FROM BREASTFEEDING TO CHESTFEEDING - UNMC
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8/20/2021
FROM BREASTFEEDING
TO CHESTFEEDING
How to Support the LGBTQIA Community
Olson Center for Women’s Health at the University of
Nebraska Medical Center
Andrea L. Braden, MD, IBCLC
August 25, 2021
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Disclosures
External Industry Relationships * Company Name Role
Equity, stock, or options in Lybbie (MamaLibra, Inc) Co-Founder
biomedical industry companies or
publishers
Board of Directors or officer Lybbie (MamaLibra, Inc) CEO
Royalties from Emory or from None N/A
external entity
Industry funds to Emory for my Georgia Research Alliance Breast Pump Translational Research
research National Institutes of Health PTSD and Pregnancy Research
Other None
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ABOUT ME
LGBTQIA+ Ally, Ob/Gyn, IBCLC,
Entrepreneur… #ADHD
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Grady Gender
Center
■ Opened summer 2017
■ Multidisciplinary practice
■ Educational modules
■ Research opportunities
– Unique population that
is underrepresented
■ Community engagement
■ Advocacy and awareness
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BREASTFEEDING
IN
TRANSWOMEN
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GENDER EQUITY IN
PRACTICE
TRANSFORMING GYNECOLOGY COLUMN
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Utilize inclusive language in the
treatment of patients who identify as
LGBTQIA+
Provide more sensitive antepartum,
Objectives intrapartum, and postpartum care for
the LBGBTQIA+ community
Use evidence-based medicine to
support LGBTQIA+ patients who
choose to breast/chestfeed their
infants
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LGBTQIA+
Speaking the Language
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LGBTQIA+
Gender
Transgender Non-
Conforming
Queer/
Lesbian
Questioning
Bisexual Intersex
Gay LGBTQIA+ Asexual
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For Example:
Otto is a transgender, Delilah is a transgender, Mabel is a cisgender,
masculine, feminine, bisexual woman. feminine, heterosexual
heterosexual man. woman.
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Transgender/GNC Identity2
A person may act on their transgender
identity:
• with real life experience or “passing”
• with initiating hormone therapy (HT)
• with surgical options
Gender dysphoria is the
stress associated with the
transgender experience
Aspen M, Nonbinary Support
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Transgender and Cisgender
Cisgender: sex = gender
Transgender: sex /= gender
• Transgender woman/Transwoman/Male-to-Female/MTF
• Transgender man/Transman/Female-to-Male/FTM
Genderqueer: non-binary experience of sex and
gender
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■ Used to be “gender identity
disorder”
■ Marked difference b/w
gender expression and
Gender gender assignment
■ Lasts >6mos
Dysphoria ■ Causes distress
(DSM-V) ■ Diagnosis:
– Pros—physicians can bill
and prescribe tx
– Cons—pathology vs.
normal variation
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CDC Behavioral Risk
Factor Surveillance
System (BRFSS)
2016
National estimate transgender
persons
■ 0.6% =1.4 million
■ Range 0.3% ND to
0.8% HI
■ Highest 18-24 versus
older adults
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Numbers4
Flores, et al. “How many adults identify as transgender in the United States.” The Williams Institute.
https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf.
Accessed 8/16/2016
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Discrimination is common in the lives of
LGBT people…5
Among LGBT people: Among transgender people:
• 39% rejected by a family • 61% physically attacked
member or friend • 55% lost a job due to bias
• 30% threatened or
physically attacked
• 21% treated unfairly by an
employer
• 30% of youth missed at
least one day of school in
the last month because
they felt unsafe or
uncomfortable
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…and in health care5
LGBT patients report Transgender patients
that providers report
• Use excessive • Being harassed in a
precautions or doctor’s office (25%)
refused to touch • Being denied
them (11%) medical care (19%)
• Blame them for their
health status (12%)
• Use harsh or abusive
language (11%)
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Stigma, Discrimination, and
Health5
Stigma/Discrimination
Chronic and Acute Stress
Impacts
Mental Physical
Access to Care Access to Competent Care
Health Health
Health Disparities/Inequities
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LGBTQIA+ Families
GNC
Cis
Cis Female
Male
Trans Female Trans Male
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Gender and Partnering Possibilities
Cisgender male Cisgender male Cisgender
Cisgender male
+ cisgender + cisgender female +
+ GNC
female male cisgender female
Transgender
Transgender
Cisgender male + Transgender
male +
female + GNC transgender male + GNC
cisgender female
female
Transgender
Transgender
female + GNC + GNC Polyamorous
female + GNC
cisgender male
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CLINICAL PEARLS
Lactation Support for LGBTQIA+ Families
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ANTEPARTUM
Establishing prenatal care and infant feeding plans
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INFANT FEEDING
CONSIDERATIONS
FOR LGBTQIA+
PERSONS
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SO YOU WANT TO
BREAST/CHESTFEED?
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Making Human Milk:
Nuts and Bolts
■ Breast ducts/lobules/acini
■ Estrogen/estradiol to mature
■ Increase in estrogen/estradiol and
progesterone (“pregnancy”)
■ Prolactin (galactogogue)
■ Reduction in estrogen/estradiol and
progesterone (“delivery”)
■ Oxytocin (”suckling”)
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Who is the gestational carrier?
• Partner with uterus
Determining • Surrogate
Is the gestational carrier planning to
LGBTQIA+ breast/chestfeed?
Lactation • Does this person have mature breast tissue?
Options • Will a surrogate be donating milk?
Is a person other than the gestational
carrier interested in lactation induction?
