Communicating Heterosexism in Queer Pregnancies: a Multiadic Interview Study

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Communicating Heterosexism in Queer Pregnancies: A Multiadic Interview Study

A dissertation presented to

the faculty of

the Scripps College of Communication of Ohio University

In partial fulfillment

Of the requirements for the degree

Doctor of Philosophy

Nicole C. Hudak

August 2019

This dissertation titled

Communicating Heterosexism in Queer Pregnancies: A Multiadic Interview Study

NICOLE C. HUDAK

has been approved for

the School of Communication Studies

and the Scripps College of Communication by

Benjamin R. Bates

Professor of Communication Studies

Scott Titsworth

Dean, Scripps College of Communication

Abstract

HUDAK, NICOLE C., Ph.D., August 2019,

School of Communication Studies

Communicating Heterosexism in Queer Pregnancies: A Multiadic Interview Study

Director of Dissertation: Benjamin R. Bates

Heterosexism is a power system in society that promotes the belief that every person is and should be heterosexual (Pharr, 1997). In knowing that heterosexism permeates everyday discourse, this dissertation examines how queer experiences are understood through the lens of heterosexism. Specifically, this dissertation focuses on the queer pregnancy experience, as lesbian motherhood is heavily scrutinized

(Hequembourg, 2007). As part of the pregnancy experience, queer women enter healthcare spaces. Both healthcare and medical education promote heterosexism in their education (Zuzelo, 2014; Murphy, 2016) and in practice (Hudak, 2016; Saulnier, 2002).

To explore how heterosexism is communicated and resisted in queer pregnancy, I conducted a multiadic interview (Manning, 2015) study with sixteen queer couples who had recently experienced a pregnancy. Through critically analyzing the interviews, two main findings emerged surrounding heterosexism being communicated in healthcare and heterosexism being communicated in public and private relationships. I used Michel

Foucault and Sara Ahmed as theoretical guides to explore how surveillance, discipline, and constructions of happiness operated to promote heterosexism in the queer couple’s experiences.

iii

Acknowledgments

Throughout the dissertation process, I was humbly reminded that success has never been accomplished alone. There were people in my life who have supported me both in the dissertation and my academic journey.

My wife, Dr. Valerie Rubinsky, I do not think I could have made this achievement without your constant support. In both my triumphs and falling moments, you have been by my side, encouraging me along the way. I could not have asked for a more caring, compassionate, and just brilliant partner to share in this journey with.

Dr. Bates, I am not sure many doctoral students have had advisors who were as flexible in the dissertation process. I have appreciated your willingness to advise this project from both near and far. Further, thank you for allowing me space to grow in my scholarship and for challenging me during these past four years.

Dr. Harter, you have taught me how to integrate my voice into my scholarship. In both classes and my writing, you have encouraged and provided feedback that has allowed me to expand my horizons as a scholar. Thank you for introducing me to new literature and scholars who have shaped this dissertation and my past and future scholarship.

Dr. Chawla, thank you for staying with me on my academic journey at Ohio

University. I believe you have strengthened my writing throughout my fours years and has given me the courage to write this dissertation. Also, I appreciate how you have introduced me to more critical scholars and varying critical theoretical perspectives.

Dr. Balbo, I am so glad that you were eager to be on this dissertation committee.

You have taught me important lessons in inclusion for varying populations. Thank you

for also answering my random medical questions that came up during the dissertation process. Finally, thank you for being an open medical provider who is actively working for positive changes for the LGBTQ community.

To my parents, Scott and JoAnn, thank you for supporting me throughout my entire educational career. I know that when I told you I wanted to get my doctorate you were nervous but supported me regardless. I cannot thank you enough for the constant love and support and for being there with me when I finally became Dr. Hudak.

Dr. Rudnick, I would not be here today without you. Around eight years ago you asked me if I wanted to read journal articles so that I could discuss them with you. You not only showed me that I was smart, but that I was capable of this grand adventure.

Thank you for always being there whenever I needed to bounce ideas or look over sections of my writing. I look forward to our future as colleagues and friends.

Finally, to my participants. I cannot thank you enough for taking the time to speak with me and share your stories. It was an honor to get to know members of my community and to learn from every one of you. Your stories were full of life and could not be fully captured in this one document. I hope that I did not misrepresent your experiences, and if I did, I take full responsibility. It was clear how much you cared for your families and the futures that you have created. I wish you all the best.

Table of Contents

Page

Abstract ...... iii Acknowledgments...... iv Chapter 1: An Introduction ...... 1 Chapter 2: Reviewing the Literature ...... 6 Understanding Heterosexism ...... 11 Patient-Provider Communication...... 25 Partner Support in Pregnancy ...... 28 Lesbian Pregnancy ...... 33 Theoretical Framing ...... 56 Chapter 3: Research Practices ...... 63 Recruitment and Interviews ...... 64 Participants ...... 70 Queer Embodiment ...... 79 Analysis...... 82 Chapter 4: “Visible in a Birth Space,” Heterosexism in Birth Related Healthcare ...... 86 Tension of Politics, Dismissal, and Visibility ...... 87 Patient-provider Communication ...... 98 Beyond Providers ...... 153 Improving Care ...... 165 Concluding Healthcare...... 173 Chapter 5: “Biologically not Yours,” Communicating Heterosexism in the Public and Personal ...... 175 Public Expressions of Heterosexism ...... 176 Communication in the Workplace...... 187 Family Communication and Support...... 197 Queer Community...... 231 Partner Communication and Support ...... 238 The Self and Heteronormativity ...... 266 Chapter 6: Conclusion ...... 276 Answering the Research Questions ...... 277 Implications...... 285

Limitations ...... 295 Future Directions ...... 298 Concluding Remarks ...... 300 References ...... 302 Appendix A: Participant Demographic Form ...... 319 Appendix B: Call for Participants...... 321 Appendix C: Couple Interview Protocol...... 322 Appendix D: Birth and Co-Parent Interview Protocols...... 324 Appendix E: Participant Demographic Information ...... 328

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Chapter 1: An Introduction

Slowly, I run my fingers down my stomach. One finger after the other,

trickling down the imagined bump. My mind wanders. I try to see my

projected pregnant body. How would I wear my body? The proposed

presence of a protruding bump limits my understanding of how I see myself.

Typical feelings of pregnancy are not there. I worry about how to perform

gender, how to control an uncontrollable pregnant, birthing body, and how

I would even explain my pregnancy. The lack of my own imagination spins

the academic wheel as I question others’ experiences. How do queer1

individuals understand and experience their pregnancies? I could not strike

an image of a queer pregnancy or begin to process what barriers a queer

individual might encounter.

While attending a conference on lesbian, gay, bisexual, trans, and queer (LGBTQ) healthcare, I observed a dialogic session on challenges LGBTQ people face within healthcare and where improvements have already been made. One participant brought to light the financial expense of the pregnancy process for lesbian women. She explained that health insurance does not cover the process; she had to sell her motorcycle to pay for the procedure. I was stunned. Unfortunately, this is not an isolated experience. In 2016,

Erin and Marianne Krupa attempted to become pregnant with their first child. Although their doctor assured them that their insurance company would pay for the procedure, their insurance company, Horizon Blue Cross Blue Shield, denied the coverage, stating that

1 Queer is being used as an all-encompassing term for LGBTQ individuals

women under the age of 35 had to demonstrate their infertility through “two years of unprotected sexual intercourse.” Because the couple could not prove that their intercourse was completed to achieve pregnancy, the company denied them coverage (Jula, 2017).

Prior to learning this, I viewed pregnancy as a viable option for myself if I wanted to have a child. Knowing that the expenses were high and I, most likely, would not have insurance coverage, my perspective was altered.

In reflecting on this new perspective, queer individuals, overall, are considered an underserved population in need of culturally competent healthcare (U.S. Health

Resources & Services Administration, n.d.). Healthy People 2020, a nation-wide initiative housed in the Office of Disease Prevention and Health Promotion, stated a goal of improving the health, safety, and well-being of LGBT individuals, among other underserved groups (Healthy People 2020, n.d.). Many queer individuals face inadequate healthcare because of the discrimination that occurs within healthcare interactions

(Rounds, Mcgrath, & Walsh, 2013) and how the healthcare system is designed for heterosexual patients (Zuzelo, 2014). Queer couples who have had pregnancies may also have experienced similar discrimination while seeking healthcare throughout the pregnancy.

There are a variety of ways in which queer individuals can experience discrimination during healthcare interactions. Discrimination can occur on many levels, from preventing a partner from being in the hospital room to ignoring a queer patient’s call light (Rounds et al., 2013). Medical intake forms can also be discriminatory. For example, Goins and Pye (2012) described an intake form on which the category of “risk

factors” listed “same-sex partner” alongside the risk of “unprotected sex.” By describing

“same-sex partner” as a risk factor, akin to having “unprotected sex,” this form projected discriminatory ideas about queer couples. Discrimination also occurs in interpersonal healthcare interactions. In Mimiga, Goldhammer, Belanoff, Tetu, and Mayer’s (2007) study, queer men experienced discrimination from their providers through various forms of communication. They cited clinicians who appeared to be judgmental based on the providers’ body language and speaking style (Mimiga et al., 2007). In a separate study, queer patients felt that healthcare providers judged them by the belittling responses of providers, providers making assumptions about them, providers making stereotypical comments, and the refusal of provider acknowledgement about their health concerns

(Rounds et al., 2013). Thus, queer patients can face discrimination through multiple forms and levels of clinical interaction.

Beyond healthcare experiences, lesbian and queer mother/parenthood has become an interest in both my personal and academic life. Knowing that women were experiencing difficulties while navigating the process continued to pique my interest.

Inquiring about these experiences is important because lesbian and queer couples do not exist in isolation. Approximately two million children are being cared for by lesbian or gay parents in the United States. (Movement Advancement Project, 2011). The number of queer parents raising children has most likely expanded since 2011 and suggests that there is a decent number of queer couples who experienced a pregnancy, and therefore, warrants further study.

The health literature has demonstrated that queer individuals experience discrimination while receiving healthcare. In addition, past research has shown discrimination against lesbian women while they were receiving healthcare during a pregnancy (McKelvey, 2014; Röndahl, Bruhner, & Lindhe, 2009; Spidsberg, 2007;

Wojnar & Katzenmeyer, 2014). However, scholars have yet to explore how heterosexism might be present within these healthcare interactions. In these studies, discrimination is discussed as a singular action, rather than a component of a part of a larger system of power. A focus on heterosexism looks at moments of discrimination within a power system that promotes heterosexual identities. Heterosexism has been shown to be prevalent in past queer healthcare experiences (DeHart, 2008; Hudak, 2016; Saulnier,

2002). Yet, the health literature has not fully focused on how larger systems of heterosexism may be present within healthcare experiences of pregnant queer couples.

Motherhood has been understood as a contested experience (Hequembourg,

2007). The addition of being a gender/sexual minority further complicates this experience. When discussing motherhood, Hequembourg (2007) stated, “lesbian motherhood is one of the most scrutinized and controversial of these experiences” (p. 67).

Having a two mother household, as opposed to a mother and father household, contests the idealized version of motherhood that exists in the United States (Suter, Seurer, Webb,

Grewe, & Koenig Kellas, 2015). Furthermore, a co-mother, a term used to describe a lesbian mother who did not give birth, is considered to be at the bottom of the United

States motherhood hierarchy (Padavic & Butterfield, 2011). Because a co-mother is not the child’s biological mother, she is deemed to be a less significant mother; she may be of

even less value than an absent biological father. Therefore, becoming a mother (or parent) as a queer person may come with unease and uncertainty when attempting to establish their role before the child is born. Because queer individuals are discriminated against in healthcare and because queer pregnancy is considered a scrutinized and potentially contested role, this dissertation will explore queer pregnancy more deeply.

The dissertation is broken up into six chapters, including this introduction. In the next chapter, I discuss how this dissertation fits into five strains of literature. The foundations of this research are in critical/cultural health communication. Then, I move into reviewing heterosexism in relation to healthcare. Next, I explain the importance of patient-provider communication, followed by discussing the support given by partners during pregnancy. After support, I review the existing literature on queer pregnancy.

Finally, I discuss how Foucault’s understanding of power acts as a theoretical lens alongside Ahmed’s use of happiness to discern individualized reactions to power dynamics. In chapter three, I explain the research practices that were used in the dissertation project. Chapter four is the first chapter of the findings. Here I discuss how healthcare providers, healthcare systems, and the queer couples communicated and resisted heterosexism. For chapter five, I discuss how the queer couples encountered heterosexism relationally, from public interactions to private, along with their self- perpetuation of heterosexism. Finally, chapter six concludes the dissertation by summarizing the findings, providing implications, reviewing the limitations, and discussing future directions.

Chapter 2: Reviewing the Literature

Contextualization Through Critical/Cultural Health Communication

In exploring issues surrounding queer individuals’ pregnancy experiences, I situate this dissertation within a larger conversation about critical/cultural health communication research. Critical perspectives recognize that knowledge and truth are constructed in dominant frameworks that perpetuate certain ideas and values (Dutta,

2010). Dutta (2010) recognized that critical health communication scholars deconstruct these dominant frameworks while simultaneously creating alternative spaces. Moving away from positivistic perspectives on health and healthcare, understanding of what is labeled as truth turns toward the recognition of multiple truths.

Through a critical perspective on health communication, understanding of truth and knowledge are interrogated. What is designated as truth is seen as a product of power relations (Lupton, 2003). In turn, knowledge production is viewed not as a universal, independent reality; rather, knowledge is constructed through individuals’ experiences and interactions to build a perspective on reality (Lupton, 2003). Critical perspectives focus on how knowledge is produced in ways that legitimize current power structures, which, in turn, perpetuate inequalities within health and healthcare (Dutta, 2010). While examining knowledge claims, critical health communication scholars “interrogate the values intertwined in the knowledge claims made by biomedicine” (Dutta, 2010, p. 535).

In this pursuit, critical scholarship aims to interrogate the values that underlie social scientific theories often used by health communication scholars (Dutta, 2010). Therefore,

the understanding of what is considered truth, historically framed through social scientific theories, can then be disrupted by critical health communication practices.

Conversations become their own truths. Every day conversations create our understandings of health. An example is when individuals talk about high fructose corn syrup, they might speak generically about how terrible it is for consumption and how people should avoid consuming it (Heiss & Bates, 2016). However, these conversations may not include medically-sound advice. The creation of knowledge is constructed in the communicative exchange. These lay medical conversations then influence the organization and management of health resources (Zoller, 2010). In this previous example, with the rise in talk about high fructose corn syrup, restaurants shifted how they label their menus and many grocery stores started carrying and prominently displaying cane sugar products.

In considering heterosexism, the medical knowledge created through a heterosexist discourse is not just constructed by a singular instructor in one communicative exchange. Instructors, students, and community members are co- constructing knowledge together. Although medical education is taught in medical school, that is not necessarily where medical power resides. Moreover, in taking a social constructivist viewpoint on reality, every individual creates medical power through the

“socialization to accept certain values and norms of behavior” (Lupton, 2003, p. 10). We can be socialized to accept medical values and norms as instituted through medical knowledge and schooling. However, we can also deviate from this expectation through socialization processes with friends, family, and other institutions. For example, although

medical knowledge states that vaccines do not cause autism, there is still a movement of anti-vaxxers who believe that vaccines cause harm to children (Sun, 2019). Medical information can also be reinforced by these same individuals. For example, there may be individuals promoting the vaccination of children through conversations with family, friends and community members. Knowledge of medicine and health are therefore situated in both scientific understandings and public socialization of what is considered to be truth and knowledge.

Risk and risk factors are also part of medically-constructed knowledge. Dutta

(2010) showed how critical perspectives can deconstruct the dominant frameworks of health risk. When deconstructing understandings of risk, there is also a creation of an alternative health communication space. In this alternative space, those same risks are looked at through different rationalities, which then provide new solutions. This reconstruction then challenges the dominant structure (Dutta, 2010). Risk is often associated with health disparities. Gay men are expected to be exposed to HIV through their risky behavior (Mimiaga, Goldhammer, Belanoff, Tetu, & Mayer, 2007) and therefore, their sexual identity is said to generate a health disparity between this population and the heterosexual population, as gay men need more medical attention.

However, critical health communication scholars argue that these risks, typically created or related to health disparities, are not created simply because of membership in a demographic category. Nor do they do appear overnight (Zoller, 2010). Although dominant discourses in health communication attribute health problems solely to individual choices and disregard cultural and structural factors (Zoller, 2010),

overlapping of racism, sexism, and classism contribute to health disparities (Zoller,

2010); heterosexism and homophobia also plays a role.

Dutta and Zoller have challenged contemporary notions of health communication.

What we come to understand as healthy is not based in inherent truth. Therefore, health communication needs to recognize that how we communicate about health has traditionally been “embedded in our taken-for-granted assumptions about what it means to be healthy, what it means to be ill, and how we approach disease and illnesses” (Dutta,

2008, p. 2). Understandings of health and illness typically come from medical authority.

However, medical authority also relegates marginalized populations into diseased and deviant categories through their categorizing of health illnesses related to sexual identity

(Carmack, 2014). For example, when healthcare providers look at sexual behaviors in considering sexual health, men who have sex with men (MSM) are ascribed a higher risk of HIV. When treating MSMs, healthcare providers have assumed that MSMs are automatically at risk of HIV without considering the men’s actual sexual behaviors

(Hudak, 2016; Robertson, 2017). Because of this notion that all MSMs are at risk of contracting HIV, healthcare providers may believe that each individual MSM will contract HIV. This thinking perpetuates the idea that gay men engage in risky sexual behavior and therefore will become diseased. Regarding pregnancy, medicine has positioned the natural process of birth into something that is considered unnatural and even an illness (Parry, 2008). Our taken-for-granted assumptions about health can create narratives about populations that place them in inherently negative categories.

Instead of following this trajectory, I challenge these notions by focusing on the experiences of queer couples and how they navigate a pregnancy though the healthcare system. Rather than expecting them to manage their healthcare through an individualized perspective only, my emphasis incorporates questions of how power structures intersect in their experiences. I follow Dutta’s lead by focusing on how we understand and negotiate “the meanings of health care embedded within cultural contexts and the values deeply connected with them” (Dutta, 2008, pp. 2-3). I explore how heterosexism as a large power structure intersects with pregnancy experiences of queer couples. Although I do not use a culture-centered approach with this research, I focus on “questions of power, ideology, hegemony and control in the discourses and practices of healthcare” (Dutta,

2008, p. 10).

In focusing on cultural aspects of health communication, I also engaged in health activism through studying healthcare experiences of queer couples. Health activism is “a challenge to existing orders and power relationships that are perceived to influence negatively some aspects of health or impede health promotion. Activism involves attempts to change the status quo, including social norms, embedded practices, policies, and power relationships” (Zoller, 2005, pp. 360-361). In Zoller’s (2005) perspective on health activism, she also includes academic writing that interrogates power structures as a form of activism. The current work challenges existing orders by exploring heterosexist practices that occur within queer couples’ healthcare experiences while being pregnant.

An overall goal of this research is to promote the change of heterosexist discourses within healthcare and health communication, hopefully disrupting the status quo. Zoller (2005)

highlights identity-based work through her focus on gay and lesbian individuals.

However, I expand on the narrower positioning of the lesbian-gay dynamic to also include other gender and sexual identities. Yet, I recognize the need to be careful as to not reinforce the logic of individualism by placing the burden of change back onto the participants or by ignoring the power-laden context of healthcare (Zoller, 2005).

In challenging notions of health communication, interrogating conceptions of health, and pursuing equity and equality of a marginalized population, I place my dissertation within the current conversation of cultural and critical health communication work. Although there is no formalized research question based on their research, Dutta,

Zoller, and Lupton largely influenced my dissertation research as I looked to them as my scholarly guides.

Understanding Heterosexism

Sitting in the waiting room, I anxiously tap my foot. My partner looks over

at me and gives me a soft smile. Finally, my name is called and I quickly

ask if she can accompany me. The nurse nods and we go back to the exam

room. We go through the motion of answering the basic questions. I barely

pay attention as I sit in my nervous energy waiting to talk to my doctor. As

the nurse walked to the door she turns towards us and says, “Oh, whenever

someone brings a person back with them we have to ask who they are.”

Before taking a beat, she asks, “is this your friend?” We both wince at this

casual display of heterosexism as I respond, “She's my girlfriend.” The

nurse apologizes as she recognizes her mistake and swiftly leaves the room.

We both sit in this moment of heterosexism, quickly commenting on the

matter as my partner reads my discomfort as it spreads through my body.

Unfortunately, the story and perpetuation of heterosexism does not end

there. Recalling my tale, I replay the story to a friend. As I wait in

anticipation for her to react, she simply provides a blank stare. She then

states, “I don't understand the big deal.” Her words are like a secondary slap

that I can still feel burn across my face. Heterosexism does not simply exist

in a singular encounter but is often replayed in the telling of our stories.

In a foundational article on heterosexism, Griffin (1998) stated, “heterosexuality is given more validity, more location, and infinite space to speak” than any other sexual identity (p. 33). These words speak volumes when discussing how heterosexism is displayed in every-day life that include representations in media, those who occupy power positions, and how people promote heterosexual identities in day to day to conversations. Heterosexism includes the promotion of heterosexuality but goes beyond a simple promotion of identity. Pharr (1997) explained that “heterosexism is a belief that the world is and must be heterosexual” (p. 16). It is the belief that every couple is first, and foremost, a couple, but also a couple of the opposite sex that conforms to gender expectations. As a result of this assumption is that those who do not identify as heterosexual are expected to live in silence as unrecognized and often invalidated

(Griffin, 1998). When assuming that heterosexuality is the default sexual identity, other sexual identities are positioned as abnormal, different, and often wrong (Meyer, 2003).

When looking back at the narrative displayed in the beginning, it may seem obvious to agree with the friend saying, “what’s the big deal?” When identifying as straight/heterosexual, it can be difficult to notice how the world is structured in a way that promotes your own sexual identity. Like most privileges, it can be hard to see. In this moment, as a queer woman, I felt that a significant part of me was invisible to my healthcare provider. By assuming friendship with my partner, the nurse erased my identity as a queer, lesbian woman. I had to take the time to explain my identity, which becomes exhausting when it occurs on a regular basis. In the moment with the friend, not only was I told that erasure was okay, but I was also told that my feelings about this type of discrimination were not valid. This invalidation then furthered the experience of discrimination that is not uncommon among other marginalized identity groups.

In discussing discrimination, a clarification is needed about the differences between homophobia and heterosexism. Homophobia is defined as a negative reaction toward queer individuals or often the fear of those individuals (Weinberg, 1972).

Alternatively, heterosexism refers to the social structure and the social exclusion of queer individuals (Pascoe, 2001). Although the terms are different, they often work together. As

Fine (2011) explained, “Heterosexism and homophobia operate in concert with one another to mark certain forms of sexual expression as appropriate and disadvantage of those who do not conform to heterosexual societal standards” (p. 521). Furthermore, heterosexism is a systematic cultural practice that actively works to disadvantage sexually diverse people (Herek, 2007). Heterosexism operates through cultural systems that promote the idea that everyone is and should be heterosexual. Homophobia can be

rooted in these cultural systems, but those enacting or participating in heterosexist systems may not be homophobic. A person can not have any ill feelings toward queer individuals, but still end up perpetuating heterosexist systems.

Heterosexism is more than just a social system. As Griffin (1998) noted,

“heterosexism is a pervasive social disease which is widely and silently accepted through family, media, and society” (p. 33). In understanding heterosexism as a social disease, I look back to the example of my encounter with heterosexism in the clinic. The disease manifests in that singular encounter. I am assumed to be straight with the statement of my romantic partner as simply a friend. That singular act stings, but at the same time, I expect it. However, the disease spreads when I tell the story to a friend and her initial lack of reaction is the start of the growth. Her telling me that it is “not a big deal” causes the disease to spread like wildfire. Because now I am told that not only do my feelings not matter, but my identity does not either. The spread can continue through the recounting of the tale by either myself, my partner, the friend, or the nurse, and anytime there is denial about heterosexism, the disease spreads.

Heterosexism is prevalent in the United States because US culture positions heterosexuality as the default sexual identity and that status can be found within law, religion, education, family, and mass media (Goodrich, Selig, & Crofts, 2014). As an example, in college classes, sexual identity is often positioned as something obscure or is ignored altogether by the instructors. The hidden curriculum in schools promotes heterosexuality while simultaneously marginalizing queer individuals (Watson, 2005). In considering the hidden curriculum, throughout my education I have noticed how notably

absent queer identities are in course materials. Rarely have there been readings that are written by queer authors or mention queer individuals. Countless times, I have noticed an absence in our curriculum about queer individuals, have seen heterosexuality as the only available sexual identity, and felt an eerie silence where instructors dare not speak sexual identity into existence. Of course, the reaction to these claims are that it is not a conscious act of prejudice, however heterosexism is a form of prejudice that is often more covert and even unconscious (Goodrich et al., 2014). Unconsciousness is not an excuse. Even if individuals do not harbor prejudice or purposefully discriminate against queer individuals, the cultural ideology that is embedded in our institutions actively works to disadvantage sexual minorities (Herek, 2007). Part of the invisibility experienced by sexually diverse individuals is the uncritical examination of heterosexuals’ own sexual prejudice and their underlying heterosexual assumptions (Herek, 2007). Therefore, when heterosexual college instructors and other individuals of authority ignore the queer population, it is often because they do not interrogate their own privileges and the heterosexist institutions that they exist in.

When battling heterosexism, it also needs to be understood that homosexuality or, rather, identifying as anything other than straight, is positioned as something a person would not choose (Griffin, 1998). Often when queer individuals are recounting their stories of coming out, parents are cited as saying what a difficult life they are going to lead (Manning, 2015a), positioning queer identity as something on which no one would willingly take, because now they must work against the heterosexist frameworks that they will constantly encounter (Griffin, 1998). Of course, in this act of stating an alternate

identity, they are attempting to disempower the heterosexist system that threatens the heterosexual identity. The more empowered queer people become, the less control heterosexism can exert over them (Griffin, 1998), actively weakening the authority of the heterosexist system.

Even with assumed progress in society, homophobia and heterosexism have not disappeared. Sexually diverse individuals are still marginalized, they experience less power and exercise fewer rights (Rostosky, Riggle, Horne, & Miller, 2009). Currently in the United States, sexuality may be considered a master status, which is an identity that assumes prominence to the extent that it erases all queer people’s personal traits and characteristics (Garnets & Kimmel, 2003). When a person actively labels themselves as part of the queer community, they tend to be viewed by others solely through the lens of their sexual identity. When sexuality is the primary personal trait/characteristic, it allows heterosexuals to maintain their power and dominance in society and continue to reinforce the marginalization of queer individuals (Johnson, 2013).

Heterosexism can have a deep and lasting impact on individuals. Even mundane experiences can still provoke deep wounds for queer people. The everyday experiences of heterosexism can affect a person's psychological well-being (Lewis, Derlega, Berndt,

Morris, & Rose, 2001). Heterosexism can also contribute to a hostile climate within organizations (Waldo, 1999). When an organization assumes that all their employees are heterosexual, the organization creates a climate that disempowers its sexually diverse members. An organizational member may feel they cannot discuss their personal life or can feel left out of workplace conversations that assume a heterosexual lifestyle.

Heterosexism does not just exist on a page. As a queer woman, I encounter heterosexism on a regular basis. The earlier story of my doctor’s appointment is only one chapter in the novel of discriminatory experiences. I understand that not all my experiences of heterosexism come from individual malice; most are part of an embedded system that assumes how relationships are meant to be enacted. As heterosexism is pervasive, heterosexism is also embedded in our institutions, including healthcare.

Heterosexism in healthcare. The earlier narrative described an enactment of heterosexism in a healthcare encounter. Unfortunately, heterosexism is prevalent in the

U.S. healthcare system (Hudak, 2016; Saulnier, 2002; Zuzelo, 2014). To elaborate on the healthcare structure, I discuss first how medical education imposes heterosexism, and then how heterosexism is experienced in healthcare interactions. For both, I discuss the implications of these processes.

Medical schools are the first site of heterosexism in healthcare for newly emerging healthcare providers. Medical schools perpetuate heterosexist and cissexist perceptions through the use of their medical materials and training programs (Murphy,

2016; Zuzelo, 2014). Medical students are typically not aware of the potential to encounter queer patients because of the “curricular inattentiveness toward sexually marginalized groups that is experienced during formative years of professional education” (Zuzelo, 2014, p. 520). To counter the previous invisibility of queer patients, some medical schools have specific LGBTQ training programs. In their survey on

LGBTQ specific curricula in North American medical schools, Obedin-Maliver and their colleagues (2011) found only a median of five hours in a student’s entire medical

education discussed LGBTQ topics. Although some schools reported more than five hours on LGBTQ training, nine reported that they did not devote any time to it (Obedin-

Maliver et al., 2011). Simply put, five hours is not enough to cover the nuances of healthcare interactions for the queer population.

Overall, there has been limited effort spent on queer curriculum in medical schools. In Murphy’s (2016) ethnographic study on medical curriculum, she talked to faculty at “Beuna Vista,” a top twenty medical school in the United States, and the faculty stated that their sexuality-related curricula were “limited” and “haphazard” (p.

269). Although faculty could cover queer content in their classes, they were also not required to incorporate queer content. In Robertson’s (2017) study on queer (in)visibility in medical education, he found that medical students expressed concern about the inadequate training they received about queer health issues and that they wanted more curricular attention on the topic. The only education medical students in this study received about queer health was limited to small pieces of information that were distributed across the curriculum (Robertson, 2017). The longest amount of time spent on queer patients included a single lecture on sexuality in a behavioral class (Robertson,

2017).

Medical schools can disrupt heterosexism; however, they can also perpetuate heterosexist assumptions. One issue with medical school training is patients used in case studies are generally assumed to be heterosexual. Robertson’s (2017) medical student participants stated that case study patients were assumed to be heterosexual and their sexual identity was never explicitly stated. One of his participants claimed that the

assumption of heterosexuality was “at the core of our academics” (Robertson, 2017, p.

164). Further, Robertson (2017) found that sexual identity was never a part of a patient’s intake information and was considered irrelevant to their care.

However, there was one meaningful exception where sexual identity became relevant in medical training. The only time sexual identity was stated for a case study patient was when the patient was a gay man who had HIV (Robertson, 2017). In these instances, the attention was not explicitly on sexual identity, but rather, on sexual behavior. Medical students have been taught to ask if patients have sex with men, women, or both (Murphy, 2016; Robertson, 2017). This question only concerns the assumed outcomes of sexual behavior, which then can be attached to sexually transmitted diseases or infections. Robertson (2017) explained, “when the medical gaze is turned to sexual behavior, it is often focused on maintaining heterosexual reproductive functionality or treating sexually transmitted infections rather than sexual subjectivity”

(p. 164). When medical programs do focus on queer health issues, the focus is often on sexual dysfunction, sexual functioning in relation to illness or disability, sexually transmitted diseases, infertility, or sexual abuse (Solursh et al., 2003). Essentially, the queer health focus emphasizes sexual dysfunction or disease, which can then lead to further discrimination against the population by promoting heterosexuality as healthier, and therefore, superior.

The discussion of sex in medical education also has its limited boundaries.

Murphy (2016) found that even when the boundaries of what is considered sexual activity is pushed, instructors could not move beyond a heterosexual understanding of sex.

Instructors discounted what gender can look like on bodies, as well as how the relationship operates between gender identity, genitalia, sex toys and surgical interventions (Murphy, 2016). Queer students in a particular class on sex felt marginalized by the class discussion, but they could not express exactly why they felt that way (Murphy, 2016). Although there were no derogatory remarks made in the class, the exclusion of sexual possibilities can create the feeling of marginalization (Murphy,

2016). “Sex,” defined within the boundary of heterosexuality limits understandings of how individuals can engage in sexual acts, promoting misinformation about sexual health.

Language is a key component of heterosexism. Murphy’s (2016) study attended to language use in medical courses. One instructor would use the word “partner” when discussing his marriage, but would often refer to students as “guys” and “gals,” thereby erasing the idea of gender neutrality and/or flexibility. Furthermore, when discussing a potential male patient’s romantic partner, he would use the term “wife” (Murphy, 2016).

When responding to female students’ questions, he would use “he” to refer to their romantic partners (Murphy, 2016). Finally, the instructor also discussed birth control in the framework of “marriage and sex and children don’t have to be a package deal anymore” (Murphy, 2016, p. 277). Simply incorporating the gender-neutral term

“partner” does not erase other aspects of heterosexist language. By using gendered language and constantly positioning opposite-sex partnerships, the instructor reinforced heterosexist paradigms. As Murphy (2016) stated, “their cumulative impact on students’ understandings of sexual diversity was drowned out by the consistency and prevalence of

heteronormative embedded messages” (p. 278). Having queer examples is not enough, we constantly need to watch our language to see whether we are actively being inclusive, or, if we are excluding identities and bodies.

Having special days devoted to queer curriculum can be a way to address discrimination within healthcare. In focusing on the specialty nature of queer-focused health programs, Murphy (2016) discussed a transgender panel that was hosted by the medical school. Even with their good intentions, Murphy argued, “the transgender panel raised as many questions as answers, and reified heteronormative conceptions of sexuality, gender, and personhood in addition to providing the medical students with at least a little sheer exposure to transgender persons” (p. 275). Although many of the students expressed interest in the panel, citing how they had never “seen” a transgender person before (although they probably had), they described their experience as seeing something “exotic” (p. 276). Panels can be helpful, but transgender individuals were never included on other panels related to other medical experiences. Through not being included in other health related panels and the students seeing transgender patients as something “exotic,” transgender patients become positioned as the “other.” For example, one panel addressed “families with young children,” and only included heterosexual couples. Moreover, the panelists’ comments referenced their biological relationships to their children, reinforcing heterosexist assumptions (Murphy, 2016). Whereas Murphy

(2016) positioned herself as only an observer, I have had the opportunity to participate in a similar panel on health experiences for the LGBTQ community. As a participant, I felt a sense of accomplishment in being able to educate future healthcare providers about my

own experiences. However, I did wonder about whether queer individuals were recruited for other health panels or patient interactions to promote the constant inclusion of queer individuals as potential patients.

Moving from medical school, healthcare spaces then enact heterosexism.

Providers in family practices often assume that their patients are part of opposite-sex parental pairs, are heterosexual themselves, and expect the patient to correct the provider if they are not heterosexual (Westerstahk & Bjorkelund, 2003). Part of the reason providers may not ask about sexual identity is because they are concerned they may offend heterosexual patients (Westerstahk & Bjorkelund, 2003). However, this excuse is in and of itself heterosexist. By saying that a different sexual identity that is not heterosexual can be offensive, it states that being of a diverse sexual identity is offensive.

Along with understanding what is considered offensive within healthcare settings, considerations of visibility for queer patients should be discussed. Invisibility is largely experienced by queer patients when discussing heterosexism in healthcare. In my previous study (Hudak, 2016), I found that lesbian and bisexual women noted that their feelings of invisibility stemmed from when they were assumed to be heterosexual. The invisibility was connected to providers’ not giving space to state their sexual identity in their intake questions or forms. Many healthcare forms do not provide a space to state a person’s sexual or gender identity (Goins & Pye, 2012). In my (2016) study on heterosexism, queer patients also experienced inappropriate questions related to their healthcare that left the patients feeling invisible. Inappropriateness was defined by how the questions were based in heterosexist assumptions (Hudak, 2016). Baker and Beagan’s

(2014) study participants recalled heterosexist questions that started with “Does your husband…?” (p. 588). This framing assumes that a woman is engaging in heterosexual relations, are monogamous and are defined by relationship status. Another typical healthcare script ascribes women’s sexual identity to existing solely with men. When entering a healthcare appointment, it is typical of a healthcare provider to ask, “are you sexually active” (Silverman, Araujo, & Nicholson, 2012)? In a yes response, the provider then asks, “are you on any form of birth control or use a form of birth control?” When the woman responds no, the provider, confused, typically then promotes that the woman use some form of birth control (Silverman et al., 2012), even if a cis-woman exclusively has sex with a partner who does not produce sperm. The healthcare provider rarely stops to think that a woman can have sexual relations without the potential of becoming pregnant

(Hudak, 2016).

Queer women (and other individuals) may also have to constantly correct the providers. In my previous study (Hudak, 2016), several of the participants expressed frustration at how often they would have to correct a healthcare provider about their sexual identity and who their romantic partner was. When queer women were accompanied by other women in medical appointments, it was assumed they were just friends, as I illustrated in my own story. However, whenever they were with men, it was automatically assumed that the man was a romantic partner (Hudak, 2016). Heterosexism exists in these interactions because women are constantly being placed into cross-sexed romantic relationships, erasing the potential for same-sex relationships. As Saulnier

(2002) found, this can then prevent non-same-sex romantic partners from being involved in healthcare communication.

Another way that heterosexism is communicated within healthcare is through the assumption of promiscuity of queer patients. Although homophobia can play a part in this assumption, assumptions that queer individuals are promiscuous are symptomatic heterosexism. In disclosing a queer identity, the patient breaks the heterosexist assumption. However, this then places the patient into an “other” category, or at least that is how many providers process them. In being an “other” from a heterosexual, the patient becomes a deviant individual. For this population, the deviant brand is in the assumption of sexual promiscuity. Although sexual liberty is not necessarily a bad thing, in this context, it is considered a deviant act. Sexual liberty, in this population, is assumed to lead to sexual disease and infections. In a healthcare encounter, queer patients may seek healthcare for a health problem that is unrelated to their sexual identity (e.g., migraines).

Once they disclose their sexual identity, however, the health problem is assumed to be a sexual infection. For example, in my (2016) study, several participants brought up similar stories of how their disclosure of their sexual identity caused their provider to focus on potential STIs (sexually transmitted infections) or HIV. Some participants mentioned that they were even treated or tested for STIs/HIV without their knowledge or consent

(Hudak, 2016).

Perceptions of heterosexist attitudes from providers can impact queer individuals’ decision to seek out certain healthcare providers. Saulnier’s (2002) study of lesbian and bisexual women found that heterosexist attitudes from healthcare providers were one of

five things that influenced women’s healthcare decisions, including whether to seek out a healthcare provider. If they did choose to see a healthcare provider, some lesbian women believed that their providers’ heterosexist attitudes impacted the care that they received

(DeHart, 2008). Heterosexism can negatively affect queer individuals by blocking access to healthcare, decreasing the quality of patient-provider interaction, and decreasing the overall quality of healthcare (DeHart, 2008). Although some queer patients seek queer- friendly healthcare as an alternative to heterosexist providers (Hudak & Bates, 2018), not all queer patients can seek out queer-friendly care due to financial, geographic, or other constraints.

As heterosexism exists in both larger society and in the specific context of queer healthcare, it is likely that queer individuals experiencing pregnancy will encounter heterosexism throughout the process. Therefore, this dissertation seeks to answer the following research questions:

RQ1: How do queer couples encounter and/or resist heterosexism in their

healthcare encounters immediately before, during, and after pregnancy?

RQ2: How do queer couples encounter and/or resist heterosexism in pregnancy?

Patient-Provider Communication

Patient-provider communication is important when exploring queer pregnancy.

Most couples will seek medical care throughout their pregnancy, meaning that they will be interacting with healthcare providers. A patient-provider communication perspective will assist in exploring the relationship between both queer parents. Moreover, heterosexism may be present within the interaction, or the providers might find a way to

resist heterosexist assumptions. Therefore, this dissertation adds to the existing literature and ongoing conversation about patient-provider communication.

Patient-provider communication is an interesting dynamic because it involves interaction between individuals where one person has more power than the other.

Providers are considered to have more power as providers have the information and treatment that patients need (Beisecker, 1990). In addition, the interaction is considered non-voluntary and it is based around the important issue of the patient’s health

(Beisecker, 1990). Because of the nature of the interaction, patient-provider communication is emotionally laden and requires close cooperation between both patient and provider (Chaitchik, Kreitler, Shaked, Schwartz, & Rosin, 1992). Furthermore, this interaction between patient and provider is the primary vehicle through which both patient and provider exchange information (Street, 1991). The exchange is considered mutual because the patient needs to know and understand their medical situation and also have the need to feel known and understood; while the provider needs information from the patient to establish the correct diagnosis and treatment plan (Ong, de Haes, Hoos, &

Lammes, 1995). A good interpersonal relationship between the patient and provider, where there is an exchange of information and agreement on making treatment decisions, can have an impact on the overall health and healthcare of the patient (Ong et al., 1995).

The ability to communicate with the patient is necessary because it is seen as the main communicative process in healthcare. This conversation is where the patient-provider relationship is established and where medical goals are achieved (Roter & Hall, 1992).

Patient-provider communication impacts and is impacted by patient satisfaction, adherence, quality of life, health outcomes, and malpractice suits (Duggan & Thompson,

2011). Patient satisfaction is the most commonly-studied outcome variable (Galil et al.,

2006; Hausman, 2004; Korsch, Gozzi, & Francis, 1968; Paulsel, McCroskey, &

Richmond, 2006). Patient satisfaction is important to study when looking at perceptions of patient health (Korsch et al., 1968) because when patients believe that their providers are competent they are more likely to be satisfied with their care (Paulsel et al., 2006). In addition, effective patient-provider communication is associated with “better health” when it comes to blood pressure, blood sugar, patient compliance, and a subjective perspective on overall health (Kaplan, Greenfield, & Ware, 1989).

Within patient-provider communication literature, there has been a focus on relationship-centered perspectives (Duggan & Thompson, 2011). Relationship-centered care recognizes that both patients and providers have a sense of personhood, it acknowledges the importance of emotion and affect, there is a placement of healthcare relationships within an understanding of reciprocity, and there is a moral value on the creation and maintenance of genuine relationships (Beach, Keruly, & Moore, 2006). In the recognition of personhood and relationship-centered perspectives, queer couples may prefer this approach to patient-provider communication because they would be recognized as a complex person, not limited to health-related behaviors. Thus, relationship-centered patient-provider communication is an important concept for this dissertation.

For those going through a pregnancy, the patient-provider interaction may serve as a more crucial exchange. Queer couples may be wary of discrimination and become hesitant in the conversation. A provider may then need to reassure the patient as they go through their interaction. In addition, by focusing on patient-provider interaction, this dissertation provides insight on how to improve the provider communication with this vulnerable population.

Partner Support in Pregnancy

Patient-provider communication is not the only type of communication that matters during a pregnancy. Throughout the pregnancy, it is possible that the pregnant individual will seek out their partner for support. This support can alter heterosexist assumptions of pregnancy or reinforce the heterosexual script of certain roles partners are supposed to play. To understand how support is understood and enacted in queer relationships, it is necessary to reflect on the current literature on pregnancy and supportive communication. Previous literature has reviewed heterosexual couples that are bound to committed monogamous relationships. The literature on this topic is sparse, with more of a focus on relationships after giving birth. Within this section, I will be focusing on perceptions of partner support and impact on the relationship.

Relational connection. The partnership between mother and father is a significant relationship during heterosexual pregnancies (Dunkel-Schetter, Sagrestano,

Feldman, & Killingsworth, 1996). Pregnancy can even impact how heteroromantic partners view each other. Women who are pregnant view their partners more positively compared to nonpregnant women and were more satisfied in their relationship (Massar,

Buunk, & Gruijters, 2013). Positive perceptions of the relationship can have other consequences. Those who perceive they are in a better quality relationship have better overall well-being because the support that they receive from their partner is believed to be more effective (Rini, Schetter, Hobel, Glynn, & Sandmand, 2006). When women are pregnant and have these positive perceptions, they will have positive expectations of the support they will receive from the partner and see them in a more favorable light (Rini et al., 2006). Women who hold positive perceptions also experience more emotional closeness and intimacy, along with greater perceived equity in the relationship (Rini et al., 2006).

Specific factors can predict the perceived relationship during pregnancy.

Dissatisfaction with a partner relationship during pregnancy is a significant predictor of a woman’s maternal emotional distress during a pregnancy (Røsand, Slinning, Eberhard-

Gran, Røysamb, & Tambs, 2011). A strong relationship within a heterosexual couple can also heavily influence how much the father is involved (Alio, Lewis, Scarborough,

Harris, & Fiscella, 2013). If the relationship is not perceived as being strong, the father may not be as involved in the pregnancy.

Father involvement. In a study on father support in heterosexual relationships, parents in the study wanted fathers to be involved in the pregnancy, however, fathers can struggle trying to achieve this goal (Widarsson, Engström, Tydén, Lundberg, & Hammar,

2015). Women felt security believing that their partners were there for them and had equal investment and interest in having the child. The two parents had to willingly share the responsibility of pregnancy and childbirth (Alio et al., 2013). In Alio et al.’s (2013)

study, they found that “the ideal father is present, accessible, and available, an active participant during the pregnancy. He is present at prenatal visits, ultrasounds, Lamaze classes, parenting classes, in the delivery room cutting the umbilical cord, and helps with birth-related paperwork” (p. 3).

The ideal father in a heterosexual partnership can present a feeling of “paddling upstream” as men attempt to achieve this goal (Widarsson et al., 2015, p. 1061). Father involvement was perceived as being difficult for the men because they often did not feel that the pregnancy was real, as no cis man could feel the baby moving within his body or see his body change like the mother can (Widarsson et al., 2015). The pregnancy did become more real for the father once he went to the ultrasound, which then boosted his willingness to help prepare for the upcoming child such as purchasing needed items, something that did not occur before the ultrasound (Widarsson et al., 2015). However, there were some barriers that prevented the father from being able to be more involved.

Some fathers could not participate in healthcare visits due to a need to be at work or the need to arrange childcare for the children at home. This provided a hinderance to support because a way for a father to participate in the pregnancy was to go on the visits to the midwife or other antenatal caregivers (Widarsson et al., 2015). Another complication was that when men did go on these visits, they did not feel they had support from the providers and all of the information and questions were directed at the mother

(Widarsson et al., 2015).

Types of partner support. According to previous scholarship examining support during heterosexual pregnancies, fathers have enacted several different types of support

for their pregnant partners. One way that fathers provided support was through preparation for the birth (Widarsson et al., 2015). Fathers would learn about the pregnancy by learning about delivery and taking care of the upcoming child (Widarsson et al., 2015). They would achieve this by going to antenatal care visits, parenting classes, and classes specific for fathers (Widarsson et al., 2015). Learning from other fathers was seen as an important way to learn about how to become a better partner and father

(Widarsson et al., 2015). Fathers would also ask questions to the healthcare providers to learn more about the pregnancy process (Alio et al., 2013).

Beyond learning about pregnancy, fathers found that they needed to help take care of the house as a form of instrumental support. A projected ideal is that the father should care for the physical environment of the home, including doing household chores such as cooking, cleaning, laundry, and taking care of any other children at home (Alio et al.,

2013). In reflecting on the enacted support, fathers felt that they needed to balance both their partner’s and their own lives by managing work, providing leisure activities, and taking care of the children (Widarsson et al., 2015). Fathers often perceived that they were doing more of the household responsibilities, but the mothers felt that they were equally sharing the workload (Widarsson et al., 2015). Along with household instrumental support, the projected ideal father should encourage the mother to have healthy choices by assisting with her management of her diet and exercise, potentially exercising with her (Alio et al., 2013). Finally, when considering how support is given during the actual labor, women wanted their partners to help sponge down and wipe their foreheads and hold their hands (Somers-Smith, 1999).

While instrumental support was helpful, fathers also provided psychological and emotional support. Pregnant women would express more irritation due to the pregnancy.

Some fathers still expressed greater understanding, even when their partner expressed irritation (Widarsson et al., 2015). Even though some fathers would not always manage this change well, the mothers perceived them to be more attentive, thoughtful and understanding. Men felt that this irritation was normal with pregnancy and knew that they could not experience being pregnant, so they simply attempted to understand their partners (Widarsson et al., 2015). Alio et al.’s (2013) findings on the ideal father supported this type of emotional support. An active father should recognize that the mother’s body is changing because of the hormone changes. During this time, the ideal father should be empathetic and patient while listening to the mother vent (Alio et al.,

2013). Mothers have agreed with this approach, as they want psychological and emotional support from the fathers enacted by the provision of care, empathy, and sympathy (Somers-Smith, 1999). While providing emotional support, fathers would attempt to calm their partners’ anxieties, however some fathers would then also hide their own worries and anxieties as part of this support (Widarsson et al., 2015).

There were some difficulties when fathers would attempt to provide support to their pregnant partners. Some fathers would attempt to provide practical support while attempting to figure out what their partner wanted, as she would not clearly express her needs (Widarsson et al., 2015). Fathers felt that they cared more for the partner once she became pregnant. They attempted to give psychological support and took care of the house, which served as a relief to the mother (Widarsson et al., 2015). However, the

support was not always considered successful because the mother would not always directly express her needs and would just expect the father to detect those needs

(Widarsson et al., 2015).

Men were unsure of as to what kind of support they should be providing during labor, as they did not have guides. They mostly defined themselves as providing general support to provide presence and comfort during the birth (Somers-Smith, 1999). During birth, fathers initially focused on their helping behaviors such as encouraging relaxation, massaging, trying to make their partner comfortable, giving her water, walking with her, holding her hand or leg and cooling her down (Somers-Smith, 1999). Women felt that the most important thing was having their partner present for the birth (Somers-Smith, 1999).

Men also admitted that they felt anxiety during childbirth but could not express that anxiety (Somers-Smith, 1999). Although some of the support was appreciated by the mothers, there were times when the lack of communication created tension between mother and father (Somers-Smith, 1999).

Expectations and experiences of support from fathers can be helpful when exploring the relationship dynamics between queer partners during pregnancy. The co- parent in the queer couple may mimic some of these expectations, or perhaps, attempt to find their own unique roles. This dissertation extends the literature on the topic by looking at more diverse couples and how support is differently communicated.

Lesbian Pregnancy

Lesbian women who become pregnant have unique experiences. The choice to become pregnant in and of itself creates its own challenges. For example, some lesbian

women feel that they need to justify their choice to become pregnant. Priddle (2015) explained that, “becoming parents necessitates a whole new layer of ‘coming-out.’

Couples must not only come out as lesbians to clinic staff, but reveal to society at large that they are choosing a form of parenting that many still see as unnatural” (p. 197). Not only do lesbian women feel like they must come out during this experience, they worry about losing their lesbian identity along the way. When lesbian women are out in public with their child, they can feel as though they are no longer seen as a lesbian but just another woman pushing their child in a stroller (Chabot & Ames, 2004). Motherhood can be assumed to be a heterosexual identity. Therefore, when seeing a child with a woman, the assumption can be that the woman is heterosexual, creating an invisibility of a diverse sexual identity. The attachment to the child, even though the lesbian woman is the child’s mother, erases the possibility of an assumed lesbian identity.

There were some women who postponed having children because of their sexual identity. It was not until they heard about ways in which to become pregnant that they shifted their position (Chabot & Ames, 2004). In pursuing reproduction, lesbian identity is a primary focus of much of these lesbian couple’s experiences throughout the pregnancy process (Chabot & Ames, 2004). Even the choice to become pregnant starts with a list of questions: “Where do we access information and support? Who will be the biological mother? How do we negotiate parenthood within the larger heterosexist context?” (Chabot & Ames, 2004, p. 350).

Being pregnant within a lesbian couple has its own unique perspectives and challenges. Based on previous research, there are several major themes that need to be

considered as part of the process: co-mothers’ experiences; legal considerations; healthcare experiences; and, relational navigation.

Co-mother experiences. Co-mother is the term used to describe the other mother in the couple who did not become pregnant (Cherguit, Burns, Pettle, & Tasker, 2013).

The use of the term is meant to include the mother as an equal parent without the alienation of biological language. Research on lesbian pregnancy has focused on the co- mother, as she has experiences separate from the birth mother that are likely to be different from a father’s perspective. There are several areas of focus on the co-mother: decision making, negotiating identity, difficulties, and making connections.

Decision making. One of the first choices lesbian couples must make when starting their pregnancy journey is who is to be pregnant. As both partners are women, both are typically capable of becoming pregnant. One way that women attempt to make this decision is by considering the gender roles and gender identities of both women

(McKelvey, 2014). With motherhood being labeled as a feminine role, lesbian couples may have considered the nuances of their gender performances and identities. The partner who does not identify as traditionally feminine more often chooses not to be the one to become pregnant (McKelvey, 2014). For couples who both prefer to become pregnant, some lesbian couples decide to take turns (Pelka, 2009a). As most lesbian couples cannot afford to or do not wish to be pregnant simultaneously, many will choose to have the older partner become pregnant first because age can impact the health of the pregnancy

(Pelka, 2009a). However, there were also times when both mothers wanted to be pregnant. When both want to become pregnant, there can be maternal jealousy for the one

who is not immediately going through the pregnancy (Pelka, 2009a). The decision of who becomes the birth mother can be complicated and take time as the decision impacts both women because it solidifies the roles they will be navigating during the pregnancy.

