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LGBTQ Fertility & Pregnancy

Reflection: I am personally endeared to the wonderful couple pictured here in this post. Lexi and Nicole Hayman-Staples are some of the most loving, beloved, and inclusive people in our community. I am filled with joy see their family growing with the addition of a new little person! My reflection is one of love and support but I would be remiss if I failed to acknowledge the challenges faced for people within the LGBTQ spectrum to find pregnancy and birth ca and birth care that is inclusive and accepting. Many LGBTQ people have experienced stigma and discrimination throughout their lives within the healthcare system and specifically around the ideologies of childbirth and parenting.

Unfortunately, to date, most healthcare providers have only been taught to recognize the heteronormative mainstream definitions of sex and gender and the direction that leads in regard to birth and parenting. There is a lack of cultural competency which fails to include LGBTQIA people in the birth world. Identifiable obstacles are lack of access to unbiased, fair and equitable care, inadequate insurance/healthcare coverage, anti-LGBTQ violence, and systemic discrimination to name a few. It is important for healthcare and birth providers to understand the various pathways to parenthood for all people, to honor the lived experience and needs of this community, and be more inclusive in their practice.

The National Transgender Discrimination Survey of 2011 reports, “ In the US, 1 in 3 trans people is a parent”. A 2013 Pew Research national survey found that "51% of LGBT adults would like to have children in the future." As more and more LGBTQ individuals and couples seek to have children, many will turn to their health care providers for resources and guidance on what to do. Are we getting any better as providers? I want to think so... There are many, many resources available (check out a few I have listed at the bottom of this page). Many of the legal issues associated with third-party reproduction and gay parenting differ from state to state. "It is very important for you and your partner to work with an experienced attorney to help ensure your parental rights are protected to the fullest extent of the law in any state you choose to build your family."

What can I do within my own community? I am becoming a midwife. The Midwives Model of Care™ holds the position that midwives care for people of all genders who are pregnant and will give birth. I feel it is important to start conversations with other midwives and birth workers about what it means to support transgender, genderqueer and intersex people. As a birth worker, I will continue to educate myself and others to better understand the difference between sex and gender, communicate my knowledge and understanding of the needs, identities, and barriers to care that many LGBTQ people experience so that this community receives the most equitable care possible. It is our duty to openly acknowledge the disproportionate effects of racial disparities and transphobia on those with other marginalized identities (people of color, low-income, or disabled), and to politely address if or when oversights or mistakes are made by people who lack an understanding of how to interact with LGBTQ people. This can also look like bringing awareness to the visual representation of information and images presently displayed in public spaces and recommending a change that would affirm and communicate acceptance and equality.

Within my practice, I provide LGBTQAIP+ inclusive pregnancy and birth care that is compassionate, respectful, culturally appropriate all clients, parents, babies, and families. I aim to educate myself by asking questions about a client’s individual needs, explain the intention is to provide safe, responsive, affirming care. Ask “what pronouns do you use?” and make note of their preferences in case there needs to be a handover of care to another provider. In my practice, I am committed to use language that is inclusive of all experiences and identities. For example, using the terms “expectant”, laboring”, “birthing”, or “gestational parent” to describe and name the person who is pregnant and giving birth. Use the inclusive term “partner” or “birth partner” to describe the person supporting the birthing parent through pregnancy and birth. Use neutral terms such as “lactation” or “baby feeding” rather than breastfeeding for those who don’t identify with the term breastfeeding. Always ask permission before touching their body, honoring body autonomy. Recognize and honor that many people may have traumatic experiences of harassment, body shaming, and history of assault.

Most recently, and in efforts of writing this, I re-read the “Open Letter to MANA” promoted by "Women-Centered Midwifery" which is a response to the shift to inclusive language in MANA’s Core Competencies. "The purpose of this response is to explain why and how the Open Letter is harmful to transgender, genderqueer and intersex people, why midwifery documents should be gender inclusive, and why people of all genders should be welcomed into midwifery care. While we are focusing on birth-related care in this letter, it is important to notice the subtle and insidious ways the "open letter" attempts to erase the lives and narratives of transgender women and other women who cannot or do not give birth. Parenting, including mothering, represents a diverse set of experiences that may or may not include giving birth." (retrieved from

***I added my signature to the list of people standing up to say: “My signature indicates affirmation and respect for people of all genders; full agreement regarding the use of gender-inclusive language in the MANA Core Competencies and in all documents regarding the profession of midwifery and provision of midwifery care; and the welcoming of transgender, genderqueer and intersex people into safe, culturally sensitive, shame-free reproductive health care. I do not refute the "life-giving power in female biology." Rather, I support a larger vision that includes the provision of midwifery care to all pregnant and birthing people.”

Additional resources:

Sperm banks can make the process of selecting and utilizing donor sperm very easy. The sperm bank screens all of its donors for infectious diseases and genetic disorders. They also obtain the necessary legal release of ownership of the sperm prior to its use.

recommended sperm banks:

  • California Cryobank

  • Fairfax Cryobank

  • Midwest Sperm Bank

  • NW Cryobank

  • Pacific Reproductive Services

  • Xytex Sperm Bank

With love, reflection, and the best of intentions,

Shelly Varelli (DeMeo)

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Feb 23, 2021

I would like to further acknowledge Challenges faced by the LGBTQIA birthing community:

Safe referral network

-All providers including pediatricians for newborn baby.


-Ask their language for preferred pronouns: she/her, he/him, Male, Female, They/Their/Them, etc

-Preferences for birthing person, birth parent, gestational parent, first parent/second parent, the biological parent

Chestfeed/Infant feeding

-If someone has had top surgery, lactation challenges

-Acknowledge any potential for body dysphoria and feelings around breast enlargement

-language/terminology for body references related to infant feeding

-Explore all options for infant feeding

Birth challenges

-Most transgender pregnancies will choose elective cesarean.

-It is important to find a provider who understands the potential trauma a vaginal birth might impose and have discussions about this antenatally.

-There is a…

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