Sunday, 25 March 2012

Yoga for Breastfeeding

My pregant belly bulged during a headstand
I practiced yoga throughout my pregnancy, including headstand.
Half-moon: balancing on one leg and reaching up while pregnant.
Half-moon pose helped alleviate back pain as well as nausea.
Did you know that yoga can have a beneficial impact on breastfeeding? While tight or ill-fitting bras (not that as a post-surgery transgender man I have anything to do with those, ha!) can damage breast tissue and inhibit the flow of milk, yoga can improve circulation in the chest and help the body to produce more milk. At least Diana West says so anecdotally in her book Making More Milk, and so does Geeta Iyengar in her impressive, enormous, virtually biblical, Iyengar Yoga for Motherhood - from personal experience, I agree with them both. I finally went again to a yoga class this week after an absence of almost a year (time well spent constantly breastfeeding Jacob - I just never felt like leaving him for long enough to go to a class).

I am far from an expert, but I did practice Iyengar Yoga for a few years before having Jacob. The Iyengar method is careful, thoughtful, and thorough. Geeta's book includes meticulous descriptions of poses to be done, and not to be done, in each trimester. Some sequences are said to alleviate pregnancy-related headaches, others are for treating nausea, others for dizziness, still others counteract high blood pressure. And, again in my personal experience, they work.

I began my yoga studies before I transitioned. I wanted to try a different physical activity in my new hometown of Winnipeg that I could do completely away from my new work colleagues. At the end of my second class I left the Yoga North studio only to see a man from my job, whose face was only vaguely familiar to me, rushing in just in time for the next session. Ugh! I came here to get away from you, I thought. Then I married him three years later. But that's a story for another time.

I kept going to the yoga studio despite Ian's presence there. At the end of my first year, I was ready to transition to male. I thought about quitting yoga - I wasn't sure I'd be at home in either the men's or the women's change room. A large and varying population of clients attend the studio, some of whom I know reasonably well and some I don't. I talked to the instructor, Drew, about my plan to transition, and he didn't see any problem at all. He didn't want me to stop attending class and said I should simply use the men's change room. He told the other instructors about my situation so that no one would be confused. When a number of my fellow students learned of my decision, they gave me a congratulatory card and a fancy razor, an incredibly kind though useless gesture since I maintained a terrible scruffiness and pretty much never shaved (and still don't). I felt completely welcome.

A few years later, in my second trimester of pregnancy, my back and hips started to ache. I didn't go to yoga because this time I really didn't believe there was any way I could stomach being seen in my unusual (for a man, anyway) state by the other students who ranged from friends and acquaintances to complete strangers. Ian mentioned my shyness to Drew, who immediately came up with a plan to teach me one on one. In the months that followed we worked together once a week right up until Jacob was born.

I am certain that these classes saved me from much discomfort during the pregnancy and helped me get through the hard work of a long labour. They also put more food in Jacob's belly. I worked with another instructor, Lisa, on creating space and lift in my chest. In addition to being an experienced teacher who has studied frequently in India with the Iyengar family, Lisa has practiced yoga through two of her own pregnancies. On days that I worked with her, I was able to express twice as much colostrum as usual. I diligently saved the precious liquid in syringes and stored it in the freezer in anticipation of Jacob's birth, fully aware that milk production would be an issue for me due to my chest surgery. Thank you Geeta, Lisa, and Drew for helping me to feed my baby in his early days some of the best food in the world.

Saturday, 24 March 2012

Newborn Bliss All Over Again

A few days ago I enjoyed a most powerful deja vu with a teeny tiny baby. I can still see her little mouth gaping wide open searching for my nipple as she tries again and again to latch. Her hands make tight fists that press into my chest, pushing herself away from my nipple, and away from what she wants so desperately - the food source. Not having much, if any, breast tissue to accommodate her limbs, I gently move her arms out of the way to bring her lips in contact with my nipple. In hunger, she puts her finger in her mouth at the same time as my nipple. Again, I move her hand out of the way. Absolutely everything in her life is about wanting to suckle and swallow.
I nursed Lila using a supplementer.
Lila doesn't care that I'm transgender - she just wants to breastfeed.
And then I feel her finally grab hold and not let go. The pull of her lips is strong and determined, yet precarious. I don't dare move my arms for fear of unlatching her. I hear her rhythmic, satisfied gulping and know that I am the centre of her universe. Nothing can distract her from her desire to breastfeed. She doesn't know or care that I'm a transgender guy using a supplemental nursing system and donated breast milk. I share in her bliss.

