The Cascade of Intervention

Gender clinics resemble some of the worst aspects of hospital maternity wards

Editor’s note: We apologize to anyone confused by the carpentry metaphors in this post. It was written by a lesbian.

The best advice regarding childbirth is this: if you want to avoid a cesarean section, don’t step foot in a hospital. That’s because walking through the door triggers a cascade of medical interventions that make vaginal delivery more difficult and dangerous.

Picture a cascade as a series of small waterfalls that are heading down a rocky slope. There are many stages in the slope as the water hits rocky areas; it sometimes pools and gets bigger and faster. There are many routes but all are treacherous and the water never seems to find a place to rest.

For parents with children and adolescents experiencing any gender distress, if you want to avoid a lifetime of medical interventions then you shouldn’t step foot in a gender clinic.

Here is a common cascade for a woman in labor inside a hospital:

First you are restricted from eating or drinking anything but clear liquids.

Second, electronic fetal monitoring begins.

Intravenous fluids are started (an IV).

Your movement becomes restricted by the monitoring equipment and IV. Your energy falls from the lack of calories. Your sense of power and ability to follow your instincts is now hampered.

Then the pain. The contractions hurt and the brain releases more oxytocin. But pain is hard to move through without the space and autonomy to move, so…

The epidural is administered.

If the mother’s natural processes hadn’t been disrupted by hospital staff from the moment she came into the hospital, eventually her endorphins would have kicked in, causing the mind to be able to handle the pain on its own. But that would take time. Time is not easy to find in a hospital.

The epidural stops the mind’s hormonal dance—it stops producing enough oxytocin—and so Pitocin is required. This constrains the mother’s movement even more. Electronic fetal monitoring is now constant.

Membranes may be ruptured when the Pitocin or epidural are administered.

The cascade is now becoming one pathway, one river leading to a single option for delivering the baby: the surgical cesarean section.

Photo by Piron Guillaume on Unsplash

A gender clinic cascade:

First someone asks a general pediatrician about a concern regarding sex, sexuality, or discomfort with puberty. If the child or parent utters the word “gender” then the pediatrician thinks—specialty care and referral.  Investigation into the child’s distress ceases, if it ever started.

Perhaps an autism screening is needed, depression or anxiety should be considered, or sensory processing therapy would help. But like the maternity ward’s restriction against food or drink, there will not be any support sustenance provided in the gender clinic except perhaps in the form of an affirming therapist.

If the child declares a self-diagnosis of “trans,” the affirming therapist will endorse it and forward the patient to a gender specialist.

The gender specialist has a few tools to choose from but they’re all hammers. They don’t stock any other tools because every patient looks like a nail to them.

Think of the puberty blocker as a claw hammer. It’s for kids just at the start of puberty (“tanner stage two”). If the child is a girl who’s already started menstruating, they get hit with the injectable birth control Depo Provera.

When the child is over 13, the doctor pulls out the club hammer: cross-sex hormones.

Just like the maternity ward restricts a mother’s movement, the gender center imposes psychological limits. Puberty blockers disrupt the brain’s normal functioning, freezing the mind in place. Real exploration would require the ability to mature, real therapy, patience, and time. These things aren’t easy to find in gender clinics. And why look for them when puberty blockers and cross-sex hormones are being hawked as an easy solution to pain and struggle?

If puberty weren’t disrupted, eventually most patients would make it through naturally.

The puberty blocker leads to the cross-sex hormones. The cascade is now rushing in one direction: concretized trans identity, surgery. And lifelong medical interventions.

The consequences of the cascade:

In both maternity wards and gender clinics, medical professionals disrupt the patient’s normal physiology. Both natural processes are difficult; both involve the loss of control over the body by the brain. A woman can no more will her way out of labor then a teen can will their way out of puberty. And they shouldn’t try. There are consequences, long term consequences, sometimes fatal consequences to the disruption of normal physiology.

Letting go of the idea that we can control everything is key. We cannot control labor, we cannot control puberty, and we cannot control our own eventual deaths. We have human bodies with human processes.

“There are ethical implications if we either withhold information or lead women to believe that they can have a safe, healthy birth in settings and with providers that routinely interfere in the normal, physiologic process of labor and birth.”*

The same holds true in gender clinics.

*Lothian JA. Healthy birth practice #4: avoid interventions unless they are medically necessary. J Perinat Educ. 2014 Fall;23(4):198-206. doi: 10.1891/1058-1243.23.4.198. PMID: 25411540; PMCID: PMC4235054.

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