EBB 401 – Perinatal Mental Health for 2SLGBTQ+ Parents with Dr. Leiszle Lapping-Carr, Clinical Psychologist
Dr. Rebecca Dekker – 00:00:00:
Hi, everyone. On today’s podcast, we’re going to talk with Dr. Leiszle Lapping-Carr about perinatal mental health for 2SLGBTQ plus parents. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.
Hi, everyone, and welcome to today’s episode of the Evidence Based Birth® Podcast. Today, I am so excited to welcome Dr. Leiszle Lapping-Carr to talk about perinatal mental health. Dr. Leiszle Lapping-Carr, pronouns she/her, is a clinical psychologist and assistant professor at Northwestern University in Chicago, Illinois. Leiszle is a queer, married, non-monogamous, white, cisgender woman with two kids and two fish. Her professional life focuses on improving sexual, relationship, and mental health for 2SLGTPQ+ folks through clinical work, education, and research, especially for people who are trying to or recently have had babies. Dr. Leiszle loves reading fantasy and historical fiction, cooking, crafting, camping, and doing jigsaw puzzles, and we’re so excited for her to share with us her knowledge and wisdom about perinatal mental health for 2SLGBTQ+ parents. Dr. Lappin-Carr, welcome to the Evidence Based Birth® Podcast.
Dr. Lieszle Lapping-Carr – 00:01:40:
Thank you so much for having me. I’m really excited to be here.
Dr. Rebecca Dekker – 00:01:43:
Yeah. So can you share with our listeners a little bit about your background and what led you to focus your research on perinatal mental health specifically for LGBTQ+ parents?
Dr. Lieszle Lapping-Carr – 00:01:55:
So I actually started my training. The first area I really focused in was sex and relationship therapy was all in on that. Started a postdoc there, like in sex therapy. And during that time, as I got like more and more further along in like being a certified sex therapist and things like that, it became apparent there was a really big gap around sexual and relationship concerns during the perinatal period. I was also pregnant at the time. So it was like very kind of like a combination of like my personal and professional world sort of colliding. And I was also starting to kind of, come out as queer. Like I was not really out for most of my life. And it’s a relatively recent thing. Then did another postdoc because that’s the kind of thing that I would do in perinatal mental health. And as I was kind of like becoming more involved with the queer community and the queer parenting community and also learning from a professional lens about perinatal mental health, I discovered that there was a really big gap in any kind of acknowledgement almost of like LGBTQ folks during the perinatal period. There was, you know, there was, you know, there was, you know, talking with leaders in the field who I was lucky enough to have as my mentors really were identifying this as a huge need, something that was very frequently not included in research and not discussed in clinical training. And so it felt like kind of like, kind of, this, made for me niche was like opening up before me, and so that became kind of like, where I started to specialize. And it also helped that, you know, I’m located at Northwestern, like you said, one of the leaders in preventive perinatal depression care at Northwestern was, his name is Darius Tandon. He does a lot of research on the Mothers and Babies Intervention. He was in the process of like, he wanted to do an adaptation of mothers and babies for the LGBTQ+ population. And so as I was kind of like, trying to figure out where I was going to launch out of training into my research career, he was looking for somebody with this kind of expertise. And so it was that it was there was a lot of like, kind of Kismet. Yes.
Dr. Rebecca Dekker – 00:04:23:
Yeah. Sounds like you’re in the right place at the right time to kind of focus your research in on this subject.
Dr. Lieszle Lapping-Carr – 00:04:30:
Yeah. Yeah, for sure.
Dr. Rebecca Dekker – 00:04:31:
And as you kind of dove into the research or the existing data and started collecting your own data, what did you find about perinatal depression rates and how those rates might look different for queer and or trans parents?
