So is this possible and who might benefit from this; if male-bodied people are now able to nurse a baby, and what might it mean for women?
So first of all it’s important to take a brief look at how breastfeeding a baby works.
During female puberty, the breasts start to develop and get larger as there is an increase in both fatty tissue and milk producing glands. These glands enable milk to be transferred out of the breast and into the baby being fed.
Boys may also experience a temporary swelling around the chest area due to changes in hormone levels, which can be worrying for them but usually disappears without any need for medical treatment.
During later pregnancy, the breasts start to produce colostrum ready for the baby, this is a thick golden fluid rich in sugars, protein and antibodies which help to protect the baby from infections and provide valuable energy (and has a laxative effect to help clear the tarry meconium from the babies bowel). Premature babies receiving their own mother’s colostrum have significantly better health outcomes.
So it is clear that someone born male will be at an immediate disadvantage if they wish to breastfeed a baby. Their body is not designed to produce milk and they do not have either the appropriate hormones circulating, nor the necessary physiological structures to produce milk. The report is lacking significant detail and it would be difficult to draw any conclusions from it – it is not clear whether the medications used were being prescribed by a medical practitioner or whether they were treating themselves without direct supervision.
It is also not clear whether the fluid being produced by the patient resembled breast milk in terms of nutrition, antibodies and energy.
The report states that the patient was producing 8oz of fluid each day by the time the baby was due to be born, and this milk was given to the baby as the sole source of nutrition for the first six weeks until they began to give infant formula in addition because of concern about not being able to produce enough milk. It is unclear whether the daily volume was being supplemented by milk that had been previously harvested and stored, formula milk, or milk from the baby’s birth mother.
So this baby would not have been able to receive colostrum, and the amounts of milk are significantly less than what a baby needs. The expected amounts of milk needed by a healthy full term baby would be significantly greater than 8oz a day but a typical mother’s body would respond to more frequent feeding by producing more milk for her baby.
On reading the details of the study, there are glaring similarities with a condition that some women live with, called breast hypoplasia (sometimes known as tubular breasts). This means that although they have experienced female puberty, there is a lack of milk producing glands in the breasts and as a result they may have difficulty in establishing a full supply of breastmilk despite experiencing pregnancy and the hormonal changes which would usually prepare the female body for nurturing an infant. These mothers commonly use a combination of breastfeeding, expressing milk, and supplementing with donated breastmilk and/or a commercial infant formula milk. Some mothers use medicines or herbs to increase milk supply.
So how did this patient stimulate milk production?
The report states that several drugs were used and there has been some discussion around the safety of these passing into the breastmilk.
There are actually very few medicines which are hazardous to babies when taken by a breastfeeding mother; more information around medicines and breastfeeding can be found here which is a charity providing breastfeeding support to UK families. In considering the risks and benefits to babies, the mother and her medical team would usually consider the risks of not breastfeeding, how necessary the drugs are, and possible alternatives that might be safer.
In this case, it appears that the medications were primarily being taken to change the appearance of the patient’s body, and to induce milk production,rather than to prevent or treat an illness.
The drugs being used included an androgen blocker – spironolactone – which causes breast enlargement as a side effect. It is not routinely taken by healthy women of childbearing age because it is principally used to treat heart failure which is uncommon in this age group.
They were also taking estradiol, a commonly used drug which is used in HRT for women experiencing menopause. Estradiol is not usually taken by women of childbearing age, and is used with caution in women who have not had a hysterectomy. They were also taking progesterone, another female sex hormone.
And finally domperidone was being taken and there has been much fuss made about this being a BANNED DRUG in the USA and imported from Canada by the patient for unlicensed use. This medicine has been widely used (to increase prolactin) to support lactation by breastfeeding women as it is known to increase the milk production in some mothers. This is somewhat of a red herring – in the UK it was until recently available without prescription for the treatment of nausea and bloating symptoms, and it was withdrawn as a result of a small number of heart problems in older people who were given it by IV drip. Healthy younger adults of childbearing age would be at very low risk of these side effects.
Also mentioned very briefly was that clonazepam was being used ‘occasionally’ and this would usually be avoided during breastfeeding.
So the bulk of the drugs would not usually be a cause for concern.
Which brings us to the final and most important question – why?
Why would a person born male, feel that they are the best person to breastfeed their child? Why didn’t the baby have the right to be breastfed by his/her mother, the woman whose body had just experienced pregnancy and was ready to provide milk for her newborn?
Why would the male-born partner feel compelled to take over the only part of caring for a new baby that can only be done by the mother, that is a nurturing and bonding experience for both and which has many health benefits for both mother and baby? Somewhat oddly, the ‘study’ does refer to some of these benefits: ‘Women who breastfeed are noted to have lower rates of … ovarian cancer than women who have never breastfed.’ despite the fact that this is entirely irrelevant to a trans identified male who will never be at risk of ovarian cancer.
What might this mean for women?
Breastfeeding is currently protected by sex discrimination law in the UK and this means that breastfeeding women and their babies enjoy the protection of specific legislation to ensure that they are able to breastfeed in public places without being asked to refrain from this or move on to another place. This is because it would be sex discrimination against women, as only women breastfeed. If breastfeeding ceases to be a sex-specific activity, will this protection still exist?
Breastfeeding support is mostly delivered by peers, that is mother-to-mother support, particularly in developed countries where formula feeding is culturally normal and many women have not grown up seeing their mothers, sisters, aunts, breastfeeding babies openly and frequently. As a breastfeeding supporter in the UK, breastfeeding support can be a very complex but rewarding area to work in, and one that can be a very sisterly skill to share with another woman.
As a healthcare professional of 20 years and a breastfeeding counsellor trained by one of the major UK breastfeeding support charities, I hope that women in future will not feel compelled to share breastfeeding their baby with another person, and we can respect that the mother and baby pair is something special to be respected and nurtured in itself.
by Rachel Young