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Experiences of Preconception, Pregnancy, and New Motherhood for Lesbian Nonbiological Mothers Danuta M. Wojnar and Amy Katzenmeyer

Correspondence Danuta M. Wojnar, PhD, RN, IBCLC, FAAN, Maternal Child and Family Nursing, Seattle University, College of Nursing, 901 12th Avenue, PO Box 222000, Seattle, WA 98122-1090. [email protected] Keywords nonbiological lesbian mothers pregnancy descriptive phenomenology

ABSTRACT Objective: To describe the experiences of preconception, pregnancy, and new motherhood from the perspective of lesbian nonbiological mothers. Design: Descriptive phenomenology. Setting: A private room at the study site and participants’ homes. Participants: Twenty-four self-identified lesbian nonbiological mothers in a committed relationship and whose partner gave birth within the past 2 years participated. All of the participants were from urban or suburban areas in the Pacific Northwest. Methods: Women participated in semistructured in person interviews that were audio recorded and transcribed verbatim for analysis. Coliazzi’s method guided the process. Results: An overarching theme of “feeling different” permeated the experiences of preconception, pregnancy, and new motherhood for the participants. The women’s narratives revealed seven themes that illustrated their experiences: (a) Launching pregnancy: A roller coaster ride; (b) Having legal and biological concerns: Biology prevails; (c) There is a little person in there: Dealing with pregnancy issues; (d) Losing relationships over pregnancy: The elephant in the room; (e) Feeling incomplete as a mother; (f) Carving a unique role: There are very few of us out there; and (g) Sadness and regret: Nonbiological mothers get the postpartum blues, too. Conclusions: The experience of preconception, pregnancy, and new motherhood for nonbiological lesbian mothers is complicated by the lack of biological and legal substantiation to the infant, few role models, and limited social support. Nurses and health care providers cognizant of these issues can play an important role in facilitating a positive transition to motherhood for this population.

JOGNN, 43, 50-60; 2014. DOI: 10.1111/1552-6909.12270 Accepted September 2013

Danuta M. Wojnar, PhD, RN, IBCLC, FAAN, is an associate professor and department chair, Department of Maternal Child and Family Nursing, Seattle University College of Nursing, Seattle, WA. Amy Katzenmeyer, MSN, FNP, ARNP, is a family nurse practitioner, Orthopedics Department, VA Puget Sound Health Care System, Seattle, WA.

The authors report no conflict of interest or relevant financial relationships.

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he definition of family in Western societies has been in a state of reorganization and diversification during the past few decades (Power et al., 2010). As a result of the gay liberation movement in the United States during the 1970s and 1980s, a significant number of lesbians and gay men have settled into two-woman or two-man households (Dunne, 2000; McManus, Hunter, & Renn, 2006). This has led to an increase in visibility of gay and lesbian families especially as some families choose to live a more open life (Suter, Daas, & Bergan, 2008). With the increasing availability of alternative childbearing options, a new population of parents has emerged to challenge the established norms of human reproduction and the traditional notion of family (Hayman, Wilkes, Halcomb, & Jackson, 2013; Wojnar & Swanson,

T

2006). Although the exact number of lesbian families with children is unknown, the 2000 Census Report listed 301,026 lesbian families, of which 103,252 (34.3%) were raising biological children (Erwin, 2007). A recent survey suggested there were approximately 400,000 to 500,000 lesbian parents in the United States (Weber, 2010). However, official estimates may not represent the true extent of this population, as many same-sex families may have declined self-disclosure to avoid the potential negative consequences of identifying themselves for statistical purposes (Erwin, 2007).

Literature Review The process of becoming parents in lesbian-led families is complex and multifaceted. Although

