One of the first lines in my recent acceptance speech for the 2021 Excellence in Leadership & Innovation Award was “I honestly never would have guessed I would have ended up here.” And I meant it, deeply. Here, in that context, meant so much more than the virtual platform at which I, a transgender and nonbinary midwife, stood to accept my award. It meant so much more than the act of receiving an award. Here was having reached a point where loneliness was no longer the most defining feature of my career as midwife. Here was a moment of hope, even as I stumbled over the flood of grief, previously carefully buried, that that hope made space for.

With the launch of a new virtual issue of the Journal of Midwifery & Women's Health (JMWH) focused on health care for transgender and nonbinary individuals,1 midwives find ourselves at a new here. When I started my midwifery education in 2010, JMWH had—in all its history—published only one article on the health needs of transgender and nonbinary people. Now, there is an online collection of JMWH articles highlighting a range of topics specific to providing care for transgender and nonbinary individuals, including gender-affirming care,2, 3 contraception care,4, 5 pregnancy care,6 educational strategies to reduce bias in care provision,7, 8 and primary care.9 Again, I never would have guessed we would have ended up here. That this is possible in a midwifery-focused space is the result of tremendous effort on the part of transgender and nonbinary midwives and our cisgender accomplices. I'm so glad we have made it this far. And, we must recognize that this is a jumping-off point rather than an end point. So where do we go next?

To address that question, I first take a step back to reflect on another notable thing about this issue of JMWH: it is the last issue under the long-standing editorial leadership of Dr. Francie Likis, a midwife and writer whom I count as one of the cisgender accomplices who has been so integral in getting us here. Francie has been a treasured mentor and friend to me throughout my career, and I have been continually heartened to see her bravery and graceful ferocity in advocating for lesbian, gay, bisexual, queer, and transgender and nonbinary communities.

Included in the health care for transgender and nonbinary individuals virtual issue are 2 editorials that Francie has written in the past 3 years regarding inclusive language in the Journal and in the midwifery field.10, 11 In 2018, Francie called me for a chat as she was working on her editorial “Intentional Inconsistency as Gender-Neutral Language Evolves.” I agreed with her that this flexible and measured approach of intentional inconsistency was appropriate to the state of the profession at that time. And I said, “This is good enough for now. But we will soon reach a point where it is not enough, and we will have to do more.” Francie and I had the same conversation about the title of the text Women's Gynecologic Health,12 which is now—to this midwife's delight—simply and accurately titled Gynecologic Health Care.13

My life as a midwife has been sprinkled with such moments of delight and victory. But in the day-to-day tedium and intimacy of my career, I have lived primarily in spaces of good enough. I have settled and I have waited and I have endeavored to carve out little nooks and crannies where my patients from communities underrepresented in midwifery can feel understood and cared for. Then, recently, I had the opportunity to work with a couple of midwives who are both newer to midwifery and newer to articulating their nonbinary identities than I am. Without intentionally setting out to do so, they taught me that in this good enough, I am still operating out of a place of loneliness, fear, and scarcity—the legacy that my nearly 10 years as a midwife has gifted me. If what I had created in the professional space the 3 of us inhabit together was a tiny chain of beautiful islands, they looked at the ugliness of the polluted sea that surrounded them and said this is not enough, this needs to change. And they were right.

The field of midwifery has reached the point of not enough, and we have to do more. In truth we have always been at the point of not enough, but we must now—as a professional community—take accountability for that fact. We must take responsibility for the reality that we simply have not done what is required of us, or we have not done it well, and that the state of our profession is not enough, in so many ways.

It is not enough that there are still midwives and birth workers who insist that gender diversity is pathology and seek to demean and invalidate transgender and nonbinary people's knowledge of who we are as pregnant and birthing people and as parents. It is not enough that midwives are just now starting to really speak about the racism that is baked into our profession, and what it has cost midwives and midwifery patients of color. It is not enough that it is so hard—and often impossible—for patients of color to access culturally concordant midwifery care. It is not enough that fatphobia continues to be a cornerstone of what midwives call “health” or that we continue to both overtly and subtly deny the sexuality and autonomy of people with disabilities. It is not enough that access to safe and legal abortion is being eroded and that some midwives and other health care providers actively advocate for this terrible loss of safety and self-determination.

The here that the midwifery profession is operating within and that we cannot divorce ourselves from—the here in which crash surgical deliveries are performed in the intensive care unit rooms of pregnant people dying of COVID-19, in which Black birthing people are dying at unthinkable rates, in which many of the babies born into our midwife hands will live their lives under constant threat of police violence or hate violence—is not enough. It is not okay. But how do midwives move forward out of this place of pain and violence, taking responsibility from what is ours to attend to and make amends for? How do we face the transition phase of our collective labor?

There are so many answers to that question, and I am not the best person to provide most of them. But in the pages of the new virtual issue and this theme issue focused on gynecologic, sexual, and reproductive health care, my suggestion is: we honor the legacy of openness to change and movement toward justice and nurturing mentorship that Francie Likis has embodied in her tenure as Editor-in-Chief. And we take it further. We do what is required of us. We push the needle forward with courage and tenacity. We use inclusive language. We build a midwifery profession that centers the needs and leadership of those most deeply impacted by health disparities. We create for our patients what we truly want for them and for ourselves. We step back when that is what is needed, we step up when that is what is needed, we show up, we do better, we do the work, we change.

We do what midwives do: usher in the next generation of hope with loving hands and courageous hearts. And then we can discover all the beautiful heres that lie ahead.