Dr. Lieszle Lapping-Carr – 00:04:46:
There’s been a decent amount of research on perinatal depression in cisgender heterosexual women. That’s been relatively well researched. While the rates vary somewhat, it’s usually about 25, 20 percent, about one in five individuals develop perinatal depression, either during pregnancy or the postpartum period. In the 2SLGBTQ+ population, there’s actually a little bit of a, the research isn’t super comprehensive, like it’s definitely still emerging. But there’s more quantitative research, like the research that gives us the numbers of things like prevalence rates with cisgender. Lesbian, bisexual, queer women. Among that population, we see, again, rates will vary, but we usually see about 50% increased risk compared to cisgender heterosexual women. And so that’s like, you know, about, you know, if we say 20% in cisgender heterosexual women, then cisgender queer women, it’s more like 30%. And so almost one in three. That’s kind of like the higher rates that we see are like 35%. The lower rates are like 15-ish percent. Among trans and gender diverse folks, there’s actually very little quantitative research. It’s almost all been more in the qualitative realm. So we get like, we have like a decent amount of descriptions of what people’s queer and trans folks experiences are like, but we don’t have, they’re all small sample sizes and we don’t have a lot of numbers. There is one small study. It’s about, I want to say about 30 individuals that participated and the rates were very high. One of the only studies that actually, you know, measured rates of depression among this, this- The gender diverse and trans population. And it was over 80% of folks were endorsing like depression, like positive depression scores on the PHQ-9, a common measure for perinatal depression. And that’s not too surprising to me. If we think about the rates of mental health concerns, like we see increased risk of mental health concerns more generally in the trans and gender diverse population, and we can talk more about that. But it makes sense to me that their rates would be higher than cisgender queer women and cis and heterosexual women.
Dr. Rebecca Dekker – 00:07:19:
What do we know so far about what might be elevating that risk in these populations?
Dr. Lieszle Lapping-Carr – 00:07:25:
To me, the big thing is the stigma and discrimination that 2SLGBTQ folks face in our society, especially in the last year or two, has really been ramping up with passages of anti-LGBTQ laws, restricting health care, restricting educational opportunities. All sorts of restrictions, both at the state and the federal level that we’re seeing in the U.S. There’s a couple of different theories related to this. One is the minority stress theory. And this has been applied not just to us LGBTQ populations, but other kind of stigmatized, marginalized groups like people of color or people with disabilities. The stress they experience living in a society that is discriminatory towards them. Results in poor health equity, poor health outcomes. And we see this in medical health outcomes as well as mental health outcomes. It’s the difference between it is not inherently being queer and trans that makes you more likely to have a mental health issue. It’s the kind of constant state of stress that you were in living in a discriminatory and stigmatizing society that leads to the poor health outcomes.
Dr. Rebecca Dekker – 00:08:54:
So that’s the minority kind of health. Stigma, discrimination effect? Are there any other factors that might be at play? Or does that seem to be the main one?
Dr. Lieszle Lapping-Carr – 00:09:05:
Well, that’s kind of like the theory underlying most of it. Another theory is the social safety theory. And it’s a little different, but it’s similar in a lot of ways. So it focuses on this idea, not so much that somebody is necessarily under constant stress, because there are lots of like queer and trans folks that don’t. Have daily experiences of like, microaggressions or like experience like specific attacks based on their identities there isn’t a sense of safety right there isn’t a like place in which they like automatically feel, accepted for exactly who they are, that isn’t a guarantee, right? They have to work really hard in order to find that. And so even in the absence of specific discriminatory experiences, the lack of overall safety in the society has a similar effect. Outside of the perinatal research, right? When we think of risk factors for perinatal mental health, there’s a few things that really kind of stand out and overlap with things that we see that are in general in the 2SLGBTQ population, like they have higher rates of this. And this includes like previous history of mental health concerns, right? That’s one of the major kind of risk factors for perinatal depression. Other things are substance abuse, suicidal thoughts, experiences of physical, emotional, and sexual abuse, and estrangement from family. So all of those things we see as risk factors for perinatal depression, and we see at higher rates in the LGBTQ population more broadly. And so we don’t have great research just on perinatal risk factors in queer and trans folks. So you got to have to piece together a bunch of different areas of research to. But together are coherent ideas.
