Monash Health is recognising International Day Against Homophobia, Biphobia, Interphobia & Transphobia (IDAHOBIT) on 17 May. For the occasion, we sit down with Jessica (Jess) Ellwood, Clinical Midwife Specialist to learn about working with LGBTIQA+ patients and their families (rainbow families) through their pregnancy journeys.
Jess primarily supports Adolescent patients in the Adolescent, Drug and Psychological Pregnancy Team (ADaPPT) with Monash Health Women’s and has for almost four years now.
“We care for mums under the age of 20 and for mums that have intellectual disabilities. On top of that, there are the filters of mental health, substance use, child protection and gender diverse families, all within that as well.”
Jess and her colleagues have supported two transgender patients and three non-binary couples since 2019. Their first gender-diverse patient was a transgender man going through pregnancy and birthing for the first time.
“On that first phone call, we just said, ‘On the GP referral, it says that you identify as he/him and this is your preferred name?’ By asking that and not assuming, he instantly felt trusted and listened to.”
“This community is extremely marginalised and has a lot of stigmatisations. We’re lucky because the core of our skills in this role is we’re able to make people feel comfortable quickly which ensures that people feel safe to be open and honest with us. We have those communication skills.”
“We knew that the staff wanted as much education as possible to make sure that the patient felt safe. Because giving birth is one of the most vulnerable times for any human being, regardless of if you identify as male, non-binary or female.”
“Within our team, there are three of us working in this role which ensures continuity of care and we can build therapeutic relationships so our patients can trust us. In turn, we can give them the most up-to-date evidence as to how it affects them and their baby in pregnancy and link them in with the relevant support networks within the community.”
Up until now, Jess and her team lean on resources from Monash Health Gender Clinic, Victorian Pride Centre and Rainbow Families to support their LGBTIQA+ patients and review their own practices. For their first gender-diverse patient in 2019, they were able to connect him with a previous patient who was also a transgender man that had given birth 8 years ago, thanks to a contact from the Gender Clinic.
“It was interesting to hear his story and about his care, what worked and what didn’t work. He was very kind to then reach out to our patient.
“It was nice to give that community feel to our patient because he hadn’t come across anyone who was transgender having a baby.
“We’re lucky because we work collaboratively. Knowing the right people to call can be helpful.”
Since caring for the transgender patient in 2019, Jess and the maternity team have been able to reflect and consider more openly when caring for rainbow families.
“Pregnancy is a time when they’re a lot of changes. In the beginning, he was happy to be breastfeeding and wanted his vagina to be called a birth canal. So that’s what we put in his plan leading into the birth space. Then 48 hours after he gave birth, he said to us ‘I don’t like that we’re calling it breastfeeding. Can we call it chest-feeding?’ So, we changed that dialect to chest-feeding for him. He successfully chest-fed for 7 or 8 months.”
“When it comes to what do you want to be called, ‘mum, dad’? We don’t give suggestions; we are just guided by them. For our patient, he was ‘dad’. His partner was a male, he/him, so it was two dads.”
“I think it’s important as a clinician to take the time to contain yourself, work out what your biases are and be mindful of your language. Try to use a little more gender-neutral language, which is something that can take time to get used to.”
“At discharge of the patient’s care with us, he said that he felt that he could just be himself.”
Jess and the Midwifery team are already updating their childbirth resources for patients and staff with more gender-neutral language. They are also working on an education module for LATTE about maternity care for transgender and non-binary patients. While also doing their best to advocate for patients’ preferences in their patient records.
“Everything’s on the computer. We have on the first page when employees go into the patient’s birth summary, their preferred name and preferred pronouns.
“Something a lot of my patients say is they would love to have their wristbands have their preferred name on it and gender.”
Through their experiences, Jess has simple advice for clinicians or support stuff who may encounter LGBTIQA+ patients and rainbow families.
“Education is great. Reflecting on your care is important, regardless of what area you are in because you can always improve.”
“Never assume and don’t be afraid to ask. If you do slip-up, it is important to apologise. That’s going to create a non-judgemental and safe environment where they can open up and let us know how they’re feeling at that time.
“I can’t speak for all, but these are our reflections of families that we have had in our care.”
Thank you, Jess, for sharing your insights into supporting LGBTIQA+ patients with ADaPPT in Monash Women’s.
Jess will be joining the panel of the upcoming IDAHOBIT event on Wednesday 17 May, 2:00 – 3:00 PM online, in recognition of IDAHOBIT. We hope you can join the event and learn more about what it means to be an Ally in the work context.
Approved by Chris McLoughlin, Executive Director, People and Culture