Then my back starts to ache from the stiffness of my pose. I look at the clock and see that forty-five minutes have gone by and she's only taken an ounce or two. Those newborns take forever to eat! She sleeps for a brief few minutes and then is ready to nurse yet again. Now I remember the sheer exhaustion of the early weeks. Still, my day spent with this seven-week-old was a gift.

My friend had called us around 10am that morning to say that she was feeling very ill. Ian picked her up and brought her to the hospital. He took her infant, Lila, and toddler, Samuel, to our home where I was entertaining a number of friends and their babies. It turned out that the poor sick mom had appendicitis and would spend that night and the following day in the hospital.

First we tried to bottlefeed our tiny charge, but she choked and gagged on the fast-flowing milk. Then my friend Emily attempted to finger-feed her with an SNS tube - sometimes it worked, other times the milk wouldn't flow at all.

In the afternoon, Ian walked Lila over to the hospital to be nursed by her mother in the emergency waiting room. He suggested that I could breastfed Lila the next time around, and my friend agreed. So, a few hours later, after a failed attempt at finger-feeding, I did what was easiest for everyone and nursed the babe.

Breastfeeding Lila was beautiful and joyful, and also brought up some anxiety for me. I have so little breast tissue that latching on a baby takes tremendous focus and determination from both parties involved. Today I am suddenly in awe of myself for having done it, day in, day out, and never, ever giving in to a single bottle feeding when Jacob was little. And I got a good reminder this week of WHY I did it: even with all my specific challenges, nursing was obviously a happier and more comforting experience to Lila, who surely must have been missing her mother.

My own Jacob is almost a year old, and I breastfeed him with ease. He crawls into my lap, pulls my usually open, button-down shirt out of the way, and latches on by himself whenever he wants. If he seems tired, or upset, or out of sorts, or even if I'm just sick of running after him and badly want to sit down for a few minutes, I get out the SNS and nurse him. I wish that more people knew about the pleasures of nursing an older baby or toddler. Gone is all that intensity and effort of feeding a newborn, and what is left, for us anyway, is a comforting, easy relationship.

After my friend received her diagnosis and a surgery was planned for later in the evening, her husband came over to pick up their kids. Lila was full and fast asleep, and Samuel, the toddler, grinned from ear to ear at the sight of his Dad. We were thanked profusely, but in all honesty I just about feel guilty: I got to nurse a precious, heart-melting seven-week-old baby and hang around with her sweet, surprisingly helpful toddling brother while their Mom was dealing with a ton of pain. I'm pretty sure I got the long end of the stick on that one.

Sunday, 18 March 2012

Time to Breastfeed Outdoors Again

I shoveled snow while wearing Jacob in a carrier under my coat
Baby's first winter presented special challenges..
All winter long in our frigid city I've been timing my walks with Jacob and my dog ever so carefully. I make sure the baby is well fed just before I start out, and I never walk for more than an hour. Usually Jacob falls asleep, snuggled comfortably against my chest in a cloth carrier and wrapped in a massive winter coat that fits around both of us. Bringing along donated breast milk and feeding using the supplemental nursing system just isn't practical in minus twenty. Thankfully I've only rarely misjudged our outings and had to rush home with a hungry, crying baby a very few times.

These last few days it's been warm enough to sit down and nurse leisurely outside again. Yesterday Jacob and I spent the afternoon in our yard looking at butterflies, cuddling, and breastfeeding as desired. We live in the middle of the city, in between one neighbour who refuses to speak to us, and a family on our other side who is just thrilled with Jacob. At first I was a little self-conscious to open my shirt outside once again after a whole winter spent bundled up, but then I felt the warm sun on my back and smelled the grass beginning to dry out, and knew that my son, too, should enjoy all this - and why not while he ate?

Of course there are reasonable limits to where I'll nurse this summer, the same as last. I won't breastfeed Jacob on an isolated park bench with, say, just a few strangers nearby. I won't nurse him down by the river where the drunks reside. But I will breastfeed my baby anywhere that I think it is physically safe to do so - at the beach with other families around, at the Winnipeg Folk Festival, in my own back yard, at the playground... If others don't like it, they can shut their eyes and listen to the birds, smell the leaves in the trees, and feel the wind in their hair. That ought to be enough for anyone.

