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Understanding midwives’ perspectives about trans inclusion in perinatal care in Aotearoa New Zealand: A national survey

Abstract:

Background: As awareness of the possibilities for trans people to attain parenthood grows, trans, non-binary and other people with diverse genders are increasingly accessing perinatal care as part of their family-building journeys. International literature confirms that midwives can feel clinically challenged by, and poorly prepared for, working with pregnant trans people, but also that they are motivated to provide high quality care and desire professional support to do so. This two-phase study included interviews with trans people who were or had been pregnant, and/or whose partners were or had been pregnant, which informed the development of a nationwide perinatal care workforce survey. Aim: Phase Two aimed to identify current practice relating to inclusion, and the knowledge, beliefs and education needs of the perinatal care workforce in relation to working with pregnant trans people. Method: An online nationwide survey of perinatal care providers was undertaken in 2022. Data were collected through single- and multi-response questions, Likert scales and open-ended text boxes. Analyses included descriptive statistics and content analysis of open-text responses. Results: Of 476 respondents, this paper reports only the midwives’ responses (67%; n = 317). Fewer than 25% of midwives recalled receiving any specific education about providing culturally safe care for trans people, but most (78%) identified interest in accessing education if it were made available. Midwives are knowledgeable regarding some clinical aspects of gender affirming care, e.g., the effects of hormone therapy on fertility, but we identified some knowledge gaps. Most articulated positive attitudes towards caring for pregnant trans, takatāpui and intersex people but a minority raised concerns about what they perceived as the ‘erasure of women’ within wider efforts to be inclusive. Many noted workforce pressure as a barrier to progressing change. Conclusion: Some midwives are already implementing inclusive practices, primarily led by Lead Maternity Carers (LMCs) who champion affirming and inclusive community-based care. Ensuring that trans people and whānau can anticipate consistently affirming care when they engage in services beyond their LMC, particularly during hospital-based care, needs prioritisation as a workforce development strategy. To date, midwives have not been well prepared to provide inclusive care to this community, but they are willing to engage in education to support affirming and inclusive practice.

10.12784/nzcomjnl.256102

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gender diversity, midwifery education, non-binary, transgender, workforce development