LGBTQ Birthing Options and Access

Written by: Jess Kimball

Gender-affirming care describes a range of social, psychological, medical, and behavioral interventions that are used to support someone’s gender identity. This form of care is life-saving. Practicing gender-affirming care can lead to much better mental health outcomes for TNGB individuals. This care model allows for bias to be assessed and confronted within providers, helping them to provide more inclusive care which greatly improves the experience of their patients. It can be exceptionally hard to find safe options for reproductive health care as a TNGB or LGBTQ individual. We recommend heavily researching places and providers before seeking care somewhere new. Choosing a medical provider is something we all want to be incredibly particular about. The app Irth allows Black and brown birthing individuals to read reviews about providers and hospitals when they are deciding where to seek perinatal care. While we are not aware of anything similar for LGBTQ folks, we do hope that something will be created soon.

The research for LGBTQ folks does not stop when they find a provider. Many are left with the unfortunate burden of learning about pregnancy, lactation, and parenting all on their own. An extremely isolating period is much more isolating for LGBTQ parents. Thankfully, many more providers are educating themselves and new resources are being developed daily. We love Baby Making For Everybody by Marea Goodman and Ray Rachlin.

My personal journey with fertility care began when I sought out a fertility clinic to do an IUI. Between my work as a fertility doula and my personal experience going through the fertility care process, I have learned quite a bit. The family dynamic we are taught (mom, dad, two kids, maybe a pet of some sort) is just not the reality.

As a doula, I have supported lesbian couples where one person’s egg is being used for the pregnancy, but the other parent is carrying the pregnancy. I have supported families adopting and wanting to induce lactation. I have met and worked alongside doulas who are transgender males but chose to carry a pregnancy and birth their babies. Some of them chestfed their baby even after their top surgery. The family dynamic I saw highlighted in the media was not that different from the one I grew up in. Just multiply those two kids by 3.5 and you would get my family as the result. However, I quickly realized through my work as a doula and my own journey through pregnancy and loss that the reality of families is far from that of the media-glorified nuclear family.

Some families may choose IVF, in vitro fertilization, to build their family. IVF is a process where an egg is fertilized with sperm in a test tube or somewhere outside of the body. Then it is transferred back into the body. Some couples may do IVF with donor sperm or they may use donor sperm and a donor egg and use IVF with a surrogate.

A surrogate is a person who will carry a pregnancy but may not have any biological relationship with the child. They have no intent to parent the baby. They are hired by a couple to carry the pregnancy for the couple. In rare cases, the surrogate is also the egg donor.

Some LGBTQ couples require fertility support but do not need a procedure as extreme as IVF. They may seek out IUI. This is an intrauterine insemination done with sperm from a partner or donor. Some people choose to do their own IUI at home. We recommend seeking medical assistance in order to avoid any risk of infection, but if you are uncomfortable with a clinical setting you can choose to work with a midwife. Goodman, co-author of Baby Making For Everybody, routinely does at-home IUIs for clients.

Donor sperm is often used for lesbian couples trying to conceive, single parents by choice, and parents who do not produce sperm or are not comfortable using their sperm for a variety of reasons. It can be purchased online through cryo-banks and is shipped to the intended user’s home. It is good for a certain amount of time in the tank it arrives in. It can be brought with the intended user to a clinic for a same-day procedure, or a user could order multiple vials of sperm and store them at their fertility clinic for months to years. Some may choose to do this to guarantee the same donor for future pregnancies.

Donor eggs are a bit harder to order, and donate for that matter! Donor eggs require IVF as the only procedure choice. The process typically consists of a consultation, preparation of the recipient (psychological counseling and screening), donor selection, synchronization, and the actual egg retrieval and embryo transfer. Some eggs are already in a bank ready to be adopted. They may not require as many meetings because the donor has already signed off and done their counseling. The counseling is a psychoeducational meeting with a licensed provider to discuss how you will share your child’s conception story with them, concerns you have, etc. For some people, it can feel like a form of gatekeeping to starting a family. Research is key when deciding who to meet with for your screening.

For those who do not want to carry a pregnancy, work with a surrogate, or maybe do not even want to have a young baby adoption may be a better option. Fostering is another option, but it is important to note that the goal of fostering is family reunification. Fostering to adopt is not considered ethical, but sometimes may end up being the best option for the child. Discrimination in fostering and adopting still exists. You can research your state policies and protections here.

When you begin to enter the territory of pregnancy and family-building options an often neglected concern is infant feeding. Many providers are making an effort to educate themselves on inclusive lactation support, but the truth is that misinformation is still out in the world. Many providers do not know that transgender parents may be able to chestfeed and that two mothers can feed one baby through induced lactation in the nonbirthing parent. It is important to find a lactation provider and begin the conversation around infant feeding early in the fertility and pregnancy process. It may not be doable for everyone, but for many if you seek care early inducing lactation work.

There are many options to grow your family. The step that needs to happen before one can really use their gut instinct to decide what is best for them is research and education. Once we learn about our options we are able to make a well-educated decision. Education is important for both providers and parents. Education allows providers to practice affirming care, doulas to advocate for clients, and patients to be self-advocates.

At Global Foundation for Girls (GFG), we are active thought partners, serving global communities of birthing persons in order to advance and support the advocacy movement. We lead webinars and trainings for providers including doulas, social workers, childbirth educators, and more! To learn more about our upcoming trainings click here!

Jess Kimball, AS, CLC, CD, PCD, PMH-C