Deeper Dive

Supporting LGBTQIA2S+ Perinatal Needs in Charlottesville, VA

The unique challenges faced by LGBTQIA+ individuals during the perinatal period, and the process of building a family, are explored here. This population will be further defined, but for clarity will be referred to as “Ostara.” Issues such as isolation, mental health concerns including Perinatal Mood and Anxiety Disorders (PMADs), fertility support, chestfeeding support, and socioeconomic needs are highlighted. 

Population Background

The perinatal period spans from gestation through 1–2 years after childbirth. However, Ostara encompasses all LGBTQIA2S+ individuals involved in expanding their family, whether through fertility treatments, fostering, adoption, surrogacy, or other methods, either in the early stages or through 1–2 years post-placement. The LGBTQIA2S+ community within Ostara includes persons that identify as “lesbian, gay, bisexual, transgender and/or gender expansive, queer and/or questioning, intersex, asexual, and two-spirit (National Association of Social Workers, n.d.).” Ostara faces unique barriers to perinatal wellness (Kirubarajan et al., 2022; Devooght et al., 2023), as well as a heightened risk of more universal concerns. 

Perinatal Mood and Anxiety Disorders (PMADs) range in severity and manifestation from anxiety, depression, OCD, PTSD, psychosis, and more (Postpartum Support Virginia, n.d.). The term PMADs has been criticized for stigmatization (Hutchens, 2019) and exclusionary language, giving the impression that these conditions are only experienced by birthing persons. While PMAD is the industry standard, this project will instead use the term Parental Yoke Response of Anxiety & Mood Disturbances to Society (PYRAMDS). PYRAMDS are more common in birthing persons but also occur in non-birthing parents, adoptive parents, surrogate parents, and any parent in the transition of adding a child to their family. Elevated risk of PYRAMDS is discussed later.  

Gender and sexual orientation are significant intersectional identities within this community. However, members of this community may experience a full range of intersectional identities. Like any group, this population is not homogenous. 

In addition to the potential for oppression from gender or sexual orientation, there is also preliminary evidence that suggests Ostara families experience poverty at higher rates than cis-gendered, heterosexual persons (McLanahan & Sawhill, 2015). This class-related identity will be addressed.

Additional intersecting identities are relevant for this population but did not stand out as more significant for this population than for the general population. These identities, such as race and ability, will be addressed as applicable, but will not be the focus of this project.

While there is a significant lack of research aimed at this population (Devooght et al., 2023; Kirubarajan et al., 2022; Reed, 2018; Reyes et al., 2021), there were a few themes that stood out across both peer-reviewed literature and organizational resources. Isolation and lack of social support were the top concerns facing Ostara. Additionally, this population faces concerns involving fertility support, chestfeeding support, mental health issues, and socioeconomic issues.

Isolation & Lack of Support

The overwhelming concern facing Ostara is isolation, specifically feeling they do not belong (Centre of Perinatal Excellence, n.d.; Devooght et al., 2023; Epstein, 2018; Jaspal et al., 2023; Kirubarajan et al., 2022; Lee, 2019; Pflum et al., 2015; Reed, 2018). The baby space is littered with gendered language as well as attitudes and policies that view the dominant class, race, gender, ability, and sexual orientation as standard. Ostara is often met with confusion, frustration, and a deep lack of empathy from service providers throughout their experience.

This isolation has been further exacerbated by a narrow representation of Ostara’s family makeup in the media. Shows like Modern Family made strides in acceptance of certain types of Ostara families. However, the singleness of such examples has further ostracized many Ostara families (Reed, 2018) and has led to further isolation for those families that do not conform to the traditional two-parent, monogamous model of family.

In addition, Ostara often experiences estranged relationships with their own families of origin (Devooght et al., 2023). Isolation and lack of social support are directly linked to an increased risk for PYRAMDS (Postpartum Support Virginia, n.d.).

Heightened Mental Health Risk

A 2022 meta-analysis of LGBTQ2S+ individuals (Kirubarajan et al.) noted Ostara experienced an increased occurrence of PYRAMDS, increased societal stigma, and a lack of support. 

Ostara experiences three or more Adverse Childhood Experiences (ACEs) at a significantly higher rate than the general population (Tran et al., 2022)—rates were often nearly double that of the general population. The largest differences are related to sexual and emotional abuse. Sexual trauma is also associated with an increased risk of PYRAMDS (Postpartum Support Virginia, n.d.), as well as the known physical and behavioral health impacts of ACEs. This fact reveals a concerning cycle in that mental illness in the home is an ACE. If Ostara experiences a PYRAMDS, then their child will concurrently experience an early ACE, further perpetuating a cycle of harm if left untreated.  

Knowing that Ostara families are at a heightened risk for mental health concerns, it is even more concerning that in the US the leading cause of death in the first year postpartum for women is suicide (Spinelli, 2021). Ostara must have access to inclusive, trauma-informed care for both PYRAMDS and general mental health.

ACES and Mindfulness, Spirituality, Relationship

Dr. Nadine Burke Harris explains on the podcast Armchair Expert (Shepard, 2019) that nurturing interpersonal relationships can change our epigenetics and halt the cycle of intergenerational trauma. In addition to relationships, Dr. Harris notes that exercise, mindfulness, nutrition, sleep, and mental health are mitigating tools for combatting the effects of ACEs, even into adulthood. To that end, each of these could be included as needs for Ostara families. 

