homebirth midwife – LGBTQbirth

Sierra Holland, she/her, All Bodies Birth

Katie: Alright, so thanks for hanging out with me today! Just to start, can you tell us a little bit about your practice?

Sierra: Yeah, so I’m Sierra Holland, I use she/her pronouns and my practice is called All Bodies Birth, so it’s kind of an umbrella for my work in a lot of aspects of reproductive healthcare. I trained primarily as a birth doula and expanded out from there to become a full-spectrum doula. So I do abortion support work, fertility support work, placenta medicine, childbirth education and now I’m a student midwife. So my practice is really focused on people who are oppressed by systems that don’t wanna recognize us, mostly queer, trans and nonbinary folks, religious minority folks, people parenting in creative parenting and family structures, and other people who just get overlooked or written out of the system.

Katie: Awesome, and what are you queering right now?

Sierra: I hope everything, everywhere I go, all the time. As a femme I have to be a little more explicit, like y’know, throwing biosafe rainbow glitter behind me everywhere I go. But generally, spaces around reproductive healthcare and family building. I’m kind of straddling two worlds right now, as a doula I work in the hospital system a lot. So that means making space for people that don’t have a space in that system or who are actively oppressed by that system. And then I’m a student midwife as well, so I’m training to be an out of hospital provider. So that means exciting things like in-home IUIs and preconception fertility care and lots of support for people’s unique family building journeys. I’m kind of in both worlds at once, trying my best to queer them all up.

Katie: Awesome. And where are you geographically?

Sierra: I’m located in Portland, Maine, so unceded Wabanaki territory, but I serve all of New England physically and anywhere in the world virtually.

Katie: What inspired you to do the work that you do?

Sierra: Oh goodness. I come from an academic background, so I spent a lot of time studying these things, family building, especially queer fertility. Feeling a sense of distance from the process in the researcher role, you don’t really get to invest in people and make their lives better directly, and that was very frustrating to me. So I knew that I wanted to be in a more practical role where I get to walk alongside individual people and give them the options and support and advocacy that they might not have elsewhere and that as a researcher I could never provide them. So I do it to make more space for people in institutions that don’t like us and to make more opportunities outside those institutions.

Katie: Awesome, and relatedly, how do you describe your support philosophy?

Sierra: Hmmm. I believe a lot in the power of individuals. And I’m also a sociologist in a past life, so I have a very structural view. What I see is that those things don’t match up a lot of the time. So my support philosophy is really about bridging the gap between individual experiences and needs and institutional limitations. So if you’re choosing to or need to be in a hospital setting, but your identity or family structure or way of existing in the world is one that isn’t recognized by that setting, then my support is in creating the space for you and helping the institution meet you where you’re at. Kind of reducing the harm that can be done when there’s such a disjoint.

Katie: Awesome, and so to shift gears a little.. We’ve asked you about your natal work, and now I also need to ask you about your natal chart. What is your sun, moon, rising?

Sierra: Yes! I’m a Virgo sun, cancer moon, sagittarius rising but super don’t identify with that.

Katie: And what’s your favorite thing about being a queer support person working with queer and trans families?

Sierra: Creativity! I mean, queers are the creative people on the planet. Just when you decide that certain rules don’t make sense or don’t apply to you, you can really do anything you want. Like, the freedom to arrange your family however you want, arrange your support system however you want, parent your children however you want. I mean, we’re all living in institutions and systems, right? But there’s just a certain amount of expansiveness that I love about queer folks and trans folks and family building that is radical in that way.

Katie: And if you could improve one thing about the experience of pregnancy and birth for queer and trans families, what would it be?

Sierra: I don’t have just one, I have a laundry list. But, right now I am focusing myself on becoming a provider. So, what I’ve seen is that we need good providers in every space and they don’t always exist where we need them to be, and they don’t always meet the needs of people in individualized and human-centered ways. So right now, the goal I’m working on is becoming another provider that can meet people where they’re at and provide that care. That’s the one that I feel equipped to work on, but my list of things is …

Katie: Rrrreal long?