 C 2013 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses

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research findings suggest that the desire and motivation to have children in lesbian relationships are quite similar to those in heterosexual relationships (Bos, van Balen, & van Den Boom, 2003, 2004; Hayman et al., 2013; Riskind & Patterson, 2010), lesbians spend more time thinking about their motives to become parents and the obstacles they must overcome to achieve biological parenthood than heterosexuals (Wojnar, 2007). Unlike their heterosexual counterparts, the journeys of lesbians to parenthood comprises several unique steps. According to Baetens and Brewayes (2001) and Wojnar (2007), most lesbian couples begin the process with negotiations about which partner will fill the role of the biological parent. This decision is usually influenced by age, desire for pregnancy, reproductive health, and security of employment (Bos et al., 2003, 2004; Renaud, 2007). The next step involves selecting a method of conception that is effective, affordable (Marina et al., 2010; Renaud, 2007), and does not interfere with the nonpregnant partner’s position in the family (Bos & Gartrell, 2010). Couples wishing to pursue biological parenthood have been able to take advantage of technological advances made over the past few decades, thus increasing their options for conception to include insemination with sperm obtained from a sperm bank or a known donor (Erwin, 2007; McManus, Hunter, & Ren, 2005; Renaud; Pelka, 2009). Although most lesbian couples designate one partner as the biological mother, some alternate between biological and nonbiological motherhood (Erwin, 2007; Marina et al., 2010; Pelka, ˇ 2009; Sobocan, 2011). Regardless of the selected method, most lesbian couples continue to experience financial burdens associated with the insemination process and some, though less so in recent years, experience difficulty with access to insemination services (McManus et al., 2005; Renaud, 2007). Research regarding the experiences of lesbian childbearing began with the work of nurse midwives in the early 1980s. Olesker and Walsh (1984) conducted the earliest published inquiry about pregnancy experiences of lesbian mothers. The participants (N = 10) described their experience in relation to fears and anxiety about the consequences of disclosure of their lesbian identity to health care providers and the potential loss of their children if custody battles with the biological fathers were to occur. Subsequently, Harvey, Carr, and Bernheine (1989) explored the experience of pregnancy and childbirth with (N = 35) White middle-class lesbian mothers. Participants reported that their motivations to become biolog-

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Feeling different permeated the experiences of preconception, pregnancy, and new motherhood for the participants.

ical parents were the desire to experience pregnancy and birth and to raise their own children. Twenty-nine of the study participants (83%) were satisfied with their obstetric care whereas the remaining women were disappointed with providers’ uncaring attitudes and lack of knowledge about lesbian health and parenting issues. Similar concerns regarding lesbian biological motherhood were reported by Zeidenstein (1990) and Kenney and Tash (1992). Later, researchers of lesbian pregnancy began to address more complex issues such as legal substantiation, access to insemination services, donor selection, childbirth, and new parenthood. Most notable is a longitudinal descriptive investigation (Gartrell et al., 1996; Gartrell et al., 1999) in which the authors followed a sample of lesbian birth mothers (N = 154) and their partners before and during pregnancy, with follow-up interviews at 1, 5, 10, and 17 years. The researchers reported common values and goals regarding childbearing and childrearing among the study participants. Although some women became estranged from their families of origin when they or their partner became pregnant, they hoped that at least some of their family members would accept them and their future children. All expectant women and their partners were concerned about raising their children in what they considered to be a heterosexist society and the potential impact of homophobia on their future children. Coping strategies to deal with stigmatization and prejudice included parent support networks, openness about being lesbian, and networking with lesbian-friendly providers and child-care centers. Most recently, Gartrell and Bos (2010) and Gartrell, Bos, Peyser, Deck, and Rodas (2012) described the coping strategies of adolescents born to lesbian relationships. Subsequent investigators (Erwin, 2007; Friedman, 1998; Hequembourg & Farrel, 1999; Renaud, 2007; Goldberg & Smith, 2008; Suter et al., 2008) shed light on the intricacy of being in a lesbian relationship with children. Although participants in these studies were generally satisfied with their couple relationship, some had ongoing concerns about the lack of support for their decisions to parent by their families of origin and others within their social networks. In addition, there was a reported overall lack of understanding regarding the

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roles of the nonbiological mothers within the family (Bergan, Suter, & Daas, 2006; Goldberg & Smith; Hequembourg & Farrel; Suter et al., 2008). To date, researchers who explored the roles of lesbian nonbiological mothers (also known as lesbian comothers or social mothers) focused on the means by which these women sought to legitimize and formalize their roles and positions within the family. Bergan et al. (2006) found that nonbiological lesbian mothers (N = 16) focused on linguistic and legal means to establish their parental identities. One symbolic example of this included giving the infant the last name of the nonbiological mother. Similar findings were reported by Sutter et al. (2008) who discovered lesbian comothers assert their positions in the family by selecting donor features similar to their own. Goldberg and Sayer (2006) identified some similarities between lesbian nonbiological mothers and new fathers; however, they noted that lesbian nonbiological mothers did not receive the same level of societal support and recognition as fathers. Goldberg and Perry-Jenkins (2007) reported that lesbian partners viewed each other as equal and experienced a fairly harmonious transition to parenthood, though Pelka (2009) found that regardless of their partners’ views, nonbiological lesbian mothers experienced feelings of jealousy related to perceptions of unequal ties to the children and desire to carry children themselves. In summary, though considerable knowledge exists regarding the experience of seeking motherhood for lesbian biological mothers, much less is known about the potentially unique issues facing their partners during the preconception through perinatal periods. The purpose of this study was to fill the gap in knowledge about this important clinical issue.

