Kristin Liam Kali is a Seattle-based certified licensed midwife who directs MAIA Midwifery & Fertility, a West Seattle fertility and parenting clinic that specifically caters to LGBTQ+ clients. In their new book, “Queer Conception: The Complete Fertility Guide for Queer and Trans Parents-To-Be” (Sasquatch Books, 2022), Kali distills the knowledge they’ve gained over 25 years of experience as a health care provider and advocate for queer and trans parents into a book filled with detailed information about fertility, family planning and parenthood.
Fertility and family planning is often catered to straight, cisgender, monogamous couples; Kali illustrates that queer and trans parents and parents-to-be have different needs and perspectives that need to be taken into account. The Seattle Times spoke with Kali over the phone about building a queer midwifery practice, navigating the process of becoming a parent and the meaning of midwifery. This interview has been edited for length and clarity.
How did you found MAIA, and what was the process of building a queer midwifery practice here in Seattle?
MAIA Midwifery has actually been in existence since the early 1990s. It was started by another midwife. I took over the practice in 2006, and we were located in the Bay Area at that time. But I had been living in Seattle and went through midwifery school here and so when I moved back to Seattle in 2014, I established the practice here. We continue to be the only midwifery practice in the country that specializes in queer conception. And among fertility practices especially, we’re really the only ones doing what we do, and have been leaders in the field since the early ’90s.
You write in the book that queer conception is about making parents even more than it is about making babies. Can you talk about the importance of that framing?
Speaking from a midwife’s perspective, midwifery is hard work, long hours and low pay — your heart has to be in it in order to keep doing it. Some midwives approach midwifery from a perspective of being focused on the baby and wanting babies to have a gentle entry onto the planet. Other midwives are really about the parent and what it is to become a parent, and I’m definitely in that latter category. There is so much richness to that transformation of identity and that major life transition that it is to become a parent. The individual personal growth, the growth that happens among couples or however many parents there are in a family. When you walk alongside someone who’s going through that process, it doesn’t take long to recognize that the human development that’s occurring is deep and rich and utterly transforming. So I’m midwifing that transition.
Culturally, the culture is so focused on the baby. Even with the current fight for bodily autonomy and choice around pregnancy, the anti-choice folks are so focused on the fact that it is the beginning of a baby. It’s a massive personal experience that impacts and affects you on all possible levels. There’s nothing about who we are as humans that doesn’t inherently intersect with who we are as parents. To be so baby-focused completely erases the enormity of that experience. I want to bring people who are going through the experience to that realization that they’re not just having a baby, they’re actually becoming a parent.
Ultimately, it’s about building people up and giving those deep elements of affirmation all the way through the process, even for somebody who picks up the book and is just considering being a parent one day.
How do you approach helping your clients navigate the often substantial financial costs of queer conception, birth and parenthood?
Everything I do is about trying to make it not so expensive. Having this book out in the world so that everyone has access to this information without having to pay me for an individual consultation is one way. When you go into a fertility clinic, not only is everything going to be at a maximum price level, but they also will often order labs that don’t actually pertain to your clinical situation, or offer treatment that may not even be the best treatment for a healthy person simply going through donor insemination.
In a clinic model, if your body doesn’t ovulate in the pattern that they’re expecting it to, then you could be literally flushing money down the drain every single month wasting that sperm that you paid for, all of the ultrasounds and the appointments and if the sperm and the egg aren’t there at the same time, then no pregnancy is going to occur. The other thing to mention here is that some people are trying to circumvent the cost by finding a donor who’s somebody they know and just using that sperm. But again, you’re talking about being connected to this person for life in a situation that could be legally very tricky and does present clinical risk. And folks in that situation actually are often refused care by virtue of using fresh sperm from a known donor. So, the care that I provide for families that are conceiving with a known donor, and what I outline in the book around conceiving with a known donor, gives people the care they need when they need it at the lowest possible cost, for ensuring physical safety and long-term integrity of the family.
Who do you hope will read this book, and what do you hope readers will take away from it?
I just hope that it supports families on every level. I hope that it makes the process of becoming parents easier, I hope that it shores people up for what it is to walk through a cis-heterocentric world as a queer trans person having a child. I hope that the seeds planted by this book carry forward the idea of what it is to really go through this transformation from conceiving to pregnancy and recovering from birth and parenting the baby. And I hope that it gives midwives and any other type of care provider who will pick it up tools to do better by our families, to care for us in a way that is not only more clinically astute but helps give providers a mindset of how to actually center queer and trans families in our experience. Ultimately through all those things, I hope that this book really raises the platform of what we expect for ourselves as queer and trans families and what we expect from our care providers.