Integrating recommendations for transgender and gender non-conforming perinatal care in the NHS: A qualitative exploration of healthcare professionals’ views

Transgender and gender non-conforming (TGNC) people are utilising National Health Service (NHS) perinatal care services with increasing frequency. Despite this, many healthcare institutions do not have policy, education, or resources in place to provide appropriate care. Research on the experience of TGNC pregnancy service users is limited within an NHS context. This study employed a qualitative approach to explore NHS midwives' views of the acceptability and feasibility of current recommendations for providing care for TGNC people in pregnancy. We conducted 10 semi-structured interviews with midwives that lasted 25-80 minutes. These were audio recorded, and transcribed verbatim. Transcripts were read, reread and coded by author 1, in discussion with author 2. Analysis was informed by queer theory. Initial codes were then collapsed into themes using thematic analysis. Participants shared their philosophies of care provision and practical integration ideas to assist the implementation of care recommendations in their care settings. Findings were grouped into three main themes: (1) external barriers, (2) safety, and (3) eagerness to learn. Each of these key themes contained overlapping sub-themes. Whilst not a key theme, internal barriers was additionally explored. The research demonstrates a desire of participants to provide physically and psychologically safe individualised care. Participants acknowledged their role within a wider multi-disciplinary team (MDT) in addition to their role within a healthcare institution. Participants felt additional education was required for appropriate care for TGNC service users. The research demonstrates the emotional processes of midwives working within the NHS caring for a minority patient group. Greater support from institutions is required to provide gender-affirmative care. Policy is needed on a national and institutional level to support midwives to provide safe care. Further research may also strengthen existing recommendations and therefore support both midwives and TGNC service users.