A growing number of individuals consider themselves gender nonbinary or gender nonconforming, which is defined as not identifying with a particular gender. This is especially true among our youth. A recent study reported that 27% of California adolescents ages 12 to 17 were considered gender nonconforming, which included 6.2% classified as highly gender nonconforming (Wilson, Choi, Herman, Becker, & Conron, 2017). Another population-based study found that 2.7% of students in grades 9 and 11 self-identified as gender nonconforming (Rider, McMorris, Gower, Coleman, & Eisenberg, 2018). It is important that clinicians understand related terminology and how to provide culturally competent care to this population.
Although only persons born as a female (according to sex assigned at birth) can conceive a child and give birth, nurses may care for individuals throughout the peripartum period who are transgender male, or gender nonbinary. We should use language, parental terms, and pronouns that convey respect for the person's gender identity (Table). For example, they may not prefer the terms woman or mother, or to go by the pronouns, she or her. They may instead choose the neutral term, parent, and pronouns such as they or them; or masculine terms and pronouns such as father, and he or him. If unsure, the best approach is to ask how they want to be addressed, including their preferred pronouns.
Although research about perinatal outcomes in this population is limited, gender nonbinary and transgender individuals are more likely to suffer from depression or report heightened psychological distress (Wilson et al., 2017) and have a history of attempted suicide (Rider et al., 2018), which may place them at higher risk for postpartum depression. This population has poorer health outcomes in general, and report discrimination and negative experiences with the healthcare system (Light, Obedin-Maliver, Sevelius, & Kerns, 2014; Rider et al.), which may have implications for health-seeking behaviors in the peripartum period. In a study of transgender men who gave birth, most reported that although their provider was transgender-friendly, this was not always true of nurses and other hospital staff (Light et al.).
Perinatal nurses can play an important role in advocating for this population by modeling gender-inclusive language and behavior, and educating others. There are many resources tailored to clinicians, here are some examples from the University of California, San Francisco, http://transhealth.ucsf.edu/ and the American Psychological Association, http://www.apa.org/pi/lgbt/index.aspx.
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