I'm nursing in the audience at a horse show
Last September I nursed Jacob at Calgary's Spruce Meadows while watching Team Canada take its victory lap. The crowd was far too busy enjoying the horses to care that we might have been doing anything out of the ordinary.

Friday, 16 March 2012

Privacy

Blackd out writing in a document
Some have wondered why the names on this blog have been changed, and, well, the answer is MY SON! I have made the choice to be a queer, breastfeeding activist - I am not only comfortable with this, I love it. It is my passion. My child, however, must be allowed to make his own decisions regarding how open he wants to be about his life. I don't want my writing to follow him around wherever he goes. For now and for many years to come, he will simply be a boy with two loving parents. I believe this is his right.

All of our friends and family know that I am transgender and that I birthed our baby. They are all fine with it. We will try to raise our boy with honesty and integrity. He will grow up understanding where he came from, but we will also have to teach him to guard his own privacy in some situations for his own safety.

This blog is important to me because I hope it will help make the world a better place for our child, and others like him, to live in. Awareness of transgender lives increases every time someone puts him or herself out there in some way. Because Thomas Beatie discussed his transgender pregnancy on Oprah, some of my friends were already familiar with what we were up to when we announced our own pregnancy. And little by little it gets better, right?

Tuesday, 13 March 2012

Dear Paramedic: I'm Transgender!

toy firetruck
Last night I sat on the cold bumper of a fire truck parked in front of my house and told a young, dashing male paramedic surrounded by burly firefighters, "well, I'm transgender and I, uh, breastfeed my baby."

He didn't blink an eye. I guess he sees all sorts of strange people in strange situations all night long and he was just doing his job. I, however, was a little bewildered to find myself coming out in this fashion.

This weekend I had the flu, or maybe food poisoning, and I was still feeling nauseous last night. I was nursing Jacob in bed when our carbon monoxide detector went off. Ian opened the windows and doors and called police non-emergency but was told that he ought to dial 911. Could be deadly serious. We waited outside on our front steps and the fire truck pulled up within minutes.

Since carbon monoxide poisoning can resemble flu symptoms, the paramedic wanted to check me out while the firefighters went inside to measure the CO levels. He took my vitals and soon asked, "are you on any medications?"

"Yes, I take domperidone." This is a drug normally prescribed, ironically enough, for controlling nausea.

"And what do you take it for?"

"Um, well, I'm transgender, and I, uh, breastfeed my baby. Domperidone increases milk production..."

So my lovely paramedic got a mini-lesson in lactation - queer lactation, at that.

As it turned out, it was all a false alarm. The firefighters determined the house to be fine, and I must have just had the flu. Unfortunately Jacob is not yet at an age where he can appreciate a fire truck but all the commotion left him wide awake until 1:15am. We'll be replacing our CO detector today.

And while I'm on the subject of domperidone, Health Canada recently came out with a new warning against its use: http://www.cbc.ca/news/health/story/2012/03/08/domperidone-maleate-drug-.html

Breastfeeding expert Dr. Jack Newman had this to say about it on Facebook:
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"Based on a study that was published in Belgium which looked at over 1000 cases of sudden death and found that some of the people who died suddenly were taking domperidone, Health Canada has put out a warning about possible concerns about treating with domperidone. This is a bit of an overreaction on the part of Health Canada. Well, a big overreaction given the data.

"Note that in the study, the youngest person who died was 55 and the average age of those who died was 75 years. What has this to do with breastfeeding mothers who are rarely older than 45 years and are usually in reasonably good health? Furthermore, this information came from a data base with no clinical information. It simply has information that so and so died suddenly and was taking such and such a drug. The thing is that domperidone in these patients was used for reflux and we know that heart disease is frequently misdiagnosed as reflux; severe pain at the top of the abdomen or lower part of the chest is typical of both reflux and cardiac pain. Misdiagnosis is particularly possible in Europe where domperidone is available in countries like the United Kingdom, Belgium and the Netherlands without a prescription and it is likely that many people are self-diagnosing and self-medicating.

