Author: stockportbirthservices

17 Fantastic Facts About Oxytocin in Birth

Oxytocin is often referred to as the “love hormone” or “cuddle hormone” because it’s associated with social bonding, love, and trust. It’s produced by the hypothalamus in your brain and is released into your body by the pituitary gland.

Oxytocin is produced in large quantities during birth where it helps to stimulate and strengthen contractions. These contractions help to push your baby down the birth canal and into the world. Although in labour your body naturally produces increasing amounts of oxytocin, there are things that you can go to help promote the production of the hormone in your body.

17 Facts About Oxytocin in Birth

  1. Oxytocin stimulates the muscles of your uterus to contract, and these contractions help to dilate your cervix and push your baby through the birth canal.
  2. Oxytocin can’t coexist in your body with stress hormones; we know that if we can reduce the stress, anxiety and fear you might be feeling, we can reduce stress hormones and promote the production of oxytocin. This also breaks the fear-tension-pain cycle.
  3. Once oxytocin levels start to rise in your body, a positive feedback loop is created. The cervix is pulled up and over your baby’s head which drops your baby down, triggering more oxytocin receptors to release oxytocin, resulting in stronger contractions which pull the cervix up and over baby’s head…
  4. Oxytocin helps to reduce your pain during labour by stimulating the release of endorphins, which are natural pain-relieving hormones.
  5. When oxytocin and endorphins mix, you enter a hazy dazy birth bubble where you zone out of the world. Peace man.
  6. An oxytocin and endorphin fuelled labour can reduce your need for pain medication during labour (although, of course, it’s still available for you if you want it…)
  7. …however, note that epidurals can impact the release of your own oxytocin, which may impact the strength of your contractions.
  8. A good amount of oxytocin in the system makes labour more efficient and effective, ie shorter!
  9. An increase in oxytocin levels during birth can lead to you feeling like you had a more positive birth experience.
  10. You’ll have the most oxytocin in your body in your lifetime just after your baby’s born but before the placenta arrives.
  11. Skin-to-skin contact with your baby can help to enhance oxytocin production and promote bonding. This goes for partners too!
  12. Oxytocin is responsible for the feelings of love and bonding that are often experienced between mothers and their babies during the postpartum period.
  13. Oxytocin helps to stimulate the release of milk in the breasts by contracting the muscles surrounding your milk ducts.
  14. After birth, oxytocin helps your uterus to return to its pre-pregnancy size and shape by contracting and reducing its volume.
  15. Oxytocin has been shown to have a calming effect on babies, reducing stress and promoting a peaceful and restful environment. Wearing your baby in a sling and having skin-to-skin contact can help with this.
  16. Oxytocin has also been linked to improved sleep patterns in both parents and babies, promoting overall health and wellbeing.
  17. Oxytocin production in your baby helps to organize neural circuits in the brain, as well as promoting a sense of attachment, security and confidence in them.

Oxytocin is an important hormone that plays a crucial role in the birthing process and in promoting the health and well-being of both the birthing person and baby. Its many benefits, including shortening labour, promoting bonding, increasing pain tolerance, and reducing stress, make it a vital hormone. By enhancing oxytocin production during labour, you can promote a positive and empowering birth experience, and create a strong foundation for the future.

To read more about oxytocin during the birth process, head over to Sara Wickham’s site where she looks at the evidence.

15 Ways To Boost Oxytocin In Labour

Oxytocin is produced naturally in your body during birth where it helps to stimulate and strengthen contractions. These contractions help to push your baby down the birth canal and into the world. Although it’s produced naturally and in increasing quantities in labour, are things that you can go to help promote the production of the hormone in your body.

