Trans* Pregnancy and Lactation: A Literature Review from a Nursing Perspective

Abstract

Pregnancy and lactation involve two aspects that are socially and culturally associated with women. However, there are a few biological differences between male and female breast tissue. Lactation and pregnancy are viable processes that do not depend on sex. Even for the latter, it is only necessary to have an organ capable of gestation. Ways to favor mammogenesis and lactogenesis in trans* women have been established. There are protocols to promote lactation in trans* women, usually used for adoptive mothers or those whose children have been born through gestational surrogacy. Chestfeeding a baby could be the cause of feelings as diverse as gender dysphoria in the case of trans* men, and euphoria and affirmation of femininity in trans* women. This study involves a review of the available scientific literature addressing medical aspects related to pregnancy and lactation in trans* individuals, giving special attention to nursing care during perinatal care. There are scarce studies addressing care and specifically nursing care in trans* pregnancy and lactation. Our study indicates the factors that can be modified and the recommendations for optimizing the care provided to these individuals in order to promote and maintain the lactation period in search of improvement and satisfaction with the whole process.

Genetic counselors' experiences with transgender individuals in prenatal and preconception settings

“…Medical, nursing, and dental trainees have expressed that they do not feel sufficiently prepared to medically treat these individuals (Greene et al., 2018; Zelin et al., 2018). There is limited and inconsistent medical education and institutional training that focuses on caring for this community (Garcia‐Acosta et al., 2020; Hoffkling et al., 2017; Paradiso & Lally, 2018; Snelgrove et al., 2012). Many providers lack the proper training, tools, or resources to provide uniform care to patients that are not cisgender.…”

“…However, trans men have described barriers to care throughout the entire reproductive period, including conception, pregnancy, delivery, and postpartum (Hoffkling et al., 2017). This may be due to discrimination, stigma, geographic location, and lack of appropriately trained providers (Garcia‐Acosta et al., 2020; Light et al., 2014; Obedin‐Maliver & Makadon, 2016). Estimates also suggest that the adult transgender population disproportionally belongs to racial and ethnic minority groups when compared to the United States’ population overall (Flores et al., 2016).…”

Maternal Health in the Transgender Population

“…TGMs may also control their gender presentation by dressing as an overweight male or binding their breasts. 35 The use of a breast binder during pregnancy could interfere with lactation and increase the risk for complications such as mastitis. Several of these factors may make TGNC patients more likely to choose alternative settings for delivery of their babies and may influence their preferences for midwives or nonphysician providers.…”

“…Excessive pumping or chest stimulation may result in increased milk production, so the wearing of clothing tight enough to prevent breast expansion is recommended, but not so much to cause mastitis. 35…”

Provision of Human Milk in the Context of Gender Diversity: AWHONN Practice Brief Number 15

“…Nurses and other health care providers should ask patients how they describe themselves, and this language should be documented in the medical record accessible to the entire interprofessional team. Little published evidence exists related to the ability of transgender women to secrete milk without the use of hormone intervention (García-Acosta et al, 2019). However, individual case reports demonstrated that feminizing hormone therapy and pumping may help to support lactation and breastfeeding (Reisman & Goldstein, 2018;Wamboldt et al, 2021), and early and individualized intervention may help to support lactation and breastfeeding goals for transgender individuals.…”