"So that's it and it does not mean that domperidone kills. I will continue to prescribe domperidone at our doses which are based on many years of clinical experience. I have treated many thousands of women with it with only minor side effects. I believe this article from Belgium proves nothing and does not require us to stop prescribing it.

"It would be a pity that mothers and babies not benefit from domperidone when used in conjunction with our Protocol to manage breastmilk intake."
Thanks for the insight, Jack! Although you might want to add "fathers" to the list of those who derive benefit from this drug.

Friday, 9 March 2012

Hormones!

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Many of us have heard before about the importance of hormones during childbirth and breastfeeding. Natural oxytocin, together with other hormones in a "love cocktail", can help you transcend the pain often associated with labour and then assist you in falling head over heels for, and breastfeeding, your baby. I am lucky enough to have had the pleasure of listening, live, to the renowned obstetrician Michel Odent speak in his lovely French accent about “ze luuuuuve coq-tail-uh”. It’s enough to make even the most prudish gay man swoon. You, too, can enjoy Mr. Odent by watching him on YouTube here.

portrait of Odent
Dr. Michel Odent

But my own hormones cause people a little confusion sometimes, so with this post I’ll attempt to clear things up. “How do you know that this is safe for your baby, what with all those hormones you’re taking?Number one most common misconception about a transgender pregnancy: people tend to assume that I continued to take testosterone while carrying the baby.

I can see how someone might think this. After all, my voice remained low, and I continued to grow facial hair, and these are (wonderfully for me) masculine traits. However, once testosterone thickened my vocal chords, ceasing injecting it into myself could never thin them. This is why male to female transsexuals often spend much time and energy learning how to speak in a higher-pitched, female voice – it is not easy to sound feminine once they have gone through a biologically male puberty (and, for the record, it's actually all way more complicated than I'm making it seem, so if you like you can read up on it here). Again, after testosterone use had developed new hair follicles on my face, nothing but electrolysis could permanently remove my beard, as female to male transsexuals unfortunately know all too well. As an aside, this is a large part of the argument in favour of providing transgender teens with hormone blockers to delay the onset of puberty – as a trans kid, once puberty hits, it’s like you’ve boarded a fast-moving express train with zero stops to a country you have no desire to visit. Oh, right, and there is NO train that can take you back unless you practically build the tracks (and train) yourself.

On the other hand, testosterone leaves the bloodstream and tissues within ten days, said my endocrinologist. We consulted with him about the idea of trying to conceive, and he paused for a few minutes, looking thoughtful. Then he said, “well, just stop taking the testosterone, and wait for your cycles to return to normal. When they do, you’ll know that you are ready to try. The eggs should still be there…. I can’t see any problem. If I think of anything else, I’ll get back to you.” He never did.

Within two weeks of my last testosterone injection, I got a period. My cycles were immediately regular, even to the time of day, but we waited through four or five of them before trying. We got pregnant on the first attempt, and the entire pregnancy was utterly normal and healthy, as is our child.

I haven’t started taking testosterone again yet because it would seriously inhibit the hormones that affect breastfeeding, plus we haven’t decided for the time being if we’d like to have more kids. Gotta learn how to take care of this 11 month old little ball of energy first!

Monday, 5 March 2012

Tips for Transgender Breastfeeders and Their Lactation Educators

 This information is free for personal use. Any trans folk are welcome to print it out and give a copy to their health care provider! However, if you wish to publish any part of it or quote this material in a presentation you must obtain formal permission. Thanks!

I'm not a health care professional and this blog entry does not constitute or replace medical advice. Please consult your doctor if you need medical advice. 

**** This blog post has been updated and now comes in three parts: 1) general information 2) assisting trans men 3) assisting trans women

Transgender/transsexual/genderfluid Tip Sheet General Information
Prepared by Trevor MacDonald

This tip sheet provides some key details you should be aware of when offering reproductive/lactation support to transgender, transsexual, or genderfluid individuals. Keep in mind that in most ways, medically and otherwise, trans people are just like everyone else. There is a list of key terms and their definitions at the end of this sheet. 

Gender vs. Sex

Our reproductive organs and sexual anatomy define our physical sex male, female, or intersex. Gender, however, is a person's inner awareness of their femininity/masculinity. Gender expression has to do with how an individual presents their gender to others within a given cultural context. For example, within western culture the colour pink has gone from being a traditional boys' colour to one for girls in only a few generations.