In considering identity of co-mothers, the choice of who becomes pregnant can affect a woman’s identity. While women couples can agree on who should become pregnant first, there are some who cannot be the first one to become pregnant or have the ability to become pregnant at all. Pregnancy can be connected to a female identity and the act of not being pregnant can affect how women see themselves. For example, in one study, a woman thought that she would be the one to become pregnant in her relationship because she saw herself as being more feminine than her partner. However, the partner wanted to become pregnant (Pelka, 2009a). During the partner’s pregnancy, the woman struggled to watch her partner go through the process because her expected self-identity had been shattered (Pelka, 2009a). When two women are involved in a relationship with a pregnancy, there can be tension about who should become pregnant and how that then affects how they see their own self-identity.

Negotiating identity. Being a co-mother can interrupt a lesbian woman’s identity.

When co-mothers were around their children or identified themselves as having children, co-mothers often found that they had to come out as lesbian women. As a consequence of heterosexism, the active presence of a child created an assumption that the parents had to be a father and a mother (McKelvey, 2014). In addition, when the women wanted to be recognized as the child’s mother, they had to come out as lesbian women to explain their parentage to the child (McKelvey, 2014). Physically being around children interrupted

the assumed identity of the lesbian women. They had to explain their connection to the child in a way that disrupted heterosexist assumptions.

Motherhood provided another identity that necessitated negotiation for lesbian co- mothers. Not having a biological connection to the child created a fear that the co-mother would not be recognized as an equal mother by their family members and the family members of their partner (McKelvey, 2014). Not having the biological connection created uncertainty because of heterosexist assumptions from these family members

(McKelvey, 2014). Due to this uncertainty, lesbian co-mothers have referred to themselves as the more “vulnerable parent” (McKelvey, 2014). This was not just legal vulnerability, but identity vulnerability. They wanted to be affirmed in their mother identity without the biological connection.

Co-mothers also found that parental language created further confusion about their own identity as mothers (Cherguit et al., 2013). Parental language emphasizes a mother and a father and does not offer terms or descriptions for co-mothers or co-parents.

Furthermore, questions by people outside of their immediate family could create additional dissonance. Lesbian couples were asked questions such as “Who is the ‘real’ mom?” and “How can there be two moms in the house?” (Chabot & Ames, 2004, p. 354).

These questions reinforced the heterosexist parenting language that there are two specific parent roles _mother and father_ and there is no room for additional roles.

In focusing on interactions within healthcare settings, co-mothers had to consider whether they wanted to be open about their sexual identity and think about their role in the process. When co-mothers were open about their sexual identity, they were more

likely to be accepted by the maternity staff (Cherguit et al., 2013). The openness could have been a way for the maternity staff to understand the relationship to the mother and child and to find appropriate language and behavior. Even prior to the pregnancy, co- mothers might need to come out to their clinical staff when going through the insemination process. Some co-mothers want to be active participants in the insemination process, including inserting the semen into their partners (Wojnar & Katzenmeyer, 2014).

To be included, they had to identify who they were in relation to their partner. Openness can come with a catch, however. Some of the co-mothers felt that they needed to appear as good partners to show support. They did not want to reflect poorly on the queer community in front of the medical staff (Wojnar & Katzenmeyer, 2014). Although the women could be open about their sexual identity within healthcare settings, they had to then deal with the pressure of appearing to be model minorities.

The dual female identity was also perceived to work in the couple’s favor. Co- mothers felt that because they also occupied a female body, they could envision what was going to happen to their partner’s body once their partner was pregnant (Wojnar &

Katzenmeyer, 2014). The envisioning of body changes could be a way for co-mothers to provide better support to their partners. Moreover, women felt like they were good romantic partners during the pregnancy because they were also women (Spidsberg &

Sørlie, 2012). Midwives echoed this sentiment. They felt that lesbian couples had both elements of love and friendship. They were described as having a “better understanding of hormonal and emotional variations, creating a special emotional understanding”

(Spidsberg & Sørlie, 2012, p. 799). The lesbian co-mothers were described as being able

to read their partner’s needs and find their place within the birthing room. There was an overall sense of bodily understanding (Spidsberg & Sørlie, 2012). Because co-mothers were viewed as similar identities to their partners there was a perception of having better partner support compared to heterosexual men.

Identity conceptions have influenced how co-mothers understand themselves in their new roles. Negotiation of identity is sometimes a part of heterosexist communication that occurs surrounding both pregnancy and queer identities. I further this research by focusing on how heterosexist messages are communicated to the co-mothers in ways that reflect their roles. Furthermore, co-mothers might also use heterosexist language to affirm their new roles as a way to manage their identities, or they may create new language to counter those heterosexist messages. Part of my dissertation focuses on the communication of queer and parental identity through language between partners, family, and healthcare providers.

Difficulties. Negotiating identities can be an exhausting experience for co- mothers. However, that is not the only difficult experience they face throughout the pregnancy process. Co-mothers have found that the overall process was exciting yet anxiety producing. Some of the co-mothers did not want to go forward with the pregnancy as soon as their partner did and would describe the process as an “unpleasant and expensive roller coaster ride” (Wojnar & Katzenmeyer, 2014, p. 54). Once they did go forward with the pregnancy process, many felt that they had similar stress and vulnerability of heterosexual parents. Yet, these feelings were not discussed because of the medical atmosphere of fertility services (Cherguit et al., 2013). The insemination

process became a place sterilized of emotions and the co-mothers had to keep their feelings to themselves. Additionally, within medical spaces, co-mothers assumed that they would inevitably experience prejudice and discrimination (Cherguit et al., 2013).

Their overall expectation of medical care and services were low. Furthermore, the co- mothers felt that they did not have role models in the system to show how they should be acting in the medical system (Cherguit et al., 2013).

Beyond the medical care system, co-mothers experienced difficulties from having a lack of support from family and friends, which ended in a loss of those relationships.

There were also some women who said that they lost support in their lesbian communities because the act of becoming pregnant was seen as conformity to heterosexuality (Wojnar & Katzenmeyer, 2014). In the new experience of parenthood, co-mothers found that they were not prepared for the emotional and lifestyle changes during the first year. Even though they prepared, they still dealt with sleep deprivation, anxiety, and stress (McKelvey, 2014). Co-mothers often found themselves taking on family and household responsibilities because their partners were constantly exhausted after giving birth (McKelvey, 2014). They had not expected these shifts in roles and relationships that stemmed from the birth of their child.

Jealousy. In the shifting of roles, co-mothers found that they would experience jealousy of the birth mother (Larsson & Dykes, 2009; McKelvey, 2014; Pelka, 2009a;

Wojnar & Katzenmeyer, 2014). Often the jealousy stems from the physical and biological relationship between birth mother and child (Pelka, 2009a). Jealousy would also increase when both women wanted to become pregnant. When fertility was an issue, the partner

might be mourning their own fertility while simultaneously watching their partner become pregnant instead. They had to navigate their own emotions while attempting to celebrate their partner (Pelka, 2009a). Sometimes when co-mothers experienced jealousy, they did not want to share these feelings with their partner for fear of upsetting them

(Wojnar & Katzenmeyer, 2014).

For a lesbian pregnancy experience, jealousy was present in acts and behaviors.

Co-mothers could become jealous when the baby wanted to be fed and soothed by the birth mother (Pelka, 2009a). Having to watch their partners breastfeed would incite jealous feelings. Even if both mothers wanted to breastfeed (with medical intervention), they found that once the baby was born the household chores would increase and both partners breastfeeding was not considered a good use of time (Pelka, 2009a). One way that co-mothers established connections was through bottle-feeding when the birth mother needed to rest (McKelvey, 2014). Still, some co-mothers ended up resenting the birth mother for the ability to breastfeed and because the process was time consuming, they were also upset about having less time with their partner (McKelvey, 2014). The lack of skin-to-skin contact also allowed for insecurity and jealousy (McKelvey, 2014).

Co-mothers also experienced jealousy when the baby simply wanted to be picked up by the birth mother instead of the co-mother when the baby was crying (Pelka, 2009a).

This could also occur during moments like bedtime routines (Pelka, 2009a). Some co- mothers had a hard time sharing motherhood with their partner (Pelka, 2009a), especially when chores had to be balanced out. Often while the birth mother would be breastfeeding

the child, the co-mother would be stuck doing the household chores, leading to co- mothers’ own experiences of postpartum depression (Wojnar & Katzenmeyer, 2014).

Through negative experiences and jealousy, co-mothers have a separate experience of the pregnancy process. In this dissertation, I explore their experiences separately from the birth mother. Co-mothers can have insights that are unique to them.

Furthermore, the jealousy of a biological connection may be based in heterosexist assumptions of parenthood. A nuclear conception of a family, which includes a mother, father, and two children, assumes heterosexuality. That nuclear family desire can be re- affirmed when lesbian women take out the father and replace him with another woman, to model after heterosexual couples. The desire for the biological children, in order to create a heterosexual family dynamic, may still persist. A woman may even take on the role of the father instead of a mother. The desire is still engrained within that heterosexual, nuclear family conception.

Creating connection. The feeling of jealousy by co-mothers was felt because they had a lack of a biological connection with their child. Many of the co-mothers feared that they would not be considered the real parent because of this lack of biological connection. Love was not found immediately with their child after birth. It was after caring for the child that they found that connection (Wojnar & Katzenmeyer, 2014).

Several of the women ended up taking time off work to become the primary caregiver.

However, there was still a belief that the biological mother had a stronger connection

(Wojnar & Katzenmeyer, 2014). Some co-mothers would attempt to establish connection with their child in different ways. For some co-mothers, having a shared family name

created this connection, and signaled to healthcare providers that, as co-mothers, they were also a legal mother of the child (McKelvey, 2014). Even in this attempt for connection, co-mothers felt that their overall connection with the child was gradual compared to the immediate connection of the birth mother (McKelvey, 2014).

These attempts for connection are based in biological assumptions. I continue this line of inquiry by focusing on whether co-mothers attempt to become close to their child and whether that closeness is situated in a heterosexist, biological perspective. In this dissertation I argued that heterosexist constructions of society do not just emphasize a monogamous, male-female couple, but also that the family will go on to biologically reproduce to create the heteronormative family. Moreover, I investigated whether the idea of connection is just from the co-mother’s perspectives or if there were others in the co-mother’s life that communicated the need for biological connection.

Second-parent adoption. Co-mothers not only have to consider their relational connection to their child, but also need to attend to their legal connections. There are inconsistencies on whether marriage provides legal connection to the child. Some couples described being frustrated that legal marriage does not provide automatic legal attachment to the child (McKelvey, 2014). Black and Fields (2014) stated that, if the parents are married, they should both be considered the child’s legal parents. If they are not married, co-mothers must go through second-parent adoption (Black & Fields, 2014).

Legal adoption may be necessary because the co-mother might need to have the child covered under her medical insurance (Black & Fields, 2014) or just for having legal security. When going through second-parent adoption, the couple has to make sure that

the donor waived any legal rights to the child because only two parents can be listed as the legal guardians (Ross, Steele, & Epstein, 2006). In addition, the legal process is a very expensive and lengthy, costing several thousand dollars (Black & Fields, 2014).

Moreover, the process is also very invasive (Black & Fields, 2014). One woman described it as “having to fight for every piece of motherhood” (Cherguit et al., 2013, p.

109). Many of the women had to go through home studies of the child that already lived with them. Co-mothers felt that the legal system was biased against lesbian parents with a need to “buy” their access to fertility services and ultimately, parenthood (Cherguit et al.,

2013).

Because of legal changes with the passing of marriage equality, the legal experiences of queer pregnancy and parenthood may have changed. Part of the inquiry of this dissertation focuses on how queer couples navigate heterosexist structures, such as the legal system while creating their family.

Healthcare. After becoming pregnant, lesbian couples usually engage in healthcare systems to keep them and their unborn child healthy. Past research has highlighted lesbian women’s negative experiences, positive experiences, how they seek out healthcare, and recommendations for future healthcare providers.

Negative experiences. Many lesbian parents have had negative experiences dealing with the healthcare system and healthcare providers. Spidsberg (2007) found that

“being a theme” was how lesbian women described their sexual identity in relation to healthcare. The process of having a baby is meant to be private, but being an out lesbian pregnant woman makes you a public person. There is no privacy (Spidsberg, 2007). The

act of being an out lesbian pregnant woman causes individuals to ask many questions about the process and the experience of being pregnant and a lesbian. Many lesbian pregnant women described how they felt insecure or nervous about how healthcare providers would react if they learned of their lesbian identity (Röndahl, Bruhner, &

Lindhe, 2009). Co-mothers also experienced vulnerability with healthcare providers and would approach them with fear and trepidation because they were worried that they would not be recognized as a parent (McKelvey, 2014). When attempting to assess potential discrimination, women would look for prejudice by reading body language and signals that occurred in their interactions (Spidsberg, 2007). Once in the system, women grew tired of having to constantly explain their situation and family dynamics to the providers. They felt that there was a lack of communication between providers that led to confusion and constant explanations (Spidsberg, 2007). One of the reasons for the constant confusion was that healthcare providers seemed to be unprepared to have healthcare interactions with lesbian couples, making the lesbian women feel unincluded or under represented (Wojnar & Katzenmeyer, 2014).

There were specific moments where lesbian parents had negative interactions. Co- mothers have found that the medical staff do not recognize them as new parents. When the co-mothers were not recognized, they felt invisible and drained from the interactions

(or lack thereof) (Erlandsson, Linder, & Häggström-Nordin, 2010). Further, pediatric services sometimes would not recognize the co-mother as an equal parent (Ross et al.,

2006). In addition, “Co-mothers were subject to unexpressed opinions about co- motherhood and homosexuality by midwives assisting at the birth of their child, and

experienced an attitude of non-cooperation” (Erlandsson et al., 2010, p. 102). Postpartum nurses were also described as providing poor care. Nurses would often ignore the co- mothers and did not recognize them as equal parents and partners (McKelvey, 2014).

Beyond failing to provide patient-centered care, healthcare providers can unintentionally cause discomfort in the interactions between patient and provider.

Curiosity about a patient’s sexual identity can take over the appointment, creating a situation where patients must educate the provider instead of the other way around.

Singer (2012) explained, “healthcare providers do not ask their heterosexual patients to teach them about their sexual practice nor do they look confused or disgusted when a man and woman present to their office for a new obstetrical visit” (p. 38). Antenatal providers that overly inquired about the patients’ lesbian identities were described as “on the verge” (Spidsberg, 2007, p. 481). In a similarly covert form of discrimination, midwives have been caught gossiping about patients’ sexual identities (Spidsberg &

Sørlie, 2012). A lesbian identity can be over focused on or became a reason to create poor healthcare situations.

One reason for the overall negative experiences of both mothers is that medical staff can present as having negative attitudes toward lesbian families wherein which they do not recognize the possibility of lesbian parenthood (Cherguit et al., 2013). However, it is hard to identify if poor treatment comes from homophobia or just generic poor treatment (Cherguit et al., 2013). Some lesbian women felt that their negative experience was not related to their sexual identity but just “bad chemistry” between patient and provider (Röndahl et al., 2009). Some lesbian women may not believe that they are

experiencing heterosexist attitudes from providers because these attitudes can be subtle or unintentional. In Lee, Taylor and Raitt’s (2011) study, they found that some women did not want to admit there was homophobia and attributed the negative treatment to other causes. Lee and her colleagues suggested that with new laws, people were not being as overtly homophobic but tried to hide it for fear of a lawsuit (Lee, Taylor, & Raitt, 2011).

Even though it can be hard for patients to recognize heterosexism, heterosexism can still be present in these interactions and warrants further study.

Medical forms and queer representation. Interactions were not the only expression of heterosexism. Many medical forms were identified by patients as being heterosexist. Several forms would present heterosexual parent names (i.e., mother and father) as the only option and were actively not inclusive (Larsson & Dykes, 2009). Some women felt that the standardized forms were offensive, conservative, and stereotypical

(Röndahl et al., 2009). The language used in the medical setting, as well as the forms, presented as heterosexist as it did not include the co-mother. In addition, women felt that they did not have an avenue to issue complaints about heterosexist issues, such as not having lesbian representation in the literature passed out in the clinic or given away with free diapers and other baby products (Cherguit et al., 2013). Even when clinics would advertise for lesbian couples, their forms did not reflect having lesbian patients.

Healthcare forms and materials need to be adjusted with creativity (Spidsberg & Sørlie,

2012) to include lesbian parents (Röndahl et al., 2009).

Education. Another place that lesbian couples experienced heterosexism was within prenatal education (Ross et al., 2006). Education often focused on mother and

father dynamics (Larsson & Dykes, 2009). Prenatal courses can be difficult because the language would be confusing when referring to straight and lesbian couples (Spidsberg &

Sørlie, 2012). When they were in the typical prenatal course, lesbian women felt discomfort when the parents split into mother and father groups (Erlandsson et al., 2010).

Calling the co-mother a “father” is incorrect because lesbian women do not identify as fathers and lesbian women presented with different types of questions than the fathers did

(Erlandsson et al., 2010; Spidsberg & Sørlie, 2012). Not all lesbian women were even offered prenatal education. Some of the women assumed that it was because the midwife did not know how to handle two mothers versus a mother and father (Röndahl et al.,

2009).

Co-mothers expressed a desire to have prenatal care that was designed for same- sex couples because they believed that having a separate class was the only way that the education could be catered towards same-sex couples (Erlandsson et al., 2010). Another reason for separate education is that some lesbian women believed that this was the only way that there could be a focus on education and not sexual identity (Röndahl et al.,

2009). Those who were offered courses for lesbian families found them helpful because they established a supportive network (Ross et al., 2006).

Positive experiences. Not all lesbian couples described having negative experiences with healthcare providers. In Cherguit and her colleague’s study (2013), co- mothers identified as having positive experiences with inclusion by the staff and that they valued fertility services’ intentional inclusion of lesbian families. They valued the ability to receive equal treatment. It was helpful when the maternity staff celebrated the two-

mother families. If a couple has positive experiences, they expected less prejudice and discrimination. Yet, positive experiences were still viewed by the couples as the exception compared to other lesbian families (Cherguit et al., 2013). In another study

(McKelvey, 2014), women described their experiences with labor/delivery and the NICU as positive. In the NICU, the staff often relied on the co-mother to make decisions and provide information (McKelvey, 2014). Even with no legal rights, the co-mother was recognized as the parent (McKelvey, 2014). Several women stated that the NICU providers made no distinctions between the co- and birth mother, and one woman talked about how the nurse listed both mothers on the crib card (McKelvey, 2014). Some women felt that the questions asked by midwives about their identity and family were sweet and positive. They thought that the midwives were trying to obtain new knowledge

(Spidsberg, 2007). Another positive experience stemmed from the obstetricians and nurses respecting co-mothers by including them in the care as equal partners (McKelvey,

2014).

Seeking care and support. To manage potential discrimination and inequity, some lesbian couples sought out various forms of queer support. Anxiety about decision making was lessened after having talked to other lesbian couples (Chabot & Ames,

2004). For those who lived in rural areas, having the support group made them feel connected to a lesbian community (Chabot & Ames, 2004). Besides support groups, some queer women attempted to find queer accepting providers. When calling around to find a provider, the women explained that no one would directly say they were opposed to lesbian couples, so they listened to their “voices” (Spidsberg, 2007). The ability to

have a safe and open environment was very important and because of this, women would make deliberate choices about their healthcare providers. Friends often made recommendations or the women used websites and materials from queer organizations that had advertisements for obstetricians (Spidsberg, 2007).

Sometimes, the choice of care was not about finding queer-friendly support, but more of a generic assumption about the type of care provider and how they supported lesbian couples. Female gynecologists were perceived as more understanding of lesbians

(Larsson & Dykes, 2009). Other women preferred midwives and doulas because they were helpful advocates with other healthcare providers (Ross et al., 2006). For some women, it was not about the type of provider, but how they were perceived. Lesbian couples identified the need to find medical professionals who were considered trustworthy and supportive (Chabot & Ames, 2004).

Choices may not have been consistent between multiple pregnancies. In a study in

Sweden (Röndahl et al., 2009), women were asked what choice they made in deciding where to give birth. Several of the women chose a clinic that specialized in lesbian competency for the first pregnancy, but then opted for a hometown clinic for their second. They chose the culturally competent clinic initially because they were new to the experience and were less confident. In the second pregnancy, they gained confidence.

They did not want their providers to focus on their sexual identity and instead, emphasized the pregnancy and parenting.

Recommendations for care. Past literature has discussed how healthcare providers can improve their care of lesbian couples throughout their pregnancy. One

issue that lesbian couples found was that healthcare providers would not bring up their lesbian identity. While a lesbian identity should not be the sole focus of the visit, it is an important identity to openly recognize. When providers do not use the word “lesbian,” lesbian women can perceive that the providers do not want them to bring up their lesbian identity, or, that the providers had a lot of uncertainty surrounding a lesbian identity.

These women said that it would be better if providers just admitted that they were uncertain instead of ignoring the topic (Spidsberg, 2007). Overall, healthcare providers should be open about sexual identities and ask questions to demonstrate their openness

(Larsson & Dykes, 2009). One way to show openness would be by providing an opening for the patient, such as by saying “So tell me the story of how you became pregnant”

(Singer, 2012, p. 38). This open statement allows for a background story that is inclusive of all people. Any language used by healthcare providers should also be inclusive

(Singer, 2012).

One major area that healthcare providers need to work on is their heteronormative communication. Regardless of intent, language used in healthcare interactions can promote heterosexuality as the only possibility, thereby erasing queer people. Healthcare providers can try to communicate more neutrally and ask for the preferences of the parents in terms of language (Pharris, Bucchio, Dotson, & Davidson, 2016). Throughout the pregnancy, healthcare providers should evaluate how they are communicating and check their assumptions (Pharris et al., 2016). Healthcare providers should not assume that everyone can accidentally become pregnant because the assumption can ignore life situations (Singer, 2012). Further, healthcare providers and staff should also be aware of

nonverbal communication and reject any use of heteronormative language (Erlandsson et al., 2010). They should also be inclusive of the co-mother from the very beginning and the inclusion should be in a conscientious and natural way (Röndahl et al., 2009).

Curiosity about lesbian couples can be nice, but most lesbian couples want healthcare providers to already have knowledge about lesbian families and how to work with lesbian patients (Erlandsson et al., 2010). Women suggested that midwives should be educated on lesbian issues to help ask questions and communicate in more neutral ways at the initial meeting. However, some women felt that this was not needed but that the midwives just needed to have an open mind and be sensitive to prospective parents’ vulnerability (Röndahl et al., 2009). Some lesbian women felt that those who worked in postnatal care were more aware of different family makeups and demonstrated this through their actions (Röndahl et al., 2009). Regardless of how providers can show awareness or education, providers should not use lesbian parents as an educational resource (Röndahl et al., 2009).

Beyond education, medical staff can demonstrate helpfulness by allowing the co- mother to stay overnight and offer support with breastfeeding. In addition, gender neutral language can be used to acknowledge co-mothers (Erlandsson et al., 2010; Spidsberg &

Sørlie, 2012). Going further than language use, healthcare systems can arrange themselves to automatically be designed for the inclusion of lesbian couples. They can label the healthcare system as lesbian friendly, assuming they are friendly, which would alleviate fears of discrimination and vulnerability. This way, lesbian couples know that

their healthcare providers are already aware of same-sex parenthood (Erlandsson et al.,

2010).

Medical forms also need to be evaluated and updated, along with other types of forms that are distributed in medical spaces (Pharris et al., 2016). Medical forms should use terms such as “non-biological mother, co-parent, social mother, other mother and second female parent” (Pharris et al., 2016, p. 23). Another way to show inclusion would be to ask the parents how they want to be referred to by their unborn child and do not question their choices (Pharris et al., 2016). Finally, lesbian couples may need help navigating different systems. Healthcare providers should know the legal system of where they are locally situated. Lesbian couples may need help navigating local legal systems and having knowledgeable contacts can help (Pharris et al., 2016). Beyond the legal system, providers need to pay attention to unasked questions and to help identify support networks that are inclusive of sexually diverse parents (Pharris et al., 2016).

Overall, women mostly just want respect (Spidsberg & Sørlie, 2012).

Past research has provided information on how lesbian couples experience healthcare. However, some of the research is based outside of the United States and all the research focuses on lesbian couples. My dissertation expands on this research by focusing on the United States and by including more than just a lesbian sexual identity.

Relational influence. A limited amount of research has also focused on how relationships beyond the couple influence and are influenced by the pregnancy.

Nordqvist’s (2015) study discussed how lesbian couples negotiated their relationships with their parents who were originally unsupportive of their sexual identities. In some

cases, the announcement of a pregnancy by a daughter helped older family members cope with her sexual identity. The lesbian couples recognized that the choice of who carried the child would impact the relationship the couples had with that person’s wider family

(Nordqvist, 2015). In certain cases, the women recognized that a parent would not recognize the child as their grand-child if it was not their daughter who carried the baby

(Nordqvist, 2015). Nordqvist (2015) explained, “these accounts suggested that carrying a child was a way for a daughter to render her lesbian life intelligible for her own mother

(and father) and slot back into a livable life” (p. 490). The lesbian women in the study did not make their decision based on the rebuilding of fractured family relationships. Instead, the decision created a powerful consequence that affected their relationships. Through the grandparents’ acceptance of only the biological link to the grandchild, the lesbian couples were keenly aware that the goodwill of the grandparents was conditional (Nordqvist,

2015). Grandparents openly admitted that they would not have considered the child their grandchild had their daughter not been the one to give birth. For the nongenetic grandparents, the study revealed that it could take time to reach an understanding of the relationship. It is also important to note that even if a grandparent accepted their biological grandchild, they did not necessarily accept the relationship between mothers and were less likely to accept the family as a whole (Nordqvist, 2015). These grandparents could hold discontent or show subtle ways that they did not recognize the family relationships. Relationships that were genetic gave a perception that, regardless of the couple relationship, they would still have a connection to their grandchild. On the other side, those who did not have a genetic relationship were more likely to have fragile

relationships with their grandchild. Because, in some cases, there was no legal recognition of parenthood between the co-mother and child. Some of the grandparents who thought that they were considered family with their non-genetic grandchild were worried about what would happen if the couple broke up because they had no legal attachment to the child (Nordqvist, 2015).

Family relations were not the only influential relationships during pregnancy. A study in Norway (Hennekam & Ladge, 2017) focused on how both the birth and co- mother understood their identity as mothers in the workplace. Birth mothers were often granted the mother identity and shifted to focus on that identity regardless of the workplace environment. Co-mothers were only granted a mother identity if they were in an accepting workplace. In the hostile work environment, co-mothers were often silently discriminated against and had an emphasis placed on their masculinity and sexual identity

(Hennekam & Ladge, 2017).

The two studies demonstrate a limited understanding as to how outside relationships can communicate heterosexism throughout the pregnancy. Family members have the potential to re-emphasize the biological connection rooted in heterosexist assumptions of family constructs. Furthermore, workplace communication between colleagues can also be a site of heterosexism, depending on whether there is an abundance of heterosexist communication within the organization. In my dissertation, I expand on this literature by exploring how the queer couples communicated with others they interacted with on a regular basis about the pregnancy.

Theoretical Framing

Past literature on lesbian pregnancy can provide background to the current study.

However, the studies did not fully incorporate ideas of power in their analysis. To further explore queer pregnancy experiences in relation to heterosexism, the ideas of the French philosopher Michel Foucault provided my larger theoretical framework. When exploring power through Foucault’s perspective, power is positioned as not having a hierarchical structure. Rather, he sees power as being flatly distributed and constant throughout interactions (Foucault, 1977). In a hierarchical structure, power is assumed to be coming from a larger force and then distributed to the individuals down below. For example, this perception of power would state that the president has direct power over their citizens, dictating how and what they should value. However, Foucault argues that power is distributed within and through relationships. In thinking of politics, power can be enacted when two individuals discuss the use of food stamps and the values attached to the issue.

If a person argues that food stamps should not be given to lazy people, they are reinforcing power structures that promote individual choices and ignore structural barriers. Foucault (1978) explained:

The new methods of power are not ensured by right but by technique, not by law but by normalization, not by punishment but by controllable methods that are employed on all levels and in forms that go beyond the state and its apparatus (p. 68).

In Foucault’s argument, power is exhibited through normalization that states how a person should act and in turn, who they should be. Normalization functions not simply through law, but in monitoring people’s behaviors and disciplining them when they are

not behaving in the assumed correct way. In the example with the food stamps, food stamps are not currently forbidden by the law, but the discourse of those on food stamps being lazy disciplines those who are on food stamps by demeaning their character. By saying people who are on food stamps are lazy, any person, regardless of circumstance who utilizes food stamps is then considered lazy. The demeaning of a person’s character might be so extreme that a person will hide that they are on food stamps, refuse to use this governmental aide, or even perpetuate the harmful stereotype by repeating this same discourse. In this way, power is able to thrive through normalization by the public and not the law.

One way that power is distributed through interactions is through surveillance.

Surveillance is used to not only keep an eye on members of society, but also allows for any deviation to the status quo to be identified and then corrected (Foucault, 1977).

Through this system, bodies are meant to become knowable, controllable objects

(Foucault, 1977). The clinical space acts as the medium where bodies can become knowable. In the clinical space, providers deploy techniques of interrogation and examination (Foucault, 1973). The providers not only examine the bodies, but ask questions of the patients, with the purpose of the providers coming to know what is occurring within the bodies. The interaction between patient and provider is not based on those who do not know and those who do. Instead, “it is made up, as one entity, of those who unmask and those before whom one unmasks” (Foucault, 1973, p. 110). Patient and provider both communicate in a way that explores the patient’s health and illness. In a clinical setting, deviation can be corrected through interactions between patients and

healthcare providers (Foucault, 1977). Surveillance is conducted by recording and studying life and bodies in great detail. The exploration is still a function of surveillance as the provider can still correct for deviant behavior by stating what is and what is not illness.

Within surveillance, bodies need to be taken into consideration. Foucault defined an important concept that is related to the body, bio-power (Foucault, 1978). Bio-power is a disciplinary power that operates in the highest level of network of practices and discourse. The purpose of bio-power is to manipulate systems that influence the behavior of the population to maintain demographic norms. Through bio-power, medical experts

“label bodily states, behaviors, and desires, thereby opening up spaces for the deployment of expert knowledges in the service of ‘cure’” (Mamo, 2007, p. 11). When experts label bodies through their states, behaviors, and desires, they are deciding what is considered normal and what is considered deviant or abnormal. The “cure” is not an actual cure, but rather punishment of bodies who fall outside of what the expert has deemed normal.

Those who do not fit within normal categories are then targets of intervention through expert knowledge (Mamo, 2007). In the process of normalization individuals are then compared to one another and their attributes are examined to decide whether they fall within or outside the norm. If a person falls outside of the norm, they are then encouraged

(or coerced) into practices that place them within the norm (Lupton, 1999). Scientific monitoring and recording coincide with bio-power as monitoring is one of the tools to maintain those norms. Both surveillance and self-surveillance play a role in bio-power as bodies can be corrected by the observer and the observed.

Knowing that almost all the queer women will be in medical settings at some point in their pregnancy, understanding Foucault’s perspective on power within clinical settings is helpful within this dissertation. Queer individuals experience surveillance within medical settings and they can be surveilled throughout the pregnancy. Both the pregnant body and the queer body intersect in these moments and healthcare providers may be communicating their power through interactions that emphasize the expectation of heterosexual bodies. Therefore, Foucault’s theoretical perspectives act as a theoretical lens for the dissertation in understanding how power functions in clinical settings.

One population that undergoes extensive surveillance, both within and outside clinical settings, is pregnant women. A pregnant woman is constantly surrounded by a number of discourses and practices that are meant to surveil and regulate her body

(Lupton, 1999). These discourses could include the natural birth movement, breastfeeding discourses, and any other information that centers on the health of the pregnant mother and fetus. Cummin (2014) exemplifies this surveillance in her story of watching a pregnant woman grocery shopping. When the woman was grocery shopping, a stranger approached her and placed their hands on her belly asking if the unborn child was a boy or a girl. Cummins (2014) argued that this invasion of privacy was a form of surveillance that pregnant women endure. Her body is the subject of appraisal by the public. Lupton (1999) echoed this sentiment when she stated, “the more obviously pregnant a woman becomes, the more she is rendered the subject of others’ appraisal and advice” (p. 60). Furthermore, when discussing Foucault and governmentality, Lupton

(1999) stated that risk discourse, in relation to pregnancy, “can be linked to apparatuses

of ‘biopolitics’ in neo-liberal societies, efforts on the part of the state and other agencies to discipline and normalize citizens, to render them docile and productive bodies” (p. 61).

Even when risk is considered low for the pregnant woman, she is still expected to seek a high level of expert surveillance while also continuing to surveil herself (Lupton, 1999).

Queer pregnant individuals will not only be subjected to surveillance because of their pregnant status, but they will also be surveilled in that their queer identity places them outside of the norm.

Foucault’s conception of power can be seen through relationships that the queer couples have. In The History of Sexuality, Foucault (1978) discussed the communication of sex through discourses of power. He asked questions such as:

In a specific type of discourse on sex…. what were the most immediate, the most local power relations at work. How did they make possible these kinds of discourses, and conversely, how were these discourses used to support power relations? (p. 97).

Local power relations, or “local centers,” are the personal connections that individuals have that communicate dominant discourses. Foucault (1978) explained that figures, such as parents and religious leaders, can control the messages children hear about sex and, therefore, shape their knowledge. The relationship between parent and child are where the interactions of power occur. I would argue, that these messages can extend beyond childhood. Parents can still have messages for their children that shape their understanding, or are extended messages from their childhood. For queer individuals, parents can play an important role when discussing their future children. Parents may reinforce heterosexist messages about biological connections of childhood and the

performance of the family or, parents may help alter the discourse by accepting a different dynamic of the queer family.

Foucault’s conception of power and surveillance goes beyond just the clinic.

Within this dissertation, Foucault’s theoretical perspective serves as an overarching theoretical lens when looking at the communication of heterosexism from all types of relationships. The power relations in heterosexism may be communicated or challenged by healthcare providers, family members, work place relationships, and even amongst the queer couple. The dissertation focuses on the process of pregnancy and how heterosexism shapes the overall experience.

In an extension to this theoretical lens, Sara Ahmed’s work on happiness is relevant to this study. Ahmed’s work focuses on affect, particularly surrounding emotions and bodies. She explores how queer feelings are produced (Ahmed, 2013). Ahmed (2013) argues that queer bodies are given a false choice between assimilation and transformation. In considering false choices of assimilation, queer women then may not have a real option between following heteronormative expectations or resisting against them, as both actions can have negative consequences.

Ahmed (2010) also looked at happiness by not approaching the topic from what happiness is, but what happiness does. She explains, “I write from a position of skeptical belief in happiness as a technique for living well” (Ahmed, 2010, p. 2). Happiness is often constructed as something individuals obtain through living a good life. However,

Ahmed (2010) asserts that the typical construct of happiness is rarely obtainable for feminist or queer folk. It is a false choice between being queer and/or feminist and being

happy. When seeking happiness, there are moments when we end up gaining other people’s happiness, leaving our own feelings disregarded. The use of happiness often reinforces gender roles that benefit men (Ahmed, 2010). Furthermore, heteronormative scripts are made to be the ideal way of living, to achieve true happiness. Deviation from that script makes it so we cannot be happy. Ahmed (2010) explores how unhappiness is positioned as something that is caused by living a feminist life style. The narrative of unhappiness as being caused by feminist life styles designs a false choice meant to trap women into wanting to pursue a heteronormative life.

Through exploring how happiness is articulated by queer women by either themselves or people in their lives, I looked at how power dynamics can potentially present the queer women into false choices of happiness.

Chapter 3: Research Practices

I rub my eyes. Exhausted, I try to prepare myself for the next interview. My

back is sore from prolonged time in my office chair. In the background I

can hear a person cleaning the nearby offices. The night moves forward as

I wait to get the next Skype call. As the ringtone chimes on my computer, I

take a breath, put on a smile, and click accept.

Two hours later, we disconnect. I stare for a moment at my screen,

processing. They shared stories through both pain and laughter. Carefully,

I click out of the boxes, shut down my computer, and place the recorder

back in the drawer. My recorder full of memory. The time is now 10 p.m.

and the University is essentially closed. I grab for my phone as I type in my

wife’s contact. She is a source of unpacking and comfort as I make my way

to the dark parking deck. It is just another evening of exploration.

In deciding how I wanted to approach answering my research questions, I considered not only what I wanted to know, but how I wanted to know. To look at the experience of heterosexism within pregnancy, there were multiple angles to consider.

The best way to understand the queer pregnancy experience was to speak to queer couples who had recently been pregnant. To do this, I used qualitative, in-depth interviews. One of the reasons for using this method is to have a deep exploration into the topic with the ability to ask questions in real time and ask about follow-up topics that may emerge (Keyton, 2006). Furthermore, as the researcher, I do not have the ability to observe interactions with healthcare providers and related interactions in real time due to

clinic access and time constraints. Interviews allow for more inquiry into these interactions after the fact and allows me to ask questions that would not be possible during a real time observed interaction (Keyton, 2006).

Qualitative interviews provide a space for mutual discovery between interviewee and interviewer. The interviewee and interviewer can reflect on the experience in a way that both individuals learn from the process. In addition, interviews provide the opportunity for understanding, reflection, and explanation (Tracy, 2013). Through interviewing, I was able to try and process the queer women’s stories and answers by asking for clarifications, asking follow-up questions, and restating what I believed they were saying to me. Interviews are focused on the individual’s experience. These moments are used for participants to reflect on their perspective on a particular area of interest

(Lindlof & Taylor, 2011). In these moments of reflection, the participant and researcher are co-constructing meaning together (Ellingson, 2017). The interviewer provides knowledge through asking questions, listening to the responses, and processing the meaning being established.

In this section, I will elaborate on the research practices I employed. I will discuss the recruitment and interview process, describe the participants, outline the analysis process, and explore my queer embodiment throughout the project.

Recruitment and Interviews

To answer my research questions, I interviewed queer couples through a multiadic approach. A multiadic approach involves interviewing the couples together as well as separate interviews with each individual in the couple. Manning (2015) used multiadic

interviews where he would interview family members separately and then interview the family together using the same interview protocol. The purpose of this approach is to gather multiple discourses on a given topic (Manning, 2013). Having different discourses from family members allowed for Manning to recognize what discourses were shared between the family members as well as noticing those discourses that were being silenced or shunned (Manning, 2013). I modified Manning’s approach. Manning (2015) specifically stated that the same protocol was used for each interview. However, having separate protocols for the couple and individual interviews allowed for the highlighting of the birth parent’s and co parent’s unique perspectives on the pregnancy. To gain these different perspectives, there needed to be different questions. Yet, there were similarities between the interview protocols to look for the discourses that are being emphasized and those that may have been hidden.

Recruitment. One of the purposes of the dissertation is to be more inclusive in the understanding of queer pregnancies. Most of the current research is about lesbian pregnancies, leaving out other queer constructions of couples who can physically give birth. However, inclusivity comes with a challenge. Queer relationships are complex in how the people within the relationship identify. Therefore, the inclusion criteria for this study was broad yet constrained. Queer pregnant relationships were defined as romantic couples who identify as part of the LGBTQ community that became pregnant through non “traditional”/male-female penetrative sex (see appendix B for more detail).

Therefore, the couples who were included are those who may have to explain their ability to become pregnant, as this could not occur through what is considered normal means.

When a cross-sexed cisgender couple becomes pregnant, few people would ask, “so how did you become pregnant?” A queer couple, as defined in this study, would likely have to explain their pregnancy process as it would not naturally occur. With this language, queerness can be defined in multiple ways. A couple may have consisted of a lesbian woman and a trans man. Another couple may have been a bisexual woman with a gender fluid partner. Queerness emphasizes gender and/or sexual identity deviation from norms.

Therefore, having these inclusions provided a broader look into queer pregnancy experiences.

Beyond identity, I also narrowed the participant call to those couples who had a child three years old or younger at the time of the study. This choice was purposeful in that a three-year window would limit the couples to those who have recently gone through a pregnancy. In having a more recent experience, they were better able to recollect their stories compared to parents who may be further removed. In addition, with marriage equality only occurring four years ago, the ruling may have changed how individuals interact with queer couples through their pregnancy experiences.

Recruitment began after the approval of the IRB. In the recruitment, to counter any confusion of who could participate in this study, I sent interested participants a form to fill out that answered basic identity questions (see appendix A). This information was used in the study if they qualified. If they did not qualify, such as a gay male couple who conceived through surrogacy, they were sent a message thanking them for their interest but informing them that they do not meet the requirements for the study. In addition, having this information prior to starting the interviews alleviated awkward demographic

questions at the start of the interview. Having this process also allowed for another type of selection procedure that I did not anticipate. Upon posting my call, many people stated that they were interested in participating. However, once I sent them a form to complete, many ended up dropping out of the study. Knowing that the interviews would be a long process, I preferred having participants drop out at that point; if they felt they did not have time to fill out a form, they would not have time to complete the interviews.

Recruitment for the dissertation was conducted through one main space. A friend served as a key informant by inviting me to join a closed Facebook group called the

Queer Parents Network. Any individual wanting to join must complete a questionnaire asking about their gender and/or sexual identity and their reason for wanting to join the group. Wanting to be upfront with the group moderators, I explained that I identified as queer, but wanted to join the group for research purposes and shared my post with them for approval. They allowed me to join the group and I posted my participant call (see appendix B). Once I posted, I received a flood of requests to participate in the study and I did not feel the need to post in another group until I had managed all the current interest.

There was a time during the interviewing process where there was a lull in who was interested. At that point, I requested permission to post my call to another Facebook group, Family Pride Network of Central Ohio, based on a recommendation from a committee member. While other queer researchers and those conducting queer research often post within the Queer Ph.D. Network, I decided not to post within that group. I avoided that group because the members of that group would often spend more time interrogating the assumed flawed methodology of the studies posted than participating in

the studies. Instead of finding participants, the history of the group suggested that studies were simply just critiqued. Furthermore, studies that use the Queer Ph.D. Network often end up recruiting an over-educated group of participants, as only those who are pursuing or have their Ph.D. can join that group. Finally, I also posted my call for participants on my own Facebook page that was then shared by others.

The interviews. For the interviews, I preferred that they occur in person. In- person interviews allow for a deeper connection and I could pay more attention to the embodied responses of both the interviewees and myself (Ellingson, 2017). The use of video messaging and phone interviews also provide unique benefits including flexibility in scheduling, decreased costs, lack of geographical boundaries, and more privacy

(Drabble, Trocki, Salcedo, Walker, & Korcha, 2016). If the couple was located within driving distance, I requested that we conduct the interviews in person. Only one couple was close enough for in person interviews. I visited their home on two occasions, one for the couple interview and the second time was for the two individual interviews. In the cases that they were not within driving distance, the interviews were conducted via a video messaging service and in some cases, they occurred over the phone when the technology was not available or if it was the preference of the interviewee.

I tested out my interview protocols with the first couple. By having an initial test of the protocol, I was able to see if there were any practical issues with the protocol

(Majid, Othman, Mohamad, Lim, & Yusof, 2017). Once the couple interview was complete, I asked the first couple if they felt that there were any questions that they had a hard time understanding or if something was missing. They stated that they felt the

questions encapsulated their experiences and they were never confused. Because the test was successful, I employed this interview guide for all remaining interviews.

The remaining interviews were conducted in three steps. The first interview that occurred was the couple interview. The couple interview was first so that they could start sharing their story together. Then, when they were interviewed separately, they could revisit the shared narrative to state if that is how they felt or if there were deviations to that story. The first interview questions focused on the story of how they came together as a couple. By starting with this story, the couples were eased into the interview by starting with a collective narrative that brought them together. Next, I moved into topics on pregnancy and birth communication. These questions focused on choices made before and during the pregnancy and birth process as well as other forms of health communication that occurred. Another set of questions looked at support they received during the pregnancy. Support is explored through the couple’s support of each other but also how other people in their life, including friends, family and coworkers, supported them (or failed to support them). Finally, I asked questions about how they viewed their pregnancy in comparison to straight/cis couples. During the entire interview, I also asked clarification questions and additional questions that were based on their answers. I attended to how heterosexism was communicated or how there may have been countering heterosexist messages. The full couple protocol appears in appendix C.

At the end of the couple interview, I asked that the couples send me a follow up email with times and dates they were available for the second interviews. Due to their busy schedules, most ended up needing reminding and we then selected times and dates.

Also, because my interviewees were parents of young children, there were times where we would have to reschedule. I requested that they find a quiet, private space for their individual interviews. Most followed the instruction, but a few chose to interview even if their partner was nearby. The protocols for both parents were identical except that I asked the co-parent their preferred term for their parental role. The protocols centered around the same topics as the joint interview, with a focus on their individual perspective.

Asking these same questions allowed me to see if they repeated the experiences mentioned in the initial interview or if they deviated from what was already stated. The multiadic approach is meant to consider what discourses are shared and which are being silenced. The birth and co-parent protocols can be found in Appendix D.

The interviews occurred in September and October of 2018. Interviews were audio recorded and uploaded onto a private, secure computer. Once they were uploaded, the audio files were deleted from the recorder. A total of 63 hours of interviewing were recorded. Couple interviews lasted between 89 and 148 minutes (M = 118.5). The individual interviews lasted between 44 and 78 minutes (M = 61). After both individual interviews were completed, I sent the couple a check for $25 dollars to compensate them for their time. The money came from a scholarship that I received for this dissertation.

All the names listed in the dissertation are pseudonyms to protect the anonymity of the participants.

Participants

Initially, 35 couples expressed interest in the study. After submitting demographic information and setting up times for interviews, sixteen couples participated. Fourteen

couples fully completed the three interviews. Two individuals from two different couples did not partake in their individual interviews. The data is comprised of these 48 total interviews.

As a researcher, I believe that a person’s identities are relevant to how they understood their experiences. Rather than providing a traditional list of the demographic break down of the participants, I decided to provide a description of each couple so that they can be attached to the stories that they share. Participants self-identified their characteristics. A compilation of the demographic information can be found in appendix

Couple 1: Sophia and Ava met in college and have been together for eleven years. Ava, the co-mother, is 30 years old, white, and a lesbian. Sophia, the birth mother, is 32 years old, Hispanic, and bisexual. While Ava already has her master’s degree and is an accountant, Sophia is currently going to school for her master’s. They reside in Texas.

Married in 2012, Sophia and Ava had a boy, David, who was 16 months old at the time of the interview. To conceive their son, they went to a fertility clinic using an anonymous donor from a sperm bank. Sophia was pregnant on her first attempt. For their prenatal care, they decided to use an ob-gyn and hired a doula. During the birth, Sophia ended up having a c-section. David also had to spend time in the NICU after he was born. At the time of the interview, Sophia was trying to get pregnant with their second child.

Couple 2: Elisa and Faith met online and have been together for 10 years, married for five. Both Elisa, the birth mother, and Faith, the co-mother are 34 years old,

Caucasian, and lesbian. They also both have their master’s degree. Faith is a social

worker and Elisa is a special education teacher. Although Chloe, their daughter, was born in Illinois, they have since moved to Michigan. Using a fertility clinic, they ended up conceiving with an anonymous donor through IVF after a year of attempting to become pregnant. For their prenatal care they chose midwives and hired a doula. However, after a long labor, Elisa gave birth using a c-section. Chloe was fourteen months old at the time of the interview.

Couple 3: Caroline and Maggie met each other while Caroline was in graduate school, have been together for eight years, and are currently married. Maggie, the co- mother, is 37 years old, Caucasian and queer. Caroline, the birth mother, is 36 years old,

Caucasian and lesbian. They currently live in New York State. Caroline, who has a Ph.D. in clinical psychology works in a hospital. Maggie has a bachelor’s degree and works in content marketing. Their daughter Lydia, who was four months old at the time of the interview, was conceived at a fertility clinic using an anonymous sperm donor. Caroline was pregnant on the second try. For their prenatal care, they decided to use an ob-gyn and hired a doula. Lydia was born through a c-section.

Couple 4: Megan and Lynn met in college at a rugby social and have been together for four years. They were married soon after their daughter, Jamie, who was fourteen months at the time of the interview, was born. Lynn, the birth mother, is 34 years old, Caucasian, and lesbian. Megan, the co-mother, is 28 years old, Caucasian, and homosexual. Although Jamie was born in Arizona, they care currently living in

Michigan. Megan has her bachelor’s degree and works as a fleet manager. Lynn has her master’s degree and is a first-grade teacher. Jamie was conceived at a fertility clinic using

an anonymous donor and was conceived on the second try. For their prenatal care they decided to use an ob-gyn. Jamie was born through a vaginal delivery with induction.

Megan is considering carrying their next child in the near future.

Couple 5: Martha and Karen knew each other in high school, but got together after meeting at a bar. They have been together for eleven years and married for four.

Karen, the co-mother, is 38 years old, white, and lesbian. Martha, the birth mother, is 39 years old, white, and lesbian. They are living in New York State and currently have two children Mason and Tyler. At the time of the interview, Tyler was just two weeks old.

Karen has her bachelor’s degree and works in insurance. Martha has her master’s degree and is a director of social work. Mason was conceived on the sixth try using an anonymous sperm donor. Tyler was conceived on the fourth try using the same donor.

Both were conceived with help from a reproductive specialist. For their prenatal care, they used an ob-gyn. Both children were born via c-section.

Couple 6: Edyth and Laura met online and have been together for sixteen years, married for four. Laura, the birth mother, is 34 years old, white, and lesbian. Edyth, the co-mother, is 46 years old, white, and lesbian. They are currently living in Illinois where they both work. Laura has her master’s degree and is a reference librarian. Edyth has her doctorate and is a professor. They had triplet boys, Aiden, William, and Owen, who were two and a half years old at the time of the interview. The boys were conceived in their ob-gyn’s office using Intrauterine Insemination (IUI), not Invitro Feralization (IVF), and

Laura was pregnant on the first try using an anonymous donor. Because of the triplet pregnancy, they had to transfer out of their ob-gyn’s office to a high-risk specialty

hospital where the boys were born via c-section. After they were born, the boys had to spend time in the NICU.

Couple 7: Sydney and Amber met through Match.com. They have been together for nine years and are currently married. Amber is 33 years old, Caucasian, and gay.

Sydney is 35 years old, Caucasian and gay. Both women have carried their children, and both had a doula to assist with their pregnancies and birth. Sydney gave birth to their older daughter, Amelia. She attempted to conceive seven total times using a known donor, five at a sperm bank and two at home. Sydney chose to use a midwife for her prenatal care and vaginally gave birth. After she was born, Amelia had to spend time in the NICU. Amber had their son Erick, who was 18 months at the time of the interview.

She chose to inseminate with the same donor at home using a midwife. He was conceived on the third attempt. Amber chose to use an ob-gyn for her prenatal care. Erick was born via a c-section.

Couple 8: Rachel and Natalie met on OkCupid, have been together for eight years, and married for three. Natalie, the co-mother, is 35 years old, white, and lesbian.

Rachel, the birth mother, is 31 years old, white, and lesbian. They currently live in

Georgia. Natalie has a law degree and is a lawyer. Rachel has her master’s degree and is a homemaker. Their daughter, Hope, was 2 years old at the time of the interview. They decided to conceive at home using a known donor and were successful on the second try.

For their prenatal care, they decided to use a midwifery group. Hope was vaginally born.

Rachel was pregnant with their second child at the time of the interview.

Couple 9: Heather and Jamie have been together since 2006. They met in the late

1990s through mutual friends and were married in 2010. Jamie, birth mother to Riley, is

38 years old, white, and lesbian. Heather, birth mother to Joshua, is 42 years old, white, and lesbian. Their interviews were conducted in their home in Ohio. Jamie has her bachelor’s degree and works as a cyber security analyst. Heather has her master’s degree and has her own private psychotherapy practice. Although both women carried children, the original plan was for Heather to carry their first child. However, she struggled with infertility for seven years. During this struggle, Jamie decided to carry their first child,

Riley, who was two years old at the time of the interview. To conceive, they used a known donor from knowndonorregistry.org and inseminated at home. Jamie used an ob- gyn for her prenatal care and Riley was vaginally born. Once Jamie had their first child,

Heather started trying again. Originally, Heather attempted to conceive using IUI, but after 33 unsuccessful attempts, she decided to use the same donor as Jamie and inseminate at home. She was successful with Joshua, who was 11 months old at the time of the interview. For her prenatal care, Heather used the same ob-gyn as Jamie. Joshua was born via c-section.

Couple 10: Bridget and Joanna have been together for eight years and met while they were attending the same university. They were married while Joanna was pregnant with their daughter Lily. Joanna is 34 years old, Caucasian, and lesbian. Bridget is 32 years old, Caucasian and lesbian. They are currently living in Ohio. Joanna has her

Doctor of Osteopathic Medicine and Doctor of Pharmacy degrees and is a physician.