Methods Design This study was a descriptive phenomenological inquiry approved by the Institutional Review Board for the protection of human subjects at the employment site of the principal investigator. Descriptive phenomenology is used to discover knowledge about phenomena that are not well understood from the perspective of research participants. The research participants are considered experts on the phenomenon under investigation (Wojnar & Swanson, 2007). Bracketing helps the investigators set aside their prior knowledge and bi-

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ases to accurately represent participants’ subjective perceptions about the phenomenon studied (Gearing, 2004). Bracketing strategies include keeping a reflective diary, prolonged engagement with study participants, and seeking clarifications from the participants and experts on descriptive phenomenological research design to ensure accuracy of interpretation (Husserl, 1965).

Sample and Procedure Study participants were recruited from various communities in the Pacific Northwest. Inclusion criteria were age 18 or older, self-identified as lesbian in a committed couple relationship in which they planned and experienced a pregnancy and childbirth as a nonbiological mother, partner gave birth to a healthy infant at term within the past 2 years, able to communicate in English verbally and in writing, and willing to share their stories. Recruitment included newspaper advertisements, posted notices, Internet advertising on lesbian-led websites, and participant referrals. Prospective participants called or emailed the investigator in response to study advertisements. Consent forms and demographic surveys were sent to women who met the inclusion criteria. Arrangements were made to conduct in-person semi-structured interviews once the signed consent forms and completed demographic surveys were returned. The interviews lasted approximately 30 to 60 minutes. Most interviews (n = 20) were conducted at the participants’ homes whereas some (n = 4) were conducted in a private, rented room at the study site. All interviews were audio recorded and transcribed verbatim for analysis. Interviews typically began with an opening question: “What has your life been like in a partnered relationship?” and continued with questions more specific to pregnancy and childbirth, such as “How did you decide about starting a family with biological child/children? What was the process of attempting pregnancy for you?” Participants were encouraged to elaborate on their stories by being further probed with questions such as “What did it feel like?” Field notes were generated after each interview. They included comments offered by the women outside of the audio-recorded interviews, descriptions of the environment while in the women’s homes, and personal insights/biases that were later discussed with the coauthor and clarified by phone with the study participants to eliminate bias

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or possible misinterpretation of data in the process of constructing a theoretical model of the participants’ common experience. Prolonged engagement with study participants (repeated interactions) and a multifaceted data collection process were carried out to enhance the credibility and trustworthiness of findings (Houghton, Casey, Shaw, & Murphy, 2013). Recruitment continued until data saturation was reached.

Data Analysis Consistent with descriptive phenomenological approach, bracketing was employed throughout the data collection and analysis process in an attempt to set aside the investigator’s assumptions about the phenomenon under investigation (Wojnar & Swanson, 2007). Using a self-reflective diary and clarifying insights with the study participants and experts familiar with the method accomplished this goal. The authors relied on this feedback to avoid bias, maintain clarity, and to present a true description of the phenomenon. Analysis was conducted using Colaizzi’s (1978) method and included the following steps: (a) reading all transcriptions for general understanding; (b) extracting significant statements; (c) formulating meanings for these statements; (d) categorizing the formulated meanings into the clusters of themes, subthemes, and processes and counting the occurrences; (e) integrating the analyzed data into an exhaustive description of the phenomenon under study; (f) checking with some participants to validate their individual experiences with the general description of the phenomenon; and (g) incorporating the insights and suggestions from the participants into the final report. The stories obtained from 24 women met the criteria of qualitative inquiry appropriateness (locating participants able and willing to provide the relevant information) and adequateness (sufficient sample size providing enough data to enable in-depth description of the phenomenon) (Morse, 1994). Transferability (Malterud, 2001) was addressed by consulting with local experts on lesbian life style and motherhood. These experts confirmed that the description of the participants’ experiences were consistent with their experience of caring for nonbiological lesbian mothers in clinical practice during the perinatal period.

