:49] Trystan Reese: It's not insignificant. The cases anecdotally, there's no data on this, but the cases where I see this egg harvesting or cryopreservation being used the most are when we're talking about [00:18:00] younger folks, so like under 24, 25, whose parents are supportive of their transition. And the one thing that's holding them back is grandbabies. So the, where I see there's a little sweet spot there where if the parents do have a little bit of financial privilege, there is a little bit of that negotiation of okay, fine, like we will support your transition and can we please pay to get your eggs frozen? There's just that little spot there. But generally speaking, it's not that accessible for a lot of people, or they don't know about it. That's increasingly, I'm seeing that in the data as well.
[00:18:38] Dr. Alicia Power: Yeah. I think that's the biggest thing, right?
[00:18:41] Trystan Reese: So that's how hormones impact ovulation, fertility in the short, medium, and long term.
[00:18:47] Dr. Alicia Power: Awesome. And then may I ask a question around after pregnancy? So in that postpartum period, when would most people go back on to testosterone? When would that, when, and obviously everybody's different, right? [00:19:00] But what that, and then obviously it's going to change if you're hoping to give baby some human milk, your own human milk versus not, chest feeding, breastfeeding, formula, pumping, et cetera, et cetera, et cetera.
[00:19:13] Trystan Reese: Exactly. Yeah. The short answer for when is the best time to go on testosterone, either for the first time or to resume testosterone postpartum is we don't know. We really don't. There's no evidence, studies, nothing. But you're right. One of the variables is, do you plan to feed your baby using your own body? And if you are going to body feed we know at least do not start testosterone while you are initiating your supply because it's completely hormonally driven. In those, as you're just beginning to go on that journey. Once supply is established and it becomes less hormonally driven, more supply and demand driven, this is a very, a huge open question of whether [00:20:00] it is safe or not to go on testosterone while nursing, once you've established your supply. Because we just don't, again, we just don't know. Some people feel that the known benefit of a postpartum parent going on hormones and the known benefit that gives them in terms of the alignment of their body, in terms of their psychological health, that far outweighs the unknown risk to the baby from possibly ingesting a little bit of testosterone in the human milk.
[00:20:33] Other people feel like the unknown risk of of exposing a developing infant to testosterone far outweighs the known benefit to a parent, right? So there's just, it really should be that informed consent model that providers who are working with folks in the postpartum period can say, we don't know. It is up to you. Here are the known benefits. Here are the known risks. Here are the [00:21:00] unknown risks. What do you want to do? And so that's sort of how we're trying to thread that needle, right now.
[00:21:07] Dr. Alicia Power: Yeah, and that's great. And I think, I had a conversation recently with one of my patients who has a high risk of cardiovascular disease, has high cholesterol, was on cholesterol medications pre pregnancy, and is now postpartum and breastfeeding, body feeding, and is trying to figure out when to restart those cholesterol medications. Totally different scenario, but same kind of we don't have that data. We haven't had enough studies done on it. We don't truly know the risks, but here's the rest to you. And here's the potential risk to baby. And you need to make the choice that you feel comfortable and safe with. And whatever that is we are here to support you with that, right? It's that same conversation that we have all the time. But when it comes to this, a topic that maybe we don't feel as comfortable with, or maybe it's just we're in this oh, I don't want to mess up, right? I'm scared of making mistakes, right? But we all make them.
[00:21:54] It seems like it's a harder conversation to have, but I think, if we can bring it back to what we do a [00:22:00] lot of the time anyways, that same conversation, and I feel like patients actually really appreciate that. Patients and clients really appreciate and respect that and being okay with that, we don't have the data, we don't really know. Here's the best I can tell you, but you have to make the decision for yourself and for your family, right?
[00:22:16] Trystan Reese: Yep. And exactly. And then whatever they decide, just like full on support. That sounds great. What can we do if you're not going to go on testosterone? Where can you find affirming spaces? How can you have that gender euphoria in your life? Do you have a little budget to invest in some really snappy shirts that you feel great in and can wear the nursing bra underneath or whatever. I think the other piece is, there's something there around the public pressure to be miserable as a postpartum person in the hopes that you will make your baby happy. And just because transgender folks or non binary folks are not women doesn't mean that we are immune from that social pressure. So I think there's also work [00:23:00] to do in affirming people who choose to go on testosterone and not take the risk with their baby to use science milk to use formula, as much as possible. And I see this, this bias comes up a lot with, sometimes in midwifery, often when I'm working with doulas, lactation consultants, that how can we do trauma informed care, how can we do, approach people and say, no problem, like formula is a great option for you here are the benefits, just to, to reaffirm for them that, listen, as long as your baby is fed. You are doing fine. And of all the choices we can make, really, truly, what kind of milk they are getting at this stage, it feels huge. Longitudinally, it's really not. And so I think if we're ever able to affirm someone's decision not to nurse, either because they don't want to for any reason, or because it's contraindicated for something that's going to help them, either psychologically or physically [00:24:00] or both, I think there's a great opportunity there.
