Elsevier

Midwifery

Volume 25, Issue 6, December 2009, Pages 682-690
Midwifery

Care during pregnancy and childbirth in Sweden: Perspectives of lesbian women

https://doi.org/10.1016/j.midw.2007.10.004Get rights and content

Abstract

Objective

to explore the views and experiences of care of lesbian women during pregnancy and childbirth.

Design, setting and participants

a qualitative study of 18 lesbian women in southern Sweden.

Findings

valid text units were formed through categorisation into four main categories: recognition of sexual orientation; openness; relationships within the homosexual family; and different encounters and attitudes within the health-care system. The interviewed women were positive about their care during pregnancy and childbirth. However, as in studies regarding women's experiences of care in general, lesbian women raised concerns about postnatal care, parent education and the structure of the patient records with no place for the female partner.

Key conclusions and implications for practice

confirmation of parenthood was important, especially for the co-parent. The participants in this study felt that when they were open about their sexuality, this was met with an openness that they felt was confirming about their homsexuality. It is important for health-care providers not to make assumptions about women's sexuality.

Introduction

According to Wilton (1999), the increasing number of lesbian women having babies is a sign that, in future, there will be an increase in the number of lesbian families. Attitudes towards homosexuals are changing; according to an American Gallup poll in May 2003, six out of 10 American adults were of the opinion that homosexual relationships should be legally recognised. Also, 54% considered homosexuality as an acceptable lifestyle (Newport, 2003). The increased acceptance and visibility has presumably encouraged more homosexual couples to consider parenthood (McManus et al., 2006). In July 2005, Swedish legislation was changed in favour of lesbian couples. Nowadays, they can apply for help to have babies and, if approved, both of the women are accepted as being parents provided that the fertilisation takes place in Sweden (SOSFS, 2005:17). However, when this study was undertaken, medical help with fertilisation was not legally permitted and no help was available from the health-care system for lesbian women suffering from involuntary childlessness. Lesbian women's experiences of the health-care system may, in general, be perceived as being negative. Lesbian women consult the health-care system less often than heterosexual women, and if they do attend, they do so later (Carroll, 1999). There is also a lack of knowledge, both among the women themselves and health-care professionals, concerning health issues for lesbian women. Many think, for example, that lesbians cannot be infected with sexually transmitted infections, which is wrong (Stevens, 1995; Carroll, 1999). It is not easy to identify homosexual women as they do not have a specific profile (Carroll, 1999). The term ‘heterosexist’ describes the dominant heterosexual ideology that is practised and sanctioned by society today. The term is also often used as a way of describing negative feelings and prejudices towards homosexuals (Westerstål, 1998). The health-care system works partly in accordance with this perspective. Forms and records, for example, are designed for heterosexuals (Hitchcock and Wilson, 1992; Morrissey, 1996). According to Carroll (1999), homophobia is a health problem for society. Many lesbian women will not tell their midwife or other health-care professionals about their sexual orientation. A British study showed that pregnant lesbians did not reveal their sexual identity because of fear of a prejudiced reaction, others worried that it would affect the care they were offered, and some were concerned that their confidentiality would not be respected (Wilton and Kaufmann, 2001). Just like a heterosexual pregnant woman, a lesbian woman wants her midwife to understand her needs and, if she has a partner, her partner should be included appropriately as a parent to be (Buchholz, 2000; Wilton and Kaufmann, 2001). In a Swedish study, lesbian women stated that one of the difficulties of being a lesbian parent is the fear of not being accepted as a competent parent from the point of view of society (Lövrie, 2003). In Stevens’ (1995) study, one woman described how she was often neglected as the other parent by health-care professionals; they did not confirm or talk to her as a parent, even if her baby called her ‘mother’.

The aim of this study was to explore the views and experiences of care of lesbian women during pregnancy and childbirth.

Section snippets

Participants

Inclusion criteria were: ability to speak and understand Swedish; and being a lesbian woman with experience of pregnancy and childbirth, either as the biological mother or as a co-parent. A ‘snowball design’ was used for sampling; i.e. one lesbian woman knew another lesbian woman who knew another, etc. (Hitchcock and Wilson, 1992; Stevens, 1995; Platzer and James, 1997; Polit and Hungler, 2001; Wilton and Kaufmann, 2001). This method is often used when investigating a vulnerable section of the

Findings

In total, 18 women were interviewed. Some lived as couples and were interviewed at the same time according to their wishes. This was not the case for those who were interviewed by telephone; in these cases, the women were interviewed separately. The four main categories formed were: recognition of sexual orientation; openness; relationships within the homosexual family; and different encounters and attitudes within the health-care system.

Discussion

The aim of this study was to illuminate lesbian women's views and experiences of their situation and their contact with the women's health-care system in Sweden in connection with pregnancy and childbirth. This study investigated the perspectives of biological parents and co-parents.

Conclusion

The confirmation of parenthood is important, especially for the co-parent, since the family constellation of a homosexual family is of a different composition to that of a heterosexual family. Health-care providers should show openness that recognises lesbian women and confirms that they are aware that all people are not heterosexual. Perhaps then, women will be more willing to discuss sensitive issues such as their sexuality. In order to give and receive appropriate care, most of the

Acknowledgements

The authors wish to thank all the participants for making this study possible, and Geoff Dykes for valuable opinions and suggestions regarding the English language.

References (22)

  • S. Cavanagh

    Content analysis: concepts, methods and applications

    Nurse Researcher

    (1997)
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