Bridget has her master’s and is an operations and events manager in the athletic

department at a university. Joanna became pregnant on her second attempt using an anonymous donor at a fertility specialist. She used an ob-gyn for her prenatal care and

Lily was vaginally born. Lily had to spend time in the NICU after her birth.

Couple 11: Danna and Jackie met at a music festival and have been together for seven years, married for six. Jackie, the co-mother, is 40 years old, Caucasian, and lesbian. Danna, the birth mother, is 45 years old, Caucasian and lesbian. They currently have two children, Easton who was almost four years old and Greyson who was a year and a half. At the time of the interview, Danna was pregnant with their third child. Jackie had some college and is a stay at home mom. Danna has her PhD and is a psychologist.

Easton was conceived using Danna’s eggs and the other two were conceived using

Jackie’s eggs through IVF. They originally started trying with a known donor but then used an anonymous donor at a fertility clinic. For the first two pregnancies, Danna used midwives for her prenatal care. In this recent pregnancy, she still used midwives but participated in Centering, a type of prenatal care. Both children were born vaginally.

Danna completed both interviews, but Jackie did not participate in the individual interview.

Couple 12: Grace and Brittany met online, have been together for eight years, married for three. Brittany, the birth mother, is 38 years old, white, and queer. Grace, the co-mother, is 34 years old, white, and queer. They currently live in Washington state.

Brittany has her master’s degree and is a global health program specialist. Grace has her master’s degree and is a mental health therapist. Their daughter, Eira, was 11 months at the time of the interview. Although Brittany carried Eira, they are considering having

another child with Grace as the birth mother. They used an anonymous donor and inseminated at home with the assistance of a midwife. Eira was conceived on the second attempt. Brittany started with midwives for her prenatal care but had to be transferred to an ob-gyn due to health complications. They also hired a doula. Brittany was induced early due to health complications and Eira was vaginally born.

Couple 13: Peggy and Tiffany met at the Fire Department where they both worked. They have been together for 14 years and married for five. Peggy, the birth mother, is 35 years old, Caucasian, and lesbian. Tiffany, the co-mother, is 37 years old,

Caucasian, and lesbian. They live in Kentucky with their son Michael, who was 18 months at the time of the interview. Tiffany has her master’s degree and is an instructional coach. Peggy has her master’s degree and is a stay at home mom. They used an anonymous donor and inseminated using a reproductive endocrinologist. Although

Peggy was pregnant on the first try, it resulted in a miscarriage. After taking a break she tried again and was successful on the second attempt. For her prenatal care she saw an ob-gyn. Due to health complications, Peggy was induced; the induction did not work and

Michael was born via c-section. Michael had to spend time in the NICU after he was born.

Couple 14: Christie and Erin met online and have been together for nine years, married for two. Erin, the co-mother is 35 years old, white, and lesbian. Christie, the birth mother, is 28 years old, Latina, and lesbian. They live in Arizona with their daughter

Mackenzie and foster children. They both have some college experience and work at the same restaurant as managers. At first, the women attempted to adopt a baby through the

foster care system. However, the birth mother reclaimed the child. Although they still care for children in foster care, they decided to give birth to a child. They decided to inseminate using the co-mother’s brother as their sperm donor, to create a biological connection to both mothers. Mackenzie was conceived at home on the second try. For prenatal care they chose to see midwives through the Centering program. Mackenzie was born vaginally through induction. Erin did not complete her individual interview.

Couple 15: Carmen and Hilary met in graduate school and have been together for five years. Hilary, the co-mother, is 34 years old, Caucasian, and queer. Carmen, the birth mother, is 30 years old, Caucasian and African American, and lesbian. Their daughter

Cassandra was born in Illinois where they lived and have since moved to Oregon after

Hilary was offered a job. Hilary has a dual master’s degree and is a public health researcher. Carmen has her master’s degree and is a stay at home mom. On the first try,

Carmen was pregnant. Cassandra was conceived at a fertility clinic using an anonymous donor. For the prenatal care, they saw midwives and participated in Centering. They also hired a Doula. Cassandra was born vaginally after 52 hours of labor.

Couple 16: Ragan and Olivia met at their workplace and have been together for ten years. Olivia, birth mother to Delighla, is 41 years old, Caucasian, and lesbian.

Ragan, birth mother to Skylar, is 33 years old, Caucasian, and lesbian. Delighla was born in Michigan and was three years old at the time of the interview. Skylar was born in

Montana, where they currently live, and was seven months old. Olivia has her associate degree and is a respiratory therapist. Ragan has her doctorate and is an optometrist.

Because neither woman had a desire to carry, they decided to take turns. Due to age,

Olivia went first and tried for two years, a total of eleven times at a fertility clinic. She started with one anonymous donor and ended up switching to another. For her prenatal care, she saw an ob-gyn. Delighla was born via c-section. It took four tries for Ragan to become pregnant using the same sperm donor as Delighla at a reproductive endocrinologist’s office. She also used an ob-gyn for her prenatal care. Skylar was vaginally born.

Queer Embodiment

As a researcher, I cannot separate myself from my work. Specifically, my queer identity played an important role for accessing my participants. I was able to enter the

Queer Parents Network on Facebook for one major reason: I was queer. To secure and provide a safe haven for queer parents, administrators of the group provide questions to new members, including: who are you and what do you want with this group? I proclaimed that I was queer, childless, but looking for participants. They kindly obliged, but I knew my straight colleagues would have been barred. Queerness was important here. While my straight cis friends may feel bewildered by a desire to have queer people research other queer people, to me, and I assume many others, it is important. A shared queer identity provides a safety net. Queer people are less likely to ask harmful questions of other queer people. In addition, there is a presumption of some shared experience.

My queer body provided comfort for me too. Traversing rural and isolated areas my entire gay life, I have often been the lone gay person in a room. Perhaps, one or two would join me. Typically, I was the only visible one. I remember a stark moment at a conference where I realized I was the only visible queer body, a clear misfit. When

engaging in interviews for this project, I was able to talk with queer women. I was not talking with just queer white men who vaguely understood my experiences, but queer women, who sometimes even looked like me: a gender queer. For the first time in my life

I felt a sense of community. I understood these experiences. We laughed and even shared some tears. I was also being guided by other queer women, whom I felt I could look up to. Academia rarely provides these opportunities as visible queer women are scarce, and therefore often hard to find.

Yet my queer body also presented a challenge. Because I was a queer woman embarking on a project about pregnancy, it was assumed that I had given birth myself, had planned to give birth, or intended to do so soon. The shared identity of queer, but a divergent identity of childlessness created a mismatch in experiences. I shared the sentiment of Chawla (2008) when she stated, “I experienced my participants as comrades, as uncomfortable strangers, and as comfortable strangers” (p.3). The comfort was our shared identity; the moments of discomfort came when they inquired about my family.

When asking what questions my participants had at the end of the interview, they would consistently ask if I had or was planning on having children. The imposition of children onto me was one with which I was deeply uncomfortable, as I felt oppression from both a sexist and heterosexist society weighing on me. Our heteronormative cultural framework provides a clear story line of dating, marriage, house, babies. Sexism tells me that my duty as a person with a uterus is to bear children.

Queer women imposing this expectation onto me was a shock, although it maybe should not have been. It is not uncommon, as Grace pointed out, for researchers to study

their own experiences. Naturally, I must have seemed interested because I shared the experience, or very least, the desire to have children. When explaining to my participants that my wife and I were currently not planning on having children, and if we did, we would go through foster care, I was met with some almost affronted responses. Many simply acknowledged my statement without too much interest. A few, encouraged our goal of fostering, stating that families come in all forms. Some others told me that I should decide soon because being an old parent was hard. These reactions almost dispelled feelings of community, as I was no longer a part of their particular experiences.

An absence of children cast me out of my own little queer parents’ group. There was now an affective divide between me and my participants. We no longer shared a true sense of community. While I mostly look on this experience with fondness, I have come to wonder how my participants felt after discovering my childless existence. I feared that they were then wary about what I would write; what I would think; if I would judge. I was an insider and outsider (Barton, 2011).

To be fair to my participants, I have also imposed my own feelings onto their experience. As someone who does not wish to bear children, I have found myself casting a negative film over their stories. In these moments I was facing my own ethical “double- blinds” (Barton, 2011). I wanted to know their stories but felt myself placing them into an unfavorable light, doing a feminist double act where I checked their behaviors but had to balance my own negative thoughts about them as participants. As a feminist, I believed that no woman should have to become pregnant to inhabit a feminine body. Yet, judging women for their thoughts and experiences was just as problematic. In these moments, I

fought myself to take a step back and to listen. I needed to reflect on the larger picture.

There is no one way to live life, especially a queer life. Queer individuals should not be expected to have children or to not have children. We should be able to live our own lives as we see fit. Therefore, in this project, I echo a sentiment taught to me by a professor: do not critique the individual, critique the larger power systems that shape our perspectives and opportunities.

I am beyond grateful to the women with whom I worked. In the inner battle of perspective shifting, I will never forget the sacrifice they have made to me. In their sleep deprivation and limited hours that come with having young children, they chose to talk with me. To share their stories. I am forever lucky to be able to hear their narratives of creating their children and the balancing of understanding their experiences while navigating a heterosexist world. Although they were financially compensated, I will never feel that I will truly be able to give back to them what they have given to me.

Analysis

I agree with Ellingson (2017) when she argued that data analysis is an embodied practice. Throughout the research I was actively in my data, whether it was the act of the interviews where my body was attempting to be in the moment, engaged with my participants, or the moments of transcription where I repeatedly listened to the voices. I was even engaged in a form of embodiment when I was buried in the completed written transcripts, combing over the written words.

Throughout the interviews and until March of 2019, I transcribed the interviews.

Transcription can take a lot of time and sending transcriptions out to services can cost a

lot of money. Due to the amount of data collected, I decided to use the help of an automated transcription service, Temi. Temi was a bot service that downloaded interviews and produced the transcripts in 10 minutes. However, because it was an automated service, the transcripts were never correct and the recordings had to be compared to the transcripts to identify and correct errors. The service was perfect for my need because it saved me time but also provided opportunities to be embedded in the transcripts when reviewing and listening for errors. Through immersion in the interviews through listening and transcription, I was able to “absorb and marinate in the data”

(Tracy, 2013, p. 188). After the transcripts were completed, there was a total of 1,195 single-spaced pages of text.

When conducting the interviews, transcribing, and listening to the interviews, I was also actively engaged in the analysis process. Tracy (2013) explained how part of the analysis process includes taking notes of moments that stick out to the researcher. I wrote notes, such as head notes, as I went through the process. These notes were on sticky pads, my phone, or a word document on my computer. The research process does not start and end in an office space, and I had many thoughts throughout the day.

Once all transcripts were completed, I read through my scratch notes, sensitizing myself to the data. After placing the scratch notes aside, I read through the data in its entirety. While reading through the data, I created separate notes. Those notes were then organized into two main themes. Once the two themes were established, I went back through the transcripts using descriptive coding (Saldana, 2016). Descriptive coding allowed for more detail to describe what was occurring in the transcripts and how these

details might represent the larger themes. In this round of analysis, I also engaged in secondary-cycle coding where I critically examined the original themes to synthesize and categorize them into more distinct themes (Tracy, 2013). Those themes then were divided into two separate chapters. Finally, the analysis continued in the writing process. Tracy

(2013) asserted, “qualitative researchers find meaning by writing the meaning into being”

(p. 275). The act of writing formed new arguments and connected the sub themes further, creating the final product.

Part of the analysis was to explore how dominant ideologies were represented in the discourses. In seeking these dominant ideologies, I engaged in critical analysis that went beyond descriptions (Covarrubias, 2008). Through a critical analysis, I was able to explore, “the interrelationships between interview discourses, social practices, power relations, and ideologies” (Lawless & Yea-Wen, 2019, p. 92). Part of critical analysis requires that researchers examine how the everyday discourses both enable and constrain dominant ideologies, power relations, and social systems (Lawless & Yea-Wen, 2019).

Furthermore, critical analysis explores both the macro and micro level discourses, practices and systems that can intersect and reproduce oppression (Lawless & Yea-Wen,

2019). The purpose of pursuing critical analysis is to reveal both the subtle and explicit ways that discourse is “embedded with the structures that provider material and symbolic privileges to some people, often at the expense of others” (Covarrubias, 2008, p. 234).

When using a critical analysis in the dissertation, I went beyond mere textual analysis of the transcripts, but incorporated embodiment of the participants and how they responded to both myself and their partners. In addition, the analysis was more than just

overt labeling of heterosexist moments that participants identified, but also the subtler practices of heterosexism that were not identified by the participants explicitly.

Covarrubias (2008) noted that in their analysis, that just exploring overt prejudice does not account for the multiple ways that racism functions. Lawless and Yea-wen (2019) explained that when they were coding their data, they paid attention to how their participants expressed dominant ideologies as part of their analysis. Therefore, my critical analysis of these interviews highlights not only how heterosexism influenced the healthcare and family interactions of the participants, but also examines how the participants may have exerted heterosexist perspectives as being part of power systems.

The two chapters of analysis explore how heterosexism was enacted and resisted within healthcare spaces and societal communication from the macro level to the micro level.

These chapters move beyond interpretive descriptions of what the queer women experienced and incorporated how power functions to affirm heterosexism.

Chapter 4: “Visible in a Birth Space,” Heterosexism in Birth Related Healthcare

Standing in line at Starbucks, my wife and I groggily wait to place our

orders. Spending a day on campus where we might have otherwise been

working from home, we are grumpy and in desperate need for caffeine.

After we are called up and have placed our order, the barista inquires as to

what name we wanted on our coffee. My wife and I look at each other and

we use her name. The barista replies, “Well, I’m never sure when friends

are ordering.” We give her a casual nod and walk over to wait in the pick-

up space. I sigh at my wife, giving her a look which she automatically

knows. My wife says, “I know. It’s too early to deal with

microaggressions.” We stand and wait for our coffee as I contemplate how

our exhaustion and lack of correction has contributed to heterosexism.

Knowing that heterosexism exists and directly confronting the individual experiences of heterosexism are two different things. On a fundamental level, I know why heterosexism surrounds my daily life. Yet, there are times when I am too tired to speak up. Too exhausted to care. Too many other things to deal with. It would be easier to not think about the myriad of ways that society promotes heterosexuality and erases queerness. The queer women who participated in the study echoed this sentiment. The everyday life of being a parent and going about the world made it difficult to reflect on how the world is designed for heterosexuals. In this chapter, I focused on the ways in which the queer women in this study balanced a tension between recognizing how heterosexism functions in healthcare and their simultaneous dismissal of heterosexist

treatment. The healthcare analysis focused on the tensions of politics, dismissal and visibility, patient-provider communication, heterosexism beyond providers, and suggestions for the improvement of care.

Tension of Politics, Dismissal, and Visibility

When discussing their healthcare experiences, the queer women in this study moved between two main ideas: they were at risk for discrimination or had the potential to experience heterosexism and that discriminatory behaviors would not happen to them.

In my critical analysis, there seemed to be three contributing factors. First, the queer women had an abundance of fear surrounding President Donald Trump and a shift in politics. That is, the queer women believed we were in a new (yet not so new) political moment in which heterosexism and open discrimination against queer people was becoming acceptable again. Second, several of the queer women thought that heterosexism and/or homophobia existed, but believed they themselves did not encounter any issues, even if they had. They used stories from other queer folk as a way to distance themselves from heterosexism. Third, a few queer women believed that heterosexism and homophobia was a past issue, and if there was a heterosexist moment, queer people should not have negative reactions. Finally, some of the queer women acknowledged that a medical space could promote queer visibility, leaving them potentially vulnerable. The combination of political fear, othered stories, dismissal, and visibility functioned in a push and pull narrative of healthcare experiences.

Political fear. Trump’s election created fear among many of the couples and caused them to contemplate what political rights they may have currently, and which

might be taken away. When discussing Trump and the current political climate, several of the queer women discussed how they were at risk for discrimination based on their queer identity. Peggy (see pages 71-79 for couple descriptions) worried about not only living in

Kentucky, a Republican state, but also how national politics could strip her of her rights.

She explained, “I wonder every single day am I going to suddenly wake up tomorrow and

Trump’s going to make it so I’m suddenly not married anymore?” While she was in that moment, talking largely about her general rights that included marriage and parental rights, Peggy then moved into what could happen in a healthcare setting. She stated,

“medical professionals take the oath to do no harm. But I know there’s people that go into medicine, but they have a bias… I feel they shouldn’t take on those kinds of patients, but I feel some of them do.” Peggy articulated that although medical providers are supposed to do no harm to patients, she felt that potentially homophobic providers still treated queer patients. In this belief, she then feared that medical providers may end up mistreating or discriminating against those queer individuals. Peggy’s uncertainty about her position in the political climate was also reflected in her fear about how healthcare providers with similar viewpoints could be the one to provide care for her or her family, creating a thought of potential discrimination.

While Peggy connected the dots to how healthcare is connected to the political climate, other individuals would sprinkle in commentary on politics. For example, Karen talked about feeling the need to go through second parent adoption. Karen explained,

“This political climate, we wanted to make sure that I was covered.” Due to Karen’s fear of her parental rights and marriage coming into question, she wanted to go through the

second parent adoption process. In addition, Grace noted how discrimination for queer people still existed, “It’s like people think Obama fixed racism, which is not true… And like now gay people can get married, so like nothing bad will ever happen to them. And like, also not true.” Grace was explaining how there is a perception that marriage equality erased the potential for discrimination for queer people, but many rights, such as a right to not be denied healthcare, to not be evicted for being queer, to not be fired for a queer identity, and so on, are still at risk or not guaranteed. Many couples were aware that their rights were not solidified because of marriage equality and that the political landscape was murky, at best, for queer folk.

Othered stories. Beyond general fear of discrimination due to the political landscape, several couples shared horror stories they had heard from the news or from others about queer couples’ experiences surrounding healthcare. Sophia and Ava stated they were often nervous about living in Texas and shared a few concerning news stories about being queer. When reflecting upon their first encounter with a pediatrician, Sophia recalled a news article she had read:

Sophia: Shortly after David was born, there was an article about the pediatrician who had met with the lesbian couple before they were born… she [the pediatrician] had like religious convictions that made her feel like she wouldn’t be able to provide care for their child and that was. Ava: And that was at the two-day appointment that she told them that, well she didn’t even have the balls to tell him like, she had one of the other doctors tell them… Sophia: That would completely have gutted us and so I feel like in terms of choosing both our pediatrician and our OB we went into it um, I think potentially a little bit more, it worked out and they were both fantastic, but we went into it with a little bit more, less skepticism than maybe we potentially should have after reading the article. It scared me.

Although Sophia noted that their providers were “both fantastic,” she and Ava still remembered the news story. Sophia explained that they went into the second day appointment with “less skepticism” than they maybe should have. Her explanation of not being as skeptical about potential discrimination highlighted her residual fear about how heterosexism and homophobia could impact her family.

News stories were not the only tales that were recounted in their interviews. Some of the couples spoke of hearing from other queer couples they had known interpersonally or through the Queer Parents group. In Ava’s individual interview, she explained how she had witnessed other co-parent stories that did not have a positive outcome: “I read a lot of stories about the doctor only making eye contact with the birth mom or continually asking who this person is… Like none of that happened for me.” Faith shared a similar story, “On some of the Facebook boards, people had a lot of problems with our fertility clinic and I never was treated any differently.” In these moments, the stories were used by the queer women as an othered experience. In an othered experience, the queer women positioned themselves outside of the queer stories, creating a divide between themselves and queer narratives. They were not like those other people; they had positive experiences. Through the sharing of narratives, both theirs and the othered, participants distanced themselves from queer stories and experiences. However, I have listened to their experiences and both Ava and Faith did have heterosexist and potentially discriminatory interactions, but when sharing others’ stories, they did not believe that was the case.

Heterosexist dismissal. While some couples recognized the heterosexism or discrimination they did encounter within the healthcare system, others were more likely to simply dismiss those encounters. Bridget waffled back and forth when reflecting on her experiences with medical care providers when her wife was pregnant and giving birth. When Bridget would bring up a moment of uncertainty or discomfort surrounding an interaction, she would then provide a justification or hesitation on whether it occurred.

For example, Bridget explained in her individual interview, “The thing that probably irritated me some was the fact that some nurses would only, during their comments when they were talking to just Joanna where I was kind of sitting there like, alright, you know,

I’m here too.” But then Bridget immediately went onto say, “But also she is the one giving birth, so I didn’t take too much stock in that.” Bridget voiced the feeling of dismissal during the healthcare interactions by being forgotten in the room throughout her interview and the couple interview. Yet, she would often couch those experiences and would not claim it as a moment of heterosexist treatment.

Bridget was not the only participant to grapple with their experiences while simultaneously dismissing them. For example, Maggie was very frustrated by how information from a provider was being presented in a heterosexist way that emphasized having a mother and father involved in the birth of a child. While she was processing her feelings to me in the individual interview, she would go back and forth between indignation and stating how it does not upset her personally, although her communication suggested otherwise. Maggie stated:

It was just annoying. Like why are you, like first of all, why have you not learned this? Because you’ve done this to other people who might be like, it might affect

more. Like, we’re kind of over it. Like, it does not hurt me, it’s just annoying. But it could hurt, it could really make other people uncomfortable and prevent them from accessing different resources. And just, why are you, why do you have to buy into this framework that clearly we don’t need?

Her narrative was conversational whiplash. It moved back and forth between a negative emotion and one of acceptance and dismissal. Her tone indicated she was upset, and her body language tightened. When she moved into the, “it does not hurt me,” her tone and body relaxed. Yet, when she said, “why are you,” her tone reverted to indicate she was upset to the point where she tripped over her words. To sit in those moments of negative feelings, to reflect on how their care might have been annoying or uncomfortable also creates discomfort. If I had dwelled on the coffee exchange for too long I would have become increasingly upset. Instead, I could move on and leave the negative emotions behind. By Bridget and Maggie moving to a place of acceptance or dismissal, they may have been attempting to just not feel a negative emotion.

Several of the queer women seemed hesitant to state that they encountered heterosexism in their experiences with healthcare providers. The inability to name their potentially discriminatory or heterosexist experiences and projecting more positive ones can be a way in which power is reinforced. Foucault (1978) articulated that one way to exert power is to have the subjugated be unable to name their own subjugation. He asserted, “in order to gain mastery over it, in reality, it had first been necessary to subjugate it at the level of language, control its free circulation in speech” (Foucault,

1978, p. 17). Taking the name out from language, to create a hesitancy to name the act, can create further control over a population. If queer women fear calling out discrimination or heterosexism for what it is, those in power, such as those who are in the

healthcare system, can continue to perpetuate heterosexist treatment of patients. This is not to say that the queer women are actively choosing to consent to their own discrimination or heterosexist treatment, but power exists in a way that becomes imbedded into our daily actions. Foucault (1980) argued that mechanisms of power get to a point where “power reaches in the very grain of individuals, touches their bodies and inserts itself into their actions and attitudes” (p. 39). Heterosexism is a part of our general attitudes and everyday lives. Even queer folk can end up participating in heterosexism because its power is so engrained within daily discourse.

Dismissal or acceptance of heterosexism was not the only coping mechanism that participants used. Others felt that queer folk should not be upset or express anger at encountering heterosexism. Edyth simply stated in her individual interview, “Don’t take things personally.” Edyth expressed that queer people should not be upset by any heterosexism they encounter. Perhaps, Edyth thought about the larger discriminatory acts that can happen, such as being denied care. Anything less than that was not worthy of negative attention. Heterosexist remarks were just simple mistakes. However, when taking this approach, other queer folk then may not feel they can voice their feelings of invisibility when providers only speak to the birth mother, when they are not included on medical forms, or other heterosexist acts that take place in medical care. By not allowing queer folk to “take things personally” they are then not allowed space to reflect on how heterosexism positions them outside of society.

A few couples felt that being offended by heterosexism was in itself, a negative reaction. When talking about discrimination or heterosexism that they had either faced,

could have faced, or heard of, Erin and Christie were quick to say that they were not one of those who are easily offended:

Christie: We’re not easily offended. It’s not like we’re like oh! Oh dear, you used the term husband or man or whatever it’s like. Erin: We have a friend that is. Christie: Yeah, we have friends that are and it’s just kind of like, no. Erin: I got other things to worry about.

Christie and Erin could indeed have other issues in their life that are more pressing and worthier of their intention. They may occupy other marginalized identities that are more salient. However, they were also making fun of their friends who would be upset about being faced with heterosexism. To make fun of queer folk who would be upset by heterosexism is a co-cultural response rooted in aggressive assimilation called ridiculing self (Orbe & Roberts, 2012). When making fun of those who are upset by heterosexist actions, they are then, potentially perpetuating the idea that heterosexism is okay.

Assuming there should be a mom and a dad is acceptable to Christie and Erin because to be upset about the notion was not something a person should feel. This reaction may perpetuate heterosexism because it frames speaking out against heterosexism as worse than a person being heterosexist.

Of course, there were a few queer women who did not believe discrimination even existed for queer couples in a healthcare setting. For example, as Ragan stated in her individual interview, “It’s hard for me to even imagine other people out there having bad experiences.” Although Ragan and her wife did experience instances of discrimination, just not by their primary provider, Ragan could not fathom someone ever being discriminated against in a medical setting. Ragan’s positive experiences with her provider

could be the reason for her belief that there was no discrimination or heterosexism within healthcare. However, Ragan also missed moments in her and her wife’s stories that were indeed discriminatory, as their conception of their children cost significantly more than their heterosexual counterparts. The belief in a lack of discrimination or heterosexism can be beneficial, as the belief can push aside negative emotions or potential fear in future healthcare encounters.

How queer women have understood their heterosexist healthcare experiences has been discussed in previous research. Other research found that queer individuals have compared their experiences to other queer folk (Cherguit et al., 2013). However, in

Cherguit and colleagues’ (2013) study, they found that queer women anticipated discrimination despite hearing positive experiences from others. In addition, Cherguit and colleagues’ (2013) participants felt that their positive experiences were the exception in comparison to the negative stories told by other queer families. Queer women in this dissertation felt that negative stories were less likely than positive, and their comparisons involved showing how their stories were more positive compared to other queer stories.

This shift could be indicative of cultural differences between the United Kingdom (were

Cherguit’s study took place) and the United States, the presence of marriage equality in the United States that was ruled on in 2015, or a combination.

Disagreeing with heterosexism or denying the manifestation of heterosexism can also have benefits. Ahmed (2010) argued that happiness is a construct that is interlaced with power. How we understand the function of happiness is based in dominant power systems and used to control how subjugated individuals respond to the assertion of

power. When speaking against power systems, people can be seen as disrupting happiness. For example, Ahmed (2010) explained that to simply speak, if you are expected to remain in the background, is an act of defiance. Particularly, in the act of defiance a person can become the “troublemaker” who “is the one who violates the fragile conditions of peace” (Ahmed, 2010, p. 61). In thinking of those who then not only speak up, but define themselves as feminists, ones who are directly against those in power, these individuals are then “attributed as the origin of bad feeling, as the ones who ruins the atmosphere” (Ahmed, 2010, p. 65). The queer women in this study who were afraid to name discrimination for what it was could be afraid of being seen as disrupting the peace. They may not have wanted to have been labeled the “troublemaker,” especially those who viewed others as complaining about discrimination to be the negative perpetrators. Omitting discrimination or heterosexist assumptions could function as a form of self-protection. In a study on queer women’s sense making in maternity care,

Lee, Taylor, and Raitt (2011) believed that the queer women in their study may have been “protecting themselves from negativity by distancing the reasons from the personal; that is, sexual orientation” (p. 987). Even in recognizing the political climate, the dismissal of discrimination or heterosexism can act as a shield. If heterosexism does not exist, they cannot be harmed. However, Foucault has argued that this shield of not naming the power being asserted may also allow systems of power to thrive. That is, by not naming heterosexism, heterosexism is empowered.

Visibility. This tension between the queer women’s identification of a negative political climate and their denial of the presences of discrimination or heterosexism in

medical encounters revealed the theme of visibility. A few of the queer women recognized that a person can become visibly queer in medical spaces. Even if an individual wants to believe they will not face discrimination, they cannot hide their queer reality from medical providers. As discussed in previous chapters, public interpretations of pregnancy are based in a heterosexual assumption. When encountering a pregnant person, the assumption is that the person became pregnant through heterosexual intercourse. Our immediate thought is not artificial insemination. Brittany and Grace bluntly said:

Brittany: I think yeah, being in that pregnancy environment. Grace: Yeah, it’s really heteronormative. Brittany: It’s extremely heteronormative.

Brittany and Grace highlight that walking into a pregnancy health environment, regardless of the specific health space, is also walking into the assumption of a heterosexual identity. Therefore, the act of including a romantic partner who is not a man in a medical encounter can create dissonance. Brittany elaborated on this idea in her individual interview:

When I was walking into a space by myself, I wasn’t as worried about being queer, but whenever my partner was there with me, I was very much like, you just have that feeling in the back of your mind about like, how are we going to be treated? Is somebody gonna say something weird?

A queer individual can decide to disclose or not disclose their sexual identity in a healthcare encounter when they are alone; they can enter the space without violating the heterosexual assumption. However, when a queer partner is involved, the queer women cannot ignore the assumptions that two same-sex people are in a non-romantic relationship or that a heterosexual relationship produced the pregnancy. Stating that the

accompanying person is a romantic, same-sex partner, breaks the illusion of heterosexuality, thereby creating queer visibility in pregnancy healthcare spaces.

In the tension of the political climate, dismissal of heterosexism, and then visibility, a push-and-pull narrative surrounds the idea of whether queer women will face heterosexism within a healthcare encounter. If queer women are visible with their partners, they may not be able to control how medical providers perceive them. Yet, if they believe that discrimination or heterosexism does not exist, they no longer need to worry. This tension can place queer women into an impossible trap. Is it better to be aware of potential discrimination or heterosexism, potentially rooted in the current political climate? Or, is it better to believe that discrimination does not and will not exist, regardless of queer visibility? There is no correct response. Queer women are placed into these positions through the ways in which power manifests in larger society and within healthcare environments. While there are many aspects of healthcare environments, one of the more immediate ways queer women can encounter heterosexism is through patient- provider communication.

Patient-provider Communication

When exploring heterosexism in healthcare encounters, patient-provider interaction is a key point of potential heterosexism. They are one of the main ways queer patients engage with healthcare systems. In my critical analysis of their encounters, there were several ways in which heterosexism was discussed or experienced by the queer women including rationalization of encounters, providers questioning who is the mother, explaining sexual identity to providers, general heterosexist encounters, resistance

through prefacing queer care, provider questions, provider resistance, and queer perpetuation of heterosexism.

Rationalization. When talking about their healthcare experiences, the queer women understood that I was most likely looking for moments of discrimination. They seemed prepared to leap into that conversation, and they were sometimes ready to defend or dismiss discrimination or heterosexism that they might have experienced. As a queer individual, I often experience moments in which I leave an interaction and think,

“something did not feel quite right in that moment.” Maybe that person was treating me poorly or maybe they were just having a bad day? Most people do not just shout homophobic slurs, although this does sometimes still happen. But, when discrimination is not outright hate, it can be confusing to process.

Several of the couples, when reflecting on their healthcare experiences, would describe an unpleasant interaction with a provider. In these discussions, they would then think about whether the unpleasantness occurred because of heterosexism or perhaps a

“personality issue.” When Edyth was discussing the providers at the high-risk clinic in her individual interview she said, “We liked some more than others. Right? And that’s just a bedside manner thing.” Edyth wanted to quickly state that the interaction was unpleasant because the providers had poor manners, something that any patient could experience. That provider was just unpleasant to everyone. She was not sure her intention came across as she then felt the need to say, “It wasn’t even because of how they treated us, it was just more of a personality thing.” Her statement then shifted to not poor manners, which could be discriminatory, but a personality. A personality means that the

provider is sharp or edgy. Edyth was not the only person who used personality as a justification for poor treatment. In her individual interview, Danna also said their provider’s “Bedside manner was shitty, like just cold and aloof and like you almost wondered why they were there. Like they didn’t seem like they really liked their job and basically it was just a mismatch in personality.” Danna repeated the same idea as Edyth.

Danna began by blaming the negative interaction on bedside manner, and she then shifted to not just a bad personality, but one that was incompatible with her and her wife. The blame is then also shifted away from the provider because it was a “mismatch in personality.” A mismatch suggests that they were all culpable for the negative interaction as all personalities were not matching, not just a negative attitude of a provider. This same sentiment was echoed by Elisa in her individual interview. Elisa talked about why she did not like the midwife with whom she labored for 12 hours; “It was just a personality thing, like I didn’t love her. We just had a mismatch, but her care was fantastic.” Elisa took it yet another step further by saying that her care was still fantastic.

The dismissing of the dislike of the interaction in Elisa’s care counters ideas of relationship-centered care that recognize the need for emotion and affect (Beach et al.,

2006). Moreover, Elisa may also follow the stereotypical belief that good doctors can have negative personality traits (Bellodi, 2004). Yet, Elisa still did not have a positive encounter with the provider, which is counter to the idea that her care could be fantastic.

An expression of dislike of a provider suggests that the provider did not give great care, at least one that was reassuring, comforting, or supportive.

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The placement of personality as the reason for dissatisfying care gave the queer women an excuse for the way in which the care was not satisfactory. Even if they took some of the blame by assigning it to a mismatch in personality, the queer women could then say the unsatisfactory care was not about their sexual identities. Anyone can experience a mismatch in personality. It just happens. Attributing negative interactions to perpetuation of power systems that work against a marginalized group of people comes with heavy consequences, as stating that the care was attributed to sexual identities means the queer women can then be labeled as “troublemakers” (Ahmed, 2010). Due, perhaps, to a fear of being the “troublemaker,” there were some couples who considered that they were potentially being discriminated against. However, they would then shift the argument and place the blame into an issue of personality or poor bedside manner. For example, Karen and Martha started talking about a negative interaction they had with one of their providers:

Karen: I was hoping that it was just her personality and had nothing to do with us? Martha: Yeah, I think it was more just like her, like the beside manner. Like I don’t necessarily think it had to do with, because it was us. Like I just think her bedside manner as a sonotech was not as good as others that we’ve had.

Karen’s tone in the interview indicated uncertainty as she discussed whether the sonotech had a negative attitude towards them because of their identity as a queer couple or if it was her bedside manner. Martha stepped in to say that she felt it was based on the bedside manner, never allowing for space that there could have been discrimination involved. Karen never commented back, with assurance of bedside manner/personality or if it was their identity. Perhaps with Martha’s certainty Karen did not feel she could state

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otherwise. It was not uncommon for one partner to be more certain than the other when considering attribution for negative behavior. Often, the more certain partner would not state a reason to be potentially related to heterosexism.

One of the reasons personality and bedside manner became labels for negative experiences could be because the discrimination encountered was not always tangible.

Several of the couples would describe feeling an “energy” or “vibe” that appeared to be

“off.” Danna and Jackie had a lengthy exchange about how they felt during their medical encounters:

Danna: It just had this vibe once in a while or from certain people. Jackie: From certain people it was just. Danna: It was just a vibe not really anything outward. Jackie: Like they never came out and said anything, no, but like the, just the energy changed and just the way that we were looked at and just I don’t. Danna: Just by some people, and some, like our main doctor. Jackie: She was great. Danna: She was fantastic and made you feel included. I felt like some of the nurses maybe were. Jackie: And some of the doctors. Danna: (to Jackie) Some of the doctors, which one? The new guy? Jackie: Yeah. Danna: Yeah there was a brand-new doctor that came on when we were. Jackie: Miscarried. Danna: Yeah, we had just started the process and he was just kind of a jerk. Yeah later didn’t we end up having better experiences with him? Like later I was like oh, okay, but it just sort of you know with the miscarriage thing he was kind of way. Jackie: A jerk. Danna: A jerk. Jackie: Yeah, I don’t know, maybe that was just his personality. Danna: Yeah. Jackie: Eh but other than that I mean, I mean he never came outward and actually said anything. I think it was more of the energy and vibe of certain people.

In this exchange, Danna starts out trying to explain how they felt in the fertility clinic with the providers. They did not have any specific instances of outward discrimination,

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but attempted to describe it as a shift in energy and the vibe people had. Perhaps they were looked at differently by the providers. However, throughout the exchange, they start to shift and give the providers excuses, once again, using personality as a potential reason for the negative feelings. Danna even went to say that although that some of their initial visits were not great, calling the provider a “jerk,” she questioned whether their experiences got better with him later on. Jackie did not comment on or agree with the improved interactions, saying that “Maybe that was just his personality.” She then tried to bring back the idea of how the vibe and energy of certain people were off, but suggested hesitancy in her tone when discussing the idea. The difficulty of not having outward experiences means there is nothing specific to which to point. No one denied them service or said anything to them about being queer. It was simply a feeling, and a feeling cannot be concrete.

Having a negative feeling about a medical encounter, a feeling that was not based in outright comments, made it difficult for some of the queer women to talk about their experiences. Bridget struggled to explain why she did not always feel included by the medical staff. She said:

From my experience they were really great to Jo. Like paid attention to you [Jo], paid attention to your needs and stuff. But like for me, I kind of felt like I was just a bystander, like kind of watching it all. And I don’t know if it would have been the same way too like if I was a male… but I kind of wondered if some of them would have included me a little more if I was a male. But that’s kinda how I felt.

Bridget was trying to show how perhaps she was not included because of her and her partner’s queer relationship and that she was not the pregnant partner. However, because

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there was no specific discriminatory comment made, she was left with uncertainty about her feelings and experiences.

If one of the queer women attempted to state a negative feeling as discrimination, their partner was not always willing to concede. During the couple interview, Erin was a fairly silent participant, allowing her wife to share more of the story. When her wife left for a short period of time to attend to their son, Erin was more vocal about how she felt.

Unfortunately, I cannot know for sure how she felt because she did not complete her individual interview. Yet there was an exchange between the two of them that showed a moment when Erin tried to say how she felt something was discrimination, but her wife

Christie did not believe it was.

Erin: And together we really thought about it because after our appointment with her like I felt uncomfortable. It was uncomfortable every time… I don’t know, just I almost feel like the first woman was not LGBT friendly. Christie: She was. I think she was. Erin: But the other ones even if they weren’t, like super super on board they weren’t, I don’t know, she was just very abrasive. She was very blunt. And, and that’s fine, you should be blunt but I don’t know. Like she just made us uncomfortable I guess.

Erin was trying to figure out if their feelings of discomfort were due to the provider not being okay with queer patients, saying how their discomfort suggested potential discrimination or dislike of queer patients. But then Christie takes away that option by saying that she was not unfriendly. Erin tries to adjust and say that maybe it was just discomfort, not related to their queer identity, but maybe it was just her way of communicating. When one partner denies the other their feelings of discrimination, there can be alienation and further doubt by the partner trying to process negative interactions.

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These kinds of negative feelings surrounding medical encounters were not always discounted. Several of the queer women would describe moments where their providers were being negative, but would not attribute their negativity to anything in particular.

Because we cannot know the intention of the providers, the poor treatment could stem from deficiencies of the providers or it could be because of bigotry. For example, Peggy had a nurse assisting her when they were trying to start her labor. The nurse was more than just unpleasant. Due to her risk of preeclampsia, Peggy was supposed to be confined to her bed to prevent falls. Originally, she was meant to have a catheter, but it was too painful. Peggy requested to be allowed to use the bathroom with the assistance of a nurse, as it was deemed too dangerous to let her go alone. The original nurse she had was nice and accommodating. When the shift changed occurred, Peggy was left with a different nurse. Peggy shared:

She was annoyed to have to come in and deal with me and I wasn’t annoying. Like I would seriously hold my pee for like at least an hour if not longer to not bother them… I’m like, if you want, if you can show her [Tiffany] what to do with my IV, she can take me to the bathroom. She’s like okay. And so at that point, I was getting up and just walking myself with my IV pulled to the toilet and the nurse was never in the room… I accidentally, when I was reaching for the toilet paper, I pulled the call string, like the emergency call string in the bathroom accidentally… within in two seconds my nurse was in my room and didn’t respond. Two other nurses came running into the bathroom looking at me like what happened?... but my nurse was standing in my room and did nothing.

Peggy’s story demonstrated how poor treatment was given to her by the nurse. The nurse would become agitated whenever Peggy needed something and did not follow the protocol, leaving Peggy alone to travel to and from the bathroom. Throughout the interviews, Peggy discussed fears of discrimination. In this instance with the nurse, she did not attribute the poor treatment to her sexual identity. Perhaps, it was indeed just a

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bad nurse. Without indications from the nurse about the reason for her behavior, there is no way to know whether this was a moment of prejudice or poor caretaking. Negative experiences, without outright condemnation of their identities, left the attribution up to the couples, and rarely did they ever think it was because of heterosexist beliefs. Lynn had a similar behavioral issue with her nurses during her delivery and induction. She explained, “The nurses that we had the hardest time with were the ones that didn’t engage with us at all. Like would just go in and do their things and not say two words to us.”

Lynn was baffled by how the nurses would not engage with her and Amanda or would not explain what procedures or checks they were completing. She explained that her birth plan specifically requested that all the providers explain what they are doing when they are performing tasks. Yet, there was no reason attributed to the nurses’ behaviors, and

Lynn and Amanda were left with confusion. In their confusion, they never stated that the poor care was based in discrimination. While the behaviors from the providers could just be negative care, there was no room for considering other attributions.

Although many of the couples did not associate their negative experiences to their sexual identity, Grace grappled with how negative experiences might be connected to their multifaceted identities. In discussing her wife’s care during their prenatal appointments and delivery, she attempted to piece together how treatment might be interconnected with other aspects of identity. She said, “I mean, it was more about being fat phobic and less about being like, you’re gay. But a lot of lesbians are fat actually… I dunno if it’s just like disrupting heteronormativity thing or whatever.” Grace started out by associating negative experiences with Brittany just being a larger person. However,

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then she realized that fatness is prevalent for queer women and, perhaps, they cannot be separated.

The queer women in this study may have been engaging in a co-cultural practice as a form of self-protection. Through redefining the providers’ behaviors, they can distance themselves from potential discriminatory or heterosexist behaviors. Redefining or justifying away discrimination is not a new phenomenon. Co-cultural theory was extended to include a form of assimilation called rationalization (Castle Bell, Hopson,

Weathers, & Ross, 2015). Rationalization is defined as “instances where individuals provide alternative explanations for communication rather than labeling them as forms of injustice” (Zirulnik & Orbe, 2019, p.85). Through using rationalization, queer women can then dissociate from queer identity in a way that would attribute to negative care.

The act of rationalization of healthcare providers’ treatment can be connected to the reduction of specific words in speech that can reinforce power dynamics. While the queer women were actors in these discourses, they were just one actor. There are still the providers who may or may not harbor ill feelings or discomfort toward queer patients and a myriad of others connected to the couples and providers. When rationalizing potential discrimination as personality issues or poor bedside manner, there is then a shift into how we talk about the negative treatment. Power exists in these moments as it is not just about the silencing of topics, but of saying things in different ways, from different points of views, and then, in turn, seeing new results (Foucault, 1978). Foucault argued that there is not a simple division between what one says and what one does not say, but rather the ways in which we find different ways to not speak about those silenced names or topics.

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In addition, there is a need to consider who can and cannot speak. As Foucault (1978) stated, “There is not one but many silences, and they are an integral part of the strategies that underlie and permeate discourses” (p. 27). In some ways, several of the queer women may not have felt they could speak allowed discrimination or heterosexism. If those moments were based in heterosexist beliefs, the inability to speak them into existence can then reinforce heterosexism as they can continue to exist without interruption. If the heterosexist discourse is rationalized as simply poor treatment, then heterosexism does not exist.

In speaking about how the queer women discussed, or rather did not discuss discrimination, it is not about their individual actions. Power is a system that exists everywhere and that comes from everywhere (Foucault, 1978). In addition, power does not function as a direct action from an institution. Foucault (1978) asserted that power is not something we are given, “it is the name that one attributes to a complex strategical situation in a particular society” (p. 93). When considering queer pregnancy, healthcare, and general communication, power is the designation of heterosexual identity as the ideal, desired identity. The idealization of heterosexual identity is then reproduced through communication from all levels of interaction. Power is a “multiplicity of force relations immanent in the sphere in which they operate” (Foucault, 1978, p. 93). These relations both find one another and create a system that enact strategies that when they take effect are “embodied in the state apparatus, in the formulation of the law, in the various social hegemonies” (Foucault, 1978, p.93). The use of heterosexist language and promotion of heterosexism can exist at all levels of interaction, including queer women

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using the language as a form of self-protection. When these acts of heterosexist communication align, they can then become part of our laws, organizations, and larger societal expectations. Therefore, through communication with providers, family members, friends, co-workers, the general public, and with each other, queer women can replicate power strategies of silencing or renaming discrimination in favor of promoting heterosexual identities, regardless of their intention.

Healthcare providers who may have had heterosexist feelings towards their queer patients also benefit from not directly speaking their reasons for being uncomfortable or disgruntled with having queer patients. By censoring their potential beliefs about queer individuals, they can then deny they exist. A queer patient then has no ground to stand on if they were to say the provider was not queer-friendly. Past research has suggested that providers may not overtly state homophobic beliefs due to equality and diversity legislation (Lee et al., 2011). If providers understand that homophobic beliefs will not be tolerated, they may withhold overt statements but still express homophobic or heterosexist beliefs in covert manners. While Foucault was specifically speaking about how sex is discussed, the same can be applied here. Foucault explained, (1978) “The logic of power exerted on sex is the paradoxical of a law that might be expressed as an injunction of nonexistence, nonmanifestation, and silence” (p. 84). Therefore, if the queer women tried to confront the providers or healthcare workers about perceived discrimination, because the providers never overtly said anything about their sexual identities, providers can then deny it ever happened. The queer women might then be in a

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better position to rationalize potential heterosexist or discriminatory healthcare experiences.

Regardless of whether the queer women felt heterosexism or if they did not want to recognize or acknowledge it, they were all placed into a dilemma created by the systems of heterosexual power. To discuss discrimination or heterosexism is to make a situation awkward. We do not like to talk about these topics. Therefore, to acknowledge and speak heterosexism into existence, the queer women can be perceived as creating tension. They can be more rewarded for accepting heterosexism as they will not be punished for disrupting the peace. As Ahmed (2010) explained, “Maintaining public comfort requires that certain bodies ‘go along with it.’ To refuse to go along with it, to refuse the place in which you are placed, is to be seen as trouble, as causing discomfort to others” (p. 69). Queer women are then faced with the choice, do we acknowledge the potential for discrimination, to articulate how healthcare assumes heterosexuality and promotes heterosexual identity? Or, do we go along with the assumption in hopes to not be blamed for the disruption of peace?

Who is the mother? Rationalization of potential heterosexism from providers was one example of how the queer women encountered healthcare interactions. While there was some distancing from naming heterosexism, there were several stories of how healthcare providers overtly upheld heterosexist assumptions dealing with defining who the mother was for the new child. Many of the healthcare providers had a hard time comprehending that a child could have two mothers. There were several instances from different couples where a provider would ask or assume motherhood to only one of the

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mothers, leaving the other to be dismissed. In Natalie’s individual interview, she explained a moment at their second pediatrician’s practice where a nurse did not understand the parentage of their daughter. She explained, “We had a nurse who said,

‘Are you the mom?’ Like, to the room, ‘Are you the mom?’ And so we both said ‘Yes.’

And she was like, ‘No, who’s the mom?’ And we were like, ‘We’re both mom.’” In this moment, the nurse at the pediatrician’s office could not understand that there could be two mothers for a child. Even if she was trying to figure out the birth mom, in that moment who gave birth did not matter. They were at an appointment for their child, not for the birth mother. In asking “who is the mom,” the provider was asserting a heterosexist expectation: a child has a sole mother and a sole father. The presence of two women does not alleviate that assumption.

The question of motherhood was present in other couples’ healthcare interactions.

Bridget and Joanna had an infuriating experience when they went to their pediatrician’s office for the first time:

Bridget: The office staff, she had us in the room and she’s like okay. And then she was talking to Joanna and then she looked over at me and I’m holding Lily like I’m holding her now. And they’re like, oh, so are you the grandma? Joanna: My head’s never spun around so fast. Bridget: No, not the grandma. Joanna: Number one, I’m older. Number two, what the fuck? Bridget: I’m like, well it kind of caught me off guard because I just was like, I didn’t know what to say. Then I like looked at Jo, like please answer this. And Jo was like, “No, this is my wife, this is Lily’s other mom.” But there was no apology or anything.

The office staff was operating from the assumption that Lily could only have one mother, who they identified as Joanna. As a heterosexist assumption provided the option only one mother, the office staff then made an assumption about Bridget, who they labeled as the

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grandmother. Both women were clearly upset at this interaction, and Joanna considered leaving the practice after that appointment.

A conversation about motherhood may also then refocus on naming a father figure. Some practitioners may seek to find out the biological father of the child, assuming that the biological connection equates to a parental role. Erin talked about a nurse that she and her wife Christie encountered, “We actually had a nurse said like,

‘Well, the dad.’ And I was like, ‘No, there is no dad. We’re two moms.’” Even if the nurse understood that Erin was the partner of Christie, the nurse still assumed there must be a dad in the picture. Beyond the question about the dad, there can also be assumptions about who gave birth when only the co-mother is in the room. In her individual interview,

Rachel recounted what happened when she left her wife Natalie alone with their daughter in the hospital room after giving birth:

Hope was a day old and she was doing skin to skin on Natalie’s chest and I was walking laps around the postpartum ward. And the doctor came in, of course assumed Natalie was the birth parent because Natalie’s the one like with her shirt open with the baby on her. Like there’s a fair number of assumptions but if Natalie is alone with the baby, that she is the birth parent.

In the recounting of her story, Rachel considered about how this interaction might be different for straight couples as she continued, “I can see how that would be different from if there’s a dad with a kid on his belly. No one thinks they’re the birth parent.”

When seeing a woman with a child, providers then see that woman as the birth mother, as there is no other identity a woman can occupy in a heterosexist framework. In assuming only one mother, the birth mother, providers reinforce heterosexism by not presenting another option of parenthood for a woman who did not give birth in a healthcare setting.

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Beyond awkward interactions with providers, healthcare environments also had policies and procedures that assumed and promoted heterosexuality. These policies could be considered small yet they still perpetuate heterosexism. Heather and Jamie talked about how although Jamie was in incredible pain due to an almost bursting bladder, Heather was not allowed to carry their baby while Jamie was wheeled down to the postpartum unit. Originally, Heather stated that, “Only the mother can hold the baby.” However, she then clarified that it was “Only the gestational mom,” as she remembered she was also the child’s mother. While this may be a simple rule, others encountered difficulties when attempting to access the NICU. When Sydney gave birth, their child had to be taken to the NICU. Amber followed their child to the NICU while Sydney was in recovery. As

Amber accessed different areas of the hospital, she introduced herself as the mother, creating confusion for the staff, as she had not just given birth. The confusion led to an encounter with the security guard outside of the NICU. Amber shared her story:

He was like, “How can you be the mother? Like you just gave birth?” And I was like “No, it’s my wife”… the midwife had to like break it down for him because it was just like, are you freaking kidding me? Like, my kid is in the NICU, like I need to go.

In an already stressful situation, Amber had to disrupt assumptions about motherhood to someone who was supposed to be granting her access to her child. Although the security guard is technically not a healthcare provider, he was still in a position of authority because he determined who did and did not gain access to that area of the hospital.

Luckily, Amber was granted access to the NICU after the long conversations between herself, the midwife, and the security guard.

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Another point of contention surrounding policies was related to the claiming of motherhood in a provider’s office. Karen discovered that once Martha was identified as the birth mother, Karen’s role as another mother and parent came into question. They shared their story about a trip to the dentist’s office:

Karen: So I took him for his first dentist appointment. She [Martha] joined me on her lunch break just to kind of see him. I brought him back whatever, we were done with the appointment, I went to go make him the next one and they asked if I was his mom. And when, and then I said yes and then they said, “Well are you are the birth mom?” I said no. And they’re like well you’re gonna need a letter from Martha giving me permission to take him to the doctor. I said absolutely not. I said we’re legally married, I legally adopted him, I’m on his birth certificate. I’m not getting a permission note from my wife to take my son to the dentist. Martha: And you already completed the cleaning. Karen: And you didn’t ask who I was and like do you ask everybody that brings in a kid if they’re their birth parent? What if we were married and I was the step parent? Martha: The only reason the question came up is because when we were checking out we were both there. In this encounter, Karen checked her son into the appointment and everything was fine.

However, when Martha entered the picture, the question of parenthood arose. The office staff did not assume Karen had the right to bring in their child because they did not accept her as the child’s mother, as the role of mother was already taken. The use of birth mom presents the idea that a birth mom is the only real mom and Karen could not occupy any other official parental role. Martha and Karen ended up leaving that dentist’s office, as they did not feel welcome there any longer.

