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When He Presents In Labor
Abstract Number: RF5BH-501
Abstract Type: Case Report Case Series
Introduction: Caring for transgender patients in the peripartum and intraoperative period requires unique, population-specific considerations involving anatomical, physiological, psychological and pharmacological aspects.1 Research is lacking in terms of optimal care specific to the needs of transgender patients. However, we do know that they experience a great deal of misunderstanding, rejection, and discrimination; all of which lead to poor healthcare outcomes.2
Case: A 33-year-old G2P1 transgender male presented for postdates induction and requested an epidural. The patient had a past medical history of depression and gender dysphoria. Prior obstetrical history included an uncomplicated pregnancy and vaginal delivery of a son, four years prior. The patient recently moved from out-of-state after coming out as male transgender to family, with plans for top surgery approximately one year after chest feeding. Documentation from several social work and obstetric clinic appointments used mixed pronouns throughout his chart. Social work documented the patient preferred to go by his male name, as well as he/his/him pronouns. Throughout his care on the L&D floor, there were mixed use of pronouns and his legal, more feminine name, both in person and in charting. Despite this, during a postpartum visit, the patient noted better experience with this delivery compared with his first.
Discussion: Sensitive and respectful interaction and care of the transgender patient is an important knowledge and skill set for anesthesiologists. Although, the need for affirmation of gender identity is variable in transgender individuals, participants in one study described the use of their preferred name and pronouns as essential to feeling safe.3 Providing safe care to the transgender patient consists of cultural competency, psychosocial comfort, maintaining good medical care and judgment, and being open to your patients’ expertise. In addition to the medical knowledge specific to transgender patients, familiarity and comfort with navigating patients’ gender identity in a respectful manner will expand our ability to care for all patients.
References: (1) Tollinche, L. et al. (2018) Anesth Analg 127: 359-366.(2) Selix, N. et al. (2016) Midwifery Womens Health 61.6: 744-75. (3). Hoffkling A et al. BMC Pregnancy Childbirth. 2017;17:332