15 Ways To Boost Oxytocin in Labour

  1. Gentle touch and massage can help to stimulate the release of oxytocin, reducing stress and promoting a sense of wellbeing. Massage can also relieve sore muscles of tension. There’s also research that shows that oxytocin rises in the person giving the massage, which is a great way to promote calmness in your birth partner.
  2. A warm bath or shower can reduce stress hormones and enhance oxytocin production.
  3. Deep breathing can turn off the sympathetic nervous system’s stress response, allowing oxytocin to relax your muscles and calm you down.
  4. Having an emotional support person who’s there solely to focus on you rather than anything medical, such as a partner, doula, or close friend, can help to enhance oxytocin production and reduce stress during birth.
  5. Cuddles! Research shows that oxytocin starts to be produced 20 seconds after a cuddle starts, so some lovely long hugs are bound to help your oxytocin levels.
  6. And on the subject of intimacy…orgasms produce oxytocin too. Just make sure you’re somewhere private first!
  7. Nipple stimulation triggers the release of oxytocin, whether this is from your own hands or your partner’s.
  8. Laughter – it really is the best medicine!
  9. Essential oils and other smells that trigger feelings of love and happiness can boost your body’s production of oxytocin.
  10. Music has been found to boost oxytocin levels, so crank your labour playlist up! Some people like to have a calm playlist and a more upbeat one – as long as it’s music that you enjoy do whatever suits you best.
  11. Start eating dates; it seems that the fruit influences oxytocin receptors and stimulates the muscles to respond to your body’s oxytocin.
  12. Creating a peaceful, supportive, and nurturing environment can help to enhance oxytocin production and promote a positive birth experience.
  13. When you’re stressed you produce stress hormones, inhibiting oxytocin. So if you’re feeling stressy during labour figure out the cause and get rid of it, allowing the oxytocin levels to rise.  
  14. Showing love and affection towards your support partner can boost your oxytocin levels; meaningful connection while bringing new life to the world, can there by anything more worthy of the love hormone?
  15. Avoiding unnecessary disturbances can help promote an oxytocin-fuelled environment. If someone’s constantly bringing you out of your hazy dazy birth bubble the oxytocin production will be disrupted – yuck.

Oxytocin is a crucial hormone for the birthing process. It has many benefits including reducing the amount of time your labour lasts, increasing your tolerance to pain, promoting bonding and attachment. By enhancing oxytocin production during labour, you can promote a positive and empowering birth experience, and create a strong foundation for the future.

For more information about oxytocin in birth, head over to Sara Wickham’s page where she looks at some of the evidence.

15 Non-Pharmacological Pain Relief Options For You To Choose In Child Birth

For those that would prefer not to use medication, or want to try other options first, you might be wondering what on Earth is available to you. Well don’t worry, you have plenty of pain relief options!

Many of these are things that will naturally enable oxytocin and endorphins to work in your body, creating a hazy dazy birth bubble that protects you. All people respond differently to different things so it’s worth putting the work in to think about what might boost your oxytocin (the love hormone) and your endorphins (your pain relieving hormones).

The brilliant thing about these is that there are no negative side effects and you can layer them up like a little pain relieving onion, and take them away when they no longer serve you. In no particular order, I bring you 15 non-pharmacological methods of pain relief during childbirth:

Breaking the fear-tension-pain cycle: Fear leads to tension, tension leads to pain. By relieving the fear you can reduce the physical symptoms of tension, ie pain! So think about some of the things that help you reduce fear and anxiety – things like deep breathing and oxytocin boosters like aromatherapy can help, as can a big cuddle from your partner!

Concept of purposeful pain: Giving birth isn’t like breaking a bone. For a start, it usually comes on gradually and builds in intensity, unlike the sudden sharp shock of a break! It’s not a something’s wrong type of pain. Reframing the lens through which you look at labour pains and understanding that each contraction brings you one step closer to your baby can help transform the way you react to the pains. Instead of being something you fear (that fear-tension-pain cycle again!), they can become something you welcome.

Breathing: Deep breathing can help encourage your physical and emotional body into a relaxed state, promoting a healthy blood flow to the birthing muscles so they work effectively. A calm, relaxed body and mind reduces the pain you experience – yep, it’s that fear-tension-pain cycle again!