Questions of motherhood perpetuate heterosexism. Co-mothers and co-parents can then be seen as the “vulnerable parent” when their identity as parents come into question (McKelvey, 2014). Several of the queer women expressed the vulnerability by

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not being identified as a mother or being misidentified as the birth mother, making their role invisible. Queer motherhood comes into question as queer couples have been asked,

“Who is the real mom,” which is a question based in biological assumptions (Chabot &

Ames, 2004, p. 354). When co-parents are not being identified as real parents, providers can then also not see the co-mother as an equal parent (Ross et al., 2006). Questions of motherhood are based in heterosexist assumptions. In knowing that heterosexism is the belief that everyone is and should be heterosexual (Pharr, 1997), heterosexism is articulated in these moments of questioning motherhood. Motherhood assumes heterosexuality by a dominant belief that women are impregnated through heterosexual intercourse. Heterosexuality is only questioned once it is revealed that there is more than one mother and, often, the providers and staff simply could not comprehend. The queer parents were also disadvantaged as queer people, a hallmark of heterosexism (Herek,

2007), as they were presented with barriers for providing care or seeing their own children. A reason for the perpetuation of heterosexism in the interactions with providers could be based on the lack of representation of queer parents in medical textbooks and programs (see Murphy, 2016; Zuzelo, 2014), as the providers would not expect queer parents to be their patients. However, many of the incidents involved non-providers

(security guard, receptionist) or lower-level medical providers (e.g., medical assistant) that have even more limited or non-existent training. They are then left to consider the dominant identities represented in U.S. culture, which is that of the heterosexual, nuclear family. The perpetuation of assumptions of dominant identities then reinforces heterosexism and de-values the co-mother’s identity.

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Explaining sexual identity. The queer couples who had their parenthood questioned disrupted heteronormativity. In their disruption, they had to then explain their sexual identity. In Amber’s situation, her midwife explained to the security guard how

Amber could also be a mother to the child, meaning that Amber and Sydney were a queer couple. The queer women in this study found that they were in situations with healthcare providers that required them to explain sexual identity. Many healthcare providers had heteronormative assumptions about pregnancy. This assumption caused frustration for several of the couples when going through parts of their care. Often, these moments with providers seemed to be simple without a need for much explanation. For example, Joanna discussed how the hospital asked her to come in for a pregnancy test while going through fertility testing prior to becoming pregnant. She stated:

You had to prove that you’re not pregnant because obviously if you expose a baby to dye and radiation then you have an alien and not a baby. So when the lab called they were like oh you have to come and take a pregnancy test. And like I understand that it’s hospital protocol better than anyone… But at the same time, it would have been nice for an acknowledgement of I understand that you don’t really need a pregnancy test, but this is hospital policy… It’s even more annoying because look at my damn chart. I’m here because I have a lady.

Joanna was frustrated that, before having her dye test to check blockage in her fallopian tubes, she was required to take a pregnancy test. Even though, as a doctor, she knew that it was protocol, she was upset that the hospital did not recognize that she could not be pregnant already because she was in fertility treatment for having a female partner. As she pointed out, it was on her medical chart. The pregnancy test protocol assumed that a woman could be pregnant as she would be having sex with a man who produced sperm.

Furthermore, if the providers understood that the procedure was not necessary, then their

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lack of acknowledgment of the flawed policy suggested they did not know or care that they were performing a heteronormative practice.

There are additional protocols created based on heteronormativity. When trying to explain why there is no need to perform a test or treatment, some of the queer women were met with confusion from the providers. Laura, in her individual interview, talked about how her providers wanted to give her a shot when she did not feel it was necessary:

There’s a shot you’re supposed to get so that in case there’s a negative blood type that it doesn’t affect your child, and I kept arguing that I didn’t need that shot and they would just be like, they wanted to do it just in case the sperm bank had incorrectly typed the blood of the donor. Then it could be a concern… And they’re like you should do it just to be safe. I’m like but you’ve said this shot is only needed if, I was like you even said it doesn’t affect this pregnant, either way it’s for future pregnancies and I don’t intend to have any future pregnancies. They’re certainly not going to happen by accident… It was just, it felt like a very circular discussion that I was like, it won’t affect this pregnancy either way. No it won’t. It only affects future pregnancies. Yes. Well I’m not having future pregnancies. And they’re like, well you can’t be sure. I’m like I am sure actually (laughs).

The healthcare providers wanted to give Laura a shot that would only affect future pregnancies and not her current one. Laura was sure that she was done after this pregnancy, since having triplets in the current pregnancy would be enough. What she was trying to explain to the providers was that she could make that choice to not have a future pregnancy because it would never happen by accident. The healthcare providers could not comprehend that explanation. Their understanding of accidental pregnancies was based in a heteronormative assumption about pregnancy, in which sexual activities are always heterosexual and therefore always pose the risk of unintended pregnancies. Laura was deeply frustrated by this incident because no matter how she tried to explain herself and reinforce her desires, they would not listen.

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Both Joanna and Laura were frustrated with the providers who wanted them to participate in procedures that were not relevant to their needs or care. However, procedures were not the only source of frustration for couples. Sometimes, the heterosexist assumptions were insulting. Natalie discussed an encounter in her individual interview that she and Rachel had with a midwife:

Natalie: The only negative was a midwife at like our second or third visit asking us if it was a planned pregnancy. And we were like, um yes, we are the parents. So that was the only particularly experience, just not recognizing that babies come in different ways. Me: Is that what you ask all the parents who come through? Natalie: Right. Like it’s an inappropriate question for a midwife to ask anyway. But like the only way it wouldn’t be a planned pregnancy would be an extra marital issue… Me: And how did you feel when she asked that? Natalie: Rachel immediately spoke up and was quite indignant about it and like shut that down… yes obviously it was planned. We’re both women.

In that moment, there were two possible situations for the midwife. The midwife could have assumed that Rachel was impregnated by a man, the father, who was not present at the appointment and Natalie was a friend or relative accompanying her. Or, the midwife simply was going down a list and did not process why that question might be inappropriate. Regardless, Natalie and Rachel were upset by this encounter because it had an erased or negative assumption about them as a couple. The midwife clearly did not consider who her patient was and how they might process the question being asked.

The protocols put into place for healthcare providers are often based around heterosexist assumptions. These assumptions place queer patients into a bind as they must decide how to respond. A few of the participants reflected on how these assumptions did not begin with pregnancy but had been in place for most of their

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healthcare experiences. Megan remembered one of her appointments growing up. She said they:

asked me a question like could you be pregnant? And my mom was with me and I’m like “No.” My mom’s like, “Well tell them why.” “Because I’m gay. I don’t sleep with men and I cannot be pregnant” (small laugh).

When these assumptions are stated to queer patients, some explain to their providers that the questions that are being asked are not relevant for the patient’s queer identity. The possibility of pregnancy is a typical question being asked of women. However, the providers rarely consider that a person could not become pregnant based on the possibility that their sexual partner(s) does not produce sperm.

The need to explain sexual identity to providers caused erasure of identity for one of the couples. In assuming that people going through a pregnancy would have a male partner, providers can then assume that only one parent can or has given birth. Sydney and Amber managed this experience during the birth of their second child. As they decided to take turns in the pregnancies, by the birth of their second child, they had already collectively experienced one birth. However, because Amber had never given birth before, the providers treated them “like parents that had never done this before” and as if they were not “second-time parents.” Amber and Sydney expressed frustration at this encounter as the healthcare providers were dismissing Sydney’s experiences of having gone through pregnancy before and for treating Amber like she did not know how to take care of a newborn baby.

The need to explain sexual identity to healthcare providers is not a new phenomenon. In my previous work (Hudak, 2016), queer patients would sometimes have

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to repeatedly explain how the medical questions were not relevant to their care or just explaining that their partner was a same-sex individual. The medical system promotes heterosexual identities, not just through the medical education, but also in practice. Any sexual identity outside of the heterosexual is considered abnormal or deviant (Foucault,

1978). Bio-power functions by providers manipulating systems to promote behaviors that maintain demographic norms (Mamo, 2007). Through providers presenting heterosexist questions to queer patients or entering into healthcare spaces with heteronormative expectations, providers are then attempting to place queer patients into demographic norms. By not providing space for queer patients to exist, providers are disciplining any deviant behavior. For example, when Laura was attempting to decline a shot that was not medically necessary for her, the providers kept pushing back, trying to explain why she needed the shot. By not listening to Laura and promoting their practices that were based on heterosexual assumptions, they were correcting her deviant behavior (Foucault, 1977).

The providers were not trying to understand Laura but projected the model of care that assumes heterosexual identity. In the act of not considering why the care might not be relevant, they were asserting a heteronormative framework for medical care.

Heterosexist care. Heterosexist care was present in several of the interactions between the couples and their providers. While the questioning of motherhood and the need to explain sexual identity is an enactment of heterosexism, this section focuses on more general incidents. First, providers assumed the pregnant partner was in a heterosexual relationship. Laura and Edyth talked about how they would often have to explain who Edyth was and what her role was in Laura’s life. Edyth elaborated on their

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experiences: “The nurses that took us back you know, there were a couple appointments that I think you [Laura] had to go by yourself because of work, and she would have to be like no, my wife.” Although the advanced registered nursing practitioners (ARNPs) knew that Laura and Edyth were a couple, the general nursing staff were not as familiar with them and would start with the assumption that Laura had a male partner.

Heterosexist exchanges were typical to the point where Joanna kept exclaiming in both her individual and couple interview about the need for providers to just read the chart. However, other heterosexist moments were sometimes more complicated. One of the ways lesbian couples have experienced discrimination from healthcare providers is the isolation or ignoring of the co-parent. Joanna explained this in her individual interview, “I think that especially towards the end sometimes they did always defer to me because I was the birth mom though. I think that was interesting. I don’t know that I was prepared for that.” In their couple interview Joanna and Bridget would discuss their interactions with healthcare providers, and Bridget would try to explain this feeling of being ignored. Joanna was typically respectful and did not say much. However, in her individual interview she openly acknowledged how Bridget was left out of some of the decision making and conversations. While deference to the birth mother may be expected, there was a sense of isolation and exclusion felt by co-parents. They felt that male partners may not have been excluded. Feelings of isolation were felt because the providers in those situations would not acknowledge the presence of an equal parent.

Silence, as stated previously, can be another form of discrimination. The lack of a response from a provider can speak volumes for queer couples. Part of the process of

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pregnancy is to find healthcare providers to support prenatal and delivery care. Some of the couples decided to find doulas who could act as support through the pregnancy and delivery. Ava and Sophia hired a doula for their birth. However, they received different responses from doulas. Ava explained in their couple interview:

There were two doulas that we emailed, and they responded and then I said me and my wife Sophia, Ava’s not a neutral name so they knew what was up and one of them responded like that and the other one took like a week. And so we signed with the one who responded before the other one even got back to me. And then she got back, she said something about how they had been at a conference or whatever, which is totally reasonable, but and she tried to go into this, “Oh we’ve worked with other lesbian couples and we’d think we’d be a really good fit” and it’s like well then you should have responded quicker (Sophia and I laugh). Because the implication was that she was delaying the response because I emailed saying wife. She waited a week before emailing back and so to me, whether it’s what she meant or not, I heard you said wife and I’m not comfortable so I’m not emailing back.

Ava commented on how the initial email received immediate response by both doulas.

Yet, when Ava used two female names, indicating a queer couple, the response from one provider was lacking. Regardless of the actual intention of the doula, a delayed response signaled discomfort.

Previous research has demonstrated similar responses from providers who would not respond to information requests in relation to becoming pregnant in a queer relationship (Spidsberg, 2007). When providers do not respond to queer patients, the patients may believe that the provider is uncomfortable with working with them as queer patients. Hesitancy suggests discomfort. Ava was also most likely engaging in discrimination-related vigilance, which is a coping mechanism characterized by the attempt to protect against anticipated discrimination (Hicken, Lee, Ailshire, Burgard, &

Williams, 2013). In engaging in discrimination-related vigilance, a person can

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continuously monitor and modify their behavior and surroundings (Hicken et al., 2013).

Ava mentioned throughout the interviews that she would often check places prior to visiting them to see if they would be accepting of queer couples. Healthcare providers should be aware of this type of self-protecting behavior. Regardless of intent, not responding to a patient for an extended period of time could signal to the queer patient that the provider will not offer a safe medical space.

Whether or not the couples experienced discrimination or recognized that their experience was discriminatory, some of them expressed concerns they had going into those medical spaces. Christie discussed how worried she was about going into delivery and her wife Erin not being able to be there. She said:

One of my big fears is like I’d be in the delivery room and then they’d be like okay, your son can’t be here, or your husband can’t be here or like, I wasn’t worried about them thinking you [Erin] were a girl… So I just wanted them to be able to recognize who we were. That we were a couple. That we were a unit. That we were a family. That we are legally married to my wife, she’s my spouse, she’s my partner, however people want to see it, I want it to be well recognized… I wanted the security of knowing that they were going to see us as a family and treat us as a family.

Christie was actively worried that the hospital staff would not recognize Erin as her partner or that they were creating this family together. Throughout the interviews,

Christie would sometimes indicate that there was no discrimination and that she was not worried. But then she would go back to this sentiment and fear that Erin would not be allowed in the room and that their family would not be recognized for who they were.

A fear of not being recognized as a family and couple was not isolated to Christie.

Other couples expressed similar fears. A fear of not being acknowledged is a queer

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experience; heterosexual couples do not enter medical spaces in the same way. Carmen and Hilary talked about this sentiment:

Carmen: I just feel like heterosexual couples probably take for granted that they don’t have to like walk into some appointment and like wonder if their partner is going to be included or if they’re just going to like me as the gestational parent. Like if they would’ve just been looking at me and directing questions to me. They don’t have to think about. Hilary: Being accepted. Carmen: Being accepted. Hilary: Or respected… every time someone walks into that room, like you just don’t know if you’re going to feel that kind of judgment with every single provider. Fortunately we, I guess even though we never felt kind of disrespected or judged or treated differently, you’re always wondering. Carmen: Yeah, until you get this sigh of relief. And you’re like, okay, this appears to be a safe space.

Hilary and Carmen pointed out that heterosexual couples do not enter medical spaces with an uncertainty about how they will be treated and often take it for granted that they will be regarded a couple. They also discussed that, regardless of the treatment actually received, the question of actual queer friendliness will always linger. The history of medical spaces not being safe for queer people is still present, creating a need for caution.

A queer person cannot relax in a medical space until it is known to be safe.

The fear of discrimination of diverse sexual identities can stem from the history of medicalization of the queer population. Up until 1986, homosexuality was labeled a mental disorder (Herek, 2012). Through the labeling of homosexuality as a mental disorder, psychiatrists would then attempt to treat homosexuality through pharmacological and behavioral treatments (Carmack, 2014). While the Diagnostic and

Statistical Manual of Mental Disorders (DSM) no longer lists homosexuality as a medical disorder, the history of medicalization still impacts care today. Fish (2006), in her book,

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Heterosexism in Health and Social Care, asserted that we cannot just erase our history and begin again with a clean slate, as our present is still influenced by heterosexist practices within medical care.

Reflecting on the experiences of the queer women, their feelings seemed centered on apprehension. They were uncertain as to whether their providers would be accepting of their family. It did not matter what the outcome was; the stress is always present.

While some queer individuals have sought out queer-friendly providers (Hudak & Bates,

2018), many do not have that option and others may still express uncertainty until they are in that space and can assess the providers and care for themselves.

Resistance in patient-provider care. Foucault (1978) argued that whenever there is power there is also resistance. Queer couples in this study also articulated ways they pushed back against the heterosexist systems. In their resistance to heterosexism in patient-provider interaction, the queer women would preface queer identities, advocate for their care, and seek out queer-friendly providers.

Prefacing queer identities. Part of resisting heterosexist systems was attempting to assert queer identity when pursuing medical care. One of the ways in which queer couples would preface their queer care was by immediately stating the nature of their relationship before the relationship identity could be assumed. For example, Laura and

Edyth attempted to state their relationship immediately, as their age difference typically caused people to question their relationship. Laura explained, “I try to start out with you know, I have a wife, trying to head this off.” By immediately stating wife, Laura hoped to prevent any additional questions about their relationship that might be offensive. Other

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birth moms tried to protect their partners by presenting the relationship upon a provider entering the room. In Bridget’s individual interview, she said, “Jo, she would just walk into the room or whatever and be like, all right, this is my wife and not miss a beat.” By

Joanna declaring Bridget’s identity as her wife, and then mother to their child, healthcare providers were then expected to follow suit and correctly identify Bridget’s role. Christie was very concerned about healthcare providers not recognizing Erin’s identity as wife and other mother. Christie would assert Erin’s role in the care of their child to healthcare providers at the hospital. Erin discussed how the nurses were often surprised when Erin was in the room as another parent and how “Christie was also very vocal, like ‘I would like my wife to help with the bath’ and so on and so forth, so they knew.” By Christie asserting Erin’s role, she was able to prevent the nurses from only including Christie in the process and ignoring Erin. While discrimination could still occur, there was a sense of control and authority by asserting the relational identity of the co-parents.

Advocating for care. Asserting the identity of the co-parent is a form of advocacy that the queer couples used. Several couples had the idea that they were responsible for preventing their own discrimination. These couples would push their identity forward to make it known, but also by paying attention to how healthcare providers were treating them, particularly as the co-parent. Edyth explained her approach in her individual interview:

Look for healthcare providers that look you in the eye, you as the non-carrying parent. That was one thing that I was really conscious of. It’s like do you see me? Would the nurse practitioner talk to me? Did the doctors talk to me when necessary?

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Edyth was attentive to how the providers were treating her. Mostly, she had good experiences. However, when her sons were in the NICU, she found a doctor had ordered treatments without consulting her and that she could fire that attending in charge of her son’s case; she did just that. By watching provider behaviors, queer couples can ascertain whether they are able to provide queer-friendly care.

For a few couples, other people functioned as advocates for them in the medical spaces. Several couples hired doulas as additional support. Doulas were support for the birth mother, co-parent, or both. Amber explained in her individual interview why they were grateful to have their doula, “It was so valuable having a doula there like to really advocate on her behalf and ask the right questions, help us really understand the full situation.” Particularly in difficult medical situations, doulas were there to answer questions about what procedures were happening to the women and in some cases, defend the co-parent’s right to access the NICU.

While doulas could be hired for support, others had friends or family act as advocates. Lynn had a difficult experience with her birth based on the medical providers with whom she worked, primarily the nurses. Her friend, Natasha, noticed her poor care and acted. Lynn, in her individual interview, explained:

If it wasn’t for Natasha, I would have been stuck with these negative Nancy nurses like trying to help me deliver this baby. And Natasha was the one who stood up and was like get the hell out of here. We’re getting new nurses. Because I was too afraid to say something and so she stood up and was like oh hell no… because you don’t want this experience, to look back and be like man that really sucked. Do you want to look back be like this is the most amazingly beautiful experience surrounded by the most amazing people, you know? Communicate.

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Although Lynn was too afraid to speak up, her friend was able to go to the head nurse and take the negative nurses off Lynn’s case. By having someone advocate on her behalf,

Lynn was able to have more supportive nursing staff around her when it came time for the actual delivery.

What Lynn articulated was the idea that queer women need to advocate for themselves in their healthcare, either by themselves or through support systems. Because they could not control what providers they first interacted with, they found the ability to speak up and state when things were going wrong with providers, leading to better experiences. When asked what advice she would give other queer parents in her individual interview, Elisa stated:

For me it would be a lot of self-advocacy so that you can trust the process. I had a really positive experience and I’m thankful for that and I would want people to know that positive experiences can exist. And if that’s not what you’re having, seek it out or demand it or expect that your providers treat you that way and if they don’t, find a new provider.

Elisa was explaining how good experiences with a provider can exist, if you demand it.

Her sentiment also argues that queer women do not automatically receive positive healthcare, it is something that requires advocacy. Maggie also attributed positive healthcare experiences to advocacy. She stated, “I think that we’re pretty good at asking questions and advocating for ourselves. So all that added up to us having a really positive medical experience.” By creating a demand for quality care, some of the women felt that they then were able to earn positive care. However, it should also be noted that both women were in progressive areas and had access to more healthcare providers compared to those in more rural settings.

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Advocacy as resistance is complicated. The advocacy that the queer women engaged in was based on promoting their own care, not the overall care of the queer community. While advocacy can lead to better care, queer women are still acting within the relationships of power allowed in a heterosexist system. Foucault (1978) argued that

“Resistance is never in a position of exteriority in relation to power” (p. 95). Particularly, the act of advocacy is still within the realm of heterosexism. By requiring queer individuals to speak up for appropriate care, they are still existing in a system that assumes medical providers are not queer competent. Moreover, pursuing advocacy as resistance does not require healthcare providers to change their heterosexist assumptions.

While queer women can have positive healthcare based on advocacy, there is no active change in the heterosexist medical system.

Seeking queer friendly providers. Another way the queer women enacted resistance was through seeking out queer friendly care. One of the reasons for seeking out providers who were deemed queer friendly was to prevent discrimination. If healthcare providers were queer friendly, queer women expected them to have higher queer competency compared to non-identified providers. The need to find queer friendly providers was considered vastly different compared to how heterosexual women find their providers. Peggy elaborated on this point, saying, “We were worried about finding an OB. I feel like most straight couples just call up whatever OB they want and they’re like, ‘Hey, I’m pregnant, I need an appointment.’” Peggy was highlighting how heterosexual women often do not need to worry about treatment from their OB because their identity and family makeup is already assumed. Queer women have more of a need

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to seek out queer-friendly providers to protect themselves from potential discrimination.

Joanna, a Doctor of Osteopathic Medicine, reiterated why it was important for her to know that her provider “wasn’t going to flip out” when she came out as a lesbian. She explained:

Honestly, I’m a medical professional and I’m a teaching physician… I teach residents and obviously we train them to be respectful of everyone, but at the end of the day, everyone has different ability and skill for that. And I know that I didn’t want to deal with somebody who is going to be like wait, what? You want to talk about what? So I asked ahead of time.

Joanna was explaining that, as a physician, she knows that some providers are more aware of queer patients and are more capable of providing queer-competent care. In knowing this, she made sure that her providers were able to talk openly about her sexual identity and the creation of her family. For her, this meant asking the OB upfront whether they were able to work with her and her partner. If the provider hesitated, Joanna would know that they were not prepared for a queer family. In addition, if they said no, she would also be aware that they were not comfortable with queer families. Having a solid yes answer can provide security for Joanna and, potentially, other queer couples.

To find queer friendly providers, the queer women took two primary approaches.

They either used websites and other print materials or their interpersonal networks. First, they looked at any materials from the healthcare provider, clinic or hospital. Sometimes this would be focused on the web presence of the practice. Sophia and Ava discussed looking for a fertility clinic:

Sophia: We were looking specifically for a fertility clinic that was um. Ava: Gay (all laugh). Sophia: Well at least like, welcoming you know, like, so we live in Texas and so a lot of times it’s really helpful to look at a website, and not that every

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organization or business that has a very strong religious website is necessarily not going to be welcoming but it’s something that we, we look for if there are specifically um. Ava: There was a whole page about LGBT family building.

Ava and Sophia brought up two points. First, in Texas, they were wary of religious conservatism that might be a sign of potential discrimination from fertility clinics.

Second, they were looking for indications that websites recognized queer families. Ava was satisfied with their clinic when she found an entire page on an LGBT family building, indicating that they would not be the first queer couple and, most likely, they would be welcomed by the practice. It was not always just about looking for pages that mentioned LGBT patients; a few participants checked to see if the providers were queer themselves. Danna talked about how she wondered about the providers’ sexual identities,

“We wondered but then I think I remember looking at all of their bios and everybody mentioned a husband or something like that.” Danna went online to look at the bios of all the providers at the midwife practice to see if any of them indicated their sexual identity, but did not find any that had a same-sex partner.

Looking for queer identity online and not finding it can also be a sign of exclusion. The absence of queer identity in the online spaces can suggest to queer patients that they may not be welcomed in the practice. Joanna was hesitant about the fertility clinic that was recommended by her OB. She said in her individual interview, “I was nervous about it because I mean there’s nothing on their website that would indicate… It was all hetero orientated material on their websites and also clearly outdated.” Joanna felt that because all the online materials indicated only heterosexual patients, she became worried that her and her partner would not be accepted. Fortunately,

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she felt that they were a “friendly clinic” and said, “They’re foolish to not advertise themselves as such because I’m a savvy professional and I would never have gone if my

OB hadn’t referred me.” Joanna pointed out that fertility clinics could lose business if they did not update to include queer patients, especially as Joanna and Bridget were not the only couple who looked at websites to determine the friendliness of the providers.

The website itself was just one way in which couples assessed queer friendliness.

Queer couples also paid attention to forms provided or listed online. Peggy talked about how she evaluated the fertility specialists:

The reason we went with who we originally went with was their paperwork. Because the other guy… on his website, I was looking at his paperwork and it was very, very, very much geared towards heterosexual couples…. It just doesn’t feel like they’re going to be accepting and this other paperwork, it would say instead of like husband it said spouse or not spouse, partner. And it was way more geared toward whichever way if you were single, if you were straight, if you were gay, it didn’t matter. Their paperwork… it was very welcoming. It wasn’t like your cookie cutter heterosexual paperwork.

Peggy looked at the paperwork associated with the different providers and found that there was a distinction between those that assumed heterosexuality and those who left the space open for multiple family types. The paperwork provided an understanding about which practice was more likely to be accepting and promoting of diverse families.

While websites provided insight to several of the couples, others found providers based on interpersonal recommendations. Some of the recommendations were not based on queer friendliness, but other couples paid attention to those with similar families and identities. Ragan talked about finding a new provider for her upcoming birth after moving to Montana. She stated, “She [OB] was a recommendation by friends of ours that also have a two-mom family that have children basically the same age as our kids.” Knowing

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that another queer couple used a provider signaled that the provider has already had experience with and could be more aware of queer couples. Other queer women found comfort in those recommendations. Christie explained:

One of our friends, her and her trans husband have two children and they used the birth center and they [birth center] were very comfortable with that situation. So it was just like okay, let’s give it a try and immediately felt very comfortable and welcomed by them.

Having recommendations from other queer people communicated that these providers have not only encountered other queer families, but the families also had enough positive experiences to label them as friendly spaces.

Seeking out queer friendly providers and medical spaces is important for queer people. While there may be other factors to consider such as insurance coverage, accessibility, and cost, queer friendlies can stand out as a reason to work or not work with certain providers. Hilary and Carmen talked about their choices in healthcare providers:

Hilary: I looked on their websites and they had pictures of queer folks that they specialize in, you know, working with queer families too so that was good. Though we probably would have gone anyways because it was cheap. Carmen: I don’t know, I mean the first support group that like said don’t go here. We had an awful experience, you know, I think if that had been the case or we weren’t feeling good about where we were going, we would have switched. But luckily you know, they were pretty good. Me: That’s good. You mentioned that you looked on their website and you saw other queer couples. What did that mean for you to have that, to be able to see that at that clinic? Hilary: I just felt safe because we had heard, I mean it always feels safer I think for any kind of service or whatever… whenever there’s pictures of queer couples, it just feels safer. Carmen: Yay queers (I laugh)! Hilary: Yeah. Just that I’m at ease a little bit more there… Carmen: You don’t have to like wonder, you know, we’re always wondering if, I am anyways. Am I going to be judged or not, you know, that you’re welcomed somewhere. And you know, it just puts, you just don’t have to wonder which is really nice.

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Initially, Hilary thought that they would have gone to whatever clinic or center was cheapest, but Carmen argued that they probably would have switched if they had a negative experience. They both articulated a need to feel safe and secure in most places that offer services, even beyond healthcare. Regardless of the resulting experience, there is a question of whether acceptance will take place, unless the health space already openly identifies as a queer space.

Queer patients finding queer-friendly providers is not a new concept. Using both online and interpersonal resources can be common for queer individuals (Hudak & Bates,

2018; Spidsberg, 2007). By seeking out queer-friendly care, queer individuals can attempt to alleviate concerns for discrimination, which is a form of resistance. However, as previously stated, they are still operating within the heterosexist structure of medical care. Providers are still within medical systems, even those who are seemingly less medicalized. Finding queer-friendly providers does not change the heterosexist system; rather, the couples are finding ways to operate within the existing system. Operating within the medical system is not inherently negative, but does not equate to resistance that can enact change. When seeking queer-friendly providers, queer women are looking for providers that are operating outside of heteronormative frameworks. Providers that are operating under heterosexist systems are still thriving, meaning that there has not been significant change to the heterosexist system.

Having access to queer resources is also its own kind of privilege. Queer resources can be few and far between, unless you are in an urban area. Several of the couples talked about how they were lucky to be able to find queer-friendly providers and

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support groups because they were in liberal areas or in cities with a lot of options. Those who were in more remote areas or who had recently moved to remote areas began to question what resources they had available to them. For example, Elisa and Faith had their child in Illinois but had recently moved to Michigan where they were planning on having their second child. They explained their situation:

Elisa: Where we are now and the jobs, we have insurance that won’t pay anything and we’ll have to pay out of pocket. The local clinic we know people who have had bad experiences… Faith: So we moved from [city in Illinois] where there’s hundreds, you know, you could go wherever you want to go, to [City in Michigan] where there is the fertility center. That’s what it’s called, The Fertility Center.

Faith and Elisa not only moved to a more isolated area, their new jobs forced them to change their insurance and coverage. They went from having access to a lot of resources, to only one. People in their network had had bad experiences with The Fertility Center.

Elisa and Faith were even considering traveling back to Illinois for undergo fertility treatments so that they could have access to their preferred providers. Hilary and Carmen were in a similar situation where they moved from a larger area to somewhere smaller.

Hilary explained, “We were really fortunate being in [City in Illinois] … they’re not going to have sessions in [city], Oregon about how to get pregnant when you’re queer like that, there’s no way.” Being part of larger communities, particularly ones that are considered more liberal, equates to more access to queer resources. When queer parents are more isolated, they can struggle to figure out the conception and prenatal process as they were not able to reach out to others in their community who might be going through or have gone through those same processes.

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When seeking out queer-friendly providers as a form of resistance, some of the couples sought comfort in having queer-identifying providers. The couples assumed that the queer providers would be good providers based on their shared identity. However, some couples found that just because a person was a queer provider did not mean they were a good provider. Natalie and Rachel talked about their experiences finding providers who identified as queer.

Natalie: I didn’t want the exuberant, I’d be open to that like, I wanted them to have a little more comfort. Rachel: Oh, discretion. Natalie: Even just having a lesbian friend would have been sufficient, like had they thrown that in (Rachel and I laugh). Rachel: You know if they said I have a friend who’s gay, we would have crossed them off the list. Natalie: That was why we almost hired the first girl (Rachel laughs). So the first doula we talked to was non-binary and. Rachel: Down with the gay, clearly. Natalie: Yeah but would have been terrible for us and we almost hired her because we were like oh she. Rachel: But the thing with the pediatrician, we just went with the gay rather than the good one.

Natalie and Rachel struggled to find a queer competent doula and were looking for any signs of queer competency, including identifying as part of the LGBTQ community. Yet, as they found, the queer-identifying providers did not work well with their family. In this conversation, they referenced the negative experiences they had with the pediatrician.

Natalie elaborated on that experience in her individual interview:

We have a really hard time finding a pediatrician. The first one we interviewed was a gay man and we thought like, we mistakenly were like, oh, he’s gonna get us because he’s gay, but he’s not a father. And so he just didn’t get parenting in a lot of ways that surprised us. There was a lot of instilling fear instead of support that we experienced. And so that, like idea that oh, he’s going to get this piece of it. And we didn’t really look at some of the other pieces that were important to us.

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Natalie articulated that only looking at identity does not account for other aspects of care that can be important to queer individuals. Although finding queer providers can be a way to find comfort, queer providers may not give the desired care.

The idea that a queer provider does not equate to a good provider was also discussed by Brittany and Grace. They had a negative experience with a provider that the couple saw because their baby was having difficulty breastfeeding. The talked about their experience:

Brittany: She asked me at one point, she said, well you know as the primary parent de de de de. And I was like. Grace: No thank you. Brittany: … Like some of the most weird and squicky experiences that we ended up having ended up coming from other queer providers, which is not things that I would have ever expected. Grace: Well it’s that thing right, where queer people are like oh, you’re like me so let me tell you the story about myself… the story I have about myself is the story that’s true about you and that’s not true. And I think I have to know that as a therapist, but I think sometimes other kinds of providers who are not constantly thinking about transference may run a ground of that and not track it. So I mean on the one hand like providers give you better care when they identify with you and on the other hand they think shits their business when it’s not.

When Brittany attended an appointment by herself, the provider implied that Brittany was the primary parent. This made Grace, who had been at previous appointments, the lesser parent. They were both upset at this insinuation and even more so because the provider identified as queer. Grace provided a professional explanation of why this may have occurred. Perhaps because queer providers assume they know the parents’ experiences as similarly identifying queer people, they may then provide inappropriate care that does not consider other facets of their patients’ identities and essential needs.

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Seeking out queer-friendly care as a form of resistance has its benefits because it can allow for potentially better healthcare experiences and a lack of discrimination.

However, not everyone has access to queer-friendly care and queer-identifying providers are not always queer-friendly providers. Finally, while seeking the care can be beneficial to queer parents, the resistance is only partial as it still operates within a heterosexist paradigm.

Provider questions. One way that healthcare environments perpetuate heterosexism is through the lack of education about queer health. Healthcare providers may not know the differences in how queer couples conceive or are even aware they could encounter same-sex couples who are pregnant. In these moments, it is not about having the intent to discriminate, but rather reinforcing a system that promotes heterosexuality and de-emphasizes other types of relationships. One way that couples experienced heterosexism that they felt was not discriminatory involved the multiple questions they would receive from their healthcare providers about their relationship and the conception of their child. The questions would sometimes be just part of the conversation. For example, Sophia and Ava discussed how their pediatrician asked them questions:

Sophia: Our pediatrician was very positive, uh like open curiosity and like. Ava: Like she didn’t know anything about the donor process and we talked about that a little bit um and the donor siblings.

Sophia and Ava felt that their provider was open about their relationship because of the questions and curiosities posed by her. In these questions, it was clear that she was

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unfamiliar and not educated on the topic. The lack of knowledge points to a gap in education for healthcare providers that may only be educated on heterosexual conception.

The lack of awareness or knowledge about queer families can signal to queer couples that these providers have not worked with many other queer couples who were trying or had been pregnant. For example, in Amber’s individual interview, she discussed how her OB signaled an unawareness: “She would ask questions that were just for more like her own knowledge, like would ask questions about like our family structure and the donor and all that stuff.” Amber noticed that the OB was gathering information about her family structure and donor process and that caused her to reflect on what those questions meant for her provider, “I got the sense that there weren’t many lesbian parents that they were working with.” Amber did not believe the questions were a negative aspect of her care as she felt her case was handled very well. Yet, she still noticed a difference in treatment by how she was asked a lot of questions that would not typically happen to heterosexual couples and how they conceived. Karen and Martha discussed a similar situation with their healthcare providers:

Karen: Maybe like some of the questions? Like how did you decide? How did you pay? You know. Martha: People are just curious. Karen: And it just always makes me seem like either we’re very open and people know that and we’ll tell you or they just never seen a same sex couple trying to have a kid before… Sometimes it feels like we are the only same sex couple that goes to a lot of these doctors.

In their conversation, Karen and Martha noted that their providers were curious and asked a lot of questions. However, Karen appeared to be more uncertain as to why they received so many questions. It could be because of her open nature, which could be the

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case as she was very open and forthcoming, or it could be the general lack of knowledge.

The presentation of how the couple felt that they were the only one in the area is based on a feeling of isolation. The providers treated the couple in a way that the couple felt the providers had not encountered other queer families before, placing them on the outside of normal care. While Martha did not seem bothered by this, Karen was more uneasy about their treatment and how it could be a negative experience. Even if these participants were okay with the questions, others may not be and may feel unwelcomed by the facility.

Asking questions about the pregnancy process for queer individuals can come from positive intentions, however, these questions can still be a form of heterosexism.

When providers ask questions about the queer pregnancy experience, they are acknowledging that they have not been educated on queer family building or, perhaps, queer families in general. Their lack of awareness or knowledge of queer families reinforces the idea that the providers are educated with heterosexist assumptions, believing that their patients have and would continue to be heterosexual. Queer individuals can have positive responses to questions from providers (Spidsberg, 2007), however, it can be more helpful to have providers already aware of the formation and building of queer families (Erlandsson et al., 2010). Further, there is also a difference between openness to queer families and asking them a multitude of questions about their family’s creation. Singer (2012) suggested that providers simply ask about the person’s story of their pregnancy. This type of question allows for openness for queer patients to provide as little or as much detail as they want, and it does not suggest that the providers are not aware of queer individuals. Constant and specific questions suggest a lack of

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education or awareness. Open-ended questions present the provider as being conscious of the multiple ways in which people become pregnant.

In considering the need for advocacy, many couples then felt it was their responsibility to educate providers on how to care for this community. A lot of the couples encountered providers who were willing to embrace their families but did not have a lot of education on how queer couples become pregnant. Because of their lack of knowledge, many of the providers then asked questions of the couples. Several of the couples then felt that it was their duty to educate these providers so that the next couples would not have to undergo that kind of scrutiny. Tiffany in her individual interview talked about how her and Peggy had to constantly educate their providers while being in the hospital:

We turn into education people when we go to places because they’ll ask questions and we are fine to, like as long as they’re appropriate people, like they’re not being rude or disrespectful or anything like that. We’ll answer whatever questions they have. So it was like education time at the hospital when we were waiting for him [son] to come because they would just come in and they would rotate. We’d get a nurse and then we’d get new ones. So then we’d educate some more and then just kept asking questions. And I mean it was nice because they were actually asking instead of just assuming.

Tiffany and Peggy live in Kentucky, a place that does not have a large, visible queer community. Thus, even when they are in the community, they feel like they are asked a lot of questions and they turn into teachers for the public. In the hospital, this continued as they had new providers constantly who had similar questions. Although Tiffany pointed out that questions are nicer than assumptions, most likely heterosexist

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assumptions, it still places the burden onto the marginalized person to have to explain who they are and how their family has come to be.

One of the reasons there is a feeling of need to educate is based on the idea that if queer people educate providers now, perhaps the next queer family the providers encounter can have improved care. Amber articulated this sentiment in her individual interview:

I’m the person that they’re going to be like, at least give them a positive experience too, you know what I mean? And so like they have the next person come through like they’ll remember me and understand what I’m looking for in a provider and hopefully take that onto the next person to make their experience even better.

Amber hoped that, by providing feedback to her healthcare providers, they could remember what care she desired for when the next queer patient came in. But Amber also mentioned that she felt she had to give them a positive experience. Perhaps if she was negative, healthcare providers would assume that was a trait of all queer patients and then not work on improving their queer competency. The need to educate providers points to the problem in the medical system where heterosexism has created an educational gap that patients feel the need to fulfill.

Provider resistance. Participants not only discussed ways in which they attempted to combat the heterosexist medical system, but how their providers performed resistance as well. There were two main ways that providers resisted heterosexism in healthcare: including the co-parent in the delivery and manipulating insurance.

When seeing assumed “traditional” birth stories from TV shows such as

Superstore, I recalled how fathers are expected to cut the cord. The cutting of the cord

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was the extent of his involvement in the delivery, other than telling his partner to breathe.

Several of the co-parents were able participate in more than cord cutting and were active members in the delivery. Without asking (although a few did), several of the providers presented the option of the co-parent “catching” the baby by assisting in pulling the babies out once the shoulders were through the vaginal canal. While the providers were risking liability, they focused more on the connection of the parents. Olivia shared her experience in her individual interview about helping to deliver her second child:

I asked if I could catch Skylar, which I thought meant Ragan would be pushing, I’d put my hands there, he would just kerplunk out into them and I would catch him. No, the minute we saw his head doctor [name] grabbed my hands and was like, had his hands on mine. Put my hands right on Skylar’s little head barely peeking out and was like push in, turn, pull. And next think I know I am pulling this baby out of her and he’s literally hands on guiding me through it. And he was just, again, he was a complete stranger. We didn’t meet him until probably maybe 10 hours before Skylar was born. He walked into the room and we had an essential oil diffuser going and he complimented how good it smelled and he’s, this room’s just great… I felt like he literally embraced us at the most important time and guided us through it.

Olivia got to share in a special moment of the birth by being able to pull her son out. Not only did she enjoy this moment, she appreciated her provider more for embracing her family without ever second guessing who they were. He even risked some liability by having Olivia help, again, without really knowing them as a couple.

One of the more special moments was for Heather when she got to help deliver her daughter. Heather struggled with fertility and her first child was carried by Jamie, her wife. The OB that worked with them knew about Heather’s struggle and made sure to include her in the delivery. Heather shared her story:

Heather: So he brought her head out and her head was this way and then twisted her head this way and he said to me, “Do you want to pull her out?” Totally, like

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probably shouldn’t have I mean that would totally been a liability… And I’m like are you serious? So I like, I reach inside of her rather, grab her by the shoulders or, her shoulders are right there. And I’m like, okay. And I am the first, I pull her out. Me: That’s so cool. Heather: And I pull her out and I was like, the first thing I said is her ears look exactly like yours (crying). Just really big ears. And um, and I put her on your [Jamie] stomach… And it was the most amazing thing and to say that I was the first one to hold her.

I vividly remember this part of the interview as both Heather and Jamie were crying, and

I was holding back tears as I handed them the tissues that were on the couch next to me.

It was clear what this moment meant for Heather; she finally was able to be a mom after so many years. Including Heather in this way solidified her connection to her daughter and still had an impact after several years, including after the birth of their son who she carried. In her individual interview, I asked Heather about this moment again and what it meant to her. She said:

What it gave me in terms of he knew how important it was for me to get pregnant. He had worked with me for a long time. He had worked with both of us. He knew that I wanted to be a mom and I wanted to carry so bad and the idea of any traditional type setting where in a delivery room where it’s like, a tradition, what I mean, like just a heterosexist type situation, heteronormative situation, where you know, the father cuts the cord or whatever.

Heather understood that when heterosexual couples experience a delivery, the father typically just cuts the cord. By having her assist in pulling out her daughter, she was able to affirm an identity of mother, not father. This significant act of resistance to heterosexist assumptions about parental roles created a lot of meaning for Heather and many other co-parents who were able to experience assisting in the deliveries.

The second way that providers resisted heterosexism was through manipulating insurance. Many of the couples found out that their insurance would not cover all or some

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aspect of their fertility treatments, citing that to prove infertility, they had to have been trying to conceive for a year without success. For the lucky couples, this could include attempts at IUIs, but for others, only heterosexual intercourse counted as attempts. To combat this discriminatory clause in insurance, some providers had methods of making the paperwork count as infertility for insurance. Elisa was originally told that her fertility treatment would not be covered at all and she would have to pay for everything out of pocket. However, when she received the bills, she discovered that the insurance ended up covering most of the costs. Elisa explained:

What we suspected happened is that because we were working with, it was [name] which is like one of the biggest fertility clinics in the Midwest, we suspect that because they had such a huge team who do like insurance and everything, they just know how to code it so even if your insurance says they won’t cover it, they will, because ultimately it was only that ultrasound fee that wasn’t covered.

Although Elisa did not know for sure what happened with the insurance, she concluded that the fertility center knew how the system was set up against queer parents and found ways to resist heterosexist insurance companies.

Sometimes it was not just how they billed insurance, but also how their care created avenues for going around insurance companies. For instance, Karen talked about how their providers gave them “quote unquote samples” for their fertility drugs so that they “didn’t really have to pay for the medication.” This medication would be covered for heterosexual couples undergoing fertility treatment. Grace and Brittany also had a midwife who found ways around the insurance companies. Grace explained, “There was time when her insurance was like maybe we won’t cover IUIs anymore and she was maybe the next time you want to have a baby, I might just come over for tea and then, if

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somebody leaves pregnant…” By not accounting for what service would be provided, the midwife could skirt the additional cost that would come from the insurance not covering the IUIs. Luckily, Grace and Brittany did not have to pay for an IUI out of pocket.

One of the last ways in which providers manipulated the insurance system, was by suggesting to patients that they should not be honest when answering insurance questions about fertility. Caroline discussed the conversation she had with her provider:

He said, “Okay, I need to determine infertility, so your insurance will pay for this.” I said okay, he goes, “So I’m going to ask you some questions, it’s very important that you respond honestly (shakes head to indicate opposite response).” Okay…. He was very supportive in helping us figure out how we could manage this without, while going through our health insurance.

In this interaction, Caroline’s provider was nonverbally telling her to not answer truthfully in the questions so that her insurance would cover the cost. As there was no way to prove whether Caroline engaged in heterosexual sex without contraceptives, all she had to do was lie on the form. Because of Caroline’s previous sexual history, she was able to not lie on the form, but what matters is that the provider understood that insurance companies were being discriminatory, and he wanted to help.

Healthcare providers are an essential part of the resistance. Having queer woman be sole actors in resistance does not create change, as one altering motion cannot reinvent the power systems at play. Foucault (1978) argued that power exists through relationships. Resistance then depends on “multiplicity of points” (Foucault, 1978, p. 95).

To create change, there needs to be resistance that “traverses social stratification and individual unities” (Foucault, 1978, p. 96). In order to create permanent change, however, there needs to be more actors across other divisions in order to revolutionize heterosexist

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systems. Yet, healthcare providers revolting against heterosexist systems and practices is a key start.

Queer perpetuation of heterosexism. Queer individuals have the potential to perpetuate heterosexism. As Foucault (1978) noted, power systems become embedded into our everyday actions. Being queer does not alleviate a person from articulating power systems. The ways queer couples responded to healthcare interactions could perpetuate heterosexist practices and beliefs, potentially as a form of self-protection.

Queer couples would sometimes disregard providers’ discriminatory practices and they would request that they be treated like everyone else, even though the everyone else was based on a heterosexual standard.

One of the most common ways couples perpetuated heterosexism was by dismissing heterosexist comments or acts from healthcare providers. In this section, it is not just about personality issues, but either stating that the providers were just being assumptive and/or acting as if the heterosexism was not a big deal and they were not affected by it. Sometimes these moments were simple. When I had asked Caroline and

Maggie about whether they felt ignored by healthcare providers that were only talking about heterosexual couples, Caroline responded, “I got the sense that they weren’t intentionally ignoring us, just that they had a script that they were supposed to follow.”

Caroline was dismissing the providers’ use of a heterosexist script. When she stated that the providers were not being intentional, she indicated that they were not harmed by the heterosexism. In her view, this was just something that the providers were supposed to do, disconnecting the providers’ responsibility from their actions. By detaching

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responsibility, Caroline is indicating that heterosexism is okay if it is not intentional.

Carmen reiterated a similar sentiment in her individual interview when she talked about her treatment; “Didn’t love some of the nurses while we’re on the postpartum floor, you know, but I think that was also like maybe to some extent, like not their fault. There’s everybody else is trying to do their job too.” Carmen was about to complain about postpartum nurses as she stated “she didn’t love” them, but she stopped herself and said that it was just them doing their job.

Participants rarely described their experiences as discriminatory or heterosexist.

As stated previously, many would find ways out of it, providing an excuse that either just dismisses the providers or co-opt responsibility in the situation. Another way couples rejected heterosexist experiences is when they would dismiss it by placing it as a singular event. Here was an exchange between Natalie and Rachel:

Natalie: Some of them we liked better than others. Rachel: They were all nice. Natalie: Yeah. One asked us if it was a planned pregnancy and we were like yes (Rachel laughs). Rachel: I’m sure that was just like on her standard form. Natalie: Yeah. It was fine. That was the only weird thing that happened because we were gay. So.

It is important to note that Natalie had discussed this incident in her individual interview.

In her interview Natalie was more upset about the question of whether the pregnancy was planned or not. She even explained why the question was a problem no matter who the person was. But here, Rachel steps in and reiterates that all the providers were nice and when Natalie brought up the specific incident, Rachel immediately dismissed it saying that it must just be standard and nothing to do specifically with them. In the couple

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interview, Natalie backs up Rachel by saying that it was fine and stated that this was the only weird moment for them, even though it was not, as indicated in their interviews.

Rachels’s dismissal of Natalie perpetuates heterosexism by stating that following a heteronormative script is fine, as long as everyone was nice. Accepting heterosexist treatment is the perpetuation of it. If queer couples do not protest this type of treatment, then it indicates to heterosexual individuals that this treatment is acceptable.

In accepting heterosexist treatment, a few of the couples either accepted the treatment or even reacted positively. Peggy told the story about how her OB reacted when they found out that they were having a boy. She said:

The funniest thing was we had our ultrasound at 20 weeks and that’s when the tech told us it was a boy… we had our appointment with our doctor and she walks in and the first thing she said, “So do you even know what to do with a penis?”

When Peggy told this story in the couple interview, we all laughed. However, as I thought about the comment after the interview, including during the transcription process,

I felt more uncomfortable with it. The question of whether the couple knew “what do with a penis” is based on the idea that, as two lesbians, they would not have had experience with one. Most likely, a heterosexual couple would not have had the same question asked of them, as one of the parents would assumingly have a penis. I was angry with myself for laughing, as I was then participating in heterosexist perpetuation. We should not be accepting this behavior from providers. Yet, it was much easier to laugh. It felt better to laugh.

The positive feelings attributed to heterosexism creates a feeling of just being like everyone else. Queer couples are not special, they are just a simple family. Many of the

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participants reiterated this sentiment of feeling like providers treated them like everyone else. As an example, in the couple interview, Karen stated, “I think they don’t make it seem any different than any other couple.” Caroline, in her individual interview, echoed this sentiment, “Nobody treated us any differently than anyone else would. Nobody even batted an eye ever.” Treated like everybody else can present an indication of having reached equality. If we are all treated the same, then we have made it. However, the idea of being treated like everyone else is based in a heterosexual standard. To be like everyone else is to be like heterosexual couples.

Being treated as heterosexual was sometimes presented as the desired standard.

As Megan stated in their couple interview, “I mean they treated us just like we were, the husband I guess.” Being treated as the husband is heterosexist treatment. A husband is not the same identity as a wife or partner. There is also a reiteration of wanting to be treated as the “norm,” which is based in a heterosexual standard (Meyer, 2003). In

Amber’s individual interview, Amber discussed how happy she was with her treatment by a provider stating, “Just felt like we were the most classic American family she’d ever heard of.” Wanting to be discussed as a classic American family is based on wanting to be included in the norm. The dominant discourse of family is heterosexual. In expressing the desire to be viewed as a classic American family, there is then the want to be viewed similarly to a heterosexual family.

A desire to be treated through a heterosexual standard does come with some problems, particularly about how participants may have explained this desire. As an example, in her individual interview, Jamie talked about how she felt about her treatment

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from providers, “I want to think that they treated us as they would have treated anybody else. It wasn’t like, we don’t need extra treatment.” Jamie felt that if they were to ask to be treated differently from heterosexual patients, then it would mean that they would need extra treatment, instead of, perhaps, just different treatment. Healthcare providers can adapt to patients based on cultural needs, a practice called cultural competency

(Spector, 2012). However, Jamie’s belief is that the queer couples would become a burden, which could then be connected to negative treatment. An expression of wanting to be treated as you are, as a queer couple, should not be considered a burden.

In wanting to be treated like everyone else, and to have providers accommodate that request, an issue is created in relation to how that may not accurately represent queer couples. Brittany and Grace talked about how they found themselves being compared to heterosexual couples by the nursing staff:

Brittany: We had this experience quite a lot at the very end of the pregnancy and beginning of Eira’s life where when we’re going to lots of appointments… also in the hospital the nurses are like look we see a lot of couples go through this experience and Grace like deserves a fucking award basically for how. Grace: And I was like raise the bar! Brittany: How amazingly supportive she is and you guys have this really good dynamic as a couple and basically they said like Grace was always there and like ready to help the nurses where like sometimes we have to like wake the dads up and be like no really we actually need you to like hold the baby right now because we have do something with your wife. And we had, we were the opposite of that experience and so I think you know, it was true and it felt, it feels good to have that affirmation of your relationship. And at a certain point it actually got uncomfortable in a whole different way where they were like oh wow! You guys are perfect. Or you know like, or like when people refer to you and your partner as like you girls are like, the way you talk out there is so different than the straight couples who sit in my waiting room. Grace: I was like raise the bar up for men, come on.

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By comparing Grace and Brittany to heterosexual couples, the staff elevated them because Grace was being an active partner taking care of Brittany. While Grace simply wanted the providers to expect more of fathers, Brittany pointed out the discomfort that it caused her. The discomfort was situated in an elevation, but also by how they were treated in comparison. Brittany noted that the providers kept referring to her and Grace as

“you girls” and how the way that they talk was so different compared to the “straight couples” in the waiting room. She recognized that they were actively being compared to heterosexual couples and in constant contrast to them. In Grace’s individual interview, she further explained, “I was held to like the dad standard.” The comparison to fathers and being treated like a father did not match their experiences. Healthcare providers should recognize couples for who they are instead of just a contrast to heterosexual patients, as this comparison perpetuates heterosexism. Even when we acknowledge a couple as not being heterosexual, if we use heterosexuality as our baseline we are still perpetuating heterosexist norms.

