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What are LGBTQI+ parental experiences of healthcare support and decision-making regarding infant feeding options? A grounded theory study

Abstract

Objective

To explore LGBTQI+ parental experiences regarding their interactions with healthcare professionals as a resource for feeding options during the prenatal-to-neonatal period.

Study design

This single-center, interview-based qualitative study of LGBTQI+ parents utilized grounded theory to identify and verify emergent themes and subthemes. We developed a conceptual framework to illustrate relationships among themes and subthemes, as well as opportunities for healthcare professionals and families to improve LGBTQI+ parental support.

Results

Thematic saturation was attained after interviewing 21 parents from 12 families. Analyses revealed four main themes representing opportunities for improvement: education, continuity of care, parental engagement and open communication. Personal and interpersonal factors influenced parental experiences and decisions, which shaped ultimate feeding outcomes.

Conclusions

LGBTQI+ parents revealed challenges of establishing feeding practices that best aligned with their values and goals. Recognizing these factors can help healthcare professionals improve their counseling, engagement and support of LGBTQI+ parents.

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Fig. 1: Preexisting personal factors (black rounded box) shape parental feeding expectations leading into the pregnancy and newborn period.

References

  1. Lee R. Queer lactation: contributions of queer theory to lactation support for LGBTQIA2S+ individuals and families. J Hum Lactation. 2019;35:233–8.

    Article  Google Scholar 

  2. The Williams Institute. LGBT Demographic Data Interactive. 2019. https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT#demographic.

  3. Gates G. The Williams Institute LGBT Snapshot. 2020. https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT#density.

  4. Hoffkling A, Obedin-Maliver J, Sevelius J. From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy Childbirth. 2017;17:7–20.

    Article  Google Scholar 

  5. Tasker F. Lesbian mothers, gay fathers, and their children: a review. Dev Behav Pediatrics. 2005;26:224–240.

    Article  Google Scholar 

  6. Cao H, Mills-Koonce WR, Wood C, Fine MA. Identity transformation during the transition to parenthood among same-sex couples: an ecological, stress-strategy-adaptation perspective. J Fam Theory Rev. 2016;8:30–59.

    Article  Google Scholar 

  7. MacDonald T, Noel-Weiss J, West D, Walks M, Biener M, Kibbe A, et al. Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: a qualitative study. BMC Pregnancy Childbirth May. 2016;16:106. https://doi.org/10.1186/s12884-016-0907-y.

    Article  Google Scholar 

  8. Baby-Friendly USA guidelines and evaluation criteria for facilities seeking baby-friendly designation. Albany, NY: Baby-Friendly USA; 2016.

  9. Eidelman AI, Schanler R. Breastfeeding and the use of human milk. Pediatrics. 2017;12:e827–41.

    Google Scholar 

  10. Chantry CJ, Eglash A, Labbok M. ABM position on breastfeeding – revised 2015. Breastfeed Med. 2015;10:407–11.

    Article  Google Scholar 

  11. Bartick M, Stehel EK, Calhoun SL, Feldman-Winter L, Zimmerman D, Noble L, et al. Academy of breastfeeding medicine position statement and guideline: infant feeding and lactation-related language and gender. Breastfeed Med. 2021;16:1–4.

    Article  Google Scholar 

  12. Ferri R, Rosen-Carole CB, Jackson J, Carreno-Rijo E. Greenberg KB and the academy of breastfeeding medicine. ABM clinical protocol #33: lactation care for lesbian, gay, bisexual, transgender, queer, questioning, plus patients. Breastfeed Med. 2020;15:284–9.

    Article  Google Scholar 

  13. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.

    Article  Google Scholar 

  14. Merriam S, Tisdell E. Qualitative research: a guide to design and implementation (Fourth edition). Jossey-Bass: San Francisco; 2016.

  15. Miller W, Crabtree B. Qualitative analysis: how to begin making sense. Fam Pract Res J. 1994;14:289–97.

    CAS  PubMed  Google Scholar 

  16. Verdinelli S, Scagnoli N. Data display in qualitative research. Int J Qualitative Res. 2013;12:359–81.

    Google Scholar 

  17. Bryant C. Nursing the adopted infant. J Am Board Fam Med. 2006;19:374–9.

    Article  Google Scholar 

  18. Wilson E, Perrin MT, Fogleman A, Chetwynd E. The intricacies of induced lactation for same-sex mothers of an adopted child. J Hum Lactation. 2015;31:64–7.