Visualisations: By creating images in your mind, especially when they’ve already been anchored in your brain to a time when you were relaxed and pain-free, can help reduce your experience of pain and give you a way to handle each contraction. Many people use the concept of a wave as your contraction during labour – the wave swells and with it so does the contraction in your body, and the wave washes away as the contraction releases; you can tie this in nicely with long deep breaths.

Hot water bottle: One of the oldest and cheapest methods of pain relief!

Laughter: Laughing produces endorphins, endorphins are your body’s pain killing hormones. Easy as that!

Bath/shower: Water promotes oxytocin and endorphins, helping that birth bubble be built around you. Being submerged in water can relieve stress hormones and muscle tension, while showers can be used to massage the sore bits.

TENS machine: These send tiny electrical impulses into your body, disrupting the pain signals that you’re experiencing from your contractions. You CANNOT use this with any pain relieving method that involves water.

Massage: Getting hands on can be a great way to reduce the pain your experiencing! Massage can relax painful muscles, relieve stress and promote oxytocin, especially if it’s someone you love doing it.

Music: Music isn’t just a good distraction in birth, it can actually disrupt your brain’s pain pathways meaning your pain is reduced! Also, when else can you listen to entirely your choice of music without someone moaning?!

Rebozo: Rebozo sifting is a really gentle way to move muscles and joints, bringing relief from any pain stored up in them. It’s not a very well known concept in the UK but one that people tend to love if they do use it.

Movement: Keeping mobile helps you move and sway into contractions, relieving your body of tension, stiffness and soreness as you go. Being able to choose which position you get into and move around helps reduce your experience of pain, as well as increasing the self-efficacy you have. Choosing upright positions can help wiggle your baby down into the cervix, helping trigger oxytocin to be released into your body and stimulating effective contractions. Win win!

Acupressure: Certain acupressure points can reduce pain intensity. One of the increasingly common ways of using acupressure is to hold a comb in your hand with the teeth pointing just below where your fingers meet your palm.

Aromatherapy: Olfactory stimulation can result in pain reduction. It can also be used to promote oxytocin and reduce stress. Some essential oils are contraindicated in pregnancy/birth so do check what you’re using with someone qualified.

Personalised oxytocin boosters: We’re all individuals and respond to different things in different ways. Have a think about what makes you feel loved up, joyful, ecstatic and on a natural high as they might be just the thing to help you in labour!

(And to finish off, if you do choose pharmacological pain relief then that’s perfectly ok! You can choose to do your birth any way you want! <3 )

Where Can You Give Birth: Your Birth Place Options

Women and birthing people are supposed to be informed of their choices about where they can give birth and, crucially, are supposed to be supported in their choice. But we know this doesn’t always happen – according to the CQC Maternity Survey Results published in January 2023 a fifth of women said they were not offered any choices about where they can have their baby. Even if they are, the choices are often presented as a list rather than a proper discussion about them. How can you pick something as important as where to birth your baby if you don’t know what each option means?!

Read on for an overview of your choices of where you can give birth.

Home Birth

A home birth is exactly what it says – you give birth at home. Midwives come to you when you’re in labour and stay until you’ve given birth. They examine you post birth, help you with a shower, feeding, and tuck you into bed and go on their merry way. There is NOTHING like getting in to your own bed after giving birth and not sharing a postnatal ward with several other mums, partners and babies.  

You’re supposed to be told that home birth is a good choice for ‘low-risk’ women as there’s a lower intervention rate and the outcomes for mums and babies is no different to in a hospital setting – there’s lots of evidence for this. You’re also supposed to be supported in a home birth if you’re ‘high risk’. You can choose to birth at home whether you’re low or high risk.

To hear more about what I’ve got to say about home birth, click here or here.

Birth Centre / Midwife Led Unit

Midwife Led Units (MLUs) are generally called Birth Centres. They come in two variations:

Alongside Midwifery Unit (AMU) – these are alongside the obstetric unit, ie on the same hospital site. Because they’re on the same site if you need extra support such as certain types of pain relief or necessary interventions, it’s a short trip usually taking a matter of minutes in order to receive it (and doctors do also have legs and can come to you if it’s really necessary!).