The expressed desired to participate in heteronormativity is not surprising.

Heteronormativity is presented as the ideal way to live. To correct assumptions or to deviate from this ideal can be exhausting. When queer folk have to present themselves outside of the ideal, to assert who they are, the constant process of this assertion “can be experienced as bodily injury” (Ahmed, 2013, p. 424). Therefore, to be presented as the norm can be seen as comforting. As Ahmed (2013) asserted, “Normativity is comfortable for those who can inhabit it” (p. 425). If queer couples want to find a sense of comfort, they may seek to be part of the norm. However, wanting to be part of the normative

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group does not mean that a person will be accepted into the normative group. Brittany and Grace were happy that their relationship was affirmed by the providers; soon after,

Brittany started to feel “uncomfortable in a whole different way.” When a person starts to feel out of place, even through praise, they can start to feel discomfort. Their body is not recognized (Ahmed, 2013). Whether in act of protection or desire, expressing the want to be part of heteronormativity is the reproduction of heterosexism. In wanting to be part of heteronormativity is then the perpetuation that a person should be heterosexual. As actors of systemic power, we all have the capacity to be ingrained with dominant ideals.

Beyond Providers

Visits to a healthcare provider were not the only aspect of the healthcare system that promoted and reinforced heterosexism. Several aspects of healthcare were mentioned as discriminatory by the queer couples including gendered birth classes/tours, gendered birth certificates, and bills and insurance.

Birth classes. Almost all the queer women attended some type of birthing class during their prenatal care. Although these classes may not be traditional healthcare, they do serve a health function, as many classes discuss healthy eating habits and the delivery process itself. In their reflection on these classes, many of the queer couples noticed that the materials and presentations were tailored to heterosexual couples. Classes would often use language that emphasized mother and father roles. Jamie talked about her dislike of the birthing classes she attended in her individual interview:

Her [Heather] gynecologist provided birthing classes that were just heteronormative and stupid. It was just like, I mean it’s like what you would imagine seeing on a video in like the 1980s or 90s… just was very heteronormative like we’re the only gay

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couple and I mean it was heteronormative… the language, mom and dad. Dad do this, you know, mom’s going to do this and it’s just… really tailored for straight couples.

Jamie was frustrated about how the classes she attended with her wife had language that overly emphasized a birth mom and dad role, leaving her on the outside. The use of mom and dad language states that this space is only meant for heterosexual couples. While other couples had instructors who would try to accommodate to them as queer couples, many instructors would still return to heterosexist language.

The language was not the only issue with birthing classes. Several of the activities were planned around a mother and father figure. Natalie and Rachel discussed their experience in their birthing class, responding largely with humor to the situation:

Natalie: Birth class was a really weird experience for me. Rachel: Because she was with all the dudes all the time. Natalie: Because I was with the dudes all the time like there was a point where they were trying to demonstrate to the pregnant moms like the size of their pelvic opening. And so they had them like touching their bones and their perinea to feel, to sort of see how big your pelvic actually is and they made me and all the dads turn around and look out the window and hum to ourselves (Rachel laughs). Rachel: You had to hum so you couldn’t (laughing). Natalie: So then the pregnant women would not feel judged and I was like this is a particular activity that there is no reason I should be facing away with the dads (Rachel laughs). Rachel: You have to tell the whole story. Natalie: Right (all laughing). Me: Oh goodness. Rachel: So like the childbirth class was the part where they had the most trouble with the fact that you were a female. Like the language and the making you hum. Natalie: Yeah and our size disparity, Rachel is (Rachel laughs) four inches taller than I am. And every other relationship the dad was much larger than his wife. In one case there was like almost a foot between the size of the man and the wife. And so the positions didn’t work because. Rachel: You’re so little. Natalie: I am smaller. I am physically unable to do some of the things they were asking us to do (she and I laugh). They like, they never thought about the fact that they might need to have modifications.

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Rachel: I remember one time I was supposed to be squatting and you were supposed to be supporting me and I was like you’re gonna drop me! Hold me! (all laugh)

I will admit, the story was funny as they recounted the tale. Both were animated story tellers. But their story points to a larger issue, the birth class was designed for heterosexual couples. Birth classes would not know how to incorporate queer women into the group, or any other non-heterosexual family or couple dynamic that might be there.

The class did not recognize that Natalie was a woman who could participate with the other women; there was no need to divide her from that experience or to push her into the dad narrative. They also mentioned how an activity assumed body differences between men and women. Men should be taller than women, therefore they can adequately support their female partners. Classes did not account that men could be shorter, but that there could also be female partners and did not know how to work with Natalie and

Rachel as a queer couple who fell outside of the heterosexual expectation.

Alongside birth classes, there was a program called “Centering” that several couples were a part of. Centering is a prenatal program that helps women conduct some of their own healthcare and, as part of their prenatal care, they attend classes as a group centered around reproduction, health, and caring for a newborn while integrating existing prenatal care. The program is typically orchestrated by midwives. While many of the couples loved the program, and had overall positive experiences, several discussed how some individual classes were overly geared towards heterosexual couples. Hilary and

Carmen discussed their experience with Centering:

Hilary: There was like one session (both laugh). Carmen: It was like birth control and what else?

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Hilary: Yeah, that’s the big thing that felt. Carmen: Sounds more heterosexually. Hilary: Heteronormative… So that day wasn’t a good day. It wasn’t the regular facilitator or midwife though. They talk about birth control in a way that didn’t feel like super. Carmen: It wasn’t really irrelevant to, it wasn’t just that, but I think it was the whole other thing. Like it was kind of awkward. Hilary: Yeah. Like activities that we just couldn’t participate in because we’re queer and they didn’t really acknowledge that or give other options or anything like that…. We just really couldn’t participate because we’re queer. Carmen: It was like what are you going to do for birth control? I’m like nothing (Hilary and I laugh). Next question (laughs).

The class they were referring to is one of the first classes in the Centering program.

Having worked with the Centering program before, I had participated in the activity to which they were referring. The person directing the class reviews the various birth control methods and their effectiveness. They also discuss how conception works and what the couples plan on doing for birth control, assuming they do not wish to have an additional child immediately after birth. Having the class is not the problem, but rather it was the lack of acknowledgement about how queer couples do not need this information.

The lack of acknowledgement can place queer couples into a bind where they either must attempt to participate, and perhaps make a joke about it, or they can disengage from the process, still creating an isolating feeling. Danna discussed how she felt during this class in her individual interview: “We spent 10 minutes or 15 minutes talking about birth control after pregnancy… and so I’m like, I’m going to shop on Amazon while you guys are talking about birth control… let’s actually talk about stuff that’s relevant to people in the room.” By not acknowledging queer women in those spaces, the Centering program is presenting that everyone should be heterosexual and that everyone should be able to participate in the birth control discussions. In addition, the facilitators place the burden

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onto the queer couples if they want to acknowledge how their sexual identity rendered the activity useless.

Finally, birthing classes and Centering groups created a visibility for queer couples. By being in those groups, the queer couples are seen as visibly different from the heterosexual couples. Almost all the couples talked about being the only queer couple in their groups, placing them on a metaphorical stage. Fortunately, most couples did not cite negative experiences from heterosexual couples in their groups. However, Christie and

Erin noticed that some of the couples in their group were uncomfortable with their presence. Christie explained this experience in her individual interview:

When I started Centering there are groups of all different family matters and I think we definitely got some looks from some of those families, where they were like, oh what are they doing here? And I’m pretty sure a couple of them didn’t come back because they weren’t comfortable with us. And that’s kind of like, well, that sucks for you guys (laughs). Sorry you had to make that decision. You really missed out on an awesome opportunity. I think one couple in particular was, they were like, kind of on the red side, very on the red side. And they were just like, oh no, we’re not going to sit in the same room with them and support this.

Being in Arizona, Christie would talk about how they were in a red state that was socially conservative. When she entered the Centering group, there were some couples who were visibly uncomfortable with the presence of a queer couple. In her case, the couples just left the group and there was no confrontation. However, Christie and Erin still had to experience the discrimination from the couples for that moment, and then to question why the other couples did not continue with the group. Even so, Christie enjoyed her

Centering group and continued with a parent’s group that was connected to the program.

She felt included and said that she was friends with most of the couples to this day. Once

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again, Christie and Erin had to deal with this experience on their own. They did not mention any of the facilitators talking to them about the negative reactions from the other couples. Christie only talked about how she noticed the couples reacting poorly. When facilitators do not acknowledge these situations, there is a pretense that they do not exist.

Both the queer couple and the discrimination are put under erasure because, if we do not speak it into existence, it does not exist.

Outside of birthing classes, couples would often go on tours of where they planned to deliver. The purpose of the tours was to show the setup of the hospital or birthing center and to walk prospective parents through the various aspects of delivery.

While the tours were relatively basic, they were often places of heterosexism and one of the largest complaints of the queer couples. Caroline talked about the issues she encountered with the hospital tour in her individual interview:

They were saying like, “This is where moms go, this is where dads go.” And they used very gendered language even though it was painfully clear that we were a same-sex couple sitting right in front of them. And they just could not be flexible in their language and they just couldn’t do it. Like I saw them kind of trying and then failing. And so everything was like, “And moms will do this and dads, what do you do? You do this and moms will do this and will do that.” And we were more than rolling our eyes by the end of it. It was pretty annoying.

The use of mom and dad terminology erases the existence of queer couples and others who may not have a father in the picture. As Caroline pointed out, the person giving the tour would look right at them and use this terminology, clearly making them invisible as a couple. Maggie echoed this sentiment in her individual interview by saying, “They were just like really bad at not saying ‘the dad.’ You know and they were looking right at me.” Maggie was clearly not the “dad” and her role as another mom was completely

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ignored. Maggie and Caroline did not express a lot of anger or frustrations toward their experiences, but this was a moment of contention. They were clearly upset by how the tour was heterosexist.

The tours can matter beyond feelings of erasure and frustration. They can also signal to the couples that they are not welcome in that healthcare environment. Peggy and

Tiffany talked about their tour:

Peggy: When we went to the birth center tour it made us like, we felt solid in our decision for the hospital but that first tour was a little dicey. Because the lady who did the tour was very heterosexual orientated and kept saying, “Oh yeah, when mom’s in labor, dad can wait here, or dad needs to bring this or dad can do that.” Tiffany: “Dad can bring his cooler.” Peggy: Yeah, “Dad can store his cooler in here or dad can come get ice here”… There was one point where I wanted to raise my hand and go, “Well where can the other mom store her flippin cooler lady? Or is she not allowed to bring one?” Because it was just getting very annoying. And so we, at that point it was too late to change hospitals kind of?... It was a little dicey. We’re like how’s this going to go down when it’s show time?

Peggy and Tiffany were concerned that, if the tour cannot distinguish between parental identities and recognize that there were more family dynamics than the heterosexual nuclear family, they would not be welcome in the hospital as a queer couple. Tiffany emphasized that they, “may have chosen a different doctor and a different hospital after we had the tour” because of how uncomfortable they were with the heterosexist framework being presented. Queer couples will often be looking for signs of inclusion and exclusion to determine the safety of the healthcare space. Having heterosexist language can tell queer couples that that hospital is not safe for them.

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A heterosexist framework can also create an intense visibility for queer couples that can cause a great deal of discomfort. Brittany and Grace talked about how they felt during their hospital tours:

Brittany: We went on a couple hospital tours and um some of them were, we went on I think maybe two or three and like one of them was really great and one of them was kind of small. There were two other couples there and they were both straight and like the friggin nurse who did the hospital tour couldn’t get over like. Grace: Saying dads. Brittany: Saying dads and husbands and things like that… that was one of the more othering experiences we had as a queer couple like during the whole process, was like you know you just feel very visible in a birth space as a queer couple because even though there’s probably other queer couples that are in the mix…. But at the hospital tours we were definitely like the only queer couple there and you just feel like you really stick out when you’re the only same-sex couple in a waiting room or a hospital tour. So you know having people who are skilled enough to just like it’s no big deal and to use inclusive language made a really big difference and we absolutely noticed it. Grace: Yeah, totally. Brittany: Compared to people who were like “Well, and your husband can go heat up his dinner in the kitchen down the hallway.”

Brittany pointed out that when a queer couple is the only queer couple in a healthcare environment, it creates an intense visibility. Yet, even in moments of visibility, the tour guides could not find ways to include them into the conversation, choosing instead to isolate them. Brittany and Grace noticed the difference between the hospitals that would be inclusive compared to those who could not alter their heteronormative language. In places where choice exists, some of the couples would move to a hospital that had the better language, as they felt visible in positive ways, without isolation.

In these birthing classes and hospital tours, staff members are articulating a heterosexist discourse that focuses on the nuclear, heterosexual family. Here, surveillance of sexual deviance is occurring. Foucault (1977) argued that surveillance is an integrated

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system, one that functions through a network of relations from top to bottom. Medical staff providing the tours and classes do not have high status but, instead, occupy a middle position within the hospital network. They can be considered people who have access to information, but that information can be accessed by others. As members who provide the tours and classes, they are still part of the system to surveil and correct sexual deviance. When those members use mom and dad language, they were evoking discipline by stating this is the only acceptable identity. By not including other possibilities for partners, whether romantic or non-romantic, medical staff were reiterating that the only identities allowed were heterosexual, (i.e. mom and dad). Moreover, when the staff members would direct the heterosexist language onto the queer couple, the staff were correcting the couple’s deviant identity. Couples were not going to be identified by their actual sexual identities. Heterosexuality is the preferred and only option. With heterosexual identity as the sole option, there is not a need to consider other identities.

The system’s purpose is then to reinforce the norm of heterosexuality.

Birth certificates and paperwork. After ruling on marriage equality in

Obergefell v. Hodges in 2015, most healthcare operations have updated their paperwork to be inclusive of queer folk, or at least that was what was indicated by the queer couples.

Many of them said that their birth certificates had neutral parent identities, they had a clear space on forms. Specifically, wristbands did not require a parental label and just had a barcode that matched the parents to the child. However, there were some parents who were not fortunate enough to have updated forms. Ava noticed that the forms and wristbands still had parents identified as mother and father. She stated, “They just

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crossed out the preprinted father on everything and then slapped it on my wrist.” It was a casual way of fixing the error without fully acknowledging that the forms were not inclusive. While Ava did not express a lot of frustration at the situation, it was still clear that the healthcare system assumed parents would be a mother and a father.

Outdated paperwork was present both within and outside of healthcare environments. Several of the couples were aware that forms still reflected only mother and father parental identities. Martha and Karen discussed the forms that they often encountered with their children

Martha: Some are like the doctors’ forms like when you’re going to fill in for like new paperwork it says. Karen: Mother/father. Martha: Mother/father versus parent/parent. Karen: I think actually on our first son’s birth certificate I’m listed as the father.

Martha and Karen have noticed that intake forms have them listed as mother and father, even though there are updated forms now that say parent one and parent two, allowing for gender neutrality and inclusivity of different parent dynamics. Karen would echo Ava’s situation where she would simply cross out father and place her name there. However, that option was not possible on their son’s first birth certificate where she had to be labeled as the father.

There were still several states that had new birth certificates that had gender neutral labels for parents. However, some of these forms were not readily available or cost extra. In their couple interview, Lynn talked about their experience with the birth certificate for Jamie, “We actually asked them about that and they’re like we don’t have the new forms in yet. We are getting them but they’re not here yet.” Even though the

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forms were technically available, Lynn and Megan could not attain birth certificates where Megan would not be labeled as the father. There was a caveat though, as Lynn explained: “We could pay money, more money to get a new birth certificate that says parent on it.” Lynn and Megan were told that yes, they could get the updated forms that would appropriately label Megan. However, they would have to pay additional fees to acquire them as they were not currently available. The only available forms, the ones that would not cost extra, were the ones that said mother and father. Heterosexual parents are automatically given the correct forms and do not need to pay extra to ship the forms with their correct parent labels.

The labeling of birth certificate and forms were not the sole issue, there were also hidden documents that would be appropriate for parent recognition, if you only knew to ask for them. Natalie and Rachel talked about the laws and hidden forms in their state of

Georgia.

Natalie: Georgia’s parentage statutes were unintentionally non-gendered (Rachel laughs). Everything just said the spouse of the mother. And it had just always been that way because it never occurred to them that a spouse would be anything other than a father. So we had no trouble with the birth certificate at all. The hospital was terrible. So I mean, they couldn’t answer any questions for us about any of it. But when I went to go pick up the birth certificates and vital records a couple weeks later they had. Rachel: Had mother/father right? Natalie: Right, so they had the form that said the day printed for me to check to make sure that everything was right, said mother and father. And I was like, she’s like, “Do you have any questions?” I was like, “Do you have a form that doesn’t list me as father?” And she was like, “Yeah, I do.” She’s like, “We have a mother/parent or parent/parent.” I was like, “Parent/parent, we want that one.” And so the state of Georgia had three different forms that they print birth certificates on, you just had to know to ask.

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In Georgia, as Natalie pointed out, parental statutes already existed as gender neutral.

However, the hospitals still had the parents listed as mother/father on their standard birth certificate that they give to all the parents. Even though Natalie had tried to ask the hospital ahead of time about the birth certificate, she was not given a clear answer. One unique aspect about this exchange is that Natalie could acquire an appropriate birth certificate, she just had to ask. Yet, many parents would probably not know they could ask and would just assume that is the way it is. The hospital should have been upfront with the choices available to parents instead of promoting heterosexuality with their automatic form.

The disciplinary system of reward and punishment operates in these scenarios.

Heterosexual parents are automatically granted the correct forms, as they either list them as mother and father or parent and parent. Both options recognize their identities. Queer couples may not be granted the correct forms and must find ways to alter the forms themselves or be incorrectly labeled as the father, a type of punishment. Furthermore, there are times when there are correct forms for queer couples, but the couples are punished by having to pay an extra fee to acquire them. Queer couples can try to resist by inquiring about other options, however, doing so requires queer couples to know that they have the ability to ask or feel as though they are entitled to ask. Having the forms labeled in a way that automatically has heterosexual identities included is part of the heterosexist system. Queer couples must assert themselves into the parental figure, however, they are still operating under the heterosexist system.

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Improving Care

Through talking to the women about their experiences, both positive and negative,

I have combined their comments and suggestions to process how healthcare providers can improve their care of this population. In this section, I offer several areas of advice that include recommendations for providers, birth classes and tours, medical spaces, and medical forms.

Providers. The queer couples had a lot to offer on how healthcare providers can improve their interactions with their patients. When considering this advice, much of it is specific to queer couples going through a pregnancy, but this advice could transfer over to queer individuals in general. One of the common suggestions and positive experiences was the constant inclusion of the co-parent throughout the pregnancy and during postpartum periods. Being included in the process was very important to many couples.

The queer women appreciated being recognized as partners throughout the process.

Inclusion was sometimes simple. When Megan talked about ways in which the providers treated her well, she said, in her individual interview, “They always recognized that I was

Lynn’s partner and wife.” If providers struggle with figuring out how to include the co- parents, simply treating co-parents as partners is a good first step.

Faith talked about her experience with the providers in her individual interview.

She stated, “I feel like they fully included me. So even though it was Elisa’s pregnancy, I was just as equally part of the process.” As Faith explained, it did not matter that Elisa was the one pregnant, the providers recognized that they were equal partners throughout the care. When I asked about what the inclusion looked like, Faith stated:

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They would direct questions at me, like in the postpartum visit. It wasn’t just like, “How are you doing Elisa?” It was like, “How are you both doing?” “Faith, how are you coping?” They only gave Elisa the postpartum depression screening. But, you know, it was just very much checking in with both of us. “How is parenting going for both of you?” It wasn’t just like, oh, you are the pregnant person, let’s focus all our care on you.

Faith appreciated that providers recognized they were both new parents and that they equally checked in on her. As Faith pointed out however, they only screened Elisa for postpartum depression. Only screening the birth parent could fail to diagnose co-parents experiencing postpartum depression. It is important for providers to recognize that postpartum depression can also occur for co-parents (Wojnar & Katzenmeyer, 2014). It may help to screen the co-parent as well as the birth parent.

Beyond including co-parents in the conversation, some of the queer women appreciated when providers actively involved them in the procedures. One of the ways co-parents were included was by either pushing the plunger to inseminate their partners, warming up the sperm containers in their hands, or a combination. Karen described in her individual interview how she really liked the reproductive specialist, partially because he was “very personable” but for other reasons as well. She said, “He explained everything.

Like when I asked if I could push the plunger he brought me right up to eyes view and explained everything I was looking at.” Karen enjoyed that he not only included her in the process, but he also took the time to explain “everything in a way in which you can understand everything.” Through communicating with the co-parent, providers can make them feel more a part of the process and start building trust.

Once the baby was born, some of the parents talked about how they were included with things like skin to skin contact, the first bath, and related experiences. They were

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treated as mothers, whether they gave birth to the child or not. Ava, in her individual interview, talked about how the NICU providers treated her as the mother by allowing her to do some of the basic care. She talked about her experience:

When he [son] was in the NICU, they were doing feeding every three hours and so there was a whole routine to it where we would test his blood sugar and then his temperature, change his diaper, and then we would feed him. And I got to do that almost every time because the nurse walked me through it a couple of times and then let me kind of run the show.

Ava was grateful to the nurses who allowed her to perform this care for her child. She actively felt that she was included and considered a mom, particularly during the difficult time of her child being in the NICU.

Providers can improve their care with queer couples by treating the partners as equals. Even if only one partner is pregnant, talking to both individuals in the appointments, including the co-parent in procedures (if possible), and allowing co-parents to provide care to the child after they are born can immensely improve the couple’s experiences.

Another important recommendation the queer women suggested was for providers to pay attention to language and assumptions. As previously stated, participants experienced heterosexism when providers assumed heterosexuality of the patients or questioned the relationship of the two women. Language should be appropriate, and heterosexual assumptions about the individual or couple should not be made. Natalie provided a simple suggestion in her individual interview, “Pay attention to your audience and if you don’t know if this is an expected mother and just a friend, just ask.” While providing this advice, Natalie also realized that there is a place where providers can look

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for this information rather than asking. She said, “You could just check the chart.” Joanna was also frustrated when providers did not check the chart. By checking the intake paperwork that typically has this information available, providers can prevent heterosexist assumptions. If that information is not there, providers can also make available an opening for the two people to describe their relationship, without assumptions. The provider can simply ask, what is the relationship of the person accompanying you today? The provider should also attempt to remember the relationship, potentially by writing the information on their chart, to remember that relationship for future interactions and inform other members of the healthcare team.

Beyond relationship status, there is also a need to watch other parts of the provider’s language. Jamie expressed the need for providers to consider how they talk to their patients. She explained in her individual interview:

Really watch your language… if we’re saying we’re married than I think they should assume that we call each other wife and just making sure they’re using the language as they would any other thing. Don’t assume that we know the donor. Don’t call the donor dad… ask what do you guys, what are you guys calling the donor? It is somebody you know? Is it going to be an uncle?... There’s so many different ways it happens in queer parenting because it is so deliberate that I think everybody’s story is different… those first visits, just ask what her story is. What is the language you like to use around this? Who are your supports?

Jamie was expressing the need for providers to consider the composition of the pregnant couple’s family. Every queer family is different, and assuming the nature of familial relationships is not helpful. By asking patients what their story is and who are support people in their life allows for an opening for patients to define their story for themselves.

Many of the queer women recognized that providers are going to make mistakes.

While providers should actively work to improve, they may not be perfect. Joanna, in her

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individual interview did say that providers should “try to use open-ended questions and let the patient’s pronouns guide you. Use whatever pronouns the patient uses,” which is great advice for providers. She then also added what providers should do if they make mistakes, “Don’t put your foot in your mouth and if you do, acknowledge it and say you’re sorry and move on.” It is important for providers to apologize for mistakes they make as it recognizes the patients’ experiences and feelings. Joanna thought back to her experience when the medical assistant assumed Bridget was her child’s grandmother and not an equal mother. She said, “If the medical assistant at the pediatrician’s office would have said, ‘Oh shit, I’m so sorry’, that would’ve been way better than complete non- acknowledgment of the fact that she just ridiculously offended me.” Mistakes are always possible, but not acknowledging them creates dissatisfaction and mistrust of providers.

Apologizing for mistakes or inappropriate behavior was important for several of the queer women. Recognizing and acknowledging mistakes does not stop at the person exhibiting the behavior. If providers or staff learn about a colleague behaving poorly, they should correct that behavior. Tiffany had a negative experience when going to see one of her providers. She shared the story in her individual interview:

I had to update paperwork and I was updating it and they were, like I could hear em behind glass, like how do I put this, like look what they have. And she’s making a big deal out of it. I could feel my blood pressure rise. And I went in, the doctor was like, “Okay, why is your blood pressure so high?” And I’m like, “It’s no big deal.” And she’s like “No, your blood pressure’s never this high.” And so I told her and she was like livid. And so that made me feel better because she was upset because I was treated that way. And so then she took care of it and I had never, I haven’t seen that lady back.

Tiffany was describing an experience where when she was filling out an intake form, she listed her wife as birth control, commenting on how heterosexist the forms were. When

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she submitted the form to the front staff, they made rude comments about it. Although

Tiffany was hesitant to share this with her provider, she was glad that her provider was also upset and had seemingly fired that staff member.

There is a need for providers to advocate for the queer patients, including queer couples with pregnancies. Providers can watch their language, follow the lead of queer patients with pronouns and relationships, and apologize for any negative experience a queer patient may have. All of this also points for a need for training medical staff, as some of these recommendations may not be intuitive. But training should not just be for the main providers as Maggie explained in her individual interview:

On a systemic level, I think they need to have diversity training. Because it’s like, I can’t say that it’s somewhat at a certain level should implement something with their subordinates because it’s like those people might need it too. So it should be like a hospital system wide, like approach that people are different from each other and this is a holistic environment where we are here to meet their needs.

Maggie pointed out that training needs to involve all levels of the medical system, not just one. Couples had poor interactions with every level of care, from billing to the OB.

There is a need for providers to recognize that no two people are exactly the same and that the entire person matters, not just the disease or illness, or for whatever a person may be seeing a provider.

Birth classes and tours. The primary concern with both birthing classes and tours is that the script that facilitators use is heterosexist. The scripts assume that the parents are a mother and a father, and classes are designed around these assumptions.

This is evident in how the activities are designed, mothers and fathers separated, and what is being discussed in the groups. The most important advice for people giving

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birthing classes and tours is to change their language. Caroline, in her individual interview, pointed out one easy change that would apply to every parent. She advised,

“Use the word ‘parent’ instead of ‘father’. That’d be great. That’s a really easy fix pertaining to everybody. You don’t need to change your language all the time, just one parent and then the other parent.” Caroline pointed out that by using the neutral language of parent in every tour or class, the script never has to be altered to accommodate diverse families. To accommodate further women who may just have a supporter with them who is not a parent, they could use support person.

When thinking about the materials covered in classes, most of the women were okay with the topics, except for the Centering course on birth control after the pregnancy.

Many heterosexual couples may benefit from this discussion, but perhaps queer couples could be informed that this topic is planned and given an alternative option. Queer couples could come in later that day or leave early, depending on how the class functioned. It is particularly important to at least acknowledge that the information may not pertain to everyone in the group. It is important to remember that heteronormativity functions on the idea that treating everyone equally is the goal, assuming that everyone is treated as a heterosexual. By openly acknowledging that there are people in the class who do not benefit from birth control, changes in the conversations would recognize that there are more than just heterosexual couples. One thing that Christie and Erin appreciated about Centering was that their materials, including their book was inclusive and used appropriate language. Erin felt that they “Probably created a book that was more inclusive.” By having inclusive language in the materials, Christie and Erin felt

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welcomed and that they belonged in the class. In continuing or starting to have inclusive materials, it acknowledges that queer parents exist and makes them feel part of the group.

Medical spaces. Most women did not specifically discuss the medical spaces.

There were some discussions about the fertility clinic spaces and how they were often covered with sperm memorabilia and decals that could be uncomfortable at times.

Beyond sperm motifs, space was not a pressing issue. However, Brittany talked about in her individual interview how the medical space reflected comfort and a type of queer friendliness. She talked about her perspective:

We had a lot of privacy there and I don’t, I never really connected that to like us being queer. But now that I think about it, I’m like yeah, you know, maybe like that was an element of it too… we weren’t sitting a waiting room with like five other couples waiting for their appointment who were like staring as us because, “where’s the husband?” And her clinic didn’t have, like a lot of clinics have the imagery of that like lady in the flowy gowns with the bump and everything. And her clinic didn’t have that. She just kind of focused on nature photography and like had lots of that kind of stuff in her clinic. So we really liked the physical environment of her space as well.

Initially, Brittany did not connect the space to queer friendliness, but upon reflection she felt they went together. Traditional clinical spaces can create a lack of privacy, as some waiting rooms can cause discomfort from other patients being there who might be perceived as judging them. While this may not be changeable, waiting rooms could be designed to create more illusions of privacy by having semi-private spaces. In addition,

Brittany spoke to how the space did not perpetuate feminine ideals of pregnancy. Instead, there were peaceful pictures of nature. Healthcare providers should consider how their spaces may be constructed and decorated and what ideals they are promoting through these material choices. Representing queer families in their waiting room materials and

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offering alternatives to promoting femininity as the only way to be a pregnant person can create more queer-friendly spaces and put queer couples at ease before they go in for their appointments.

Medical forms. Most of the medical forms encountered by the queer women had an updated label of parent/parent instead of mother/father. Participants reiterated that inclusive forms were meaningful to them. Ava talked about how many of the forms still had father and either the medical staff or she had to cross out father. In her individual interview she stated, “It’s always exciting whenever I find a folder that I don’t have to cross out father.” The simple act of not having to cross out father was significant for Ava.

By having an appropriate label, Ava saw her parental identity as both accepted and expected. Some of the couples noted that the forms they received were already inclusive.

Heather said, “It was cool filling out the birth certificate form in the hospital, it was parent one, parent two.” It was a relief to not have to worry about how they would be identified on the birth certificate and other forms. By having parent or mother listed, the couple can be affirmed in their identity. As Bridget stated in her individual interview, “To put on Lily’s birth certificate that I am her mother, I mean, it’s a huge deal.” Through having inclusive forms that are readily available and not at an additional cost, queer parents can feel recognized and confident in their new parental identities.

Concluding Healthcare

The queer women in this dissertation discussed the multiple ways they have encountered and reacted to their healthcare. They attempted to navigate a medical system designed for heterosexual couples. There was no single correct way a couple should have

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responded. Being in a marginalized position, every choice the women made was typically made for self-protection. Heterosexism is exhausting in any setting. Attempting to create a family makes those situations even more vulnerable. The point of the chapter is not about what queer couples should do to combat heterosexism, but, rather, reflects on how queer couples have navigated those systems and whether or not they were able to break through the heterosexist power system.

Queer couples are just one actor in this system of power relations. Any change they attempt to make cannot be done in isolation. Healthcare providers need to work against the heterosexist systems through education, training, and continual work with the community, as do non-medical members of the healthcare establishment, such as security guards, receptionists, and others. The burden for change cannot be placed onto the queer couples alone. When I was speaking on a panel for LGBTQ healthcare, there were two providers who discussed their experiences working with the queer community. When they did not know the answer to queer patients’ questions or realized their education did not equip them with the necessary knowledge, they went out and educated themselves.

They did not make the patients provide self-care. These providers’ actions, to self- educate, and then promote education for other providers, can make a real difference in combatting heterosexism in healthcare.

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Chapter 5: “Biologically not Yours,” Communicating Heterosexism in the Public

and Personal

The dial tone rings as I wait for my mother on the other end. Good news

comes with a warning. My mother squeals with excitement when I tell her

that I plan on proposing to my girlfriend in the coming week. I pause, as I

move into the reason for calling. Caution. “Mom, I want to prepare you for

how your family might react.” Silence. She is confused. My mother’s family

is conservative. In the past, my aunt told my mother that she did not believe

gay people should be married. By posting my announcement on Facebook,

I was promoting an act that my aunt believed was most unholy. Weeks later

in another phone call, my mother expresses disappointment as she discusses

how her family did not congratulate me on an exciting life event. Ringing

silence from the end of her family. No congratulations. No

acknowledgement. The silence speaks volumes. Even in engaging in a

heteronormative practice, my extended family appears to not truly accept

me.

Society is riddled with heterosexist expectations (Herek, 2007), especially about what counts as a family. Family, through heterosexist assumptions, consist of a mother, father, and a few children that were reproduced through the mother and father. The queer couples in this study encountered heterosexism in interactions with strangers, co-workers, and family members. The queer couples also perpetuated and resisted heterosexism within their communication. Demonstrating that heterosexism is a system of power that

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functions at every level, the queer women encountered heterosexism at every level of their interactions.

The queer women’s experiences oscillated between non-acknowledgement and intense visibility. Queerness is a polarizing embodiment. Either the queer couples felt they were on display as queer people or they were erased through heterosexist assumptions. In this chapter, I look at how heterosexism was communicated in public spaces, workplaces, family communication, the expressed need for queer support, through partner support, and within themselves.

Public Expressions of Heterosexism

How queer couples experienced heterosexism changed with each stage of their families’ development. First, when the queer women were pregnant, they were both extremely visible and yet invisible at the same time. Pregnant women are under intense scrutiny from the public (Hequembourg, 2007). People want to ask questions and touch pregnant bodies without permission. Queer women are not exceptions to these phenomena. They still get the questions. They still get the scrutiny. In addition, heterosexism is projected onto them, as pregnant bodies are assumed to be heterosexual bodies. Queer women would receive questions about the father of the child, assuming there was a husband or father in the picture. Hilary talked about a comment from one of their neighbors, who they did not know well, after Hilary told him that Carmen was pregnant: “He’s like ‘Oh yeah, I noticed that. I wasn’t really sure about it. I ain’t never seen a boy around or anything.’” Hilary and Carmen laughed at this story, as they felt they were part of an inside joke that the neighbor just did not understand. They did not

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correct the neighbor and instead Hilary just said, “I was like yeah, yeah, no, no boyfriend.” Although Hilary agreed that there was no boyfriend, she did not say that she was Carmen’s partner and instead, left the conversation situated in heterosexist assumptions.

The heterosexist questions about fathers created awkward tension for the queer women. Many felt uncomfortable and did not want to disclose their identities to strangers. Ragan talked about what people asked her when she was pregnant, “I suppose most people would ask about husband or dad or something like that, dad’s very excited.

That type of thing.” In these questions, queer women would be asked about if the dad was excited for the upcoming birth, assuming there was a father in the picture. When I asked how Ragan handled those conversations, she replied, “I ignored it. And just, I didn’t really go into detail. I was just like, oh yeah. Very excited.” By stating that the dad is

“very excited,” Ragan would go along with the heterosexist script. With the invisibility of queer identity and projection of heterosexism, several of the queer women felt insecure about confronting those comments. Or perhaps, just tired.

The invisibility of queerness and the intense visibility of pregnancy seemingly created a lot of tension for the queer women. They were placed into positions, like

Ragan’s, where they were confronted with heterosexism. Yet, because the questions were from strangers, they seemed to be more nervous to correct them. Sophia described in her individual interview how she felt about being both pregnant and queer:

In my experience, being pregnant is that you become a lot more visible. So people want to ask you how far along you are, strangers want to talk to you and touch your belly and asking how far along you are. All kinds of personal questions… You’re so much more visible as a pregnant woman. People can be kind of

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intrusive and it put me in a position a lot more times to, uh, I did come out to more strangers than I maybe necessarily felt comfortable with.

For Sophia, the visibility of pregnancy also then placed her into a position where she felt that she had to come out to more strangers than she had been previously. When she was not pregnant, strangers would not come up to her and have conversations with her that stated an assumed heterosexuality. The visible presence of a pregnant belly brought her more attention and that attention came with spoken heteronormative assumptions. While other queer women just decided not to disclose, others felt a sense of duty to come out.

Sophia further explained her feelings of visibility:

If I ever decided, you know, to like, what’s the word, like kind of avoid it then that’s also a decision too, that carries a little bit of maybe guilt about not being 100 percent authentic about who I am and not creating a more inclusive space for the people who come after me and like it makes me feel sometimes responsible for not moving things forward.

Sophia admitted that there were times when she did not correct people’s heteronormative assumptions. The decision not to come out caused her some guilt, as she also believed that she was not creating an inclusive space for other queer people.

Pregnancy presented bodies as being heterosexual. The embodiment of a queer identity meant that strangers would articulate heterosexual assumptions. In the articulating of heterosexual assumptions, queer women then had to either go along with the assumptions or correct them. Being seen as a more visible body in public from being pregnant and simultaneously being erased as a queer person, placed queer bodies into a

(in)visible space. Uncertainty about strangers could prevent queer women from wanting to correct heteronormative assumptions. Queer women could place themselves in unstable positions because they would not know how the stranger would react upon

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learning the woman was queer. However, the choice to not correct assumptions perpetuates heterosexism, and as Sophia put it, potentially creating less space for future queer generations.

When the queer women had the babies, there were still heterosexist assumptions, but how they were articulated changed. Having the child in the picture, instead of the pregnant body, brought on more questions and assumptions from the public. Caroline shared a story about an experience she and Maggie had at their YMCA with their daughter:

Maggie was at the elliptical and I’m talking to the Y girl next to the YMCA emporium next to me and I said, “Well we’re going to go swimming as soon as mommy gets off the treadmill” and I’m like breastfeeding my baby and she just had this weirdest look on her face (Caroline & Maggie laugh). She didn’t know she was, like what was happening. Like did she think I’m the wet nurse? (laughs) Like wtf.

When both moms are visible in a space, whether through site or spoken into existence, people can become confused because they do not assume that both are the mothers.

Instead, many will assume non-romantic relationships between the queer women and assume that only one of them is the mother. For the YMCA worker, she was left with a lot of confusion watching one woman breastfeed and calling another woman the mother.

Based on the worker’s confused reaction, it appeared as though she believed there could only be one mom.

The queer women felt that many people would question their mother identities when out in public. Either strangers would assume that one woman was the only mother or strangers would outright ask which woman was the mother. Karen and Martha shared

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how some people who they encountered in public did not approach them with, as Karen put it, “respect:”

Karen: We’ve had people when we’ve gone out ask whose kids, like we went out with our oldest son and they said, “Oh, who’s kid is that?” Like we’re both there, that seems to happen a lot like, “Who’s kid is that?” “Who’s the mom?” Stuff like that. So I never get that when I go out with my sister and the kids. Where we go out, she and I go out together people want to know who’s the mom. Like, “Who’s kid is that?” Martha: Right. Karen: Very weird. Martha: Like in the grocery store. Karen: Yeah in the grocery store, at Target, like the cashier at Target.

Karen and Martha discussed how when they were out in public, such as the grocery store or Target, they would be approached by strangers asking who is the mother of the child that is with them. In their question, it seems to be they were assuming that only one woman can be the mother. Karen also noted that when she is out with her sister and the kids, she does not get the same questions. It could be because she and sister behave and look like sisters so that strangers can then assume that they have a non-romantic relationship. The assumption of a non-romantic relationship then leaves room to assume the mother of the children is heterosexual, as there is an absence of a romantic partner.

Regardless, strangers asking, “Who’s kid is that?” and “Who’s the mother?” implies only one woman can occupy a mother identity. Karen discussed in her individual interview the frustration she had with these questions:

Random strangers when we were out would question whose kids they are? Like “Who’s kid is that?” Like it’s ours. Like, “Oh, who gave birth?” Like, why does it matter? I don’t know you. Like I don’t know if they, I don’t know if we’re the only ones who get that and I don’t know if it’s because Mason looks so much like me that they don’t know who gave, but I just don’t understand the need to know. Like if I see a woman with kids, I don’t question whose kids they are.

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Karen articulated that when going out as a family, people would question the parental identities of their children. As Karen pointed out, these questions rarely occur for non- queer couples or women who are out with their children on their own. Because heterosexism assumes that parents are a mother and father, having two women present creates confusion for strangers. Only one can be the real parent. If both women are stated to be parents, strangers may feel a need to ask who the birth mother is to find, who they believe is the real mother.

Another question that can occur when out in public revolves around the conception process. When strangers recognize that two women are the parents of the child, strangers become curious as to how the queer women became pregnant. Laura talked about how she was approached in places like the grocery store when she was with her triplet sons:

When we’re out in public, when we get these questions, like I’m trying to be friendly because this could be a possible play date or just to be polite. And I’m like, you think you’re getting to know someone and be like “Oh hey, where are you from?” And so like are you supposed to do the same kind of dialogue when you’re meeting a new person and they’re like “Oh hey, how’d you conceive?” I’m like am I supposed to ask that back to you?... it just feels uncomfortable and awkward and when you ask the question back they just look really offended… But then if you ask if their children were planned they just look offended. I’m like exactly.

Laura and Edyth constantly would receive questions about their fertility process when they were out in public. Being new to the area, Laura wanted to try to develop relationships with people that she met. However, when constantly getting inappropriate questions from strangers, she felt more isolated and frustrated. In trying to have a social conversation, she would ask the same questions back to the strangers, who would become

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upset. As Laura stated, that is exactly how she felt. When strangers ask how Laura and

Edyth conceived their children, a few things could be happening. First, they could be asking specifically how triplets are conceived, assuming fertility treatment, which is still an invasive and inappropriate question to ask strangers. Second, they could also be recognizing that Laura and Edyth are a couple, as Laura was describing when “we’re out in public,” stating that Edyth is there with her. The strangers’ conception questions are then based in Laura and Edyth being a queer couple and then conception is considered unheard of or confusing because a man is not directly involved. Finally, strangers may not realize Laura and Edyth are a couple, but the question is still inappropriate and intrusive, something that heterosexual people are not asked as the strangers were affronted when Laura reciprocated the question. Through stranger questions about conception, they were treating Laura and Edyth as a curiosity, potentially as both a queer couple and parents of triplets.

The last tension that occurs with identity and children is how the presence or absence of a partner creates (in)visibility of queer identity. Brittany in her individual interview talked about how she felt about her queer identity in relation to parenthood:

I’ve never felt more out in my life as a I have as a queer parent with my partner, actually. Like it’s much harder to hide your queerness when you have a kid. I think in a way, I mean in certain ways when it’s just me and the baby, I feel like all my queerness becomes invisible. But when it’s me and my partner and the baby, I feel like we are very, very visible and especially the older that she gets and when she starts being verbal and talks about both of us.

Having two women with a child, as discussed, may incite questions and therefore visibility as queer parents. However, when only one mom is present, heterosexism is not visibly disrupted. Strangers then assume heterosexuality of the parent, as nothing present

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disrupts that assumption. Yet, as Brittany pointed out, when their daughter becomes more verbal and articulates both women as parents, they can become increasingly more visible.

Heterosexism exists in the questions about parental identity. In addition, heterosexism exists when people do not ask questions, assuming that the woman with the child is heterosexual. The way that heterosexism would not exist in these scenarios is when a sexual identity is not assumed and when recognizing a queer family, there is not a need to know who gave birth, as the answer should not matter.

Based on questions received from strangers about family identities, the queer women articulated a need to have a clear family story for their child. They wanted to feel comfortable in telling their family identity. Having comfort in their identity can then be transferred to their child, communicating that their family is just a different type of family. Sometimes, the initial confrontation from strangers resulted in awkward moments that made the queer women feel the need to find a shared family story. Lynn and Megan discussed an interaction with strangers that they had in a restaurant:

Megan: I was holding her [their daughter] at the time and this lovely old couple, grey hair, super sweet, from the south, she looked at her like, “Does she look more like you or the father?” I’m like, “It’s Lynn’s baby!” Lynn: She like handed the baby to me and was like “It’s her baby!” I was like, we really need to figure out how to respond when people ask us who’s like, who she belongs to because we need to get confident in that so that when she’s older then she’s confident enough. And so I went on like a mommy website and I was like, “How do you guy’s respond like when people ask who the dad is?” And everyone’s like my wife says I’m the dad, we make jokes about it, we do all these things. And so after we like decided oh, we’re both the parents and there is no dad. There’s just a donor and we were comfortable with that. We were out somewhere else and somebody asked, “Who does she look more like the dad or the mom?” And Megan was like, “We’re both the moms!” Like she was so excited because we got comfortable in this decision.

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In their story, Megan animated the scene for me. After the couple asked the question of

“Does she look more like you or the father,” Megan mimed handing over the child to

Lynn as she said, “It’s Lynn’s baby!” The movement was rapid, and she exclaimed the sentence to indicate a panicked energy. After the interaction with the older couple, and

Megan’s insecure response, Lynn and Megan realized that they needed to find a way to appropriately answer those questions, as those questions were most likely to continue as their child got older. Furthermore, they also wanted their daughter to be self-assured in her response as she became able to answer questions from strangers. When seeking out answers from other queer parents, Lynn and Megan considered how some parents responded with jokes or had more straight-forward answers. After thinking about those options, Lynn and Megan decided that they were both the most comfortable with saying that they were “both the moms.” While there were several options, it mattered for Lynn and Megan that they were able to respond to questions with comfort so that their daughter, in the future, can respond with security.

The future of their children was important to the queer couples. As their family no longer consisted of just the two of them, they wanted to find ways to tell their family creation story to their children and others. Brittany’s advice for other queer couples was about how, “The more you tell your story and you practice it, even before your kid can understand, it becomes part of the story you tell about your family and then you’re way more comfortable telling that story.” By practicing a shared story, the families can become comfortable and have a clear narrative that can be shared with others when they are confronted. Bridget felt that comfort was incredibly important for her daughter. Prior

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to her daughter’s birth, Bridget was not out to her co-workers and referred to her now wife as her “roommate.” However, as soon as Lily was born, she felt a need to come out.

She explained, “I’m not ashamed so I don’t want Lily to feel ashamed to have two moms.” By coming out, she was showing her daughter that being queer is not a shameful identity, but one of which to be proud.

The queer women in this study were not alone in their feelings of (in)visibility.

Priddle (2015) found that when queer people become parents they have a whole new layer of coming out into which they are forced. The layer of coming out involves the decision to promote diverse sexual identity that counters expectations of heterosexism or feed into the heterosexist framework and remain invisible. Chabot and Ames (2004) found that lesbian women can be made to feel an invisibility of sexual identity when pushing a stroller because people do not see women with children as anything but heterosexual. The public narrative of motherhood is one of heterosexuality and those who fall outside of it are either ignored or ostracized.

The belief that everyone is heterosexual is the underlying principal of heterosexism (Pharr, 1997). When the queer women were out in public, pregnant or not, they were assumed to be heterosexual. A pregnant body does not break that assumption, but often reinforces it. The reactions from the public are not just about assumptions, but also about reinforcements. In considering how the public responded to the pregnant bodies, those that made heterosexist comments to the queer women in this study impressed upon the queer women that they are heterosexual by asking questions about the assumed father and husband. There was no consideration of a partner who would not

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be labeled as the father. When members of the public state heterosexual assumptions, they are surveilling the queer women by stating this is who you must be. As Foucault

(1977) reiterated, “Our society is not one of spectacle, but of surveillance” (p. 217). The strangers in the interactions with the queer women were not just spectators of sexual diversity but corrected the queer women’s identities through the stranger’s assumptions.

By imposing heterosexual identity onto the queer women, the public was correcting a deviant behavior, a behavior that cannot exist. Sex and sexual identity are not considered private issues. The public has a “web of discourses, special knowledges, analysis, and injunctions settled upon it” (Foucault, 1978. p. 26). The discourses and analyses are based in heterosexuality. The strangers could only talk to the queer women through heterosexual assumptions such as asking about the dad’s excitement and asking who the mother is. There is no other part of the discourse that would suggest that two women can be in a romantic relationship and have their own children. When the public asserts heterosexual identity onto queer women, they are imposing an ideal that has already been dictated as an acceptable identity.

A pregnant body being a visible body imposed a challenge for the queer women.

By being a focal point for their embodiment of reproduction, they were now under more intense scrutiny. As Foucault (1977) asserted, “visibility is a trap” (p. 200). By being visible as pregnant women, they were forced to decide to counter heterosexism or be active participants in heterosexism. Heterosexual women are not placed into that same bind because the assumptions are accurate and because living as heterosexual women reinforces assumptions about sexual behavior and identity. They are allowed to have

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more privacy because, “The legitimate couple, with its regular sexuality, had a right to more discretion” (Foucault, 1978, p. 38). Queer women, both pregnant and those with children, lose a right to basic privacy. They can access privacy only if they choose to not disclose their sexual identity, thus being more private yet more invisible. In gaining privacy, they then perpetuate heterosexism by not correcting the heterosexual assumption. When being placed in public scrutiny, as both pregnant women and then women with children, the public surveil the queer women by promoting a heterosexual narrative.

Communication in the Workplace

Heterosexism is not reinforced only by strangers, but also by acquaintances such as co-workers. How co-workers reacted to the pregnancies differed, ranging from negative reactions creating an adverse atmosphere to positive and supportive environments. Negative experiences were rooted in male dominated work spaces that promoted hostile beliefs about women and pregnancy. Positive experiences had the potential to reinforce heterosexism through gender roles or resist heterosexism through recognizing queer identities.

Several of the queer women worked in male-dominated industries or had predominately male co-workers. While being male is not inherently bad, their reactions to the pregnancy were inappropriate or they presented a belief that pregnancy was not relevant to the workplace or their employees. For example, while Lynn, the birth mother, had a very supportive workplace, her wife Megan was in a primarily-male environment.

Megan’s job was a fleet manager and the other employees were mostly men. Because of

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the male-dominated work space, Lynn and Megan had very different experiences. Lynn explained, “I tried to get them to throw her a baby shower and the whole place was like, nah, we’re good on that.” Lynn was disappointed that Megan did not get to have the same warm embrace that she had from her co-workers, but she understood that, “It’s not the same industry.” Megan described her work in her individual interview as, “high stress get your shit done, put your head down, kind of workplace.” Because of this attitude, she did not have a lot of connections and although they knew her wife was pregnant, they did not express interest, except for one female co-worker. Due to the nature of her job, Megan was not able to attend several of the prenatal appointments and had a shorter family leave. While one could assume the reaction was based on Megan not being pregnant, some of the other co-parents did receive baby showers from their co-workers, were allowed more time for appointments, and had longer family leaves.

Beyond missing experiences, male-dominated workforces did not know how to communicate or process maternity needs. Natalie worked in a law office where the ones in a position of higher power were men. At one point, when discussing another potential worker’s family leave, Natalie discovered that the men in her office did not understand what family leave looked like. Natalie shared the story in the couple interview:

There were four of us in the company when she was born and at that point I worked for two bros. They were 35-year-old single men with no longer term relationship history…The firm was looking at hiring someone who I knew was pregnant and I told the guys and one guy’s response was, “I don’t know if we can afford six months of paid maternity leave.” And the other guy’s response was, “I was thinking six weeks of unpaid maternity leave.” And I was like well neither of those is going to work… So like I knew that they basically, I was just going to have to tell them what it was going to be.

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Natalie discovered that the men did not know how long family leave should be and had very different ideas as to what family leave should involve. At the time, Natalie had just become a salaried employee as an attorney. Her leave ended up consisting of one-week paid leave and two weeks of working from home. In her absence, the men in her office did not initially recognize that they would need to hire someone to cover Natalie’s duties.

Natalie stated, “Two days after family leave started they hired a paralegal and she started the next day because they were unprepared for me to not be there.” It was clear that the men in her office did not have a conception of what family leave consisted of and how it may impact the office. In Rachel’s current pregnancy, Natalie hoped to have three weeks of paid family leave without having to work. She discussed talking with her now law partner about hiring an additional attorney to cover the slack but doubted whether the law office could function without her, stating “We’ll see how many times my paralegal calls.”

Male-dominated work forces seem to struggle to understand how typical family leave functions, in addition to how family leave might look for co-parents.

In my participants’ workspaces, men also had inappropriate comments about pregnancy and infant-related topics. Maggie stated in her individual interview that,

“dudes say the most absurd things.” When I asked what those comments were from her co-workers she explained, “Like, ‘if you don’t want her to have another baby, make her breastfeed because sore nipples are the best birth control on earth.’” Maggie was insulted by this comment, as it was upsetting and highly inappropriate. Because male co-workers did not know how to treat women, particularly the co-mothers, as Megan, Natalie, and

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Maggie were all co-mothers, some of the queer women were left feeling uncomfortable or pushed aside at their places of employment.

Basic heterosexism and discriminatory remarks also occurred at the queer women’s workplaces. When reflecting on their places of employment, several of the queer women shared stories of how their jobs were not always queer friendly. For example, Ava thought about how Sophia’s principal had negative attitudes towards queer folk. She stated, “A student said I’d like to start a GSA. Sophia went to the principal and said this kid would like me to sponsor a GSA, she said ‘Oh we don’t want to encourage that do we?’” The principal clearly did not know that Sophia identified as bisexual, regardless, the principal was promoting homophobic beliefs. Other moments may not have been as blatant. For instance, Laura found out that when she was on family leave, they cut her position. While she cannot know if it was her sexual identity that caused the reason for the dismissal, or if it was a simple violation of the Family and Medical Leave

Act of 1993, it does suggest an unwelcoming environment.

