Perspectives on group prenatal care and doula support among transgender people and their partners

Background Pregnant transgender and gender diverse (TGD) individuals face unique challenges before, during, and after pregnancy. Group Prenatal Care (GPC) and doula support are two types of nontraditional prenatal support that have shown benefit in other marginalized groups of pregnant people but have not yet been explored for TGD patients.Aims To better understand the unmet prenatal care needs of TGD people and their partners and to explore the potential role of doula support and GPC in meeting those needs.Methods We conducted a qualitative study of TGD individuals and/or their partners who were formerly pregnant, currently pregnant, or planning pregnancy in the next 12 months. We recruited participants through the University of Chicago Medical Center and local LGBTQ+ organizations, then completed demographic surveys and semi-structured interviews exploring participants’ prenatal care perceptions and experiences. Interviews were transcribed, dual-coded, and analyzed in ATLAS.ti using modified grounded theory to identify salient themes. Intercoder reliability was assessed using Krippendorff’s alpha.Results Twenty-three participants completed interviews. Thirteen participants identified as TGD and are planning or carrying a pregnancy, six identified as TGD with a pregnant partner, and four identified as cisgender pregnant women with a TGD partner. Three major themes emerged from the interviews: (1) the limitations of traditional prenatal care for TGD individuals and their families, and the ways that (2) group prenatal care and (3) doula support may address gaps in prenatal care for these individuals and families. A majority of interviewees believed doula support and GPC could be helpful, particularly when those supports were identity-concordant with and/or specifically designed for TGD people. Of note, our study found that among the 19 participants with personal prenatal-care experience, 14 (74%) concealed their own or their partner’s TGD identity from at least one healthcare professional. Factors affecting their choice to reveal or conceal their identity could be complex.Discussion Our study provides new data regarding the needs of TGD people and their partners during pregnancy, a marginalized and historically understudied sector of pregnant individuals, and suggests two potential avenues that healthcare professionals can explore to better meet those needs.