What LGBTQ+ Parents Can Do for a Better Pregnancy Experience
It’s no secret that much more work needs to be done to ensure quality care for all pregnant people in the United States, especially for marginalized and LGBTQ+ identifying populations. The unfortunate truth is that today, LGBTQ+ parents are more likely to have negative pregnancy and postpartum experiences than cisgendered, heterosexual women—and that’s unacceptable.
These communities have largely been left out of research on prenatal and postpartum outcomes. (In fact, the US Census Bureau didn’t start including data from LGBTQ+ individuals until 2020.) But the statistics that have been gathered show that LGBTQ+ parents face heightened challenges both during and after pregnancy. “While the research is incomplete in this area, what we do know is that these outcomes may be related to disenfranchised status related to sexual orientation [or gender identity], low socio‐economic status, limited access to healthcare or health insurance and limited healthcare services equipped to treat specific population needs,” says Julie Croll, a clinical researcher and lead author of a 2022 report on the increased adverse outcomes that LGBTQ+ parents face.
So what are new and expectant parents to do? Read on to learn more about some of the difficulties many LGBTQ+ parents encounter during and after pregnancy, the possible reasons behind it and what families can do to advocate for a positive entry into parenthood.
In a 2022 survey conducted by the Association of American Medical College’s (AAMC) Center for Health Justice, 31 percent of LGBTQ+ parents reported having a less than “good” (meaning fair, poor or very poor) birth experience, compared with 18 percent of their cisgender, heterosexual counterparts.
That negative experience extended beyond childbirth too: LGBTQ+ parents reported higher incidences of postpartum complications, including those related to mental health (61 percent, compared with 34 percent of cisgender heterosexuals), physical health (40 percent, compared with 21 percent of cisgender heterosexuals), breastfeeding/chestfeeding (44 percent compared with 35 percent of cisgender heterosexuals) and returning to work (25 percent, compared with 16 percent of cisgender heterosexuals).
Croll’s 2022 report also points to inequities for LGBTQ+ parents. The data shows that lesbian and bisexual women face an increased risk of preterm birth and pregnancy loss, as well as a higher risk for postpartum depression and other mental health concerns.
Transgender and nonbinary individuals have also been overwhelmingly left out of research, but Croll notes most of the available research focuses on barriers that trans and nonbinary individuals face during family planning, rather than outcomes. “Transgender, and specifically transmasculine individuals who want to be pregnant, face obstacles like disruptions in hormone therapy, issues surrounding fertility preservation and increased levels of birth trauma (especially within the context of gender dysphoria),” she says.
According to Croll, “the risk factors of adverse outcomes for LGBTQ+ parents are as diverse as the intersecting populations themselves.”
Bias, discrimination and lack of support for LGBTQ+ individuals within the healthcare and family planning systems is unfortunately very real. According to the AMCC survey, 51 percent of LGBTQ+ parents felt their care was impacted by bias or discrimination.
“LGBTQ+ people who are building families, especially those who interface with the medical system, face systemic bias and invisibility, particularly in certain regions and communities of the US,” says Abbie Goldberg, PhD, a professor of psychology at Clark University in Worcester, Massachusetts. “People who identify as gender-nonconforming or trans may feel especially invisible or misunderstood in reproductive contexts, which can cause stress.”
To make matters worse, many medical professionals don’t have adequate training in addressing the experiences and needs of LGBTQ+ families. According to 2018 survey, less than 50 percent of ob-gyns reported being properly trained on best care practices for LGBTQ+ patients.
According to Goldberg, some examples of bias and discrimination in healthcare include:
- Excluding the non gestational partner during the pregnancy and birth and not recognizing them as the other parent
- Only using terms and imagery applicable to heterosexual couples, either in the paperwork they share, within their physical office space or on their website
- Using microaggressions towards queer and trans couples, such as questions like, “Who is the dad?”
Inconsistent health checkups as well as lack of communication may also play a role. According to a 2023 report from Gallup, the percentage of American adults identifying as LGBTQ+ is 7.2 percent and has approximately doubled in the past decade. However, despite these growing numbers, due to concerns over bias and discrimination, patients and doctors often don’t communicate openly about sexual and gender identities, says Daniel Roshan, MD, director at Rosh Maternal & Fetal Medicine.
Preexisting health conditions are another potential contributing factor. In its 2012 committee opinion, the American College of Obstetricians and Gynecologists (ACOG) notes higher rates of obesity, alcohol use and tobacco use among lesbian and bisexual individuals. This in turn could lead to gestational diabetes, high cholesterol, preeclampsia and c-section deliveries, Roshan says. “One [complication] can lead to another.”
