Working with lesbian families.

What difference does it make if your clients are lesbians? In many ways the pregnancy and birth will be just the same as those of your heterosexual clients. In other ways, lesbians' lives are different. Knowing something about their legal rights and risks, how the health-care system treats them differently, what family issues may come up for them, and other likely issues, will make you a more intelligent listener. Your clients will feel more comfortable with you if they don't have to constantly explain their lives to you.

The partner of a pregnant lesbian is often not acknowledged by healthcare workers. "We only need the mom in here, your friend can wait outside," is typical even though male partners with pregnant women are welcomed. As their children grow up, lesbian families often find that healthcare workers, and school personnel, can only see one of them as the child's mother. This can be thoughtlessness, or it can be real homophobia and hostility. Hospitals, doctors' offices, and schools may just ignore one of the women, or persist in asking "Who's the real mom?" It's important that you clearly acknowledge both partners as parents. You may also need to advocate for them in the hospital around this issue.

Word Choice. Ask your clients what words to use. Some lesbian couples think of themselves both as mothers, others do not. Some lesbians refer to their partner as "my wife," which may sound unfamiliar when you first hear a woman saying it but is perfectly logical. In your classes, try using the word "partner" because that covers everybody: biological fathers, lesbian couples, and single women who have brought a friend or relative to support them during the birth.

Marriage: "We're married in the state, but not federally." After Massachusetts extended legal recognition to same-sex marriage on May 17, 2004, many same-sex couples got married in the state. However, the federal government does not recognize these marriages and the couples are still dealing with uncertainty about their legal rights, including health insurance, inheritance, and others. Their marriages are also not recognized by other states. Vermont offers civil unions giving many of the same rights as marriage, and a new California domestic partners law will be very similar. Also, just as with heterosexuals, not all lesbian couples want to get married. One woman, living with her partner for many years and raising their daughter together, said "now I feel like there's all this pressure, like we have to get married. I'm not sure I want to."

Custody of children: "We got married, and I adopted the baby. But if we leave Massachusetts we will both be single parents." The woman who does not give birth does have the option of adopting the baby and becoming a legal parent, whether she and the mother who gives birth get married or not. In fact, second parent adoptions have been happening for years, long before gay marriage was a possibility. So your client's partner may plan to adopt the baby and become a legal parent. As a childbirth professional, you don't need to be an expert on these legal issues, but it's probably best if you're well-informed so they don't have to explain things to you.

Healthcare proxy. If two women are not married, or possibly even if they are, they may want to talk with the hospital about a healthcare proxy. This gives the non-birthing mother power to make medical decisions for her partner, if she is not able to speak for herself, and for the baby. The hospital can provide a healthcare proxy form. It simple to fill out, and no lawyer is needed. Part of your job as your clients' advocate would include letting hospital staff know there is a healthcare proxy if it becomes relevant.

Privacy and curiosity: "People I hardly know ask me things like, 'where did you get the sperm?' which they would never ask a straight woman." Many lesbian couples face intrusive curiosity about their families. Few people ask a heterosexual couple anything about how they got pregnant, how long it took, etc. But many feel free to question a lesbian couple about whether they used frozen sperm, who the donor was, whether the child will know who the donor was, how they will explain this to their child, and other personal questions. Some couples feel fine about answering these questions, even eager to discuss them, while others find them intrusive. Your client may want to share this information with you, or may not. Don't ask, just as you wouldn't ask a heterosexual woman how she got pregnant.

For your own background information, many couples will have used artificial insemination. If they have chosen an anonymous donor, and obtain sperm through a doctor, the donor may be permanently anonymous or information about him may be available to the child at age 18. In this situation, getting pregnant may have been very expensive, as they probably have had to pay a sperm bank for frozen sperm as well as pay the doctor.

The couple may have chosen a donor whose race or ethnicity matches that of the partner who is not giving birth. Or, they may have chosen a friend, or a relative of the woman who is not pregnant, to be the donor. In this case, they could have done the insemination themselves, with no medical professionals involved. Or, the pregnant woman may have become pregnant through a sexual relationship with a man, with the plan of raising the baby with her female partner. The biological father may plan on being involved in the child's life or not.

Extended family: "This baby has solved everything with my parents," one pregnant lesbian said. Her parents, who had had mixed feelings about her sexual orientation, were delighted to come grandparents and the birth allowed everyone to settle into a new, warmer, family relationship. It doesn't always work that way. Sometimes the parents of the woman who has not given birth do not accept the child as their grandchild, which can be very painful. Like any couple, these clients may appreciate a chance to talk about how their extended families are responding.

Prejudice and discrimination. There's been lots of progress in recent years in both legal rights and social acceptance for gays and lesbians. However, prejudice and violence are still common, and many lesbians have been physically attacked, sometimes by their own relatives. Probably all have faced discrimination and hostility. They may be cautious, for good reasons.

Couple Issues: "My wife has no idea what I'm going through" Don't assume that your pregnant client's partner will automatically know how to support her, and be extra sensitive and understanding, just because she is also a woman. Every couple's relationship has complexities and issues, whether it's two women or a man and a woman. And if your client's partner has never been pregnant, she may know as little as a first-time father does about what pregnancy is like or what the pregnant woman needs.

Breastfeeding. The nonpregnant partner will probably also need the same kind of information about breast-feeding as a male partner would, in order to support the birthing mother. Or, in some lesbian couples, both mothers plan to breastfeed. It is possible to breastfeed without giving birth. Adoptive mothers have done it, and have produced milk in response to the baby sucking, although not enough to be the baby's sole source of food. A good resource is the book Breastfeeding the Adopted Baby, by Debra Stewart Peterson.

Love. Your lesbian clients are not just roommates, or close friends. If you have not spent time with two women who are expressing their love and tenderness for each other, will you need to prepare yourself to be comfortable with your clients during the intensity of birth?

Everybody's different. Lesbian families are as varied as heterosexual families are. You may meet someone whose gender you are not sure about at first. Some lesbians may be politically active, and want to raise their child in a community of other lesbian families. Another may be a suburban couple focused on schools and lawn care. But the most important thing about caring for lesbian clients is something you already know: how to care for each woman as an individual, and to see each birth both as similar to other births and also as special and unique.

Learning more. Below are some further resources to help you learn more about the issues discussed in this article.

It's a Family Affair by Lisa Saffron.

The Essential Guide To Lesbian Conception, Pregnancy, and Birth by Kim Toevs and Stephanie Brill 

Breastfeeding the Adopted Baby by Debra Stewart Peterson.

Becky Sarah, M. P. H., is a lay midwife, a childbirth educator and a licensed acupuncturist. She worked for several years in a fertility program serving both lesbian and heterosexual women. Site has two grown children and one grandchild. Site can be reached at [e-mail]