[00:24:03] Dr. Alicia Power: Yeah, I often tell the story of both my babies would be dead without formula. So let's just say. Yay for formula, when you need it, when you want it, go for it. But, I don't know if you went through this with your child, but when you're starting solids, I did like such a deep dive into like baby led weaning versus like purees, and then you go on the internet, and then there's these like forums that are like, if you don't do baby led weaning, your child will not develop, and then there's these ones that if you do baby, your child will choke and die. You know what? I did it for both of them. They both eat now, and they're both awesome kids. So there's all of this rhetoric out there, and social media can be great, and it can be horrible, and choose your sources, and listen to your own insight, your parental kind of because... It doesn't matter what other people think. It matters what you think, and it matters what you're doing for your child. And if other people don't, are judging you for that, [00:25:00] or are making you feel bad, then they're probably not worth your time, to be totally honest. I know that's a mean thing to say, but... You need to trust your own instincts. You need to follow your own path and do the thing that's right for you and your family, right? Nobody else can know what that is because they don't, they're not in your shoes. And that's just a general, generalization for all new parents out there.
[00:25:19] Trystan Reese: Yeah, I'll say like for my unique situation it was quite different for us because we had already parented two other kids. I already knew that a kid is going to survive my parenting. I already had that sense of listen, you shouldn't lose sleep over whether they're saying dada at 6, 8, 10, 12 months. None of that matters. Whether they're reading, none of that matters. Reading to your kids, yes. Are they recognizing letters earlier? None of that is important. And so I think we've had a lot less stress and anxiety having a newborn and then as he's gotten older, because we already have the two older kids, and so I think that the sort of [00:26:00] agita around timelines and doing this or that we were like, man, it'll be fine.
[00:26:05] Dr. Alicia Power: I knew the one and three year old that maybe they weren't one and three at the time but to distract you from the, right those first babies were so intently focused on them if that's the only person in our house right, whereas the second babies, you're right, you haven't killed the first ones, you're obviously doing an adequate job, if nothing else-
[00:26:19] Trystan Reese: And by the time you get to the third, all bets are off.
[00:26:23] Dr. Alicia Power: The first one will take care of them, right? So just to wrap up, I would love to hear some kind of concrete, a couple of concrete tips that you would suggest to care providers who are hoping to do better in their general humanity care of patients just to give people some skills that they can take away from this and think about and try to get into their own practice.
[00:26:47] Trystan Reese: Yeah, so there are two stories I want to tell. The first one is really I think illustrates why just having that baseline understanding of inclusive language is helpful. So when I was pregnant, I learned [00:27:00] that my HMO here in Oregon, that they cover free therapy through your entire pregnancy. And I was like, yes, please. I will. I'll take it. So I asked the nurse midwife who was overseeing my care. I said, by the way, I heard that I could get a therapist and she was like, oh, yeah, no problem. And so they connected me with her. I went to go see her the very first. Meeting that we had the first appointment I had with Regina, I said, she said, what concerns do you have? I said, I'm worried my partner doesn't really seem that connected to the pregnancy yet. And she was like, a lot of non gestational parents don't feel connected during the pregnancy. That's okay. Nothing's wrong. So the fact that she used inclusive language immediately, she didn't say a lot of dads. Because that to me signals like, oh, you don't see me as a dad. My partner weirdly also doesn't really feel like a dad in that way. There's that separation in trust. Her using inclusive language right away meant that we like leapfrogged over all the trust building pieces. And I was like, Oh, thank [00:28:00] goodness. Like this is someone that I can just talk to. And then also in that first appointment, she said, Oh, and then have you been experiencing any dysphoria throughout the pregnancy so far? Dysphoria being the word we use to describe a profound psychological distress that comes with the lack of alignment between one's body and then how the world thinks one's gender should be showing up. So the fact that she could just throw that word into a conversation again, I was like, Oh, okay. I'm not gonna have to teach this person. She's gonna really be able to show up for me instead of the other way around. So number one, as much self education as you can do, attending workshops, watching videos, whatever it happens to be, so you can know what is dysphoria? How do I talk about non birthing parents? So you can have that fluency. That's really gonna help.