Beyond co-workers, customers or clients in workplaces can also make the places hostile environments for queer folk. Olivia talked about an incident she had when providing care at her hospital:

It was right around the time of the Supreme Court thing, I walked into a patient’s room to do a breathing treatment and her husband was watching the news and he was just going off about gay marriage. And I just, I turned around, I walked out, I went downstairs to my boss’s office and I just sat down and cried.

Fortunately, Olivia’s boss was understanding and provided support for Olivia in that moment. However, working with patients who can articulate homophobic beliefs can put queer individuals into a space where they feel guarded. Queer individuals may feel

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hesitant to share about their families or reveal their queer identities. After that moment,

Olivia said, “I’m not going to put myself out there at work like that.” Having unfriendly workplaces can put queer women on the defense or only allow them to speak partially about their lives.

Another area of difficulty in the workplace was about how co-workers struggled to comprehend a co-parent’s role. These can be simple moments where co-workers do not understand why a co-parent would take time off. Faith stated, “The people I work with, they were like, ‘Why are you going on maternity leave? You’re not having the baby.’”

Because Faith was not the birth mom, people in her work could not process why she would be taking a maternity or family leave. Here, heterosexism also functions to hurt men who would also benefit from taking family leave when they and their partners have children or adopt. One of the difficulties that hurt Faith and most likely men is that we still refer to family leave as maternity leave. Maternity leave suggests that the person taking the leave will be the one to give birth. Other experiences went beyond just a misunderstanding. Edyth’s department chair at her university was less than supportive when her triplet boys were born early and had to spend significant time in the NICU.

Laura shared the story in their couple interview:

Even with all the advanced planning her department chair was just ridiculous like coming to the hospital requiring Edyth to meet with her and requiring Edyth to come in to work like a few days after the boys were born… they’re like well, you need to teach classes. I’m like what if she was the gestating parent? Like you would have had to figure out something for her to be off for three months… her department chair specifically was just ridiculous, hounding her with you need to meet with me… was very pushy and very difficult and unreasonable when they knew this was coming for many months, before the semester had started, like you can make a contingency plan for someone else to cover your class.

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Due to the nature of their triplet pregnancy, Laura and Edyth knew that she was at risk for going into labor early and that they could spend significant time in the hospital. They both warned their superiors and attempted to prepare for the inevitable hospital stay. Yet, when the time came, Edyth’s department chair would not allow for her to take the time off, requiring her to teach her classes and have one-on-one meetings, all while their boys were undergoing intensive care. As Laura pointed out, this would likely not have happened if Edyth was the birth parent. Edyth’s department chair did not respect their and did not extend understanding for a family that was in a crisis.

While some of the co-workers were clearly unsupportive, others would present the guise of support and then not follow through when the time came. Tiffany’s co- workers said they wanted to throw her and Peggy a baby shower after finding out that no one was hosting one for them. Even though Tiffany was not the birth parent, her co- workers wanted to show support. However, the shower was never scheduled, and Peggy had to go in for an induction prior to the due date. Tiffany explained in her individual interview what happened after their son was born, “I think the weird thing for us is they, like after he was here, nobody really came to see him or us and really worried about how we were doing or anything like that.” Although Tiffany described how her co-workers initially seemed to be supportive, when it came to the birth, they were largely absent.

Tiffany stated, “I think it was a little difficult to swallow sometimes, because you think people care and then all of a sudden it’s like your opinion of how people act towards you is different than how they truly do.” The lack of support suggested to Tiffany that her co-

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workers really did not recognize her family and ignored their new addition. Her views had now changed, and she seemed to be more distant from those co-workers.

Not all the co-worker experiences were negative. Several of the queer women discussed how supportive their workplaces were. Many of the places threw baby showers for the women, mostly for the birth parents. Christie and Erin worked at the same restaurant and both found their co-workers to be supportive and encouraging. Christie said, “People from the restaurant gave us gifts and just gave us words of encouragement and wisdom, kept us in their thoughts and stuff.” They were embraced by their workplace and after their daughter was born, would bring her by where she was known as the “front room baby.” Hilary felt that her co-workers were also very supportive and was surprised when they threw her a baby shower, even though she was not the birth parent. One of her co-workers spearheaded the shower after finding out that no one was throwing her one.

Hilary said in her individual interview, “It was her idea to have a baby shower for me/us because she was like, oh, I know that my wife wanted to feel as included as possible.”

Because her co-worker was also queer and understood the co-parent experience, she went out of her way to make sure that Hilary felt just as included in the pregnancy.

Beyond baby showers and general sentiments of support, other queer women had co-workers and bosses that made sure they were taken care of. Caroline talked about how her boss “made” her stay home when she was ill during her pregnancy:

You know when I was so sick that they almost hospitalized me, like I was like [to her boss] “It’s okay, I can make it in tomorrow morning.” She’s like “No, I want you to stay home for two days. You need to stay (laughs), do not come to work.” I’m like “I really,” she goes, “No, if I see you here I will be angry.”

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Recognizing that Caroline was very ill from her pregnancy, Caroline’s boss made her take days off so that she could rest, and threatened her if she were to come in. Because of this gesture, Caroline felt very supported in her pregnancy and was able to take some days to rest, especially since she was almost hospitalized due to the amount she was throwing up and losing fluids. While other bosses may be annoyed with a pregnant woman who must take time off because of the pregnancy, her boss encouraged her to stay home and take care of herself, something she really needed. Others felt cared for by having co-workers embrace their new addition to the family. Although Bridget was not out prior to the pregnancy, she shared with her director about how her wife was giving birth and sent him information about their daughter. Bridget shared her experience in her individual interview:

The athletic director, I told him when Lily was born, I sent him a picture, several pictures of her and he was like, “Is it alright if I sent out an announcement?” Cause he always sends out announcements… So he asked me first if I cared that he did that and I was like no, absolutely not. I’m so proud, go for it. I think they were shocked by the initial email cause I don’t think any of them knew that I had a wife… but I was touched by the outpour of support that I had with them.

Bridget’s director made sure that Bridget wanted the information shared, potentially because he knew that he should not out Bridget without her permission. Even though

Bridget’s co-workers did not originally know about her wife, they gave her a lot of support once they found out she had a child. Bridget was also able to be on family leave after Lily was born.

One potential reason for having an abundance of support is when workplaces or work cultures are openly supportive of queer folk. Ragan found that she had a lot of support when she was trying to get pregnant. Her boss allowed her to take sick leave for

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her IUIs and some of her co-workers were “excited about seeing ultrasound pictures.”

She then explained how her job might have set her up for this type of support, “I work on an Indian reservation and being gay in the Crow culture isn’t necessarily something that is a negative thing.” Because queer identity is already supported in the culture, Ragan felt that her family was being embraced in her workplace. Whether it was based on cultural expectations or workplace culture, several of the queer women were embraced by their co-workers for the new addition to their families.

The queer women’s experiences were in line with the one study on queer pregnancy in the work space (Hennekam & Ladge, 2017). Birth parents were often supported as any other woman in the workplace who had been pregnant. Co-mothers were only granted that support if the workplace was actively accepting of their identities and families. One workplace projected support but then did not provide support once the child was born. This one example could be based on the workplace or it could be a moment of heterosexism from the co-workers.

Heterosexism existed in the workplace when co-workers made inappropriate comments. In reinforcing male-centered work spaces, the co-workers in those cases were perpetuating both sexism and heterosexism. The queer women in those spaces were both being denied experiences as women and queer women. As women, several of their co- workers made sexist comments to them, sometimes treating them as if they were one of the guys. Furthermore, their queer identities were also discounted because places would not always recognize the co-parents’ roles as equal mothers. Surveillance also functioned in these spaces by discouraging behaviors that the workplace deemed unacceptable such

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as being on family leave for non-birthing parents. When Edyth’s chair forced her to perform work duties during the difficult time of their family’s hospital stay, she was punishing the behavior of being an active mother, denying her the identity of being a second mom. Edyth’s chair may be invoking surveilling behaviors that speak to what a good worker is (Zoller, 2003) and in this case, the good worker does not include an active parent identity. Or, perhaps Edyth was being positioned in a male, father role and a father that is a good worker does not take the time off.

When considering supportive work spaces, heterosexism can be more complicated. Part of heterosexism is also the reinforcing of gender roles that contribute to sexism. For the birth mothers, they were often supported by their workplaces, particularly for those who worked in education. They were given baby showers and many of their co- workers expressed excitement. Yet, those spaces often reinforced sexist expectations of women. Those who work with small children can be assumed to have children of their own. Elisa explained in her individual interview what her workplace was like:

I kinda think elementary education is like the best place to be pregnant because it’s run by a bunch of women and usually like childbearing age women… so it was just an easy place to be pregnant because everyone else was… And like it wasn’t like my principal was like frustrated or upset that I’d be on maternity leave. She expected it from her staff, frankly. That you run a building where all your teachers are, you know, 25 to 35, they’re going to have babies (laughs).

Elisa felt that she was able to receive an abundance of support from her co-workers and boss due to the environment of elementary schools. Here, she stated that she felt it was just expected that women in her profession would become pregnant. Her statement expressed a potential for internalized sexism, as women are simply expected to just become pregnant because they work with small children. Therefore, while she may have

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felt support, the support might have been based in sexist expectations of women that, regardless of sexual identity, women may still be expected to procreate.

There may be a key difference in how workplaces provided support to women that either reinforced heterosexist/sexist expectations of women or resisted heterosexism.

The workplaces that went beyond good worker expectations and provided key leave time when the queer women needed it resisted power dynamics. Individuals in these workplaces provided support in ways that helped the queer women during their time of health needs such as receiving IUIs and intense nausea. In addition, workplaces that promoted baby showers for the co-parent could be resisting heterosexism by embracing their mother role even if the queer woman was not pregnant. However, those workplaces that promoted sexist expectations of women may have contributed to heterosexism by treating them like other heterosexual women who are expected to become pregnant. Even if the queer women felt the acts were supportive, their feelings may also be based in internalized sexism.

Family Communication and Support

Workplaces provided examples of communication that resisted or reinforced heterosexist expectations and those roles were often by those at a social distance from the women as co-workers. Communication and support that reinforce or support heterosexism also came from family members, who appeared to be more influential. The queer couples had varying reactions from family members during their pregnancy and birth of their children. Several family members reinforced heterosexist expectations and others provided key points of support.

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Family heterosexist expectations. Part of family responses included emphasizing heterosexist expectations. In considering how families are formed, most family members were already comfortable with heterosexual conception. It was the process of conception for the queer couples that caused discomfort and confusion. Some family members did not know how the process worked. Lynn described how Megan’s mom talked about the conception process to other people, “She was telling people that like we mixed our DNA together, like in an egg, like a scrambled egg.” Even with this misunderstanding of how Lynn became pregnant, Lynn did not feel comfortable walking family through the details of their conception, “where’s like family’s just kinda like eh you’re pregnant bleh bleh like that’s all I need to, you know like? Megan’s parents didn’t really need to like know, like the in-depth about it.” While Lynn was comfortable sharing details with friends who were curious, she did not share those same details with family members. Potentially because family members either subtly or more explicitly expressed discomfort to the exact details of how the queer women became pregnant, they were reinforcing heterosexual ideals of conception. Particularly by not attempting to familiarize themselves with queer conception and spreading misinformation, family members can be perpetuating heterosexist understandings of how conception only happens with heterosexual couples. Other family members expressed negative and inaccurate thoughts about the process of becoming pregnant for the queer couples.

Brittany shared her mom’s perspectives on sperm donors, “My mom is very worried that there’s no vetting of these donors and that maybe it was somebody who just, like a heroin addict who just rolled in off the street.” Knowing that sperm donors go through a lengthy

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vetting process, Brittany knew that these thoughts were incorrect, but her mother we convinced otherwise. Her mother might have suggested that heterosexual conception is safer with the belief that we know the father, even though heterosexual couples may know less about the health of the man than Brittany would know about the sperm donor.

Other families struggled with a combination of how the conception occurred and how to discuss the sperm donors. Faith and Elisa talked about their experience communicating with Faith’s family:

Faith: When we were going through the process, just some inappropriate comments like grandpa, “How do you get pregnant?” You know and just like, “Well, we picked a sperm donor and the doctors do it.” And like the funny thing was like my family was very insensitive about it. But like my brother was going through IVF at the same time as us. So I’m like, “We’re doing it the same way Mike is.” You know? But people just wanted to make a bigger deal with it than it was. We’ve gotten a lot of inappropriate questions of who carried? Why did you choose that person to carry? What else did we get? Your [Elisa] mom decides to call the donor dad and we had to. Elisa: We had to tell her no. Faith: We had to correct that real quick and we were just getting mad and mad. So we lived with Elisa’s parents for the last ten months until a month ago and Elisa’s mom would just keep on talking about the dad and we’re like nope, the donor is Donor Dude. That’s what we call him, Donor Dude. And we’re really thankful for his gift. But it’s Donor Dude. He’s not Chloe’s dad.

Faith expressed frustration at her family not being able to understand the IVF process that both she and her brother were simultaneously experiencing. It appears that their family could not understand based on heteronormative expectations of family. Families seemed to believe that IVF was a way for heterosexual couples to conceive after struggling with fertility, not a process queer couples go through to become pregnant. Furthermore,

Faith’s family also seemed to understand that Mike was the biological father and his wife would be the biological mother. There was no additional mother involved and they knew

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who was contributing sperm, unlike Faith who was using a sperm donor. Moreover,

Elisa’s mother had difficulty talking about the sperm donor and kept referring to the donor as dad, connecting biology to a parental identity. The combined frustrations reiterated heterosexual expectations of family, as the family members could not comprehend queer constructions of family, even if they go through similar processes as heterosexual couples.

In considering the multiadic analysis in the couple conversation, Faith and Elisa talked about how both of their families struggled with talking about their conception process. However, in Faith’s individual interview, she only talked about how her family was negative and praised Elisa’s family. Faith had a difficult and strained relationship with her family, a relationship that was based in abuse, whereas Elisa’s family had better relationships. In fact, Elisa and Faith lived with Elisa’s family for a period of time after

Chloe’s birth. Faith said, “My family was not as good as her family and Elisa’s family was just wonderful the whole step of the way. Like they were praying for a donor.” Faith omitted the part where Elisa’s mom kept calling the donor dad and overly praised their reactions. Her response could because Faith had had mostly negative experiences with family, those directly attributable to heterosexism and those that are more indirect like the history of abuse, while Elisa had had more positive experiences. By having a comparison, one positive and the other negative, there could be more of a balanced experience.

Some families took a while to come around to the idea of children, particularly for the parents whose child was not giving birth. Jackie and Danna talked about how Jackie’s parents struggled to process their growing family:

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Jackie: Every pregnancy we told my parents and they’re just like, oh. Danna: Well this third one, they were almost, they were like I can’t remember what they said but it was almost like. Jackie: My dad was like, “I would have stopped after one.” And I’m the third. Danna: She’s the third kid in their family and I’m like, do you guys realize what you’re saying? But it was like they were stressing for us. Jackie: They were like, “Oh no, not again.” Oh, you know kind of thing. Danna: “You’re going to have to move.” Well. Yeah it was just totally like nothing like congrats until like the next day I think they were like, “How do you feel?” Jackie: No, the next day my dad was like, “So when’s this all happening?” And I was like what are you talking about? “You know, that thing that’s in her belly.”

Jackie’s parents were not described as being overly accepting of their family, but almost as merely tolerant. In the conversation, Jackie attempted to justify her parents’ reactions by saying how her mom is just not the kind of person who asks about things like ultrasounds and that, “you can see they actually, they enjoy the grandkids.” Her parents may indeed enjoy being with their grandchildren, but their communication did not suggest support, but rather discomfort. Originally, Jackie’s father could not articulate a potential baby and instead said, “that thing that’s in her belly.” By not being able to openly discuss a new grandchild, Jackie’s parents expressed uneasiness about Jackie and

Danna’s expanding family.

Part of the family discomfort surrounding the pregnancy can be connected to prioritizing biological relationships. Several of the grandparents seemed to have felt they had a better connection to their grandchild if they had a biological tie to the child. Jamie discussed in her individual interview how her dad described their children, “My dad has been like, ‘Well Riley’s my blood.’ And I’m like dad you can’t say that shit. Like, you know, you have to treat them equal.” Jamie and Heather had each given birth to one of their children. Jamie found that her father was favoring Riley, to whom she gave birth.

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Heather discussed similar issues with her side of the family in her individual interview,

“You can tell they’re preferencing, like the preferencing is happening, a little favoritism… I mean they love Riley and honestly it would feel easier to not have to fight a little bit for that.” Heather gave birth to Joshua, and because of this, Heather’s family favored him more than Riley. Interestingly, Jamie and Heather did not have this same discussion in their couple interview. It was only in their individual interviews that they talked about favoritism that was occurring for their biological children.

There were a few couples who both gave birth to their children, like Heather and

Jamie. Their dual pregnancies allowed for comparisons on how their family treated both the couple and their children. Sydney would receive remarks from family and friends about Amber’s identity as a parent. She discussed her experience in her individual interview:

There’s definitely weird moments that come up where, it’s sort of like Amber’s not referred to as one of the parents. Like one of my uncles, like looked right at Amber and was like, “Oh, is that, like where’s Sydney’s daughter?” So there’s definitely, you know, little things that have come up like that. Or like after Amber gave birth, she had a friend who wished her a happy first Mother’s Day. She’s like, “Thanks, I’ve been a mom for three years.”

Sydney’s uncle and Amber’s friend articulated that the only way to be a true parent was to be biologically connected to the child. By saying, “Where’s Sydney’s daughter?”,

Sydney’s uncle was implying that Amber could not be a mom to that child as she did not give birth nor have a biological connection. Further, by Amber’s friend implying that

Amber was having her first Mother’s Day only after having given birth emphasizes biology as true parentage.

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Grandparents have demonstrated how they do not have as strong of a connection to their grandchildren who are not biologically tied to them. When Olivia was pregnant with their first child, her mother told her, “There was no way Ragan’s parents could ever love this baby that was growing in me as much as she could,” reinforcing biological logic. While Ragan’s parents did not behave that way, and really supported Olivia and

Ragan in their new child, Olivia’s mom had a harder time when Ragan gave birth. Olivia noticed that her mom did not behave the same way when Ragan was pregnant with their second child. She explained the differences in the two births during her individual interview:

Skylar was born in February. My mom didn’t meet him until July when we took him back to Michigan… both of my brothers’ children, my mom was at the hospital waiting for them to be born. I remember her being up at five in the morning curling her hair to go. When Delighla was born, she was there waiting. When Skylar was born, she was nowhere around. Actually, Skylar was born February 15th. In March, her and her boyfriend took a road trip. They drove from Michigan to the Florida Keys and back. So you know, it’s not like she didn’t have the means to travel or the ability to travel. She chose to go to Florida instead of coming out here to meet my son… And sometimes I wonder if she was trying to tell me something when she was telling me that Ragan’s parents couldn’t love Delighla like she could.

By looking at how Olivia’s mom reacted to both her children being born, she could see that her mom favored the child to whom she gave birth. Like Olivia, many of the queer women who experienced a distancing of their grandparents from their children was one of surprise, and some are still grappling with the idea. Sophia, in her individual interview, attempted to process how her family treated her son differently compared to her nephew based in having biological ties to the family. She stated, “My parents, there seems to be, like blood seems to matter in a way that I would have never told you.” Regardless of how

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the queer couples conceptualized their family, grandparents and other relatives can struggle with the lack of a biological connection to the children.

With or without biological connections, children play an import role in fulfilling heteronormative expectations of family. There is an expected progression of dating, marriage, home, and then children. Queer families can have those same expectations projected onto them. Grandparents often promoted heterosexist scripts for the queer couples. Christie talked about how her dad initially struggled with accepting her sexual identity and relationship with her wife Erin:

One of the biggest supporters that surprised us was my dad because he was very close minded about our relationship initially… he was really against, not against us, but unsupportive of us for a long time… when we told him, I think he actually went into this back room and cried…. This man that once upon a time was like, it’s just a phase. No two women belong, deserve to raise a baby or have any right to raise a baby… It was just like, you know, like my homosexual daughter can still have a family, can still live a normal life, can still have a child if she wants.

In the beginning of Christie’s relationship with Erin, her father had hateful ideas toward queer people. However, once he realized that his daughter could have a “normal life” he became more accepting. By being able to complete the heterosexual life script, as

Christie and Erin were also married and had their own home, Christie’s dad was able to embrace her life as it looked like ones he understood, just with two women.

Babies can act as ways to solidify a life script for queer couples. Weddings do not always provide enough of a link to a heterosexual lifestyle that families can accept.

Having a child, however, fulfills the heteronormative script. It is the end game. If queer couples can reach that point, they can be accepted. Jamie and Heather were very simple in their discussion.

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Jamie: They wouldn’t come, they wouldn’t participate in our wedding because it’s against their beliefs. But then. Heather: But anyway, through the pregnancies, like everyone has kind of gotten on board.

Heather’s family had strict religious beliefs that were against queer couples’ rights to marry. However, as Heather put it, through the pregnancies, her family was able to be more accepting. Lynn and Megan went the “nontraditional” route by having their wedding after their child was born. Initially, they believed that more people would be excited about the wedding. Megan shared her thoughts about the situation in her individual interview, “We thought people would probably be more focused on trying to make that event then what may happen with Jamie coming… it turned out to be the opposite?” They were planning their wedding at the same time as Lynn was pregnant, and they believed that more people would try to attend the wedding than be there for the birth. However, they found out that the opposite was true as more people were concerned about being present when their child was born. Megan went on to say, “I guess when people talk about babies they just get really excited.” Babies are a bigger deal than the wedding, and more relatives emphasized births over the ceremonies. Other couples mentioned similar reactions where they compared how their families responded to the wedding compared to the birth of the child. Faith explained how her mother responded,

“Until the birth of our child, my parents never visited… like four years of not visiting me in [city in Illinois] and then the baby’s here and she came three times.” For some it was about religious convictions, and for others, it seemed to be more about reaching that final heteronormative goal of reproduction. As marriage is only the second step in a heterosexual life script, having a baby is the final stage. Family members may be more

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accepting of the queer couple once they can see that they are just like any other heterosexual couple, having been able to reproduce their own children.

While some family members were able to celebrate reaching the end of the heterosexual life script, others seemed to reject the children through their silence.

Unfortunately, several of the couples found family members would not be present immediately after the birth or communicate about the pregnancy and birth. The silence was often noticeable. Grace described how her aunt did, or rather did not, respond when her wife gave birth to their daughter in her individual interview:

My aunt has sent me $75 for every birthday until I was 30. Didn’t send my kid a card when she was born or when she, like when her first birthday, you know. Like and I know, you know when her first birthday is because I told the person who does the family calendar. So cute. It was cute when you’re like that.

Grace discussed how her aunt has a history of responding to relatives’ birthdays.

However, when it came to her daughter’s birth and first birthday, her aunt did not provide any recognition. Who gave birth did not seem to matter, as Grace’s brothers had children, and it appeared that her aunt would recognize their birthdays using the family calendar.

Other family members would simply not be present during the birth or come to see the child when they were back home. Their silence was very noticeable when the one woman’s family members would be present. Maggie, in her individual interview, talked about this distinction:

My family didn’t communicate about it [pregnancy] very much at all. Like to the point that like no one sent a card. No one has like, they nothing, radio silence from anyone who’s not my mom or my sibling, or my one aunt. And then Caroline’s family is just like, this is our life and we’re having a grandchild and we’re all family together.

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The lack of cards, acknowledgement, or visitation from family signals lack of support, especially in comparison to other family members who openly communicate their support. For Maggie, she noticed the “radio silence” from many of her family members when Caroline gave birth. While it was fortunate for some family members both on her side and Caroline’s to celebrate their new child, the silence can be deafening.

In couples who both gave birth, they were able to easily compare how family members reacted. Sydney and Amber both talked about how Sydney’s family did not seem as supportive when Amber gave birth. These conversations, however, took place in their individual interviews. In Sydney’s discussion, she was thinking about how it might have been different if Amber was the only one to give birth:

I do wonder if my family wouldn’t have been as involved as they are because I gave birth first. Even when Erick was born… like nobody came to the hospital when we were there with him and we were there with him for five days. It was sort of like, oh, we’ll come see you when you get out and we’ll come see you on your first trip over. So like my parents who did drive over when I gave birth, like didn’t drive over when Amber gave birth.

Sydney was not ready to acknowledge how her parents favored the child to whom she gave birth, but as she reflected on the birth she could not help but notice how the treatment changed when Amber delivered. In Amber’s individual interview, she described how Sydney’s mom helped after the birth of their child:

Sydney’s mom came and helped a little bit after his [Erick] birth too and it was funny, like I don’t think they came, I think that they didn’t come for like ten days after the birth, which was kind of weird because with Sydney, like her mom was in the room and they were like there right afterwards, very quickly. And so it’s kind of like, oh, it’s just because it’s not biologically yours, or like what’s going on here? Because they definitely, based on their scheduling could have definitely come down immediately. And they’re only an hour and half away.

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Amber connected the dots between the differences of their births, which emphasized who was biologically tied to the child. Although she was a bit hesitant, Amber believed that the lack of a biological connection attributed to the family’s absence for their second child.

Silence, absence, and a lack of recognition can signal to queer couples how family members feel about their children. But silence is also confusing, as perspectives must be defined in the absence of concrete rejection. Grace articulated how discrimination against queer people can be confusing, “I think people don’t understand that homophobia often looks, it doesn’t necessarily register as hateful speech… [it] registers in people’s silence or lack of engagement.” A silence from family members or others can signal that they do not support the queer couple’s families. By not showing up or by having noticeably different treatment, family’s actions can demonstrate how they feel. When people do not speak or do not acknowledge queer families, they can perpetuate a silence that queer families do not matter as in their minds, they may feel they do not exist.

Family serves as an important site of power. Foucault (1978) argued that there is a need to focus in on the most local power relationships and to ask, “How did they make possible these kinds of discourses, and conversely, how were these discourses used to support power relationships” (p. 97). Families are considered “local centers” and how they communicate with their children (i.e. the queer couples) demonstrate how they can use discourse to promote power relations. In the above cases, family members often reinforced heterosexist understanding of family. They generally promoted biological relationships and distanced themselves from queer conceptions of family.

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It was once argued that marriage was what defined a heterosexual relationship.

Foucault (1977) asserted that “there were two great systems conceived by the West for governing sex: the law of marriage and the order of desires” (pp. 39-40). However, now that marriage is attainable for queer folk, marriage has lost part of its institutional power.

Although power still does exist in the way that the queer women felt pressured to be married for legal protections, the fact that queer couples are legally allowed to be married loses power because more people can obtain it. Therefore, family members may not have felt that the queer couple became an official couple through marriage, as anyone could obtain this benchmark. The act of having children, something seemingly designed for heterosexuals, was the true epitome of reaching official coupledom. Being a part of a couple is important here as any single woman, regardless of sexual identity, would be shamed for having children without a married partner. Children are part of compulsory heterosexuality that “shapes what it is possible for bodies to do” (Ahmed, 2013, p. 423).

Queer female bodies are now able to reproduce heterosexuality through the bearing of children. However, queer women are only valued when they have a biological connection to their child. The queer woman who does not give birth is outside of the heterosexual identity.

When family members chose not to engage with children to whom they were not biologically related, they were enacting a silence surrounding those relationships. In the act of not speaking they were reinforcing the idea that “one must not talk about what is forbidden until it is annulled in reality; what is inexistent has no right to show itself”

(Foucault, 1978, p. 84). Family members, in this instance, did not recognize the children

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as their own grandchildren by omitting a relational connection. If they did not speak, visit, or actively participate in the children’s lives, the relationship did not exist. The grandparents and family members who did have the biological connections and had active relationships with the grandchildren reinforced the necessity of having biological connections to maintain a relationship. In addition, family members who did not participate in weddings or spend time with the queer couples but then increased their relationships once the child was born demonstrated that necessity of the heterosexual life script and the reaching of coupledom. Having a biological child demonstrates the solidity of the coupledom, reaching true family. Those who do not have biological children do not count as having children. The women did not bear their own child, so the child does not exist as part of the family.

Discipline functions in these family discourses by observing who does and does not count as family. Through these discourses, they are normalizing definitions of family.

Those in the family can provide a hierarchy that values certain attributes. In determining value, there is a “constraint of conformity that must be achieved” (Foucault, 1977, p.

183). In this hierarchy, family members normalize what it means to be connected. In normalizing, discipline can then be used to classify and to punish those who do not fit into the standard (Foucault, 1977). When deciding what moments are important in the queer couples’ lives, for example marriage versus birth of a child, they are promoting a conformity to family discourse. In addition, when family members choose which child to favor over the other, they are both punishing and rewarding the queer couples. Rewarding goes to the child that has the biological connection. Punishment goes to the child without.

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Family members thus reinforce a nuclear, biological family discourse embedded into our heterosexist society. Although one may assume that heterosexual couples who utilize IVF have the same punishment system, this is most likely not the case as the couple can still use both the egg and sperm from each partner and, if they chose to use a sperm donor, they have the ability to keep that fact hidden, unlike queer couples who have to explain how they conceived when neither partner produces sperm.

The queer women who did not want or could not process negative responses from their family members were most likely responding in a form of self-protection.

Recognizing injustice, particularly from those we love is not an easy feeling to unpack. In the act of noticing a moment of unhappiness we can then seem to cause it. Ahmed (2010) explained that “if it can cause unhappiness simply to notice something, you realize that the world you are in is not the world you thought you were in” (p. 86). To realize that your family does not accept you for who you are is deeply unsettling. Blame can also then be placed onto the queer women because recognizing injustice can be seen as the theft of optimism, or the inability to move forward and to separate from our histories

(Ahmed, 2010). Therefore, it is easier to simply ignore, or not fully confront these issues.

By not admitting that family members do not accept the queer relationships, there can be no real harm inflicted.

Family support. Not all families had negative reactions to the pregnancies.

Several of the families showed tremendous amounts of support. One of the ways that families provided support was through throwing baby showers and providing gifts.

Ragan’s family bought baby clothes and got her a massage package during the pregnancy

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where “they got me a whole like trio of facial, um pedicure massage right at the very end.” Natalie and Rachel did not want a lot of physical items for their baby, as they had a small living space. However, their parents were able to find something Rachel did want.

Natalie shared in her individual interview, “My mom and Rachel’s mom took her nursing bra shopping.” In addition, Rachel’s mom and sister in law threw them a baby shower.

Edyth and Laura were in need for clothes and similar items, as their family was expanding by three. Fortunately, Edyth’s sister was “like Martha Stewart, but nice” and

“made us a bunch of stuff for the boys” with her sewing machine. Further, Edyth’s sister helped them find a triplet stroller at a garage sale, an expensive item to purchase new.

Hilary’s mom “loves to buy stuff for the baby” and would send Carmen care packages once she was pregnant. Particularly for those who lived far away from their families, having gifts and care packages sent was a primary way of demonstrating support. For a few couples, family members would become over excited and send more than what was necessary. Jamie stated in her individual interview, “Our families are just so fucking overbearing sometimes…. My mom, like would just mail shit.” In her explanation Jamie said that they were just “super excited,” but the constant arrival of packages became a bit too much for Jamie.

Families also provided tangible support by helping the couples with household tasks. Caroline’s parents lived nearby and would help them with chores that needed to be done around their house. Maggie and Caroline discussed how her parents helped during the pregnancy:

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Maggie: And her dad mowed the lawn until he hired us a lawn service. Caroline: And they gardened for us after the baby came. The baby came in May and like right at the beginning of gardening season, like it wasn’t quite done frosting, so we hadn’t planted anything yet. But like we had this barren landscaping in front of the house, I find it embarrassing, Maggie didn’t care. But my mom came over with my dad and they spent like two days planting stuff in my garden which was awesome.

Caroline’s parents also helped by watching their dogs for a few weeks while their family re-adjusted to life with a newborn. The one chore that Caroline’s parents would not do, was provide any meals or meal prepping for them, which was more than fair.

Another form of support included family members attending or supporting the birth, whether to be there in the delivery room or provide child care. Lynn talked about how their “parents all flew in after Jamie was born” and how “all of our family went out there as soon as she was born.” They were surrounded by family members who visited them in the hospital and the parents stayed after to help them transition to having a new born. When queer couples already had a child, family members would help by caring for the older children while parents were in the hospital. Karen talked about how Martha’s

“sister came down from [city in New York] so she came down the night before and stayed at the house… she took care of him [son] and then that night she slept here.”

Providing child care during the delivery of the second child allowed the couples to focus on the delivery knowing that their first child was taken care of. Finally, family members helped with taking care of the queer couples’ animals, especially when the couples had extended hospital stays. Peggy was originally not prepared to be in the hospital for almost a week’s time and she said, “Luckily my sister stepped up and would let the dog out in the morning and feed the cats.” Because they had not planned on being in the hospital

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that long, they did not have care in place for their pets. Peggy was grateful that her sister could help with that task. Joanna was also thankful that her parents were able to help let the dogs out when their daughter was in the NICU. Joanna explained, “That was nice and at the time both of my parents, my dad lived three hours away and my mom lived four hours away so there was a significant amount of driving for them to be available.”

Having this type of help allowed for parents to have an ease of mind, particularly for elongated hospital stays of either one of the mothers or the child.

Of course, family members provided much-needed emotional support during and after the pregnancies. Emotional support, particularly for Amber, demonstrated that “they cared and were excited.” Part of the emotional support included grandparents talking about their grandchildren in a positive manner. Sophia jokingly discussed her mother in her individual interview, “My mom’s an assistant principal at an elementary school and I think probably every single one of her teachers knows that she has a queer daughter.

They certainly know about her grandson now too.” By openly talking about Sophia and her son, Sophia’s mom is showing how much she cares for and supports her daughter, especially in comparison to other teaching environments Sophia encountered that were less than queer friendly. While texting and talking on the phone were the most common ways family delivered emotional support, others were able to physically be there for the queer women. Joanna had a complication with her pregnancy and as a result, she was in the hospital and then on bedrest for 10 days. In her individual interview, Joanna said, “So mom came up that weekend Bridge had to work, which was really nice because I couldn’t do a whole lot.” Joanna’s mom’s physical presence enabled Joanna to have some

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company, as she went stir-crazy staying in bed. Even in times of health, parents traveling to support their children during the pregnancy was significant for the queer women. In her individual interview, Hilary talked about her parents coming to visit during Carmen’s pregnancy, “which was kind of big cause they didn’t visit a ton.” Having people be there for emotional support, whether virtually or physically, provided comfort to the queer parents, especially in contrast to family members who were notably absent.

Responses to family. In encountering both heterosexism and support from family members, queer couples varied in how they responded. When family members presented heterosexist perspectives, there were some couples who then presented a heteronormative life script as a gift to their parents. Caroline shared a story about her mom when she came out:

When I came out she was really sad because she felt like she was never going to get to go to my wedding and she wasn’t going to get to have a grandbaby and she’s like, “I wasn’t sad because you were gay, I was sad that you were going to miss these milestones. That you were going to miss these milestones that are really meaningful in our family.” And we haven’t really talked about that conversation since then but like in my mind I’m like we got married, we had a wonderful wedding, like I wore a wedding dress, my dad walked me down the aisle and now my mom has a grandbaby that she watches one day a week and is very involved in and I think it’s really nice for my mom and dad to like have everything that they wanted. I’m really happy to be able to give them that.

When Caroline came out, her mother was upset because she assumed that Caroline could not participate in a heteronormative life. Caroline was happy in the end that she was able to give those milestones to her mother, a gift of heteronormativity. In her story, Caroline proposes that if she did not follow those life steps, her mom may not be as happy. For example, what if Caroline never got married but was in a committed relationship? Or perhaps, if they adopted or fostered children instead of reproduced, would her mother still

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be happy? Several couples presented these same ideas: by following a heteronormative path, they were able to provide happiness for their parents. In thinking back to Christie, her father was initially bigoted toward queer people, believing that the queer identity was not real. However, once she was able to both marry and become pregnant, her father expressed joy because she could live what Christie called a “normal life.”

Some of the queer couples were apprehensive about how their family members would react to their growing family. To manage the apprehension, some of the couples would attempt to prepare their families by telling them how they should respond by reminding them how they would relate to the child and why it mattered. Because some of the queer couples were worried that their families would not respond appropriately, they would frame how their families should respond. Grace shared how she talked to her family:

I tried to like communicate, my family is like medium emotionally intelligent. So I tended to be like, “We’re having a baby. You’re going to be an uncle. You should be excited.” As a way of like communicating expectations because my family has a habit of being pretty disrespectful around queer stuff or around things that feel like of emotional import.

Grace was concerned that her family would not respond in a way that was supportive with the news of her upcoming child. To try and curtail their reaction, she stated how they should react. Her brothers did provide some support, but they still did not respond in the way that she expected a sibling should respond to the news. They provided minimal support. The inability to react positively to queer-related news was not uncommon amongst family members. Some families were still struggling to accept queer identities.

Joanna and Bridget talked about how they spoke about the pregnancy to Bridget’s father:

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Joanna: This is a good story that you will appreciate. So she wasn’t exactly out to her dad. She wasn’t exactly not out to her dad. They had just never ever talked about it. So last October we went to the Pumpkin Show and her dad was there and he’s kind of quiet, but like her dad’s just fine. Did your dad know that I was pregnant at the time? Bridget: Ah, I don’t, yes, he knew. Joanna: Yeah, he knew that I was pregnant but um, so I went up to her dad at the Pumpkin Show and I was like, “So [dad] are you excited about being a grandpa?” And he paused and he didn’t really say anything. And I said, “Okay, the right answer is yes. Because as Lily’s grandfather, you’re going to have certain expectations, like you have to teach her how to fish.” And like he started laughing… so I did totally like stone cold, like set the expectation for him like, “Hey, you are going to be the baby’s grandfather”… like that was my way of making sure that he knew like, my expectation is that you are going to act like her grandfather because you are her grandfather.

Because Bridget had an uncertain relationship with her father in terms of her sexual identity, Joanna wanted to make sure that he understood that his role for Lily would be that of grandfather and that he should react accordingly. Some couples had to make those roles clear as their family members had more heterosexist expectations of family and did not know how to define family outside of that realm. By articulating their family roles as similar to heterosexual ones, they were able to see the children as real, connecting to fulfilling the heterosexist life script.

While some of the queer couples were met with love and support, others experienced levels of homophobia and heterosexism from their family members. There were varying levels of bigotry expressed. Some were met with rigid viewpoints. Maggie discussed how some of her family members responded to the pregnancy:

My family lives in the 1950s in rural Pennsylvania. Caroline didn’t experience homophobia until she went there. It was pretty stressful telling my mom, my stepdad really helped us do that and I don’t know like, my mom would check on how Caroline was during the pregnancy but the baby is a secret from my grandmother. We went through this process in therapy I decided that I was going to tell my grandmother. And then I went home and I told my mother and we had a

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very very tearful Xanax filled conversation during which I realized that it wasn’t going to be a very good option so. I accept what that was going to mean which is that we probably aren’t going to go to my hometown very much at all ever with this baby and my mom, she compartmentalizes.

Maggie recognized that her family has homophobic beliefs and that because of them, her grandmother does not know that her child even exists. However, in the recounting of this story, I noticed that Maggie did not seem that upset. Moments where I felt it was leading to a negative emotion, the story would shift to acceptance, not anger or sadness. Those who dealt with homophobic family members often did not express negative emotions but just accepted that was part of their life.

Both Lynn and Megan encountered homophobia from their family members.

During their couple interview, Megan had to leave for a work event. After Megan left,

Lynn told me about how her brother has reacted to her creation of her family. In this story, she described it as “crushing.” Lynn explained:

My brother started going to a church and he had to do these like overnight things with this church and he basically, before Megan and I got married called and like started quoting bible verses at me… I’m like, we can go back and forth all day long with these bible verses and he’s like “It’s not too late.” And I’m like “not too late for what?” He’s like, “It’s not too late to end this and you can be with a man and you can make it work and don’t marry her”… Then when we got pregnant and he was like, really standoffish which I knew was going to happen because his church is like very anti and he called to tell me that because we’re gay, our sin is no better than that of like rapists and murderers… he doesn’t want anything to do with us and I hate it because Jamie is the coolest kid ever. She’s so down to earth and he’s never gonna know who she is because his religion is more important than our family.

Lynn was clearly upset at how her brother was rejecting her and her family. She expressed negative emotions when sharing this story and was upset with her brother.

However, her expressions changed when Megan had to deal with homophobia from her

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family member. Megan’s grandmother refused to attend their wedding, choosing instead to sit in the parking lot. Originally, Megan was upset and started to distance herself from her grandmother. In her individual interview Lynn talked about how she discussed the topic with Megan:

I had to like work with Megan a lot on it and was like, “Listen, life is too short to be holding grudges against this woman. She could die tomorrow and it would kill you.” So she finally, Megan loosened up and started to accept the fact that Nanna’s never going to call it a wedding. Is never going to be okay with the gay thing and she’s okay with that now. It’s hard. I don’t want her to hurt. I don’t want her to cry over stuff like that.

Lynn felt that Megan should not be upset over her grandmother, and instead, should work to accept her grandmother’s beliefs. In Megan’s individual interview, she reiterated those same sentiments and compared it to her brother-in-law’s religious beliefs:

He chose that to be a part of our life, which, it sucks but it’s fine because whenever he chooses to come back he’s my brother-in-law and I will love him and who cares? New chapter of, we’re good. But I was starting to realize how he was shutting us out, I was doing the same thing to my grandma. I’m like, well that’s horrible. Just because I’m not super religious I’m now thinking that I’m better than they are.

Megan thought back to how her brother-in-law distanced himself from their family based on religious beliefs about sexual identity. Combined with pressure felt from Lynn to accept her grandmother, Megan than compared herself to her brother-in-law and believed that she was doing the same thing to her grandmother. However, Megan’s comparison was not accurate, as both her brother-in-law and grandmother appeared to have beliefs set in hatred of a group of people, not accepting that hate is not in itself hateful. Megan’s situation brings up the paradox of intolerance, coined by Karl Popper in his 1945 book

The Open Society and Its Enemies. The paradox of intolerance argues that, if we do not

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have a limit on what we tolerate, those who are tolerant will eventually be destroyed by those who are intolerant. In Lynn and Megan’s viewpoint, they believed that Megan distancing herself from her grandmother based on her intolerance of their relationship was equal to the grandmother’s intolerant beliefs. However, if Megan accepts her grandmother’s viewpoint she is also accepting of intolerance, meaning the tolerant is defeated by the intolerant. Megan and Lynn’s reactions were based in reacting to family members who present them with homophobic beliefs; to preserve themselves, they had to not tolerate the intolerant. Several of the queer couples struggled with processing grief toward family members who do not accept them for who they are and instead, often accepted and repressed negative emotions toward those family members.

Another way couples responded to reactions from family members was by omitting information about their conception process. A few of the couples recognized that their family members may be uncomfortable discussing how they conceived, so they decided to either conceal information or lie about some of the details. In Laura’s individual interview, I had asked her to discuss to whom she talked about their sperm donor. She explained:

I’m fine with like friends that are open but my family, not so much. I only have one sister that I would discuss it comfortably with. Others are very uncomfortable with Edyth and I as a couple in general. So, it’s just something we don’t discuss.

Because family members already struggled with accepting Edyth and Laura’s relationship, Laura assumed that they would be equally or more uncomfortable discussing the details of their conception, which would include the sperm donor.

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Others had family members that accepted their identity as a couple but were potentially uncomfortable with the more intimate details of the insemination process.

Amber and Sydney talked about how they told their parents that they used a sperm bank for their whole process, ignoring the times that they did at home insemination on their own:

Amber: I think for their own peace of mind, we did tell them eventually, like we’re using a sperm bank. So I don’t actually think to this day that they realized for Sydney we didn’t do that. We did it at home (laughs) because I think just like we, right? Like we never told our parents that we ended up not using the sperm bank? Sydney: No, I didn’t tell them (Amber laughs). …. Sydney: I think I may have told my mom that we were having a midwife come. Amber: Oh yeah, you’re right. Sydney: Because it was easier.

Amber and Sydney did at home insemination for when Sydney conceived, without any medical assistance. They perceived that it would be easier to just say that a midwife assisted, rather than explain how they were able to inseminate on their own. Because family members may express discomfort with the process, couples just found it easier to hide or lie about the exact details.

Responding to family members revolves around conceptions of happiness. How can the queer couples promote happiness seemingly for themselves and for their families?

The tension of queer identity and happiness is centered on queer identity causing unhappiness for others, which is why the process of coming and being out is a both a site of possibility and struggle (Ahmed, 2010). Happiness is positioned within heterosexual love. Heterosexuality is “the possibility of a happy ending; about what life is aimed toward, as being what gives life direction or purpose” (Ahmed, 2010, p. 90). Therefore, it

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is not surprising that family members promote heteronormative lives to the queer couples, as that is where happiness lies.

In considering Caroline’s gift of heteronormativity to her mother, she implies that she is the one who is happy. However, her mother was the one who was upset for not being able to achieve the goals she had wanted for Caroline. Her mother was the one who desired for Caroline to follow a heteronormative life script. If Caroline were not to follow this life script, she would be the cause of her mother’s unhappiness while simultaneously threating the reproduction of social form. Ahmed (2010) asserted, “The daughter has a duty to reproduce the form of family, which means taking up the cause of parental happiness as her own” (p. 58). In this act, Caroline did not necessarily achieve her own happiness, but achieved her mother’s happiness.

Similarly, when looking at how the queer women did not have negative reactions to their family member’s homophobia, we can explore conceptions of happiness. In family spaces, queer folk often participate in “straight hospitality,” wherein they are perceived as being guests in other people’s homes. As guests, queer individuals rely upon their family’s good will and must be grateful for any bits and pieces of acceptance bestowed upon them. Ahmed (2010) explained, “To be a guest is to experience moral obligation to be on your best behavior, such that to refuse to fulfil this obligation would threaten your right to coexistence” (p. 106). For those who have family members that minimally accept them, the queer women are expected to be grateful for it. As “guests” they cannot demand equal treatment, or they may be thrown out of the metaphorical house. When Lynn argued for Megan to meet her grandmother where she was at, she was

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telling her to be grateful for whatever she was given, as a guest. Queer women can be treated as guests in their lives and happiness and therefore need to promote others’ happiness over their own.

Many of the queer women had conditional forms of happiness, happiness that relied on the happiness of others around them. In conditional happiness, there must be a shared orientation of what is good. There needs to be an agreement upon how happiness is being defined. For the queer women, this often-meant heteronormative expectations of family. To be happy, meant to achieve heteronormative life goals. However, these terms of conditionality are unequal, as Ahmed (2010) asserted, “If certain people come first then their happiness comes first. For those who are positioned as coming after, happiness means following somebody else’s goods” (p. 56). When queer women place their family’s happiness above their own, conditional happiness is not equal. This is not to say that they cannot be happy in their life, but when acting for other’s happiness, the other person’s happiness is promoted over their own.

Resistance through redefining family. Several of the family members expressed heterosexist attitudes toward family. While some queer couples participated in heteronormativity, others found ways to resist heterosexual ideals through ways that redefined family. Several of the queer couples experienced discrimination from their family members. In response, some of them decided to stand their ground and hold true to their newly formed family. For example, Caroline in her individual interview talked about how a few of Maggie’s family members do not know about their child. She discussed how some of their traditions have now changed:

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We usually go to Thanksgiving with Maggie’s family every year. They have a big potluck with her extended relatives and all that, but we’re not going this year because her mother has decided not to tell her grandmother that we had a baby. And I’ve made it very clear that I’m not going anywhere where Maggie is not acknowledged as the mom, as Lydia’s mom. I’m not gonna pretend that I’m a single mom and that Lydia doesn’t have a second mom. That’s just not something I’m interested in.

By refusing to participate in holiday celebrations that ignore Maggie’s identity, Caroline is resisting the heterosexist expectations of Maggie’s family members. In asserting who they are and not backing down, they are combatting heterosexism.

While Maggie experienced isolation from one family member, other couples were not always as fortunate. A few of the queer couples had multiple family members who had distanced themselves whether for non-related issues or specifically related to their sexual identity. Because of this alienation, some of the queer couples redefined how they understood family. Tiffany in her individual interview talked about how she felt about her family members in relation to her son:

I feel bad for him because he doesn’t really have the side of my family. He doesn’t hang out with and see cousins and nieces and stuff, but it’s also, he’s like this awesome guy who it’s really their loss. I mean if, if he doesn’t have that piece, then it’s just going to find his own family and that’s what we created for ourselves.

While Tiffany was upset at the lack of extended family her son has, she reinforced that they have created their own family that falls outside of tradition, and that was okay. In fact, it was her extended family that was losing out on the relationship. Her act of creating a new family resisted heteronormative ideals of family and promoted their own construction.

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Another way that queer couples resisted heterosexism was through reconceptualizing family through donor siblings. Donor siblings are children that are connected biologically to one another by having the same donor. These children can exist across the world, as many of the sperm banks have international consumers. Here, resistance is only partial. By expanding family to include those outside of your immediate family, as in those who live in your house and share a communal space, they are resisting traditional ideas of family. However, by basing relationships in biology, they are still conforming to some conceptions of heteronormativity. Several of the queer couples were considering whether to join donor sibling registries. These registries connect families who have used the same donor. They can share information with one another and are often connected through Facebook groups. Hilary and Carmen discussed how they felt about the donor registries:

Hilary: We talked a lot about just kind of expanding and challenging our traditional ideas of what a family is. If we had used a known donor, like having that person in their life in an important way, but not being a parent. And even now, having used a sperm donor, there’s donor siblings and you now, it really kind of just, yeah, like challenging and expanding our idea of what it means to be a family and who family is. So I think we first really started realizing that that was something to think about when we were thinking through the process of potential using a known donor. You know, challenging those ideas. Carmen: Yeah I think it’s good. You know, when she can decide later, tell us what she wants. The options will be there for her. Even more extended family if she wants.

Hilary and Carmen recognized that having a donor, known or anonymous, can change conceptions of family. Knowing that their daughter was conceived using an anonymous donor, they found that she could have connections to biological half-siblings. By having these connections available, their daughter can redefine family for herself. They believed

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these challenges were positive, as it went outside of heteronormative expectations. Yet, they were still placing an emphasis in a biological connection.

Danna and Jackie had a unique experience when discovering donor siblings.

Attending a music festival, one where they had first met, Jackie talked to an acquaintance about their donor experience. The acquaintance had recently found out they were pregnant using a sperm donor. Through sharing their stories, they discovered that they had used the same donor, and that their children were biologically related. Because of this connection, Danna and Jackie had to consider what this meant for their family. Danna stated:

It’s so weird, had they not had that conversation, I don’t know if we ever would have had that conversation. But now these friends, who we weren’t super close to, we’re a lot closer to because we have half siblings together.

Now that they know that they have this relationship, Danna and Jackie bring their kids to meet up with this family twice a year. Once again, the relationship is based in biology, however they are resisting heteronormative expectations of family by connecting siblings together that have separate parents.

Beyond siblings, other queer couples established different relationships with their sperm donors. Those who knew who their donor was, would sometimes create newly defined relationships where the donor was not a parent, but had their own kind of family role. Rachel and Natalie discussed their relationship with their known sperm donor:

Rachel: So like no parenting role but he comes over for dinner, brings Hope some books. Just like any other kind of family friends do. Natalie: Yeah, he’s a little closer than that. Like he was the first person who got to see her at the hospital besides us. So he got there before our families did. He was at the baptism. Sometimes he does birthday parties… but yeah he gets no parenting decisions and doesn’t get to be involved in any of that sort of stuff.

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Rachel and Natalie have a person in their life that is in-between family and friend.

Because their donor does not have a parent role, he is not quite family, but has more connection and involvement than a typical family friend. Through this relationship, they are redefining what it means to be family, pushing the heterosexist narrative.

One of the more unique families out of the participants was Amber and Sydney’s because they used a known donor who ended up creating his own family with his female partner. The families remain close and discussed ways in which they could define their connections. Understanding their connection came with uncertainty while attempting to find definitions. Amber explained their struggle:

Well it’s hard because there’s not, at least among straight, you know like 99 percent of the population, there is no other language that’s really understandable, aside from like sibling or half-sibling, or step sibling, which, like in our situation that isn’t fully accurate (both laugh). But there’s just no other word, there’s no other word that everyone outside of the queer community would understand. Like we’ve heard of dibblings and stuff like no one under, no one knows what a dibbling is outside of the queer community.

When trying to find language that accurately described the relationship between Amber and Sydney’s children and their sperm donor’s child, the parents kept hitting road blocks.

