This article was originally published in The Doula in Autumn 2019.
Doula clients include lesbian and bisexual women, and there will be lesbian and bisexual women amongst your fellow doulas. Doula-ing rightly centres care on the pregnant person, but we also include the whole family. Lesbian families are often invisible in maternity policies (which may talk about partners and dads as though they were interchangeable), and also in maternity research, where it isn’t even yet the norm to ask about sexual orientation as part of equality monitoring. Anecdotally, lesbian birth mums report experiences of poor care, especially in terms of genital checks after birth, and breastfeeding support. And lesbian co-mothers report feeling excluded by both policies and the care offered. As doulas, when we are invited into such an intimate and vulnerable time in a family’s journey, it is important that we make sure that we can offer an inclusive service, which respects different family formations and identities equally. As doulas we also take care of one another, and ensuring you include and respect your lesbian and bisexual doula colleagues is a key part of creating a safe and welcoming doula community.
This article gives 9 top tips for ensuring the language we use promotes inclusivity.
- Don’t make assumptions. Sometimes it is obvious that your client or fellow doula is a lesbian – if a client’s female partner is present at the interview for example, or if they talk about their wife. But on other occasions, you may not be aware of someone’s sexual orientation. Single lesbian and bisexual women in particular often report that maternity services make an assumption that they are heterosexual. ‘Coming out’ to people repeatedly can be emotionally fraught, because you always have to prepare for a negative reaction. It can also damage a relationship that is just forming, as the person realises that you have fundamentally misunderstood something major about them. As doulas, it is important that we do not add stress to a client by assuming heterosexuality in the absence of them coming out to us.
- Listen carefully and mirror language. If you are going to avoid assuming someone is heterosexual, you need to listen to what they say about their partner, or their ex, or their baby’s conception, and mirror that back. If a lesbian couple have not disclosed how they conceived, do not refer to ‘the clinic’ or ‘the donor’, as this may not be accurate. If someone is talking about a partner and saying ‘they’, copy that, rather than assuming heterosexuality and saying ‘he’. Case study 1 gives an example of how damaging it can be to get this wrong, both for the parents and the baby.
- If in doubt use gender neutral terms. Phrases such as ‘do you have a partner? Will they be at the birth?’ are much more inclusive than ‘will your husband be at the birth’, and signal that you are aware clients may be in a same-sex relationship.
- Use gender neutral terms on your website, leaflets, posters, or in other promotional material. As above, this avoids anyone feeling excluded by your services before you have even met them. Take a look through all your forms – do they refer to dads, or to partners and/or dads?
Case study 1 – Branwen and Ffion
• Branwen is pregnant.
• Ffion is intending to fully breastfeed, and has followed a lactation protocol.
• They knew antenatally that their baby would need to spend a few days in hospital after the birth.
• But Ffion is only allowed in during visiting hours. They complain about this.
• The NHS replies to their complaint, upholds the policy, and states ‘fathers are not allowed on the ward overnight’.
- Be aware of bi-invisibility. Bisexual people are often categorised by who their current partner is. A woman in a same-sex relationship may be a lesbian, but she may also be a bisexual woman. Equally, a client might have a male partner, but be bisexual. Research shows that invisibility can have a negative effect on self-identity, and that bisexual mothers are especially vulnerable to this.
- If you need to know, it is okay to ask. If you aren’t sure about something relating to a client’s sexual orientation, and you need to know it to provide the best service to them, it’s okay to ask. For example, if a baby was conceived through IVF, a client may be offered more scans than usual, and may be offered an earlier induction than a client who conceived using donor sperm not involving IVF. If circumstances arise in which this piece of knowledge might affect how you doula, it is absolutely fine to ask questions. It is often a good idea to briefly explain why you have asked that question too, to avoid the next barrier to inclusion…
- Don’t be nosey. Whilst it is fine to ask questions that you need to know the answer too, it isn’t fine to ask about things you don’t need to know. Case study 2 demonstrates the impact that this can have.
Case study 2 – Pelagia and Renee
• Lesbian couple, having their first baby.
• During labour a new midwife comes into the room, and asks ‘so, how did THIS happen’?
• This is the story they still tell about their birth 15 years later.
- Ensure your knowledge is up to date. You don’t need a detailed knowledge about every possibility to be a great doula for a lesbian couple, but you do need some basic knowledge about conception choices and postnatal choices, such as induced lactation. Basic knowledge of the legal situation for lesbian couples in labour and after birth can also be useful, as it is different to that for heterosexual couples. It can also be useful to have an idea of which books and resources that you might suggest make assumptions of heterosexuality, and which don’t. You could also compile a reading list of books about lesbian pregnancies or families that you can share with clients.
- Avoid using problematic terms. Unintentionally, some birth workers (including doulas) can use terms which cause distress. Below are two examples – there are many more. Think about the language you might use that could be problematic.
Case study 3 – Sophie and Mary
• Medically necessary IVF pregnancy, using Sophie’s egg, with Mary carrying the baby.
• But UK surrogacy law is based on genetic fatherhood.
• Lesbian surrogacy is therefore not legal.
• Sophie legally has to be Mary’s egg donor, Mary cannot be Sophie’s surrogate in law.
• This means that Sophie has to sign all her parental rights away in order for treatment to proceed.
- ‘Doula-wife’, used to indicate a doula you have a friendship and informal or formal business partnership with. Many lesbian and bisexual women fought for years to have the right to call another woman their wife, putting their jobs, their right to live with their children, and their personal safety on the line. The term wife is therefore very precious to some lesbian and bisexual women, and using it in this way is offensive and appropriative. Using the term wife may also lead others to assume you are a lesbian, and they may then treat whatever you say about lesbian and bisexual women as being an insider view, which can be problematic. Also, even though same-sex marriage is now legal, inequalities with heterosexual marriage still exist. One area of inequality is that a woman cannot divorce her wife for having sex with another woman (only with a man). This inequality arises from a view that sex between women is somehow not real sex, or that sex between women cannot be defined. By using wife to refer to a non-sexual relationship between two women, you are furthering this view.
- ‘Real mum’, used to ask or define which partner from a lesbian couple gave birth. If two women have chosen to have a baby together, they are both real mums. If you need to define which one gave birth, you can ask that question, or give that information. The idea that someone is only a real mum if they gave birth can be upsetting to lesbian mums who did not give birth, and also to adoptive mums. This idea can also lead to problems for lesbian couples accessing maternity services, as shown in case studies 1 and 3.
Mari is a lesbian birth mum and foster mum, and has been a doula for around a decade. She now mentors new doulas, and works as an academic, investigating pregnancy and birth choices, traumatic births and Queer pregnancy, birth and parenting at King’s College London.