Successful Co-Lactation by a Queer Couple: A Case Study

Abstract

Introduction: With cultural and social evolution and improvements in reproductive technology, an increasing number of babies are born to lesbian, gay, bisexual, transgender, intersex, queer and/or questioning, and asexual and/or ally parents. As parental roles and gender expression become more expansive, the role of breastfeeding a baby must naturally also expand to include the option of sharing of breastfeeding among parents, called co-lactation (Bamberger & Farrow, 2021). In most cases, co-lactation involves a gestational parent and a non-gestational parent. If a non-gestational parent desires to produce milk for the purpose of breastfeeding, they do so by inducing lactation. While interest in and research about induced lactation are developing quickly, little information is currently available about co-lactation. Main Issue: A couple identifying as queer presented with concerns about inducing lactation in the non-gestational parent, as well as seeking assistance in managing a successful sharing of the breastfeeding relationship. Management: Breast massage, milk expression, acupuncture, hormone therapy, and galactagogues, including domperidone, goat’s rue, and malunggay ( moringa oleifera) were used to initiate and establish lactation by the non-gestational parent. Parents shared the breastfeeding relationship equally and carefully managed milk expression when the other parent was breastfeeding to maintain or increase lactation. Conclusion: With professional lactation support, commitment to a lactation plan, responsive parenting, and strong communication and cooperation between parents, two parents were able to successfully co-lactate for more than a year. Breastfeeding was shared equally and supplementation of breastfeeds was rarely needed.

Safety of pharmacologically induced lactation

“…In the case reports discussed earlier, where domperidone was used to induce lactation, side effects were generally either not reported, or it was unknown whether the authors monitored for side effects. However, side effects were reported in two cases 11,20 . In one case, the mother experienced symptoms of motion sickness that disappeared over time 11 .…”

“…The current pharmaceutical regimen for induced lactation often includes hormonal therapy with a combination of estrogen and progestin 6–14 . The purpose of hormonal treatment is to mimic the effects of these hormones during pregnancy and thereby prepare the mammary tissue for breastfeeding.…”

“…Short-term conventional-dose treatment with domperidone has been shown to slightly increase milk production in puerperal women with insufficient lactation compared to placebo 18,19 . The evidence supporting the effect of domperidone on inducing lactation in nonpuerperal women is based on 11 individual case reports 8–14,20–23 . The cases include induced lactation in adoptive mothers, 8,9,20,21 intended mothers of surrogacy, 10,22 lesbian couples wanting to co-lactate, 11,12 and transgender women wishing to breastfeed 13,14,23 .…”

“…The current pharmaceutical regimen for induced lactation often includes hormonal therapy with a combination of estrogen and progestin. [6][7][8][9][10][11][12][13][14] The purpose of hormonal treatment is to mimic the effects of these hormones during pregnancy and thereby prepare the mammary tissue for breastfeeding. However, there are no randomized controlled trials evaluating the effect of combination oral contraceptives on induced lactation.…”

“…18,19 The evidence supporting the effect of domperidone on inducing lactation in nonpuerperal women is based on 11 individual case reports. [8][9][10][11][12][13][14][20][21][22][23] The cases include induced lactation in adoptive mothers, 8,9,20,21 intended mothers of surrogacy, 10,22 lesbian couples wanting to co-lactate, 11,12 and transgender women wishing to breastfeed. 13,14,23 The daily dosage of domperidone administered in the case reports was between 60 and 80 mg.…”