In most cases, a persons biological sex conforms to their gender and gender expression. The term for such people is cisgender. Transgender, transsexual, and genderfluid people have a gender identity or gender expression that does not match what their particular society expects of them according to their anatomy. Some trans people choose to use medical therapies such as hormone treatments and/or surgeries to alter their bodies. Others do not want or are unable to obtain such interventions, but may express their gender in other ways such as choices of clothing or makeup.

Gender Identity vs Sexual Orientation

A person's gender identity has to do with how they self-identify. Their sexual orientation refers to what kind of person they are sexually attracted to. A person can be trans and gay, or trans and straight, or trans and bisexual, etc.

Asking Questions

It may be essential to ask questions regarding an individual's gender identity or history of medical transition in order to provide adequate care. However, only ask those questions that are relevant. Do not ask questions solely out of curiosity.

Language

Always use the pronouns that refer to an individual's expressed gender, not their assigned birth sex. For example, a male-to-female transsexual woman is 'she'. If you are unsure of which pronouns a particular individual may prefer, simply ask in a respectful manner. If you make a mistake, apologize promptly and move on. Some people prefer gender-neutral pronouns, such as 'them' and 'they' or 'ze' and 'zir'.

The following terms are derogatory. Do not use: tranny, he-she, she-male, gender-bender, or transvestite.

Do not refer to someone 'masquerading', 'pretending', 'disguising', etc. in their gender.

Use transgender as an adjective, not a noun or verb.
            He is a transgender person, not "He is a transgender." (similar to how it is best           to say             "He is a black person", rather than "He is a black")
            A person is transgender, not transgendered. It is never necessary to add the suffix 'ed' to transgender.

Common terms

*Note that these definitions explain how the following terms are generally understood. However, individuals within the trans community may define them differently or may self-identify outside of these labels.

cisgender: someone whose gender identity matches their assigned birth sex (they are not transgender)

FtM: female-to-male trans person

MtF: male-to-female trans person

gender binary: The notion that there are two genders, male and female. Many trans people understand gender as a spectrum. 

gender expression: a person's outward presentation of their gender through physical traits, clothing, makeup, etc.

genderfluid/genderqueer: someone who identifies between or beyond the extremes of female and male on the gender spectrum, or who identifies as both female and male at once or as some combination of genders.

gender identity: a person's inner sense of their gender.

intersex: a condition in which an individual is born with reproductive and/or sexual anatomy that does not fit the usual male or female definition.

trans: an umbrella term meant to include transgender, transsexual and genderfluid people

transgender: a person whose gender identity or expression does not match the typical societal expectations of their birth-assigned gender. Transgender people may or may not wish to modify their bodies to varying degrees by taking hormones or having surgery.

transition: a change in one's public gender identity (one's inner gender identity may have been the same since birth).

transsexual: a person whose gender identity does not match their sex as it was assigned at birth. Transsexual people usually wish to modify their bodies in order to alleviate this incongruence.




Tip sheet for assisting trans men

Trans men are individuals who were born with anatomy typical of females but identify on the masculine side of the gender spectrum. Some choose to give birth and/or nurse their babies, and may require lactation support.

Language

Although both men and women have breast tissue, the word 'breast' is most often associated with women. Trans men may be more comfortable referring to their 'chest' and 'chestfeeding' or 'nursing' their infants, rather than 'breastfeeding'. Trans men may refer to themselves as 'dad', 'papa', or another term, rather than 'mom'. Don't make assumptions. Remember that if you are unsure, it is best to ask about which names and pronouns an individual prefers to be used. If you make a mistake, apologize promptly and move on.

Testosterone Use

Many, but not all, trans men choose to take testosterone. Testosterone normally causes the cessation of menstruation and ovulation, and brings about male secondary sex characteristics such as deepening of the voice, growth of facial hair, and male pattern baldness.

When a trans man stops taking testosterone, his cycles are likely to return after several weeks or months, depending on how long he took the medication and his own physical particularities. However, most of his male secondary sex characteristics will remain. For example, once testosterone has stimulated the growth of hair follicles in a person's face, those follicles will stay there and hair will keep growing unless extensive electrolysis treatments are undertaken (a common element of male-to-female individuals' transitions).