Freestanding Midwifery Unit (FMU) – these are on a separate site to the obstetric unit. Because they’re not in the same place it will take more time to receive extra help. If you needed that support you would need to be transferred to the local obstetric unit.

Midwifery Led Units are, as the name suggests, led by midwives rather than care being shared between midwives and doctors. They tend to be a little bit more ‘home from home’ like than labour wards and often have birth pools, twinkly lights and pretty murals on the wall. If it’s a particularly well-equipped one you might even find birth ropes, birth stools and other exciting birth equipment.

You have the right to choose to give birth at a Birth Centre if you wish, however sometimes this may involve a negotiation as your trust literally hold the keys and may encourage you to believe that it’s ‘not allowed’.

Labour Ward / Delivery Suite / Obstetric Unit

On Labour Wards care is shared between doctors and midwives. This is generally where those who are expected to have a complicated birth are recommended to give birth, however sometimes your definition of “expected to” may differ from your caregiver’s definition! It’s also where caesarean births take place.

The environment tends to be more clinical looking and less oxytocin-promoting than at home or in Birth Centres, which is a bit silly because people having complicated births are arguably more in need of oxytocin promotion! There is access to more significant pharmacological pain relief such as opiates and epidurals if you want them. By definition, more interventions happen here – because they can’t take place at home or on the Birth Centre.

You have the right to choose to give birth in a Labour Ward either vaginally or by planned caesarean section if you want to. However, you should be advised that unnecessary intervention is more likely to happen on a Labour Ward than either at home or Birth Centres.

So there’s your whistle stop tour of where you can give birth. Where you choose to give birth to your baby is a really important decision because even planning to give birth in one place but actually giving birth in another can change your birth outcomes. So make sure you really consider it and don’t dismiss any of the places until you’ve thought about them properly. And remember, you can change your mind at any point before your baby arrives!

A strategic plan integrating community development concepts for the trans and non-binary childbearing population in perinatal services.

[Originally submitted as an assignment for MPH @ University of Manchester]

Community and Public Health Issue

The community in focus is the England’s transgender male and non-binary[1] childbearing community. Trans people are individuals whose gender identity falls outside the stereotypical gender norms of their biological sex. No definitive figures exist for how big the trans community is due to lack of research, fear of reprisals, no standardisation in definitions, and outdated data systems lacking recording capability[i] [ii] [iii] [iv] [v]. An approximation suggests around 600,000[vi] trans people live in the UK. We can assume the number of trans people is likely rising due to the increase in referrals to gender dysphoria clinics[vii]. Therefore, the trans childbearing community is likely rising too – although subject to the same recording and accuracy issues as the wider trans community – meaning providing gender-inclusive perinatal care is becoming more of a pressing concern for service providers.

Trans individuals are likely to have had previous negative experiences within healthcare settings and suffer from healthcare professionals (HCPs) not understanding their specific needs adequately[viii]. The trans childbearing community are trying to access services created for heterosexual ciswomen[2][ix] so information, clinical space and HCPs are usually heavily gendered, making it more difficult to access services from outside that binary. If trans people are unwilling or unable to adequately access perinatal services their and their baby’s health is risked. A public health central tenet is to prevent disease and improve health by offering services accessible to all; therefore ensuring gender-inclusive perinatal services is a public health issue.

Theory of Change

Problem:

Perinatal care is essential for the perinatal dyad; without it there are increased risks of adult and child morbidity and other serious adverse outcomes[x]. Trans people are at increased risk of not accessing healthcare services due to real or perceived stigma, discrimination and bias from HCPs, lack of cultural competency, systemic barriers such as inadequate IT systems and sociocultural barriers such as increased mental health challenges[xi] [xii] [xiii]. This is particularly an issue in perinatal healthcare where services are largely created by and for ciswomen, adding an additional cis-centric dynamic to accessing care, and where it is possible any experienced gender dysphoria can worsen.