The limits of heteronormative family language inadequately described their family identities. Even though queer language exists, they recognized that people outside of the queer community would be confused, potentially creating confusion for their children.

When attempting to find the right language for their family, Sydney and Amber came to an agreement after a situation arose with Sydney’s family. In Sydney’s individual interview she explained what happened:

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There was actually, so it’s kind of somewhat of a falling out in my family, which actually sort of pushed her [Amber] over the edge to let her be like, to say to agree that they could just refer to each other as siblings. She thought, like something about what happened with my family made her want to promote like other positive relationships in our children’s lives.

In asking Sydney what happened between her family that caused this shift, she continued:

The gist of it is like, Amber and I parent very differently from my brother and his wife and their three kids and sort of as a result of it, they’re not really coming around anymore. And so Amelia, our daughter, is really excited to spend time with her cousins, but she’s not getting a lot of it. And so it was like, she has these other, these children in her life, her cousin who she really wants to be with but she can’t be with. So it was kind of like well, let’s create. We have this opportunity literally right now to create another scenario with young children who she will grow up with who she can be close with.

Because of the negative relationship that now exists with her brother, Sydney and Amber decided that they should instead promote positive relationships that already exist in their lives. They decided to call the children siblings, without qualifiers, and created a newly defined family. In her individual interview, Amber described this new relationship:

When our kid was born we asked him [sperm donor] to be godparents and now with their daughter being born, they’ve asked us to be godparents. So it was just really cool that we’ve kind of created this whole little family together.

Through creating a new family, they were resisting heterosexist understanding of family dynamics that emphasize the nuclear family. While their relationships still have a base in biology, their sibling relationships are both defined and yet not fully defined by biology, and their family unit is expanded.

Biology comprised a complicated domain for a few of the couples who understood that biology should not be used to define family, but simultaneously drove family connection. Hilary grappled with her relationship to her daughter, who did not have any biological ties to her in her individual interview:

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My relationship with her might be different or I might feel different about it because she’s not biologically mine… I grew up with non-biological family members and that’s not really a big deal for me, biology. But it is a difference.

Hilary recognized that biology is not necessary for family relationships, but she also felt that biology created different relationships between those family members. Grace had similar struggles in reconciling how biology may play a role in family relationships:

The sort of biological connection, it doesn’t not matter. It does matter. Or, but it’s not the only thing. And it’s not the thing that creates intimacy or trust or safety in a relationship. It’s just part of the story… just because they don’t have your nose does not mean that they will not come to deeply shape themselves based on your proximity and like that’s awesome… I mean like we talk about queer family, but it really just means sometimes it just means you’re present and emotionally available.

Grace articulated that biology can matter, but it is not what defines family. In our relationships, we create and understand family. By being there. Moreover, Grace brought up queer family, which is how queer folk redefined family to mean people outside of biology because of the disowning from traditional family. Through understanding family outside of biology, but recognizing biology, queer couples must figure out how they are recreating family identity.

Trying to understand how family is reshaped by non-biological and non- normative identities can be exhausting. Yet, it is exhilarating when others recognize the value of these unique families. Bridget shared a story about how her niece reacted to the new family member:

My oldest niece was like, “I just can’t believe it.” And she’s like four. And I’m like, “What can’t you believe?” She’s like, “Lily has two moms and zero dads”… She’s like, “I think she’s gonna be just like you.” Like it was awesome to hear that from family and I know she’s four, but they all consider her a cousin.

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Bridget was excited that her extended family acknowledged that Lily was just another cousin. Further, she was happy that her niece did not care that Bridget did not give birth to Lily, and that Lily could be just like Bridget.

Resisting through redefining family is complicated, as the redefinitions are often based in biological ties to new family members. In wanting to connect with donor siblings or have definitive relationships with the donor siblings, the queer women are still reinforcing biology as what creates a family. In a study on donor siblings, Hertz, Nelson, and Kramer, (2017) found that blood mattered when defining family. They argued that blood mattered because it acted as a latent tie and insurance policy. Family members could go to these donors and donor siblings to find more information (Hertz et al., 2017).

The biological tie can also matter because the parents and children with donor siblings felt that it provided a deep connection and appears to be defined as extended or even part of the nuclear family (Hertz et al., 2017). Yet, the concept that biological ties matter as part of forming families is still based in the heteronormative notion of nuclear family.

Queer families have a history of promoting that biology does not make a family, but rather love and choice are primary ways to create family ties (Roth, 2017). However, the desire to connect with donor siblings promotes biological ties over choice, as the only relational connection that typically exists is based in having a shared sperm donor. Pelka

(2009) argued that making choices, such as connecting with donor siblings, is based in queer families caring about biological connections and in turn participating in heterosexism that idealizes biological family ties. However, Roth (2017) argued that

“motivations behind such choices are no doubt complicated as are their meanings,

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making it difficult to determine that any given reproductive choice expresses or means anything in particular” (p. 460). Yet, Roth (2017) continued to state that regardless of intention, promoting biological ties can still contribute to heterosexism.

To say whether the queer women were resisting or promoting heterosexism is complicated. Many of the queer couples struggled with their pre-defined families. Several of the couples who considered or sought out donor siblings experienced distancing from their family members. They desired to find new family, and direction on how to recreate family without biological connections may have not existed. Simply going outside of the predetermined family is still a form of resistance for them. Furthermore, those like Grace and Hilary noted that biology does matter in the current U.S. culture and to not recognize that does not make it untrue. It is not clear how to redefine family without feeling implicated in biological connections. With pressure from family and the law, biology becomes an easy way to submit to heteronormative definitions of family.

Queer Community

In considering complications from family relations, most of the queer women sought support in the queer community. Many of the queer couples articulated a need to find support from those that understood their experiences: other queer couples. Carmen explained why having queer-related resources was helpful, “It’s like a little bit of a fast track way to find out the answers to the questions that you’re going to have from people who are going through it rather than just googling around the internet.” Searching the internet to find answers to queer reproductive questions and experiences can be difficult.

During this project, I attempted to find basic answers about various parts of the

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conception process for queer couples, and I also struggled. For example, in Christie and

Erin’s couple interview, Erin explained legal restrictions on home inseminations. She explained, “I have a couple of friends in Indiana that was trying to get pregnant and like you aren’t legally allowed to do at home insemination.” After the interview, I was curious as to what the legal restrictions were. However, when attempting to simply google the answer, I was not able to find a reputable source that confirmed whether Erin’s statement was true. As Carmen noted, having the Queer Parents group allowed for ways to crowd source information from those who have had experience with the various parts of queer reproduction and family experiences.

Finding answers to questions is not the only reason to seek out queer spaces and networks. In her individual interview, Danna stated why she felt it was important to have queer connections, “You’re not going to get a lot of support or at least understanding I think from straight communities that don’t sort of have these unique things that come up in their families.” Danna explained that queer families have their own experiences to which heterosexual couples cannot relate, such as struggling with family acceptance or figuring out how to designate family roles that are outside of the heteronormative family structure. Having a baby as a queer couple goes beyond having a newborn. Brittany, in her individual interview, articulated why it was important to have a queer community,

“Find that community of people who understand not only what it’s like to have a new baby, but also to understand what it’s like to be queer and have a new baby.” Queer couples may struggle to find trustworthy healthcare providers as demonstrated in the previous chapter, navigate heterosexist encounters as demonstrated by Lynn and Amanda

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in how to respond to questions about parent identities, and so on. Those experiences will most likely not be understood by a heterosexual person. Therefore, it is not just about caring for a new baby. It is about having support while figuring out how to raise a baby while being queer.

Another reason why couples wanted connection to a queer community was so that their children could see other representations of families that looked like theirs. Sydney discussed why they wanted to find more queer friends after their children were born, “We didn’t want them, us to be the only two mom family they saw. And be like, why is everybody else we know have a mom, a dad, or whatever.” Those questions about family identities can happen for children and having other queer representations can be important for explaining family diversity to children. In her individual interview, Olivia talked about why she valued having queer families in her neighborhood:

It’s so much easier when Delighla’s like, “Just boys have daddies.” Because her preschool class is all boys and they all have straight parents. So she’s like, “Just boys have daddies.” And I can just say, “Well no, if you go down the street to [name]’s house, he’s a boy and he has two moms. Families are all different”… she’s going to go to school with these kids and the teachers at that elementary school, we’re not going to be the first gay moms that they meet. So I think finding the community, finding your community within the community is pretty huge.

By having other queer families in their neighborhood, Olivia can show her daughter that all families are unique. She also expressed how relieved she was that she would not be the first queer person that a teacher met, that the teachers would already have had that experience.

Those who have other queer families in their area are fortunate, as there are queer couples who are the only queer family or struggle to find other queer couples in their

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community. In those situations, queer couples have recommended seeking out spaces on the internet, such as the Queer Parents group. Elisa discussed how it was difficult moving from a place with many queer families to being only one of the few. However, she still wanted to find queer connections. She stated in her individual interview, “If you don’t have that in your community and you haven’t built that group yet, then the Internet’s a great place to find it.” Queer communities can be spread out and not localized to specific areas. The internet creates a site for these individual communities to come together in a collective space. In addition, queer families can use those spaces to connect to other queer families in the area. Where queer families are lacking, queer couples can feel isolated. Maggie in her individual interview talked about why she felt that having heterosexual couples did not fulfill a need that she had:

I think we had a lot fewer peers to talk to because I think that with straight people it’s like, most people are hetero/cis people, so it’s like they’re making a lot of babies (both laugh). They’re automatically connected to a lot of people having babies. As queer people and in a small city, we just did not find that many queer people making babies.

Maggie felt that heterosexual people already have people surrounding them who have had similar experiences. Queer families can be more isolated. She went on to say, “Just this morning I went to Life with Baby and it’s like thirty people with their babies and I’m the only non-bio mom.” Being signaled out by difference can be exhausting. A queer space can alleviate those feelings of isolation. When talking about seeking queer community

Maggie said, “Use the Internet, use your community, ask people if they know somebody, just find what you need because it exists, it just might not be right in front of you.” To

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find queer parents, the queer couples would use the internet to create meaningful connections or to have a safe space to ask questions related to queer parenthood.

Queer networks can be important. In Laura’s individual interview, she said,

“Many queer couples for various reasons don’t have that support either, especially not a family support network.” When lacking support, queer couples can find it through both in person and online queer communities. However, queer communities are not without their own problems. Grace was an illuminating person to interview. She had many thoughts about queer identity and the queer community and how they intersected with parenthood.

Her perspectives were not necessarily shared with the other queer women, but her insights were important to consider as she articulated tensions that exist within queer spaces.

One of the first problems Grace highlighted was how queer communities are often built around an evening life, one that is not compatible with parenting. Grace explained:

Kids go to bed really early and most queer events are not until like eight p.m. … I mean in the way that we’re like, we’re old now, why would we go to a show and stand until two am, that sounds like not fun. But the idea that we could, or you know, going to dinner and having it end at nine is not a thing we really do right now because we have a baby.

Grace was explaining how the queer community hosts events that are late in the evening.

For queer individuals who are older and/or have children, these events do not cater to them. In a study on spaces related to parenting, Luzia (2010) noted that what makes a neighborhood queer friendly does not transfer to what makes a space child friendly. In addition, queer parents did not relate to the typical queer scene of drinking and dancing, and had stopped connecting with that part of the community briefly before becoming

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parents. They found themselves further detached when they were parents (Luzia, 2010).

For the queer families who are near queer spaces, they can encounter difficulties when trying to connect to a queer community as those spaces may not be designated for them.

The tension between whether having children is assimilative or just a queering of the idea of family poses another issue that can exist for the queer community. When I began this project, I grappled with this tension and remained uncertain as to what the answer was. When Grace spoke about it in her individual interview, I was curious to hear about her perspective. Grace spoke about assimilation in her individual interview:

Having queer community that was really politicized before we became parents, we really struggled to, that was a little bit of like shifting of the perception of our choices as being kind of normative or simulative and having to kind of interact with that as part of the community conversation around our space to have kids and a lot of the projection of a lot of people who may be like, don’t talk to their parents or who have really strange relationships with family of origin folks… I don’t think that having children intrinsically is, uh, I mean it can be normative but it’s not intrinsically like assimilative but it was perceived that way by some folks in our community and our friends, larger friend network.

In Grace’s queer community, they were struggling with whether reproducing children was a form of assimilation into heterosexual lifestyle. Pelka (2009) also articulated that forms of reproduction for queer folk can be considered assimilation to heterosexual ideals. Grace argued that queer folk can reproduce heteronormative ideals through having children, but the act of having children does not equate to assimilation. Queer communities are not without their problems; however, we can consider ways to expand our notion of both queerness and of families.

The tension of assimilation and the need for queer support was evident in the interviews with the queer couples. Most of them had spoken about a need to be like other

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families or how they were not that different from heterosexual couples in one way or another. Yet, the expression of a need for queer community suggests that they are different from their heterosexual counterparts. When citing a need for queer community, the queer women are saying that heterosexual couples do not have the same experiences and, therefore, queer folks need to connect with those who inherently understand. As

Maggie noted, she felt isolated at her Life with Baby group, stating that there were not any other non-biological moms, which then means there is a difference between her and the other assumed heterosexual moms. Moreover, the need to see other queer families presents a difference of queer families from heterosexual families. Even Ragan and

Olivia, who had expressed feelings of similarity between their family and heterosexual families, talked about how important it was for them to have other queer families in their community. The queer couples who discussed needs for queer community were pointing out how the world is designed to assume heterosexuality. There was an important need to have queer representations in their lives for themselves and their children. However, the queer community that was needed was not just the queer neighborhoods, but queer communities that were connected to having children and families. The Queer Parents group on Facebook was designed specifically for parents or those who want to have a family. The queer families potentially occupy a space between mainstream queer culture, one that involves drinking and dancing, and heterosexual culture that promotes the nuclear family.

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Partner Communication and Support

Queer communities provided a form of support for queer couples, however, couples received the most significant amount of support from their partners. Part of the focus of the study was to explore how partners communicated with one another and provided support during the pregnancy. Many of the queer couples noted that there was not a supportive script for them to follow and that the dad supportive standard was low.

In addition, the queer couples noted how they were able to provide both instrumental and emotional support to one another. Furthermore, the birth parent also provided support to the co-parent to re-assure their parental identity. Finally, the queer couples also discussed moments where they did not provide or receive support by themselves or their partners.

When going through a pregnancy, many individuals will rely on a partner for support. Heterosexual couples appear to have an available script to follow. By reviewing the literature on how heterosexual men provided support to their female partners (Alio et al., 2013; Somers-Smith, 1999; Widarsson et al., 2015), there is an expected standard. In contrast to heterosexual couples, queer couples identified an absence of a clear narrative for supporting a pregnant partner, and instead found that they were often held to a dad standard. The dad standard was often described as disappointing and low. Several of the couples discussed how they saw their partner being supportive compared to their straight male counterparts. Natalie and Rachel discussed how Natalie’s support has been different from the heterosexual couples they know:

Natalie: I think I probably went to way more appointments. Rachel: Yeah no kidding! Other couples I’ve talked to, their partners are not nearly as supportive or involved as you are. You’re not scared of vaginas. You read all the books that I read. You went to all the appointments.

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Rachel argued that Natalie was more supportive than other couples she knew, implying that those other couples were heterosexual. The differences seemed simple. Natalie did many of the basic tasks of reading books and being at appointments. She also did not squirm at the mention of female reproductive organs.

Ava and Sophia also noted how Ava was a more supportive partner compared to their heterosexual friends. When asking how Ava showed support to Sophia during the pregnancy, they talked about how Ava provided a needed resource:

Ava: I bought lots of sick bags (Sophia laughs). So Amazon sells the really nice hospital style sick bags and I bought lots of those and kept them everywhere. Sophia: Mhmm, she didn’t get mad when I threw up in the sink. Ava: Or in the restaurant. Sophia: Oh my gosh that was awful, I always, yeah (Ava laughs). Ava: Yeah, so I’ve actually, a lot of the women that I know have really crappy husbands, like I have a friend who her husband would get really mad that she would throw up in the sink. And she’s, “First off, throwing up in the toilet, the toilet smells so bad because all of it’s heightened. And second, I don’t want to get down on the floor because I’m not going to get up again.” And I was like, “Well I just bought my wife bags so that she could throw up wherever she wants.”

During the pregnancy, Sophia was constantly nauseous. Knowing how uncomfortable

Sophia was, Ava made throwing up simple by just having accessible, disposable bags for her around the house. Ava’s heterosexual friends did not have such accommodating partners. In her individual interview, Ava went on to say, “I kinda love talking to my heterosexual female friends and they start complaining about their husbands and how they handled the pregnancy.” By being an active partner, Ava was made to feel superior to heterosexual male partners. As described by some of the queer women, heterosexual men were made to seem inferior as partners compared to how they supported one

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another. Grace and Brittany discussed how dads presented as having already contributed to the process by providing the sperm:

Grace: Well, because I think also the dads were nice but like they think they did something really special. Brittany: Straight dads don’t understand (all laugh). Grace: No, no they’re like, “Well I made this kid!” And I’m like, “I put sperm in her just the same as you, not the same way you did, but I did that too.” So therefore, you didn’t even look at her cervix a bunch.

During their insemination, Grace would attempt to check Brittany’s cervix to see if she was currently fertile. In considering a man’s contribution to creating a child, Grace felt that she did just as much and even more than they did, making fathers’ roles less special.

By being compared to the dad standard, many of the queer women felt they exceeded support expectations.

Feeling superior to heterosexual men was based in their own assessment. Ava,

Natalie, Rachel, Grace, and Brittany talked about how they felt this superiority themselves, not something that was told to them. In the previous chapter, Brittany talked about how when the nurses praised them for being a supportive couple, she felt uncomfortable. Her reason seemed to be based on how they were in a constant comparison. However, when Brittany and Grace shared their own comparisons of themselves to heterosexual men, they found it more amusing and seemed to feel more elevated. Perhaps queer couples feel that when they make their own comparisons to heterosexual couples it is okay, however, when other people compare them to a heterosexual standard, queer couples start to feel uncomfortable. There is then a clear tension between how queer couples want to be spoken about and how they perceive themselves.

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Instrumental support. Beyond simple comparisons to heterosexual men, queer couples noted the ways in which they provided instrumental support. A key manner in which couples provided support to one another was through gifts or treats given to the pregnant person. In thinking about the stereotypical example of running out to buy a pregnant woman food she was craving, Megan shared how she “ran to get donuts and milk at nine o’clock at night.” Pregnancy is hard on the body, and so are fertility treatments that some of the queer women underwent. To help, many of the queer co- parents would provide things that would aid them through those processes. Faith, in her individual interview, talked about how she created an “IVF care kit of Frozen and Hello

Kitty Band-Aids and socks for the transfer and retrieval” along with “a magazine and a book to read” for when Elisa was on bedrest for the two days after. For Faith, gifts were an important form of support because her “love language is presents and cards.” To express how she cared, and to help with the strain on the body, Faith gave Elisa things to cope.

Gifts and items were a common discussion of support as they were tangible objects that the queer couples could draw on. For Christie, she remembered key things

Erin brought her during the days of her pregnancy. In her individual interview, she talked about these items:

I’m really digging chocolate drumsticks right now. Like the chocolate ice cream ones, like they’re super yummy to me…. I remember she [Erin] had worked all day. I definitely had done nothing like but watching, like I hadn’t even cleaned up the house or anything like I could have done on my day off… And she comes home from like a 12-hour day with a Costco size box of chocolate drumsticks. I was like oh my god, my dreams have come true (both laugh)… I was looking at these post labor, what do you call them? Like they’re basically like, you know after labor they give you like ice packs for down there. But like they’re pads that

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you put Aloe Vera and like lavender and witch hazel… but it’s suppose to like soothe down there after all the meds have worn off. So I was like, I really want to get these. I was trying to prepare my hospital bag. And so I remember one day her coming back from work with like all the things I needed to make them… she was just like super, super thoughtful.

Christie recognized that Erin never had to get these things for her, she did it as a form of support. She found the support to be very thoughtful. Giving gifts showed both love and helped with needs for food cravings and just comfort.

Ava enacted a distinct form of instrumental support. During their couple interview, neither Ava nor Sophia brought up the basket of medication. However, in the individual interview, Ava did remember it. She described one of her key items of support:

I had a basket next to her side of the bed where I had taken pictures on my phone of all the different medicines that you’re allowed to take because the very smallest, like you can’t even take Advil, you can only take Tylenol. And you can’t take Pepto, which made her really sad, but in this basket was all of the things that you were allowed to have like and most of them, if the label wasn’t clear about its purpose, I have labeled like, this is what you take when you are feeling like you’re gonna throw up. This is what you take if you have bad gas. This is what you take for heartburn. This is how many pills and how often you can take it.

Ava went above and beyond with the basket of medication. Not only was it specific to what Sophia could take during the pregnancy, she even labeled which medicine to take for which type of bodily discomfort. Although Sophia did not bring up this basket of medication, it was clear that Ava was proud of this support.

Another form of instrumental support included completing household chores or tasks. All the queer couples cited moments where the co-parent would do an extra chore or task when they were pregnant. When I asked about how they supported one another

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through the pregnancy, several of the couples would just list tasks the co-parent did. For example, here is Danna and Jackie’s response:

Danna: You did all the heavy lifting (Jackie laughs). Jackie: I did the heavy lifting and did all the cat litter. Danna: The cat litter. Jackie: Garbage.

Danna was physically unable to perform these tasks. Although Jackie did say that after their final pregnancy, Danna would have to go back to picking up the cat litter.

There were a few of the queer women who experienced constant nausea during their pregnancies. In those cases, many of their partners ended up taking on more of the household tasks. Sydney described how Amber provided support during her pregnancy:

She provided a ton of support to me because I kind of just like laid on the couch all day… she was doing everything like grocery shopping, she was taking care of the dogs and she was making all the food and she was like prepping my food that I could eat during the day because I didn't want to cook it during the day. And then I, and then she would cook veggies in the house and I would tell her that's nope, bad, like you have to cook your vegetables outside, so she would cook her vegetables outside on like a little electric grill so that the house wouldn’t smell. Um, I mean she basically took care of pretty much everything that wasn't related to like me just trying to take care of myself.

Because Sydney had difficulty moving around the house and even eating, Amber moved much of her life around Sydney, taking over the everyday chores and then some.

A common task that the co-parent would take on is cooking. Several of the co- parents who did cook an extra meal or two never did the cooking in the house originally.

For example, Joanna talked in her individual interview about how Bridget showed support through cooking, “She, a couple of times made tomato soup and grilled cheese which is a big deal because Bridge doesn’t cook at all.” As the non-cooking partner in my

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own relationship, I recognized how significant that type of support can be when the partner does not usually take on this task.

Other couples found that they had to change their eating habits during their pregnancy. Eating habits did not necessarily have to do with cravings, but more lifestyle choices. Peggy in her individual interview talked about how Tiffany started to make dinner during the pregnancy:

Before the pregnancy, we were really bad about cooking at home because we have a microscopic kitchen. It’s an eat in kitchen and it has really no counter space and no storage and no dishwasher… So we just had a bad habit of going out to eat, which is not good for health and pregnancy or your weight. So then she would find healthier recipes and cook dinner for me.

Knowing that it would not benefit their pregnancy to keep eating out on a regular basis,

Tiffany would cook healthy meals in their unbearable kitchen, which was a form of significant support for Peggy. A select few were concerned about gestational diabetes, which meant dietary changes. Here, the support was not just about cooking food but having food in the house that coincided with a friendly diet. Brittany spoke about how

Grace was supportive when it came to food and how they “basically ate is if I had GD to prevent GD for most of my pregnancy… so Grace was really great at making sure that the food that we had at home was more or less in line with that.” Food is a significant part of pregnancy and by both cooking and having appropriate food, co-parents were able to provide support for their partners.

The instrumental support provided by the queer couples seemed standard. The co- parent often brought the birth parent food items, helped out around the house, and changed eating habits to support their partners. Their use of instrumental support

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coincided with idealized versions of fatherhood by taking over most of the household chores (Alio et al., 2013). When talking about their support, the couples never expressed moments of frustration surrounding the instrumental support. The co-parents in the individual interview or couple interview did not seem upset at having to provide these tasks. The tasks were just something they felt they were supposed to do. For those who went above and beyond, like Ava and Amber, they appeared to be pleased in their support, usually discussing it with a tone of satisfaction. While they may have acknowledged that they did go further than most couples would in providing support, they seemed to feel as though that is just what a partner does when their partner is pregnant. Their response to support was different compared to heterosexual men who believed they were taking on more than their fair share of household tasks (Widarsson et al., 2015). Unlike the men in Widarsson and colleagues’ (2015) study, the queer women did not feel this was unfair or feel like their partner was just completing their fair share of the workload. Although some appeared to follow heterosexual tropes of running to get donuts or cleaning the cat litter (pregnant women are not supposed to clean this because of the risk of toxoplasmosis), in the moments where the instrumental support went beyond these expectations, they created their own scripts. The couple’s supportive acts were not expected, as they went outside of the assumed norm, and it was something that they simply enacted.

Emotional support. Emotional support comprised one way that queer couples supported each other. While queer partners did provide a lot of instrumental support, they were also there for one another and were able to meet emotional needs. Pregnancy

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elevates hormonal responses and can heighten emotional sensitivity, which several of the queer couples recognized. Bridget, in her individual interview, talked about how she helped deal with Joanna’s emotional sensitivity. She described how she was “just kind of being patient with her in that sense” and she made sure to not antagonize her, even though she found it funny at times. She was also, “really in tune to like asking her how she felt.” Because emotional responses wavered, some of the queer women struggled with monitoring their emotions. Hilary described how Carmen was just very focused on getting, then being, pregnant and bearing their child. She also said that Carmen “wasn’t necessarily super excited all the time.” To help manage those feelings, Hilary tried to reassure her about their commitment. Carmen, in her individual interview said that Hilary would say, “thank you for growing a baby for our family.” By showing emotional support through reassurance, Hilary was able to be present for Carmen.

Emotional support also involved promoting positivity to the pregnant partner.

Some of the queer women talked about how they would go down rabbit holes of horror stories and start to panic. In Lynn’s individual interview, she talked about how Megan tried to keep her calm. She said:

I go at like zero to a hundred like all the time. And Megan is the calmest person ever… Megan’s like, “Babe, you are not allowed to read those stories anymore. Like no more documentaries, we’re just going to fill your mind with only good things, only positive things”… so she’s just always been that calm to me. Like the calm in the storm.

Megan had to not only reassure Lynn, but reminded her to promote positivity instead of worrying about worst-case scenarios and binge-watching crime documentaries. However,

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on one occasion, Megan provided emotional support by taking charge of a negative situation. They shared a story in their couple interview:

Megan: She got a flat tire once and we had to call the Nissan dealership because we didn’t know where, because she has one of those lock lugnuts you need like a special… nut to get it unlocked. So she’s calling Nissan trying to figure this out and the lady hung up on her (laughs). Lynn: I’m like oh hell no! Megan’s like “Get in the car” (stern voice). And I’m like, “What?” She’s like, “Get in the car” (stern voice). So I get in the car and she’s driving to Nissan and I was like, “Are you about to tear this woman’s ass off?” She’s like, “Yes!” And I was like, “Babe!” She’s never, she’s not confrontational (I laugh). You will not talk to my wife like that, oh my god it was hysterical.

Emotional support sometimes involved the non-pregnant partner speaking up in emotionally-charged moments. They ended up getting the car fixed, but it would not have happened if Megan did not act in that moment.

The pregnant partner was not always the one who needed support. There were times when the co-mother would need emotional support from their partner. Caroline and

Maggie talked about how Caroline would provide support during the pregnancy:

Maggie: Oh my god she encouraged me to go to trivia, that was awesome. Caroline: So Maggie sometimes like wants to help so badly that she’ll do it in lieu of doing things that are nice for herself. She gets really stressed out and overwhelmed and tired and feeling like she never has any me time, so I see it as part of my responsibility to make sure that she takes time for herself.

Caroline recognized that Maggie often tried to help around the house and Caroline so much that she often neglected her own needs. To help Maggie, Caroline would make sure that Maggie would do things that she enjoyed that makes her happy.

Other co-parents found a need for emotional support because of difficult situations with family members. In those times, they relied on their partners for comfort.

Grace explained that Brittany was great by providing reassurance, particularly around

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feelings about family. She said, “Whenever my family would, was not great about it, uh, she was really, really supportive. And I think she was supportive of me pursuing whatever sort of self-care things I needed to do.” Pregnant or not, queer couples had to cope with poor family treatment and would often rely on one another for that needed support. Tiffany also described how Peggy provided support to her in her individual interview:

She was listening to me rant about my parents because I mean it was a very difficult time to fall out with my mom and that ended up being a fall out with my entire family. And so she would just listen and try to give insight, the best that she could without trying to swing one way or the other… my mom does not think when she says stuff. So she says very insensitive things and I didn’t want to put my son in that situation where he has to feel bad about who he is and where he comes from… I didn’t want to have to worry about that… it was more of a decision that we talked through and I was like, this is what I’ll do. And she just supported me in that decision that I had made.

Making choices about family is never easy. Peggy provided emotional support by being there for Tiffany in that difficult time and, ultimately, supporting her choice to disconnect from Tiffany’s family. Pregnancy can be a difficult time for queer couples because it creates an outness that family members may not be prepared for. By providing emotional support in those moments, queer couples can cope and then re-define who they are, as previously discussed.

Attending pregnancy-related appointments provided a related form of support.

Being at appointments, the queer couples were able to use those moments as solidifying their connection to their child. Particularly for the co-parent, appointments were something in which they could participate. Several of the co-parents were able to go to all or almost all the appointments, which they prioritized. Laura had many appointments

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because she was considered high risk with the triplets, but Edyth was able to be at “98% of the appointments.” Peggy was not working full time so technically she could schedule the appointments whenever she wanted, but she made sure to schedule them so that

Tiffany could come “and she came to every OB appointment.” By being at the appointments, both parents demonstrated their commitment.

Going to class or prenatal appointments also served as a bonding time for the couples. Co-parents would often go to these classes or appointments, even if they were not entirely comfortable. In Rachel’s individual interview, she talked about how her and

Natalie did a childbirth class together. She explained, “I got the most intensive one I could find. And it’s not her style. We did birth art where we draw pictures about our feelings. It was so not her style, but she was a trooper.” Even though Natalie was not comfortable, she participated as a way of showing support and doing something together that involved the pregnancy. Lynn shared a similar sentiment in her individual interview when talking about birth classes:

It was like this fun bonding thing that both Megan and I could do together. Because we’re always surrounded by a million people and I know she hates that because I’m such a social butterfly. So it was this one thing that she and I could do together to really like solidify the fact that like holy crap, there is no backing out like we are totally doing this.

Megan may not have preferred to spend time with other people in her spare time, but they did the birthing class together to have a shared experience.

A few of the couples did not express the need to be at appointments or classes, and some could not attend because of conflicting schedules. In addition, a few of the birth parents did not understand why the co-parent would want to attend, as the appointments

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could be short and constant toward the end. Faith in her individual interview spoke about how she felt about the appointments:

She [Elisa] thought I didn’t want to go to the doctor’s appointments and like towards the end when she was going all the time and like I communicated, “No, that’s how I’m like a part of this.” And so she, so then she started scheduling them so I could go, which she’s like, “They’re boring.” I’m like, “I know, but I get to hear the baby’s heart beat so I want to be there.”

Even if the appointments were indeed “boring,” they were a space where co-parents could have a level of interaction with their child that they did not get otherwise. By having them come along, they were able to feel a part of the pregnancy.

Emotional support was significant for the queer couples that deviated from heteronormative expectations. In previous literature on heterosexual partner support, women wanted their male partners to provide more emotional support, but men felt more comfortable providing instrumental support (Somers-Smith, 1999). By queer couples recognizing and appreciating provided emotional support, they have deviated from heterosexual expectations. The queer couples also deviated in two other main ways. First, queer couples needed more emotional support when dealing with a lack of family support. When one of the queer women had difficulties with their families, she relied heavily on her partner for emotional support. The partner was there to provide reassurance and understanding, especially for Tiffany who had to make the ultimate decision to part from her family members. Experiences such as parting from a homophobic family are outside of heteronormativity because heterosexual parents are not likely to face familial rejection for their sexual identities.

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Second, the co-parents often needed more assurance about their roles and wanted to participate more in the birth related activities, as they did not get to feel the birth experience. By being able to attend appointments and other prenatal activities, the co- parents felt emotionally more satisfied. Furthermore, some of the birth parents also provided emotional support by reminding the co-parents to take care of themselves and their needs, something that has yet to be seen by the heterosexual literature on partner support in birth. Perhaps, co-parents want to be so involved in the varying aspects of pregnancy that they forget to find moments to themselves. In these ways, the queer couples move outside of heteronormative expectations of partner support and once again, create their own support scripts.

Supporting the co-parent. While it is expected that the birth mother would need a lot of support during the pregnancy, co-parents also had supportive needs in their roles.

Some had simple needs and others needed more reassurance and involvement in the pregnancy process. For example, Karen had one thing that she wanted to do before the baby was born. In her individual interview Karen said, “Once she gets pregnant I go into full nesting mode and I have to have everything done.” By allowing Karen to set up the kid’s room, Martha was giving her the needed support.

A few of the birth parents practiced reassurance for their partners that involved telling them that they will attach to the new baby, as this was a concern for some. Bridget in her individual interview talked about how Joanna would “reassure me that Lily is just as much my daughter, you know, she is mine or hers. She was constantly reassuring me in that way.” Similarly, Faith said that Elisa gave “a lot of encouragement” by saying

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“you’re going to attach to the baby” and “You know that she’s going to love you. You’re going to love her.” During the pregnancy, they were worried about whether they would form a bond with their child. Their partners would remind them that they are equal parents and there would be equal love.

Some of the birth parents would also find ways to assert their partner’s role in the pregnancy and parenthood. When talking about how Laura involved her in the pregnancy,

Edyth described how Laura would assert Edyth into the doctor’s conversations. She said,

“When we were at the doctor’s office… if they asked her a question she would defer to me too and be like, ‘Oh I don’t know, what do you think?’” By simply involving Edyth into the decision making, Laura reminded the doctors about Edyth’s role. In Brittany’s individual interview, she discussed the importance of speaking up about Grace’s parental role and identity:

Me being the one to communicate to our daycare that, my partner’s preferred parent name is Baba and that might be new for you but like, we have an expectation that this is what you call her and we want you to reinforce that with our kid when our kid is verbal… me taking the responsibility of giving that information rather than making it fall to my partner.

Brittany’s role as birth mother is already clear and people understand that role. The co- parent role can be new to others, and instead of letting the burden fall onto the co-parent to constantly assert their identity, the birth mom can take on that role as a form of support.

Beyond emotional support, the queer couples also described fun routines that allowed both parents to be equally involved during the pregnancy. Faith and Elisa did weekly bump pictures and documented the pregnancy through memorabilia. In her

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individual interview, Faith said, “The book turned out really nice and it’s a special little keepsake.” Having the routine that developed into documentation was something in which Faith could actively participate. Ava wanted to be an active participant in the pregnancy, but admitted that during the beginning, there was not much she could do. To compensate, Sophia and Ava had a special routine. Ava described it in her individual interview:

We used the app, The Bump and it’s one where like every week it gives you an update of how big the kid is and you know it’s like fruits or toys or animals… so whenever it was fruits, before it was big enough to feel or see that her belly was growing or any of that, when it was a blueberry and then a raspberry and a lime. On Sunday, was when it would go to the next fruit, and on Sunday night we would have something with that in it… I mean it’s dumb, but it’s the most we could interact with him at that point was seeing this little blueberry or bean… she would make me some dish with whatever he was at that point.

By having a routine where each week they had a meal that incorporated the “fruit” that demonstrated how big their child was, Ava was able to feel a part of the pregnancy.

Especially when there was little to do and few appointments, having this activity allowed for a shared experience.

Support through donor connection. Co-parents sometimes feared a lack of connection to their child. Because they are not biologically related, co-parents can feel that they are not as connected. As a form of support to address these fears, some of the carrying parents made sure to have sperm donors that appeared to look like the co-parent.

By having a sperm donor that matched the physical characteristics of the co-parent, the child had the potential to look like them. In their couple interview, Laura described how after “a lot of discussions, that we would choose Edyth’s physical characteristics so the child would have the potential of looking like both of us.” This choice did narrow down

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their sperm donors as Edyth had blue eyes and red hair, which, according to Laura “is less than one percent of the population.” Later in Edyth’s individual interview, she talked about what that choice meant to her:

I love the idea of her wanting to use someone who biologic, that characteristically looked like me… I think it just, it made me feel like she was truly including me. Like if we had adopted kids, anything like that, that would have been fine. If we had not chosen a sperm donor like that, that would have been fine too. And I just felt like it was her way of taking that extra effort to want to include me in the process.

Choosing a sperm donor that matched physical characteristics was not always about establishing a connection to the child, but showed that the birth parent wanted their partner to be just as involved in the process. Seeing as only one partner could carry (at least typically), birth parents had to find ways to involve the co-parent.

It was not always the co-parent who appreciated physical connections between co-parents and children. Several of the birth parents loved having that connection as it unified their family. If no one could tell who the birth mom was, then they looked like they all belonged, or at least that was the sentiment. Christie spoke about what it meant for her to use her brother-in-law as their sperm donor:

To us that was really important. And even though, like I know it’s not logical that two women have baby, but it’s still, when people tell us, people tell us all the time that baby looks just like Erin. And I just love to hear that because it’s like, technically it is her blood line. She is related to her. She is her daughter.

By having a biological connection to her child, Erin appears to have more of a claim to her child. In looking like one another, they appear to have formed a connection, that even

Christie appreciates.

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There were a few cases where a co-parent perceived that the birth parent cared just as much about the physical connection when, in reality, the birth parent did not. In

Faith and Elisa’s couple interview Faith had stated, “It was really important to both of us that the donor looked like me.” Faith continued this sentiment by describing why she wanted their child to have similar characteristics of blonde hair and blue eyes in her individual interview. She said, “Looks aren’t important but I also selfishly wanted people to think, oh, you could have had this kid.” While Faith had a personal desire for having matching characteristics, in both the couple and individual interview, she expressed that it was both of their desires. In Elisa’s individual interview, when I asked about this choice, she said, “I was fairly apathetic about the sperm donor choice. For me it was just like, it sounds, I don’t know, I feel bad saying I didn’t care, but I didn’t really care.” Faith described both of them equally caring about the choice to use matching sperm characteristics, however, Elisa made it clear that she did not care about the choice. While some couples did make that unifying decision, and were both equally happy, there were a few who just let the co-parent make the decision and were fine with whatever that choice was.

The need for co-parent support operates as both heteronormative and resisting heteronormativity. Co-parents often expressed a need to feel more connected to the child through reassurance or participating in pregnancy related activities. The need for more connection presents the idea that the co-parents are not assuming father roles, which is often more detached from the pregnancy. In wanting to be more involved, they are once again creating their own script to follow. However, the need for reassurance about

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attaching is based in biological parentage assumptions, stating that they fear not attaching because they do not have a biological connection. The co-parents are then stating how biology is a key factor in raising a child, a factor that comes from heteronormative parent expectations. The co-parents then operate in a dual tension of knowing that they are different from heterosexual parents, but wanting to reinforce heterosexual ideals surrounding biological children.

The need for queer women to have an apparent biological connection to their child is based in heterosexism. In needing to match donor characteristics to the co- mother, the couple is attempting to replicate heterosexual families. Wanting to find matching donor characteristics is not new (Chabot & Ames, 2004), yet the expressed fear and need to have a visible connection to the child promotes problematic expectations of parenthood. Children should not need to look like their parents in order to feel a part of their family. Yet, co-mothers expressed this need to provide security in their parental identity. In addition, it would make sense for the birth parent, like Elisa, to not care as much about having this connection, as their biological relationship is already established with their child.

Moments of non-support. Several of the couples had moments where they recognized, either collectively or separately, moments where they were not being supportive of one another or where they were simply lacking. A few of the queer couples discussed how, during the pregnancy, their relationship was not in the best place. Natalie and Rachel, in their first pregnancy were leading what Natalie called “separate parallel lives.” They mostly only saw each other on weekends, and they were not maintaining

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their relationship through their absence. In their couple interview, I had asked how they supported each other during the pregnancy. They both laughed, and Rachel responded by saying “Not so well” and Natalie replied, “It was a low point in our marriage.” Although they currently felt in a better place, they both admitted that their marriage was not great at the time, and, through working together, they were able to improve.

A few of the queer women also had moments where they recognized that as individuals, they were just not being supportive or expressed negative emotions. Karen in her individual interview talked about how her support was worse with the second pregnancy. She explained:

I think on the second time, I think I was just tired. I just didn’t have it in me as much as the first time. You know, the second one’s always a bit different. I think it’s like you’re trying. Plus, I stay home three days a week with him [first son] and I was taking him back and forth to his early intervention therapies, trying to get the room ready. I was like, I’m tired, like rub my feet, you know? (laughs)

Because with the second pregnancy they already had a small child, Karen felt exhausted as a caregiver and worked on creating a space for the new child. Through her exhaustion, she felt that she had little energy to care for her pregnant wife. This was not uncommon for the queer couples who had more than one child, as their responsibilities had shifted over time.

Other queer women had moments where they knew their negative emotions might have gotten the best of them. For example, Grace became upset at Brittany for not moving forward fast enough with the pregnancy process. Grace, in the couple interview, mentioned how upset she was, “There were bouts of me being like, ‘Why are you taking so long? Don’t you want this with me?’” Her emotional positioning made it so she was

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less understanding of Brittany’s hesitancy to move forward with the pregnancy. Heather also discussed moments in her individual interview where her emotions had a negative impact on her wife Jamie. She said, “I would sometimes say insensitive things. I was a bear at times.” Although Heather was frustrated that Jamie did not understand these emotional pregnant moments, she was still aware that her insensitivity had negatively impacted Jamie during her pregnancy.

Finally, a few of the queer women mentioned how they were just less understanding of what their partners were experiencing. Natalie had originally envisioned her family coming to be through adoption, not reproduction. She never had an interest in pregnancy and went forward with the pregnancy because that was something Rachel desired. Because it was something Rachel wanted, Natalie recognized that she was less understanding. She explained:

I have very little patience for some of it. That’s not true, I have very little patience for some of the complaining about the symptoms because at this, in this pregnancy she knew what the symptoms were like because she had done it before. There’s a lot of like, you should take care of me because I’m carrying our child. And I feel a lot of you chose to do this like yes, I love having children and there are lots of ways for us to have children. And this is a specific method that you chose, and these symptoms are a choice that you made.

Because Natalie felt that the pregnancy was a choice, she did not feel that she was required to dote on her wife as much as Rachel expected, particularly during their current, second pregnancy.

In the individual interviews, I had asked the queer women if there were times that they felt their partners were being unsupportive. A few felt that their partners were always supportive, at least in the ways they wanted. However, some did share moments

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where their partners were lacking. These moments were never discussed in the couple interview, whether it was because I did not ask about it specifically or because they did not feel comfortable sharing their feelings in front of their partners.

One of the ways partners felt that they were not being supported has to do with the shared pregnancy. For those who had both partners being pregnant at different times, some of the queer women felt that their partner was not being as understanding as they should be. When Heather spoke about her insensitivity and “bear-like” mentality, she was also frustrated that Jamie seemingly did not remember what it was like to be pregnant and experience increased emotional sensitivity. Ragan had similar feelings when she reflected on how Olivia seemed to minimize her pregnancy pains:

I think to some degree the level of pain that I was experiencing was difficult for her to understand. In some ways I felt a little bit like she thinks I’m making it up a little bit. She would still, it didn’t make her less supportive necessarily. It was just kind of like a feeling that I had, I guess about like she was maybe thinking that I was being a little bit more whiney than I actually needed to be type of thing.

Ragan’s pain was directly related to her pregnancy and she felt that Olivia was not understanding of her pain. Perhaps, Olivia felt that her pain was not that real.

Being partners, queer women also recognized that sometimes a partner’s needs were taking over their own. For example, Grace felt overwhelmed when Brittany would complain about Grace as a partner because it was taking up space for her own feelings.

She told me what she either wanted to or did express to Brittany:

You’re mad at me and I hear that. But like you can also tell somebody else you’re mad at me. Complain to someone else about me, you know? So, things like that I think I felt, it felt less supportive to say, but also you’re not the only, like you are pregnant and that matters. And also, you do not usurp all needs for support or your needs are not the only needs in this house.

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Grace recognized that Brittany was pregnant and needed some support, but she was not the only one in their household that had needs. By Brittany complaining about Grace to her, Grace felt there was little emotional space for herself. Danna also noticed how Jackie was being less supportive in her most recent pregnancy. She explained how Jackie was clearly stressed out from being a stay at home mom with two kids. At the same time,

Danna said, “I felt like she hasn’t been as able to step out of her own stress to be supportive.” Danna also admitted that, at that point in the pregnancy, she did not feel as though she needed a lot of support. She still recognized that Jackie was not as present with her and that they “end up neglecting each other a little bit more.” When partners are not present for the other, there can be an imbalance meeting emotional needs.

When partners discussed moments of non-support, couples would either collectively recognize the same moments, like Natalie and Rachel, or they would have different perspectives on what occurred. Perhaps, moments of non-support were more about the moments that mattered, and which was more salient to one person over the other. Maggie and Caroline both mentioned moments where support was lacking and they each had different perspectives. Caroline talked about how Maggie reacted to her constant nausea:

When I was really sick, I just threw up all the time and it didn’t always matter where I was, I didn’t really have control over it. And so there were many mornings I threw up in the garbage disposal. And especially in the beginning she was super grossed out by it and like kinda got pissed at me for throwing up all over the place. And I was not thrilled with her being sick at me for throwing up because it wasn’t exactly like this was something I could control. So we had a pretty big fight over that.

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Caroline felt that Maggie was not providing support in these moments and that Maggie was actually angry at her for something she could not control. For Caroline, this was a significant moment in their relational support during the pregnancy. When I asked

Maggie about how she provided support during the pregnancy, she started out by saying what she did and then moved into a time Caroline said she was not being supportive. She said:

One time we were on a walk and she told me, “I feel like I’m alone.” And so I was like, “What, how do we fix that? What do I need to do?” So I just, I tried really hard to listen and to ask… I mean she told me that she felt alone and that was devasting because I did not feel as though I was being unsupportive.

Maggie felt that this was a significant moment in their relationship, as being in a relationship, one should never feel alone. Yet, this was not the moment that Caroline brought up and never told me this story in her interview. How couples perceived unsupportive behavior could vary and be inconsistent.

The moments of non-support do not necessarily set the queer couples apart from their heterosexual counterparts. No person can be supportive all of the time or necessarily provide the support that a partner wants. Heterosexual couples have noted times where they had moments where the partners wanted different types of support than what was given or moments where they did not know how to give support (Somers-Smith, 1999;

Widarsson et al., 2015). The unique aspects of the queer couples’ support was based in two main areas: both members of a couple experiencing pregnancy, and knowing that pregnancy is a choice for queer couples. For couples in which both women were pregnant, the person who was pregnant second noted how it appeared their partner forgot what it was like to be pregnant. Heterosexual, cisgender men do not have the ability to

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become pregnant or share those same bodily experiences. However queer women can share in these experiences, and their shared experience can suggest that they would have mutual understanding in having both been pregnant. Both Ragan and Heather noted how their partners were not as understanding about their bodily experience, even though their partners had been pregnant in the not too distant past. In these moments, queer couples should be having experiences outside of heteronormativity, but seem to then replicate father expectations. When reflecting on Natalie’s feelings of non-support, she lacked empathy for her pregnant partner Rachel because pregnancy was viewed as a choice. For these queer couples, pregnancy is an intentional choice, something that cannot happen by accident. Therefore, Natalie did not feel the need to care for Rachel as much as Rachel appeared to have wanted because Natalie felt that there were other options to create a family. Although heterosexual couples can also create families through different means, the heteronormative expectation is one based in reproduction, and pregnancies can also occur by accident, making the father feel more responsible. By having these different types of experiences, queer couples have deviated from heterosexual expectations of support.

Being women equated with being more supportive. When considering how their partners supported each other, and moments of non-support, the queer couples also sometimes recognized that their support was unique and potentially better because they were both women. Some were certain of this fact, while others placed it as a possibility.

One of the reasons the queer women felt they were able to be more supportive is that as

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women, they understood the bodily experience. Karen talked about how she could understand what her wife was going through in her individual interview:

I can understand that she’s uncomfortable. Like you know, the shoes didn’t fit, the clothes don’t fit, you know. Like you understand what it’s like when your clothes don’t fit anymore and you’re uncomfortable because you’re wearing like eight bras, it’s just that kind of, I think you just understand more of what the body feels like.

Because women know what it is like for the body to go through changes in uncomfortable ways, Karen believes that women are then able to be more supportive of their partners. Megan echoed this sentiment in her individual interview. She said, “I probably feel like I was more informed because I understand what the female body gets to go through. I know what a period is and how that affects things and hormone swings and wanting chocolate.” While getting your period is not the exact same thing as being pregnant, there are similarities and knowing those similarities can allow for a deeper understanding.

The other reason for why the queer women felt that they were more supportive also involved gendered labor divisions in the household. Several of the queer women believed that men are not expected to participate as equally in caring for a child. Ava talked about how she read a dad’s book on preparing for pregnancy, “Books for dads are so terrible, like they’re so sexist… I read a couple pages and it was talking about just stupid things about like maybe you’re going to help out.” Ava pointed out that books for dads often promote the idea that the woman is the main care taker and that the expectations for men are extremely low. Joanna was less certain about whether women

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are inherently more supportive. In her individual interview, she reflected on stories she heard from other women:

I hear straight women complaining like their husbands don’t change diapers or they’re not as involved. Bridge is really involved with Lillian. Bridge changes just as many diapers as I do. She, you know, yeah. So like I wondered if Bridge is more involved because she’s female.

By comparing stories from heterosexual women, Joanna has questioned whether the difference is based in the fact that Bridget is another woman. In Jamie’s individual interview, she discussed how the division of labor between heterosexual and queer couples is different:

Whereas I think in some heteronormative couples there’s a lot of that dichotomy, like you’re the woman and you do this and you feel more responsibility for taking care of all the soft things around the house. And whereas like we do it all. So it’s a mix of like who’s doing what. So like I think we’re probably a little bit more supportive.

Heterosexual division of labor can be equated to gender roles. Men do the rough work of fixing broken household items and yard maintenance, and women do the laundry and dishes, the soft work. When two women are involved, that division is no longer there.

Jamie believed, as did several of the other queer women, that because the division is gone, they more equitably divide the work. When the division of labor is more equal, couples can be more supportive of one another.

In comparing the queer women’s experience to heterosexual couples, past research has shown how fathers want to be involved in the pregnancy, but are not sure how to be active in the pregnancy (Widarsson et al., 2015). The queer women had moments of uncertainty, but founds ways to assert themselves into the pregnancy by being at as many appointments as they could, finding connection through donors, and

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being creative with their connection. Widarsson and colleagues (2015) found that men had difficulty connecting to the pregnancy because they could not understand how the pregnancy felt. Several of the queer women believed that they were able to understand what their partner was going through with their pregnancy because they could remember similar physical experiences, such as having menstrual cramps. Although the shared bodily understanding could be beneficial to the couple, they could also perpetuate biological essentialism that promotes heterosexuality. Widarsson and colleagues (2015) also noted that there were barriers for fathers to be involved, such as an inability to leave work or attend appointments. The co-parents that were in male-centered workplaces had similar struggles as they were not allowed to take off work to attend the appointments.

The queer couples did have moments where they were not happy with the support, or recognized where they did not give the type of support desired, but most seemed satisfied with the types of support given. Queer women found their own routines when providing support. Several of the queer women followed the stereotypical roles of how fathers would provide support through instrumental ways. Yet, the queer couples often went beyond that and created their own forms of support. Queer women are in unique positions and having a queered relationship allows for flexibility for both good and bad.

In these ways, couples can meet heteronormative standards of partner relationships by showing up to appointments and doing a few extra chores. Alternatively, queer couples can surpass the standard and create new relational norms outside of heteronormativity.

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The Self and Heteronormativity

Moving toward the personal, queer women can also reproduce heterosexism through their own beliefs and actions. Queer women can struggle with understanding the queer experience versus upholding heterosexual ideals. In this final section, I explore how the queer women perpetuated heterosexism through their beliefs and actions.

Desire for pregnancy. One of the frequent ways that the queer women reinforced heteronormative expectations was through their desire to become pregnant. The desire to become pregnant is not necessarily heteronormative, unless it is based on the belief that women should be pregnant if they wish to be fulfilled as women, or, if pregnancy was part of the expected life script. For example, several of the queer women made statements about how pregnancy was just part of a person’s life script. Rachel commented on why she wanted to be pregnant, “It just seemed like a given to me that like, let’s get married, have a baby, having a house like these are all the things I wanted forever.” Several of the queer women echoed this sentiment by saying it was all part of their life plan. Ava commented on how it was something they were supposed to do, “We moved in together, we got married, we bought a house, we were supposed to have kids.” When considering pregnancy as something that a person is supposed to do, they are reinforcing heterosexist expectations. In thinking of pregnancy as a part of life’s trajectory, they are re-instilling the heteronormative script of dating, marriage, house, and baby.

