Written by Priscilla Blossom
Giving birth is one of the most physically, mentally, and emotionally demanding things we can do — and the days, weeks, and months that follow aren’t easy either. (Despite being – hopefully – full of plenty of magic, too).
For LGBTQ+ individuals, however, the challenges often multiply. Postpartum depression (PPD), postpartum anxiety, and birth-related PTSD, can affect anyone who has just given birth. But while research on the topic is slim, studies indicate higher instances of PPD among lesbian and bi individuals, and greater overall rates of mental health conditions among the LGBTQ+ community, increasing their odds of experiencing postpartum mental health concerns.
Being LGBTQ+ doesn’t automatically make you more vulnerable to experiencing conditions like depression and anxiety. However, the Mental Health Foundation points out that if you experience discrimnation, isolation, or rejection because of your sexuality or gender identity, it may lead to poor mental health.
New parenthood can be a really exciting time, but it’s also incredibly tough, especially when you factor in sleepless nights. If you don’t feel supported by your medical professional or your biological or chosen family, you can end up feeling very alone.
That’s why we’ve rounded up some of the most common mental health concerns new LGBTQ+ parents face, along with information on where to find support.
Despite the progress that has been made around rights, LGBTQ+ people continue to face homophobia, biphobia, and transphobia in their everyday lives — and this can have very real negative effects on their mental health after having a baby.
“I know for sure that people experience homophobia,” says Genavieve Jaffe, an entrepreneur and lawyer in Philadelphia. Jaffe is a mother who carried her partner’s embryo via reciprocal IVF (R-IVF). She says she knows some people will only refer to one parent as the “real” parent within same-sex couples. While she believes people’s questions about the genetics of her child aren’t always ill-intentioned, it doesn’t mean they aren’t hurtful. “[It] can be devastating,” Jaffe tells Flo.
But the problems are deeper rooted than comments from friends and strangers. “I have heard of homophobia when it comes to certain fertility clinics, where a nurse will continue to ask where the ‘husband/father’ is when they know it’s two wives, or they will refuse R-IVF,” Jaffe explains.
The fact is, discrimination against the LGBTQ+ community within clinics, doctors’ offices, and hospitals remains a major issue. Around 15 percent of LGBTQ+ Americans postpone or actively avoid seeking medical care for this reason alone, according to American Progress. One in three trans patients also said they had to educate their health professionals about trans matters just so they could receive proper care.
The statistics don’t improve in the U.K. either. Stonewall found that 14 percent of LGBTQ+ people avoided getting medical help due to fear of discrimination. A fear that’s clearly founded — almost a quarter of those surveyed had personally witnessed discrimination by health care staff.
And that’s not even getting into the reported rise in recent years in anti-LGBTQ hate crimes worldwide, from the U.S. to the U.K. and Germany, which can leave many struggling mentally and emotionally while they embark on their parenting journey.
From “mommy and me” classes to birthing and parenting workshops geared toward “moms and dads,” it can be emotionally difficult for many people in the LGBTQ+ community to not see themselves reflected in the conversation. And even when such spaces claim to be open to all, they frequently fall short.
“Often childbirth education classes are geared to heterosexual parents and may not be equipped to support transgender parents,” says Casey Tanner, MA, LCPC, and Certified Sex Therapist at The Expansive Group.
You only have to look at the most popular birthing and parenting resources to see this is in action. Many feature gendered language like “keep mother and baby together; it’s best for mother, baby, and breastfeeding,” while others use phrases like, ”for the mother-to-be and her birthing companion.”
This can leave LGBTQ+ parents-to-be feeling excluded and isolated, which in turn increases the risk of postpartum mental health disorders, especially during periods of isolation like the COVID-19 pandemic.
Freddy McConnell, a trans man who is currently pregnant with his second child, explained what needs to change in a recent article for Flo.
“All we are asking, now that awareness of diversity in birth is growing, is for inclusion,” he wrote. “It’s not about never saying ‘mother’ or ‘woman.’ No one would want that. It’s about saying ‘mothers and…’ or ‘women and….’ This is increasingly known in the birth world as the ‘additive’ approach.”
There is also a need for more doctors, nurses, lactation consultants, and other birthing professionals to offer respectful, gender-affirming care to trans and gender-diverse patients.