Sierra: Very, very long. And some days, it’s like, y’know, burn it all down, we don’t have a use for these systems anymore. But most days, I can see the need for them for a lot of people in different situations. I think the other big one I want to change is access. I care a lot about people having access to the kind of care that they need and want when they’re building their families. So that’s hopefully gonna be a cornerstone of my practice.

Katie: And one piece of advice for new or aspiring queer and trans birth workers?

Sierra: Find other people. Other people will make it doable and sustainable. What’s really kept me going the last few years as a doula, in particular, is having a network of queer doulas that understand that our identity is so mixed up in what we do and don’t try to advocate for us to be a different person in those spaces. So: find other queer and trans folks that will see you for your whole self and that you can rant about institutions with often and decompress after tough interactions with institutions. Because nobody understands this work like other queer birth workers, really. Also, don’t train with DONA. You can edit that if you need to, but that’s my…

Katie: (laughing) absolutely not. What’s something not nata/birth/reproductive related about your life that you wanna share?

Sierra: I’m a former, so now retired, roller derby skater and coach. So I love being in environments where alternative forms of masculinity and femininity and being get to thrive and get celebrated. So I spent some time in Boston coaching the little ones on skates- you think having a kid is hard, have a kid on skates. That’s really hard. And that was a big part of my life for a long time. Unfortunately the on call lifestyle of being a birth worker is a little incompatible with that. So, these days I’m a rock climber, climb a lot of rocks, and read a lot of fantasy and sci-fi books with my cat when he will entertain me.

Katie: Can I ask what your derby name was?

Sierra: Madam Secrescary.

Katie: STOP!

Sierra: Yep, Scary for short. Which is such a good… (smiles) yeah.

Katie: And where can people find you on the internet-land?

Sierra: I’ve got an instagram and a facebook under my business name, All Bodies Birth. Also AllBodiesBirth.com. Pretty easy.

Katie: Awesome, and is there anything that we haven’t asked you that the people need to know?

Sierra: Find a queer/trans birth worker near you and ask them what they need on your journey. Find a black or person of color midwife and ask them what they need on their journey. A lot of us are facing barriers to access for getting into this kind of work, and I believe a lot in having care by people who look like you and who have a shared affinity with you. So: find an oppressed birth worker, aspiring birth worker, plant the seed, buy their books from a local bookstore… that’s a really good way to get more of us out in the field to give better care for queer and trans people and other oppressed communities.

Katie: Alright, thank you so much Sierra!

Ray Rachlin, they/she, Refuge Midwifery

Katie: Alright! Well thank you so much for making the time to chat today. Just to get started, could you tell me a little bit about who you are and about the kind of work you do, about your practice?

Ray: Sure, my name is Ray Rachlin, my pronouns are they and she. I’m a professional midwife, licensed midwife and lactation counselor here in Philly, Pennsylvania. I serve kind of Philadelphia, southeast PA and then all of south Jersey. My practice is part home birth, so I’m a home birth midwife and I help people give birth in their living room or their bathroom or y’know, hallway, wherever. And I also help queer folks get pregnant. So, specifically doing home intra-uterine insemination or home IUI, and kind of trying to build community with queer people who are trying to concieve, get pregnant, have new babies. Both through teaching classes like “Beyond the Baster” which is my favorite, funnest class to take when how to get pregnant when you lack sperm, and also community events.

Katie: Awesome, that work is so important! What are you queering right now?

Ray: I think I’m constantly trying to queer birth work and the birth world. I think… yeah, pregnancy and birth and having new babies is like the most gendered experience in our society. I got into birth work from a social justice/reproductive justice perspective, and what I kind of continue to find and work around is that the way that the childbearing year is gendered really takes away people’s agency and humanity in the process and y’know, queer-centered care is individualized care that calls people by their names and treats them as respected individuals, and everybody deserves that. That’s what I’m kind of trying to work for and build within the birth community here in Philadelphia. Folks that are providing queer-centered care in all aspects of y’know, pre-conception, pregnancy, birth and postpartum.

Katie: Awesome. And what inspired you to do the work that you do?