Research into LGBTQ2S+ individuals further indicated that mindfulness and spirituality were supportive factors for Ostara families, as well as mindset and self-advocacy (Kirubarajan et al., 2022; Lee, 2019). Mindfulness, yoga, and spiritual resources offer hope to Ostara.

Additional research further validates that supportive relationships and community are critically important to Ostara’s mental well-being (Devooght et al., 2023; Jaspal et al., 2022; Pflum et al., 2015; Centre of Perinatal Excellence, n.d.) and may even reduce PYRAMDS symptoms by nearly half (Feinberg et al., 2022). The efficacy of peer support groups was reiterated throughout both the research and organizational literature.

Fertility

In some locations, lesbian and gay couples are estimated to represent up to 30% of donor insemination clients (Epstein, 2018). Additionally, the author has learned anecdotally that fertility support is a significant need for Ostara. Various terms have been used to refer to fertility treatments; Assisted Human Reproduction (AHR) and Assisted Reproductive Technology (ART) both refer to treatments that involve handling embryos or eggs (Centers for Disease Control and Prevention, 2023; The Society of Obstetricians and Gynaecologists of Canada, n.d.). AHR is more often used in the international community, whereas ART is more common in the United States. However, this project will use the terms interchangeably.

Unfortunately, it is often in ART spaces where gendered practices combine with classist and ableist practices to create significant harm to Ostara, especially those experiencing ableist oppression (Epstein, 2018; Roberts & Jesudason, 2013). Epstein’s 2018 study, conducted in Canada, outlined a variety of gendered microaggressions as well as blatant discrimination. One lesbian mother was asked to forgo her parental rights to undergo an AHR procedure. 

Additionally, local fertility clinics may have web pages dedicated to Ostara but still use heavily gendered and stereotypical language (Virginia Fertility & IVF, n.d.). While Ostara needs fertility support, they also severely need inclusive, affirming, and affordable care.

Chestfeeding

Chestfeeding support is a common need amongst all perinatal individuals and is of particular concern for trans men, who have experienced a gap in support and understanding (Kirubarajan et al., 2022). In addition to simply needing support with chestfeeding, further complications arise for trans folks who may be anxious for a return to testosterone treatments (Epstein, 2018; Kirubarajan et al., 2022; MacDonald et al., 2016; Yang, et al., 2023). 

Even outside of Ostara who identify as trans men, the gendered and dominant cultural influences within the chestfeeding space can cause harm to Ostara (Yang et al., 2023).  Lee (2019) notes several instances where Ostara has been disallowed to participate in or lead chestfeeding and other parent-related supports. Lee also notes a supportive case of self-advocacy in which Trevor MacDonald, a trans man, challenged the La Leche League policy that required group leaders to be “mothers.” The result was a change in the policy to reduce gendered language around requirements for leaders. That said, La Leche League still uses the term “breastfeeding” throughout most of their literature and website, only once using the term in their prerequisite for leading: “personally breastfed/chestfed a baby for at least a year.” (La Leche League International, n.d.).

Socioeconomic

Initial investigations suggest that Ostara families might encounter elevated levels of poverty, food insecurity, and housing instability (Brown et al., 2016; Gates, 2015; McLanahan & Sawhill, 2015). However, these findings often lack peer review and are based on insufficient data. For instance, Gates (2015) suggests that children in same-sex households face a poverty rate of 24%, contrasting with 14% for different-sex couples. Examining the source data, the Public Use Microdata Sample (PUMS), uncovers significant issues: the data does not differentiate between gender and sex, and is binary (U.S. Census Bureau, 2021). Consequently, a transgender man and a cis-gender woman may be classified as a “different-sex” couple, which does not accurately represent Ostara families. Furthermore, a non-binary individual may opt to leave the value blank or select one, and same-sex couples married before 2004 were excluded. In attempting to address these concerns, Gates eliminated 7.9% of “different-sex couples” and 28% of “same-sex couples” survey responses (2015).

These preliminary findings rely on data sources inadequately configured for Ostara families. The American Community Survey (ACS), the parent data source of PUMS, also only permits binary sex reporting without gender differentiation (U.S. Census Bureau, n.d.). While scholarly research in this domain is limited, conversations with members of the LGBTQ+ community corroborate these assertions. This highlights the extreme need for increased research into the needs and supports for Ostara. While socioeconomic concerns are acknowledged, they are not the primary focus of Ostara’s needs.

Concluding Exploration of Needs

Although research on the best support for Ostara remains limited, identified themes have allowed for clear recommendations. Ostara faces a spectrum of unique concerns, ranging from mental health and social support to inclusive, trauma-informed chestfeeding and fertility assistance. Affordability should be considered to address potential socioeconomic challenges.

Specifically, free or low-cost peer support groups are recommended, along with inclusive spiritual spaces. General safe spaces are also recommended for Ostara, regardless of their focus on the baby stage, especially if they encourage self-advocacy. Additionally, mindfulness-based movement resources are also recommended, with priority given to reduced-cost options. It is important to prioritize inclusivity over locality in support groups for Ostara.

