Supporting Transgender, Non-Binary and Gender-Diverse (Trans+) Service Users

The Obstetric Anaesthetists’ Association (OAA) is committed to ensuring that all service users have access to high-quality, evidence-based information and compassionate clinical care, regardless of their gender, sexual orientation or identity. As practising clinicians, we must work in ways that ensure all birthing parents and birthing partners feel respected, included and safe, with their individual needs recognised and met throughout pregnancy, labour and birth.

To support this:

Inclusive communication

While terms such as “woman”, “mother”, “husband” and “father” remain in common use within maternity and labour ward settings, not all service users identify with these. It is therefore important to sensitively ask and confirm the name(s) and pronoun(s) used by the birthing patient and their birthing partner. Exploring and understanding the patient’s family structure is also advised (Practice Committee of the American Society for Reproductive Medicine, 2024).

Awareness of dysphoria

Some transgender individuals may experience heightened gender dysphoria during pregnancy, labour and the postpartum period, particularly where bodily changes or clinical processes reflect the sex assigned at birth (World Professional Association for Transgender Health, 2022). Examples include chest or breast tissue changes, uterine enlargement, or the temporary cessation of binding. Using the patient’s preferred terminology—for example, “chestfeeding” where appropriate—may help reduce distress.

Appropriate ward accommodation

International guidance recommends that trans+ patients be accommodated on wards consistent with their lived gender. Where this cannot be facilitated, a single-occupancy room should be offered (World Professional Association for Transgender Health, 2022).

Gender-affirming hormone therapy (HRT)

Transgender men typically discontinue gender-affirming HRT when planning pregnancy, though this may not always be the case. There are no recognised contraindications between gender-affirming HRT regimens and any obstetric anaesthetic technique, and the full range of pain-relief options should be considered unless other contraindications exist.

Awareness of gender-affirming surgery

A variety of gender-affirming surgical procedures—such as mandibular angle augmentation, thyroid augmentation and injection laryngoplasty—may have implications for airway management. Identifying any previous surgery at the earliest opportunity is essential to reduce the risk of unexpected airway difficulty during general anaesthesia for caesarean birth (Harding, Marsh, & Lennie, 2023).

Holistic health considerations


Trans+ patients experience a disproportionately higher prevalence of mental health challenges, substance use, smoking, cardiovascular disease, renal disease and blood-borne viruses, including HIV. These areas should be approached with sensitivity, ensuring early identification and appropriate support throughout the peripartum journey (Harding, Marsh, & Lennie, 2023).

The OAA remains committed to promoting inclusive, evidence-based obstetric anaesthetic practice that recognises and values the diversity of all those who use maternity services.