Journal of Obstetric, Gynecologic & Neonatal Nursing
IN REVIEWLesbian Experiences and Needs During Childbirth: Guidance for Health Care Providers
Section snippets
Sources of information
An inclusive search of the electronic literature databases PsycINFO, Ovid, PubMed, Ebscohost, and Cinahl from 1980 to 2004 was conducted using a combination of the following key words: lesbian, childbirth, parenting, health care providers, pregnancy, artificial insemination, and parental rights. To be included in the literature review, articles need to directly address factual accounts of lesbian experiences during childbirth or provide guidance for HCPs caring for this patient population. This
Review of the literature
Lesbian women considering parenting face unique challenges: finding a caregiver, options for conception, involvement of their partner, and legal implications of same‐sex parenthood.
An overview of the literature identified four primary areas of concern for lesbians considering parenting, the 1st of which was the pros and cons of disclosing sexual orientation to HCPs coupled with the difficulty of finding lesbian‐sensitive HCPs. The 2nd concern revolved around the options when deciding how to
Disclosure of sexual orientation to HCPs
One of the 1st questions that arose for any lesbian couple was whether to disclose their sexual orientation, more commonly known as “coming out” to HCPs. The review of the literature revealed that many lesbians feared that their degree of honesty, with respect to sexual orientation, might affect their experience throughout the pregnancy, birth, and through their child's formative years (Harvey et al., 1989, Tash and Kenney, 1993). Dardick and Grady (1980) found that lesbian (and gay male)
Options for conception
The question of how to conceive a child was not an issue usually faced by heterosexual couples,2 although it was of prime concern to the lesbian couple. The 1st choice must be whether to conceive through sexual relationship or
Partner involvement
While caregivers, friends, or society do not usually question the role of the father in a heterosexual family, the role of the lesbian coparent is frequently not only questioned but also misunderstood and ignored (Kenney & Tash, 1992). Wilton and Kaufmann (2000) found that over 30% of the women surveyed reported their partner had been excluded from the process at some point. This problem becomes particularly acute when couples choose not to let their sexual preference be known to HCPs, as
Legal considerations
The legal issues of parenthood can be daunting for the lesbian couple. Lesbians identify the “lack of social and legal recognition of their family structure and of the non‐biological mother as a parent” (McNair, 2003, p. 644) as a major challenge throughout the process of pregnancy and childbirth. Three primary legal issues that should be addressed with the lesbian couple include the legal relationship between the women, the legal relationship between the child and the non‐childbearing mother,
Limitations of the literature
In the limited literature on childbearing lesbians available for review at this time, it is discouraging to note that the same concerns identified by Harvey et al. (1989) are still being addressed by Wilton and Kaufmann (2000) and by Buchholz (2000). In the research reviewed, several significant social limitations are noted. All authors cite obtaining an adequate sample size as a problem. Wilton and Kaufmann (2000) obtained the largest sample, but with 50 participants, their study cannot be
Implications for HCPs
It is vital that both lesbian couples and their HCPs are aware of the issues relating to lesbian childbirth and how to communicate about them. As outlined, the considerations for lesbians contemplating parenthood are immense and often overwhelming. Many couples seek support from friends or relatives, or both, others from parenting groups and lesbian/gay organizations, and some others will turn to their HCPs as being the experts in this field. The information and education provided to the couple
Disclosure of sexual orientation
The ability of the patient to be candid about sexual orientation leads to increased satisfaction and improved outcomes for the childbearing lesbian (Dardick & Grady, 1980). It has been recognized that lesbians are more likely to disclose their sexual orientation to an HCP who is perceived to be sensitive to the needs of lesbian women (Tash and Kenney, 1993; Zeidenstein, 1990). Clues that an HCP is lesbian sensitive may be demonstrated by the use of gender‐inclusive wording and images in
Options for conception
Health care providers involved in gynecological care, preconception counseling, and prenatal care require a knowledge of insemination options. Health care providers need to know that success rates for home inseminations are slightly less than for those done in medical offices (Smith, 2004). They need to have an understanding of the differences in success rates with and without fertility medications or with the use of fresh sperm as compared to frozen. This knowledge enables the caregiver to
Partner involvement
Health care providers must ensure that the needs and desires of the couple are recognized and met by the entire health care team. This can be accomplished through incorporating all previous suggestions as well as by utilizing a process of anticipatory preparation for all HCPs who will be present during the labor and birth (Buchholz, 2000, p. 308). Health care providers should be aware that their attitudes, both conscious and unconscious, can be reflected in both verbal and nonverbal behavior
Legal implications of lesbian motherhood
The legal issues associated with lesbian childbirth are of concern, not only to lesbian couples but also to HCPs. Ideally, HCPs should educate themselves with a basic knowledge of how local laws affect the same‐sex couple. For the legal protection of the child as well as both mothers, details such as power of attorney, 2nd‐parent adoption, and legal guardianship should be addressed with the couple before the birth of their child (Kaufman & Dundas, 1995). It can be helpful for HCPs to ensure
Conclusion
This article provides an overview of the literature on the subject of lesbian experiences with the health care system during the processes of conception, pregnancy, and childbirth. Four primary issues facing these women are identified and suggestions provided to enable HCPs to become more culturally competent in the care of the childbearing lesbian woman and her partner. A discussion of the limitations of the literature describes the invisibility with which many lesbians are forced to live
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