Pregnancy, birth, and gender: a starting point for midwives
Midwives provide care for all pregnant people across the childbearing continuum. Pregnant members of trans, non-binary, and gender creative* communities require person-centred, gender affirming care that preserves the safety of them and their baby.
Experiences of discrimination, hostility, and inequitable treatment in healthcare services may lead pregnant people to distrust midwives and perinatal services, or even avoid them altogether (MacDonald, 2016; Bachmann and Gooch, 2018). Midwives need to adapt their practice when working with trans, non-binary, and gender creative people to ensure they are appropriately supported throughout pregnancy and birth (Charter et al, 2018).
MAMA Academy is taking our first steps to learning how to empower midwives to adapt their practice when providing individualised, person-centred care. We are committed to learning how to inform expectant trans, non-binary, and gender creative parents about stillbirth prevention methods to help more babies arrive safely.
This short resource is intended for midwives with no known experience of working with trans, non-binary, and gender creative pregnant people, and is a starting point only. Additional support should ideally be provided by Gender Inclusion midwives (where available) and/or midwives with relevant knowledge and experience.
What to do when a pregnant person…
Shares their gender identity.
Almost 1 in 5 trans people (18%) have not told anyone about their gender identity when seeking medical care (Bachmann and Gooch, 2018). If a pregnant person shares their gender identity with you, this decision is courageous and should be treated with sensitivity, respect, and confidentiality. Thank them for sharing and offer to document their gender identity on their care records. Please note that documentation should be an offer only, and information shared should only be recorded with informed consent. Some people may feel comfortable sharing their gender identity with a small number of well-known and trusted care providers, but may not feel comfortable disclosing this information to all staff who can access their records.
Communicates their pronouns.
Correctly using pronouns shows respect, validates someone’s gender identity, and helps them feel safe in your care. If you do not know how to use their pronouns, ask for an example. Make clear you will try your best and invite them to correct you if mistakes are made. If corrected, thank them, apologise for your error, repeat what you have said with their pronouns used correctly, and move forwards with the conversation. It is good practice to sensitively ask all service users their pronouns when first meeting them and learning their name. It is also polite to offer up your own pronouns too. Correctly guessing a person’s pronouns based on their presentation alone is not possible, and by sharing your own pronouns you can demonstrate recognition of this fact.
Asking how to proceed with other gendered language is vital for providing safe and individualised care. How do they want to talk about their body? Infant feeding? Which anatomical terms should be avoided and how can adaptations be made? How do they want to be called as a parent? Use this language and document their preferences, if they give informed consent and are happy for you to do so.
Attends a clinic, Children’s Centre, or hospital.
Where possible, book them onto a continuity of carer pathway. Building a trusted relationship with a known midwife removes the need for repeatedly sharing personal information with unknown individuals, as well as maximising opportunities for affirming and empowering perinatal care. Keep the multi-disciplinary team as small as possible, making sure that referrals are only offered where clinically necessary and of benefit to the pregnant or birthing person.
Ask where they would like to receive perinatal care. Maternity settings can be heavily gendered environments, and a trans, non-binary, or gender creative pregnant person may feel safer receiving care at home. When receiving care in a hospital or Birth Centre, offer them private or side rooms, with en suite bathrooms where possible. Just as with documentation of gender and pronouns, this service is optional, not mandatory. Make sure that all areas where care is provided have bathroom options for men and non-binary people, as well as women. Provide sanitary disposal facilities in all bathrooms.
* Terms an individual may use to communicate their gender identity also include (but are not limited to) gender non-conforming, gender diverse, gender atypical, genderfluid, gender expansive, and genderqueer.
Reference list and further learning
Gender inclusion resources provided by Brighton and Sussex University Hospitals NHS Trust (now University Hospitals Sussex). Available online at: https://www.bsuh.nhs.uk/maternity/our-services/specialist-support/gender-inclusion/.
Barker, J. (2018) A deal with the universe. BFI Player.
Finlay, J. (2010) Seahorse: the dad who gave birth. BBC, Vimeo.
Sakula-Barry, G. (2020) Our baby: a modern miracle. Channel 4, 4OD.
Bachmann, C. and Gooch, B. (2018) LGBT in Britain: health report. Available at: https://www.stonewall.org.uk/system/files/lgbt_in_britain_health.pdf.
Bainbridge, A. and March, R. (2021) ‘Gender identity: student midwifery beyond the binary’, The Student Midwife Journal, 4(2), pp. 18-21.
Barker, M. and Scheele, J. (2010) Gender: a graphic guide (London: Icon Books).
Brown, J. (2019) Queer and pregnant: a pregnancy journal (Philadelphia, PA: self-published).
Charter, R. et al (2018) ‘The transgender parent: experiences and constructions of pregnancy and parenthood for transgender men in Australia’, International Journal of Transgenderism, 19(10), pp. 64-77. doi: 10.1080/15532739.2017.1399496
Hagger-Holt, S. and Hagger-Holt, R. (2017) Pride and joy: a guide for lesbian, gay, bisexual and trans parents (London: Pinter and Martin).
Macdonald, T. (2016) Where’s the mother?: stories from a transgender dad (Winnipeg: Trans Canada Press).
Resource created by student midwife Ash Bainbridge [they/them] with support from Gender Inclusion midwife Ash Riddington [he/him] and doula Leah Digby [she/they].