Dr. Rebecca Dekker – 00:11:08:
So there is a higher rate in general in queer and trans folks, perinatal mental depression. But what are some ways or examples of ways that we can prevent perinatal depression that are effective in this community?
Dr. Lieszle Lapping-Carr – 00:11:25:
Yeah, absolutely. And I’m glad that you brought this in because I feel like we end up talking a lot about disparities and the problems. But it’s actually, I mean, there’s so much community.
Dr. Rebecca Dekker – 00:11:37:
There’s got to be protective things we can do.
Dr. Lieszle Lapping-Carr – 00:11:40:
Tons of that. And I think one of the main things is that community, right? Like there can be a really strong queer people are very experienced and very good at finding chosen family, right? Finding the people in their lives that do accept them and are there for them in the ways that they need. And so that’s one of the things that we see as very protective when somebody has a really strong support system. And it often looks pretty different from what like maybe the traditional Cishet, like nuclear family version looks like. It’s a lot of friends. Sometimes it’s multiple romantic partners, like being able to share responsibility as well as ask for help and accept that help, which that can be challenging. .. And then I’d say other things, right? Like, you know, I mentioned this adaptation that I’m currently working on. I’m working to adapt the Mothers and Babies Intervention for queer and trans folks.
Dr. Rebecca Dekker – 00:12:52:
And what is the Mothers and Babies Intervention?
Dr. Lieszle Lapping-Carr – 00:12:55:
So it is specifically a perinatal, a preventive perinatal depression intervention, right? So it’s one of a couple that I think has been identified as like a gold standard approach to preventing perinatal depression. It’s largely cognitive behavioral therapy based, can be delivered in groups, can be delivered individually. In this adaptation work that I’ve been doing, or before I jump to that, it has been really well researched and been shown to be effective and implemented in many different ways across the U.S..
Dr. Rebecca Dekker – 00:13:30:
Is there like a set curriculum or is it just using the principles of cognitive behavior therapy?
Dr. Lieszle Lapping-Carr – 00:13:35:
Yeah, there is a set curriculum. There’s a manual, there’s a participant manual and a trainer manual or a facilitator manual. It’s often delivered through with home visitors, actually, which are kind of like a going to the home kind of support system that is funded by a lot of states where it’s like rather than the person who’s postpartum having to leave and go seek care somewhere. Somebody comes to them to offer support.
Dr. Rebecca Dekker – 00:14:03:
And they don’t necessarily have to be a psychologist. They could be a community health worker delivering this intervention.
Dr. Lieszle Lapping-Carr – 00:14:09:
Exactly. Yeah. So there are a lot of things that were really appealing about this intervention that I was like, OK, it’s already shown a lot of like widespread ability to reach different people. And it is I mean, the name of it is Mothers and Babies. And it has like a companion called Fathers and Babies. And so it’s very like that assists and heteronormative in its language, in the kinds of ways that the materials
Dr. Rebecca Dekker – 00:14:35:
that they give you.
Dr. Lieszle Lapping-Carr – 00:14:37:
Yes. It’s all purple. It’s all got like these long flowing hair, very feminine people as the parent, as the birthing parent. Right? And so there was like. Already a call among folks at like delivering this intervention, trying to work with queer and trans folks being like, we need something better. Like we need something different than this.
Dr. Rebecca Dekker – 00:15:01:
This isn’t, this feels embarrassing. Bringing this into someone’s home that it doesn’t match.
Dr. Lieszle Lapping-Carr – 00:15:07:
Yeah, exactly. Exactly.
Dr. Rebecca Dekker – 00:15:09:
But the core of it, the heart of it is evidence-based. It just needs like a different wrapping, essentially.
Dr. Lieszle Lapping-Carr – 00:15:17:
Yes. It needs different wrapping. That’s one level, but there were some things that we adjusted. One of which was, right, like one of the modules in it is thoughts, right? And, you know, cognitive behavioral therapy is often about let’s change those thoughts.
Dr. Rebecca Dekker – 00:15:33:
Like identifying your negative thoughts that spiral you downward.