Results The final sample included 24 women who selfidentified as lesbian nonbiological mothers in a committed relationship. Their mean age was 37.2 years with a range from 28 to 48. The mean

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Transition to motherhood for study participants was complicated by the lack of biological and legal substantiation and lack of understanding of their roles within the family.

length of couple relationships was 8.7 years with a range from 2.5 to 16. The majority of participants had college degrees (n = 18, 75%) while a few had high school educations (n = 6, 25%). Most of the women were employed (n = 20, 83%), with an average annual income of $50,000 and a range from $20,000 to more than $130, 000. The majority of women were White (n = 20), two were African American, and two were mixed ethnicity. The ethnic representation of the women in this study is fairly consistent with the official statistics regarding ethnic diversity in the Pacific Northwest (de Place, 2010). An overarching sense of “feeling different” permeated the experiences of prepregnancy through new motherhood for the study participants. The women’s narratives revealed seven themes that characterized their collective experience: (a) Launching pregnancy: A roller coaster ride; (b) Having legal and biological concerns: Biology prevails; (c) There is a little person in there: Dealing with pregnancy issues; (d) Losing relationships over pregnancy: The elephant in the room; (e) Feeling incomplete as a mother; (f) Carving a unique role: There are very few of us out there; and (g) Sadness and regret: Nonbiological mothers get the postpartum blues, too.

Feeling Different Feeling different was the overarching theme that captured the nonbiological lesbian mothers’ experience of pregnancy launching, expectancy, childbirth, and the postpartum period and was the commonality that linked all of the other themes. For many of the women, feeling different was not new but rather was something that they lived with long before deciding to become parents. Some women described their difference in terms of outward appearances in how they acted, dressed, and looked; others described it in terms of altering their behaviors in ways that conformed to the expected social behavior of supportive partners to avoid making their extended families and society uncomfortable about their positions in the family. Even women who described themselves as very comfortable with their sexual orientations and the chosen roles indicated that they felt different, isolated, or disconnected at some point during their

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journeys toward motherhood or in early parenting processes: Because we were different . . . I felt I had to be perfect . . . I dressed neatly and I was really supportive to my partner. I was afraid a nurse or a doctor would come into the room and judge that same-sex couples who decided to have babies are not good to each other or that I don’t know how to be a supportive partner in labor or postpartum period. Launching Pregnancy: A Roller Coaster Ride. The period between talking about motherhood and conception by the women’s partners was a time of launching pregnancy. During this time the participants and their partners made short-term decisions regarding the source of donor, provider, and insemination process and preliminary longterm decisions about parenting roles. The women referred to this experience as exciting but anxiety provoking. Several of the participants expressed the need for better jobs, homes, and financial security before starting families but deferred to the wishes of their partners and agreed to start families sooner than they had desired. All but one wanted children but did not want to physically give birth. The majority of participants described the process of conception as an “unpleasant and expensive roller coaster ride.” They experienced a cycle that ranged from anticipation to devastation for themselves and their partners with each month they failed to conceive. Some participants described a feeling of disconnect from the process, as their roles was ones of support rather than biological contributions: My partner went through fertility treatments to get pregnant and every month it was sort of emotional roller coaster, we would get our hopes up and end up being disappointed . . . a cycle we went through over and over again. After a number of months I told her, “I can’t go there with you anymore, all the way up and down” but I agreed to try a couple more times because I knew how much she wanted a child of her own. Then, she got pregnant and we ended up having X. Having Legal and Biological Concerns: Biology Prevails. Part of the parenthood negotiation process for the study participants was determining whether to foster, adopt, or conceive a child. Several of the women were initially in favor of fostering

