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The Birth Mag

Providing LGBTQIA+ Inclusive Care: How to Get Started

December 30, 2020

providing LGBTQIA+ inclusive care
by Dr. Aliena (Ali) Davis, DC

This article initially appeared in Vol. 1, Issue 1 (Winter 2020) of The Birth Mag and is now being made available online to improve accessibility.

Someone you know is LGBTQIA+, possibly even someone you love.
If you’ve been in practice for any length of time, chances are you have LGBTQIA+ clients.
Even if you don’t know which ones they are.
Even if you practice in a small rural town.
Even if you think your practice serves a “different” niche of clientele.

This article is a very basic guide to shifting your practice to be more inclusive to LGBTQIA+ clients.

1. Let’s start with the basics: what does LGBTQIA+ stand for?

This is one acronym that is often used to represent the community – many folks have different preferences on acronyms. I recommend that as you learn more on this topic you hear people’s perspectives about the acronyms they prefer.
For purposes of this article, we will be using LGBTQIA+ which stands for Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual (+ because there are nearly unlimited identities within and outside of these categories that deserve to be acknowledged.)

2. Expand your terminology.

This is a very simple, efficient, and impactful way to practice inclusivity and communicate to your clients that you are working to be inclusive, and it costs nothing except time and effort.

Some examples of expanding your terminology include:

  • Do not assume the gender of a client’s partner(s)…or that they have a partner…or that they have only one partner. For example, instead of asking a pregnant person “Will your husband be joining you during our consultation?” You might ask “Will you be bringing any partners or support people with you to our consultation?”
  • In your discussions of pregnant and birthing people in general (such as on websites, blogs, and social media) replace “pregnant woman” with “pregnant person” or “pregnant client,” replace “mom and dad” with “parents,” replace “husband/wife” with “partner” or “spouse”.
  • In your discussions of babies/children/newborns in general (such as on websites, blogs, and social media) replace “he/she” with “they”. Additionally, if your profession is closely tied to this discussion (looking at our fabulous ultrasound techs), briefly addressing the difference between sex and gender can be a great way to help empower parents to protect their future children from nonconsensual, medically unnecessary genital and gonadal surgeries that many Intersex children are subjected to.
  • Add pronouns to your intake forms, and practice using them.

3. Learn about health disparities and intersectionality.

I recently had a conversation with someone who posed a fascinating question: “does every birthworker need to be inclusive [to LGBTQIA+ people]?”

My answer is yes. As mentioned above, LGBTQIA+ people exist everywhere.

We always have, and we always will. In fact, if you work in an area where you believe this work is inapplicable to your practice, that’s a sign that it’s even more essential that you be inclusive because what that signifies is a lack of visibility and safety for the LGBTQIA+ people who ARE occupying that space.

LGBTQIA+ people face higher rates of various physical and mental health struggles, and as a healthcare provider, being attuned to that risk is essential. When you encounter an LGBTQIA+ client who has a condition that needs to be comanaged with a specialist, who in your referral network is a safe provider to whom you can refer that client? A place where their gender identity and pronouns will be respected? Where they can converse openly and freely about their partner(s) without fear? These are the things that providers need to be considering when coordinating care for these clients.

Additionally, learn about intersectionality for the sake of your clients. People rarely bring only one identity with them into our offices, and we need to be aware of how their experience living in their identities of race, gender, class, ability, and other identities may shape their healthcare needs.

4. Never “out” a client.

This should go without saying, but unfortunately, it still happens.

NEVER “out” a client or patient (reveal their sexual orientation or gender identity without the person’s express permission).

First, this is dangerous and can get people killed. (This is not an exaggeration. I’m writing this article on Trans Day of Remembrance 2019 and the final count is over 300 Trans people who have been killed in the last 12 months. Hate crimes are real and still happening.)

Second, if you’re a profession that’s bound by HIPAA, you shouldn’t be sharing this information anyway.

5. Learn about HIV and AIDS, but probably not for the reason you’re thinking.

This question almost always arises during discussions on LGBTQIA+ healthcare.

Sadly, there are still so many misconceptions about this topic that it honestly deserves it’s own article, but I’m going to discuss a couple of key points here.

First, HIV/AIDS is not just an LGBTQIA+ issue. People who are not part of this community also contract HIV, and someone being LGBTQIA+ is NOT synonymous with HIV positive.

I have heard too many stories of students in my own profession refusing to care for patients because they assumed they were HIV positive simply based on their sexual orientation or assumed sexual orientation. This is wildly inaccurate and unnecessarily stigmatizing.

Second, HIV and AIDS are different. They are not synonymous. HIV (Human Immunodeficiency Virus) is the virus that a person contracts. AIDS (Acquired Immunodeficiency Syndrome) is the syndrome that the HIV virus can cause after a long period of infection.

Third, there are medications that can help people who have HIV live healthy lives and even achieve undetectable viral loads, and even prevent infection after exposure to the virus. There is also ongoing research to develop vaccines to prevent infection as well as on possible treatments to eliminate the virus.

