How norms concerning maternity, femininity and cisgender increase stress among lesbians, bisexual women and transgender people with a fear of childbirth.

OBJECTIVE: To explore and describe norms concerning maternity, femininity and cisgender in lesbian and bisexual women and transgender people (LBT) assigned female at birth, with an expressed fear of childbirth (FOC). DESIGN: Semi-structured interviews were conducted with self-identified LBT people with an expressed FOC. PARTICIPANTS: 17 self-identified LBT people participated. 15 had an expressed FOC, and two were non-afraid partners. FINDINGS: Participants described how their FOC was related to ideals of "the primal woman", including ideals of a natural birth. They also described stress in relation to expectations of gaining a feminine-coded body during pregnancy and of being related to as feminine women. KEY CONCLUSIONS: Maternity ideals, and the ideal of the "natural" birth, can be particularly stressful on those who fear childbirth. Norms concerning femininity and cisgender can contribute to FOC among those who do not comfortably conform with feminine body ideals or feminine gender expressions. IMPLICATION FOR PRACTICE: Treatments of FOC must be designed to acknowledge whether and how norms concerning maternity, femininity and cisgender affect the individual's FOC.

Minority stress adds an additional layer to fear of childbirth in lesbian and bisexual women, and transgender people.

OBJECTIVE: To explore and describe thoughts about and experiences of pregnancy, childbirth and reproductive healthcare in lesbian and bisexual women and transgender people (LBT) with an expressed fear of childbirth (FOC). DESIGN: Data were collected through semi-structured interviews with self-identified LBTs with an expressed FOC. PARTICIPANTS: 17 self-identified LBTs participated. 15 had an expressed FOC, and two were non-afraid partners. FINDINGS: Participants' fears were similar to those previously described in research on FOC, e.g., fear of pain, injury, blood, death of the child or of the parent. However, minority stress, including fear and experiences of prejudicial treatment, in maternity care and at delivery wards add an additional layer to the fear of childbirth. KEY CONCLUSIONS: LBTs with FOC are a particularly vulnerable group of patients, whose needs must be addressed in healthcare. IMPLICATION FOR PRACTICE: The findings call attention to the need for LBT-competent treatment prior to, and throughout pregnancy and childbirth. In the most vulnerable patients, caregivers must work extensively to build trust, in order to explore and reduce FOC.