Some pregnant trans people are minimising contact with health services and choosing to give birth at home due to being misgendered and questioned about their identity in Aotearoa medical settings, a report has found.
The research project, Warming the whare for trans people and whānau in perinatal care, was released today and seeks to understand the need for trans, non-binary and takatāpui inclusive perinatal care.
While some participants reported positive experiences with individual care providers, many struggled with cisnormativity and a lack of recognition of gender diversity in some perinatal care settings.
One non-binary gestational parent said they chose to have a home birth in part because they didn’t want to be misgendered while delivering their child.
Another participant said a surgeon who was about to perform an emergency caesarean section on them said their non-binary pronouns were invalid.
Lead researcher Dr George Parker told the Herald going into the project they knew there was a “huge gap” in the perinatal system for trans people.
“Services were still running on the assumption that service users were women if they were having babies.”
They said whānau in the study came into perinatal care with low expectations because they very often had negative experiences in the health care system.
“So they come in feeling nervous about their care and when that care isn’t experienced as safe and affirming, then they go out of their way to minimise their contact with services.
“If we make perinatal services places that aren’t safe and welcoming, then the trans whānau have less of an opportunity to have quality care and equitable outcomes with cisgender people.”
They told the Herald the study showed trans people were less likely to participate in childbirth education, which has a direct impact on their early years of parenting.
“Most commonly whānau will tolerate negative experiences because they want to make sure that their babies arrive safely. So a bigger concern for us is the hurt that this causes and that it gets our families off to a negative start.”
Parker said the research was important because the health system has a mandate to deliver equitable care to diverse communities.
“No one in our perinatal system should ever feel like they are unsafe in the hands of their carers, that’s unacceptable.”
In phase two of the research they spoke to healthcare professionals and found people wanted to “get it right” but they weren’t given access to education on gender diversity.
“We’re letting our workforce down as well as our whānau when we’re not providing access to that education.”
The wider system was a challenge, Parker said, because inclusive care was resting too heavily on the shoulders of “rainbow champion midwives” and sometimes obstetricians.
“It was so affirming to hear of how transformative care could be when it was provided by perinatal providers largely LMC (lead maternity carer) midwives who champion inclusive practice, they are the leaders in this and they make a huge impact, a hugely positive impact through the care they provide.”
Many participants shared examples of both subtle and overt acts of exclusion throughout parts of their care where they had little autonomy to self-determine their gender, their whānau and their health needs as trans people.
Olly, a trans man and gestational parent, told researchers his lead maternity carer’s practice partner continually misgendered him, “she-ing” him and calling him “mum”.
“Or referring to mums in general and me in that, and it was just a real blow, and especially because I was like, fuck, if there is something going wrong you are not the person that I want, but I felt like I didn’t have a choice.”
Others described the anticipation of entering a service where they were likely to be misgendered if they did not advocate for themselves.
The report, funded by the Health Research Council of New Zealand and Manatū Hauora, recommended healthcare services provide opportunities within the process for trans people to self-determine their gender, words used to describe their bodies, and who is part of their whānau.
“We need providers to go on a journey of reflection about where are the points in service interaction that exclude trans whānau, so do we have physical facilities like bathrooms and signage and information resources and posters that communicate inclusion,” Parker said.
They told the Herald workforces need to have access to education about what it means to provide inclusive healthcare for the trans community.
You can read the full report and its recommendations here.
Katie Harris is an Auckland-based journalist who covers social issues including sexual assault, workplace misconduct, crime and justice. She joined the Herald in 2020.