Small study of poly pregnancy and childbirth experiences gets continent-wide attention

A sign of the times for us:

Canadian researchers got surprisingly wide news attention for their study of polyfamilies' experiences with the medical world during pregnancy and childbirth. The researchers wrote, "Our aim was to identify barriers to prenatal, antenatal and postnatal care for polyamorous families and to share results and strategies with health-care providers in the hope of overcoming them."


Let's start with the press release from the journal that published the paper, the prestigious Canadian Medical Association Journal (October 15, 2019):

Polyamorous families face stigma during pregnancy and birth

Polyamorous families experience marginalization during pregnancy and birth, but with open, nonjudgmental attitudes from health care providers and changes to hospital policies, this can be reduced, found new research in CMAJ (Canadian Medical Association Journal).

...Few studies exist on the experiences of polyamorous families in health care, and it appears there are none on experiences during pregnancy and birth.

"[G]iven the high proportion of polyamorous individuals who are of child-bearing age and the substantial potential for stigma, it is important to investigate polyamorous individuals' experiences with reproductive care providers to better inform practice," writes Dr. Elizabeth Darling, a study author and assistant dean, midwifery, and an associate professor, Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, with coauthors.

Several themes emerged in this qualitative study of 24 participants, including 11 women who gave birth within the last 5 years and 13 partners.

Key points:

     – Participants deliberately planned families, choosing health care providers who they thought would be less discriminatory because of relationship status.

     – More partners means more support, although some partners were not able to fully share this support because of discomfort in disclosing polyamorous relationships.

     – People in polyamorous relationships often chose to disclose their status when it was medically relevant, and they received both positive and negative reactions from health care providers.

     – Navigating the health system presented challenges, including administrative barriers, in which forms did not have enough space for additional partners, or newborn identification bracelets that could be issued for only two parents
To improve health care experiences for polyamorous families, the study participants suggested health care providers should acknowledge the partners' presence and roles, be open and nonjudgmental, adapt administrative forms and procedures, and advocate for patients and their families.

"Our findings align with recent reports that individuals engaging in consensual nonmonogamy face stigma with respect to accessing health care," write the authors. "Our results also suggest that polyamorous individuals face concerns similar to those of other gender and sexual minorities regarding administrative barriers and challenges with disclosure to health care providers."

The authors state that substantial work needs to be done to remove marginalization experienced by these families in the health care system.

"[R]educing providers' implicit biases toward sexual minority groups, and patients in consensually nonmonogamous relationships in particular, is vital to addressing health disparities," writes Dr. Sharon Flicker, Department of Psychology, California State University, Sacramento, California, in a related commentary.

"Health care providers have an opportunity to mitigate this stress by providing inclusive environments and sensitive health care."

The research paper itself (online October 15). Here are its title and abstract:

The Polyamorous Childbearing and Birth Experiences Study (POLYBABES): a qualitative study of the health care experiences of polyamorous families during pregnancy and birth

BACKGROUND: As many as 1 in 5 adults practise some type of consensual nonmonogamy such as polyamory; many are married, have children, or both. Polyamorous families face unique challenges when accessing care during pregnancy and birth, and qualitative descriptive studies are needed to understand their experiences and inform health care providers’ practice.

METHODS: Participants, who self-identified as polyamorous, had given birth in the last 5 years and received at least some prenatal care, were recruited through convenience sampling on social media. Any of the birthing individual’s partners were also invited to participate. All participants completed a short demographic questionnaire and participated in a semistructured interview. Interview transcripts were coded using Braun and Clarke’s iterative thematic analysis.

RESULTS: A total of 24 participants, 11 who had given birth and 13 partners, were interviewed. Of those who had given birth, 5 received midwifery care only, 4 received obstetric care exclusively and 2 received shared care. Polyamorous families described sharing many common experiences during pregnancy and birth that were affected by their polyamorous identity. Although participants reported both positive and negative experiences with health care providers, when accessing health care all had experienced some form of marginalization that was related to their polyamorous status. One particular challenge for families was with respect to disclosure of polyamorous identity in hospital environments. Participants offered suggestions for improving the health care of polyamorous families during pregnancy and birth, including creating nonjudgmental spaces, accommodating difference through minimizing administrative barriers and allying with patients by providing patient-led care.