An inclusive, trauma-informed fertility clinic and chestfeeding support are imperative for Ostara. This may require disregarding ’local’ centers in favor of longer travel distances to safeguard Ostara’s well-being from potential harm in local establishments. Similarly, achieving inclusivity, affordability, and proximity in chestfeeding support may pose challenges, necessitating consideration for different Ostara subgroups.

Lastly, although addiction was not explicitly addressed in the research, anecdotal evidence suggests that inclusive addiction recovery support could benefit Ostara. However, since this did not emerge prominently in the general literature, its inclusion in the final resource list may be limited.

References

Brown, T. N., Romero, A. P., & Gates, G. J. (2016). Food insecurity and SNAP participation in the LGBT community. The Williams Institute. https://escholarship.org/uc/item/6f84z0m9

Centers for Disease Control and Prevention. What is assisted reproductive technology? (2023, September 11). Retrieved February 19, 2024, from https://www.cdc.gov/art/whatis.html

Centre of Perinatal Excellence. LGBTIQ+ parents (n.d.). Retrieved February 19, 2024, from https://www.cope.org.au/new-parents/lgbtiq-parents/

Devooght, A., Stinnett, R., Philippi, K. J., Cahill, A., & Neuer Colburn, A. A. (2023). Promoting wellness for an inclusive perinatal population: Strategies for counselors. Journal of Mental Health Counseling, 45(3), 264–279. https://doi.org/10.17744/mehc.45.3.06

Epstein, R. (2018). Space invaders: Queer and trans bodies in fertility clinics. Sexualities, 21(7), 1039–1058. https://doi.org/10.1177/1363460717720365

Feinberg, E., Declercq, E., Lee, A., & Belanoff, C. (2022). The relationship between social support and postnatal anxiety and depression: Results from the Listening to Mothers in California survey. Women’s Health Issues, 32(3), 251–260. https://doi.org/10.1016/j.whi.2022.01.005 

Gates, G. J. (2015). Demographics of married and unmarried same-sex couples: Analyses of the 2013 American Community Survey. The Williams Institute.  https://escholarship.org/uc/item/3td6n3q0

Hutchens, B. F., & Likis, F. E. (2019). A mental health acronym that must be stopped: PMAD. Archives of Women’s Mental Health, 22(5), 709–709. https://doi.org/10.1007/s00737-018-0932-0

Jaspal, R., Lopes, B., & Breakwell, G. M. (2023). Minority stressors, protective factors and mental health outcomes in lesbian, gay and bisexual people in the UK. Current Psychology (New Brunswick, N.J.), 42(28), 24918–24934. https://doi.org/10.1007/s12144-022-03631-9 

Kirubarajan, A., Barker, L. C., Leung, S., Ross, L. E., Zaheer, J., Park, B., Abramovich, A., Yudin, M. H., & Lam, J. S. H. (2022). LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. BJOG : An International Journal of Obstetrics and Gynaecology, 129(10), 1630–1643. https://doi.org/10.1111/1471-0528.17103

La Leche League International. Volunteer with us! (n.d.). Retrieved February 19, 2024, from https://llli.org/get-involved/volunteer-as-a-leader/

Lee, R. (2019). Queering lactation: Contributions of queer theory to lactation support for LGBTQIA2S+ individuals and families. Journal of Human Lactation, 35(2), 233–238. https://doi.org/10.1177/0890334419830992

MacDonald, T., Noel-Weiss, J., West, D., Walks, M., Biener, M., Kibbe, A., & Myler, E. (2016). Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: A qualitative study. BMC Pregnancy and Childbirth, 16(1), 106. https://doi.org/10.1186/s12884-016-0907-y

McLanahan, S., & Sawhill, I. (2015). Marriage and child wellbeing revisited: Introducing the issue. The Future of Children, 25(2), 3–9. https://doi.org/10.1353/foc.2015.0009

National Association of Social Workers. LGBTQIA2S+. (n.d.). Retrieved February 15, 2024, from https://www.socialworkers.org/Practice/LGBTQIA2S

Pflum, S. R., Testa, R. J., Balsam, K. F., Goldblum, P. B., & Bongar, B. (2015). Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 2(3), 281–286. https://doi.org/10.1037/sgd0000122

Postpartum Support Virginia. Perinatal mood and anxiety disorders (PMADs). (n.d.). Retrieved February 3, 2024, from https://postpartumva.org/types-of-perinatal-mood-and-anxiety-disorders/

Reed, E. (2018). The heterogeneity of family: Responses to representational invisibility by LGBTQ parents. Journal of Family Issues, 39(18), 4204–4225. https://doi.org/10.1177/0192513X18810952

Reyes, A. M., Akanyirige, P. W., Wishart, D., Dahdouh, R., Young, M. R., Estrada, A., Ward, C., Cruz Alvarez, C., Beestrum, M., & Simon, M. A. (2021). Interventions addressing social needs in perinatal care: A systematic review. Health Equity, 5(1), 100–118. https://doi.org/10.1089/heq.2020.0051

Roberts, D., Jesudason, S. (2013). Movement intersectionality. In M. L. Anderson & P. H. Collins (Eds.), Race, Class, and Gender: Intersections and Inequalities (10th ed., pp. 471–481). Cengage.