Although very rare, some trans men have been known to become pregnant accidentally while taking testosterone. Testosterone is highly toxic to the fetus and should never be used during pregnancy. However, because the body metabolizes and clears testosterone rapidly, it is considered safe to conceive within a few months of discontinuing most forms of testosterone therapy.

Testosterone use during the period of lactation would likely interfere with the hormones required to produce milk and achieve let-down.

Top Surgery

Some trans men choose to have male chest-contouring surgery, also known as 'top surgery'. This is different from a mastectomy (a cancer treatment), or a breast reduction, which is performed to make a smaller but still female chest. The goal of top surgery is to create a male-appearing chest. In order to do this some, but not all, of the client's mammary tissue is removed. Complete removal of the mammary tissue would result in a sunken chest shape.

The preferred surgical technique for top surgery is variable, depending on factors such as volume of tissue and skin elasticity of the client. The 'double incision' technique usually involves nipple grafts, and is not ideal for maintaining nipple sensation nor preserving milk ducts. The 'peri-areolar' approach, with incisions that go around the outer borders of the areolae, leaves the nipple stalks intact and likely has better results in terms of future breastfeeding and milk production.

Binding

A trans man who has not had top surgery may choose to bind his chest in order to flatten it, thereby managing his gender dysphoria. Many years of binding may adversely affect the glandular tissue. Binding during the immediate postpartum period will increase the risk of blocked ducts and mastitis and may damage the milk supply. However, some individuals have had success with occasional, careful binding once the milk supply is well established and regulated. Anyone who practices binding during the lactation period should be advised of the risks of doing so, and should monitor the health of their chest closely.

Chestfeeding Goals

Some trans men who give birth do not want to chestfeed at all, in some cases for reasons to do with mental health. Others do, and opt to postpone desired top surgery so that they will be able to produce a full milk supply. Others who have had top surgery may still wish to develop a nursing relationship and may do so using an at-chest (at-breast) supplementer.

Gender Dysphoria and Chestfeeding

Gender dysphoria occurs when an individual feels discomfort due to parts of their body that do not match their gender identity. Growth (or re-growth after top surgery) of chest tissue during pregnancy may bring up extreme feelings of gender dysphoria in some individuals, possibly causing anxiety or even depression. Chestfeeding can do the same. For this reason, deciding to chestfeed is a very personal choice.

Supporting the Decision NOT to Nurse

Support an individual who has chosen not to chestfeed by sharing how he can quickly reduce his milk supply after the birth. Explain the supply and demand system that governs lactation. Encourage the client to remove only as much milk as necessary to feel relatively comfortable, since removing more milk will cause the body to increase production. Cold compresses and cold cabbage leaves may help reduce pain and swelling. The parent should NOT bind at this time due to the increased risk of pain, blocked ducts, and mastitis. Several herbs such as sage, peppermint, and parsley are said to decrease milk supply.

Discuss the many other ways of bonding with baby, such as bed-sharing, babywearing, and loving, attentive feeding. You may wish to let the client know about the possibility of obtaining human milk through milk sharing sites such as Human Milk 4 Human Babies or Eats on Feets.

Supporting the Decision TO Nurse

Be respectful when providing hand-on care. As in most health care situations, ask permission before touching an individual's body, explaining what you are planning to do and why. If an individual is not comfortable being touched, find other ways to help, such as demonstrating on yourself.

Watch for signs of postpartum depression. Trans individuals may be particularly at risk due to struggling with gender dysphoria in addition to the usual challenges of giving birth and caring for a newborn.

When assisting those who wish to chestfeed after a previous top surgery, it is essential to remember that nursing a baby is not only about the milk. An individual who has had surgery may produce a surprising amount of milk, or only drops, or nothing at all. Any amount of milk is valuable. By using a supplementer, the parent and baby can gain the benefit of bonding through a nursing relationship even in the absence of milk production. In addition, the action of nursing helps promote the normal development of the jaws and teeth in the infant.

Latching may be challenging for the parent who has had previous top surgery due to a relative lack of pliable tissue and skin. The parent may need to learn how to vigorously mould the chest tissue (make a 'sandwich'). When providing assistance, be creative and expect to try many different grasps from varying angles in order to find what works.

A reclining position may unfortunately cause the chest tissue to become even more taut and difficult to latch to. In this case, football hold or cross cradle may be easier.