Dr. Lieszle Lapping-Carr – 00:15:38:
Exactly. And so one of the things among the queer and trans community is like, Some of the thoughts that are really distressing are very like fact based. Right. It’s about the fact that they are having their rights taken away in a kind of like systematic way in the culture. Right. That they are facing discrimination. And so like when thoughts are. Rather than just focusing on changing what the thoughts are, right?
Dr. Rebecca Dekker – 00:16:12:
Because the thoughts are true. Like they are actually experiencing these things.
Dr. Lieszle Lapping-Carr – 00:16:17:
Yeah, right. It’s not a catastrophizing thought. It’s accurate to the experience that happened. So instead, we incorporated a lot more kind of like acceptance kinds of like strategies and changing your response. Like, how can you acknowledge that this thought is true and it is terrible and it is distressing? And how can you still kind of live the life you want to live while having these distressing thoughts coming up for you? And so that was kind of one of the like more content focused shifts that we made based on we did a lot of work with interviewing. We were in TransParents as well as having a community advisory board to help decide what adaptations to make. And I’d say another one was really de-centering biological family. Like there was a lot of like, and that feels a little bit like wrapping as well, right? Because we’re still talking about building your social support system. But we’re taking out biological family and we’re removing church or religion as a really strong or like as a frequently mentioned recommendation of places to find connection and support. Because both of those spaces are often. Really- Problematic, that’s the word I’m looking for.
Dr. Rebecca Dekker – 00:17:44:
When you mentioned cognitive behavioral therapy, you know, you and I are both very familiar with that. I got to train in CBT as a doctoral student and I loved it. But for our listeners who aren’t familiar with it, could you just kind of give like a crash course, like one minute description of what it is since we’re going into depth about it?
Dr. Lieszle Lapping-Carr – 00:18:02:
Yeah, sure. Okay, so cognitive behavioral therapy. I mean, it is based on this premise that our thoughts or our cognitions and our emotions or feelings and our behaviors are all interrelated. And if we can address, or any one kind of like in that triangle, any one of the thoughts, feelings, or behaviors and kind of change it, then it will influence the other ones. So, and a lot of times with cognitive behavioral, we focus on the thoughts, the cognitions, but behaviors are also a common one. And so the idea is that like, if you’re having really distressing thoughts, which are, you know, contributing to high degrees of emotional dysregulation or worry or sadness, right? Then you can change the thought, right? You can catch yourself when you are like expecting the worst situation that has very little likelihood of happening, or when you are kind of stuck in all or none thinking, like either it has to be perfect or I can’t do it at all, right? Like those aren’t helpful thoughts.
Dr. Rebecca Dekker – 00:19:19:
Either I’m a great parent or I’m a disaster or failure at parenting.
Dr. Lieszle Lapping-Carr – 00:19:25:
Yeah, exactly. Right. And so like if you can catch yourself in those thinking patterns and try to like change it to give yourself some grace, give yourself a little bit of like acknowledge the truth of like this is a really hard moment and I’m doing the best I can. Right. Like then it can really help to relieve some of that distress. And with practice, you can make it so that those. You can catch yourself and prevent those thoughts from even coming up as frequently because you kind of rewire the way that you think so that you are less prone to those kind of negative problematic thought cycles.
Dr. Rebecca Dekker – 00:20:09:
And what are some other thoughts in your adaptation of this mother’s and baby’s intervention? What are some of the other negative thoughts or behaviors you might see in the LGBTQ plus population that might, you know, might not see in the heterosexual cisgender population? You mentioned the one about stigma and discrimination, my rights being taken away. What are some other ones?