Shepard, D. (October 10, 2019). Dr. Nadine Burke Harris (147). Retrieved February 10, 2024, from https://armchairexpertpod.com/pods/nadine-burke-harris

Spinelli, M. (2021). Postpartum psychosis: A diagnosis for the DSMV. Archives of Women’s Mental Health, 24(5), 817–822. https://doi.org/10.1007/s00737-021-01175-8

The Society of Obstetricians and Gynaecologists of Canada. Pregnancy info: Assisted reproduction. (n.d.). Retrieved February 19, 2024, from https://www.pregnancyinfo.ca/before-you-conceive/human-reproduction/assisted-reproduction/

Tran, N. M., Henkhaus, L. E., & Gonzales, G. (2022). Adverse Childhood Experiences and mental distress among US adults by sexual orientation. JAMA Psychiatry, 79(4), 377. https://doi.org/10.1001/jamapsychiatry.2022.0001

U.S. Census Bureau; American Community Survey data. (n.d.) Census.Gov. Retrieved February 19, 2024, from https://www.census.gov/programs-surveys/acs/data.html

U.S. Census Bureau; Understanding and using the American Community Survey Public Use Microdata sample files. (February 2021). Retrieved February 19, 2024, from https://www.census.gov/content/dam/Census/library/publications/2021/acs/acs_pums_handbook_2021.pdf 

Virginia Fertility & IVF. Assisted Reproductive Technology (ART) For LGBTQ (n.d.). Retrieved February 19, 2024, from https://www.vafertility.com/lgbtq-family-building/

Yang, H., Na, X., Zhang, Y., Xi, M., Yang, Y., Chen, R., & Zhao, A. (2023). Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: A cross-sectional study. eClinicalMedicine, 57. https://doi.org/10.1016/j.eclinm.2023.101847

Local Resource List

Charlottesville, VA is a generally welcoming and LGBTQ+ friendly city so there are lots of resources. That said, we struggle with many of the same national issues for Ostara – not as much overlap for those services as we’d like. Eleven resources are included and over 20 are mentioned briefly. A Google map of these resources is here: LGBTQ+ Perinatal Resources in Charlottesville, VA 

• Support groups & mental health

  • Postpartum Support International & Postpartum Support Virginia

  • Women’s Initiative

• Chestfeeding

  • La Leche League of Charlottesville & Share the Drop

  • University of Virginia Breastfeeding Medicine Clinic

• Fertility and birth support

  • Virginia Fertility & IVF

  • Common Grounds Healing Arts - Nearby Baby

• Mindfulness 

  • Ashtanga Yoga

• Community

  • Charlottesville First United Methodist Church

  • Trinity Episcopal Church

  • A Beautiful Idea

• Addiction

  • On Our Own

Support Groups and Mental Health

Postpartum Support International & Postpartum Support Virginia

Postpartum Support International (PSI) is an international non-profit organization focused on advocacy and support services for all perinatal persons and families. Postpartum Support Virginia (PSVa) is a partner, Virginia-based non-profit that has similar support for perinatal families. PSI offers several virtual support groups. While any person is welcome to join most support groups, they also offer identity-specific groups, such as neurodivergent parents, dads, loss, fertility struggles, BIPOC, Spanish-speaking, and Queer & Trans Parent Support. Groups require registration but are free with a simple form to register. Most groups meet weekly. The LGBTQ+ focused group caps at 16 participants, this is likely a limitation for all groups, but given this is the only group specifically targeting Ostara this detail is important to note. 

In addition to support groups, PSI and PSVa both offer care coordination and warmline support. Warmline support allows parents to call in with non-emergency concerns and a trained PMAD survivor volunteer will be available to listen and transfer for care coordination as needed. In addition to a static provider directory on both websites, care coordinators do the leg work to contact mental health providers, lactation consultants, etc on behalf of the parent in need. Care coordinators get an appointment slot for the parent and have a certain time to accept it. Care coordinators validate insurance/pay compatibility, affirmative care compatibility, trauma-specific needs, and more based on conversations with the parent. 

PSI and PSVa also provide peer mentorship to parents. PSVa are all in the state of VA and may or may not be geographically close enough to meet in-person/online. Typically PSI mentors/mentees are from across the country. Again, matching with a trained peer mentor also takes into consideration preferences for identity and availability factors. There are currently queer peer mentors in the program, but no trans mentors as of yet. This could be an excellent growth and healing opportunity for Ostara after overcoming the perinatal phase of life.

PSVa also provides in-person support groups across Virginia. In Charlottesville, there is one group that currently meets at Sentara Martha Jefferson Outpatient Center and is coordinated by Sentara staff. PSVa also offers microgrants to parents up to $500 for mental health support.

All services by PSI and PSVa are free with no requirements on income, etc. PSI and PSVa have services available in Spanish and English, however, the National Maternal Mental Health Hotline has translators available in over 60 languages; these groups are closely partnered and can provide a variety of support to many different language-speakers. 

The Women’s Initiative

The Women’s Initiative (TWI) is dedicated to improving the mental health of all women, and they are welcoming and affirming to Ostara as well. TWI’s LGBTQ+ program coordinator confirmed while the LGBTQ+ programming is open to anyone in the community, it does focus on people who are not cis-gendered men. Nonbinary and trans men are welcome, in addition to anyone identifying as “woman.” This does not serve all of Ostara.