Support Meetings

Encourage the trans breastfeeding parent to attend group meetings and ensure that a safe and positive environment is provided. We know that peer support is an important predictor of a parent's success achieving their personal breastfeeding goals. Trans parents may already feel isolated, especially if they do not know other LGBT families. Group meetings can be tremendously beneficial.

Those facilitating the meeting should know the location of a men's washroom or gender neutral washroom near the meeting room. They should use gender-neutral language such as "breastfeeding parent" instead of "mother" when addressing the group.

Other Support and Resources

The community of trans individuals interested in birth and various infant feeding methods is growing fast. At this time, the only online support group is the Facebook-based Birthing and Breastfeeding Transmen and Allies, with over 500members worldwide. The group includes many interested and supportive lactation consultants and LLL Leaders.

Toronto's LGBT Parenting Network runs a weekend course once every few years for transmasculine individuals considering pregnancy.

Diana West's book, Defining Your Own Success: Breastfeeding After Reduction Surgery, contains information relevant to trans men who have had top surgery. Also see her web site, bfar.org.


Tip sheet for assisting trans women

Trans women are individuals who were born with anatomy typical of males but identify on the feminine side of the gender spectrum. Some trans women may wish to breastfeed their children via induced lactation and/or using a supplementer.

Inducing Lactation

Trans women may induce lactation by following the Newman-Goldfarb protocol. A physician would need to prescribe the appropriate medications. Birth control pills should be started about six months before the baby is expected or as soon as possible. Domperidone is also suggested in the protocol. 6-8 weeks before the birth, the birth control pills should be stopped, and the woman should begin pumping frequently to stimulate glandular tissue and to remove milk. The domperidone is normally continued for the duration of the lactation period.

A trans woman should discuss with a physician, such as a reproductive endocrinologist, what kind of hormone treatment is best to take during lactation. Unfortunately, there has been little to no research done in this area. Some trans women have successfully taken a decreased dose of their usual estrogen while lactating. Any medications, such as anti-androgens or estrogens, should be carefully considered for safety during lactation on an individual basis.

Expectations

Some trans women have induced lactation with impressive results, providing nearly a full supply to their babies. The amount of milk that is produced will depend somewhat on how many years the women used hormones prior to inducing lactation, and how fully her glandular tissue developed during that time. If the woman had implant surgery, she may encounter some difficulty with severed ducts, damaged nerves, compressed glandular tissue, and/or scarring.

As is the case with chestfeeding trans men, the amount of milk that is produced is not as important as the nursing relationship itself. An at-breast supplementer may be used to support a nursing relationship.

Support Meetings

Encourage the trans breastfeeding parent to attend group meetings and ensure a safe and positive environment is provided. We know that peer support is an important predictor of a parent's success achieving their personal breastfeeding goals. Trans parents may already feel isolated, especially if they do not know other LGBT families. Group meetings can be tremendously beneficial.

Resources and Further Information

"Trans Women and Breastfeeding: A Personal Interview" by Trevor MacDonald, available at http://www.milkjunkies.net/2013/05/trans-women-and-breastfeeding-personal.html.

"Trans Women and Breastfeeding: The Health Care Provider" by Trevor MacDonald, available at http://www.milkjunkies.net/2013/07/trans-women-and-breastfeeding-health.html

Facebook-based Birthing and Breastfeeding Transmen and Allies group welcomes trans women interested in nursing their infants.

Diana West's book, Defining Your Own Success: Breastfeeding After Reduction Surgery, contains information relevant to trans women who have had breast surgery. Also see her web site, bfar.org.

An All-Boy House

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My female dog digging in the snow
The only female member of our household.
Sometimes people have trouble understanding even the basics of our family, never mind the breastfeeding and milk sharing and everything else. A friend of mine overheard her four-year-old talking to her grandmother on the phone:

“This afternoon we’re going overto Trevor’s house… Trevor and his baby Jacob… No, it’s a boy house. Trevor, Jacob, and Ian… No, it’s all boys! [sounding more emphatic] Well except forQuinoa [our dog]…. Trevor, Jacob, and Ian!... Jacob is their baby!!"

Hopefully grandma figured it out in the end. Yep, guys can raise babies too. In our more audacious moments we even like to think we're pretty good at it.