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or adopting children instead of their partners conceiving through donor insemination. Legal and biological concerns guided their initial preferences. Legal considerations were multifaceted and included an understanding that federal law prohibited nonbiological mothers from adopting the children prior to birth, which placed them at a legal disadvantage should something happen to the biological mother during childbirth or the waiting period for adoption. For the women who had strained relationships with their partners’ families, this legal concern raised fears about their partners’ parents removing the children from the home in the event that the biological mothers died. Like others, one of the women believed, “You can have as many legal papers as you want, but when it comes to calling the shots, biology [will] always prevail.” Legal concerns also guided the decision of participants about whether to choose known or unknown donors. Although several participants strongly considered insemination of their partners from known donors based on their beliefs about the importance of knowing the children’s origins, the majority (n = 20) selected unknown donors to eliminate any question as to who had legal rights over the children. The use of a known donor was viewed as a complicated and unappealing prospect for the participants that required establishing legal parameters and negotiating donor involvement in the child’s life, all of which necessitated a high level of trust and the addition of a third individual into the family dynamics. One woman and her partner contemplated having a coparenting arrangement with a gay couple, but after long discussions ended up choosing an unknown donor to eliminate any threat to the nonbiological mother’s position as parent: My partner had a childhood friend who, she thought, would be a good donor for our baby. He wasn’t a threat because at the time he was in a gay relationship himself. We approached them and had a lot of back and forth discussions. They wanted to be in the picture after the baby was born and I thought it would be too confusing for everybody and in particular to the child to have four parents. I put my foot down and we ended up with an unknown donor. Although mindful of legal issues and the need to protect themselves and their families, participants also shared concerns about biology and its potential role in the attachment process, ability to parent, and position in the family. These considerations

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weighed heavily on the study participants in their decision-making process prior to their partners becoming pregnant. Nearly all of the women forecasted that the child would love the biological mother more because she was the “real” parent: It is just hard to comprehend for someone who is not in my situation. Though I love my partner dearly, we talked about the baby for several years before I caved in to her becoming pregnant. She was ready for a long time and had an idea of a donor we both knew and liked but I had my concerns. The truth is, if anything happened to her in the process, the baby’s donor and her biological family would have the right to the baby before me, until the adoption process went through. You can never predict how people, even people you really trust, will behave in such situation. And so, I was slow to agree.

There Is a Little Person in There: Dealing with Pregnancy Issues. This theme referred to emotional and behavioral responses of the study participants after their partners received confirmation of pregnancy. For the participants, the news of pregnancy was a joyful event because pregnancy was planned and very much wanted. The experience of pregnancy marked an end to monthly insemination rituals and signified the beginning of expectant parenthood. The initial visualization was also the first time the women were able to think of the infants in concrete terms rather than as something that was happening to their partners: When she was seven weeks pregnant we went to have an ultrasound; there were husbands and their wives in the waiting room. We were all waiting for the test that was going to confirm beyond any doubt that we were going to become parents. And it was both an anxious and exciting time for me because until then the baby didn’t feel real to me. I think it was during one of the ultrasounds that he became real to me . . . . He looked like a little person and he was actually moving in there and he had a heartbeat . . . and it dawned on me, “yes, there is a little person in there.” All women in the study desired to be active participants in the pregnancy process to help them become attached to the infants like biological parents. The majority carved unique roles for themselves from the beginning to accomplish this goal:

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Well, I didn’t want to get crazy about counting her calories from the beginning, but I was kind of looking through the pregnancy cookbooks and cooked for her what I thought would be high in vitamins and minerals and first and foremost calcium. My partner was banned from picking up anything, from moving anything, and from doing anything to maintain the pregnancy, so I kind of took on the role of everything. I cooked and shopped and cleaned and took out garbage. It was a real shift in our relationship because for a number of years, I was the one who was catered to. And so, my life went upside down, literary. But, I didn’t mind because this is what we both wanted.

Losing Relationships over Pregnancy: The Elephant in the Room. This theme referred to the struggles participants experienced by losing relationships as a result of the pregnancies. Many women encountered a lack of support for their pregnancies within their extended families. Others felt lack of support in the lesbian community because of shifting priorities and in some cases a view within the community that the couples seeking pregnancies were trying to emulate heterosexual families: Once we went to a gathering of lesbian friends and my partner was visibly pregnant and she wasn’t drinking, but nobody mentioned it or congratulated us on it; they went on with whatever they were doing; it was like an elephant in the room. At that point we realized we no longer fit with our usual crowd and we had to look for new sources of support. The thing is, I think, a faction of people in our community think we just want to be like heterosexuals and this is why they are not supportive of pregnancy and babies. A major milestone in the transition to parenthood for the study participants was determining where they could cultivate support for the pregnancies. Making this determination entailed a conversation about whether the news should be shared, and if yes, who would be informed. For some of the women, their families were a source of support, but many others found themselves withholding the news based on fears of being judged or rejected. This fear was related to strong religious beliefs in the family, a previous lack of acceptance for their identity as a lesbian, or a lack of acknowledgment of their partner. Some women who