In order for these outcomes to truly change, it’s the responsibility of care providers to learn how to make their LGBTQ+ patients feel empowered, safe and heard. “Overall, I feel that the onus is on the medical community to improve outcomes rather than on patients,” says Elizabeth Tammaro, MD, an assistant professor of family medicine at Brown University. “There’s significant evidence that the disparities we see in perinatal outcomes for LGBTQ+ families are related to stigma and marginalization, particularly the disparities in care and treatment that these families face within the medical community.”
Still, until the gap in care is closed, there are some actions you can take to up the odds of a positive pregnancy, birth and postpartum experience:
Find providers you trust—and be honest with them
Assembling an affirming prenatal team can be challenging based on where you live, especially since some fertility clinics and providers may refuse to care for LGBTQ+ patients, Roshan says. But certain online resources, like the LGBTQ+ Healthcare Directory, aim to make it easier. “It’s so important that all gestational parents have a team of healthcare providers both that they can trust, and are trained in all of the diverse needs of LGBTQ+ populations,” Croll says.
Once you’ve found an affirming provider you trust, Roshan advises empowering yourself to clearly and openly communicate with them. This way, your doctor has all the information they need to provide effective care. In fact, a 2019 study from Finland cited LGBTQ+ parents’ willingness to become more open about their sexual orientation and gender identities as an important tool for empowerment.
Build a supportive community to lean on
Community support is valuable for any individual, but especially for marginalized communities. Goldberg recommends finding other LGBTQ+ parents and families and connecting with them in-person if possible. Not only can having a supportive community like this help validate your experiences, but it can also help you find affirming providers. “Speak with LGBTQ+ friends or allies that have been or are pregnant,” Croll says. “Ask which healthcare teams they use and if they practice gender affirming care.”
Unequivocally advocate for yourself
If you feel like you’re being mistreated, as long as it’s possible and safe to do so, trust your gut and advocate for yourself, Goldberg says. Write a clear birth plan that “specifies what the care team can do to best support the family during birth,” Tammaro says. If financially accessible, consider working with a support person, such as a doula, who can help to advocate for your wishes and rights. And ensure you have access to mental health resources, like therapists, advocacy groups, hotlines and other resources to manage any anxiety and depression.
Communicate with your support network
If you’re on this journey with a partner, it’s crucial to have an open line of communication with them. The Finnish study also cited respectful partnerships’ and teamwork in all decision-making as a crucial part of positive experiences for LGBTQ+ parents. Try to talk openly about everything, including your feelings towards the care team, your experiences, any concerns you have, finances and how you want to parent your children.
The sad truth is that most Americans lack the support required during family planning, pregnancy and postpartum, but “the harm of these and other policies falls unequally on LGBTQ+ patients and other marginalized communities,” Tammaro says. Ultimately, “improving outcomes requires policy and system-level changes to improve care for all pregnant people—with the needs of marginalized groups at the center,” she adds.
Croll agrees: “Pregnant LGBTQ+ patients require all of the same support as heterosexual patients—and then some,” she says. “All patients deserve access to reproductive autonomy and to affirming healthcare that takes into account the diverse psychological, emotional and physical needs that a person has before, during and after pregnancy.”
About the experts:
Daniel F. Roshan, MD, FACOG, FACS, is the director at ROSH Maternal & Fetal Medicine in Manhattan. He specializes in maternal-fetal medicine, high-risk pregnancies, recurrent pregnancy losses, preterm labor, managing chronic diseases during pregnancy and more. He’s also an active member of the American College of Obstetricians and Gynecologists (ACOG) and the American College of Surgeons (ACS).
Abbie Goldberg, PhD, is a professor of psychology at Clark University in Massachusetts. She earned her bachelor’s degree from Wesleyan University and her master’s degree and doctorate from the University of Massachusetts. She has been a professor with Clark University since 2005.
Elizabeth Tammaro, MD, is an assistant professor of family medicine at Brown University. She completed her medical degree at the University of Massachusetts and completed her residency at the Tufts Family Medicine Residency at Cambridge Health Alliance. She completed her fellowship in maternal child health at Brown University.
Julie Croll, MB, BCh, BAO, is a clinical researcher. She completed her master of public health degree at Brown University and earned her medical degree from the Royal College of Surgeons in Ireland.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
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