Long-Term Goal:

Strategic aims of this health plan are to:

  • Reduce the real/perceived stigma faced by trans childbearing people that stops them accessing perinatal care
  • Improve the experience of the trans childbearing community accessing perinatal care
  • Improve the health of trans childbearing individuals and their infants through the perinatal period.

These goals will be met when all trans childbearing people who want to access perinatal care do so, and in doing so no harm is caused emotionally or physically to the dyad.

Key Audience:

Stakeholders involved in this strategic plan will be trans childbearing individuals, perinatal care workers (including midwives, obstetricians, infant feeding workers, health visitors), and other HCPs e.g. endocrinologists, together with representation from Clinical Commissioning Groups and the VCSE sector.

Backwards Map from Goal:

Examination of the preceding stages from the long-term goals necessitate a collaborative approach from all identified stakeholders so all necessary changes before the goal can be met are considered.

To reduce overall stigma and improve the experiences of trans individuals accessing perinatal care there needs to be:

  • Reduction of internalised stigma
  • Reduction of healthcare stigma from individual practitioners
  • Reduction of structural stigma

Which needs:

  • Motivation to change from the institution and HCPs within it
  • Belief from trans childbearing individuals that cultural change can occur

Which leads to accessibility of perinatal services for trans people through:

  • Improved understanding of the challenges faced by the trans childbearing community leading to an increase in desire to help overcome these challenges
  • Equipping HCPs with the skills and competencies needed to support the trans childbearing community
  • Cultural changes in the behaviour of HCPs which leads to a visible awareness for the trans childbearing community
  • Improvement in the existing structural systems
  • Motivation of individuals to access a changing system for health gain

No change is independent of any other or relates only to one long-term outcome; they are symbiotic in nature therefore it is unrealistic to assume that a singular change will lead to a singular outcome. Coproduction is a vital part of the plan to ensure that the assumptions and underlying logic of approaches are valid and fit for all stakeholders, but particularly the service users.

Strategies and Interventions:

There is a paucity of research about trans childbearing experiences of pregnancy care in England; what little exists are small-scale qualitative studies, often undervalued in the medical world[xiv]. This failing of research existence results in organisations having little solid evidence to base the redesign of services on[xv].

A key principle underpinning all strategies is that they will be developed through true coproduction with relevant stakeholders including service users, to ensure they best fit the needs of the community (while recognising that the trans childbearing community has not one homogenous voice).

Strategies which have been published can be broadly grouped within the following themes.

                Culturally Competent Training

HCPs often lack understanding and awareness of the trans childbearing community and the specific problems they face when accessing highly gendered healthcare services. To help alleviate this, cultural competence education including use of appropriate language should be given to staff[xvi]. Cultural competency can help staff interact with people they care for in a way that does not cause mental harm; for example, using correct pronouns, not deadnaming[3], misgendering or conflating gender identity with sexual orientation[xvii]. Fit-for-purpose cultural competency training can ensure HCPs provide appropriate medical care rather than subjecting trans individuals to superfluous and sometimes voyeuristic practices[xviii], or giving incorrect medical information[xix].

Cultural competency training would be included in this strategic plan to help meet the long-term goals. Training would be offered firstly to all core perinatal HCPs and then rolled out to affiliate HCPs. The training would impact on:

  • improving understanding of challenges faced by the trans childbearing community by HCPs
  • increasing HCPs’ skills and competencies to deal with diverse challenges
  • increasing vocalness and visibility of trans rights and needs in pregnancy making perinatal care more accessible for the trans childbearing community
  • reducing healthcare stigma, discrimination, and bias
  • improving the experience of trans individuals accessing perinatal care
  • improving the health of the trans childbearing community.

Limitations recognised by the strategic plan of this intervention are that:

  • the trans childbearing community are not a homogenous group therefore their needs may be disparate; poorly designed training courses may give HCPs the impression that a one-size-fits-all approach is possible
  • this specific type of education is relatively new; no research exists to evidence its efficacy other than anecdotal feedback. However, it is likely that it will have the same level of positive impact on patient outcomes as other types of cultural competency training[xx].