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anticipated a poor reception found that their parents were excited by the news. However, not all of the participants received support, which resulted in stress, decreased contact with extended family, or severing of family ties. One woman expressed that although her family members did not overtly reject her partner, they purposefully did not acknowledge her pregnancy: My partner’s family was pretty supportive of pregnancy but not my own family. The majority of people in my family are very conservative. When my partner got pregnant we decided to build stronger ties with my family of origin for the baby’s sake. We traveled to see them for Thanksgiving and by then she was 6 months pregnant. We got really cold reception and returned home the next day. I was really mad, but there was nothing I could do. Most women who shared the news with friends and coworkers received positive feedback because, admittedly, they told only the selected individuals they could count on to be sources of support. However, they also gained support within the heterosexual community of parents. One participant summarized, “Being parents makes us like straight couples because we now belong to a larger community than ever before, the community of parents.” Some participants formed strong friendships with men at work who they felt best understood what they were going through: A man at work was just a great friend. No expectations, just there for me when I needed a sympathetic ear, when I was confused, or unsure of my place in the whole process. The thing is that my partner got so wrapped up in pregnancy, I felt there was hardly room for me in it. He was there to listen and this is just what I needed.

Feeling Incomplete as a Mother. This theme referred to thinking about the pregnancy and developing feelings of attachment to the unborn infant. One source of relationship strain was the different ways in which the partners thought about the unborn infants. One participant explained, “Even though I planned for it and wanted it very much, I didn’t feel complete as a mother, at least not at first.” All of the participants found the attachment and bonding experience difficult, from conception through the postpartum period, even after they acknowledged the personhood of the unborn infants.

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For the majority, the unborn infants were abstract concepts happening to their partners’ bodies: It was very different for my partner because she was the pregnant one so she knew her body and she could feel it change before anyone could see it was changing. She expected me to feel the same way about it from the beginning and I just couldn’t, not until I saw the baby move. Then it became more real and I did purposeful things to get attach to the baby but to be honest, the attachment part didn’t happen for me until after she was born. Purposeful efforts were made by many study participants to overcome the barriers to feeling attached to the infants by making it seem real as soon as possible. For example, some women read a book about pregnancy, attended prenatal appointments, or referred to the infants using special names: There was an immediate excitement for me about what was going to be happening in the next few months with my partner, but I couldn’t feel excited for me. To overcome these feelings I bought a pregnancy book that went week by week. Reading it was like opening a present. I enjoyed reading and she enjoyed watching me doing that. When the baby started moving I started playing games with the baby in an effort to start getting attached. Most participants found that even after the children were born, there was not an instant “falling in love” but that attachment happened gradually through typical child care, such as rocking the infant and changing diapers. Many of the participants made references to their lack of a biological connection as a reason they were unable to form immediate attachment: “We were the mesh of so many biological ties that I really worried they were going to divide us.” To facilitate the attachment process, the women sought to balance the lack of biological substantiation by designating themselves as the primary caregiver after birth, taking time off to be with the infant alone, and developing special childcare routines. In all cases, the participants felt that this scenario provided them with the best opportunity to form emotional bonds with their children. However, there was still a pervasive feeling that the biological mother had a connection with the child that the nonbiological mother could never attain:

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I was the one who stayed behind and changed the diapers and fed him. But when she came home from work he would instantly squeal in joy. Sometimes I felt there were just the two of them in the entire universe. He loves me too, there is no question about it, but when it comes to choosing between the two of us, he knows who is his real mother. I guess the biology always prevails when it comes to mothers and babies. Carving a Unique Role: There Are very Few of Us out There. From conception to birth and throughout the postpartum period, study participants struggled to define their roles. One woman explained, “It was really hard because I had to learn how to be one [a co-mother] . . . there are very few of us.” Some of the women described feeling out of control while others felt segregated but reluctant to share these feelings for fear of spoiling either their couple relationship or their partner’s joy. One woman sought advice from a book on how to be a supportive partner but felt that the book failed to capture the complexity of her situation: I am a very strong woman in general. It was the first time in life when I felt left out and judged. I wanted to be recognized as equal and be congratulated equally when the baby was born. Instead, everybody, including doctors and nurses, was asking me how she was doing and most congratulatory words were directed to her not to us. And I went through this period of confusion and feeling sad and it really took considerable time for me to work through these emotions. After the baby was born I turned to my mother for help to know how to be a good mother; she looked me in the eye and asked about the meaning of becoming a mother to another woman’s child. She said, “you are not the mother, she is.” I felt angry and confused and found her comments very unsupportive, but deep in my heart I understood what she was talking about because the baby was not my genetic material. At that point I knew it would be up to me to create a meaningful place in the family for myself. Sadness and Regret: Nonbiological Mothers Get the Postpartum Blues, too. Many participants described the transition to parenthood as a time of isolation and confusion as they attempted to define their roles within the context of meeting the