Dr. Lieszle Lapping-Carr – 00:20:33:
One that comes up is often related to, and this is true for birthing parents, but also very true for non-birthing parents related to the biological relationship with the child. It’s much more common for there to be kind of a less direct biological relationship, right? And so there can be thoughts related to like, I’m not- How can I be like a good parent if I am not actually related to this child, right? I need to prove that I am as good of a parent. Not a lot of feeling of not wanting to repeat negative experiences that they had as a child, right? I’m like, I don’t want to, like, I, and like, that can lead to kind of an overcorrection, right? Like, if their parents were, like, really judgmental and strict and- Pain-based, right? Then sometimes that leads to, like, a complete, I’m not going to do any of that, and then there’s less structure, than what is actually useful for a kid during their development. But so it can be kind of a reactionary, like, I’m not going to do what my parents did kind of a thing, and focused on what they don’t want to do rather than how they do want a parent. I think there’s a lot of loneliness. One thing, like, you know, I talked about this community building, and I do think that that’s really helpful. But there was, in the research that I’ve been doing, a common theme is kind of, like, there’s there being this separation between queer support, like, queer and trans community, and parenting community, right? Like, it’s really hard to find that overlap of other queer and trans people who are having babies, too.
Dr. Rebecca Dekker – 00:22:23:
You were at the playground at the same time as you when you’re bringing your baby or toddler there.
Dr. Lieszle Lapping-Carr – 00:22:28:
Yeah. Yeah. And so there can be very much like a I don’t quite fit anywhere. Like my parenting friends don’t understand how my queerness plays into this. And my queer friends really don’t understand the parenting thing at all. Right. So I think that’s that’s another one. Like, just the sense of like loneliness and isolation and really not knowing where to turn to find people who who it feels like they get it.
Dr. Rebecca Dekker – 00:22:57:
So it sounds like you have to dig deeper to find that parenting queer community that you can blend together. So I know with cognitive behavioral therapy, when you’re changing behaviors, and a lot of times people with depression, they don’t want to go out, right? They want to isolate themselves, which then impacts their emotions and their thoughts. And like you said, it’s all interrelated. So what are some behaviors that like in this intervention, you encourage queer and trans parents? Like what are some behavior changes they can make that might make them feel better?
Dr. Lieszle Lapping-Carr – 00:23:31:
Yeah, absolutely. And we do have like one of the modules is called pleasant activities, right?
Dr. Rebecca Dekker – 00:23:37:
I love that. Right.
Dr. Lieszle Lapping-Carr – 00:23:39:
And so it’s all about trying to find things that are enjoyable for you to do, right? And we talk about, we include like these weekly kind of personal projects where you try out different things. And we think about kind of low cost. We think about the difference between doing things with your baby versus doing things on your own. Right? Like going for a walk in the park with your baby is great. Like that can be really like lovely and calming, especially if you live at a place that has nice weather. December in Chicago is a hard time to go for a walk.
Dr. Rebecca Dekker – 00:24:17:
It’s not going to be that pleasant at the park.
Dr. Lieszle Lapping-Carr – 00:24:19:
Exactly. But there’s also, I think we also encourage people to find ways to spend time on their own, right? Like to allow like a partner or a friend to take care of the baby for a little while so that they can get like a bath or go to a movie with a friend, right? Like do a thing that’s like more about like nourishing themselves in addition to like nourishing their relationship with their child.
Dr. Rebecca Dekker – 00:24:50:
Maybe making a list of like you call them pleasant activities and finding ways to do them. And I think some people can get so stuck in depression that it can be hard to even do one thing. And so maybe thinking of it as like an experiment, like I’m just going to try this once. I’m going to try it for 20 minutes, you know, maybe you’re not going out for a whole three hour movie, but you’re just going on a walk by yourself.
Dr. Lieszle Lapping-Carr – 00:25:17:
Yeah, exactly. Right. Like that graduated piece that like starting small and working your way up. Absolutely. And yeah, we do like in the intervention that we have a whole list, like one of the handouts is like a list of lots of different kinds of pleasant activities, including, right, like something as simple as having a cup of tea, right? Like it can be really small or it can be those bigger things like going to a party, right? Which might feel really unapproachable depending on where somebody’s at with their mental health.
Dr. Rebecca Dekker – 00:25:50:
So how can people access treatments like this that you’re talking about where somebody comes to your home and delivers? Is this pretty uncommon in the United States or is it? What are your thoughts?