Ray: I definitely got into it through activism and social justice work. Long before I got into birth, I was a labor organizer and then… life situations came up and I was like, “I want to learn how to support people!” so I became a doula. It was like this switch flipped: oh, this is what I’ve supposed to be doing with my life. And birth kind of had all the answers of all the ways I saw problems and systems of oppression coalescing and it was like, “Oh, this is where everything starts and where I want to work.” I felt like, as a doula I was a bandaid on a gaping wound and the first time I went to a home birth, it was life changing. Because I was there as a doula, I’d probably been a doula for like 1-2 years at that point. And what I saw was the midwife worked around the needs of the person in labor. That when you bend over to listen to the baby, instead of telling someone, “Oh, we lost the baby, you need to get back in the bed.” birth looks completely different. I saw agency, I saw empowerment in a way that.. And just a birth that was fundamentally different from anything I saw in the hospital, and it was like OH – that’s what I need to be doing. And If I’m doing this at home and hospitals have to compete with this kind of care, they’re gonna have to behave better. That started off this long trajectory of choosing to become a direct entry midwife, so I trained exclusively with out of hospital birth, so home birth and birth center. So I just wanted to create a different paradigm of how we get to provide care that restores choice and agency to families and ultimately creates competition for hospitals so they have to change their practices to be more family centered.

Katie: Yeah. I really appreciate the framing of that both for what it is in and of itself and the uniqueness of out of hospital birth experiences, and also how that is also like pushing change within the systeem.

Ray: Yeah. I think there’s lots of different ways that, y’know, midwives are change agents in every part of society in every society that exists. But midwifery in the US is particularly a mess and like, some folks choose to work within systems to try to create change and that was not the road for me. I was like, I wanna work out- I want to create an alternative that isn’t navigating the same systemic oppressions in the ways that I’m having to provide care. There are a lot of limitations to out of hospital birth in the united states, and like, working outside the system but for me the benefits are outweighing the downsides and we can create our own alternative that better meets our needs.

Katie: And you’ve touched on this in all of your answers, but just to be really explicit about it, how do you describe your support philosophy in the care that you provide?

Ray: I think for me, being a midwife is about showing up for this process. I don’t have a particular stake in what choices people make or how their birth goes but it’s about providing consistent support, providing full information so you can make decisions about your body and understand what’s going on, feel supported and like someone has your back through the whole process. I think that’s what helps people into empowered parenthood. Just having someone in your corner for all of it. A good friend of mine phrased this well, and I kind of like, this is what I always come back to: Midwifery is about the restoration of choice. Y’know, bringing choice and autonomy and agency and respect back to pregnancy and birth. It’s done through relationship with my clients, it’s done through informed choice, it’s done through slowing things down and so there’s time to make decisions. It’s creating a revolution in our life and society through birth.

Katie: And so, I asked you a little bit about your natal work, but I also need to ask you about your natal chart. What’s your sun, moon and rising?

Ray: I’m a Capricorn. I think it’s very obvious to anyone who meets me. I’ve also had folks tell me they’re glad— I’m right on the cusp – I was born at like 11:55am on the cusp day in January, and I’ve had many people tell me they’re glad I’m a Capricorn, not an Aquarius as a midwife and I’m like, okay sure. I always get my rising and my moon confused! One of them is Taurus, the other is Aquarius. When I first was trying to figure it out, my partner was like, “Well, definitely Taurus cause you’re very stubborn” and I was like, “Huh, yeah.. probably true.” But I think, yeah 100% Capricorn.

Katie: As a fellow Capricorn sun, I… I’m also glad to have you in the mix of Capricorn birth folks.

Ray: It’s like extremely organized, regimented, y’know, with this process that you cannot predict at all..

Katie: Yeah, yeah, like, mmm no idea what’s gonna happen, but let me tell you, I have 36 plans already made and we’re gonna just pick whichever one, we’re gonna just keep switching them around til something works!

Ray: That is exactly true, yes.

Katie: What is your favorite thing about being a queer support person, a queer midwife and/or about working with queer and trans families?

Ray: I think it’s just the way that I can provide culturally competent care. It’s these little things that y’know, you don’t necessarily know this til youre in it, but I remember once doing a postpartum for a family I’d helped catch the baby of that, we were just talking about going through butch phases when we were teenagers and… just having a provider that y’know, just kinda gets it. Understands you, your family, your pronouns. There’s just a lot of shared understanding so you don’t have to explain yourself in a way that leads to a more relaxed care experience. And ultimately, a better care experience, cause you’re seen.

