Creating change with families: reflections and recommendations for the care of gender diverse and LGBTQIA+ individuals and their families throughout pregnancy and birth

Objective
To derive a deeper understanding of transgender and non-binary people’s experience pregnancy and birth, and ways to improve practice to provide inclusive care.

Design
Two case study reports describing two participants journey who received pregnancy and birth care through a Midwifery Group Practice program.

Setting
A large tertiary hospital in the Norther Suburbs of South Australia with approximately 3800 births per annum.

Methods
Qualitative interviews utilising open-ended semi-structured face to face interviews were undertaken in May 2021. Interviews were audio recorded and transcribed verbatim to analyse and identify themes.

Findings
Both clients feared being misgendered within pregnancy care services. They appreciated the constancy of the Midwifery Group Practice midwife which meant they did not have to repeat their history to multiple health care providers. They appreciated their pronouns being documented on case notes and welcomed staff attempts use their preferred terms. Both felt the pregnancy care environment was focussed on cisgender females and found this alienating. They appreciated the midwife’s suggestion that the cot card for their baby did not have to be pink or blue. They both made suggestions for staff to use more gender neutral language and resources when providing pregnancy care.

Key Conclusion
Staff attempted to support these parents, and this was appreciated by these parents, but the continuity provided by the Midwifery Group Practice model was valued by both, regardless of risk status. It was identified that further education for staff was required to provide more inclusive care.

Implications for Practice
The case studies identified a need for greater awareness and education for staff. Simple adjustments had a big impact. Further research is needed to identify how best to meet the needs of gender-diverse people and address the educational needs of staff.

Highlights
Continuity of midwifery care was integral to the experience of these clients. Small adjustments to clinical practice had a big impact, although rigid systems within the service, which would require major rethinking and investment were also identified. This study highlights the need for staff education regarding care for people who are non-binary or transgender.