14 May 2017

Jenna's Breastfeeding Journey: Trans Motherhood

Image: Mother in a purple shirt holding a baby over her shoulder. Quinn Dombrowski, Flickr Creative Commons.
Yes, trans women can breastfeed! I wrote about this before, when I interviewed Sarah* about her personal experience. In another post, I talked to health care providers Dr. Jack Newman, Marylynne Biener, IBCLC, and Diana West, IBCLC, about what we know so far when it comes to trans women and breastfeeding .

Continuing on with this series of posts, I recently interviewed another trans woman, Jenna. She talked to me about her experiences with breastfeeding and raising her two children, whom we’ll call S and A, with her partner, E.

I’m so grateful to Jenna for sharing her story on this blog. I believe it is deeply important to tell these stories so that others in the trans community who might be dreaming of being parents one day can access this information and know that they are not alone. Thank you, Jenna!

Banking Gametes

Seven years ago, Jenna knew she might someday want to have kids that were genetically related to her. She chose to store her genetic material before she began taking estrogen as part of her transition. I asked her if she had any tips about banking gametes.

Jenna: Think about where you’re going to store your sperm in terms of where you might eventually want to use it for insemination. I didn’t do the research. It wouldn’t have been very hard for me to reach out and ask lesbian parents – which clinics are the good clinics, where did you conceive your child? Instead I went by location and I just went to the closest sperm bank to my apartment at the time. It turned out that we picked one of the worst sperm banks in our city in terms of being queer-friendly.

When we tried to use the sperm we thought, well, it’s already there, we might as well use this clinic, but we had some really bad experiences. In the end, we packed up our sperm in liquid nitrogen and moved it to another clinic. It was a big difference, and it all started with where I chose to store my sperm.

Jenna explained that the first clinic she and her partner used was very male-dominated. Doctors and staff seemed uncomfortable with transgender people in general, and they misgendered Jenna. A doctor doing an insemination procedure for Jenna’s partner, E, didn’t make eye contact beforehand, and left the patient with the light on and equipment still between her legs when he exited the room afterwards. At the new clinic, there was a greater diversity of clients, more female staff, and a more respectful attitude on the part of the doctors.

Why Breastfeed?

Jenna: I always thought breastfeeding was an important connection to have with a child. Because I couldn’t carry the child, I thought it was going to be the next best thing. I’d seen many people have that connection through nursing. That felt like something I needed to do. I knew it was possible for trans women to breastfeed, but I didn’t know much about how to do it.

Preparing for Breastfeeding

Midwife Alanna Kibbe referred Jenna and E to the Newman Breastfeeding Clinic in Toronto to learn about inducing lactation and breastfeeding. She had referred transmasculine clients there in the past and knew the clinic was welcoming of LGBT families.

Jenna: My timeline was that I’d been on estrogen therapy for 14 months before I had bottom surgery. I had my operation and stopped producing testosterone, and then our first baby was born three months later. It was a whirlwind. I received my papers for my legal change of sex only weeks after our baby was born. I’m technically her father, and there’s no way the government will change that. So I’m legally our first child’s father, and our second child’s mother. 

Anyway, when I induced lactation, I was not producing testosterone. They put me on a protocol similar to adoptive mothers, which seems so obvious, but it wasn’t obvious to most other providers I’d talked to. It’s really not that big of a deal. It’s the same thing that other non-gestational mothers – cisgender females – would do to induce lactation .

About two months before the birth, I was put on high doses of progesterone in the form of birth control pills. Then I stopped taking the progesterone three weeks before the birth, and I began pumping. I pumped about three times a day, although I was supposed to do more than that according to the protocol for inducing lactation.

Jenna explained that her endocrinologist had prescribed only estrogen for her at the time of her transition, not progesterone. Her progesterone was prescribed later by the lactation professionals. Similar to Sarah*, the other trans woman I interviewed with regard to breastfeeding, Jenna wonders if the common regime of estrogen-only for trans women is an over-simplification of the endocrine system. She suspects there may be health benefits to taking progesterone, outside of lactation.