    Article  Google Scholar 

  19. Juntereal NA, Spatz DL. Breastfeeding experiences of same-sex mothers. Birth. 2020;47:21–8.

    Article  Google Scholar 

  20. Parameshwaran V, Cockbain BC, Hillyard M, Price JR. Is the lack of specific lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) health care education in medical school a cause for concern? Evidence from a survey of knowledge and practice among UK medical students. J Homosex. 2017;64:367–381.

    Article  Google Scholar 

  21. Greene MZ, France K, Kreider EF, Wolfe-Roubatis E, Chen KD, Wu A, et al. Comparing medical, dental, and nursing students’ preparedness to address lesbian, gay, bisexual, transgender, and queer health. PLoS One. 2018;13:e0204104.

    Article  Google Scholar 

  22. Chetwynd E, Facelli V. Lactation support for LGBTQIA+ families. J Hum Lactation. 2019;35:244–7.

    Article  Google Scholar 

  23. Bridges N, Howell G and Schmied V. Exploring breastfeeding support on social media. Int Breastfeeding J. 2018;13:22.

  24. Regan S, Brown A. Experiences of online breastfeeding support: support and reassurance versus judgement and misinformation. Matern Child Nutr. 2019. https://doi.org/10.1111/mcn.12874.

  25. Skelton KR, Evans R, LaChenaye J, Amsbary J, Wingate M, Talbott L. Exploring social media group use among breastfeeding mothers: qualitative analysis. JMIR Pediatr Parent. 2018;1:e11344.

    Article  Google Scholar 

  26. Tang K, Gerling K, Chen W, Geurts L. Information and communication systems to tackle barriers to breastfeeding: systematic search and review. J Med Internet Res. 2019;21:e13947.

    Article  Google Scholar 

  27. Engström H, Häggström-Nordin E, Borneskog C, Almqvist AL. Mothers in same-sex relationships – striving for equal parenthood: a grounded theory study. J Clin Nurs. 2019;28:3700–09.

    Article  Google Scholar 

  28. Steen M, Downe S, Bamford N, Edozien L. Not-patient and not-visitor: a metasynthesis fathers’ encounters with pregnancy, birth and maternity care. Midwifery. 2012;28:422–31.

    Article  Google Scholar 

  29. Niela-Vilén H, Axelin A, Melender HL, Salanterä. Aiming to a breastfeeding mother in a neonatal intensive care unit and at home: a thematic analysis of peer-support group discussion in social media. Matern Child Nutr. 2015;11:712–26.

    Article  Google Scholar 

  30. Gawlik S, Müller M, Hoffman L, Dienes A, Reck C. Assessing birth experience in fathers as an important aspect of clinical obstetrics: how applicable is Salmon’s Item List for men? Midwifery. 2015;31:221–8.

    Article  Google Scholar 

  31. Balogun OO, O’Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev. 2016;11:CD001688.

    PubMed  Google Scholar 

  32. Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M, Luchters S. Involving men to improve maternal and newborn health: a systematic review of the effectiveness of interventions. PLoS ONE. 2018;13:e0191620.

    Article  Google Scholar 

  33. Tohotoa J, Maycock B, Hauck Y, Howat P, Burns S, Binns C. Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. Int Breastfeed J. 2009;4:15.

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Acknowledgements

This study was supported in part by the University of Rochester Clinical and Translational Science Award (UL1 TR002001) from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank Casey Rosen-Carole, MD, and John Cullen, PhD, for their input on preliminary study materials and the LGBTQI+ family for help piloting our interview guide.

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Authors

Contributions

JJ and RD conducted the study design, interviews, data analyses, and manuscript preparation. LM and MC were involved in data analyses and manuscript preparation. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Jason R. Jackson.

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The authors declare no competing interests.

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Jackson, J.R., Moreno, L., Carmen, M. et al. What are LGBTQI+ parental experiences of healthcare support and decision-making regarding infant feeding options? A grounded theory study. J Perinatol 42, 1083–1090 (2022). https://doi.org/10.1038/s41372-021-01259-4

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