Lesbian Experiences and Needs During Childbirth: Guidance for Health Care Providers

doi:10.1111/j.1552-6909.2006.00008.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 35, Issue 1, January–February 2006, Pages 13-23

https://doi.org/10.1111/j.1552-6909.2006.00008.x Get rights and content

Objective

To provide an overview of the literature regarding lesbian experiences of childbirth and to offer health care providers guidance in supporting the childbearing lesbian couple.

Data sources

A search of the literature from 1980 through 2004 was conducted using PsycINFO, Ovid, PubMed, Ebscohost, and Cinahl, and the key words, lesbian, childbirth, parenting health care providers, pregnancy, artificial insemination, parental rights.

Data extraction

A critical review of all articles from relevant journals was included with attention to the needs of lesbian women concerning childbirth and implications for health care provider care.

Data synthesis

The four areas of concern identified for lesbians considering parenting were (a) the pros and cons of disclosing sexual orientation to caregivers and finding lesbian‐sensitive caregivers, (b) the options available when deciding how to conceive, (c) assurance of the desired level of partner involvement, and (d) the legal considerations for the conception process and for the protection of both parents as well as the child. Methods and strategies to assist health care providers to meet the needs of lesbian clients were gleaned from the literature.

Conclusion

A growing numbers of lesbian women are becoming consumers of childbirth health care. Health care outcomes of lesbian women and their infants are affected by experiences during pregnancy and childbirth and by the attitudes and actions of health care providers. Evidence exists that health care outcomes for lesbians are improved when health care providers are knowledgeable about and sensitive to the unique needs of lesbian clients. JOGNN, 35, 13‐23; 2006. DOI: 10.1111/J.1552‐6909.2006.00008.x

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

References (48)

S. Buchholz
Experiences of lesbian couples during childbirth
Nursing Outlook
(2000)
S.M. Harvey et al.
Lesbian mothers: Health care experiences
Journal of Nurse Midwifery
(1989)
J.M. Marrazzo et al.
Reproductive health history of lesbians: Implications for care
American Journal of Obstetrics and Gynecology
(2004)
E. Olesker et al.
Childbearing among lesbians: Are we meeting their needs?
Journal of Nurse Midwives
(1984)
L. Zeidenstein
Gynecological and childbearing needs of lesbians
Journal of Nurse-Midwifery
(1990)
T. Adkins‐Bates
When there are two mommies
International Journal of Childbirth Education
(2002)
Batie, A. (n.d.). The history of the Stonewall rebellion. Retrieved April 17, 2004, from...
U. Boehmer
Twenty years of public health research: Inclusion of lesbian, gay, bisexual and transgender populations
American Journal of Public Health
(2002)
California Family Code: Section 7613(b). Retrieved June 28, 2004, from...
H. Caulfield et al.
Next of kin
Nursing Standard
(1998)

D. Chosnoff et al.

That's a family: Statistics on US families

(2002)

Kaiser Permanente National Video Communications and Media Services (Producer). (n.d.). Cultural issues in the clinical...

F. Cunningham et al.

Williams obstetrics

(2001)

L. Dardick et al.

Openness between gay persons and health professionals

Annals of Internal Medicine

(1980)

G. Dunne

Opting into motherhood: Lesbians blurring the boundaries and redefining the meaning of motherhood

(1999)

A. Epstein

Gay basics: Partner medical rights documentation

(2003)

E.P. Gruskin

Treating lesbians and bisexual women

(1998)

E. Haimes et al.

‘Everybody's got a dad…’ Issues for lesbian families in the management of donor insemination

Sociology of Health and Illness

(2000)

G.M. Herek

Sexual prejudice: Understanding homophobia and heterosexism

(2004)

M. Kaufman et al.

Directions for research about lesbian families

J.W. Kenney et al.

Lesbian childbearing couples’ dilemmas and decisions

Health Care for Women International

(1992)

J.B. Lehmann et al.

Development and health care needs of lesbians

Journal of Women's Health

(1998)

E. Lewin

Lesbian mothers: Accounts of gender in American culture

(1993)

L.Y. Littleton et al.

Maternal, neonatal and women's health nursing

(2002)

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IN REVIEWLesbian Experiences and Needs During Childbirth: Guidance for Health Care Providers

Objective

Data sources

Data extraction

Data synthesis

Conclusion

Section snippets

Sources of information

Review of the literature

Disclosure of sexual orientation to HCPs

Options for conception

Partner involvement

Legal considerations

Limitations of the literature

Implications for HCPs

Disclosure of sexual orientation

Options for conception

Partner involvement

Legal implications of lesbian motherhood

Conclusion

Nursing Outlook

Journal of Nurse Midwifery

American Journal of Obstetrics and Gynecology

Journal of Nurse Midwives

Journal of Nurse-Midwifery

When there are two mommies

International Journal of Childbirth Education

Twenty years of public health research: Inclusion of lesbian, gay, bisexual and transgender populations

American Journal of Public Health

Next of kin

Nursing Standard

That's a family: Statistics on US families

Williams obstetrics

Openness between gay persons and health professionals

Annals of Internal Medicine

Opting into motherhood: Lesbians blurring the boundaries and redefining the meaning of motherhood

Gay basics: Partner medical rights documentation

Treating lesbians and bisexual women

‘Everybody's got a dad…’ Issues for lesbian families in the management of donor insemination

Sociology of Health and Illness

Sexual prejudice: Understanding homophobia and heterosexism

Directions for research about lesbian families

Lesbian childbearing couples’ dilemmas and decisions

Health Care for Women International

Development and health care needs of lesbians

Journal of Women's Health

Lesbian mothers: Accounts of gender in American culture

Maternal, neonatal and women's health nursing

IN REVIEW
Lesbian Experiences and Needs During Childbirth: Guidance for Health Care Providers