TWI provides a vast array of support for people. They have a walk-in clinic, individual counseling, group counseling, support groups, creative arts groups, several Spanish-speaking groups (though currently there are no Spanish-speaking LGBTQ+ focused groups), several BIPOC-focused groups including yoga and meditation, education groups and events, and mindfulness and movement activities. They also partner with many local organizations to provide even more support. The staff is predominantly counselors and social workers. 

All services through TWI are either free or low-cost. The staff is also racially and ethnically diverse, which can be important for someone to feel seen and heard. 

Importantly for Ostara, TWI has an LGBTQ+ program coordinator and currently hosts multiple groups for that community. While none of them are specifically geared toward parents, these groups may still be beneficial to Ostara. They have a weekly Trans Women group that is open to all trans women 18yo+. From speaking with a staff member these groups can get large, the last one being ~20 people. 

TWI is fully wheelchair accessible and offers some virtual options. The main building is located on the north end of town. Their parking lot is decent size with adequate parking and there is also plenty of street parking nearby. It is also 138 ft from a bus stop.

Additional Notes

Region 10 is a local community services board and in conjunction with Common Grounds Healing Arts (CGHA), they host a variety of groups for Ostara. The Blue Ridge Center location has plenty of parking and is next to a bus stop. The weekly LGBTQ+ support group (not perinatal-focused) meets in this building and is open to visitors. This location also hosts yoga classes and other offerings from CGHA.

Chestfeeding

La Leche League of Charlottesville & Share The Drop

La Leche League (LLL) has now made shifts to “require” inclusivity of all LGBTQ+ parents. However, not all localities will exhibit the same level of affirmation. Fortunately, the Charlottesville LLL is a welcoming and affirming community. 

Ostara should know that LLL was founded as an anti-feminist movement to encourage women to be stay-at-home mothers. They should also know that it has only allowed transgender fathers to lead groups for ~10 years after denying the application from advocate, Trevor MacDonald. Additionally, there are known incidents of LLL leaders exhibiting dogmatic adherence to “breast is best”, even in the face of intense hardship due to a parent’s effort to chest feed.

Present-day La Leche League is devoted to supporting and advocating for chestfeeding for all parents. Local LLL leaders are all gender-affirming and they are comprised of a variety of racial identities. They do not have consistent second-language staff, as all leaders are volunteers.

The location of LLL meetings occasionally changes, but meetings are currently held both virtual and bi-weekly in-person at Westminster Presbyterian Church near the University of Virginia. Westminster is ⅓-mile from the nearest city bus stop and has a large parking lot as well as plentiful street parking. The building is wheelchair accessible.

LLL meetings are free to attend and they also have a warmline where Ostara can call in and get quick advice regarding chestfeeding support.

Share the Drop is an app that seamlessly connects parents who would like to utilize human milk but are not able to produce or practice chestfeeding themselves. It is founded by a social justice advocate who has experience in food insecurity advocacy, a long career as a doula and perinatal yoga instructor, and is an avid supporter of inclusivity and affirmation for all persons. 

University of Virginia Breastfeeding Medicine Clinic

The Breastfeeding Medicine Clinic at the University of Virginia Health System (UVA) is led by Dr. Ann Kellams. Dr. Kellams works closely with UVA’s Dr. Catherine Casey, a family medicine doctor who is passionate about caring for LGBTQ+ individuals and also works in the Family Medicine and Specialty Care Crozet Clinic at UVA. That clinic provides hormone therapy, gynecology, mental health support, voice therapy, and gender-confirmation surgery. Both Dr. Kellams and Dr. Casey are avid supporters and very affirming of Ostara. Dr. Kellams and her lactation support team are very supportive and affirming of all LGBTQ+ individuals, including trans women and trans men. While the clinic has “Breastfeeding” in the title, it has been confirmed by multiple members of the LGBTQ+ community that it is an affirming space nonetheless. 

Ostara should know that UVA is a large complex. The Family Medicine clinic mentioned above is a 20-minute drive from Charlottesville and does not have public transit access. However, the Breastfeeding Medicine Clinic is located in UVA’s new Battle Building, with ample garage or valet parking. It is 0.2 miles from the nearest bus stop and both clinics are wheelchair-accessible. UVA accepts all insurance and Medicaid. It should also be noted that UVA’s billing methods are confusing for clients and patients are often sent multiple bills for the same service, broken out by lab space, provider, and by clinic. If Ostara is daunted by such cumbersome billing and paperwork it would be prudent to offer support and either advocate for Ostara or encourage them to speak with an advocate in the hospital system. The Breastfeeding Medicine Clinic also offers virtual appointments for chestfeeding support.

Ostara should know that UVA Health is tied to UVA, which was founded by Thomas Jefferson. Jefferson enslaved many people and fathered several children from at least one enslaved woman, Sally Hemings. While Jefferson freed Sally Hemings and her children upon his death, it does not make up for the atrocities committed both in his estate and in the building of UVA. UVA has taken measures to paying tribute to enslaved laborers, such as building a memorial for enslaved laborers of UVA. However, many BIPOC folks in Charlottesville are vehemently opposed to anything related to UVA. This should be taken into consideration when making recommendations to Ostara.

