By R. Featherstone, dual-certified Psychiatric & Women’s Health Nurse Practitioner
For many, navigating assisted reproductive technology (ART), pregnancy, or adoption can be emotionally challenging, bringing up mental health concerns throughout the process. Below are 4 tips for protecting your mental health as an LGBTQ+ (lesbian, gay, bisexual, transgender, queer) person embarking on your parenthood journey.
Redefine family and parents
Queer family building doesn’t always include the support of blood relatives or close loved ones. This is because many are estranged from their families of origin after disclosure of gender identity or sexual orientation. Social support groups are a necessity when navigating the emotional roller coaster of crossing the threshold to parenthood and preventing any mental health problems: strategically timed intercourse, fertility treatments, deciding on a donor or surrogate, or waiting to be chosen as an adoptive parent are all very emotional events. Be sure to choose people, whether that be family members, friends, support groups, and/or professionals, to confide in who will respect both your gender expression and privacy, participate in advocacy and nondiscrimination efforts, celebrate your happy days, and support you on the hard ones.
Effectively recruiting a new family, or a second family, will help you adjust to your new and evolving role. As a perinatal mental health provider, I always ask my patients, “Who would you call in the case of an emergency?” because if there aren’t a few people to pick from, you will need to nourish more supportive relationships or mental health services to guide you there. Godparents, honorary grandparents, and alloparents, or people functioning as additional parental figures, are all ways of achieving this goal.
If you choose to work with a donor or surrogate/gestational carrier, choosing someone who you are already close to may be a way to make them an honored and appreciated part of your family. Be cognizant of the fact that you will need to make sure that expectations on all sides are clear and outlined in a formal agreement.
Understand your (many) options as an LGBTQ+ family
With LGBTQ+ couples, there is no guarantee that the intended parents are able—or even desire—to carry a pregnancy. Due to gender-affirming care and other medical or genetic factors that may affect your physical health, conception may be difficult or carry higher health risk factors. In cases where the parents have only uteruses, then the question is more of who desires to carry the pregnancy and who desires to use their eggs—as well as who will donate sperm. For parents who only produce sperm, the question then becomes a decision of gestational surrogacy through an agency or trusted individual.
Understanding your options allows you to make the decision that makes the most sense, based on your preferences, financial situation, medical status, and overall well-being. The best way to understand your options is to talk with other LGBTQ+ parents or a fertility specialist, and ideally both.
People have differing levels of comfort with disclosing information about their parenthood quests. Candid conversations about who can say what and when is important, especially when it comes to navigating bad news. In my practice as a reproductive psychiatric provider, I am often working with patients who have had miscarriages or losses. When these people receive their bad news, they feel incredibly alone, especially if they had not announced the pregnancy beforehand. They may struggle with things like low self-esteem, or even anxiety or depression. In situations involving a gestational carrier, parents may feel even more invisible without the outward signs and reminders of pregnancy.
This becomes especially important in the case of fertility challenges and pregnancy loss. The partner carrying the pregnancy often feels grief regarding the event differently, experiences hormonal shifts that can worsen mood, and has heightened anxiety with future pregnancies. While some more introverted parents may not want information to be shared on the internet, or shared outside of select close friends or family, others may need confidantes who are more readily available than their mental health professional. Try to remember that you’re not alone: loss experiences are both awful and common, occurring in 11% of pregnancies.
Get a specialized family lawyer (if applicable)
While this caveat will not apply to all in the LGBTQ+ community, this does hold for anyone using donated sperm or eggs, as well as those working with a gestational carrier or traditional surrogate. In some states, same-sex couples may need lawyers in order to have both parents on the birth certificate. Unfortunately, laws regarding LGBTQ+ families and children are unique to each state, so consulting with a lawyer is advisable. In any scenario, having legal contracts and fact sheets outlining expectations of roles of the caregivers and future involvement with the child will help the future parents rest easy at night, knowing that there is a much smaller risk of their claim to parenthood being complicated by unexpected changes of heart by anyone involved.
It is inevitable that relationships and families change with each new member added. However, the more predictability and routine that can be maintained, the better for everyone’s mental health needs. I always encourage my patients to set aside time to nourish all of their relationships, especially with the other parent, outside of parenting or fertility-related time. This is essential to the foundation of the family, and the happier the parents are, the more that the (future) children benefit.