Table 1:
Recommended systems-level and interpersonal-level interventions for trans-inclusive care in and around pregnancy
| Intervention | Audience | |
|---|---|---|
| General principles: | Train and monitor that all front desk staff ask patient’s chosen names, and to respect and document pronouns | Clinic, Hospital administration |
| Train and evaluate that all medical assistant and nursing staff ask patient’s chosen names and pronouns | Clinic, Hospital administration | |
| Discuss with clinic and hospital administration the need for transgender and gender diverse -inclusive sexual orientation and gender identity (SOGI) training and data collection for patient medical records | Clinic, Hospital administration | |
| Encourage all health care providers to attend focused trainings on transgender and gender diverse -inclusive health care and clinical practices | Medical providers | |
| Provide information and assistance to support changing and updating legal documents to reflect patient’s gender identity.25 | Social work, Legal administrators (e.g., DMV, medical records personnel, durable power of attorney) | |
| Improving the clinical environment: | Work with clinic and hospital to implement welcoming environment to diverse patient populations (e.g., display trans-inclusive signage and flyers in the clinic) | Clinic, Hospital administration, Building supervisor |
| Discuss the use of gender-neutral language for spaces, consider names such as “Sexual and Reproductive Health Center” versus “Women’s Health Center”26 | Clinic, Hospital administration | |
| Offer all-gender restrooms in clinic and hospital | Clinic, Hospital administration, Building supervisor | |
| Preconception: | Regularly discuss patient’s reproductive desires informed by a reproductive justice framework for full spectrum contraception, abortion, and family-building | Medical providers |
| Do not assume reproductive desires based on sexual orientation, gender identity, gender expression, sex assigned at birth, or family configuration | Medical providers | |
| When discussing hormone therapy consider medication effects on fertility; ask about current and future fertility desires before initiating gender-affirming hormones or puberty-suppressing medications | Medical providers | |
| Providers and staff can consult Transline: Transgender Medical Consultation Service https://transline.zendesk.com/hc/en-us or reference the growing numbers of clinical resources27, 28, 29 for assistance with clinical questions regarding transgender health care | Medical providers, Hospital and clinic staff | |
| Pregnancy: | Offer training to enhance environment sensitivity, equity, and inclusion for people of all genders among all staff in outpatient and inpatient settings who may encounter patients during pregnancy | All staff who may encounter patients in outpatient and inpatient settings (e.g., health care providers for the prenatal patient and the infant, nursing staff, clerical staff, birth certificate office staff, radiology technicians, janitorial staff, meal service staff) |
| Train sonographers regarding difference between sex and gender and use of gender-neutral language during ultrasounds for patient and fetus | Sonographers and other ultrasound clinical staff | |
| Prepare staff to offer patients psychosocial support if they experience gender dysphoria due to pregnancy or change in hormone therapy (body changes, more difficulty passing or being misgendered) | Social work, Hospital and clinic staff, Mental and Medical Health providers | |
| Routinely ask about patient experiences navigating the health care system with referral for necessary social work support | Social work, Medical providers | |
| Approaching delivery: | Offer tour of labor and delivery unit prior to delivery in order to orient to the space and ideally meet staff beforehand | Health educators, labor and delivery staff |
| Offer to speak with birth certificate office to ensure that preferred titles and names are written on the birth certificate document (e.g., able to list 2 fathers, or people with non-binary genders) | Birth certificate office | |
| Offer labor, birth preparation, and infant care preparation workshops with workshop facilitators trained in transgender and gender diverse inclusivity | Health educators | |
| Discuss contraception options using shared decision-making, consider future fertility desires | Medical providers | |
| Intrapartum: | Refer to patient by correct pronouns during labor (e.g. referring to “parental heart rate” instead of “maternal heart rate”) | Medical providers and labor and delivery staff |
| Offer capacity for non-gendered tracking of children on the labor and delivery suite and nursery (e.g. Baby Smith instead of Baby Boy Smith) | Labor and delivery, nursery providers and staff, lactation consultants | |
| Post-partum: | Offer support for informed infant feeding including options for chestfeeding and formula feeding.30 | Medical providers |
| Ensure that hospital providers and staff are aware and supportive of patient’s desire to chestfeed and of safety of chestfeeding | Labor and delivery, nursery providers and staff, lactation consultants | |
| Counsel about contraception options in the context of future fertility desires and future plans for hormone therapy | Medical providers | |
| Counsel that progestin-based contraception, including the IUD and implant, are not thought to interfere with masculinization (some may enhance androgen activity), and can be used in transmasculine patients | Medical providers | |
| Ensure social support in caring for infant and in post-partum recovery | Social work, Medical providers | |
| Counsel about anticipatory guidance re: post-partum depression | Social work, Medical providers | |
| Discuss desire to restart hormone therapy, coordinate with desired timing and duration of chestfeeding | Medical providers |