Perinatal mental health
We acknowledge that there are very few resources that address perinatal mental health concerns in transgender, Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) , and non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. people. It is an ongoing focus of Trans Care BC to address this gap.
While some authors have suggested that transgender (trans) men who have been pregnant may be at higher risk for postpartum depression due to systemic discrimination, isolation, loneliness, and gender dysphoria Distress resulting from a difference between a person’s gender and their sex assigned at birth, associated gender role, and/or primary and secondary sex characteristics. (Source: WPATH) [1], little is known about the prevalence of perinatal depression, anxiety, or other perinatal mental health disorders in transgender, Two-Spirit, and non-binary (TTNB) people [2].
There are many factors that contribute to our limited knowledge of perinatal mental health in TTNB parents. Research into TTNB reproduction is relatively young, with most literature emerging in the last 15 years. Research is often limited to the experiences of pregnant trans men, excluding other TTNB people and families. Diverse participants are underrepresented and factors that are known to influence mental health outcomes, such as education, race, socioeconomic status, and disability, are not included [3,4].
The burden of navigating gendered pregnancy and infant feeding care spaces may make TTNB people more susceptible to mental health conditions. This burden may include being misgendered in healthcare spaces, needing to balance safety and disclosure during pregnancy, anticipating and experiencing poor care experiences, and striving for choice and control in all aspects of their care (often driven by fear) [2]. These experiences may cause TTNB people to feel lonely and excluded in reproductive spaces, a finding that has been linked with postpartum depression in cisgender Refers to people who are non-trans, i.e. whose gender matches their assigned sex at birth. women [5].
Being misgendered may increase feelings of gender dysphoria Distress resulting from a difference between a person’s gender and their sex assigned at birth, associated gender role, and/or primary and secondary sex characteristics. (Source: WPATH) and contribute to worsening mental health in the perinatal period [2]. In community interviews done by Trans Care BC, community members reported that they experienced (and, in some cases, continue to experience) negative mental health effects from gender dysphoria and being misgendered during pregnancy and infant feeding [6].
For all parents, major risk factors for perinatal mood disorders include personal or family history of mental health illness, low social support, and current life stressors [7].
Providing gender-affirming, relational care for TTNB clients and their families will improve the experience of care and may positively impact their mental health.
For more information, see Gender-Affirming Approach to Infant Feeding.
For more information on a gender-affirming relational practice, see Trans Care BC’s Gender-Affirming Relational Practice Course.
Anticipatory guidance may decrease anxiety and stress by outlining what to expect in pregnancy, birth, postpartum, and during the infant feeding journey.
For more information, see Anticipatory Guidance in Pregnancy.
The journey to parenting may be long and complicated for TTNB people. It may be costly, emotionally draining, and/or increase feelings of gender dysphoria Distress resulting from a difference between a person’s gender and their sex assigned at birth, associated gender role, and/or primary and secondary sex characteristics. (Source: WPATH) [8]. This may impact the energy a family has to navigate complex infant feeding plans.
Providers can normalize talking about mental health concerns by including a mental health check in alongside other routine assessments. This can include asking about mood, energy levels, sleep health, work/home balance or functioning, relational concerns, and overall well-being [7].
The Edinburgh Postnatal Depression Scale (EPDS) is the current standard of care in BC to screen for mental health concerns in the perinatal period. Although it uses gender neutral language, it is unclear if it is valid for TTNB people due to a lack of research. As a screening Process of checking for signs of a health issue or medical condition before symptoms appear. tool, it may be a useful tool for beginning a conversation about mental health.
Complex infant feeding plans (such as lactation induction, co-feeding, or bodyfeeding after chest surgery) will impact client’s sleep and may lead to worsening mental health for some clients. Consider socio-ecological factors and available support systems when working with clients to create infant feeding plans. Discuss the importance of sleep and create a plan to ensure a minimum of six hours every 24 hours. Ensure clients are aware of safe sleep practices for infants to avoid unsafe bedsharing due to exhaustion.
For more information about safe sleeping, see Perinatal Services BC’s clinical guidance on Safer Infant Sleep .
While this document offers TTNB specific considerations for perinatal mental health, it is not comprehensive. The Perinatal & Newborn Health Hub, developed by Perinatal Services BC, provides province specific clinical guidance on many different topics, including mental health:
- Perinatal Services BC offers this simple handout on the basic steps of self-care in the postpartum period: NESTS for Well-Being
- Taking Care: A Short Guide to Breastfeeding and Substance Use (inclusive but uses gendered language)
- Pacific Post Partum Support Society’s Postpartum Support for 2SLGBTQIA+ Families (not TTNB specific)
- Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstetrics & Gynecology. 2014;124: 1120–1127. doi:10.1097/AOG.0000000000000540
- Greenfield M, Darwin Z. Trans and non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. pregnancy, traumatic birth, and perinatal mental health: A scoping review. Int J Transgend Health. 2021;22: 203–216. doi:10.1080/26895269.2020.1841057
- Budge SL, Thai JL, Tebbe EA, Howard KAS. The intersection of race, sexual orientation Refers to terms such as lesbian, gay, straight, and queer, which are based on patterns of emotional, romantic, and/or sexual attraction to groups of people. Sexual orientation terms are commonly (but not always) defined by the gender(s) of the people that the individual is attracted to. Sexual orientation also refers to a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions; for example pansexual, bisexual, LGB, heterosexual. , socioeconomic status, trans identity, and mental health outcomes. The Counseling Psychologist. 2016;44: 1025–1049. doi:10.1177/0011000015609046
- Fischer OJ. Non-binary reproduction: Stories of conception, pregnancy, and birth. International Journal of Transgender Health. 2021;22: 77–88. doi:10.1080/26895269.2020.1838392
- Charter R, Ussher JM, Perz J, Robinson K. The transgender parent: Experiences and constructions of pregnancy and parenthood for transgender men in Australia. International Journal of Transgenderism. 2018;19: 64–77. doi:10.1080/15532739.2017.1399496
- Trans Care BC Community Interviews. 2023.
- Provincial Council for Maternal and Child Health. Perinatal mental health: Guidance for the identification and management of mental health in pregnant or postpartum individuals. 2021. Available: https://www.pcmch.on.ca/wp-content/uploads/PCMCH-Perinatal-Mental-Health-Guidance-Document_July2021.pdf
- Ellis SA, Wojnar DM, Pettinato M. Conception, pregnancy, and birth experiences of male and gender variant gestational parents: It’s how we could have a family. Journal of Midwifery & Women’s Health. 2015;60: 62–69. doi:10.1111/jmwh.12213
| Current version | January 14, 2025 | |
| Authors | Caitlin Botkin | Nurse Educator, Trans Care BC; Registered Midwife (non-practicing) |
| Rowan McNiven Gladman | Registered Midwife, IBCLC | |