Breast/Chest Feeding and Lactation for LGBTQ+ Families

/ Advocacy, Breastfeeding Communities, LGBTQ Plus Human Milk, News / By

Breastfeed Durham’s LGBTQ+ Human Milk Feeding Committee will be hosting our 2nd Annual Queer Family Planning Health fair on May 18, 2024 at Soul Sanctuary! There will be exhibitors and speakers about various aspects of family planning, including fertility, adoption, legal issues, lactation, and more. 

In anticipation of the big event, this blog will provide some information about ways in which queer families might incorporate human milk into their family feeding plans. People of all genders can potentially lactate and/or feed their babies at the breast or chest. Part of our mission at Breastfeed Durham is to promote equity in lactation information and care, helping to reduce disparities in health outcomes and ensure that everyone has access to the resources they need to support their feeding goals.

This blog will examine why some parents choose human milk and/or body feeding. We’ll also look at how they make it work, introducing some of the ways that people feed human milk to their babies in the context of different family structures. Lastly, we will provide a list of some helpful resources. 

First, some definitions/terminology:

  • Lactation: the secretion of milk from the mammary glands, intended to feed a baby; it occurs naturally after pregnancy
  • Inducing lactation: the process of producing milk in the absence of a pregnancy
  • Co-lactation: when more than one person is lactating to provide milk for a baby
  • Breastfeeding/chest feeding/body feeding: when baby feeds at the breast or chest, obtaining milk from the mammary gland itself, and/or an at-chest supplementer

If you are in the early stages of considering expanding your family by adoption, surrogacy, or your own pregnancy, you may not have thought about how you will feed your baby when they arrive. Formula feeding is the option that some families choose, while others choose to feed their babies human milk (by lactating and/or feeding milk from a milk bank or other donor). Some families use a combination of both.

It is possible for people of any gender to lactate/produce milk, even without having given birth to a child. Let’s look at a few possible scenarios: 

  • In a couple where one parent gives birth to the baby and automatically lactates, the other parent wants to share in the feeding, so they induce lactation. 
  • In a couple where neither parent gives birth, one or both parents might induce lactation for their adopted baby. The gestational carrier might even contribute some milk to be fed to the baby for several days, weeks, or months. 
  • A transmasculine person can give birth to a baby and would automatically lactate if they have mammary tissue. After top surgery to remove most or all mammary tissue, the ability to lactate would be minimal to none. In either case, he could feed the baby at his chest using an at-chest supplementer to provide milk or formula. 
  • A trans man who still has mammary tissue could also induce lactation to feed a baby born to a partner or other gestational carrier. 
  • Transfeminine people can induce lactation and might do that for a baby born to a partner or other gestational carrier, feeding at the breast/chest, and/or expressing the milk to feed via bottle.
  • Some parents purchase donor milk or obtain it via informal milk sharing. This milk can be fed to a baby by bottle, or by using an at-chest supplementer while baby is suckling at the parent’s chest/breast.
  • Sometimes multiple parents, relatives, or friends might want to share in the feeding process.
WHY CONSIDER BREASTFEEDING/CHEST FEEDING/HUMAN MILK FEEDING?

Whether inducing lactation or lactating naturally, the lactation process requires a lot of time, effort, and dedication. There are many reasons that people put forth so much effort into producing milk and/or body feeding:

  • BF/CF fosters attachment between parent and baby
    • sensory stimulation—skin-to-skin contact, cuddling, scent, eye contact
    • in the case of adoption, this helps heal the baby’s break in attachment from the birth parent and helps baby form connection to and trust in the new parent(s) 
    • establishes a biological connection between parent and baby; this might be especially important to a parent who was not able to gestate/give birth. Lactation and feeding baby at the chest can be important in the parent’s healing process 
  • Human milk is the ideal/normal food for human babies
    • it provides ideal nutrition and is easily absorbed; its composition changes to meet the changing needs of the baby as it grows
    • it helps reduce baby’s risk of chronic illnesses, such as asthma and type 1 diabetes
    • it helps strengthen baby’s immune system; milk contains antibodies that are transferred to baby, reducing the risk of illnesses like ear infections, respiratory infections, and GI illness
    • it helps reduce the effect of stress (inherent in situations of adoption, surrogacy, foster care, traumatic birth, etc.) on the baby
    • it is optimal for baby’s digestive system and the growth of brain and body
  • BF/CF supports normal infant development
    • swallowing, speech, jaw/palate development
    • vision, hand-eye coordination
    • brain development
  • BF/CF improves parental health*
    • can decrease risk of breast, ovarian, and uterine cancer
    • can decrease risk of heart disease, high blood pressure, stroke, and diabetes 
    • can help reduce postpartum depression

*(Studies on health benefits for lactating parents have included primarily cis-women who breastfeed, so more research needs to be done on lactating people of all genders!)

HOW DO YOU INDUCE LACTATION?

Many healthcare providers are not familiar with inducing lactation. Before you start this journey, find out if your OB, PCP, or pediatrician has experience with this, or if they are willing to learn along with you and help develop a plan. Increasing numbers of physicians and advanced practice providers in various specialties are learning about Breastfeeding and Lactation Medicine and incorporating it into their practices. Also seek out an experienced lactation consultant (IBCLC); they can help you every step of the way, and they may be able to recommend a medical provider to work with.