Some of the queer women did question why they believed in heteronormative expectations. For example, Brittany said that she “really wanted to be married first” before having a child. Immediately after, she said, “I don’t know, that felt important for

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me for reasons I’m not entirely sure why.” Because we grow up with a narrative that emphasizes marriage and children, a narrative that also presses heterosexual relationships, there is an expectation of how we are supposed to live our lives. Heather also reflected on her need to be married prior to getting pregnant. She stated, “I want to get married before having children (laughs). These institutions, how they’re impressed upon you at a young age. It’s so bad. It’s so awful.” Heather recognized that her desires were based in institutions, not an inherent desire she found on her own. Those institutions can have consequences. Heather struggled for years to become pregnant, and it was not until the end of her pregnancy that she felt that she was an “acceptable, fertile person.”

Personhood should never be defined by capacity to bear children, but that myth is part of the heteronormative belief, which can be instilled upon a person regardless of sexual identity.

A few of the queer women thought deeply about why they desired to follow the path of marriage and children. Elisa explained how she had always wanted to become a mother and that had always been a part of her identity. However, in her individual interview, she thought on why she wanted those things:

I guess more of a feeling of like, this is a necessarily where I expected my life to be. I guess pregnancy was definitely tied up in my much younger understanding of myself as straight, that I would get married and like up until I came out there was kind of always this thought in my head that I’ll get married, I’ll marry a guy that’s a lot older than me, we will have kids, we, you know, just the perception of my life was very different. And then when I realized I was gay and came out, a lot changed. And so even though that wasn’t like a hugely traumatic problem or anything like it was fine. I guess my thinking of myself as having children was still connected to that older version of my life than what my life had become.

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Having children is not necessarily a bad choice. The problem is that the desire to be pregnant is wrapped in heteronormative ideals and we are not raised with any other conception of what life can be. Elisa talked about how her need to have children was tied to a heterosexual life path she assumed she would always be on. That desire to have children was still tied up in that heterosexual identity. Without reflection, we can reinforce heterosexist ideals.

One of the potential reasons for perpetuating heterosexist values is that queer women are bombarded by heteronormative expectations. Part of heterosexism assumes that the only way to be a mom is by reproducing with a man. Thus, when some of the queer women came out to people, they were given the message that they could never be a mom. Caroline shared a story in her individual interview about how she came out to a friend in high school:

I remember when I came out to them, we were ski buddies and he said, the first thing he said to me was, “Caroline, I always though you would be such a good mom.” And I looked at him and I said, “[name], I could still be a good mom, you know.” And he goes, “Oh.”

Caroline’s friend believed that because she was now a queer person, that she could never assume the identity of mom. The role of mom is reserved for heterosexual women who are married to men, who reproduce with them. By not occupying that role, Caroline could then never be a mom. In a similar story, Lynn talked about coming out to her sister and how she was “hysterical.” Her sister responded, “Does this mean I’m never going to have any nieces or nephews?” A queer identity has historically been wrapped up in childless identities, as only heterosexual people are being able to have children, and only through reproduction.

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Heteronormative expectations can then be internalized when confronted on a regular basis. Heather talked about the struggle she had feeling like a legitimate parent in her individual interview:

At times, I really felt like I was, just the experience of not being with a man or being, doesn’t even matter married to a man, just like the presence of a man like solidifies my pregnancy as legitimate or something versus again, the invisibility of the non-gestational parent that like having been that, know that, and then what it’s like to be pregnant and Jamie on my side.

Heather recognized that her pregnancy could only be seen as legitimate by other people if a man was in the picture. When having a female partner, people then question the pregnancy and parental identities. When a woman is the non-carrying partner, the role they occupy is often invisible based on those expectations.

Unfortunately, queer women can also impose heterosexism onto their partners.

Bridget discussed how Joanna was talking about their second child immediately after their first was born, “She’s like, ‘Bridge, don’t you want one of your own? And I’m like… no because she is mine.” In this moment, Joanna was asserting that their daughter was not really Bridget’s and that for Bridget to “have one,” she would have to give birth to a child. This a heteronormative expectation because Bridget’s parental role is not defined by biology or birth, but through a relational experience of being a partner with

Joanna and making the decision to have a child together.

Several of the women engaged in self-defense mechanisms to cope with heterosexism. One of the ways the queer women coped with heterosexism was through promoting the idea that being queer and pregnant is just the same as being heterosexual and pregnant. Caroline talked about how she had many questions as a new parent, but

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being queer was not a factor, “My questions are rarely about being queer with a baby.”

Ragan reinforced this sentiment in her individual interview:

I can’t think of there necessarily being any difference except for it initially being monitored for the IUIs with follicle scans and that type of thing. But that’s not exclusive necessarily to LGBT people either. I don’t know, I mean, I feel like more than anything it’s just commonalities. We all were just pregnant.

Saying that being queer does not affect pregnancy omits the experiences that many of these same women discussed. Being queer influenced multiple aspects that went into their pregnancy and how they were then treated, whether for good or bad. Olivia felt similarly and said:

I don’t feel like our experiences would really have been all that different… But I mean, I think pregnancies the same. There’s a baby growing inside a uterus, whether you’re straight or gay. You know, raising a kid, it’s, we’ve all got to potty train them. We’ve got to feed them. You’ve got to play with them. It doesn’t matter if you’re two moms, two dads or one of each.

Although Olivia made this statement, the rest of her interview indicated the opposite response. Throughout, she complained about the double standards, how insurance was discriminatory, and how she must still pay off her children while her heterosexual counterparts were covered by insurance. Yet in saying that they are all the same, she can hope that they will indeed have the same experiences, regardless of what occurs.

A second way that some of the queer women coped with heterosexism was by defending heterosexual individuals. For example, Joanna just felt that people were going to make the wrong assumptions, “You have to a certain degree accept that even people who mean well are going to get it wrong and ask if you have a husband or a wife.” By accepting that people will make heterosexist assumptions, she is technically saying that

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heterosexual people are not responsible and do not need to change, placing the burden onto queer people.

More than just accepting heterosexist assumptions, a few of the queer women went as far as saying that queer people are often the ones in the wrong. Edyth discussed how queer people can be the judgmental ones, “We’re so quick to judge the heterosexual relationships in child rearing and things like that, and if you’re going to want people to be accepting and understanding of you, then you need to extend the same courtesies.” While

Edyth’s sentiment can sound nice, Edyth is not recognizing that the critique of heterosexual relationships is often the critique of heterosexism and sexism. When thinking about how men are expected to do less than woman, we should recognize that this is a sexist expectation. Not allowing for a critique of heterosexism reinforces heteronormativity as perfectly acceptable. Christie went a bit further with her defense of heterosexual couples by placing the blame onto queer people. She said, “We’re not very pushy like as far as like, I mean we’re not like, ‘We are a same sex couple and this is our child,’ we’re not, I don’t know, we don’t try to shove that down anyone’s throat.” In her statement, Christie was implying that queer couples that assert their family identity are

“pushy,” reinforcing a narrative harmful to queer families. By placing herself outside of the narrative, she protects herself from heterosexism and discrimination from those who believe that queer people are just rubbing their identity in people’s faces. However, at the same time, she promotes the harmful belief.

The final way that queer couples have engaged in protection that can promote heterosexism is by not allowing themselves space for anger at the injustices they

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experienced. The lack of anger was highly present when talking about second parent adoption. In second parent adoptions, queer couples would have to pay legal fees to adopt their own child. By adopting their child, they can then have more legal protections in the event of a divorce or the death of the birth parent. While many of the queer couples recognized the discrimination behind the need for second parent adoption, they would not allow themselves to be upset over it. Faith described their reaction to the adoption process, “We decided we could be mad about it and it’d be a horrible awful experience, or we could celebrate it.” They decided to celebrate it as Faith described, “We all wore fancy outfits, we’re like well we could be mad at how injustice is that I have to adopt my own child? Or we could just celebrate the day.” Elisa and Faith took the approach that they would not be mad about how discriminatory the requirement was, yet the lack of anger does not erase the injustice. Furthermore, there is nothing wrong with being angry.

Some of the women would try to deny their anger, but it was evident that they were indeed angry. Megan stated that she was not mad, but then went on a mini rant about the situation, “I’m not mad about it because the government doesn’t live in my house. So to me it’s just a piece of paper that makes them feel better because my family’s going to continue to live and do whatever we want.” Despite her saying that she was not mad, her tone was otherwise. She was clearly upset that the law did not recognize her as a legal parent of her child unless she went through the second parent adoption process.

Natalie expressed her deep frustration with having to go through the second parent adoption, “I knew how important the adoption was, but I was ticked, I’m still ticked that I had to do it. I’m not happy about doing it this time either.” At first, Natalie acknowledged

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her anger about the situation, but then she immediately said, “But I have decided to just have a better attitude about it.” There is no need for a better attitude. Queer people can be angry about the injustices they experience. However, by having a more positive approach, they can wrap themselves in self-protection.

Queer women may express a desire for having a heteronormative life through pregnancy because they were attempting to achieve happiness through gender roles. In gender roles, women are expected to want to become pregnant and take on a maternal identity. These gendered scripts can also be “happiness scripts” that show what both men and women should do in order to be happy (Ahmed, 2010, p. 59). Happiness determines how we get along with others, meaning that we must exert happiness for the correct things (Ahmed, 2010). To deviate from these gender roles, particularly the ones that are designed to make men happy, is then to be deviation from happiness itself (Ahmed,

2010). Therefore, the queer women may connect a pregnant identity to one of happiness.

If they never become pregnant, they can never be happy, as this is the narrative that they have been told.

Yet these forms of happiness could be false, a fake feeling. Ahmed (2010) argued that “Going along with this duty can mean simply approximating the signs of being happy – passing as happy – in order to keep things in the right place” (p. 59). Or perhaps they are happy. The problem is that happiness is constructed through heterosexism, meaning that we cannot understand happiness without understanding that happiness is created through heterosexism. The power of heterosexism is everywhere and therefore, influences how people understand happiness. Therefore, when the queer women try to

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process their feelings and consider why they made their life choices, they cannot separate themselves from institutional power.

Projecting happiness or following heterosexism could also be strategic. To be recognized like every other family, to be seen as following a heterosexist script, could be needed in order to survive (Ahmed, 2013). Using a narrative of assimilation to become like heterosexual couples, queer folk also then need to minimize signs of queerness (i.e., a childless existence). However, promoting the idea that to be happy as a queer person also means that they are promoting social forms in which some queer folk cannot participate (Ahmed, 2010). Reproducing is very expensive for queer folk, and therefore, not accessible to many families. Simultaneously having children as queer individuals and not following heterosexual norms may not be possible. Ahmed (2013) asserted,

“Maintaining an active positive of ‘transgression’ not only takes time, but may not be psychically, socially, or materially possible for some individuals and groups” (p. 429).

Particularly, those queer couples with limited resources in both support and materiality, may not be able to distance themselves from heteronormative ideals.

Finally, queer women who did not allow themselves to be angry were most likely acting in self-protection. Those who are oppressed tend to show signs of happiness, as this demonstrates that they have been well adjusted (Ahmed, 2010). It is difficult to be both angry and oppressed because if an oppressed person does not show they are happy then they are automatically read as being angry, hostile, or any other negative emotion. In this way, “happiness becomes the expected ‘default position’ for those who are oppressed” (Ahmed, 2010, p. 66). Instead of showing anger at injustice, several of the

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queer women moved to acceptance and potentially celebration. They are not allowed to feel their anger. Yet, to deny the existence of discrimination comes with a consequence.

In presenting positive emotions towards discrimination, the positive emotions have the potential to reimagine “the world as if there is no discrimination: and as if in bearing new life, the world itself will become bearable in the time of the arrival of new life” (Ahmed,

2010, p. 113). To deny discrimination, to not meet it where it is, presents the world as if there is no discrimination, no room for change. The queer women are then put into a binding position: to take on heteronormative “happiness,” or be presented as purely angry.

Heterosexism existed in every aspect of the queer couples’ lives. How they and those around them reacted to heterosexism varied. It is important to remember that regardless of how the queer women responded, they were automatically trapped in a position that has no true right answer. To perform as heteronormative means queer women get to try to be part of the norm and hopefully be accepted. To resist heteronormative ideals means they can suffer the consequences that impact themselves and their new child(ren). From the public to the personal, queer couples often encounter heterosexism and attempt to find support from themselves and others.

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Chapter 6: Conclusion

Sipping my wine, I listen to my mother-in-law and her sister talk loudly at

the table next to me. After a long day of interviewing, I try to create energy

that is no longer there. They turn to ask me about my interviews, knowing

that was the reason I did not participate in the day’s activities. My

interviews had become my favorite subject. I smile as I tell the tale of

Christie and Erin and their use of Erin’s brother as their sperm donor. As I

share the story, I wonder at the negotiated familial boundaries. Their eyes

widen as I talk. They cut my story off to exclaim, “Jay should be your sperm

donor!” My eyes bulge in horror thinking about my brother-in-law and

quickly state, “No, no.” As their talking turns into a pregnancy fairy tale, I

start to fester in my discomfort. They know mine and my wife’s desire either

not to have children or to potentially foster, if we were to reproduce at all.

My interview had now planted a possibility for them.

The dissertation does not have a true conclusion. My life has become intertwined in the queer women’s stories. The more I share the queer women’s narratives, the more people interrogate not only their own lives, but mine as well. Even as I discuss the findings of this work, I can see my listeners carefully tracing their own connections to heteronormativity to see if they have spoken heterosexism into existence; or perhaps, they become quickly defensive and dismiss examples of heterosexism so that they do not have to feel guilty. While this chapter is labeled as the conclusion, these stories will not

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end. In this final chapter I discuss the answers to the research questions, implications of the findings, the limitations of this work and some of the future directions.

Answering the Research Questions

The dissertation began with two research questions that shaped the interview guide and the multiadic approach to data collection and analysis. In this section I will summarize the answers to those research questions based on the two analysis chapters.

The first research question asked, “How do queer couples encounter and/or resist heterosexism in their healthcare encounters immediately before, during, and after pregnancy?” There were several ways that the queer couples encountered heterosexism within healthcare. First, the queer couples grappled with the tensions among politics, dismissal, and visibility. Many of the queer women recognized that the current political landscape placed them at a higher risk for discrimination. The current landscape endangered both their basic rights and had implications within a healthcare environment.

Other queer women would dismiss heterosexist encounters or deny their existence. Even so, some of the queer women also felt they were more visible in healthcare spaces as queer and pregnant women. This push and pull tension encouraged queer women to either recognize the potential for discrimination (a choice that would cause them harm through fear of discrimination) or the believe that discrimination no longer exists and that everything would be fine (which would allow heterosexism to proceed without challenge). Systems that promote heterosexism created this tension for the queer couples without a seemingly correct response.

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Patient-provider communication was a specific area where these tensions of heterosexism emerged. Several of the queer women rationalized when they experienced negative interactions with healthcare providers. They often placed the blame onto issues such as bedside manners or personality issues. In creating a reason for the negative encounter not based in heterosexism, they could place themselves in a safer space that did not warrant further analysis of how they might have been treated poorly because of their sexual identities. When heterosexism was noted by the queer women from their providers, the experiences included providers questioning who the real mother of the child was, assuming that only one woman could hold the parental identity of mother.

Further, several of the queer women felt they were required to explain their sexual identity, as their healthcare providers could not operate outside of heteronormativity.

Finally, healthcare providers could end up perpetuating heterosexism through asking questions about the creation of queer families to the queer couples. By asking questions to the families, they were demonstrating that they were not educated on the topic as they ought to have been through their formal medical education or through their own research.

Outside of providers, when queer couples would request to be treated like everyone else, they were perpetuating heterosexism by equating everyone else as only heterosexual couples. Further, queer couples would perpetuate heterosexism by dismissing healthcare providers heterosexist practices.

There were several ways that resistance was enacted in patient-provider communication. Some of the queer women attempted to preface their queer identities when working with providers so that the providers would understand the partner’s role in

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the relationship. Moreover, the queer women would engage in forms of advocacy, both by themselves and through doulas and friends. Several of the queer women would also seek out queer friendly care in hopes of preventing potential discriminatory care from providers, but queer friendly care could be limited to those who had access to queer resources. In addition, there is no guarantee that a queer provider will give quality care.

Providers would participate in resistance by including the co-parent in the child’s delivery and through manipulating insurance to cover the costs that occur for queer couples during insemination.

Heterosexism also occurred in medical contexts beyond patient-provider interactions. Birth classes were typically based in heterosexist language that would promote mother and father identities. The classes were often tailored for heterosexual couples, and they struggled to incorporate queer couples in several of their activities.

Like birth classes, hospital tours also promoted heterosexism through heterosexist language. They would often speak of a mom and dad and could not adapt their language for queer couples. Finally, birth certificates and paperwork only allowed space for a mother and father. While some forms were available that accurately represented the queer couples, they were not always as accessible compared to the forms that only assumed heterosexual parental identities.

Surveillance and discipline functioned in medical settings for the queer parents by monitoring their identities. Several queer women in the study did not articulate heterosexism into existence, furthering the silence of power systems which allow heterosexism to thrive. In both the providers and the queer women not speaking the name

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or stating overt heterosexist comments, heterosexism is able to continue without interruption. Providers also disciplined queer identities by presenting heterosexual identities as the only possible identities for the queer women to occupy. Through their assumptions about motherhood and non-romantic relationships of the queer couples, they were telling the queer women that they can only occupy a heterosexual identity.

Surveillance was also present through the multi layers of the healthcare system, as providers at all levels of interaction assumed heterosexual identities of the queer women.

Aside from the perpetuation of heterosexism through surveillance and discipline, healthcare providers and the queer women attempted to resist heterosexist structures.

When the queer women attempted to resist through prefacing their queer identities, advocacy, and seeking out queer friendly providers, their resistance was only partial because they were still embedded in the heterosexist system and did not go outside of that system. Healthcare providers also resisted heterosexism through including the co-parent in the delivery and by manipulating insurance coverage. Their resistance was significant because they were power actors that were directly combatting the heterosexist systems. In order to change the heterosexism in healthcare, healthcare providers need to serve as key members of the resistance.

The first research question focused on healthcare encounters of the queer women.

The second research question asked, “How do queer couples encounter and/or resist heterosexism in pregnancy?” Queer couples encounter heterosexism in the ways people engage their pregnant bodies and the assumptions that people make about the nature of

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their relationships. They resist heterosexism, primarily, through negotiating familial, workplace, community, and relational spaces in ways that alter heteronormative scripts.

In public encounters, the queer women often dealt with heteronormative assumptions from strangers. Strangers largely assumed that pregnant bodies and bodies near children were heterosexual bodies. The heteronormative assumptions included questions of mother identity both when the two mothers were present and when only one was visible. In these assumptions, the queer women were positioned as (in)visible bodies.

The queer women could be extremely visible based on their embodied pregnancy, but they would often be assumed to be heterosexual. Queer bodies lack a sense of privacy as heterosexist questions placed them into positions to either correct these assumptions, interrogating their lives further, or they to hide inside heteronormativity to gain access to privacy. In these moments, the public surveils queer bodies placing them into the trap where they are forced to state their deviancy to the heterosexist narrative or perpetuate heterosexist assumptions.

When the queer women occupied work spaces they often dealt with heterosexism from their co-workers. This heterosexism often manifested in misunderstandings of the co-mother’s role. In addition, male-dominated co-workers also expressed levels of sexism surrounding pregnant and female bodies in addition to perpetuating heterosexism.

Support that was given by the co-workers in a few of the pregnancies could be acts of resisting heterosexism however, there was also the potential to contribute to sexist rhetoric by reinforcing gender roles in pregnancy.

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Families appeared to have the most capacity for reinforcing heterosexist expectations of the queer couples. Several of the family members promoted biological relationships with grandchildren, relationally distancing themselves from the grandchildren who did not share the biological connection. Furthermore, family members would be confused by or prefer not to hear about the details of the conception of queer couples’ children. Family member discomfort seemed to be based in heterosexual understandings of conception. Resistance to heterosexism existed when families chose to provide support, particularly when their daughter was not the one who gave birth. In doing so, the families embraced both the couple’s relationship and the new grandchild. In addition, the queer couples themselves attempted to resist heterosexist family structures by redefining family through relationships with sperm donors and donor siblings. In trying to resist heterosexual definitions of family, they were only able to partially do so as the queer couples were still articulating family identity through biological relationships.

The queer community seemed to be an important safe space for the queer couples to cope with the heterosexism they encountered. The queer couples would seek out queer connections, mostly online, to find answers to their questions based on being queer with a child. Face-to-face connections were, however, challenged by some of the queer community’ s hostility to pregnancy. In emphasizing the need for a queer space, several of the queer couples countered their beliefs of queer parenting. Several of the queer women stated that they believed they were no different than heterosexual families, yet these queer women also often sought out other queer representations of family. By citing a need to have their children connected to other queer families as a reference point, they

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acknowledge that their family was also different from heterosexual families.

Heterosexism, both when it is enacted and when it is resisted, may place queer couples and their families into a unique queer space in between mainstream queer culture and the heterosexual culture that provides a model for the nuclear family.

In reflecting on their internal understandings of their couple and parental roles, several of the queer women perpetuated heterosexism. Their need to be pregnant to achieve womanhood and to have their relationships validated emphasizes a construction that is based in the nuclear model and its biological ties. Another way that the queer women perpetuated heterosexism was by removing responsibility from heterosexual individuals for stating heterosexist remarks. The queer women sometimes struggled to resist heterosexism because they did not allow themselves to have negative emotions when encountering heterosexism. They would promote the need to find happiness or acceptance when encountering heterosexist systems that disadvantaged the women or their families.

Surveillance and discipline were present in the queer couple’s interactions with the public and private relationships. The public surveilled the queer pregnant women when they were visible as pregnant bodies. When members of the public would approach the queer women when they were pregnant, they would comment on their bodies by asking about the father of their child. In these moments, the public were also disciplining the queer women by stating that they only acceptable sexual identity is a heterosexual identity. The queer women would sometimes then perpetuate heterosexism by not correcting these strangers about their assumed sexual identity. Power continues to thrive

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in these moments and discipline has served its purpose. Family members would also engage in disciplinary acts by promoting biological relationships with their grandchildren over the grandchildren that they did not share this biological relationship with. In showing a preference, the family members were stating that they only acceptable familial relationship is one that replicates the nuclear family. Some family members would also enact discipline to the queer couples when they would not communicate with them about their children or other aspects related to their queer identity. Whether it was the public or more private relationships, discipline served to remind the queer women that the only acceptable familial identity to occupy is that of the heterosexual, nuclear family.

In addition to Foucault’s theoretical perspective of power, Ahmed’s articulation of happiness provided a key theoretical lens for the queer couples’ experiences. In using

Ahmed’s arguments of happiness, it was evident that the queer women were battling with how they understood their own happiness as well as those around them. I was able to articulate how the queer women were trapped into fake binary ideas of happiness that often-promoted other’s happiness over their own. Further, Ahmed’s perspective also reiterated that the queer women were also trapped into assimilation and resistance that would still punish them for either choice. Ahmed allowed for the understanding that there is no correct way to have a queer family, and that these false binary choices surrounding happiness perpetuate an idea that the only correct choice is through following other people’s perspective of happiness.

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Implications

This dissertation provides implications for practice, literature, and theory. In this section I discuss how there are practical implications for healthcare providers, healthcare practices, the general communication, families, community, and for queer couples. I also review the implications for the interpersonal communication literature on partner support during pregnancy. Finally, I discuss theoretical implications of Foucault and Ahmed in this dissertation.

Practical implications for providers. The hope and goal for my dissertation is that other actors, outside of the queer women, seek positive changes to disrupt heterosexism. While queer women can resist, they cannot be the sole actors; otherwise, the power systems will never change. First, healthcare providers need to work to improve their care of queer, pregnant couples. In following the previous literature, healthcare providers need to use open ended questions to be inclusive of queer patients (Singer,

2012). In particular, healthcare providers should remember that not everyone can become accidentally pregnant through sexual intercourse (Singer, 2012). Rather than make this assumption, healthcare providers should listen to the sexual practices engaged by their patients and recognize that sex without sperm and a uterus cannot produce a pregnancy.

The findings in this dissertation also suggest that healthcare providers should attempt to avoid using queer couples as an educational resource. While some of the couples did not mind the questioning, there were those who then felt ostracized when the providers continually asked questions about their family’s conception.

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In considering past recommendations for healthcare providers, Pharris and colleagues (2016) explained that the intake forms need to be updated to include both parents with their correct parental labels. Most of the queer women found that their medical forms were updated. However, several of the updated forms were not readily available. Instead of medical facilities automatically offering the form that lists “mother” and “father”, the automatic forms should say parent one and parent two, to be inclusive of different family dynamics. One thing that was absent from the existing literature that was discussed heavily by the participants in this study was the inability to understand the two- mom relationship. Many of the healthcare providers did not understand how a child could have two mothers. This indicates that there needs to be more education for healthcare workers through the healthcare network (not just main providers) on diverse family dynamics so that they do not promote heterosexist beliefs about family. The need for a multi-level education on queer families is based on how the queer couples encountered heterosexist assumptions from all levels, to the security guard through their ob-gyn.

Related to healthcare, birth classes and hospital tours need to work on their inclusivity of queer families. Past research has indicated this need for improved prenatal classes for queer couples (Erlandsson, Linder, & Häggström-Nordin, 2010; Larsson &

Dykes, 2009; Ross, Steele, & Epstein, 2006; Spidsberg & Sørlie, 2012). Birth classes have not improved for the queer couples in the United States. To improve this type of care, the birthing classes need to permanently incorporate gender neutral language to account for same-sex partners in the classes. Because the class leaders had difficulty switching to appropriate language when the queer women were present, they should

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consistently use gender inclusive language, as this language still accounts for heterosexual couples. While Erlandsson and colleagues (2010) found that the lesbian women wanted separate prenatal classes, the queer women in this study did not provide that as a solution. They simply wanted the classes to be aware of queer couples and to provide accommodations when necessary, such as activities that assume a male-female partnership or that all couples use birth control to prevent pregnancies. One unique contribution of this study is that the queer women complained about the heterosexism in the hospital tours. Previous literature did not note that detail perhaps because they do not exist outside of the United States or those providers were more aware of queer couples.

Hospital and birth tours need to also utilize gender inclusive language, such as birth parent and supportive partner, to acknowledge the varying partnerships that can take place in a birth settings.

Implications for general communication. Regardless of connections to queer communities, people need to broaden their understandings of families. Families do not need to be formed through heterosexual reproduction to be considered valid. Our public perceptions of family and pregnancy need to be altered. When encountering a pregnant individual, we should not assume that the woman was impregnated by a heterosexual cis- male partner. Pregnant women, in general, should be under less scrutiny by the general public so any conversations that inquire about the pregnancy may not be appropriate.

However, if you are in a conversation with a pregnant woman you do not know, be mindful of the assumptions you may be making about her, her partner, and her family.

Particularly, avoid comments or questions revolving around the father of the unborn

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child. Finally, if a queer individual discusses heterosexism they encounter, do not react by stating that the heterosexism may not have existed or that the person or entity was not purposefully discriminating. These reactions can prevent queer individuals from speaking about or recognizing encounters with heterosexism, perpetuating these power inequities.

Implications for work spaces. Work spaces in this dissertation was both a site of heterosexism and support. To improve their relationships with queer families and other workers that have families, work spaces need to be aware of the Family Leave Act and how families do have the right to take family leave with the addition of a new child, regardless of if that child was given birth to by the employee. In addition, support of birth parents should be scrutinized to determine whether the support is based in sexist notions of how women are expected to give birth to fulfill a feminine ideal. If workplaces choose to support those who have an addition to their family through baby showers, they should be equally held for all employees, unless the employee specifically states that they do not want a baby shower. If that cannot be met, work places should then consider no longer hosting baby showers for their employees. Overall, workplaces should be mindful of how they talk about birth in the workplace and parental role expectations. Discussions of employees and their families should not be based in heteronormative expectations and gender roles.

Implications for queer communities. Many of the queer couples sought out online queer supportive communities while going through and after their pregnancies.

These spaces should continue to grow and thrive as there is still an ongoing need for this type of support. However, queer communities should also reflect on how they may be

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perpetuating both heteronormative and homonormative expectations of queer families.

Families do not need to replicate heteronormativity in order to be valid. In addition, there is also no singular way for queer couples to create their families and reproduction does not necessarily equate to assimilation. Queer communities can also consider creating more queer family spaces and community events in their local areas. Those not based in larger cities may benefit from LGBTQ centers or community groups hosting family events to get to know other queer families in the area. These family events should be hosted during family friendly hours and should be for any family makeup, not limited to those who chose reproduction.

Implications for families. Many of the family members in this study articulated heterosexist expectations of families. Regardless of if a family member is queer or not, the general population in the United States should work to understand how family can exist outside of heteronormativity. This includes understanding that birth and biology does not determine family dynamics. When talking about and considering family formation, we should openly talk about adoption and fostering as pathways to parenthood. Further, parents who are not connected by biology can be just as equal of a parent compared to those who are connected by biology. Biology does not determine a family. Grandparents also still struggle with biological connection. Similar to Nordqvist’s

(2015) study, grandparents in this study promoted biological relationships over the grandchildren who were not biologically related. Grandparents should reflect on how they may be purposefully or implicitly favoring grandchildren that they are biologically connected to.

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Implications for queer couples. The queer couples in this study both followed heteronormative scripts of support but also deviated to create their own. Several of the couples appeared to be happy with the type of support given and received, suggesting that having their own script allowed for more certainty in that support. However, in the times where support was lacking or misunderstood, queer couples could benefit from potentially having more honest conversations. Further, queer couples should consider why there is a need to affirm co-parents’ relationships to their children when they do not share a biological connection. Is the fear and anxiety based in themselves or society’s expectations? In addition, choosing a donor based on matching characteristics of the co- parent should also be reflected upon. That choice is not necessarily harmful, but it could be perpetuating heterosexist family ideals. Choosing a sperm donor is a unique choice without a script, so it can be easy to then follow the heteronormative ideals by matching the co-parent characteristics. Consider other ways in which family can be established outside of heteronormativity. Mostly, reflect on why the sperm donor choice is being made.

Implications for queer individuals. Knowing that heterosexism is ingrained in

U.S culture and within ourselves, it can be hard to reflect on how our choices can perpetuate heterosexism. Sometimes heterosexism can be a tool of survival. As Ahmed

(2013) noted, we do not always have choices of resistance readily available. What we can do is continue to reflect on why we make family and life choices. Are we choosing to be married as a form of survival, to be recognized by society, to be recognized by our family, or because we are told this is the next step in the relationship? There is no correct

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answer to choose. However, in moments where we have privileges, such as the ability to be married or the ability to form families through children, we can reflect on whether our choices are based in heteronormative expectations or if they are something we believe we desire. While we can never know the “true” answer, reflection on our choices can help prevent overt perpetuation of harmful heterosexist beliefs and practices.

Implications for interpersonal literature. Past literature on support during pregnancy has specifically looked at heterosexual couples. This study expands on this research by exploring how same-sex female couples supported each other during pregnancy. There were overlaps in supportive communication through instrumental support given by the co-parent and heterosexual men. Both men and queer women would increase their chores during the pregnancy to help keep the household in order. However, heterosexual men would feel that the chores were not equitable, and they were doing more than their fair share while their female partners believed they were doing just their equal amount (Widarsson et al., 2015). For the queer couples in this study, both women recognized that the co-parent’s chores increased, but they felt that this was just something they were supposed to do.

The unique contributions of this study focused on how support was given to the co-parents in the queer pregnancies. Heterosexual men in the previous studies cited that they would suppress their own fears and anxieties (Widarsson et al., 2015). The queer women, however, seemed to communicate those fears and anxieties with their partners, and their partners were able to help them cope. Further, the co-parents had unique fears surrounding attachment with their future child. Because they did not have a biological

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connection, the co-parents worried they would not immediately attach to their child. The birth mothers would then provide the emotional support be reassuring the co-parents that they would form a bond with their child. This particular fear was not present in the heterosexual studies because the men were biologically connected to their children.

Another way that queer couples had unique support was through the need to support one another with tumultuous family relationships. Several of the couples explained how their partners provided support in the difficult times with their families.

Because family relationships were complicated due to distancing whether it was related to sexual identity or a similar issue, the couples often leaned on each other during those difficult times. Heterosexual couples would not need this same type of support, as most of the family turbulence was related, at least partially to lack of acceptance of sexual identity from their families.

Finally, the queer women noted comparisons in support to their heterosexual counterparts. They would discuss how the dad standard was low for support and that in comparison, they were able to provide a superior type of support. In the previous studies, there was not an indication of necessarily low support from the male partners (Sommers-

Smith, 1999; Widarsson et al., 2015), sometimes just that the women would not state what support they wanted from their male partners (Widarsson et al., 2015). Without having a direct comparison, it is not certain whether queer women were inherently better supportive partners, they just perceived themselves that way through comparing themselves to baby preparation literature and their heterosexual peers.

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Theoretical implications. This dissertation utilized Foucault’s theoretical perspective or power and Ahmed’s discussion of happiness as theoretical tools. The findings provided insight into theoretical implications for both perspectives. First,

Foucault’s conceptions of power have been expanded to explore how queer identity is surveilled in clinical, public, and more private settings. In clinical settings, healthcare providers are still surveilling and disciplining queer bodies. Healthcare providers disciplined queer bodies but stating only one motherhood identity is possible even when both mothers were present. In their articulation of a singular mother identity, they were reinforcing heterosexist expectations of bodies and identities, as the co-parent is not acknowledged by the providers. Instead of the discipline just being about the queer identity, discipline is used to state that queer bodies cannot occupy parental identities.

The birth mother is not read as queer, as her partner was not recognized as her romantic partner. The co-parent is also then not acknowledged as both queer and the other mother.

Discipline can punish more than one identity at a given time, to reinforce dominant ideals of bodies.

Outside of the clinical setting, Foucault’s work on local centers was expanded beyond childhood. In The History of Sexuality, Foucault argued that local centers shaped children’s discourse on sex. The local centers were only discussed as being influential in children’s lives. Within the queer women’s experiences, it was clear that parents still acted as local centers moving into adulthood. Parents still exuded power over their children by showing recognition only to their biological grandchildren, disciplining the grandchildren who did not have the same biological connection. The parents also

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reinforced the heteronormative script for their children when they were adults by only accepting them as officially reaching coupledom when having reproduced.

Foucault’s understanding of power has been beneficial to analyzing queer couple’s encounters of heterosexism when experiencing a pregnancy. Through Foucault’s perspective on power, it was evident that queer couples are not only disciplined through legal restrictions, but also through their everyday interactions with the public and with their more immediate relationships. Foucault’s work was expanded to demonstrate not only how sex has been punished, but the embodiment of diverse sexual identities.

Ahmed’s work on happiness has also been expanded in this dissertation project.

In her book Promise of Happiness, Ahmed mostly utilizes literature and popular culture to provide examples of her arguments. This dissertation expands on her work by using it to analyze discourses from queer women and their experiences of pregnancy. Moreover, this dissertation explored how queer women are placed into an impossible binary choice that is built off of Ahmed’s theoretical arguments of constructions of happiness. The impossible binary choice then asks what if anything, can queer women do to discover their own happiness through family creation? Finally, in looking at happiness, the findings of the dissertation also bring forward the question to Ahmed about how queer women, if at all, understand their happiness outside of heteronormativity? Ahmed’s work brings forward questions about queer women’s experiences and how they can be promised as part of a heteronormative society.

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Limitations

With every study comes limitations. While I attempted to do justice to queer identities and families in this project, there were limitations to my representation. My definitions of my desired participants presented a few challenges. In attempting to be inclusive of varying gender and sexual identities that fit the parameters of the study, I chose specific language. This larger pool of potential identities to be included in the study allowed me to draw more attention to those who would not be included as well. Because I used the phrase “queer pregnancy,” some individuals in the Queer Parents group were displeased that they were excluded because they were bisexual individuals with cross- sexed, cisgender partners. When an individual commented about this lack of inclusion, I explained my rationale, that cross-sexed, cisgender relationships that produce a pregnancy do not have to explain their pregnancy to others. I was crushed by how these individuals felt excluded in the community. However, a few of my participants brought up the conversation about my research that was posted in the Queer Parents group. The conversation I had at the end of Ava’s individual interview is representative:

Ava: How are you feeling about people's reaction to how quote unquote exclusionary your proposal is? Me: It was hard. Like I knew, I knew that was going to be an issue and I talked about it for like months that this was, you know, someone was going to say something and like talked about why, you know, why a bisexual woman who is with a man who had a kid, like why that wouldn't fit what I was doing. It always hurt, it hurts for me to hear that I was being exclusionary because that's something I actively try not to do. Ava: Yeah, that’s exactly, when Sophia and I were talking about it last night, um, she said like, just because you don't fit into the study doesn't mean that you are in any way trying to say that they don't, that they're not valid. Like you have to choose a point to study. We can't, like I want to look at all pregnancies that have existed, you know. Me: That wouldn’t be a study.

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Ava: Especially because that's great if you're bisexual, but if you're bisexual conceiving through natural methods with a man. Do you know how you're perceived when you go to your OB? Me: Straight. Ava: You know? And that's, and like, do you need to make sure that you're OB knows you're bi? No, it doesn't matter. And so, I'm sure I would get a lot of crap for saying something like that there. Me: I mean, it, it does matter for the study because you know, I'm looking at, you know, how do you see visible difference, you know and that, when you have two women coming in that's visible difference.

I greatly appreciated Ava in that moment. While I did not completely agree with her viewpoint, she provided a sense of relief that I needed, that I was not being a bad researcher or bad member of the queer community. What I had been trying to articulate in the participant call, although truthfully not being that explicit, is that queer pregnancy was being defined by the relationship exhibited, not by the person’s individual sexual identity. A queer relationship would then be considered those who were not in heteronormative relationships, which would include bisexual individuals in cross-sexed, cisgender relationships. Being in a cross-sex, cisgender relationship provides access to all of the heterosexual privileges that queer relationships cannot obtain. Therefore, bisexual people in cross-sexed, cisgender relationships can experience marginalization through erasure, they do not experience the same marginalization the queer women went through in their pregnancy experience.

Another way the call for participants became limiting was also based in the openness of defining sexual and gender identity. I had hopes that more ambiguous language would help me recruit transgender couples as well as cisgender couples.

However, my participants all self-identified as female, with some gender diversity in how they talked about themselves, just not through identification. Even though I had hoped to

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go beyond mostly lesbian couples, that was the largest section of my participants. I did end up having participants who identified themselves outside of a lesbian identity, which still contributed to the literature.

Besides issues with the definition for inclusion in, recruitment also posed a challenge in terms of who received the recruitment message. Most of the participants were relatively affluent. Many of the participants were well educated and had well- paying jobs. This is not surprising as the insemination process is very expensive. Most of the couples reported spending thousands of dollars on sperm and related medical costs.

Affluence, education, and steady jobs are all indicators of high socio-economic status. In addition, almost all the participants were white. The whiteness of the study is also not unexpected, although it is limiting. Race and ethnicity are connected to socio-economic status, access to reproductive services likely reflects white privilege. As such, the finding of this dissertation may not apply to queer couples of color or queer couples of lower socio-economic status.

A second recruitment challenges was that, to be a part of this dissertation, participants were required to commit a great deal of time. At minimum, participants had to set aside two and a half hours each. Those who worked longer hours and/or could not hire childcare may not have been able to participate in the interviews. While I was very flexible in my interviewing schedule, the concern for potential participants may not have been about the time of the interview, but about having the extra available hours. For example, people who worked multiple jobs would not have had the extra time to participate in this study. Further, recruitment came from an online community, one that

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would require regular internet access. Those who could not afford to have internet available to them on a regular basis would most likely not be apart of the group or able to participate in the study.

Limitations to the research are important to note, as the experience of the queer women were based in whiteness, socio-economic advantages, and some cisgender privilege. They do not encompass the entirety of the queer pregnancy experience.

However, the study still provides a needed discussion on how these queer couples experienced heterosexism that greatly adds to the current, minimal research.

Future Directions

There are several directions for expanding the literature on queer families. First, based on the limitations of this study, there is a need to study queer pregnancies for queer folk of color. Much of the current literature, including this work, has been based on white, queer families. Future work should involve spending time in queer women of color spaces to gain access to this population to study their experiences. Their experiences will most likely involve intersectional power dynamics that involve racism. In addition, future research can also work to see how queer families expand in lower incomes. Seeing as most queer pregnancies involve access to money and resources, queer female families may not find pregnancy accessible and expand their family in other ways. Or, they may find cheaper avenues of becoming pregnant. Regardless, there is a need to explore queer families in lower income households.

One area of interest is the experiences of donor siblings who may become included in queer families. Many of the queer couples talked about connections with their

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donor sibling families through Facebook groups or through interpersonal communication.

I want to further explore how queer families and their donor siblings understand those relationships and what they discuss. The goal would be to interview multiple parents from several donor sibling groups to see how they virtually connect with the potential for physical gatherings. In this research, I can continue to explore the creation of new ideas of family that both resist and perpetuate heterosexist biological ideals of family.

Another area of research would be on gender non-conforming pregnancies. A few of the participants talked about how their gender identity did not match expectations of feminine pregnancy. They mentioned discomfort with maternity clothes and how the images associated with pregnancy were not relatable to their identities. A future study could explore more specifically the embodiment of pregnancy exclusively by those who did not identify as cisgender women, which could include those who are gender queer or transgender. In this study, the focus would be solely on the individual who was pregnant, with a potential follow-up that utilized multiadic analysis to explore both hidden and more salient discourses in couples where the pregnant partner was gender non- conforming.

Finally, I am interested in continuing research on queer families by exploring family creation outside of reproduction. Queer families also form themselves through adoption and fostering. Knowing that healthcare providers would often question the relationship of the parents to the child, this may also happen for those who adopt or foster their children. It is important to understand what heterosexist encounters they have, if any and how family members react to their new families, especially as the families are

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created outside of reproduction and biological connections. Through this exploration, I could continue to expand on heterosexism in queer families.

Concluding Remarks

This dissertation has profound implications on my life. The ability to know how other queer families have created themselves, in some ways, has placed pressure on my family choices. Conversations about my family’s creation have not stopped since the start of this project. My wife and I have encountered conversations, either as a joke or in complete sincerity, of how we would reproduce. Now that I know how queer women become pregnant, those around me present my becoming pregnant as a possible option. I remind them that reproduction, when done safely, is beyond our economic means. And, even when I make this economic argument, I seem to accede that becoming pregnant might be a possibility for me. A casual acknowledgment may be made, but the conversation does not end. I have found myself reflecting on whether becoming pregnant is something I would ever want, once again tracing the lines over my assumed baby bump. But I know, this is not something I want in my life; having a baby is just an expectation placed upon me. As I continue in life, I know the conversation will always be there waiting. Even when my body will no longer be capable of reproduction, the conversation will just turn to one of assumed regret.

I also wonder how my participants would react to my compiling of their stories.

Analysis goes beyond simply reporting what was said, and an analysis also assigns the analyst the power to interpret what was said. Confronting systems of oppression can be exhausting. I hope that I have done my participants justice, but I fear that I have not.

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Parenthood is already complicated; queer parenthood is its own story. I know that with every choice made, the queer couples believed they were doing what was right for them and for their family. And these choices that they made were simply part of a system meant to disadvantage them.

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Appendix A: Participant Demographic Form

Partner A

Age:______

Age of child (only or most recently born): ______

Race or Ethnicity: ______

Sexual Identity (Orientation): ______

Gender Identity: ______

State residing in currently: ______

State residing in during pregnancy and birth:______

Birth Parent: _____ yes ______no

Occupation: ______

Level of education: ______

Type of healthcare provider seen during pregnancy:______

How long had you seen the provider prior to the pregnancy: ______(months or years)

Length of time in your the romantic relationship prior to pregnancy: ______(months or years)

Willing to participate in couple interview: _____ yes ______no

Willing to participate in individual interview: _____ yes ______no

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Partner B

Age:______

Age of child (only or most recently born): ______

Race or Ethnicity: ______

Sexual Identity (Orientation): ______

Gender Identity: ______

State residing in currently: ______

State residing in during pregnancy and birth:______

Birth Parent: _____ yes ______no

Occupation: ______

Level of education: ______

Type of healthcare provider seen during pregnancy:______

How long had you seen the provider prior to the pregnancy: ______(months or years)

Length of time in your the romantic relationship prior to pregnancy: ______(months or years)

Willing to participate in couple interview: _____ yes ______no

Willing to participate in individual interview: _____ yes ______no

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Appendix B: Call for Participants

Hello, my name is Nicole Hudak and I am a doctoral student at Ohio University conducting research on queer or LGBTQ pregnancies. As a queer woman, I have thought about what queer couples experience when they decide to become pregnant.

My dissertation is focusing on how queer/LGBTQ couples experience pregnancy.

For my study, I am seeking queer couples who have had a pregnancy within the past three years. In defining queer, I am looking for couples who did not conceive through

“traditional”/male-female penetrative sex and identify as part of the LGBTQ community.

Participants would engage in interviews about their pregnancy experience. They would have a 1-1.5-hour couple interview and then each partner would be interviewed separately for 1 hour. Depending on location, interviews will take place in person or via a video messaging service.

To compensate for their time, each couple would receive $25. If you are interested in participating in this study or have any questions, please contact

[email protected].

If you do not want to or cannot participate, please feel free to share this call on your own

Facebook page or with those who may be interested.

This research project has been approved by Ohio University’s Institutional Review Board

Approval number: 18-X-260

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Appendix C: Couple Interview Protocol

Thank you for taking the time to talk with me today. Before we start, I want to make sure that you both have understood the consent form that was provided to you prior to the interview. Do you have any questions about the consent form or the study at this time?

Focus: Pregnancy and Birth Communication

1. Tell me about your relationship.

a. Probe: How long have you been together? b. Probe: How did you meet?

2. Tell me about the decision to have a child.

a. Probe: When did you decide to have a child? b. Probe: What were those conversations like? c. Probe: How did you decide who was going to be the one to give birth?

3. Tell me about the process of becoming pregnant.

a. Probe: What choices had to be made?

4. How did you make healthcare choices?

a. Probe: How did you choose your healthcare providers?

5. Tell me about your healthcare experiences during the pregnancy prior to the birth of your child.

a. Probe: Who would attend the appointments? b. Probe: How did the healthcare providers interact with you as a couple?

6. How did you make decisions about your birth plan?

a. Probe: How did people in your life talk to you about your birth plan? b. Probe: How did you make these decisions as a couple?

7. Tell me about the birth of your child.

a. Probe: How did the healthcare providers communicate with you? b. Probe: How did you feel during the experience?

8. How do the healthcare providers give care after the birth?

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a. Probe: How did healthcare providers give support? Focus: Support

9. How did you talk about the pregnancy with people in your life?

a. Probe: Describe conversations with friends, family, and/or co-workers.

10. How did you recognize or celebrate the child before birth (such as baby showers)?

a. Probe: Who was involved in the celebration(s)? b. Probe: How did you both feel about these celebrations?

11. How did you support each other during the pregnancy?

12. How did people in your life provide support during the pregnancy?

a. Probe: Were there those who did not provide support? How did you feel about this?

Focus: Comparative Pregnancy

13. How would you describe the pregnancy process and experience to straight/cisgender individuals?

a. Follow up: How would you describe the pregnancy process and experience to other LGBTQ couples?

14. What advice would you give to other LGBTQ couples who want to become pregnant?

15. How do you think your pregnancy experience was different compared to straight/cis couples?

Closing

16. Is there anything else that you think I should know about your experience that I have not already asked?

Thank you for your time today and I will be scheduling separate follow up interviews with each of you. I look forward to our continued conversation.

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Appendix D: Birth and Co-Parent Interview Protocols

Birth Parent

Thank you for speaking with me separately today. The purpose of this interview is to focus on your individual experience with the pregnancy and to share with me your own thoughts, feelings, and related experiences.

To start, in thinking about our first interview, is there anything you would like to discuss before I start with my questions?

Focus: Pregnancy and Birth Communication

1. (Refer to the choices to become pregnant) How did you feel about the choice to become pregnant?

2. How did you feel about the choices that were made in relation to the pregnancy? (donor, clinic choices, when the pregnancy would happen, etc)

3. How do you feel about the healthcare providers that worked with you throughout the pregnancy?

a. Probe: Describe positive experiences with your healthcare providers b. Probe: Describe negative experiences with your healthcare providers c. Probe: Tell me about advice that you would give to healthcare providers.

4. Tell me about your individual experience during the birth of your child.

a. Probe: How did healthcare providers give care?

Focus: Support 5. How did your family communicate about the pregnancy?

a. Probe: How did they or how did they not provide support? b. Probe: How would the support change (or not change) if you had not been the birth parent?

6. How did your friends communicate about the pregnancy?

a. Probe: How did they (or not) provide support?

7. (if parent works) How did your coworkers communicate about the pregnancy?

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a. Probe: How did they interact with your after the news?

8. In thinking about your partner, how did they provide support to you throughout the pregnancy?

a. Probe: Were there times that you felt they were not supportive? b. Probe: How would you want your partner to have provided support?

Focus: Parent Identity

9. How would you describe the differences and/or commonalities in your pregnancy compared to your straight and cis counterparts?

10. What advice would you give other LGBTQ birth parents?

11. How do you see yourself as a parent compared to your partner?

12. Is there anything that you specifically wish you knew prior to the pregnancy that you know now?

Closing

13. Is there anything else that you think I should know about your experience that I have not already asked?

14. What questions do you have for me?

Thank you for taking the time to speak with me today.

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Co-parent Protocol

To start, in thinking about our first interview, is there anything you would like to discuss before I start with my questions?

Is there any term that you like to use to describe your parent identity? (co-parent)

To start, in thinking about our first interview, is there anything you would like to discuss before I start with my questions?

Focus: Pregnancy and Birth Communication

1. (Refer to the choices to become pregnant) How did you feel about the choice to become a co-parent (or preferred label)?

2. How did you feel about the choices that were made in relation to the pregnancy? (donor, clinic choices, when the pregnancy would happen, etc)

3. How do you feel about the healthcare providers that worked with you throughout the pregnancy?

d. Probe: Describe positive experiences with your healthcare providers e. Probe: Describe negative experiences with your healthcare providers f. Probe: Tell me about advice that you would give to healthcare providers.

4. Tell me about your individual experience during the birth of your child.

b. Probe: How did healthcare providers interact with you?

Focus: Support 5. How did your family communicate about the pregnancy?

c. Probe: How did they or how did they not provide support? d. Probe: How would the support change (or not change) if you had been the birth parent?

6. How did your friends communicate about the pregnancy?

b. Probe: How did they (or not) provide support?

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7. (if parent works) How did your coworkers communicate about the pregnancy?

b. Probe: How did they interact with your after the news?

8. How did you provide support to your partner throughout the pregnancy? c. Probe: Were there times that you felt you were not supportive? d. Probe: How did your partner provide support to you as a co-parent?

Focus: Parent Identity

9. How would you describe the differences and/or commonalities in your pregnancy compared your straight and cis counterparts?

10. What advice would you give other LGBTQ co-parents?

11. How do you see yourself as a parent compared to your partner?

12. Is there anything that you specifically wish you knew prior to the pregnancy that you know now?

Closing 13. Is there anything else that you think I should know about your experience that I have not already asked?

14. What questions do you have for me?

Thank you for taking the time to speak with me today.

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Appendix E: Participant Demographic Information

32 participants were apart of this study. Through self-identification participants described themselves as Caucasian (n=18), white (n=12), Latino (n=1), Hispanic (n=1), and

Caucasian/African American (n=10. For their sexual identity, they identified as lesbian

(n=24), queer (n=4), gay (n=2), homosexual (n=1), and bisexual (n=1). Participants ages ranged from 28 to 46, median age being 35. They lived in a variety of states including

New York (n=6), Michigan (n=4), Ohio (n=4), Arizona (n=2), Texas (n=2), California

(n=2), Illinois (n=2), Georgia (n=2), Washington (n=2), Oregon (n=2), Montana (n=2), and Kentucky (n=2). However, there was a difference in where they gave birth including

New York (n=6), Illinois (n=6), Arizona (n=4), Ohio (n=4), Texas (n=2), California

(n=2), Georgia (n=2), Washington (n=2), Kentucky (n=2), Montana (n=1), and Michigan

(n=1). Their education background consists of some college (n=3), associate degree

(n=1), bachelor’s degree (n=5), master’s (n=17), doctorate (n=4), doctor of osteopathy

(n=1), and JD (n=1).

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