PLANNING
When I was pregnant and looking ahead to having a newborn, it was very hard for me to tell how I would feel about nursing. I have dysphoria around my chest that fluctuates and when I read information on or listened to people talk about ‘breastfeeding’, my dysphoria would get worse. I didn’t always know if that was because I was feeling more masculine at the time I was absorbing the information, because the language used was dysphoria inducing, or because the act itself would cause dysphoria.
So we planned for all options. I learned what I could about nursing (which turned out to be just the basics because it would inevitably make my dysphoria worse). We purchased a set of bottles, nipples, a sterilizer, and formula. And I looked up information on pumping and bought a basic manual pump to try. No matter how I felt about nursing or how our baby did with it, we had a way to feed them.
NURSING
The first time I tried nursing was nothing special. There was no feeling of euphoria or ecstasy, no overwhelming feeling of connection with my baby. But it went well and within the first few days both of us had figured out the mechanics. During this initial phase, it was all about learning a new skill and as long as I focused on that, the dysphoria was secondary.
By the fourth day we had pretty much gotten the hang of it but my baby was still looking a bit jaundiced and was showing signs of dehydration. It turned out that although my milk was coming in, my let-down was nearly non-existent. My midwives explained that this is common after receiving an epidural. So they showed me how to hand express during nursing to increase the flow.
This worked well and my baby quickly improved. However, hand expression meant I had to be constantly engaged with my chest during nursing every few hours. My let down didn’t seem to improve a whole lot and after a week of doing this my dysphoria had increased to the point where I needed to keep myself, and therefore the baby, covered during feeding. I would express by feel and be able to watch tv as a distraction without the view of my chest in my peripheral vision.
The juxtaposition of the baby that I had a lot of love and connection to and my chest that I was increasingly uncomfortable with was very emotionally taxing. But due to the intense fatigue that comes from recovering from a four day labour and sleep deprivation from having a newborn that needs feeding every 2-3 hours, I was in survival mode and didn’t recognize how emotionally drained this experience of nursing was making me.
In addition, nursing sessions were lasting longer and longer, often an hour or more. According to everything I had read and been told, once my milk came in and the baby learned how to suck and swallow efficiently, nursing would get faster and faster, eventually down to about twenty minutes. I didn’t know why this wasn’t the case for us but I knew it likely wasn’t good. Not to mention the longer sessions were increasing my dysphoria significantly faster.
At our two week follow up with the midwife we found out that the baby wasn’t gaining weight like they should. Despite all the physical and emotional energy I had been putting into nursing, it wasn’t working. Without warning, I broke down into tears. I felt like we had been doing well. The midwife explained that between the baby’s lower body weight and the long nursing sessions, it sounded like I didn’t have enough milk supply. The baby was burning more calories than they were getting. So we decided to start supplementing with formula.
BOTTLE FEEDING
The plan was to nurse at each feeding time for 15-20 minutes per side, then offer formula in a bottle until the baby decided they were full. We discussed other supplementing options like a supplemental nursing system or SNS but since we already had bottles and it would mean that my husband would get a chance to be involved in feeding (which he was excited to try) we decided bottles were the way to go. Besides, an SNS would likely only increase my dysphoria further.
Luckily our baby took to bottle feeding very easily. Maybe it was because it was a clear source of the nutrition they had been struggling to get from me but without all the effort. My husband did the first bottle feeding session using a paced feeding technique. At the second meal, I tried it. The emotional experience of feeding my baby from a bottle as compared to nursing was significant.
I was able to stay engaged, watching my baby figure out how to coordinate sucking, swallowing, and breathing. I could enjoy the cuddles without experiencing dysphoria at the same time. Since both my husband and I were feeding the baby this way, it was a completely gender neutral or gender irrelevant experience. It was lovely.
Once I discovered how much better feeding my baby from a bottle was, I was reluctant to keep nursing. But I wanted to feed my body as much human milk as I could because of the health benefits and the ease of digestion for their still developing gut. So in order to keep increasing my supply without nursing, I had to start pumping.
PUMPING
I started using the manual pump I had purchased while pregnant. It was fairly easy to figure out. I still didn’t have much let-down due to low supply and therefore had to continue to hand express while pumping which meant the dysphoria was just as bad with pumping as with nursing, but it wasn’t competing or overshadowing the positive emotions I had for the baby. I could experience my love and bond with my baby separately.
I also had a feeling of altruism because I was doing the hard work of extracting the milk so my baby didn’t have to. Unfortunately, pumping 4-6 times per day with a manual pump while hand expressing takes a toll on your hands pretty quickly. My hands started getting too sore to express and too sore to pump more than 3 times a day. So I had to be satisfied with whatever milk I got from those sessions (one eighth to one fifth of what my baby was eating) and say that it was better than nothing.
Luckily, my midwives were connected with a publicly funded, trans inclusive lactation clinic in my area and put in a referral.
LACTATION SUPPORT
As soon as we discovered that I had low supply, I started taking supplements to help increase my supply slowly. I was reluctant to take the stronger, recommended medication in case it increased my supply more than I could handle in terms of dysphoria. I really disliked the few times I experienced the feeling of being engorged while my milk was first coming in. The supplements or the pumping seemed to be working because my supply was increasing. By the time the initial visit with the lactation consultant came up, I was consistently producing a fifth to a quarter of what my baby was eating.
Despite knowing that the lactation clinic was trans inclusive, I had significant anxiety and dysphoria leading up to the initial appointment. But they turned out to be great. The intake form that I filled out online in advance didn’t ask explicitly about identity and pronouns but it used inclusive language for the most part and had a fill-in-the-blank box at the end where we could put anything else we thought would be relevant.
They clarified my pronouns right off the bat and asked about my goals. They made it clear that their role was to support me in achieving whatever goals I had, whether it was to increase supply, maintain current levels, or stop lactation altogether. They were understanding and respectful of my experience of dysphoria and my need to balance that with the desire to feed my baby as much using my milk as possible.
Ultimately, I started taking the standard medication to increase supply and rented a hospital grade, double electric pump. I was nervous about how this style of pump would feel and it definitely took some getting used to but it allowed me to set it and forget it while still getting as much milk as possible. I adapted a sports bra to hold the flanges in place and was able to watch tv or play on my phone while pumping. Best of all, I didn’t have to wear out my hands to get milk. Sure, the altruism factor related to the hard work was less but being able to stay covered up and ignore it was great.
WHERE WE ARE NOW
Now, at three months postpartum, I am producing three quarters to 100% of what my baby eats. We have noticed a big improvement in our baby’s amount of gas and therefore their ability to sleep through the night. Even that, without any other benefit, is enough encouragement to keep me going. I am still taking the medication and my supply is still increasing slowly but with minimal feelings of engorgement and only pumping three times per day.
My plan is to continue what I’m doing for another three months. I will stop taking the medication after about eight weeks on it or once my supply is to the level I want, whichever comes first. Once my baby is six months old and starts eating solids, the lactation clinic will help me decrease and ultimately stop lactation.
I am happy with how this journey has turned out, despite the struggle at the beginning. I have had phenomenal support from my midwives, the lactation clinic, and especially my husband. Regardless, I am definitely looking forward to the day when I can wear my binder again.
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