Assumptions made regarding training as a strategy to meet the long-term goal of this strategic plan are that:

  • HCPs are not transphobic and any failings in service provision come from lack of understanding which can be overcome
  • HCPs are motivated to better their awareness and understanding of the challenges faced by the trans childbearing community
  • HCPs have the time to do additional training outside their caseloads
  • the interpersonal skills needed to enable HCPs to provide care to trans people are teachable
  • there is a supportive space for HCPs to learn in and competent experts to provide the training.

Although there may be logistical challenges in staff finding time for training these are not insurmountable, and it is likely an organisation considering such training will be supportive of people in that learning sphere. It is probably best to assume the good intentions of all workers to be motivated to do better unless proven otherwise[xxi] – which can be dealt with under an organisation’s disciplinary policy.

Individualised Care

The trans childbearing community are not a homogenous group and cannot be treated as such, needing a heterogeneric approach to care to match their diverse experiences. Personalised care is an integral to the NHS’ Long-Term Plan[xxii] and should be prioritised for the trans childbearing community through proportionate universalism.

One individualised approach needed is regarding language used. Some trans individuals have a definite preference for their gender identity, some are comfortable with a variety of terms (e.g. male, female-to-male, transman, assigned-female-at-birth)[xxiii]. Alongside this is pronoun choice; trans people have a more positive healthcare experience – and therefore less exposure to mental harm – when correct pronouns are used[xxiv]. There is also the degree of ‘outness’ both in terms of gender identity and pregnancy to consider: for some, being seen as male but not pregnant is critical to good health, for others being out as male and pregnant is important, for others passing as a cisgender woman while pregnant is how they feel safest[xxv]. Birth tends to be pathologised in England[xxvi] and it is possible that being trans in itself may put individuals onto a high-risk pathway even if there is no medical indication, increasing intervention rates with the potential of increasing physiological and mental harm[xxvii].

Specific interventions within this strategic theme to be implemented are:

  • ensure individualised care through thoughtful conversations between pregnant person and culturally competent HCPs
  • reduce the need for the “trans story” to be repeated (thereby causing mental trauma) by having continuity of carer, a strategy which itself improves perinatal outcomes for parent and child[xxviii]
  • have language needs clearly identified “at a glance” on notes so professional contact remains consistent and accurate[xxix]
  • not place on an obstetric pathway for trans status alone[xxx].

The impact on the strategic plan’s long-term goals is to:

  • reduce stigma for the individual by building a close, personable relationship with a small team of carers
  • increase the belief that ‘the system’ can meet the needs of a subjugated community, therefore making it more likely individuals within the trans childbearing community will seek future healthcare
  • improve individuals experience within the perinatal system, reducing mental distress
  • improve the health of the perinatal dyad by ensuring accessibility to fit-for-purpose services and staff.

The limitations of these interventions within this strategic plan may be that:

  • self-identity is complex and may change as a pregnancy progresses, and may need more time, patience, and experience than an HCP has to give
  • the maternity system is not resourced adequately to staff a pathway that requires more time; although continuity of carer pathways should be implemented for “most” birthing people by 2021[xxxi] there are already severe shortages in midwifery[xxxii] that means this is not happening[xxxiii].

Assumptions made with these strategic interventions are that:

  • it matters to trans childbearing people how they are identified by others
  • maternity services are resourced adequately to provide continuity of care and properly individualised care – not just lip-service.

These assumptions can be overcome by conducting transparent and open conversations with each individual. Resourcing is not so easy to challenge however the financial benefits of keeping parent-and-child healthy in the perinatal period can be used as a basis for a proposal for extra resources.  

Systematic Change

The system within which perinatal services exist also needs change to meet the trans childbearing community’s need. There is institutional erasure of trans pregnant people: only one trans-inclusive maternity policy exists in England[xxxiv], IT systems do not have capacity to accurately record gender[xxxv] [xxxvi], physical space is aimed almost exclusively at women[xxxvii], and educational literature features predominantly heterosexual ciswomen.