[00:28:53] And then the second story I'll tell is, I mentioned that I had a pregnancy loss after my first pregnancy was a very short [00:29:00] pregnancy. It was only a few weeks. The zygote did not develop and I had to actually have a DNC. And there was one moment when I called the nursing station because I was like, look, it's been a week. I'm still bleeding. What do I do? And the nurse, she just had a vibe where I never felt like she believed that I had done something wrong to cause the miscarriage. And at one point on that call, she said, Tristan, you're not going to believe me now, but there will be a time when you will look back on this and realize that a miscarriage is not a failure, it's a success. A miscarriage means your body recognize that this pregnancy was not viable and took care of it so that your body would be healthy enough to carry the next pregnancy to term. And there was just something so beautiful about that,[00:30:00] as an emotional support person. And so I think number one. The knowledge and the, language is important. Number two, the attitude. Because we can feel it as trans people in our bodies when you're judging us, and so if you do have hang ups, don't be ashamed of them. It's normal, natural to be like, Oh no, this is new. And Oh no, judgment is coming up. That's okay. But find places where you can work through it. Find people that you can call who are further along on their journeys to say, Yeah, a patient showed up today and I was... I found I was judging him. Can you help me figure that out? Find places to put that, so that we don't feel in our bodies when we're working with you that there's judgment there. We'll shut down. We may not come back. We may avoid care altogether. A shockingly high number of trans people in studies have zero prenatal care, because they are worried about medical trauma. They're worried about transphobia in medical systems. A shockingly high number of trans people opt for out of hospital births, either [00:31:00] home birth or freestanding birth centers. And those are regulated very differently in Canada I understand, same with midwifery, than in the U S and I'm neutral, have a baby wherever you want, but have a baby wherever you want, because that's what you want, not because you're afraid of something else. I want people to make the choice not from trauma, but from excitement about what feels most empowering for them and what's most medically advisable for them.
[00:31:25] Dr. Alicia Power: Yeah. Awesome. We did a, I did a podcast with a, an amazing person in Vancouver Sarah, and she self describes as asexual and she was a carrier for her best friend and his partner. And her experience with that feeling of being, not being judged, but having to explain over and over within the system and it wasn't, it wasn't your quote unquote typical pregnancy. And so she chose to have a home birth, even though she was considered high risk because of the fact that just every time she went into the hospital, she had to explain [00:32:00] herself. And every single time there was all these questions and confusion and there wasn't a good birth plan and there wasn't a good kind of like care plan set up. And and it all worked out well. But it was just this, it was just such an interesting perspective to hear, and I think oftentimes we don't, as care providers, we don't take the time to listen to people's perspectives and understand how our actions, even if they're not ill intentioned, even if they're not at all, can impact their care trajectory.
[00:32:27] And I think if we can bring it back to, patient centered care, people centered care, we can all really progress in, in doing better, right? And being a better human and being a better care provider and providing safe spaces. I'll link that in the show notes of this podcast, just so people can hear that kind of that personal story. And I know you're going to tell a little bit more about your story in, during our November 4th con on conference as well. So certainly if people are interested to learn more from you, then make sure you, guys sign up. We'll link the sign up in our show [00:33:00] notes as well.
[00:33:00] Trystan Reese: And I'll say that's one of the really cool things. I've worked with so many providers where they were like, Oh, I started using your tools around instead of assuming that someone's gonna nurse their baby asking, what's your plan for feeding your baby? And how can I support your plan? They said that, for example, there were some women patients they had who were like, Oh, I'm a survivor of sexual assault, and I don't want to nurse my baby. Thank you for asking it in that way. A lot of surrogates who've been like, Oh. Yes, I'm not going to be breastfeeding because I'm a surrogate. When we use best practices, even if we intend for them to be inclusive for trans people, oh my gosh that's universal design, right? If you build your work so that it's accessible for the most marginalized people, oh my goodness, how many other people now feel like they're getting really wonderful care from you. Yeah.