• Does this person have breast tissue that can be
stimulated to produce human milk?
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LGBTQIA+ Pregnancy and Birth
Planning
■ Ask before assuming parental/support roles
■ “Gender-reveal” might be offensive
■ Establish/document preferred names/terminology to be
used by healthcare team
■ Breast/chestfeeding may be traumatic for someone with
gender dysphoria
■ Set expectations about possibility of needing to supplement
human milk if lactation induction is pursued
– Consider prenatal lactation consultation
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INTRAPARTUM
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Intrapartum Considerations for
Lactation in LGBTQIA+ Persons
Pairing Lactation Options
Cisgender Man + Cisgender Man Donor milk
Cisgender Woman + Cisgender Lactation by gest carrier, induced
Woman lactation, or both
Transgender Man + Cisgender Lactation by gest carrier, induced
Woman lactation, or both
Transgender Woman + Cisgender Donor milk, induced lactation in
Man transgender woman
Trans/Cis Any + GNC or Lactation ability dependent on
Polyamorous organ inventory of interested party
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Watch Your Language
Father It’s a boy!
Wife
Breastfeeding
Mother
Vaginal delivery
Husband
It’s a girl!
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Role of the Health Care Professional6
■ LGBTQIA+ families comprise 4% or more of the US
population
– Learn more about these populations
– Learn terminology use for various sexual orientations
and gender identities
– Use language that is comfortable for each unique
person
– Approach individuals with cultural humility
■ Provide non-judgmental care that is inclusive and affirming
so that all child-bearing family members can grow and
develop into the parents they aspire to be
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Advanced Troubleshooting7
Spironolactone use
Chest-binding practices
Milk supply
History of masculinizing surgery
Lactation-induced gender dysphoria
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POSTPARTUM
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Access to LGBTQIA+-friendly and
LGBTQIA+ knowledgeable lactation support
Families:
Social stigma and gender dysphoria
Unique when nursing in public
Barriers
Lack of nursing-friendly clothing
After options for varying gender expressions
Bringing
Limited number of peer support
Baby Home8 groups
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BIRTHING AND BREAST OR
CHESTFEEDING TRANS PEOPLE
AND ALLIES9
https://www.facebook.com/groups/TransReproductiveSupport/
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MILK JUNKIES10
http://www.milkjunkies.net/
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THE
CHANGING
LANGUAGE OF
HUMAN MILK
FEEDING11
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CASE-BASED
LEARNING
Practical Skill Application
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Cisgender male
couple
First baby is due Jack and
in 3 months Spencer
Would like baby
to be fed with
human milk
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Jack and Spencer
1. What additional history do you need to obtain before
counseling on feeding options?
2. What are Jack and Spencer’s options for human milk
feeding?
3. Are there any special considerations for this couple?
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Cisgender
female couple
Baby #3 is due Lily and
next month Savannah
Would like baby
to be fed with
human milk
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Lily and Savannah
1. What additional history do you need to obtain before
counseling on feeding options?
2. What are Lily and Savannah’s options for human milk
feeding?
3. Are there any special considerations for this couple?
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Jasper and Miranda
Transgender male and cisgender female
couple
Expecting first baby in 1 month
Would like baby to be fed with human
milk
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Jasper and Miranda
1. What additional history do you need to obtain before
counseling on feeding options?
2. What are Jasper and Miranda’s options for human milk
feeding?
3. Are there any special considerations for this couple?
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Faye and Cooper
Transgender female and cisgender male
couple
Baby #2 due in 5 months
Would like baby to be fed with human
milk
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Faye and Cooper
1. What additional history do you need to obtain before
counseling on feeding options?
2. What are Faye and Cooper’s options for human milk
feeding?
3. Are there any special considerations for this couple?
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Ivan, Jace and Rory
Polyamorous partners: transgender male,
gender non-conforming, and intersex
Planning pregnancy soon
Would like to discuss birthing and
human milk feeding options
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Ivan, Jace and Rory
1. What additional history do you need to obtain before
counseling on feeding options?
2. What are Ivan, Jace and Rory’s options for human milk
feeding?
3. Are there any special considerations for this partnership?
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THANK YOU!
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268/20/2021
QUESTIONS?
ANDREA.BRADEN@EMORY.EDU
@WHOLEHEARTEDDOC
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References
1. https://www.genderbread.org/
2. https://nonbinary-support.tumblr.com/post/121648186793/aspens-guide-to-gender-dysphoria
3. https://www.cdc.gov/lgbthealth/
4. Flores, et al. “How many adults identify as transgender in the United States.” The Williams
Institute. https://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-
Transgender-in-the-United-States.pdf. Accessed 8/16/2016
5. https://www.lgbthealtheducation.org/
6. Duckett, LJ, Ruud, M. Affirming language use when providing health care for and writing about
childbearing families who identify as LGBTQI+. J Hum Lact. 2019. Vol. 35 (2) 227-232.
7. MacDonald, TK. Lactation care for transgender and non-binary patients: empowering clients and
avoiding aversives. J Hum Lact. 2019. Vol. 35 (2) 223-226.
8. MacDonald, TK, et al. Transmasculine individuals’ experiences with lactation, chestfeeding, and
gender identity: a qualitative study. BMC Pregnancy and Childbirth. 2016. Vol. 16: 106. 1-17.
9. https://www.facebook.com/groups/TransReproductiveSupport/
10. http://www.milkjunkies.net/
11. Dinour, LM. Speaking out on “breastfeeding” terminology: recommendations for gender-inclusive
language in research and reporting. Breastfeeding Med. 2019. Vol. 14 (8) 523-532.
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