Katie: Absolutely, and then that time that is not actually about you trying to educate your provider about who you are and instead, and is instead about like “what do you need?”

Ray: Yeah.

Katie: Wildly different experiences of care.

Ray: For sure.

Katie: Reladetly, if you could change one thing about the experience of trying to get pregnant, prengnacy and birth for queer and trans families, what would it be?

Ray: It’s a good question, I think I have a two part answer. The first is insurance reimbursement, because our families are not recognized in the insurance structure and not recognized in fertility treatments, not recognized in our care needs. Trans people have a really, really high out of hospital birth rate and out of hospital birth is not well reimbursed so the options that we try to seek out to meet our care needs and our unique family needs are not, are only available to people with money and typically white people with money. So I think there’s the systemic ways for families to be better recognized in the insurance system so we can access the fertility support we need: access sperm, access second parent adoption with a lot more ease. But then also just the real issue is lack of representation. Pregnant people are assumed to be moms, and their partners are assumed to be dads, and that’s represented in pictures, in books, in literature, in providers offices and it is so, so, so engrained. And It’s really hard to figure out our own family narratives when we’re not represented anywhere, and we’re constantly having to translate stuff to apply to us.

Katie: What is one piece of advice that you would give to a new or aspiring queer/trans birth worker?

Ray: I think linking up with other queer birth workers. I feel like I have been gay for a long time, and in that time I’ve not always been a queer/trans competent birth worker. Gender is so ingrained in pregnancy, birth and postpartum and I had to do a lot of unlearning and really the best way to continue to do that unlearning and learn how to best serve my community is through the people who are already leading this work. We’re probably the best able to meet our community needs, and also being queer is not a given for being a queer competent or trans competent birth worker, for sure. There’s a lot of extra work that needs to be done.

Katie: Absolutely. And so much of it is about the stuff that we’ve also internalized about ourselves that also it’s sooo, it becomes so personal.

Ray: Yeah, like gender and babies – I constantly find myself at growing edges where I have a client using they/them pronouns for the baby and I slip up on their pronouns like 5 or 6 times like what the hell? I have more work to do. There’s always more work to do. But it’s like having the community both to learn from and also to support me in continuing to do that work.

Katie: I think that those communities both of support and accountability are so important.

Ray: Yeah.

Katie: And what is something not natal related or reproductive related about you and your life that you want to share?

Ray: I think (laughs) my biggest, like, hobby or side-thing outside of midwifery is powerlifting.

Katie: Yeah!

Ray: It’s kind of, yeah, I’ve been like a gym bro for like many years. (laughs) Now that I can’t go to the gym, ummm, yeah, now like a home gym bro, I guess. But, yeah! Feels like a very different side of my life and personality, but is also a very big part of my identity.

Katie: Wow. That’s incredible. I mean, I feel like a similar type of intensity in like..

Ray: Yeah- I only do things that are intense. I don’t really, like, so I knit so maybe that’s not intense. But typically, it’s like…

Katie: Just something I can really go hard at!

Ray: Yeah, my best lift is bench, which I’m very proud of.

Katie: In. Credible. Finally, where can people find you in the internet land?

Ray: I think most people find me through instagram, so my practice is Refuge Midwifery, it’s that on Instagram and Facebook. It’s been a really amazing tool for connecting with birthworker community, queer perspective parents and just like trying to continue to build knowledge and power around our families and birth and birth justice. I do an “ask the midwife everything Friday” (some Fridays), and just ways to access midwifery care that doesn’t involve hiring me as your home birth midwife. Y’know, as a practice, I’m serving around an hour radius around Philadelphia for home birth and for doing home IUIs, and I do also sometimes have folks who are outside my service area who just want to do preconception care with me because I’m good at helping people get off gender-affirming hormones to create a pregnancy and just want someone to help navigate that that knows the same language. And definitely the pandemic has opened that up more, so I’m doing a lot more virtual care than I ever have before, so for that you can find me on my midwifery website which is refugemidwfiery.com

Katie: Awesome, thank you so much. It was so wonderful getting to chat with you.

Ray: Yeah! Thanks for asking me to do this, I’m excited for the resource that you’re making.