Lastly, quite a few healthcare providers still ask “what special precautions do I need to take when working with HIV positive patients/clients?” The answer is that you should be practicing universal precautions with every single patient/client in all clinical interactions – regardless of a patient’s HIV status.

This means that you don’t need to wear gloves when caring for an HIV positive patient if the situation would not otherwise call for wearing gloves or other PPE (looking at you, fellow chiropractors…).mDoing so is unnecessary and stigmatizing.

6. Always work to expand your knowledge and understanding.

Some great resources from which to learn include this publication as well as various books and social media outlets. This article was just a very brief introduction to this topic and is by no means comprehensive.

Here are a few places to start:

Intersex & Genderqueer Recognition Project
(http://www.intersexrecognition.org)

The Trevor Project
(https://www.thetrevorproject.org)

Book: Contesting Intersex
Book: The Body Keeps the Score
Book: White Fragility

Aliena (Ali) Davis, DC – Birth Worker. Author. Activist. [She/They]

Filed Under: LGBTQIA+

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New on the website this week, from Dr. Ali Davis, New on the website this week, from Dr. Ali Davis, DC (@dr_ali_thechiro ): 

"Someone you know is LGBTQIA+, possibly even someone you love.
If you’ve been in practice for any length of time, chances are you have LGBTQIA+ clients.
Even if you don’t know which ones they are.
Even if you practice in a small rural town.
Even if you think your practice serves a 'different' niche of clientele."

Read the full article at www.thebirthmag.com 

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Community led, community based. The Birth Mag is l Community led, community based. The Birth Mag is looking for new submissions! Are you a birth worker? Are you interested in helping your fellow birth workers learn and grow to be more inclusive and educated on the issues birthing people are facing today? We want to hear from you! Compensation starts at $35 for any article that is used. Please e-mail us at thebirthmag@gmail.com for more information or to submit an article.
#Repost @thevaginachronicles
• • • • • •
There is so much to learn from this week. So much to give and receive. .
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This list is not an extensive and in no particular order but it is some of the HARD and persistent work that we must do. .
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Black people breastfeed. Even when we tell you no after you’ve asked 15 times if we want formula. Even when we are afraid of what it looks like and how we can continue It. Even when we see how you look at our breasts not understanding how different they can be. Even when we must figure out breastfeeding complexities by ourself. Even when we had to do it for you, before we could do it for our own children. .
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WE BREASTFEED!
#Repost @blkbfingweek • • • • • • HAPP #Repost @blkbfingweek
• • • • • •
HAPPY BLACK BREASTFEEDING WEEK! 🤩

By our histories and by the truths we know from living, our possibilities are greater than any imagination. 

For all the days that have felt hopeless, we invite you to enter a period of nourishment to revive.

Where there has been loss, grief and uncertainty, our restoration is key to being present and imagining healthy futures. 

And all through #BBW20, we reclaim our time, lives and families. 

Let’s gooooooo! 

#ReviveRestoreReclaim #blackbreastfeedingweek

Artist: Andrea Pippins @andreapippins
#Repost @storkandcradleclasses • • • • • #Repost @storkandcradleclasses
• • • • • •
New York, New York

Today starts Native Breastfeeding Week. Here are some native breastfeeding facts you should know.

-“The mission of the Native Breastfeeding Week community is to reflect the diversity of native breast-feeding experiences and to encourage and uplift visibility of native breast-feeding experiences”
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-many native mother’s insurance doesn’t cover donor milk which could greatly benefit infants.
-many native women lack breastfeeding support because of social and cultural norms.

Facts are from @ja_lyonhawk article posted at illusa.org 2019

Please visit Native Breastfeeding Week’s Facebook Page for info about the virtual events you can support this week. ❤️

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Black Maternal Health Week is EVERY week •
•
Art @designedbydg •
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The best way I’ve improved my ability to care for black parents is to listen to them. But before I could learn to listen, I had to commit to the LIFELONG task of confronting my biases against them. I must also commit over and over to the a promise that I would confront bias and racism I witness in my colleagues, providers, leadership and institution. This involves being brave, frank and unapologetic, and well-versed in the mechanisms for reporting abusive and problematic  behavior, even in situations with an imbalance of power (nurse v. physician, etc.) Anti-blackness is the default in our culture. As healthcare workers if we don’t intentionally, diligently, and sustainably work to confront and destroy our biases, these biases WILL lead to black birthing people and babies’ harm and death.
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Every birth worker - doctor, nurse, doula, midwife - needs to invest in an anti-racism training - @rebirthequity ~ @theblackdoula ~ @shishi.rose ~ @abide_women are some leaders who receive compensation to help you confront your biases against black birthing people. Anti-racism training is not CULTURAL COMPETENCY TRAINING. Cultural competency training is required by most employers, it’s been around for a while, and it doesn’t change s#%^.
•
Follow 
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#blackmamasmatter #maternalmortality #blackmaternalhealthweek
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