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Easing Postpartum Conversations: Students Work to Improve the Experience for Diverse Families

Penn nursing asked KC Benchimol, Nu’14, GNu’18, GNu’19, RN, WHNP-BC, and Monika Wasik, C’12, Nu’15, GNu’18, RN-CBC, to walk us through the policy change they spearheaded across postpartum units at the University of Pennsylvania Health System—a simple change that makes it easier for all people to participate in the postpartum experience and symbolizes
acceptance of LGBTQ+ parents.

Their Preparation

As students at Penn Nursing, we honed a critical eye that allowed us to identify a simple way to update the paperwork and improve the postpartum experience for diverse families. While our educations gave us the confidence to confront a system in which diverse families were not being appropriately recognized and valued as well as to speak up to implement change, our graduate policy course helped provide us with the tools we needed to connect our proposal to current health care policy.

Enforcement is a key part of ensuring inclusive care for LGBTQ+ individuals. Despite being currently challenged, the law protecting patients on the basis of sex still stands in any hospital receiving federal funding, including Medicaid and Medicare. Our primary analysis and working experience utilizing the birth certificate (BC) and social security number (SSN) applications on the postpartum unit revealed that these forms were not appropriate for many LGBTQ+ families. As nurses caring for a diverse patient population, we strive to mitigate discrimination and health disparities, and we aim to include a “broad definition of family,” as defined by the Joint Commission in 2011, within hospitals’ policies and practice. Therefore, our proposed change was to replace the gendered language ‘Mother’ and ‘Father’ on the BC and SSN worksheets with the gender-neutral alternatives, ‘Parent 1’ and ‘Parent 2’.

The Implementation

To implement these changes, we collaborated with nursing leadership on our own unit to create an informal working group. We conducted a thorough literature review of LGBTQ+ experiences in health care to add to the anecdotal support from the patients we cared for to determine the most inclusive terminology alternatives and to ensure we were making an evidence-based intervention. We then contacted leaders across the University of Pennsylvania Health System (UPHS) in addition to the system’s Medical Record Committee, Operations, Birth Registry Unit, and government agencies for review and appraisal. This effort resulted in a health system-wide change in the language of the Birth Certificate and Social Security worksheets—in English and Spanish—to reflect diverse family structures.

During the implementation process, we informed staff of the change through Unit Council meetings, e-mail, and shift huddles, and provided them with resource tip sheets to assist LGBTQ+ patients in completing the BC and SSN forms. Since implementing the new paperwork system-wide, no families have expressed discomfort or difficulty utilizing the paperwork in a way that applies to their family structure. The change also symbolizes that all family structures are welcome (Benchimol, Wasik & Scalise, 2018).

Furthering Change

We also provided a framework for a more national change to not just BC and SSN papers, but to all forms and documentation within the gender-exclusive ‘Women’s Health’ arena. We presented on our project at the Association for Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) Annual Convention, where we shared our policy changes and provided handouts to guide nurses, providers, and hospital stakeholders in implementing gender neutral paperwork in their own hospitals.

Amending the paperwork terminology is an effective way to include LGBTQ+ families within the hospital system, but it also exposes the need for continued evaluation of all clinical paperwork and gendered terminology usage in the postpartum setting, and the sustained need for more research about best practice care for childbearing LGBTQ+ individuals and their families (Benchimol, Wasik & Scalise, 2018).

Plans for the Future

  • Continue to advocate for removing gendered language from the EPIC electronic health record
  • Implement gender neutral ‘crib cards’
  • Create a policy for non-gestational parents to provide human milk

Tips for Implementation

  1. When creating new paperwork and designing resources for your unit, be aware of gendered language and evaluate its necessity.
  2. Seek management buy-in and involve people from the LGBTQ+ community in any changes made.
  3. Collect data from patients, even informally, via surveys or error-reporting systems.
  4. Know your state’s laws and legal protections for LGBTQ+ persons and families.
  5. Know resources in your area to refer your patients.

Resources

  1. Human Rights Campaign State Equality Index (state scorecards)
  2. RAD Remedy LGBTQ+ Resources
  3. American Civil Liberties Union
  4. Your local LGBT Center or LGBT Health Center

Additional citation:

The Joint Commission. (2011). Advancing Effective Communication, Cultural Competence, and Patient-and-Family Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide. Retrieved July 23, 2018, from https://www.jointcommission.org/assets/1/18/LGBTFieldGuide.pdf.