LGBTQI+, Lactating, Breastfeeding, and Chestfeeding

Breastfeeding support can feel very heteronormative. From a care provider who makes an assumption about your partner’s gender, to a baby tracking app that color-codes your child’s pees and poops based on their sex. At UR Lactation Medicine, we use our expertise in the physiology and mechanics of feeding to help you develop a lactation plan that works for you and your family, using all of your unique strengths! There are certain considerations for families who identify as LGBTQI+, such as making decisions around co-lactation, inducing lactation, chestfeeding, effects of affirming care treatments on milk production, using donor milk and others. Below, there is some information about these topics, and you can check out the Academy of Breastfeeding Medicine protocol on "Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients," written by our group and presented around the world!

Learn more about UR Medicine's policies and respect for LGBTQI+ patients and families.

Co-Lactation

Some people who have children can both lactate. This may be in the case of adoption, two moms, mom and dad, or simply "parents." They may choose co-lactation or co-feeding to help make more breast milk for an infant, share the responsibility and bonding of baby feeding, or other reasons. If you are considering co-lactation, there are a few things to think about:

• What will the birth hospitalization look like? See our "co-lactation infant feeding plan" for a document that can help you think through the steps and carry it to providers who may not be familiar with co-feeding.
• Protect the birth parent’s milk supply. If there is a birth parent who will be feeding, this milk supply needs to be protected by frequent removal of milk. This can be with the baby nursing or by pumping/hand expression.
• Is there someone who needs to induce lactation? Although induced lactation can happen for some people within a few weeks, having a longer (months) lead time can help the process work the best.
• How will both milk supplies be maintained, who else is there for support? Maintaining a milk supply requires emptying at least 6-8 times per day. If two parents "split" the feeds, each nursing or pumping only 4 times per day (1/2 of feeds), it is likely both will lose their supply. On the other hand, with two parents feeding or pumping 6-8 times per day, other supports for home and work life may be needed.

Human Milk Sharing

Formal human milk sharing happens through Human Milk Banks, operated in North America, by The Human Milk Bank of North America, The New York Milk Bank, or Prolacta.

In order to get Milk from a Milk Bank you need a prescription. The milk from Milk Banks has been pasteurized and tested for diseases, and is generally used with premature infants, although it can be available to other infants.

It generally costs somewhere around $4-5 an ounce, although it can be covered by insurance in some instances.
 
Informal Milk Sharing is also called Mother-to-Mother milk sharing. It is not recommended because there is no guarantee of the safety, purity, or quality of the milk. 

IF you are sharing human milk, you should know the following:

• Do not buy human milk from anyone other than a milk bank, milk bought online has shown levels of dilution, cow’s milk, rice milk, bacteria and cotinine (from cigarette smoke). It may also be taking milk from another baby who needs it.
• Shared milk is not pasteurized or tested (unlike milk from milk banks), rather they are donations from parents who have stored extra milk in their freezer and are willing to help those in need. It is up to the parents receiving the milk to determine the safety of the donors. Some questions to ask a donor include:
  • Date of the milk, age of the infant
  • Handling conditions (hand washing, no longer than 4 hours at room temperature, making sure it is transported on ice)
  • Any medical conditions of the donor
  • Medications, drugs or cigarette exposure of the donor
  • Prenatal labs of the donor (HIV, other infections, etc.)
  • Any ongoing rashes (Herpes, Impetigo, etc.)
• One of the keys to informal milk sharing is open communication between the donor and recipient, in order to ensure that the breast milk is the safest possible (free from medications, drugs, alcohol and infectious diseases).  It is important to choose a donor that you feel comfortable with.
• Many women that participate in informal milk sharing either ask that their donor provide copies of test result showing that they are free from infections disease, and they look into the requirements to pasteurize the breast milk just prior to the baby’s consumption. 

For more information on milk sharing risks and benefits, or pasteurizing, visit the Academy of Breastfeeding Medicine 2017 Position Statement on Informal Milk Sharing.

Chestfeeding

Chestfeeding is a term used by many masculine-identified trans people to describe the act of feeding their baby from their chest, regardless of whether they have had chest/top surgery (to alter or remove mammary tissue). It can be a joyful and tender experience, but may also feel complicated or uncomfortable. There may be social pressures surrounding a family in which someone is chestfeeding. Trevor MacDonald is a prominent transgender dad who has written a book on chestfeeding (MacDonald T. Where’s the Mother? Stories from a Transgender Dad. Trans Canada Press, 2016), writes a blog and runs an online support group. Find him on Facebook for more information.

For an evaluation on inducing lactation, co-feeding, or co-lactation, please call (585) 276-MILK. Please also download our Lactation Care Protocol for more information.