“Hospitals can often be spaces where individuals are constantly being misgendered [using language that does not respect a person’s gender identity] and where their partners may not be recognized as the second parent,” says Tanner. According to one report by the Center for American Progress, 23 percent of transgender people reported being misgendered by a doctor or health care provider in 2018.
Jay has recently had a baby. They know firsthand the impact misgendering can have. Though they had a very trans-inclusive OB-GYN, the attending gynecologist at their delivery was not.
“Even the providers who knew how I identified … defaulted to feminine and cis-heteronormative language, which definitely made me uncomfortable and made it harder to advocate for myself,” says Jay, who believes this played a role in the amount of unwanted interventions they had, including a non-emergency induction at 39 weeks.
“My son is healthy, and I’m very happy about that, but I definitely think that my labor and the trauma and lack of agency I experienced had a significant role in my PPD.”
For LGBTQ+ individuals, the constant struggle to be seen and heard, to be treated with respect, and to have their experiences and feelings validated — especially in the postpartum period — can be extremely draining.
Being misgendered, discriminated against, and having your identity completely ignored by the people who are supposed to be prioritizing your care are all factors that contribute to a greater risk of LGBTQ+ parents experiencing mental health difficulties after birth. And if you feel silenced or invalidated by your health professionals, it may also make it more difficult to seek support for your mental health when you need it most.
PPD and anxiety aren’t the only mental health concerns new parents face. Body dysmorphia can cause an individual to become fixated on perceived defects or flaws in bodily appearance, and it’s something that affects many individuals in postpartum, whether they are LGBTQ+ or not.
Gender dysphoria, however, is LGBTQ+-specific. It’s the feeling of discomfort or distress when one’s gender differs from the sex they were assigned at birth. Identifying as trans or non-binary is just another label that describes someone’s identity. It’s not inherently anxiety-inducing. However, gender dysphoria is rooted in how society perceives and treats non-binary and trans people.
An LGBTQ+ individual may experience gender dysphoria about certain parts of their body, such as their chest, hips, and genital area, that may be exacerbated during or after pregnancy. Pausing hormone replacement therapy in order to have a baby may also trigger feelings of gender dysphoria, as can a doctor misgendering a trans or non-binary patient or using the wrong pronouns.
Both gender dysphoria and body dysmorphia can cause or exacerbate anxiety and depression, especially for trans men (and gender-diverse individuals) during the stressful postpartum period.
“Pregnancy, birth, and postpartum cause a huge amount of hormone fluctuations … and can change your body in a way that might feel incompatible with your gender and gender expression,” says Tanner. “This can be really difficult for individuals to navigate internally on their own.”
When Lys Sorresso, a writer and editor in Chicago, first became pregnant, they knew they wanted a C-section and that they had anxiety around vaginal birth.
“After I had my baby, my anxiety disorder became more pronounced, largely because of the adjustment to being a new parent,” says Sorresso. “I also felt extremely uncomfortable in my postpartum body.”
Sorresso later realized they were also experiencing body dysmorphia, especially around their chest. “The feeling of breasts against my skin in a new way was disconcerting to me,” they explain.
Family support might be a given for many cisgender, heterosexual new parents. Sadly, this isn’t always the case for those within the LGBTQ+ community.
According to a 2018 study by the HRC, only 24 percent of LGBTQ+ youth feel they can be themselves at home. So when these young people go on to start families of their own, they often do so in isolation from loved ones like parents, grandparents, or siblings.
“People who hold any identity that isn’t cis/straight/white/thin-bodied are frequently neglected at higher rates in hospital settings and might not have as much community or familial support,” says Tanner.
“Postpartum support is essential to an individual’s recovery, and LGBTQ+ individuals are not always afforded that same level of support and care.”
While research has highlighted that LGBTQ+ people are more likely to experience discrimination in a medical setting, the experience of LGBTQ+ patients isn’t universal. Your experience is often dictated by how your gender identity and sexuality intersects with your race, age, and ability.
A study published in the journal Ethnicity and Inequalities in Health and Social Care found that because Black trans women often face both transphobia and racism, they’re more likely to experience depression. Further research has found that Black or ethnically diverse LGBTQ+ people in the U.S. face unique barriers to accessing health care, including discrimination by providers and limited access to health insurance.
Similarly, a report titled LGBT People With Disabilities highlighted that there are around five million LGBTQ+ people with a disability living in America. The report explained that limited access to LGBTQ+-inclusive, comprehensive, affordable health care is a major issue for this group.