Breastfeeding the New Baby – Sharing Breastfeeding and Managing the Milk Supply

Since Jenna’s partner was giving birth and planning to breastfeed, the couple needed to coordinate breastfeeding together. Milk production works on the principle of supply and demand, meaning that as milk is removed from the body, the body receives the signal to produce more milk. If less milk is removed than what the baby is consuming (for example, if the baby is being given supplemental bottles or if another parent is breastfeeding the baby), then milk production will likely decrease. I asked Jenna how she and her partner worked with this.

Jenna: I didn’t produce a lot of milk. I knew from the pumping. I’d get a few tablespoons, or maybe an ounce at a time. But I was able to nurse. I nursed my baby for about six weeks. Lactation consultants were worried about how my nursing might affect my partner’s supply, but it turned out that my partner had an oversupply of milk . So it didn’t play much of a role in her nursing experience. I was producing pretty small quantities so for a while it felt more like I was a human pacifier than actually giving many nutrients to this baby.

We joked that the baby would drink all four boobs – she’d go through all four of them and still be hungry, or still appear hungry. It was convenient for both of us to be able to nurse. In the birth centre, the day she was born, I nursed her in the rocking chair while E was getting stitched up from the birth, which was a pretty nice co-parenting experience. My partner was able to let go of the baby and know that she was getting the skin-to-skin time and the nursing and everything while she had to get stitched up, which is a relatively common occurrence after birth.

We were both working a lot that summer on our farming business. So I would nurse the baby but E would still nurse every two hours. On a half-day shift, I’d bring the baby to E so she could nurse her, but then I’d also nurse her in the off hours as well.

My nursing experience was really tainted by the fact that my partner produced so very much milk. I feel like it would have been a different experience if we’d had twins or if my partner had a low milk supply, and if there was more of a need for my milk. It was a lot of work to maintain my milk supply. I wasn’t getting up and pumping in the night. I was nursing sometimes in the night, but not as regularly as E was, and E had milk literally pouring out of her. And it was like, well, I’m enjoying the experience, and I feel like I had the experience for the first six weeks, but it didn’t seem like it was going to be a long-term viable situation.

Latching Challenges

Jenna: I found it difficult to latch her because I have quite small breasts, and quite small nipples. I was always doing the sandwich technique and I was restricted to quite precise nursing positions. Whereas, E could lie on her side and the baby would nurse from her, and E really didn’t have to hold on to one of her breasts and pinch it to get a good latch. The only position that worked for me was sitting in a chair with one arm grasping the back of the baby’s head and neck and my other hand pinching my boob.

I think it would have been different if I had more tissue there. My breasts have grown significantly in the last year. It took me four to five years of hormone therapy until I felt like I saw some significant breast growth, which isn’t too big of a surprise. But I think all trans women want it to happen in the first month, the first year.

For me (Trevor), as a transmasculine person who had chest surgery before my children were born, I can relate to Jenna’s challenges with latching. I’ve never been able to nurse comfortably while lying on my side, even after six years of nursing babies. As my babies grew bigger and stronger, I eventually no longer had to make a “sandwich”  for them to latch, but I continue to need to hunch over a bit so that my chest tissue isn’t too taut.

Baby Number Two

I asked Jenna if she nursed her second baby as well.

Jenna: Almost not at all. She latched on one night when I was alone with her during a crying fit, and it really hurt. Because of my partner’s milk supply and with A being born at the height of farming season, it didn’t make much sense to nurse. I didn’t want to do the work. Even though I loved the experience with my first and I’ll cherish that forever, it wasn’t totally the experience I was looking for. Again, I think it was because of my partner’s over-production, and her strong desire to nurse, as well. It didn’t make much sense for me to change my hormone therapy, to spend the time pumping.

