Updated: Sep 7, 2018
Guest Author: Courtney Durfee, RN, BSN, CLC, CD(DONA), HCHD
It’s September, which means that we’ve all made it through another National Breastfeeding Month. Whether you knew it or not, you just lived through the World Association for Breastfeeding Action’s World Breastfeeding Week (WBW), August 1-7; the Global Big Latch On, the first Friday & Saturday of August; The University at Albany School of Public Health’s Breastfeeding Grand Rounds; and Black Breastfeeding Week, August 25-31.
If you identify as LGBTQIA+, you might not have noticed that August was National Breastfeeding Month, because of all of those events, the only one that is truly inclusive of trans* and non-binary parents is Black Breastfeeding Week (BBW). BBW organizers deliberately include graphics centering chestfeeding, hand expression, pumping, and breastfeeding.
Other events, including The Big Latch On, have made halfhearted attempts at inclusivity, such as using the term “breastfeeding people” as opposed to “breastfeeding mothers”. But not all lactating parents breastfeed. Some parents prefer the terms nursing or chestfeeding. Where is the support for trans* and non-binary parents?
It may not be National Breastfeeding Month anymore, but it’s always the right time to talk about how LGBTQIA+ folks nourish their families. QHG supports lactating and chestfeeding parents of all gender and sexual identities. To show QHG’s support for you and your families, we’ve asked Courtney Durfee, a Certified Lactation Counselor, RN, DONA-certified Birth Doula, and co-owner of Hudson River Doulas based in the Mid-Hudson Valley Region of New York to highlight some of their experiences supporting parents across the spectrum and share some resources you may find helpful.
QHG supports lactating and chestfeeding parents of all gender and sexual identities.
Courtney Durfee on LGBTQIA+ Chestfeeding:
Supporting LGBTQ+ populations wasn’t even part of my curriculum in my doula training, my lactation education, or my nursing education. LGBTQ+ people can and do lactate. Trans* people can and do lactate. The T is included in that first sentence too, but it’s important that you really hear it because less informed people may try to tell you otherwise, so I said it twice so it sticks. Some use the term chestfeeding or nursing as opposed to breastfeeding because it feels most comfortable to them.
LGBTQ+ people can and do lactate. Trans* people can and do lactate. The T is included in that first sentence too, but it’s important that you really hear it because less informed people may try to tell you otherwise, so I said it twice so it sticks.
The International Lactation Consultant Association recognizes the diversity present in gender identity of parents by stating that breastfeeding/chestfeeding is the term to use “when referring to parents of any gender directly feeding at the breast/chest.” Much like your pronouns, you know which words are fitting for you and you may need to remind your clinical care providers and lactation professionals along the way. As a parent, nurse, doula, and lactation counselor, I use lactation and nursing as a blanket terms to cover milk-producing by parents of any gender but as you can tell from WBW and National Breastfeeding Month, that’s not the industry standard.
Let’s take a look at what the options are for infant feeding and try to address some misconceptions.
Misconception #1: If You Get Top Surgery, You Will Never Be Able to Chest Feed
Did you know that top surgery does not preclude you from feeding your baby your milk? It can impact your production, depending on a how it was done, but you can still feed your baby. Use of a supplemental nursing system (SNS) can help provide additional milk, either parent’s own expressed milk or donor milk, to your baby while they are breastfeeding/chestfeeding/nursing at the breast/chest. Some people use an SNS to supplement with formula at the breast/chest as well.
Misconception #2: Chestfeeding is Only for Birth Parents
Inducing lactation is an option for non-gestating parents. In some families, parents choose to co-feed a baby. Couples that I have worked with shared that they were never asked by their care providers if they wanted information on induced lactation or co-feeding, some weren’t even aware that it was an option. One couple shared that although a friend had once mentioned co-feeding during the pregnancy, care providers never offered any information on it. That couple commented that parents who were assigned female at birth (AFAB) who are masculine-presenting can run into roadblocks when asking about and having an informative discussion about feeding options. The mom also noted that having such a discussion with a knowledgeable care provider who used appropriate and inclusive terminology would have really benefited their family. As author Diana Kort once wrote, “If I don't know my options, I don't have any."
Lactation professionals and clinical care providers need to do a better job of meeting the needs of the community and it can be as simple a start as just asking questions about what you know, what you would like to know, and what other options may be available for your family. There are many modes of feeding and figuring out your family’s feeding goals and support systems are an important step.
Misconception #3: No One is Talking About Trans*-Inclusive Lactation Support
Trevor MacDonald is perhaps the best known male lactation supporter and proponent for trans*-inclusive lactation support. He has worked towards building support systems for families for years. The importance of his work cannot be overstated. From the Transgender Parents page on one of the most popular lactation information websites, to the La Leche League becoming more inclusive, to publishing both qualitative research on chestfeeding and a book, to being a truly amazing and inspiring human being- Trevor MacDonald has made great strides. He runs a website on feeding and parenting from a transgender perspective. On his website, he has interviews with trans* mothers like Sarah who was able to successfully induce lactation and breastfeed while on a decreased dosage of her estrogen protocol and Jenna who induced lactation and co-nursed her children. He also has a very detailed page on using an at-chest supplementer and shares about his own experience nursing.
Now that we’ve addressed a few misconceptions, let’s talk about some important points to ponder when planning infant feeding.