Dr. Lieszle Lapping-Carr – 00:26:03:
So my understanding, you know, I’m not like an expert on home visiting, unfortunately. I should know more about it than I do. But my understanding is that most states through their kind of like they have a home visiting program. Like and it depends on exactly what the state laws and the county you live in. But it’s like run by the state. It’s not a private thing. And so it is like public
Dr. Rebecca Dekker – 00:26:27:
health. And it depends. Sometimes I know it depends on like if you meet certain criteria where I live. I think, you know, it’s offered to all teenagers who have a baby, but not necessarily to other people.
Dr. Lieszle Lapping-Carr – 00:26:39:
Yeah, no, that would make sense to me. Right. And then I think other ways to get asked. So there’s like a little bit of like. You can ask your OB or your midwife when you’re getting your prenatal care or when you’re like after delivery about if there are any resources like that that you could access.
Dr. Rebecca Dekker – 00:27:01:
Like group or individual mental health care interventions.
Dr. Lieszle Lapping-Carr – 00:27:06:
Yeah, and then because then there’s also a lot of kind of like more private practice kinds of spaces, right? Like mental health clinicians that offer this kind of support. A lot of hospitals have like kind of like breastfeeding support classes or something like that. Or there’s like new parent groups that you can find online. But that’s less that’s much more kind of support group based rather than kind of like mental health treatment or prevention based. And so I would say Postpartum Support International often has like a really nice way to find mental health resources generally. And there is a way to sort. There is like a flag on there for queer and trans friendly providers or like affirming providers. And so for people from the 2SLGBTQ+ community, you would want to find somebody who. At least tries to identify themselves in that way. Unfortunately, it can be really hard to find somebody that has perinatal mental health expertise and has good training and awareness of how to provide queer and trans affirming health care. They seem to- Not have a lot of overlap. Mental health clinicians in particular, right, like the mental health field has a long history of really pathologizing queer and trans identities. And so there can be a lot of kind of like bias baked in that people aren’t aware of and that can come out in harmful ways if they’re not really doing work to unlearn some of those messages that they’ve been taught throughout their life.
Dr. Rebecca Dekker – 00:28:58:
Right. It’s like we already have a shortage of perinatal mental health providers, like clinicians who are trained in the perinatal side and then also who are queer and trans affirming and, you know, trained in helping that population. So it’s like you get smaller and smaller in terms of numbers.
Dr. Lieszle Lapping-Carr – 00:29:18:
Exactly.
Dr. Rebecca Dekker – 00:29:19:
I did want to know if you go to postpartum.net and look at the support groups, they have a lot of different types of support groups to help different groups of people. And one of them is a queer and transparent support group that meets every Wednesday and every second Sunday. So that is something that and it’s free to participate in. So that’s really cool that that’s an option.
Dr. Lieszle Lapping-Carr – 00:29:43:
Yeah. Yeah. I actually I’ve I know that exists. I don’t know anybody that’s actually gone to it, but it’s really nice. Like I did meet somebody who was one of the organizers and she was she was absolutely lovely and very enthusiastic and passionate about her work. So-
Dr. Rebecca Dekker – 00:30:04:
So access to the professional care side is tricky.
Dr. Lieszle Lapping-Carr – 00:30:09:
Yes.
Dr. Rebecca Dekker – 00:30:09:
And not always equitable.
Dr. Lieszle Lapping-Carr – 00:30:11:
Yes, exactly.
Dr. Rebecca Dekker – 00:30:13:
How can queer and trans parents advocate for their mental health and find supportive care? Maybe they’re thinking about prevention or they need treatment. Like what are some steps they can take right away if they’re worried about this?
Dr. Lieszle Lapping-Carr – 00:30:27:
Yeah, I mean, I think one important message is that like, it is good to talk to your doctor or whatever. Like it is good to seek help. Sometimes there can be a worry that if you’re seeking help for mental health concerns, you’re going to. Have an increased risk of child protective service involvement. There’s some research showing that that’s a major concern for queer and trans folks when it comes to being honest about the mental health struggles that they’re having, because there are kind of higher rates of having CPS involvement.