Other Not Highlighted Chestfeeding Options

Milk & Cradle is a local lactation consultant and doula that offers very affordable lactation services (sometimes half the cost of other providers). She has experience working with and is affirming of Ostara. She is also a Birth Sister with the Birth Sisters of Charlottesville (a BIPOC doula collective in Charlottesville that will be further discussed later). 

Flow Lactation is a boutique lactation consultant that accepts insurance and private pay. She has taken additional training to support Ostara folks with chestfeeding concerns. 

It should also be noted that Sentara Hospital accepts Medicaid and all insurance for lactation consultations. That said, their ability to be affirming is questionable and so they were not featured. The Sentara lactation consultant interviewed had undergone both mandatory LGBTQ+ affirming training and additional continuing education on the topic. However, when asked about “chestfeeding” as an alternative term to “breastfeeding”, she seemed unaware of its gendered implications and the necessity for gender-inclusive terminology. She mentioned that Sentara hadn’t encountered any trans men giving birth there, suggesting they likely opted for UVA due to her perceived high-risk factors of such a birth. Sentara is also Martha Jefferson Hospital, named after Thomas Jefferson’s daughter, and Sentara Health System was originally formed as a Christian hospital – this may be challenging to some Ostara folks. If Ostara utilizes Sentara then they may need additional alternative supports to counteract any microaggressions or discrimination they may face.

Fertility & Birth Support

Virginia Fertility & IVF

Virginia Fertility & IVF (VF) is a local fertility clinic that supports all people with a variety of reproductive technology tools. Any Assisted Reproductive Technology (ART) is expensive, and VF is a well. They do accept insurance, have plans for Military families, and have several loan and payment plan options featured on their site. Pricing for treatments is listed on their site where possible. VF does not openly advertise this, but personal communication with a past client indicated that VF coordinates and supports the donation of unused fertilized embryos from one family to another with no charge for the embryo. 

VF has a webpage dedicated to LGBTQ Family Building, in which they outline a variety of modalities, including Reciprocal IVF. This is significant because in research Ostara typically had to explain their reasoning for wanting Reciprocal IVF. Given that VF has called this out is a good sign. While the author has been unable to get a thorough review from an Ostara client, multiple families have indicated that this was a very welcoming space. One past client gave the example of seeing two burley men coming to ask about a maintenance item and were greeted the same as any other person walking in and were asked if they were here to check in, and who they were scheduled to see. 

Ostara should know that ART has had a long history of being used to cause harm to persons with disabilities – this should be considered when making recommendations to Ostara. The building itself is wheelchair accessible and is on one level even with the sidewalk and parking lot. There is plentiful parking available at VF and it is 0.5 miles from the nearest bus stop. 

VF also collaborates with a local mom’s coaching group, Mother Tree Wellness, to offer support groups to their clients experiencing fertility struggles. The author has been unable to confirm if these support groups are adequately affirming for all Ostara.

Common Grounds Healing Arts - Nearby Baby

Common Grounds Healing Arts (CGHA) is a fabulous community resource that has recently shifted its support. They have over 12 recurring offerings ranging from inexpensive acupuncture, yoga, massage, meditation, sound bath, Qi Gong, support groups, and more. Ostara should know that there is not one central location for all of these offerings, they are scattered across 6 in-person locations, as well as virtual, with many at the Region 10 Blue Ridge Center off Elliot Avenue.

The pricing structure for each service varies with provider, though some are free and others are offered at a reduced cost. This may further add to confusion when seeking support from CGHA.

It should also be noted that there is a local coffee shop named “Common Grounds” that should not be confused with CGHA. The physical location of CGHA is in the Jefferson School City Center, but it is unclear if clients can visit without an appointment. Again, the “Jefferson” is a tribute to Thomas Jefferson and may be challenging to some BIPOC Ostara folks.

Most notable for Ostara is Nearby Baby. Nearby Baby was previously a standalone nonprofit providing pay-as-you-can postpartum doula care to families in a variety of languages. CGHA & Birth Sisters of Charlottesville have recently taken over this mission. As a component of CGHA now, the Nearby Baby program is also able to incorporate postpartum doula care with various somatic, craniosacral, and other bodywork supports. 

Postpartum doula care has been shown to drastically improve parent’s self-efficacy, mental health, and well-being of all family members. Ostara should know that the postpartum doulas are all independent contractors and thus may be affirming or not to varying degrees. That said, the Nearby Baby postpartum doula training has a week of training dedicated to supporting LGBTQ+ clients. Most of the doulas would be affirming and many are members of the LGBTQ+ community themselves. However, it would be important for Ostara to disclose their concerns in reaching out for support from Nearby Baby.

Other Birth Supports

Like many supports in Charlottesville, there are a wide array of potential supports. I’ve highlighted just a few here. Bright Birthing is a local doula group with average pricing. They do not take insurance, nor Medicaid, but do offer reasonable pricing. The doulas are all affirming and dedicated to inclusivity for all.