There are protocols developed by Dr. Jack Newman and Lenore Goldfarb in Canada in the 1990s. These protocols describe some effective ways to use medications, supplements, and pumping to induce lactation. There are numerous ways to individualize the process, depending on the timing, parent’s health, desire to use meds and herbs, etc. 

It is ideal to start the process 6 months before the baby’s due date, if known. If there is little or no lead time before the baby arrives, the protocol will be shortened.

The first step is usually to give the inducing parent hormones (like combination estrogen/progesterone birth control pills, or just a progesterone) continuously for a few months to mimic the hormonal effects of pregnancy. Breasts will typically become fuller (usually will increase about a cup size) and possibly tender. A trans-feminine or transmasculine person on hormone therapy may need to adjust their meds, under the guidance of their provider, to optimize lactation. 

The hormones are stopped (or decreased, in the case of a transfeminine person) about 6 weeks before the due date. This simulates the hormonal effects of giving birth (drop in estrogen and progesterone, which triggers the elevation of prolactin, the milk-making hormone). 

At this point, the parent starts pumping, ideally with a double electric hospital grade breast pump.  Pumping every 3 hours, similar to the frequency that a newborn would nurse, stimulates increased prolactin and oxytocin, resulting in milk production and expression. 

Adding some galactogogues (substances that promote lactation) can help. Options might include  moringa, goats rue, fenugreek, and torbangun. Regular consumption of oats or brewer’s yeast can also promote lactation. There is a medicine called domperidone that some people use to help induce lactation. It is part of the Newman-Goldfarb protocols, but it cannot be prescribed in the US. It is generally safe, but there are some potential interactions with other medicines, and there are some cardiovascular conditions in which there may be more risk of adverse effects. It is possible to get domperidone from other countries without a prescription, but we strongly advise discussing this with a knowledgeable  healthcare professional before taking domperidone or any other supplements. 

Initially while pumping, there may be no milk, but within a couple of weeks, usually drops will appear. Supply should continue to increase gradually. Even small amounts of expressed milk can be stored in the freezer for future use. By the time that the baby arrives, pumping could yield several ounces per day in some people. 

In the hospital, latching the baby onto the lactating breast will stimulate let-down of milk for baby to ingest. Milk production usually will continue to increase gradually in response to the removal of milk by the baby and/or pump. 

Some people choose to induce lactation without taking hormones or galactogogues; others will avoid hormones and only use galactogogues and pumping. Some parents will only nurse the baby at breast or chest, without using hormones or galactogogues or pumping. An at-chest supplementer can be used so that the baby gets milk or formula while suckling, even if the parent is making little or no milk.

WHAT CAN YOU EXPECT WHEN YOU GO DOWN THE ROAD OF LACTATION?  

Remember, everyone’s bodies and feeding goals are different. If you go down this path, have realistic expectations; remember that most people who induce lactation will not make a full milk supply for their baby and may need to supplement with donor milk and/or formula. In any situation, it is critical to have regular appointments with the baby’s healthcare provider to make sure that baby is growing and developing normally and is getting enough milk.

It is normal for some people to experience gender dysphoria with pregnancy and lactation. Conversely, lactation can feel very affirming for people who identify as feminine. Seek support from a mental health professional as needed, and look for peer support groups that include people in similar situations. 

With co-lactation, make sure to discuss details of feeding plans ahead of time with everyone who plans to lactate for the baby.

It’s nice to seek support from close family and friends, but don’t be surprised if you meet some resistance. They may need to be educated about why this process is important to you, and how they can be supportive. If they are not helpful, don’t let them discourage you. 

You define your own success. Remember that any drop of breast milk, and any time at the breast or chest (with or without iactation!) will be beneficial for your baby and for you, and it should be counted as a win! Know that inducing lactation will require a lot of effort, persistence, and support. Be prepared to adjust your plans as you see how things go. Parenthood is a journey with a lot of unexpected twists and turns, so try to be flexible, and work with your lactation support team to modify strategies. Seek support when you need it, and do what is right for you and your family! 

RESOURCES FOR INDUCING LACTATION AND BODY FEEDING: 

Clinical Protocols:

Books:

  • Breastfeeding Without Birthing by Alyssa Schnell
  • Queer Conception: The Complete Fertility Guide for Queer and Trans Parents-to-Be by Kristin Liam Kali
  • Feed the Baby: An Inclusive Guide to Nursing, Bottle-Feeding, and Everything in Between by Victoria Facelli, IBCLC and Shruti Nagaraj, MD, MPH
  • Where’s the Mother? Stories from a Transgender Dad by Trevor MacDonald

Trevor MacDonald’s website/blog, Breastfeeding and Parenting from a Transgender Perspective

Information about chest feeding and top surgery:

Breastfeeding After Breast and Nipple Surgeries website

Kellymom:

La Leche League International

Facebook groups:

  • Inducing Lactation for Adoptive and Non-Gestational Breast/ Chest Feeding
  • Birthing and Breast or Chest Feeding Trans People and Allies

Donor human milk resources:

Find a provider: