Q and A with Dr. Robyn Moxley
Sunnybrook Health Sciences Centre is proud to celebrate the 2SLGBTQIA+ community.
It is also working to create environments for both staff and patients that welcome diversity and are built on a foundation of respect so that everyone feels included.
This is true across Sunnybrook’s various care departments and teams – including family medicine obstetrics.
Dr. Robyn Moxley is Co-Lead of Family Medicine Obstetrics at Sunnybrook. Dr. Moxley has conducted research and done educational work on how pregnancy care providers can better serve the 2SLGBTQIA+ childbearing community through more sensitive language, behaviour and environments that affirm diverse sexual and gender identities.
Dr. Moxley spoke with Your Health Matters about what affirming pregnancy care means and why it’s important for patients and their families.
As a family doctor at Sunnybrook, you provide gender affirming and inclusive prenatal care. What does that mean?
For me it means providing care in a way that does not assume heterosexuality or cisgender identity so that everyone can feel safe knowing they will be respected for how they identify.
You are also helping to start a new prenatal outreach clinic in the area. What will that involve?
The clinic is a partnership between Sunnybrook and Vibrant Health Care Alliance, a community health centre near Yonge and Eglinton. We are accepting referrals from physicians or self-referrals for prenatal care. As one of the doctors involved, my priority for the clinic is accessibility and affirming care for queer and trans patients who might be seeking prenatal care.
When it comes to providing care that is inclusive to the 2SLGBTQIA+ community, how important is language — and what are some examples of inclusive terms?
Language is very important because the words we use can either be inviting for people or make them feel less welcome. For example, if we only refer to women or mothers when we are talking about pregnancy, somebody who is non-binary or a trans man, for example, might feel like that is not a safe space for them. I always try to use terms like pregnant person or parent, and partner or support person, so that we can include people who have different gender identities or different relationships.
What should care providers do if they aren’t sure about the best word or term to use with a patient?
My advice is to start with neutral terms and then ask the person what terms they prefer. I also suggest they explain why they are asking. And I think we should be aware that we won’t always say the right thing, so we need to accept feedback and be willing to learn if we say something that is not correct.
What are some steps Sunnybrook is taking to better educate physicians about how to provide gender affirming and inclusive care?
There are lots of opportunities to learn and there is more awareness. I think some of the changes that are coming, including the addition of fields for gender, pronouns and chosen name on some of our electronic records, will help further raise awareness.
What kind of difference can gender affirming and inclusive care make for Sunnybrook patients and their families?
It can make a difference in whether they even choose to come to Sunnybrook, so it is very important that we are providing safe care that honours gender identity for everyone.
Pregnancy is a time when we need a lot of interaction with the healthcare system so it’s essential that we don’t alienate people or make them feel uncomfortable.
As prenatal care providers, we are trying to gather a lot of information about a person and their identity and their family history. If we are not doing that in a sensitive way or explaining why that information is important, we risk making someone feel uncomfortable or even causing trauma.
It is difficult to capture clinical outcomes of gender affirming and inclusive care because that relies on people to give that feedback and disclose how they identify and how that affects their care. So there is more to learn about how we provide this kind of care and how we can improve.
What do you hope family doctors who provide care before, during and after pregnancy will keep in mind going forward?
I hope we can remember that people with different sexual orientations and gender identities can and do become pregnant and have families, and that we put aside any assumptions about a person’s identity just because they are pregnant. And I hope we can remain open to learning more and accepting feedback from our patients when we need to be corrected.
What do you enjoy most about the work you do in this area?
I love being involved in pregnancy care and childbirth because it’s such an amazing and powerful moment in a person’s life. It is such a privilege to be there to help welcome a new life into the world.
Being part of the 2SLGBTQIA+ community, I really want those patients to feel like we are providing the best care and I want them to feel safe when they are seeking care from us. So the educational part of my work is also really important for me to help support that community.