In the end, E didn’t take much maternity leave at all, and I spent most of the winter with the baby after farming season was over. I was on parental leave for nine months. Even now that she’s a toddler, and I’m still the one that’s here for her every night and every morning. I’m developing a different connection.

It’s rare that I spend a night away from these kids, which is good and bad. I’m hoping as they get older, it’ll be easier to get away from them a bit more. It’s clear that S really doesn’t like it when I’m not here. When she comes home from daycare and I’m not here, she doesn’t like it. That’s the connection I’m enjoying with her, and that I have with our second child, A, too.

I’m an important person in A’s life even if I don’t nurse. We have our battles on the nights when E’s not here, but I put A to sleep every night. That was one of my biggest fears before I had children. I saw so many heterosexual couples where the male father couldn’t even get their kids to sleep at night. And I saw these mothers that were totally overwhelmed because they could never get a night away from their children because nobody else could put them to sleep.  In our family, it’s really me, I’m the one that puts my baby to sleep every night, even though I don’t nurse. That’s really important for me.

The birthing parent in our case is the one that works outside the home and is more career-driven. Clearly she still has this other bond with the toddler that I don’t have, in terms of the comfort that is sought out from nursing. I can see when she wants to nurse, and I can replace it pretty well with a bottle of breast milk. We’re trying to slowly wean our toddler, especially at night, so I try to use the milk from the freezer sparingly.

Learning from the Experience

I wondered if Jenna had any advice for other trans women who would like to breastfeed.

Jenna: You have to prepare. A trans woman has to prepare for breastfeeding when gestation starts, when the partner or surrogate becomes pregnant. You need to give yourself those nine months. Before pregnancy begins, you have to know about the hormonal protocol and know when you’re going to start it.

And it’s a lot of work. It’s not easy. I don’t want to take away from cisgender women’s experiences, but sometimes for cis women, breastfeeding seems easy. I know that’s not true for all cis women, but for many, milk production is this natural thing that happens without extra effort. For trans women, you have to put in some effort to make it happen.

Another tip would be to get a good electric breast pump! And to pay for the little attachment that holds the breast pump to your breasts so that you can have your hands free.

Confronting a Myth

Jenna: I came up against this idea from lactation consultants that the birthing parent’s milk is the best milk and that co-nursing might have negative impacts on the baby or on the birthing mother. This came out quite obviously in a prenatal course at the birth centre, when the lactation consultant there made a stern comment towards our situation. She presented this idea that the birthing parent’s milk is formulated specifically for the baby. That’s not untrue, but in contrast, the opinion we received at the Newman clinic was that a diversity of milk would actually be beneficial to the baby. Yes, the birthing parent’s milk is great for the baby, but that doesn’t mean other milk isn’t beneficial as well. Of course, I liked the latter opinion the best. I think the “mother’s milk is best” type attitude was more about discomfort with co-nursing and maybe discomfort with a trans woman nursing, but it was scapegoated onto the baby’s health.

Scientists do know that breast milk changes in terms of its fat, protein, carbohydrate, and antibody content as a baby matures, and even over the course of a feeding, or from one feeding to another. However, we don’t know for sure how all that happens. One theory is that the breastfeeding parent receives biofeedback from thebaby’s saliva through their nipples. If the baby is fighting off an infection, the parent’s body reacts by producing specific antibodies in the milk to help. If this theory is correct, then surely a trans woman who didn’t give birth to her baby would still receive this biofeedback through saliva while nursing. If two mothers co-nurse their baby, the baby would benefit from a greater diversity of antibodies.

The World HealthOrganization states that the best milk for a baby is its own mother’s milk, or if that is not available then milk from another mother, and if donor milk is also unavailable, then formula. 

Jenna is her baby’s own mother. A transgender mother is her baby’s mother and I believe she produces her baby’s best milk if she’s breastfeeding.

** If you’re a trans woman willing to share your own story about breastfeeding, please contact me at milkjunkies (at) ymail (dot) com. 

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