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needs of their partner and the new infants. As a result, they felt exhausted and emotionally disconnected from the bonding process. They also described this time as a period of upheaval in which nothing mirrored their previous existences. Some of the women felt resentment at being charged with an even greater amount of household tasks while the biological mothers were only responsible for bonding with and caring for the newborns. There was also the perception that though the biological mothers’ lives changed, their process was clearly defined and tied to the newborns, whereas the participants lacked clear direction. Thus, they felt their lives were altered more significantly: She was so in tune with him that she totally forgot me and isolated me . . . our relationship didn’t even remotely resemble what we had before. So as a result, I was the one going through postpartum blues not her. I felt I was going crazy but had nobody to talk to. I felt confused and ashamed about my feelings. Throughout the pregnancies and postpartum periods, the participants also experienced grief with regard to the changes in the relationships as their partner became absorbed with becoming mothers. Several of the participants were active throughout the entire transition, but others felt disconnected and that this “was her baby” or “she didn’t need me to be part of the process.” One woman described the postpartum period as one of emotional disconnect due in part to a lack of understanding from the biological mother about the vulnerability of the participant in terms of her position within the family, the law, and society. Finally, the transition to parenthood marked a period of grief for the participants as many recognized a lack of support from their own mothers and family members. Although a small number of participants received immediate support from their families, a majority either lacked parental support or received modest support after the children were born: I wanted to be a really good mother. But it was difficult; there were many barriers I didn’t foresee; for example, many people in health care and our community, some even very close to us, did not really see me as the other parent. It was all about her pregnancy and how she was feeling. There are no good role models in the society to help

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Nurses and health care providers cognizant of the unique issues facing lesbian nonbiological mothers can facilitate a positive transition to parenthood for this population.

me know how to be a good other mother in this situation. Many delayed informing their parents of their decisions to parent until the pregnancies were well established in an effort to avoid ridicule and judgment. In these cases, the participants longed for acceptance of their identities as lesbians and for their new roles as mothers: I read in a book that postpartum blues are hormonal, but in our relationship I was the one who had the postpartum blues. It started in the hospital when someone referred to the donor as the baby’s father, and then every form referred to the father, not the other parent. Don’t take me wrong, they were nice to me but as the birth support, not as a new parent. After the baby came she was so absorbed with the baby that there seemed to be no room in the relationship for the three of us at first. I didn’t want to spoil her happiness and I kept all these crazy feelings I had to myself. I was even contemplating to take the dog and just leave and I don’t think she would notice that we disappeared. Thankfully, we were able to work through our differences and life is back to normal. She just wasn’t aware how I felt. It shows how important it is to speak up.

Discussion In this study, the experience of transitioning to parenthood highlighted and reinforced the nonbiological lesbian mothers’ differences with mainstream society: they had a desire to parent but they were unable to contribute biologically and were not protected legally until the adoption process was complete. They wanted to support their partners throughout the conception and perinatal period but often felt unwelcomed and misunderstood in the healthcare settings and their families of origin. They wanted to be active participants in the birthing process but felt unrecognized as the “other mother” by hospital staff. They sought resources on how to be good lesbian co-mothers but found themselves unrepresented and subsequently feeling isolated and depressed.

