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According to WHO, the concept includes a satisfying and safe sex life with access to good contraception, the ability to reproduce, and good care during pregnancy and childbirth.
Try out PMC Labs and tell us what you think. Learn More. Objectives The aim of this study was to gain insight into how women in same-sex relationships experience the process of forming a family through the use of assisted reproduction technique ARTfrom planning the pregnancy to parenthood, and their experience of parental support from healthcare professionals.
Methods The participants were 20 women in a same-sex relationship who had conceived through ART at a Swedish clinic. Semi-structured interviews including open questions about pregnancy, parenthood and support from healthcare professionals were conducted. The interviews were tape-recorded and transcribed verbatim. The data were analysed according to grounded theory.
The core category, A stressful journey through a heteronormative worldemerged from the analysis, as did three sub: A journey fraught with difficulties and decisions; The nuclear family as the norm ; and A need for psychological support. Same-sex parents expressed a need for more information about how to access ART in Sweden. Both the healthcare organization and treatment were perceived as heteronormative.
In particular, these women lacked psychological support during the demanding process of utilizing a sperm donor to conceive. Conclusions for Practice Professionals in antenatal care should undergo mandatory cultural competency training to ensure cultural sensitivity and the provision of updated information, tailored brochures and early parental support for families with same-sex parents. All parents need guidance and support from competent, caring personnel throughout the entire process of forming a family. What is already known on this subject?
Families with two mothers are becoming increasingly common; therefore, healthcare providers are likely to encounter two-mother families in antenatal care. research shows that professionals in antenatal care use heteronormative language and lack knowledge of the unique experience of two women embarking on parenthood.
What this study adds?
This study offers insight into how women in same-sex relationships experience the process of forming a family through assisted reproduction at Swedish clinics. Sincewomen in same-sex relationships in Sweden have had the legal right to assisted fertilization with semen donated at clinics.
Such treatment demands basic medical and psychosocial investigation Socialstyrelsen According to Swedish legislation regarding gamete donation, both partners become legal parents with t custody of the. Couples have described the process of becoming pregnant as stressful and difficult, with many insemination attempts Goldberg Similar UK studies have highlighted difficulties in dealing with semen when utilizing a sperm donor to conceive Nordqvist Although Swedish society is considered to be egalitarian, many people make heteronormative assumptions, and this becomes apparent when same-sex couples meet with healthcare professionals to discuss pregnancy and childbirth.
However, same-sex couples trying to form a family in Sweden have also reported good psychological health and low parental stress Borneskog et al. Owing to changes in the law concerning access to assisted reproduction technique ARThealthcare providers are likely to encounter same-sex couples in antenatal care. Studies have shown that antenatal and child healthcare personnel lack competence in providing culturally sensitive care.
Thus, the aim of this study was to gain insight into how women in same-sex relationships experience the process of forming a family through assisted reproduction, from planning the pregnancy through to parenthood, and the parental support they receive from healthcare professionals. The study employed grounded theory GTas this method is aimed at generating explanations of social processes and formulating a preliminary model grounded in empirical data Corbin and Strauss Nurses at healthcare clinic distributed a letter describing the study to prospective participants, and the information was posted on a web for same-sex families.
Interested parties contacted the first author for further information. The inclusion criteria were birth mothers and non-birth mothers in a same-sex relationship, who had had through assisted reproduction at a Swedish clinic, with the child being around 1—3 years, and the parents having t custody and living in mid-Sweden. In line with GT, the sampling procedure was purposeful and theoretical. Purposeful sampling is intended to produce maximum diversity Corbin and Strauss ; therefore, the study targeted participants from both rural and urban areas.
Eight couples and an additional four birth mothers participated. Twelve participants had one child and eight had two or more children. Thirteen participants were married and seven were cohabiting.
The lengths of their relationships varied from 4. Fourteen participants had a university degree and six had a high school diploma. An interview guide with open-ended questions was constructed according to the themes of planning for parenthood, pregnancy, childbirth and parental support. The analysis was ongoing; when data generated new questions, they were addressed in the next interview.