Dr. Rebecca Dekker – 00:31:04:
And being targeted.
Dr. Lieszle Lapping-Carr – 00:31:05:
Exactly. Right. And so- I understand the fear, right? And like, asking for help before it gets to like a really extreme place is gonna, um, like when you first start to notice that’s going to be one of your, one of your, uh, most effective approaches. It’s, it’s really hard though. Like the, there is a burden of advocacy on, on queer and trans folks, right? Like of needing to like educate, educate their own clinicians about what it meet, what they need as a queer or trans person. And that’s really hard, but there’s, and it’s, it’s also. There is like a bit of like a, I wouldn’t want to encourage somebody to just, you know, not advocate for themselves and continue to receive poor care.
Dr. Rebecca Dekker – 00:31:59:
I mean, because often what you see, you know, in any group of people that feels like this burden, they will often avoid seeking care from that provider. Right. They just stop going to appointments or they don’t make appointments.
Dr. Lieszle Lapping-Carr – 00:32:12:
Exactly. It’s frustrating that this is what the state is, but word of mouth is one of the most common kind of approaches is, like talking, like finding an online group in your area of, in your general area of queer and trans parents and or trans parents who have been able to vet some of the folks that provide care.
Dr. Rebecca Dekker – 00:32:35:
That word of mouth recommendation can be so powerful so that you can find someone who is a safer provider for you.
Dr. Lieszle Lapping-Carr – 00:32:42:
Definitely. Especially there’s, I feel like the doula space, there’s a lot of, a lot of birth work, like doula doulas who are specialized in the queer and trans community. Like that’s a space where you might have more luck with find- With, figuring out how to tap in to that network. And I would also say like, in some ways I recommend folks going to explicitly kind of like queer and trans mental health care. And then like, within that space, looking for somebody who has some knowledge in like perinatal rather than going the perinatal route, because I have seen that it is usually easier to find somebody who can do like decent perinatal care in an LGBTQ space than the other way around. Right. Doing decent queer and trans affirming care in a perinatal space is usually harder to find.
Dr. Rebecca Dekker – 00:33:37:
And the perinatal mental health spaces are often like highly gendered and focused towards heterosexual clients.
Dr. Lieszle Lapping-Carr – 00:33:45:
Yeah, very much so. Right. And that’s one of the things like you walk into a waiting room and you see nothing that at all matches your experience. And the intake forms don’t give you a place to describe your gender or the gender of your partner. And it’s just like it is off putting from the outset and it makes it really hard to want to stay.
Dr. Rebecca Dekker – 00:34:09:
Like you said, you know, speaking of, you know, how provider spaces are not always welcoming and affirming, what are some small steps for any of our listeners who might be health care providers or birth workers? What are some small steps they can take to improve? Their care of queer and trans parents. Maybe current clients or potential clients.
Dr. Lieszle Lapping-Carr – 00:34:31:
Yeah, absolutely. I mean, I think it does start with that first impression, right? Like the waiting room space.
Dr. Rebecca Dekker – 00:34:38:
The intake form.
Dr. Lieszle Lapping-Carr – 00:34:40:
The intake form. Having a way to track your patient, like for there to be a difference between your patient’s legal name. And what name they actually use, right? Because a lot of people haven’t gone, like for gender diverse folks, they may not have gone through the formal legal process of changing their name. And it’s still like distressing for them to be referred to by their legal name. If it’s like a dead name for them, a name that they have decided is no longer fitting with their identity, as well as pronouns, right? Like having a way to track pronouns. You know, in the peridictal space, it’s so common, to call any pregnant person mama. Right. And it’s like there’s lots of folks who don’t use that term. And like I even heard from a lot of cisgender queer women that the hyper gendered nature of these spaces were really off putting for them, even though they don’t. They personally-
Dr. Rebecca Dekker – 00:35:38:
Yeah, they see, like you’re assuming that I want to be called mommy or mama right now.