Birth Sisters of Charlottesville is a collective of BIPOC doulas (aka “birth sisters”) serving Charlottesville’s BIPOC birthing population. While the birth sisters this author has spoken to are open to working with Ostara, they acknowledged that they would further educate themselves if they worked with a childbearing trans father as they would be worried about causing harm due to their lack of knowledge. They are a generally supportive group and have happily worked with lesbian persons and other LGBTQ+ folks in the past, but have not yet pursued robust training for that population. The Rock House where they are located is typically staffed and available for folks to simply visit and be in the space. They host yoga, meditation, massage, education, lactation, and other types of events and groups. Birthing persons who qualify for Medicaid are served at no cost, there is a deep sliding scale, and no parent pays more than $500 for birth doula support. They are funded by many organizations, including the Department of Health, UVA, and Sentara hospitals. Birth Sisters has also taken on some of the postpartum doula services previously offered by Nearby Baby.

Additionally, Planned Parenthood is a very welcoming space in Charlottesville to Ostara and supports trans folks with hormone therapy as well as infertility or other reproductive concerns. They are quite a ways from downtown Charlottesville, but have plenty of parking, wheelchair-accessible entrance, and are near a bus stop. It’s important to note that Planned Parenthood was founded by two sisters interested in eugenics.

Yoga and Mindfulness

Ashtanga Yoga

Ashtanga Yoga is a local yoga studio that prioritizes mindfulness and offers inexpensive practice. This breathwork and movement yoga would be a great resource for Ostara. The staff at Ashtanga are an affirming and supportive group.  

Ashtanga’s rates are half those of other local studios. Even with these reduced rates, Ashtanga offers a variety of ways to further reduce costs if it is a barrier for folks. 

Ashtanga also offers prenatal and postpartum yoga classes. The instructor for these classes is a doula, midwife, and founder of the Virginia Prison Birth Project, working towards improved birth outcomes for incarcerated women across Virginia. 

Ashtanga is dedicated to dispelling the myth that yoga is for a certain type of body or person. All body types and abilities are welcomed at Ashtanga. That said, it’s important to note that the studio is at the top of a fairly narrow staircase and the old building does not have a wheelchair-accessible entrance. It may also be challenging for people with other types of physical disabilities to get into the studio. Virtual classes are available, but that is not a viable option for everyone. 

The studio is located in the Belmont neighborhood. Parking may be challenging at Ashtanga. There is a very small parking lot next door and limited street parking. The surrounding blocks have a lot of street parking, but it would not be uncommon to have to walk multiple blocks over as there are more businesses than parking available in that area. It is 0.8 miles away from the nearest bust stop.

Ashtanga also has guided chants available anytime on their website. Chanting and singing are known somatic practices that benefit well-being.

Other Mindfulness Options

One alternative would be NOW Yoga Cville. Their studio is located near downtown on the same level as the parking lot. They are an affirming space but are double the cost of Ashtanga. That said, they do offer financial assistance if needed. 

Additionally, Benita Mayo is a local Trauma Center Trauma Sensitive Yoga (TCTSY) instructor. She provides 1:1 or small-group TCTSY to individuals of any identity and is gender-affirming. She practices out of her studio at the McGuffey Art Center and has a sliding scale with a commitment not to turn anyone away based on ability to pay. McGuffey is 0.2 miles from the nearest bus stop and has a wheelchair-accessible entrance. 

Lastly, Riverbend Integrative Trauma Treatment (RITT) offers Yoga Therapy for Trauma Recovery groups. These are closed groups that open at various points throughout the year. All forms of payment are accepted and there is also a sliding scale. RITT is dedicated to the inclusivity of all identities. They are located on Pantops, with a large parking lot, and 0.7 miles from the nearest bus stop. The facility is wheelchair-accessible.

Faith Communities

Charlottesville First United Methodist Church

Charlottesville First United Methodist Church (CFUMC) is one of several churches in Charlottesville that are openly and explicitly affirming of Ostara. Some staff members are part of the LGBTQ+ community, they have a strong social justice mission, support unhoused populations in Charlottesville, and address food insecurity, LGBTQ+ rights, racial inequity, and more. They also have a parent’s group that meets every week after worship services with childcare provided. This group rotates between book-club focus and random meetup focus. Chestfeeding space is also provided where the sermon can still be heard and they offer childcare during the worship service. There are also various bible studies and other small groups that meet at the church. While CFUMC is extremely affirming, the United Methodist Church does not officially accept practicing LGBTQ+ community members for ordination.

Ostara should know that when the author attended a worship service at CFUMC church the congregation was nearly all White and all staff were White. Unfortunately, most of the overtly LGBTQ+ churches faced this same problem with most of the staff lists showing nearly all-White staff, except for sexton positions (similar to a custodian). This poses obvious optic issues regarding racial diversity and imbalances of power. 

CFUMC is fully wheelchair accessible via the parking lot entrance and a short elevator to the sanctuary and elevators to other levels. 

CFUMC is 0.1 miles from a bus stop, is surrounded by free street parking, and has a small parking lot. Worship services are also broadcast over Zoom.

Ostara should know that CFUMC is situated facing Market Street Park, which was the site of violent alt-right domestic terrorist gatherings in 2017. Market Street Park was previously known as Robert E. Lee Park and was formed around a statue of the Confederate general. CFUMC is also situated near Congregation Beth Israel, which has also been threatened by violent domestic terrorists. Ostara may not feel comfortable attending a church with such proximity. 

