Contributor: Kelsie Barta, MSN, APRN, FNP-C, IBCLC

As a people pleaser at heart, I would not have believed you if you told me five years ago that a social media post sharing my dissertation recruitment information would be met with “laugh” and “angry” reactions, and that I’d be fine with it!

In recent years, there have been many discussions about the growing movement toward using gender-inclusive language when discussing perinatal issues. For example, the Biden administration’s use of “birthing people” instead of “mothers” or “women” in the 2022 budget was a point of contention for many (Fearnow, 2021). This type of language is meant to recognize that not all people who become pregnant or give birth identify as women, and to be more inclusive of transgender and non-binary individuals. There has been pushback against the use of gender-neutral language in this context. Critics argue that by avoiding the use of the word “women,” advocates for gender inclusivity are erasing the experiences of cisgender women who have historically been oppressed when it comes to issues traditionally thought of as pertaining to women’s health (Powell, 2022).

As a lactation consultant, I care for families struggling with some aspect of the infant feeding experience. Most of my patients use the term “breastfeeding.” However, we know that for those with gender non-confirming identities, the use of the word breast may not correspond with how they see themselves and can lead to gender dysphoria. Some individuals prefer to use the term “chestfeeding” for themselves when they describe the action of latching their infant or expressing their milk for their infant’s consumption (MacDonald, 2019). In my research recruitment materials, I opted to invite those who were “breastfeeding or chestfeeding” to participate in my study.

As I reflected on my decision-making process with the language choices in my dissertation work, I can’t help but try to connect my experience with Carper’s (1978) ways of knowing. I tend to rely on empirical knowing; I love the idea of dazzling my adversaries with cold hard facts. As a doctoral scholar, I’m so tempted to pack this blog post full of impeccably cited articles, demonstrating the body of evidence supporting the need for gender-affirming care to minimize health inequities in these groups who have been historically marginalized. I’ve also come to consider myself an ethicist as of recent years, and I think I could build an effective, if not pedantic, case for the use of inclusive language by walking the blog readers through the ANA’s Code of Nursing Ethics point by point. My first draft of this blog post included attempts at both of the above.

Instead, I think it makes sense to connect my process with a pattern of knowing not included in Carper’s initial conceptualization: Emancipatory Knowing.

Chinn and Kramer introduced emancipatory knowing as a fifth pattern in 2010 (Chinn et al., 2022). This way of knowing acknowledges the social, political, and cultural influences on health and caring. This understanding requires one to critically analyze power dynamics and health inequities. And perhaps most importantly, it requires the nursing praxis- the reflective action toward social change.

As much as I’d like to think I can win any dispute if I can just make my counterpoint understand my argument, at least some of the disagreement with my inclusion of the word “chestfeeding” stems from transphobia or at the least the denial of the validity of transgender and other gender non-conforming identities. While people can and do confront such internalized biases and change, it is probably not the best use of my time to try to “change someone’s mind” on this topic. If I can’t explain to someone why bigotry is not a good idea, I can at least acknowledge that such hatred exists, confront my own internal biases, and amplify the voices and concerns of those who are harmed by it.

I do want to acknowledge the perspective that cisgender women have also been historically oppressed and erased. And certainly, I can understand the discomfort with clinical, desexed language when it pertains to an intimate, relational activity such as breastfeeding one’s baby. As a researcher, I must be precise with my language- and to say that I surveyed breastfeeding mothers for my study would not have been accurate- I had several participants who identified as gender non-conforming. I’ve seen inclusive attempts at lactation language be misconstrued. Like a screen-grab of a sensationalized news story along the lines of “we apparently aren’t allowed to use the words ‘breastfeeding’ or ‘mother’ anymore.” This is not my intention, nor have I seen calls for this type of completely neutralized language about lactation or pregnancy. My approach, which seems to align with recommendations from professional lactation organizations (Bartick et al., 2021), is to use inclusive language when referring to diverse groups (for both preciseness and harm-reduction reasons) and individualized language according to personal preferences when communicating on an individual level.

Perhaps I’m not the people pleaser I once thought myself to be. Or, I’ve matured enough to know that I can’t make everyone happy and that remaining apolitical is impossible. Declining to comment in the face of injustice and inequity is a stance just as much as sharing one’s beliefs is. The debate around gender-inclusive language in perinatal issues reflects larger discussions around language, identity, and inclusivity, and society will continue to grapple with how to acknowledge and respect diverse experiences and perspectives. As nurses, we must embrace our role and wisdom in this emancipatory process.

References

Bartick, M., Stehel, E. K., Calhoun, S. L., Feldman-Winter, L., Zimmerman, D., Noble, L., Rosen-Carole, C., & Kair, L. R. (2021). Academy of Breastfeeding Medicine position statement and guideline: Infant feeding and lactation-related language and gender. Breastfeeding Medicine, 16(8), 587–590. https://doi.org/10.1089/bfm.2021.29188.abm

Carper, B. (1978). Fundamental patterns of knowing in nursing. ANS. Advances in Nursing Science, 1(1), 13–23. https://doi.org/10.1097/00012272-197810000-00004

Chinn, P. L., Kramer, M. K., & Sitzman, K. (2022). Knowledge Development in Nursing: Theory and Process (11th ed.). Elsevier.

Fearnow, B. (2021, June 7). Biden admin replaces ‘mothers’ with ‘birthing people’ in maternal health guidance. Newsweek. https://www.newsweek.com/biden-admin-replaces-mothers-birthing-people-maternal-health-guidance-1598343

MacDonald, T. K. (2019). Lactation care for transgender and non-binary patients: Empowering clients and avoiding aversives. Journal of Human Lactation, 35(2), 223–226. https://doi.org/10.1177/0890334419830989

Powell, M. (2022, June 8). A vanishing word in abortion debate: ‘Women.’ The New York Times. https://www.nytimes.com/2022/06/08/us/women-gender-aclu-abortion.html

About Kelsie Barta

Kelsie Barta (she/her) is a family nurse practitioner and an international board certified lactation consultant (IBCLC) at the Lactation Foundation, a grant-funded lactation clinic associated with McGovern Medical School at UTHealth in Houston, Texas. She is currently pursuing her PhD in Nursing at Texas Woman’s University, where her interests include ethical communication, maternal satisfaction with breastfeeding/chestfeeding, and psychological need satisfaction in the context of lactation.