“When you become sexually active, do you think your partners will be men, women, or both?”
The shy teenager shrinks down in her chair a little farther, scared to make eye contact with me, but manages to squeak out, “I think….maybe….both”
A huge grin hits my face and I (at the total dismay of this teenager who would like to be doing literally anything else in the world) launch into my spiel about safer, pleasure-based sex with men, women, and people of all genders. It’s not 20 seconds until I’m drawing a diagram of how to make a dental dam out of a condom and my patient looks simultaneously horrified and intrigued.
I talk to so many people about how to have better sex every day, their identities, and some of the most intimate details that someone could know about a person and I feel so humbled and honored to be a part of my patients’ lives in that way.
I have written about so many parts of who I am as a midwife over the years, and, although I’m a little late for this to be a Pride-related blog entry, I figured it was high time for me to write about being a bi midwife.
Its difficult to be out at work, and as most bi folks know, no matter who our partners are, our identity tends to be erased. I wish I couldn’t recount the number of times I have had to tell people, “nope, still bi even though I’m married to dude!” And even though it’s difficult to explain to my co-workers, I still have a Pride flag that sits in my pen-holder and a big button that says “total Bi visibility” on my corkboard along with all my guidelines and resources I use on a daily basis.
But what about being out with my patients? I have always struggled for the best way to do this, without also divulging information that might make the visit seem like it’s about me or my identity. I know lots of bisexual, queer and gay providers struggle with this, and luckily over the years, most of us become known as “the queer NP” as word travels through the community that we are safe and competent and understanding health care providers.
One of the more visible things that is deeply a part of how I present my identity is that I don’t shave my armpits or my legs, and hope that this acts as a small signal to my queer patients that their health and identities are safe and respected in my hands. I try to use language like, “we,” when explaining concepts, like, “when we are dating men bacterial vaginosis isn’t considered a sexually transmitted infection and I wouldn’t treat you both, but when we’re dating women/vagina owners, I would treat you both.”
When taking a sexual history I always ask if my patients are sexually active with men, women, or both/all genders, even though there’s a check box on the history form. So many times the answer I receive after building rapport with someone and ask in a non-judgmental, kind way changes from what’s on the form. This was the case especially when I was seeing men at Planned Parenthood due to the increased shame around men having sex with other men.
In midwifery school our education about queer health was laughable. We had one lecture for our whole cohort essentially giving the basics of language and how not to be or act like a bigotted asshole to your patients. What we really needed was a whole course on how to talk about sexuality, pleasure and consent-focused sex, and the different health needs of men who have sex with men and women who have sex with women. Instead, I was left woefully underprepared for giving my patients the best sexual health education I could give when I entered practice.
As a queer midwife myself, who has so long felt like I don’t belong in the gay community because my partners have been (up until this point) primarily cis-men, I felt like I was failing my siblings by not knowing what I should. Luckily, my first job out of school was at Planned Parenthood where I got a crash course in just about everything I needed to know from increased risk factors to what everyone needed to be screened for and how often, Pre-Exposure Prophylaxis (PrEP) counseling and how to tell someone they have HIV.
Unfortunately, many folks view bi and queer people as the “most privileged” of the LGBT community because our sexualities are often hidden, but this actually makes us higher risk for things like depression, suicide and self-harm, drug and alcohol addiction. What that actually feels like is that we don’t belong in the gay or straight worlds, and both places tell us we don’t quite belong in either place.
I try to share as much of myself with my patients as possible (and professional!) insofar as it will help them with their journeys and struggles with depression, loss, parenting, and discovering and exploring their sexuality. It is my favorite thing in the world when I can hear a big exhale from a young queer patient when they know they don’t have to explain themselves to me. That I get it and I get them.
To all my queer, bi, and not quite straight friends, family, patients, coworkers, and fellow midwives, I see you and I know I am seen, and happy (belated) Pride to you all