Dr. Lieszle Lapping-Carr – 00:35:42:
Yeah.
Dr. Rebecca Dekker – 00:35:43:
Maybe I just want to go by my name.
Dr. Lieszle Lapping-Carr – 00:35:45:
Yes.
Dr. Rebecca Dekker – 00:35:45:
Yeah. And I don’t want to be kind of. Just put into a box like you know, I’m not just here, as, uh, as a mom, if that’s what I identify as, exactly. Exactly.
Dr. Lieszle Lapping-Carr – 00:35:57:
Um, and then like training staff, is really important. Because sometimes it’s like, the clinician themselves, might do a decent job of it. But the front desk staff, or the like physician’s assistant, or you know, or not not the physician like the medical assistant. Right. Any of them, if they also like, are struggling with being affirming, then that’s not gonna like. It can’t just be the clinician, it needs to be kind of the whole practice. Another good step is to introduce yourself with your pronouns. Right. Like whenever, like, you say, hi I’m dr Leiszle Lapping-Carr, I use she/her pronouns, I’m a licensed clinical psychologist. Right? It just you integrate it in, it’s not a big deal, but it is a, kind of green flag that like you’re aware that this is a thing, that people might care about. And things like pride flags, right? Like having some visual indicator that this is an affirming space. But you can’t just do the surface level changes without kind of really attending to.
Dr. Rebecca Dekker – 00:37:13:
Yeah, you could have the rainbow flag, but then you could have somebody at your front desk who’s really homophobic.
Dr. Lieszle Lapping-Carr – 00:37:19:
That’s not going to work well.
Dr. Rebecca Dekker – 00:37:21:
Yeah, it doesn’t work well. I’ve also seen some providers put it in their email signature, which I found, you know, that was a really nice way of kind of signaling that they’re a safe space.
Dr. Lieszle Lapping-Carr – 00:37:33:
Yeah, for sure. Right. Like I’ve definitely at this point, like anywhere there’s a bio of me anywhere. Like I like include my pronouns on my name here. What I, what I typed it in before our podcast today, I made sure to include my pronouns because it is it is a way of signaling your awareness. One of the common mistakes I see with clinicians is either like a real hyper focus, like way too focused on people’s identities or completely ignoring people’s identities. Right. It’s like and it’s all about really listening to what the patient is coming in with, saying they need help with. If they’re saying that, like, I’m having a lot of dysphoria as I’m trying to chest feed my child. Right. It’s like, well, then their gender dysphoria is the thing that you should be talking about. Right. But if they’re coming in saying, like, I can’t get out of bed because I’m so depressed because. I have a three-month-old and I’m in the midst of a really deep depression, right? Then you don’t really necessarily need to focus so much on their gender identity, right? And if you do, then that can be seen as attributing their depression to them being trans or them being queer. And that’s like highly offensive and inaccurate.
Dr. Rebecca Dekker – 00:38:55:
That makes sense. You know, like this. Basic dignity of reading the room, you know?
Dr. Lieszle Lapping-Carr – 00:39:03:
Yes. And like, I get that sometimes people are just like, if they don’t have a lot of experience working with queer and trans folks, they’re trying really hard. And sometimes they just like, you know, need more, need more training, need more time and practice making it a bit more natural.
Dr. Rebecca Dekker – 00:39:23:
We’ve given us so many like pearls of wisdom. I love like all the tips that you’ve given throughout today’s discussion. So Dr. Leiszle, thank you so much for sharing so many pearls of wisdom and just ideas and recommendations and tips for our listeners. It’s really important the work that you do. And we’d love to link to some of your work in the show notes. If you could send us information about the intervention that you’ve been adapting and anything else you want to share with our audience, we’ll make sure to put that in the show notes. But thank you again so much for coming on today’s podcast.
Dr. Lieszle Lapping-Carr – 00:39:57:
Yeah, thanks for having me. It was really fun.
Dr. Rebecca Dekker – 00:40:00:
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