Unfortunately, it is rife with layers of issues. Being someone who would be two-spirit, transgender, gender-diverse, or part of the 2SLGBTQQIA+ community is already difficult. If you then layer on being indigenous, that's only going to become more difficult. The indigenous experience in health care has traditionally been extremely difficult. Combining that with something that's already difficult, as well, would make it, unimaginably, almost impossible.
The idea of being two-spirit is something that is very foreign to most health care providers. They often associate that with being gay, bisexual, or something, and it's just a totally different thing. It's sacred; it's spiritual, and an understanding of that would probably increase the ability to seek gender-affirming care. However, especially if you're in a rural or remote community, it's going to be almost impossible to do that.
In regard to your first comment about having access to birthing services, yeah, it's a decision between bringing your midwife, your doula, or your child, and which child do you choose if you have several? Do you bring your partner, or does your partner look after them? Hopefully, there are elders in the community. There are just layers of having to decide who to have with you.
Mr. Shields was speaking about having a navigator with you. Having a navigator is great, but so is having family, and having just one person is not enough when.... I'm sure many folks here have been around people who have given birth. You're allowed to go to the hospital. It's easy. You drive over, you go, and you get to see the baby. It's incredible.
That doesn't happen for the majority of indigenous people who give birth and have family members. They have to wait until they fly home. Flying is already traumatic for some folks, but never mind with a newborn, so the layers and layers of barriers just continually keep coming up.