Point to Ponder #1: Accessibility is an important consideration, whether feeding at the breast/chest or expressing milk.
If you are feminine expressive, there are tons of mainstream options for lactation-friendly clothing. To my knowledge, there isn’t currently a GNC or masculine-expressive nursingwear company so if any of you reading this are into clothing design, opportunity is knocking.
Limited clothing choices shouldn’t dictate your feeding choices. Despite the name, a brand named boob makes my favorite t-shirt to layer under my normal shirts while nursing. They also make an accessible hoodie that I recommend sizing up for. You don't need to buy lactation-specific clothing. Layering may be a more comfortable option for you and your baby while you are lactating and, if you bind, consider a larger sized binder that zips. Be aware that binding may impact your supply and may cause an increased incidence of clogged ducts and mastitis so it can be important to account for that when considering the frequency, duration, and intensity of binding while lactating.
Point to Ponder #2: Be aware of leaking, engorgement, and mastitis.
All of these things are manageable and can happen after birth, even if you don’t plan on feeding baby your milk or if you decide to wean. I leaked a lot with my first and almost not at all with my last baby. I have yet to find a pad for leaks, whether disposable or washable, that doesn’t show through everything because they’re generally designed with bra-wearing people in mind. In theory, that’s exactly what these silicone pads are supposed to do but I haven’t personally tried them. One good thing about having a community of like-minded parents as a support system, whether web-based or local, is that you can get real feedback on things like what products are worth your money as well as somebody to commiserate with when you’re dealing with other people who default to cisheteronormativity or “pronouns are hard” on the daily and you need the reassurance that you’re not alone in this.
Point to Ponder #3: Community support is key.
Everyone should have access to knowledgeable support from somebody who really gets it. When my babies were nursing, there were definitely some feelings I had to work through. I know human milk is baby’s best feeding option and lactation support is one of my primary professional foci. Some days are fine and I logic my way through it and other days the dysphoria can pop out of nowhere- I’m also touch averse so having someone attached to me every two hours was something I worked through with mixed feelings til the very last latch. It was great to watch my babies grow, knowing I did that, but I was happy to be able to keep my chest tucked away when they were done and weaned.
Some parents do need to stop breastfeeding/chestfeeding due to feelings of dysphoria, but that’s not always the case. Gendered-female language used by care providers and lactation professionals may contribute to feelings of dysphoria so it is important that they acknowledge your needs by using inclusive language and appropriate pronouns. Lactation expert Liz Brooks, JD, IBCLC, FILCA says, “Words matter. Changing language to reflect inclusive and culturally congruent care is an ethical obligation, and reflective of the best practice of patient-centered care.” Diane West, IBCLC has an informative page on transgender lactation for professionals and parents alike.
Point to Ponder #4: Know your resources!
There may not be a whole week dedicated to normalizing infant feeding methods in the queer community during National Breastfeeding Month, but there are resources that support, normalize, and encourage LGBTQIA+ lactating parents year round. Facebook has become a hub of social support through shared interest groups in the last decade. This trend applies to today’s topic as well. If you are looking for social support check out these great groups:
Birthing Beyond the Binary by Gender Illumination is a safe space for queer, trans, and gender non-conforming and people and healthcare providers to discuss preconception, conception, gestation/pregnancy, birth, postpartum and lactation.
Queer Liquid Gold group on FB: Inclusive and safe space for queer identified parents to discuss lactation and infant feeding.
Of course - you can always find support on the QHG Community Space!
You can find the support you need to help you reach your feeding goals. There are multiple levels of lactation support from the above online peer support groups, La Leche League, WIC Peer Counselors, Certified Lactation Counselors (CLC), to International Board Certified Lactation Consultants (IBCLC). While the bulk of their training and expertise may be geared toward cisgender women, inclusive lactation support is something that should be available to all people. Finding local support may be a more difficult task than the niche online communities but in some areas there are many options for inclusive lactation support. One mom shared that switching from one group to an overtly inclusive group farther from home helped her family to feel better supported. You may not feel a click with every group so find the one that's best for you and your family and it can make a world of difference. Some places to start would be:
Check in with your local full-spectrum doula, midwife, CLC or IBCLC. Not sure where to find one? Trevor MacDonald’s group has a provider list for members, TransBirth has a public (though slightly outdated) list, RAD Remedy also has a provider search (no Lactation Category, try Reproductive Health)
Check in with your local LGBTQ+ Center and if they don’t have a queer parenting group, suggest that they start one, possibly in conjunction with one of the above birth or lactation professionals.
Mombian shared the Strong Families Movement tool which suggests asking when selecting your insurance provider, “Are there LGBTQ+ lactation or trans*-friendly lactation consultants available on this plan?”
Even La Leche League is starting to embrace the terms chestfeeding and nursing as opposed to only breastfeeding. Their website now features an informative page specific to trans* and non-binary parents and men were finally able to volunteer with LLL starting in 2014.
Courtney Durfee, RN, BSN, CLC, CD(DONA), HCHD is a Certified Lactation Counselor, nurse, birth & postpartum doula, and health educator. Courtney is a co-owner of Hudson River Doulas, providing pregnancy, birth, postpartum and lactation support for families in the mid-Hudson Valley region of New York. Courtney's educational background is in Community & Human Services, Healthcare Management, Nursing, and Early Childhood Education with nearly ten years of experience in perinatal health.