When complications arise during birth: LBTQ people's experiences of care

LBTQ parents' bonding experiences after complicated births: managing minority stress and traumatic experiences

BACKGROUND

Birth complications increase the risk of birth injuries and neonatal complications, as well as the risk of experiencing childbirth as a trauma. This, in turn, increases the risk of postpartum mental ill-health and may affect early bonding with the baby. Birth complications add additional stress on lesbian, bisexual, transgender and queer (LBTQ) parents, as they also must navigate hetero- and cisnormative assumptions, being subject to othering, and negative attitudes from healthcare staff.

AIM

To explore LBTQ parents' experiences of bonding with their child following a complicated birth.

METHODS

Semi-structured interviews with 22 birthing and non-birthing parents. Interviews were recorded, transcribed, and analysed using thematic analysis.

RESULTS

The results describe obstructive and facilitating factors. Being traumatised was the main obstacle for mentally engaging with the baby. A focus on physical injuries and healing hindered caretaking and bonding for birthing parents. Stress related to their parental role was obstructive for some non-birthing parents, who struggled to find space to process their own experiences when the partner and/or child was not well. Other non-birthing parents experienced a head start in the bonding process when their partner was injured. Some birthing parents had positive bonding experiences despite the birth complications, as they felt an alliance with their child in the harsh situation.

CONCLUSION

Complicated births and minority stressors can increase the risk of bonding difficulties and mental ill-health. Tailored, LBTQ-competent care is essential to support both birthing and non-birthing parents in overcoming these challenges.

LBTQ parents' needs for support postpartum following a complicated birth: A matter of reproductive justice

LBTQ people have increased risks of complications during birth, risks potentially driven by minority stress and increased levels of mental illness and fear of childbirth. With the aim of exploring reproductive injustices in postpartum care for LBTQ people, we analyzed qualitative interviews where 22 LBTQ birth and non-birth parents shared their experiences of support needs during the postpartum period after births where complications had arisen. Results point to the importance of providing an LBTQ safe space, which includes the need to feel safe regarding one's gender or sexual identity, by avoiding cisheteronormative assumptions and using inclusive language. In the context of recently experiencing birth complications, parents needed a space where they were able to focus on physical and mental healing. The results further show the need for validation of the non-birth parent and inclusive breast/chest-feeding support. Results emphasize the need for more psychosocial support around the birth experience, including better medical support and information during the whole process of childbirth.

Family building and pregnancy experiences of cisgender sexual minority women

BACKGROUND

Although 10% to 20% of cisgender women aged 18 to 40 years have a sexual minority identity (eg, bisexual, lesbian, and queer), there is limited research on the family building and pregnancy experiences of sexual minority cisgender women. Improving our understanding of the family building and pregnancy experiences of cisgender sexual minority women is critical for improving the perinatal health of this population.

OBJECTIVE

This study aimed to compare the mode of family building, past pregnancy experiences, and future pregnancy intentions among cisgender sexual minority women by sexual orientation.

STUDY DESIGN

This is an observational study which was conducted using cross-sectional data collected in 2019 from a national sample of 1369 cisgender sexual minority women aged 18 to 45 years.

RESULTS

Most participants (n=794, 58%) endorsed multiple sexual orientations, most commonly queer (n=641, 47%), lesbian (n=640, 47%), and/or bisexual (n=583, 43%). There were 243 (18%) cisgender sexual minority women who were parents. Pregnancy was used by 74% (181/243) of women to build their families. Among participants who used pregnancy, 60% (108/181) became pregnant through sexual activity with another parent of the child, whereas 27% (64/243) of women used donor sperm. An additional 10% (n=24) became parents through second-parent adoption, 10% (n=25) through adoption, and 14% (n=35) through step-parenting. Bisexual women more often used sexual activity to become parents (61/100, 61%) compared with queer (40/89, 45%) and lesbian women (40/130, 31%). In contrast, lesbian (50/130, 39%) and queer (25/89, 27%) women more often used donor sperm to become parents compared with bisexual women (11/100, 11%). Among the 266 (19%) cisgender sexual minority women who had ever been pregnant, there were 545 pregnancies (mean, 2.05 pregnancies per woman). Among those pregnancies, 59% (n=327) resulted in live birth, 23% (n=126) resulted in miscarriage, 15% (n=83) resulted in abortion, and 2% (n=9) resulted in ectopic pregnancy. A quarter of women had future pregnancy intentions, with no differences by sexual orientation. Overall, few participants (16%) reported that all of their healthcare providers were aware of their sexual orientation.

CONCLUSION

Cisgender sexual minority women primarily built their families through pregnancy and a quarter have future pregnancy desires. In addition, there were important differences in family building methods used by sexual orientation. Providers should be aware of the pregnancy and family-building patterns, plans, and needs of cisgender sexual minority women.