Case Study: History Taking

You are meeting Edie for her history and physical appointment. She arrives to the appointment alone. She is a 32 year-old G1P0 and she presents as a cisgender, femme woman. The first section of the Ontario Perinatal Record asks for information about the pregnant person’s partner.

Question 1

How can you greet Edie and ask her questions about her partner in a way that is in inclusive of 2SLGBTQI folks and also acknowledges that not every pregnant person has a partner?

“Hi Edie, welcome to our clinic. I’m going to be asking you a lot of questions today as we go through your history. Can I start by asking if you have a partner in this pregnancy?”

By asking “do you have a partner” instead of “what is your partner’s name,” the midwife is leaving space for clients who are un-partnered during pregnancy.

Edie answers that yes she has a partner.

Question 2

How do you ask questions about Edie’s partner without making any assumptions about the partner’s gender?

“What is their name?” Using they/their pronouns to ask about a client’s partner until the client has identified the gender of their partner allows space for the client to name their partner’s gender without asking direct questions. Once the client names their partner, the midwife can refer to the partner by name only, avoiding pronouns until the client names the partner’s gender.

Once the client names her partner’s gender the midwife can mirror the language the client is using to refer to her partner. Asking follow-up questions about other partners can start to open the conversation toward sexual orientation and also avoids assumptions that pregnant people are monogamous and acknowledges the existence of poly relationships.

Sexual Orientation: The new version of the Ontario Perinatal Record (OPR) has space to ask about sexual orientation. Learning about a client’s sexual orientation is important in addition to gaining information about the client’s current partner. Many queer or bi women present in pregnancy in relationships with cis men. Without careful history taking their queer identity may be erased during their time in midwifery care. This erasure may lead to feelings of anxiety or depression. Midwives should avoid the assumption that clients are heterosexual, even when they present to care in heterosexual relationships. Questions like “is Viviane your only sexual partner at this time?” and follow-up questions about sexual history like, “Do you know what the term ‘sexual orientation’ means?” “Can you tell me about how you identify your sexual orientation?” “Can you tell me if you have had sexual relationships with men, women, or both?” can help the midwife to establish an accurate sexual history. Note that many people will identify as straight when asked even if they have had/are having same-sex relationships, so asking varied questions, and asking specifically about sexual history and not just sexual orientation is important.

Gender Identity: Unfortunately neither the new nor the old OPR has space for noting the gender identity of clients or their partner(s). However, midwives can be attentive to using gender-neutral language, mimicking the language and pronouns used by clients and their partners, and asking direct questions about gender identity. Midwives should avoid the assumption that midwifery clients and their partners are cisgender.

Question 3

How can you ask questions about how the pregnancy was conceived without making any assumptions about the origin of the gametes?

Questions like: “Did you use any fertility treatments to conceive this pregnancy,” can get the conversation started for 2SLGBTQI clients and for straight clients alike, but if no fertility treatments were used then the midwife will need to keep asking open-ended questions in order to elicit a complete history.

Midwives should avoid assumptions about the gender of the people sitting in their clinic rooms and even avoid assumptions about which partner is the pregnant client. A couple may present as a straight, cis appearing couple, but the couple may include a trans man who is the pregnant client and not his cis, female partner. History taking that uses inclusive, open-ended language benefits all clients (cis & trans, queer and straight) because an open-ended approach to history taking leaves space for all clients to honestly share their stories so that as care providers, midwives get the most complete and most accurate information and also begin to build trust with clients from the first clinical encounter.