[00:33:56] Dr. Alicia Power: Yeah. Agree. Agree. Tristan, thank you so much for having this [00:34:00] conversation and teaching me and teaching all of us a little bit more, sharing your experience. I know it's very, it can be very vulnerable sharing one's experience, but I think it just brings so much more to the, it just makes it more heartfelt and tugs on our own heartstrings strings as human beings to help understand why and how we should really be doing more work right and be learning more and growing more and yeah, so thank you.
[00:34:24] Trystan Reese: Of course, I think the final thing that I wanted to say that I'm trying to get better at talking about is even for medical providers, allowing space for the sacred. I think the one thing that I didn't get during my pregnancy loss experience was if someone had suggested to me if there is an opportunity for you to have some kind of a ritual. A kind of a letting go a kind of a closing out of this experience, because it was a shitty miscarriage, like it ended then it didn't end, and then I had to go into the hospital, like it was [00:35:00] just messy and physically messy. And I did end up just sort of stumbling into a ritual space where I was able to do a whole water thing, like a water ritual of letting go. And I didn't know that's what it was. I was just showing up for church that day because they had free childcare and my kids were driving me crazy. And she was like, today we're doing a letting go ritual with the changing of the season. And I did it. And I don't know that I would have really been able to fully embrace my second pregnancy, if that hadn't happened, and of course we don't want to assume anybody's religious beliefs or spiritual beliefs. I don't even have any spiritual beliefs, but I think just remembering that this isn't just a medical thing. And if people bring some kind of spiritual belief into the space, just, allowing for that.
[00:35:49] Dr. Alicia Power: Yeah, and I think we don't always recognize or verbalize that a miscarriage is still a loss. It's the loss of that potential human for us for some people, right? Once they [00:36:00] find out they're pregnant, they dreamed about this child growing up, right? And you need to take the time to grieve that loss and recognize that it is a loss. In Victoria, we have this amazing, it's called a little spirits garden. And it's for kind of any perinatal loss, but also childhood loss. And there's just these just incredible opportunities there to just hold space for that loss. And if you want to come back, annually or whatever it is to hold space for that. I agree with you. I think it's such an important piece of it and everybody's going to do it differently. And that's totally fine. And partners are also going to do it differently. And that's something we never talk about is the partner is also had a loss is going to look very different and people are going to grieve differently you'll grieve together and you'll grieve separately and that's totally fine, right?
[00:36:41] Trystan Reese: Or not, that's the my most popular story that people asked me about is after I had the miscarriage and after we did this water ritual, actually the pastor at this little, church this small congregation, she pulled me aside afterwards and said, you're new. I'd love to take you to coffee if I could. I said, sure. And we [00:37:00] went to coffee and she asked me what drew you to come to our gathering, and I thought about I said, actually, I had a miscarriage. And I think I was looking for just a place to be present with it. And she said, you had a miscarriage, what was that like for you? And it was the first time that someone hadn't said, I'm sorry for your loss. And I actually really loved. That she did not assume that I saw it as a loss. It wasn't that clear, direct, specific. Cause it, it was way messier than that, and so when she said, what was that like for you? I was like, Oh, this is a revelation. Because she can hold all the complexity of it. And I'm not a religious person.
[00:37:41] I don't, I didn't see it as a loss of a baby. I just didn't, it was something else, something weirder. Something more complicated. So yeah, that's the story. People love that story. I still get like DMS on social media being like, I use the what was that like for you today instead of assuming someone's experience, so yeah, lots of amazing...
[00:37:57] Dr. Alicia Power: Really goes to show how [00:38:00] important language is.
[00:38:02] Trystan Reese: Yeah. Thank you for that. Yeah. Excited for the conference.
[00:38:06] Dr. Alicia Power: Now, where can people find you if they want to reach out? I want to say... They're interested in the work that you do. They want to learn from you. All positive comments. Yes. They appreciate this podcast.
[00:38:17] Trystan Reese: Yeah. So if if people have trans patients or clients or community members, they can go to transfertility.co which is my portal, which has a bunch of resources, essays, articles, interviews with trans folks who've been through fertility processes. And that's also a place where providers can go to access some online learning. If they are like, I want to know more about the language piece. How do I change my website? It's called Mama's Milk. I would like it to be a little more inclusive. What can I do? That's all there as well.
[00:38:46] Dr. Alicia Power: That's awesome. Thank you so much, have a great day.
[00:38:50] Trystan Reese: You too!