Improving pregnancy outcomes for LGBTQ+ patients

From increasing attempts to legislate gender affirming care, to the rippling repercussions of Dobbs, to semantic debates around how we should refer to those who experience pregnancy, the LGBTQ+ community has been long embroiled in the contentious discourse around reproductive health. Healthcare for LGBTQ+ patients has historically been impaired by stigma and bias, leading to delayed detection for time-sensitive pathologies like cervical cancer (Quinn et al. 2015). The unique experiences of LGBTQ+ patients and their families impact their pregnancy outcomes, particularly for patients of color who are bearing the brunt of the US maternal health crisis.

Pregnant patients identifying as LGBTQ+ are more likely to experience adverse birth outcomes. In the last five years, evolving data practices like inclusive language on birth certificate registries have enabled analyses on pregnancy outcomes for patients in sexual and gender minority (SGM) partnerships. Birthing parents in SGM relationships experience significantly higher rates of labor induction, postpartum hemorrhage, and severe morbidity (Leonard et al. 2022). Compared to heterosexual women, self-identified LGBTQ+ women are more likely to report a pregnancy ending in stillbirth. Lesbian women are more likely to report low birth weight infants, and both bisexual and lesbian women are more likely to report preterm births (Everett et al. 2019). Notably, analyzing by racial subgroup reveals that for white women, identifying as bisexual or lesbian correlates with better birth outcomes, whereas for Black and Latina women, sexual minority identities are instead associated with significantly worse birth outcomes (Everett et al. 2021).

The self-reported experiences of pregnancy for LGBTQ+ patients differ significantly from those of the cisgender, heterosexual population. 31% of LGBTQ+ individuals reported having a less than “good” childbirth experience (“fair”, “poor”, or “very poor”), compared to 18% of their cisgender and heterosexual counterparts. Additionally, 51% of LGBTQ+ birthing people reported that discrimination and bias had affected their pregnancy, birth, and postpartum care, compared to 35% of cisgender and heterosexual people (“Understanding the Experiences of LGBTQ+ Birthing People”, 2022). By intentionally identifying bias and promoting inclusive language and practice, providers can mitigate this gap in care experience (Hoffkling et al. 2017).

At Delfina, our goal is to improve birth outcomes for all pregnant patients. Just as we are studying the ways in which racial biases appear in and affect clinical decision making and risk analysis, we strive to provide an affirming perinatal experience for our LGBTQ+ patients. The personalized care plan developed by Delfina provides crucial parental empowerment. We center the unique experiences of LGBTQ+ families by adopting best practices for culturally competent care that yield better care experiences and improved health outcomes (Bass & Nagy 2021). Moreover, the synergistic inclusion of mental health professionals in our care model is essential to a positive pregnancy experience, given increasingly high levels of perinatal depression in sexual minority women (Marsland et al. 2021).

Stakeholders across our healthcare system are working to develop a better understanding of how to optimize pregnancy care for LGBTQ+ patients. For all those interested in making a positive impact on LGBTQ+ pregnancy care, we invite you to join us.