Jennifer's experience breastfeeding as a transgender woman.

Image description: Two white women in a hospital room. Sandi is on the left. She is in a hospital bed, holding a newborn baby and Jennifer is on the right. She has her arm supportively around Sandi as she leans in for the picture.

My name is Jennifer, I am paramedic for the Queensland Ambulance service here in Australia, I am married to a beautiful and supportive wife, we have a 3-year child, and I am also transgender. I would like to share my story of fertility and how I was able to breastfeed, although brief, potentially stopped our baby from becoming very sick. I want to share my journey of breast feeding and the birth of our child.

Before I transitioned, Sandi, my wife and I had been trying for a baby for about 6 years and nothing happened. We eventually got referred to a fertility clinic where we were told that we had unexplained infertility. We tried several things to help increase our chances, but nothing worked. At the same time as being referred, Sandi was unfortunately diagnosed with Multiple Sclerosis, and the clock was now ticking. After a year of trying these other things, we decided that IVF was the only way. To make things even more complicated, I had decided to transition, and this would make things harder . . . or would it.

While I may have regrets about not mentioning to my parents at a younger age that I was a girl, I am thankful at the fact I have been able to biologically have my own child. Before taking hormones in October 2017, I had to undertake fertility preservation for the future. Had I transitioned as a child, this would not have been possible for us. So, for Sandi and me as a married couple, it was important for us to do that fertility preservation.

Being transgender, there is another thing with fertility that I have been experiencing and want to share. This has been ongoing for several years, and it is hard to explain and may sound odd. But for a while now it has felt like my body has been trying to tell me that I am running out of time and that I need to hurry up and conceive, even though I anatomically can’t. It is a strange feeling and a feeling that has made me cry at times knowing that I never will be able to even though I want to.

But there was something I could do. When Sandi was 28 weeks pregnant, I had an appointment with my Endocrinologist, and she asked a question – Did I want to breastfeed?

I had read a study about a transgender woman who breast feed exclusively for her child, as the birthing mother did not want to breastfeed as all, and I didn’t realise that it could be an option for myself. My endocrinologist helped induce lactation by mimicking pregnancy in my body. This was done by increasing my estrogen levels to those of a pregnant woman by increasing my oral estrogen dose. Next was to also increase my prolactin through a medication called domperidone, a drug that is used to help mothers that may have reduced milk supply. And finally I was on an anti androgen to suppress my testosterone called cyproterone and suppress my testosterone it did, to undetectable levels. Along with this, to encourage lactation, I had a daily routine of using a breast pump to encourage my body to express milk. At first it was only a small amount but gradually increased was producing approximately 40-50mls per day. It was amazing that I was able to produce this amount.

For my wife and I, she was always going to be the primary feeder and I would be supplemental, and we never were going to breastfeed long term as Sandi ceased her treatment for MS while doing IVF and was to resume approximately 1 month after birth.

A week before the due date I was to decrease my estrogen levels to again mimic giving birth in my body which would increase my supply, unfortunately our baby had different plans and arrived 2 weeks before his due date and this led to a series of events. He was born very quickly; he was in a rush to get into this world. My wife got to experience her skin-to-skin contact and to initiate her breastfeeding which is important for new mums. Unfortunately, due to his speed at which he came, he causes an arterial tear and Primary postpartum hemorrhage. While my wife was being tended to, I was able to have skin to skin contact and to attempt to breastfeed, which was an amazing experience, but also not as easy as I thought it would be. Prior to this I had been storing and freezing would I had expressed, which would come in handy soon enough.

The next few days in hospital my wife would struggle with breast feeding, telling midwives that she felt like she was not feeding our baby, and her being told she was doing it wrong and needing to try harder. For her it was soul crushing, for me as a medical professional it was annoying to hear and see my wife’s concerns ignored. But that wasn’t the worst. Inducing lactation in transgender woman is not common and as such, the midwives and doctors were unaware that I was able to do that and had been doing this for the past 3 months preparing to breastfeed out baby. They did not want me to breastfeed our baby in the hospital due to there concerns on my ability to be able to do so and went as far to have discussion with my wife when I wasn’t there and wanting her to sign waiver forms and to declare my blood infectious status. To my wife, she was mortified at how they were treating her and myself. Mean while she was struggling and voicing her concerns about her breastfeeding and concerns that our baby was now going jaundice. Not one to take this, I ended up just bringing my frozen milk and a bottle in when seeing my wife and kid and feeding him this way and he would drink like he was starving.

Unfortunately, things would get worse for us. Not even 2 days after she was discharged home, I was calling an ambulance for my wife who was tachycardic, pale, diaphoretic, with significant abdominal pain. It turns out that she had retained placenta products as a result of the midwife yanking on the placenta and as a result of that her body didn’t recognize that she had gone through childbirth and so was not producing breast milk like she was. This meant that the only food our baby was getting was from the breast milk I had stored and was able to feed from my breasts which wasn’t a lot. All the stress associated with the childbirth and the emergency at home meant my body stopped producing milk. The night she went back to hospital via ambulance we decided that we would formula feed from now on as we just wanted him to be fed.

Although brief, it was an amazing privilege to be able to breast feed. To be able to feed and provide nutrients to our child especially when my wife wasn’t and when she was not being listened too. Sharing our story is about letting transgender women know that they can breast feed, they are able to induce lactation and that it should be normalized. The other side of our story is to not ignore your instincts. If something doesn’t feel right, speak up until someone hears you. While the majority of births go smoothly, many don’t and many women experience birth trauma, something we have since discovered is very common and not talked about often.

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