Interventions which may positively impact on this area and will be included in the strategic plan are:

  • creation of perinatal guidance and policies which are gender-inclusive
  • redevelopment of physical space and literature to ensure representation
  • upgrading of IT systems so perinatal gender options are representative.

The interventions would:

  • improve the environment in which trans childbearing people access perinatal services, making services more accessible
  • make it easier to accurately record a true gender identity, helping increase visibility and break down stigma, both individual and structural.

The limitations of these interventions are that:

  • it may be costly to implement wide-scale change on infrastructure that is nationally devolved
  • systematic change takes time
  • there is likely to be resistance from people who lack education around the trans community[xxxviii].

Assumptions made regarding the implementation of this strategy are that:

  • there are resources to implement wide-scale change
  • there is appetite to do so on a wide-scale; national change needs a top-down approach and if the most senior leaders do not understand the importance of change it cannot happen at the scale it needs to.

Mental Health Focus

Poor mental health is a common theme for trans people navigating healthcare systems, especially perinatal services, therefore it is imperative that action is taken to improve the trans childbearing community’s mental health status.

Gender and genitalia dysphoria before pregnancy, antenatally, intrapartum, postpartum, and longer-term postnatally including infant feeding choices is a big concern for trans childbearing people, and a situation that can shift and worsen significantly as a person passes through these experiences[xxxix] [xl]. It is essential that culturally competent carers understand the impact of dysphoria during the perinatal period and that there is access to culturally sensitive specialist counselling[xli], interventions which are included in this strategic health plan. Alongside professional support is the value of peer support: feelings of isolation cause great distress for trans childbearing people[xlii] and appropriate, specific peer support can be invaluable – HCPs need to be able to signpost this support effectively[xliii].

These interventions would help:

  • reduce internalised stigma through visibility, reducing isolation and improving access to health education in an informal setting
  • improve mental health leading to greater accessing of healthcare and reducing poor physical outcomes.

The assumptions underlying these interventions are that:

  • trans people will want to access perinatal services if mental health is nurtured
  • specific peer support is accessible.

Mitigating these assumptions may take time and resources to increase knowledge and earn trust, and there may be a chicken-and-egg scenario of trans childbearing people peer support not being ‘lumped in’ with generic LGBT support groups – there needs to be volume to necessitate support but without such support the true volume of need may not be known.

Responsibilities:

Providing the space (physical and mental) and resources for the interventions listed to be adequately provided are the responsibility of the HCPs responsible for this strategic plan. The community will decide whether this is enough for them to overturn previous negative experiences and engage with perinatal services, however it is noted that it takes time for underserved communities to develop trust and engagement with a service that has historically overlooked them. There must be an element of goodwill belief from the trans childbearing community that things can change; while this will be true of some there will be others who make a choice never to engage.

Outcome Measures:

Strategic interventions will be measured and evaluated through a framework of user experience data-collection tools. Baseline data prior to the implementation of intervention will be needed so outcome metrics can be tracked against implementation.

  • Friends and Family Test[xliv]
  • CQC Maternity Services survey[xlv]
  • Locally designed Maternity Voices Partnership care survey[xlvi].

Wider benefits should also be seen in health outcomes for both parent-and-child, increasing positive outcomes in maternity dashboard[xlvii] figures generally.

Programme Narrative

The needs-based approach to health improvement of the trans childbearing community holds the assumption that the community face disparity in health outcomes during the perinatal period. This has been evidenced through an assumptive approach based on the wider trans community’s relationship with accessing healthcare and the limited research available on the trans childbearing community and perinatal care experience.

A big limitation of the programme is that the trans childbearing community in England is unknown due to systematic failure of data capturing and heterogeneous approaches to self-identity, exacerbated by fear of stigma, discrimination, and bias. The trans community is growing and even if not the trans childbearing people deserve to have access to appropriate healthcare.

