Queer midwife chats about new book on starting a family as LGBTQ+ parents

Philadelphia Family Pride (PFP) hosted a book chat at William Way LGBT Community Center on June 21 with queer midwife Ray Rachlin, who co-wrote “Baby Making for Everybody.” 

“This book is for queer people and hopeful solo parents who want to grow their family and don’t know where to start,” said Rachlin, who co-wrote the book with Marea Goodman. “It’s a really practical, step-by-step guide both to the logistics as well as the social-emotional piece of creating families and thriving in our community.”

The book includes guidance on how to go about finding a sperm donor, options for methods of conception, the legal aspects of starting and protecting a family as queer parents, surrogacy, fostering and adoption, advice for trans individuals who want to get pregnant, what happens in the case of miscarriage, and more. Personal stories from queer parents about their journey to having kids are also prevalent in the book.

Rachlin spoke in front of a small group of prospective parents, people who work in the health-care field and those aspiring to work in the birth community. Stephanie Haynes, executive director of PFP, joined Rachlin and filled in some blanks in the discussion.

Rachlin began by underscoring the fact that there is a dearth of resources for starting a family as an LGBTQ+ couple or solo parent, and that the model of fertility care is, for the most part, created for heterosexual couples experiencing infertility. Philadelphia is home to some fertility clinics with health-care professionals who have experience working with queer people, Rachlin pointed out, but that’s not the case in many parts of the country.

“How do we find our center and find the place where we want to make decisions when often the process of conception starts with scarcity for us?” Rachlin asked rhetorically. “Often people feel like they have infertility before they even start trying. The preconception process is the hardest, and I think the most isolating. The intervention ladder is not designed around queer bodies. We don’t have full reproductive autonomy because we don’t have financial access to equal rights.”

Barriers to fertility care for LGBTQ+ people manifest in part as inability to access fertility care, even in the case of infertility coverage, without an infertility diagnosis. Infertility is defined as trying unsuccessfully to get pregnant for a year if you’re under 35, and trying to get pregnant for six months if you’re over 35. 

“Social infertility is not a part of that diagnosis,” Rachlin said. 

After introducing the book and the need for this type of resource, Rachlin gave a rundown for prospective parents with uteruses on how to go about acquiring sperm. Couples or individuals who lack sperm have two main options: using a known donor or an unknown donor. A known donor can be a friend or family member, or a person a parent-to-be connected with on the internet, Rachlin explained. Using sperm from an unknown donor involves buying it from a sperm bank. Although sperm banks are not regulated, some are more reputable than others, but also more expensive, Rachlin said. 

One of the pros of using a known donor is that if the donor is local, prospective parents can use fresh sperm, which lives longer than frozen sperm and therefore offers more flexibility in terms of doing an insemination at home alone or with one’s partner.  

“It also allows for unique family dynamics and relationships,” Rachlin said. “Having a child conceived with donor sperm, you can know where they came from. [With] many queer couples, the partner who’s not carrying may use a sibling so both partners can be genetically related.”

The downside of using a known donor is that it requires a legal process to establish parental rights and the relationship the donor will have with the baby, if any. When using sperm from a bank, the donor relinquishes their right to parenthood, Rachlin explained. The donor also undergoes thorough STI testing and gets a sperm count, so not only will the legal separation process be taken care of, the person utilizing the sperm can rest assured that their health will be intact. 

“The legal needs are not as immediate,” Rachlin said. “When someone uses a known donor, it varies state to state if that donor is going to have parenting rights. Your family’s parenting rights are never actually secure until you complete a second parent or confirmatory adoption.”

Rebecca Nayak, adoption and assisted reproduction attorney, who was also present at the event, is on the board of PFP and contributed to Rachlin’s book. Nayak said that the most common legal misconception for couples using a sperm donor is that the birth certificate alone ensures parental rights.

“Birth certificates aren’t the same as orders confirming parentage,” Nayak said. “I’ve unfortunately been involved in custody disputes where someone’s on the birth certificate and their parentage is still challenged. That’s something that there’s always a need for education on, but there’s a whole host of other legal considerations and documents to think about when you’re creating a family with a donor.”

Another topic of discussion at the event revolved around methods of insemination, some of which include intracervical insemination (ICI) intrauterine insemination (IUI) and in vitro fertilization (IVF). ICI involves inserting the sperm at the base of the cervix, and can be done at home. An IUI procedure involves inserting the sperm directly into the uterus, which requires a healthcare provider to do. 

IVF is something else entirely. One way it can be done is using one’s own eggs, which involves doing a work up at a fertility clinic, and once insurance information is available, stimulating ovulation using medication, then having eggs retrieved and fertilized in a lab. The prospective parent then finds out how many embryos resulted from the fertilized eggs. From there, the embryos can be implanted in one’s own body or in their partner’s body, which is called reciprocal IVF.

“The IVF process is no joke,” Rachlin said. “It’s expensive, it’s really draining, there’s a lot of hormonal highs and lows. Our success rates are higher with queer people because they’re not going in for infertility, but the age of the eggs is often one of the main factors in how successful the process is. But it is a really cool way of creating families.”

Attendees were engaged in the discussion, and asked a variety of questions pertaining to the process of starting a family.  

Hadar Spector, one of the attendees, hopes to work in the birth community as a lactation consultant or a doula. 

“I wanted to learn more about how to support people in the queer community when it comes to having a baby,” Spektor said. “I’m not familiar, coming from the ‘easy route’ with having a husband. It worked out pretty easily for us, we didn’t have to do any intervention. But we did start to look into it and it was really challenging for me, so I could imagine that for somebody who has even more hoops to go through [it’s even more challenging.]” 

For more information about Ray Rachlin and their book, “Baby Making for Everybody,” visit babymakingforeverybody.com