For LGBTQ+ parents who carry another’s embryo, there’s another level of complexity that can affect their mental health.
“When you are the non-genetic parent, there can often be feelings of lack, loss, and disconnection,” says Jaffe, reflecting on her own experience.
She adds that in such cases, the non-genetic parent isn’t even considered the “legal” parent of the child until they go through the process of second-parent adoption, which requires background checks and sometimes even a home visit to ensure they are a “fit” parent. “It can certainly bring up a lot of other feelings and emotions,” Jaffe says.
In the U.K., after a child is born, the person who gave birth is automatically registered as the child’s mother, regardless of how that person identifies. This can trigger a lengthy legal process if the person who gives birth isn’t a woman, or if two gay men or a non-binary couple have a baby via a surrogate.
For those who need to seek donors and/or undergo fertility treatments, Jaffe created Connecting Rainbows — a directory of LGBTQ+-inclusive fertility clinics and lawyers who specialize in issues like second-parent adoption, surrogacy agreements, and more.
“Seek out an affirming OB, midwife, and/or doula early on in your pregnancy,” suggests Tanner.
If finances are an issue, she recommends reaching out anyway for a consultation to inquire about sliding scale options or referrals.
Additionally, finding LGBTQ+-inclusive lactation consultants is especially important for trans and gender-diverse individuals who wish to nurse or chestfeed their babies. Pediatricians are another consideration once you’re in postpartum.
“Set up [appointments with] gender-affirming pediatricians and other medical personnel prior to birth,” says Dr. Gauri Khurana, a clinical instructor at Yale University School of Medicine’s Department of Psychiatry. She recommends asking for recommendations from other LGBTQ+ parents. “Perhaps even look for a physician that is LGBTQ+ and can speak directly from their experience.”
And for those for whom it is safe, Tanner also recommends birthing at home. “[This] will make it much easier to avoid the constant microaggressions and misgendering that will come in [some] hospitals,” she says.
However, it should be noted this isn’t an option for all, including individuals experiencing a high-risk pregnancy. The American College of Obstetrics and Gynecology also advises against home birth for those pregnant with multiples, those whose baby isn’t settling into a position for a head-first delivery, and individuals who have had a previous C-section. Talk to your health care professional for more information about the right birth plan for you.
Joining support groups is another great way to get through the difficult parts of postpartum life as an LGBTQ+ person.
“I would encourage LGBTQ+ people to find queer-specific groups online and in-person, as much as comfortable,” says Sorresso.
“There is really nothing that can replace talking to someone who is going through the exact same thing as you, especially when you don’t see your experience reflected in the world around you.”
Jaffe agrees that virtual support groups are best, though she says in-person groups are often available in more LGBTQ+ accepting areas like New York City and the San Francisco Bay area. She also recommends the site Postpartum Support International, which has LGBTQ+-inclusive resources.
Additionally, you can reach out to trusted LGBTQ+ parent friends, your midwife, your OB-GYN’s office, and the hospital where you gave birth for information on support groups.
When it comes to postpartum mental health, it’s extremely important to seek out professional help whenever possible. This might involve speaking with your primary care provider, seeking a therapist or counselor for regular sessions, seeing a psychiatrist about medication, or a combination of all three.
“I was able to find a therapist rather quickly, and though she wasn’t trans, she was well-informed and supportive,” says Sorresso, who opted to take medication for their anxiety. “After decades of trying other methods to calm my mind, I finally admitted that I needed (and wanted) drugs to help me regulate my emotions and reactions to stress,” they say. “Honestly, it has been one of the best decisions of my life and has greatly impacted how I can show up as a parent and a partner.”
For additional help finding mental health resources in the U.S., reach out to your local LGBTQ+ center; look into national mental health resources like NAMI; ask LGBTQ+ friends for recommendations; or even check out Pride Counseling — a digital source for those seeking therapists (virtual or in-person) who specialize in LGBTQ+ patients. You can also refer to this comprehensive list of hotlines via the Human Rights Campaign for more help.
The Mosaic Trust and Q Life work tirelessly to support the mental health of LGBTQ+ people across Australia. And in Canada, The LifeLine Canada Foundation and Rainbow Health offer resources and therapy information for the community.
Please note these resources are just for reference and are in no way associated with Flo
If you’ve been affected by anything in this piece or are struggling with your mental health and would like to speak to someone, Flo has gathered links to support services that might be helpful. Please visit this page for helplines in different countries.