Inclusive clinical practices improve obstetrical care of gender-diverse patients

Adjusting clinical practices to promote inclusive patient care and interactions is essential in providing appropriate obstetrical care to gender-diverse people, according to a presentation at The Pregnancy Meeting.

“Pregnancies among people who are transgender and gender-expansive are common, and if we ask our patients about their gender identities, we’re going to find that we’re already taking care of these people,” Justin Brandt, MD, assistant professor at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, said during his presentation.

Despite how common transgender and gender-expansive (TGE) people are in the OB/GYN setting, a 2017 study of EDs reported that the main problems encountered by TGE patients were lack of provider sensitivity and training about the TGE population.

“How can we improve provider sensitivity?” Brandt asked. “The answer to that is creating a culture in our health care settings that affirms the sexual and gender identities of all people.”

Creating a positive experience for patients begins before they meet with a doctor and must be inclusive on all levels.

“We need to train and empower all staff who interact with patients on the appropriate ways to ask about names and pronouns,” Brandt said. “Not just the patient-facing staff but everybody that a patient may encounter. From the moment [patients] enter the system, [staff] need to know how to talk with patients and to be inclusive.”

Brandt highlighted ways to improve TGE people’s experiences with routine clinical care — proposed by Heidi Moseson, PhD, MPH, and colleagues in 2020 — such as:

• asking patients for their preferred name and pronouns vs. only their legal name;
• having clinic staff introduce themselves using their pronouns;
• asking how patients prefer to refer to their body parts;
• asking about sexual partners’ gender(s) and body parts; and
• using gender-neutral terms to describe routine clinical care.

Additionally, images and signage that represent everyone who may be seeking care should be present in clinics, as well as clearly posted nondiscrimination policies.

As for training OB/GYNs on providing appropriate care to TGE people, there is “still a long way to go,” Brandt said.

An anonymous survey conducted by Jennifer M. Burgart, MD, MS, and colleagues found that “half of OB/GYN residents indicated that they were having transgender education as part of their educational curriculum, but just about half reported that they had not ever taken care of transgender people,” Brandt said.

“Acknowledging the lack of exposure is really important if we are going to work on fixing the problem,” he continued. “This is so important because surveys of transgender people show that they often have to teach their physicians about their medical needs.”

Ultimately, the way to overcome barriers to TGE people’s obstetrical care is to normalize gender-neutral clinical care and patient interactions.

“Transgender and gender-expansive people have unique needs, but much of their obstetrical care is routine,” Brandt said. “By getting more comfortable in this space, we demystify the complexities, and what we’re left with is a lot of routine prenatal care.”

References:

• Burgart JM, et al. Transgend Health. 2021;doi:10.1089/trgh.2020.0018.
• Chisolm-Straker M, et al. Transgend Health. 2017;doi:10.1089/trgh.2016.0026.
• Moseson H, et al. Obstet Gynecol. 2020;doi:10.1097/AOG.0000000000003816.