E tūtaki ana ngā kapua o te rangi, kei runga, kei runga te Mangoroa e kōpae pū ana || The clouds in the sky close over, but above them spreads the milky way

Supporting Rainbow Community Families

During Pregnancy, Birth, and Early Parenting

Supporting Rainbow Community Families

Many people have a capacity and a desire to become pregnant, and some of these people are transgender or gender-diverse. There can be little support for those in the Rainbow/LGTBQIA+* community who are interested in conception, becoming pregnant and early parenting. Transgender and gender-diverse people also face stigma and discrimination navigating the healthcare system.

Because queer, gender-diverse or trans people can be more prone to having mental health issues, either from their gender identity journey, or a history of being mistreated or disrespected, the journey into new parenting can exacerbate already existing mental health issues. This can happen regardless of whether someone is hapū or is the birthing partner, because parenthood is an additional significant life change, and it is important everybody receives gender inclusive appropriate perinatal healthcare.

*LGBTQIA+: Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and/or Questioning, Asexual and/or Ally

Support for Queer Families with Postnatal Depression

By queer, we mean any lesbian, gay, bisexual or trans-gendered parent. This is an all encompassing term that the authors have carefully considered and believe to be an appropriate term. Sometimes being a lesbian, gay, bisexual or trans gendered parent can feel like a pretty invisible position. It’s easy for people to make the assumption that because you have a baby, you are in a heterosexual relationship. The transition to becoming a parent is also rife with different kinds of issues, which may present more challenges along the way.

Conversely, becoming a queer parent may be a great opportunity to become more comfortable with your own identity, to connect more with your family of origin and to get lots of positive feedback from other people about what a great parent you’ll be. There is not a lot of research out there, but what research has been done suggests that lesbian mothers may experience slightly higher rates of symptoms of post-natal depression. Importantly, this research also suggests that there might be different kinds of reasons involved.

Go to our page: Queer Families and Postnatal Depression

Transgender and Non-Binary for Health Professionals

Resources to support families in the rainbow community

Transgender Parents PADA Resource
From data sourced from Aotearoa New Zealand, it is likely that transgender and non-binary parents make up about 1% of the postpartum population at present. It is anticipated this number will continue to increase with time. This is because the social stigma associated with being transgender or non-binary is continuing to decrease, and more people are feeling safe to identify and be open about being transgender and non-binary.

The increase in social acceptance of people whose gender differs from their assigned sex at birth has also led to increased awareness and access to gender affirmative care and fertility preservation for transgender and non-binary people. This means that more people feel safe to medically and socially transition, and there is greater access to support services to help them make this transition.

A helpful comparison to this increase in transgender and nonbinary visibility is the incidence and visibility of people who are left handed. In the early 20th century there were very few left handed adults as children were discouraged from using their left hand due to religious beliefs. As these beliefs changed and children were allowed to use their naturally dominant hand without punishment the number of left handed adults grew from around 2% in the early 20th century, to sitting around 12% for the last sixty years.

As children are allowed to explore their gender identity more freely, we will likely see the number of transgender and non-binary adults continue to grow over the next several decades.

Transgender and Non-Binary for Health Professionals

What does being transgender and non-binary mean?

Transgender and non-binary are both umbrella terms – transgender refers to people who identify with a gender different to the gender usually associated with their assigned sex at birth. They may have received affirmative medical care such as surgery or hormones to live comfortably within and help others perceive their true gender.

Not all transgender people receive gender affirming health care and many face significant barriers accessing broader health care as well. Non-binary refers to somebody who does not feel they fit within the binary ideas of ‘man’, or ‘woman’, but rather both, or somewhere in between. Non-binary is not a third gender and isn’t a synonym for androgynous. Some non-binary people also identify as transgender, and some transgender people also identify as non-binary.

The best way to know how somebody identifies, and what pronouns they use is to ask them – you can’t know somebody’s gender or pronouns just by looking at them.

Transgender and Non-Binary for Health Professionals

Resources to provide support for families

Supporting Transgender and Non-Binary Parents

PADA Resource – Supporting Transgender and Non-Binary Parents

 

Download the free resource Supporting Transgender and Non-Binary Parents. If you would like any hard copies of this, please email [email protected].

Watch: Inclusive practice with non-binary and gender diverse people in the perinatal period

“Because gender queer, gender diverse and trans people are already more prone to having mental health issues, it’s a proven fact that when you enter in to parenthood, those things are exacerbated” – DK

A short video for clinicians working with non-binary and gender diverse people in the perinatal period.