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For most women in this study, identifying as a two-mother household proved to be a difficult and challenging task after years of being in a harmonious couple relationship. After the infants were born, the participants sought ways to overcome the lack of biological substantiation to the infant, but to some degree they all feared that the infant would somehow sense the lack of a biological connection and love them less. These findings are consistent with previous research (Hequembourg & Farrell, 1999; Pelka, 2009; Renaud, 2007) and demonstrate that the transition to parenthood for lesbian nonbiological mothers is a complex process compounded by lack of biological and legal substantiation and very few role models in the society, which leaves them open to feelings of invisibility and isolation. With regard to their health care experiences, study participants desired to be treated in a similar manner as fathers and have the same rights as would any other spouse or partner, which proved challenging. Despite an effort to select providers in support of their lesbian relationships and decisions to start families, the health care setting as a whole proved not quite ready to receive them. Although providers’ attitudes were for the most part open and accepting, participants noted nuances in which they felt under-represented or left out. For example, all forms referred to “father” rather than partner. Provider language was also crucial for nonbiological mothers in terms of establishing or undermining their identities, especially in cases where providers referenced the sperm donor as “the baby’s father.” Different understandings of expectations and the lesbian partner’s role within the health care system resulted in feelings of resentment among the participants. Those whose partners gave birth in hospitals described their experiences as mostly positive but found that they were virtually ignored by staff as new parents and often went without their basic needs being met. Women in this study acknowledged that though some nurses were comfortable with their presence as a labor support person, they felt less comfortable when faced directly with the comother role, a finding consistent with prior reports (Renaud, 2007; Wojnar & Swanson, 2006). Our findings suggest that the perinatal period is a time of vulnerability for nonbiological lesbian mothers. These women do not reflect the childbearing norms of the current societal structure of parenthood. The postpartum period appears especially challenging because their mothering role

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Wojnar, D. M. and Katzenmeyer, A.

is ill defined and rarely referred to in the literature. In some instances, the co-mothers are also faced with the challenge of developing a new support system when they no longer fit into the lesbian community that supported them prior to becoming mothers (Wojnar, 2007). As a result, lesbian comothers must carve out a unique mothering role for themselves within society and their new families. For study participants these steps included obtaining legal recognition and purposefully forming attachments with the children to ensure a sense of being equal to the biological mother. Participants’ experiences of health care support the results of McManus et al. (2006) especially with regard to the importance of healthcare providers’ attitudes and actions. Similar to the McManus et al. report, participants consistently felt excluded from the childbearing process either by hospital policies, provider language, or terminology used on intake forms. This is a period of vulnerability for lesbian comothers and also a time when knowledgeable and sensitive health care staff can be a part of the newly developing support structure. Positive health care experiences help reaffirm the nonbiological mothers’ roles in the process and help identify them as parents. A unique finding was the pervasive feeling of otherness and the complexity of nonbiological mothers’ emotions surrounding parenthood, in particular during the postpartum period. The majority of study participants admitted to going through a period of confusion and significant symptoms of depression that could have been addressed and treated as part of the family centered postpartum care but were not attended to, an experience previously reported for new fathers (Matthey, Barnett, Howie, & Kavanagh, 2003, Melrose, 2010). Another unique finding is the desire of study participants to have access to resources that would acknowledge their roles as equal parents and thus help normalize their transitions to motherhood. Likewise, they desired to be acknowledged as legitimate parents by the legal system and community at large from the beginning of the process of parenthood. Hence, they desired resources that would help others understand their positions and roles within the family and help them carve out their parental roles as the “other mothers.”

ographic boundaries, and consistent with descriptive phenomenological approach, nonrandom representation. To mitigate these possible limitations, reflection was ongoing, with authors meeting regularly to discuss the emerging findings and to examine their own assumptions and biases that could potentially influence the interpretation of data. Finally, the findings were presented to the participants and clinical experts for validation. In addition, although findings from this small and localized sample cannot make claims to generalizability, they provide means through which the complexities of the common experiences regarding the phenomenon under investigation can be better understood and addressed in clinical situations (Wojnar & Swanson, 2007).

Conclusion Our findings show that lesbian nonbiological mothers can experience feeling different, invisible, and isolated during the transition to parenthood. Nurses and other health care professionals need to be aware of these feelings and acknowledge the potential differences between partners’ experiences of preconception, pregnancy, and new parenthood. Caregiving needs include verbal acknowledgment of the nonbiological mother as the other parent and their individual needs and concerns, invitation to participate in the care of their partners, and documentation forms that are more inclusive. Providers need to address the possibility of postpartum blues or depression for the lesbian partners during the postpartum period. The issues of lesbian coparents are especially relevant for nurses interested in policy development as they can play a critical role in creating inclusive hospital policies and advocating for equitable adoption laws.

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