Trinity Episcopal Church

Trinity Episcopal Church is a historically Black church with a large BIPOC population. The Episcopal Church was one of the earliest denominations to allow ordination of openly practicing LGBTQ+ persons. That said, the church website had only a small mention of inclusivity in the letter from the rector; there was no public proclamation of LGBTQ+ inclusivity on the website, nor at the physical location. After not getting an answer via the phone, the author emailed the rector, who confirmed that Trinity is a welcoming place for Ostara and that some staff are members of the LGBTQ+ community. 

Trinity has children’s programming during church services, but there are no other activities with childcare. There are various small groups throughout the week, but not catered to parents.

Trinity has a social justice focus and targets food insecurity. Trinity also leases their commercial kitchen to local healthy-food businesses for reduced rates as part of their larger ministry to address food insecurity and equity.

There is also a weekly virtual Centering Prayer group. Centering Prayer is a form of silent, meditative prayer. 

Trinity is next to Washington Park (a park in which celebrations of Black culture and community often take place) and 300 feet from a bus stop. There is a small parking lot and very limited street parking. Some congregants park at the lower parking lot of Washington Park, but that lot is also limited. The building is fully wheelchair accessible. 

Other Faith Communities

There are several LGBTQ+ affirming faith communities in Charlottesville, all were not included above here mainly for space. A few of particular note are the Wesley Memorial United Methodist Church, Sojourner’s United Church of Christ, Unitarian Universalist Congregation of Charlottesville, Church of the Good Shepherd Episcopal Church (south of town on 29 S; not to be confused with the Good Shepherd in the Music Resource Center downtown), and Charlottesville Friends Quakers Meetings.

Supportive Community

A Beautiful Idea

A Beautiful Idea is a 4-owner retail store on the downtown mall. “The Beautiful Idea is a trans-owned antifascist bookstore, queer makers’ market, alternative event space, and radical community hub.” The store hosts pop-up events for LGBTQ+ artists, has Narcan and harm reduction supplies available, has an antifascist book club, has a small sex-positive shop of sex toys, and a small meeting space in the back of the shop. 

It should be noted that while the shop does not have a long stairway, there is an elevated stoop at the entrance that may be challenging for someone in a wheelchair. That said, it is highly likely that the staff or other customers would make themselves available to support. Being on the downtown mall, there is nearby parking, but customers would likely need to walk a block or more from limited street parking or a nearby garage. The nearest bus stop is 500 feet. In addition, they also support food insecurity and have a strong BIPOC focus in the shop as well. 

This community has books about Ostara but does not have events or gatherings specific to that group. Activism is a prominent theme in the shop. Many customers are friends and family of LGBTQ+ folks seeking to educate themselves to reduce harm. A Beautiful Idea is included here because simply being in the shop could contribute to a sense of belonging and community. Even though events are not geared directly towards the perinatal time of life, this can still provide comfort and support to Ostara, particularly if they are facing microaggressions in their daily lives.

Other Local Confirmed Safe Spaces and Notes

It is not surprising that there are plenty of affirming places in Charlottesville, but it is also true that there remain some places that are not safe spaces for Ostara. Therefore, I am including a short list of local businesses that are known to be inclusive and host local Ostara-related meetups. Blue Moon Diner is a less-obvious safe space, offering diner-style food in midtown. Umma’s Korean and Firefly Restaurant are also safe spaces that regularly host LGBTQ+ meetups. Visible Records is an art gallery near the Belmont neighborhood, committed to diversity, equity, and socioeconomic support. 

The organization PFLAG Greater Charlottesville was not included as a standalone resource. It appears to exist, but different versions of the webpage exist and the activity on social media makes it unclear if they are active. The author attempted to reach out to the organization but was unable to get a response. That said, several of the supports listed in this document are indicated as being put on “in partnership with PFLAG”. 

Addiction

While addiction and recovery were not prominent in the research, I am including resources briefly here based on anecdotal evidence of the need for affirming support. There is an active AA, NA, and Al-Anon community in Charlottesville. Those meetings range in inclusivity, but the Monday 8 pm Al-Anon meeting is an affirming group of folks. 

Also, Region 10 (mentioned above) partners with Project Link to offer a prenatal group for pregnant persons struggling with a substance use disorder. That said, the author was unable to confirm if this would be an affirming place for Ostara.

On Our Own

On Our Own is a local recovery group consisting solely of peer support, with many being certified peer support specialists. A small staff and volunteers run the various activities. It should be noted that when trying to reach out the author was unable to reach a person. That said, many of the groups have links posted on their website or in-person meeting times listed. This includes their weekly virtual peer support group “open to any LGBTQIA+ adult (18+) experiencing challenges with mental health, substance use disorder, or trauma.” 

They have over 21 groups meeting weekly that range from goals groups, SMART recovery support, knitting, artistic, music, and meditation groups. All groups are free and do not require advanced planning or registration to join.   

In addition to support groups, they have donated food available both ready-to-eat and to-take. On Our Own also has Narcan available, and supports persons experiencing homelessness or in moving out of homelessness. 

The building is historically significant in that a Black doctor owned it and was an early home of a Black doula collective. Johnson House is now home to On Our Own, but has maintained homage to the heritage and is committed to supporting racial diversity. The author was unable to confirm if there was a different wheelchair-accessible entrance, but the front entrance has a series of 4 wide steps from the sidewalk. There is limited street parking nearby, and a garage at the nearby Jefferson City School Center 0.1 miles away.