Thank you to the Rule Foundation for funding to create this video.

Transgender and Non-Binary for Health Professionals

Increased risk factors for transgender and non-binary people

Transgender and non-binary people already have higher rates of mental illness compared to the cisgender population. Being transgender or non-binary is not a mental illness in itself. One of the main reasons for this is minority stress; in which the stress of living in a society that discriminates against, devalues, or denies the existence of one’s identity leads to poorer health outcomes. Counting Ourselves Survey (2019) shows that transgender and non-binary people have significantly higher rates of self harm, suicidal ideation, depression, anxiety, eating disorders, and other mental distress. 48% of LGBTQI+ people in Aotearoa New Zealand feel that they can cope with the stress of everyday life – this is in comparison to 86% of the general population. *Page 48 of Counting Ourselves

Pregnancy, birth, and postpartum can make mental health conditions worse for transgender and non-binary people

There are many overlapping factors that can make pregnancy, birth, and postpartum stressful for transgender and non-binary people. This includes increased dysphoria with their changing body, hormone changes including having to stop hormone therapy, previous medical or sexual trauma, and lack of inclusive care from their care providers. This may include having to use perinatal healthcare services that are designed for cisgender people (for example language, posters, resources, and signage that assumes that all pregnant people are women), misgendering, and care providers without adequate knowledge about transgender and non-binary peoples’ care needs.
Transgender Pregnant Person PADA Resource

Remember, you don’t have to get it perfect every single time.

Transgender and non-binary people report that knowing that their care provider has authentic and good intentions, and are aware of the limits of their knowledge is helpful to establishing a respectful relationship. Sometimes you’ll get it wrong, if you do, a quick apology and making sure you don’t repeat the mistake is all you need to do.

Transgender and Non-Binary for Health Professionals

How healthcare providers can help

Care providers can help alleviate mental distress during pregnancy, birth and postpartum for transgender and non-binary people.

As a care provider there are plenty of things you can do to be aware of transgender and non-binary people’s increased risk for perinatal mental distress, to minimise that distress, and to help them to seek support when necessary.

Create a welcoming environment

This includes considering whether you have gender neutral toilets, ensuring you ask your client their pronouns and their name (the name they use may be different to their legal name) and are careful to use these correctly. Avoid asking invasive questions that are not relevant to their pregnancy, birth, or postnatal care. Be mindful of the language you use in documentation that may be inherently gendered, for example the term “maternal health,” is gendered, instead you might use “perinatal” or “parental health.” Ask your client what language they prefer to use to refer to parenting terms (ie mum, dad, baba, mama, papa,or something else), what language they use to refer to their breast tissue and genitals, and what language they use to describe their identity (eg agender, transgender, nonbinary, takatāpui, bigender, transmasculine, transfeminine).

Provide trauma informed care

Many transgender and non-binary patients have prior traumatic experiences both sexually and with other forms of violence and abuse, and within health services. This means engaging with health services, particularly in relation to reproductive health, can be traumatic. Asking parents what support they might need throughout the duration of their care, and taking a trauma informed approach to sensitive topics and examinations such as breast/chest or internal vaginal examinations can lessen the impact of this trauma.

Advocate for the person in your care

If you are the primary care provider for a transgender or non-binary parent, your role as an advocate when they are engaging with other healthcare services or providers is vital. With permission of the parent, informing other services about their pronouns, name, identity, and any specific considerations for their care when making a referral or consultation can help ensure they are not misgendered or otherwise retraumatised by allied health professionals. Do not assume that the pronouns and identity described in correspondence from other health professionals, or file notes about your patient, will always be accurate.

What the numbers tell us

Percentage of LGBTQIA+ people in Aotearoa New Zealand feel they can cope with the stress of everyday life:

48%

Percentage of the general population in Aotearoa New Zealand who feel they can cope with the stress of everyday life:

86%

Educate yourself about the specific needs of the transgender and non-binary community – each person in your care will have different needs, desires, and expectations.