Within the framework of perinatal services provided by the NHS in England, the programme will adopt an integrated approach to improving the health of the trans childbearing community which places individuals from the community at the heart of the proposed strategic interventions. The programme will take a symbiotic approach to the interventions of cultural competency training, individualised care, systematic change, and a focus on improving mental health.

Through partnership working of all stakeholders and in particular collaboration with the community using (or intending to use) the service, the programme will implement strategies that increase awareness and understanding of the additional vulnerabilities and challenges the community face, ensure supportive care that meets the unique needs of the community, changes the system within which perinatal care currently exists, and ensure mental health is as protected as physical health. This will allow broader goals of reducing real and perceived internalised, healthcare, and structural stigma; improve the experience of navigating the service, making it more accessible and giving HCPs the skills needed to provide care to a vulnerable and diverse community; and improving the long-term health of parent-and-child, impacting not just on them as individuals but the wider communities they exist within. Long-term one of the benefits of the programme is that this underrepresented in healthcare community group will be more likely to access perinatal care as they know their community is understood and represented.

Although the strategic themes have been identified through this programme this truly will be a collaborative community health programme and relevant stakeholders but especially the trans childbearing community themselves will coproduce the final programme strategy, implementation, and evaluation methods to ensure they are flexible and adaptable to maintain community relevancy through emerging and changing needs, priorities and in response to any future published evidence.

Sustainability of the programme will be supported through participatory actions of the community themselves and by ensuring that interventions are measured against the long-term goals of the programme with a mechanism for future growth and development of the programme as the long-term goals are achieved.

[1] For the purpose of this essay the umbrella term ‘trans’ will be used throughout unless specifically noted.

[2] A woman whose gender matches their assigned sex at birth.

[3] Using the birth (or legal name if not yet changed) of a trans person even though it is not their preferred name. This can be accidental or intentional.

[i] Nolan IT, Kuhner CJ, Dy GW. Demographic and temporal trends in transgender identities and gender confirming surgery. Transl Androl Urol. [Online]. 2019;8(3):184-190. [Accessed 26 April 2021]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626314

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[xxii] NHS England. The NHS long term plan. [Online]. 2019. [Accessed 1 May 2021]. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf

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[xxix] Brighton and Sussex University Hospitals. Pronoun stickers. [Online]. [Accessed 1 May 2021]. Available from: https://www.bsuh.nhs.uk/maternity/documents/pronoun-stickers/

[xxx] Brandt, J, Patel AJ, Marshall I, Bachmann, GA. Transgender men, pregnancy, and the “new” advanced paternal age: A review of the literature. Maturitas. [Online]. 2019.

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[xxxii] Royal College of Midwives. Fears for maternity as staffing shortages hit safety and morale says RCM. [Online]. 2020. [Accessed 1 May 2021]. Available from: https://www.rcm.org.uk/media-releases/2020/november/fears-for-maternity-as-staffing-shortages-hit-safety-and-morale-says-rcm/

[xxxiii] Care Quality Commission and NHS England. 2019 survey of women’s experiences of maternity care. [Online]. 2019. [Accessed 2 May 2021]. Available from: https://www.cqc.org.uk/sites/default/files/20200128_mat19_statisticalrelease.pdf

[xxxiv] Brighton and Sussex University Hospitals. Perinatal care for trans and non-binary people. [Online]. 2020. [Accessed 26 April 2021]. Available from: https://www.bsuh.nhs.uk/maternity/wp-content/uploads/sites/7/2021/01/MP005-Perinatal-Care-for-Trans-and-Non-Binary-People.pdf

[xxxv] Hoffkling, A, Obedin-Maliver, J, Sevelius, J. From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy Childbirth [Online]. 2017. 332. [Accessed 29 April 2021]. Available from: https://bmcpregnancychildbirth-biomedcentral-com.manchester.idm.oclc.org/articles/10.1186/s12884-017-1491-5#Bib1

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[xlvi] National Maternity Voices Partnership. http://nationalmaternityvoices.org.uk/

[xlvii] Maternity Services Dashboard. https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/maternity-services-data-set/maternity-services-dashboard