Making Obstetrics And AI More Welcoming For Transmasculine Patients

Fenway Health has a proud tradition of helping our clients grow and care for their families. Since 1983, we have been an international pioneer in helping lesbian, gay, bisexual, and transgender people become parents. While transgender visibility and advocacy have increased dramatically in recent years, transmasculine and gender non-conforming people who hope to become parents still face many medical and societal barriers. Fenway Health is teaming up with Boston’s Beth Israel Deaconess Medical Center (BIDMC) to ensure that this underserved population has access to safe and positive pregnancies and childbirth.

“Providing competent care around transgender and gender non-conforming identities is not about some isolated concept; it’s a continuation of general inclusion and diversity practices that help meet the unique individual needs of each patient,” explained Cei Lambert, Patient Advocate for Fenway’s Transgender Health Program.

“All kinds of people make all kinds of families in different ways,” he added. “This subgroup does have particular medical needs around how they make their families, but the idea that somebody would come to parenthood in a new and unique way isn’t a novel concept to many folks working in a labor and delivery department.”

Lambert, along with other staff from Fenway’s medical team and Transgender Health program, has done extensive trainings on transgender issues at BIDMC– our partner hospital where most of Fenway’s pregnant OB/AI patients deliver their babies. These trainings are designed to educate people about what conception, pregnancy, and labor may look like for transmasculine patients, including fertility stimulation and how top surgery may impact the pregnancy or post-pregnancy experience. Ensuring that these patients have sensitive and affirming care from conception through delivery and beyond is a natural continuation of Fenway and BIDMC’s commitments to the highest quality services.

“Parent’s identities are intertwined with their relationship to their children,” said Lambert. “If a parent asks that they be referred to as the father of a child, this wish should be respected, regardless of your perception of the person’s gender. The same goes for someone asking to be referred to as the mother.”

It’s also important to remember that being transgender is only one facet of who a patient is, Lambert added; respecting cultural and religious differences also plays a factor into caring for the whole person. “A transmasculine person may be coming here to carry and deliver a pregnancy, but that’s not all that’s going on with that person,” he said. “There may be preferences culturally or spiritually on how they want their delivery to be carried out.” Lambert stresses that these aren’t all new concepts to health care professionals. “This isn’t outside the realm of understanding. Staff already have the tools they need to provide culturally competent care in so many other ways,” he said. “Transgender cultural competency is just another tool in that box.”

Lambert and the Transgender Health team have outlined a number of steps that can be taken by healthcare providers, as well as doctor office and hospital staff, to ensure the safety and comfort of transmasculine and non-binary prospective parents:

  • Making structural and physical amendments to OB/AI spaces, such as changing the signage to be gender non-specific on patient showers; working to make peripartum, antepartum, and postpartum services gender inclusive; and creating signage for baby cribs and NICU that list “parent” instead of only “mother.”
  • Ensuring that all patient interactions are sensitive and affirming of gender identity by respectfully seeking information about someone’s identity and pronouns, choosing to ask sexual orientation and gender identity questions of all patients; honoring gender non-conforming and non-binary identities, and using gender-neutral pronouns when in doubt.”With language, building a practice of asking people who they’d like to be referred to in general is a really good strategy,” said Lambert. “That philosophy works not just with a transgender patient, but with the general population. Everyone has ways that they identify themselves and are important, and a lot of those identities come to bear when someone is making a family.”
  • Demonstrating a deep understanding of gender identity and how it differs from sexual orientation, including the current understanding and social presentation of transgender and gender non-conforming identities and gender as something that occurs on a spectrum rather than a binary.
  • Training all staff in cultural competency around gender expression and the importance of respecting gender identity in traditionally gender-exclusive spaces, such as labor and delivery. This also includes managing other patients in these spaces who may not be respectful.
  • Offering information on negotiating the legalities of being a transgender parent, such as submitting adoption papers, parental laws regarding reciprocal IVF, and understanding Massachusetts parental laws versus those in other states.

For more information on Alternative Insemination at Fenway, please click here.

For more information on Obstetrics at Fenway, please click here.

For more information on our Transgender Health Program, please click here.