Some things to discuss and consider with your clients are:

  • How do they intend to feed their baby, will they need to see a lactation consultant for support after top surgery induced lactation, co-feeding, or using a supplemental nursing system?
  • Who are their support network and does this differ from their biological family?
  • What are their intentions for future fertility and gender affirmative healthcare? Eg. will they need support to continue lactating while restarting testosterone therapy, or will they need contraception since testosterone is not a contraceptive?
  • Due to pre-existing trauma from health care, transgender and non-binary people may prefer to birth in a nonmedicalised setting. Consider whether you can support them to have a non-hospital birth, and if not, how you can advocate for them in the hospital environment.
  • Do they have specific requirements about how the sex/gender of their baby will be talked about?
  • Does the non-birthing parent/s have specific requirements to support their inclusion in care
  • Are existing childbirth education options safe and inclusive for trans and non-binary parents?
Transgender Person PADA Resource
The best way to know how somebody identifies, and what pronouns they use is to ask them – you can’t know somebody’s gender or pronouns just by looking at them.

Transgender and Non-Binary for Health Professionals

If you are concerned about a transgender or non-binary parent

Transgender and non-binary parents have the same access to the same support systems as cisgender parents, however these services may not be appropriate for them.

Here are a list of organisations who will be able to help.

Rainbow Mental Health

Resources on supporting rainbow people in Aotearoa’s mental health settings! A practical guide for any mental health professionals who provide mental health support in Aotearoa, including (but not limited to) counsellors, psychologists, psychiatrists, psychotherapists, tohunga (Māori healers), social workers, mental health nurses, and GPs. It will also be helpful for youth workers, group facilitators, and peer supporters.

The Professional Association for Transgender Health Aotearoa (PATHA) An interdisciplinary professional organisation working to promote the health, wellbeing and rights of transgender people. We have over 200 members who work professionally for transgender health in clinical, academic, community, legal and other settings. Read more: Guidelines for Gender Affirming Healthcare (2018 – New Zealand)

Gender Minorities Aotearoa has a database of transgender and non-binary friendly care providers including general practitioners, psychologists, and psychiatrists.

Gender Minorities Aotearoa PADA Transgender Resource

OUTLine NZ can provide funded counseling services to LGBTQI+ people coming to terms with their gender or sexual identity, and other issues including mental distress that may be of concern. They have a free number staffed by volunteers 0800 OUTLINE (0800 688 5463)

OUTLine NZ PADA Transgender Resource

The Trans Pregnancy Care Project

The Trans Pregnancy Care Project is an 18-month study funded by the Health Research Council of New Zealand. The project is led by a team of trans, non-binary, takatāpui and cisgender researchers and community members.

Academy for Breastfeeding Medicine Clinical Protocol #33: Lactation Care for LGTBQIA+ People

Lactation/breastfeeding/chestfeeding: Pregnant people and parents who identify as LGBTQIA+ need access to non-traditional lactation supports that may be unfamiliar to healthcare providers. The Academy of Breastfeeding Medicine (ABM) seeks to provide guidance to those caring for individuals who identify as LGBTQIA+.

Glossary of terms

Transgender
An umbrella term for people whose gender identity and/or gender expression differs from what is culturally typically associated with the gender/sex they were assigned at birth.

Non-binary
Preferred umbrella term for all genders other than female/woman/girl or male/man/boy’

Agender
One who feels neutral in their gender or who rejects the influence of gender on their person. Sometimes the term ‘nongendered’ is used similarly.

Takatāpui
A te reo Māori term that has been embraced to encompass all Māori who identify with diverse genders, sexualities or who are born with variations of sex characteristics. Takatāpui describes the weaving together of a person’s taha Māori and rainbow identity/ies.

Cisgender
Cisgender people identify more or less with the gender/sex assigned to them at birth

Deadname
The birth name of a transgender person who has changed their name as part of their transition. Using somebody’s deadname should be avoided.

Chestfeeding
A neutral alternative term for ‘breastfeeding’, for people who feel the term ‘breast’, is gendered and/or not representative of how they feed their baby. Read more here.

Gender dysphoria
Clinical term referring to dissonance between one’s assigned gender and/or body, and their personal sense of self. Dysphoria can be heightened by both internal/physical processes, such as menstruation, and social and environmental factors, such as being misgendered

Gender affirmative care
Medical care that affirms somebody’s expressed gender, which differs from their sex assigned at birth. Examples include hormone replacement therapy, surgical intervention, or simply affirming a person’s gender by using their chosen name and pronouns.

Other Resources

Read more about the basic principles and understandings of trauma informed care and for information within an Aotearoa context.

Statistics come from Counting Ourselves, an anonymous community-led health survey for trans and non-binary people living in Aotearoa New Zealand.

Resource and content authored by Lou Kelly (they/them), Registered Midwife. Photos from Huriana Kopeke-Te Aho and The Gender Spectrum Collection