INTERPRETATION: Polyamorous families face marginalization when accessing pregnancy and birth care. Care experiences for polyamorous families can be improved by nonjudgmental, open attitudes of health care providers, and modifications to hospital policies to support multiparent families.

Okay, a small interview study of 24 self-selected participants, about experiences in a fringe population, right?

Well...

● The same day, Canada's nationwide CTV News aired this report:



From CTV's webpage for the story:

Polyamorous families face discrimination from health care providers during pregnancy: study

...This unconventional family is part of what researchers say is a growing trend of polyamorous relationships, where several consenting adults engage in romantic relationships, sometimes living together. And sometimes, like the Spence family, even sharing a home and raising children together.

“We have three parents that can take care of our kids as opposed to just two,” Taryn told CTV News. ...

But Canadian researchers at McMaster University who studied 24 of these “alternative families” say they aren’t always accepted by the medical system when they decide to have a baby. ...

...“Sometimes there is a repeated need to disclose family arrangements and that can be challenging for people to have to constantly explain their relationship to strangers,” [Elizabeth Darling] said.

A midwife could take on the responsibility of explaining the family status to all the health care providers involved in the pregnancy or birth.

“Participants [of the study] said having that advocacy was very much appreciated,” said Darling.

Doctors could also explain the medical relevancy of their questions. ...

“When selecting a provider, the families would often approach their first visit as an opportunity to interview the doctor,” she said. “They might ask direct questions or make assessments about the space, such as look for symbols that would suggest it’s an LGBTQ2-friendly space. They would also assess the kind of language the care provider uses in their initial interaction.”

● Right behind was CBC, Canada's national public broadcaster: Polyamorous families face stigma in pregnancy care, researchers say (Oct. 15):

Getty Images/iStockphoto

 
Polyamorous families face stigma during pregnancy and birth because of attitudes and policies in health care that are built around monogamy, researchers at McMaster University in Hamilton say.

The Canadian Medical Association Journal published a study Tuesday based on interviews with 24 polyamorous Canadians — 11 who had given birth in the previous five years and 13 partners — recruited through ads posted on social media groups.

The researchers with McMaster University's midwifery program say their inquiry was motivated in part by some team members' personal involvement in the polyamory community and a shared interest in inclusive health care.

Co-authors Erika Arseneau and Samantha Landry say their findings suggest that while participants reported both positive and negative health-care experiences, all faced some form of marginalization rooted in "mono-normativity," the assumption that romantic relationships are limited to two partners.

"There's a lot of people that are engaging in polyamory and a lot of them are having children, contrary to popular belief, and their experience is very similar to monogamous families in a lot of ways," said Arseneau.

"In other ways, it's enhanced by the fact that they have multiple relationships and multiple support people in their lives."

...According to a study of more than 2,000 Canadians published in the Journal of Sex Research last April, four per cent of Canadians who are romantically attached reported being in an open relationship, and 20 per cent said they had previously engaged in the practice.

In 2016, the executive director of the Calgary-based Canadian Research Institute for Law and the Family used social media to ask polyamorous Canadians to take part in an online survey. Of the 500 people who responded, more than 40 per cent said there were children living in their homes full- or part-time.

...Due to fears of discrimination, many participants opted not to disclose their polyamorous status unless it was medically relevant, said Landry.

Those who revealed they were polyamorous encountered an assortment of interpersonal and administrative challenges.

For example, some health-care providers would refer to a third partner as an "uncle" or "aunt" rather than their preferred title as a parent, said Landry.

...Arseneau noted that intake forms often only provide spaces for two parents, which can restrict a partner's access to the delivery room and involvement in medical decisions.

...Arseneau said she hopes the study helps health-care providers educate themselves about polyamory so they can acknowledge and accommodate the full spectrum of family structures.

"If you're creating a respectful, inclusive and accessible space for conversations to take place, whether it's about health care or social ideas, then that allows more room for difference and acceptance," said Landry.

● Canada's Global News network also ran the story the same day: Canadians unlikely to reveal polyamorous relationship during pregnancy: study (Oct. 15)

Oliver Rossi / Getty

 
...Polyamory is typically characterized by engaging in multiple intimate relationships with the consent of all parties involved.