The longer the interview process was, the more detailed the questions became. The interviews lasted between 35 and 70 min and were recorded and transcribed verbatim. A three-step constant comparative analysis was conducted. The first step was open codingwhere the material was read line by line to identify codes, which were compared and sorted to form. Data collection and analysis occurred simultaneously and the process was ongoing Corbin and Strauss The second step, axial codinginvolved coding around each category to determine its properties and the relationships between and sub.
The last step, selective codingwas aimed at reaching saturation of the and sub see Table 1 and defining and linking around the core category see Fig. The analysed material was divided in two parts: i The experience of the process of forming a family and ii The experience of parenthood. This article describes the former. Process of forming a family through assisted reproduction for women in same-sex relationships.
Theoretical memos were written throughout the process and were used to link and verify analytical interpretations of the data. The participants were informed orally and in writing about the study and were guaranteed confidentiality. Further, they understood that participation was voluntary and could be withdrawn at any time. All participants gave written informed consent. Participants described the process of forming a family through ART as a stressful journey through a heteronormative worldwhich formed the core category.
The three sub were i A journey fraught with difficulties and decisionsii The nuclear family as the norm and iii A need for psychological support. Participants did not know where to turn to receive information about, or support with, ART. They described healthcare professionals and treatment guidelines as heteronormative, and the transition to parenthood as stressful and lacking in support. Participants described their desire to have and difficulty in knowing where to get counselling. How do we do it?
But it was very short, unpleasant. I wanted information. Some participants felt that these professionals had limited knowledge and were unable to help; in fact, they had had to educate the staff. Participants were left without information or someone to guide them through the process.
The journey involved making various decisions, like how and where to access ART and which partner would be the birth mother. In most cases, going to a Swedish clinic was an obvious choice. Almost all participants felt safe about ART in Sweden, as the clinic is responsible for the whole treatment process and the child has the right later on to obtain information about the donor.
Another ificant factor was the low cost, since ART at Swedish clinics is publically funded. Some had always wanted to be pregnant and give birth, while others did not. Another participant said that it did not matter as long as they got. Some couples had taken turns. The women mentioned age and career as factors influencing this decision. The heteronormativity of the healthcare organization and treatment evinced that the nuclear family was considered the norm.
Images of nuclear families were in every brochure and on medical forms. Participants had different experiences with healthcare professionals. Some described their meeting with the midwife as very good, while others felt that they and their partner were not treated as a couple and that the midwife was not prepared to meet a family with two mothers. They also characterized parental groups as heteronormative.
Non-birth mothers felt singled out and excluded from the group. Heteronormativity was also evident in that same-sex couples received the same treatment scheme as infertile heterosexual couples; the fact that they had to undergo a tubal flush and preparation of oocyte treatment with hormone stimulation confused some of the women. I would rather have done it without hormones, and then we also got twins.
Mother of twins. Participants also stressed how difficult hormone therapy had been to undergo; it sometimes led to over-stimulation and unbearable pain.
Almost all participants perceived the process of conceiving as time-consuming, stressful and clinical, and the healthcare professionals as lacking knowledge. They found the process mentally demanding, with great anticipation and fear of miscarriage—and, if a miscarriage occurred, the process would start again.
Yes, it took quite a while for us. We did all four inseminations, so it was quite intense. And so, it was a pretty tough time, really. Everything goes very slowly when you are waiting and hoping. In addition, ART was physically and mentally painful. Participants mostly described the healthcare professionals as friendly and positively curious, but sometimes lacking in knowledge. One participant described midwives as follows:. They had very little knowledge of IVF and artificial insemination, and everything that you go through. It was probably the worst.
It felt really weird because it was next-door to the fertility unit, so it felt like a different world, actually. You feel a little left out when they do not know what you went through. She thought that healthcare professionals should provide information to avoid this.
The women in this study described different ways of experiencing the process of planning and becoming a parent, but their common experience was of stressful, heteronormative treatment. research supports that the process towards parenthood is perceived as stressful Goldbergalthough one Swedish study reported low parenting stress during assisted reproduction Borneskog et al.