Statistics on the prevalence of polyamory are hard to come by, but there are numbers to suggest that non-monogamous relationships may be on the rise in Canada.

According to a study of more than 2,000 Canadians published in the Journal of Sex Research last April, four per cent of Canadians who are romantically attached reported being in an open relationship, and 20 per cent said they had previously engaged in the practice.

In 2016, the executive director of the Calgary-based Canadian Research Institute for Law and the Family used social media to ask polyamorous Canadians to take part in an online survey. Of the 500 people who responded, more than 40 per cent said there were children living in their homes full- or part-time.

It appears the law is slowly catching up to this evolution of Canadian families. Last year, a court in Newfoundland and Labrador recognized three unmarried adults as the legal parents of a child born within their “polyamorous” family. ...

● Three days ago the researchers themselves published an article about their work on The Conversation ("Fact-based articles straight from academic experts to you"). News media worldwide often pick up The Conversation's articles under its free Creative Commons license. More romantic partners means more support, say polyamorous couples (Nov. 10)

...We found that those in polyamorous relationships benefit from each other but not from the system. Many of our interviewees expressed the view that having more partners garners more support.

They told us that although navigating multiple relationships can be difficult, it can also offer greater financial and logistical support when it comes to raising a family. One participant said:

“There’s extra one-on-one. When the 13-year-old middle child is sad and sick and whatever and just wants Momma, and the three-year-old just wants Dad… great, there’s still another adult to take care of those other kids.”

Our research participants also expressed difficulty navigating formal and informal social systems — including the health-care system — as we live in a world that tends to privilege monogamy.

"Polyamory is an increasingly common
relationship choice. (Shutterstock)"

...The polyamorous families we interviewed expressed a great deal of deliberateness in their decision-making, specifically around family planning.

They put substantial efforts into communication around whether children were desired within relationships, when to have children, who in the relationships would be biological parents and what parenting roles individuals would have.

Although this was not always the case, many of our interviewees also reported difficulty disclosing their polyamorous status due to fear of judgment. This was true for disclosure to family, friends, colleagues and, in the case of pregnancy and birth, to their care providers.

...“They asked who is allowed to make appointments for your child, and I said me, my husband and my girlfriend. And I had to give her name and her number. And they asked me several times, are you sure? What’s her relationship to the child? I’m like, well, I guess she’s technically his mother. And they’re like, well, we’ll just put down his aunt because we can’t put down multiple mothers when you already have a father, apparently.”

...Our participants expressed facing barriers such as lack of physical space for additional partners, lack of inclusion in medical decision making and facing judgement with disclosures. ...

● In the United States, Health Day published a story that got picked up by US News & World Report: When Baby Makes Four (Oct. 15)

By Amy Norton

When people in non-monogamous relationships decide to have a baby, they may find that hospitals are not ready to handle their childbirth needs, a new study suggests.

The study is among the first to look into the health care experiences of people in "polyamorous" relationships.

...While polyamory might be fairly common, there are many misperceptions about it, according to Flicker, who wrote an editorial published with the study.

Some see it as an aberrant behavior. However, Flicker said, "there is nothing inherently pathological about these relationships."

Another misperception is that polyamorous relationships are strictly casual — in the vein of "swinging," said Elizabeth Darling, the senior researcher on the study.

But, in fact, many people build "stable family units" where there are simply more than two adults taking care of the kids, explained Darling, an associate professor at McMaster University, in Hamilton, Ontario, Canada. ...

● And in Popular Science, or at least its website: Stigma against polyamory could put families’ health at risk (Oct. 21). "Nevertheless, research shows polyam families offer serious benefits to their kids."

...For Landry, a big takeaway from the new research is that a lot of people are in relationships outside of what healthcare workers might consider “traditional.” To keep parents and kids as healthy as possible, doctors and nurses should make sure they stay informed. Of course, this study is still one of the earliest to even discuss the topic of CNM parenthood, so more data and study are needed.

“Understand that people are happy and see huge benefits from having multiple relationships,” she says. "It's not just something that 'those other people' do. Most people probably know someone who is polyamorous, whether they are aware of it or not."

● And more, including MSN, Medical Health News, Foreign Affairs New Zealand, and MedIndia.

People these days are really interested in us.

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