Making a Full BreastMilk Supply as a Transwoman

A transmom's Guestpost

When my husband and I married in 2015, I was not certain of what the future would have in store for us. Would we have a child or not? It was an open question. For many people this is very much a deal breaker before marriage but I felt it was acceptable in my situation. As a transsexual woman marrying a cis-man I knew that having children the normal way was not possible for us. But by the time 2018 rolled around, we had decided that our journey of life would be more complete by raising a child together. We then needed a plan to make that happen, and we were able to partner with a surrogate mother and an egg donor to help create our child.

I had read about non-birthing mothers breastfeeding their babies in recent years- mostly the non birthing partner in lesbian couples; but also a few scattered accounts from transsexual women. The emotional bonding and attachment development provided by breastfeeding seemed to be something that would benefit our child immensely and something I wanted to develop with our son. Additionally the health benefits of antibodies in breast milk were a big positive. So after doing research into the Newman-Goldfarb protocols, I began the journey to breastfeed our soon to be born son.

With a due date in January 2020 I began a hormone and galactagogue regime in June of 2019. I was taking 20mg Domperidone 4 times a day, 200mg Progesterone twice a day, and 2mg estradiol twice a day. After a referral from a friend I began consulting with Lactation Consultant Serena Meyer RN IBCLC in September 2019. Based on her advice I purchased a Spectra breast pump and began pumping 4 times a day 10 minutes at a time. I also increased my domperidone dosage to 30mg 4 times a day, my progesterone to 200mg twice a day, and my estradiol to 2mg 4 times a day.  At first I pumped very little, about 8.5ml on average each day for the first week, and 13.4 ml on average a day for the second week.

By week 6 I was averaging 82.8ml a day. Again based on advice from Serena I moved to “power pumping” in week 7 – pumping 4 times a day still but each pumping consisted of 10 minutes followed by 5 mins rest, another 10 mins, another 5 mins rest and a final 10 minutes. Within two weeks of that I was averaging 152.8ml a day. I then increased my pumping  to 5 or 6 times a day. I'm not going to lie – holding down a full time job and getting all this pumping done was hard! But I wanted to share this special bond with our child, and I knew that it would all be worth it if I was successful.

By week 13 (and three weeks before the expected due date) I was pumping 310ml a day. At that point, per the Dr. Jack Newman protocols, I stopped the progesterone and cut the estradiol back to 4mg a day. I also increased my pumps to 7 or 8 times a day. The week before the baby was born I was pumping 385.5 ml a day. The day before our son was born I pumped 454ml.

Our son was born at 1pm on Jan 5th. The birth mother healed well and we were able to visit with her a number of times in the days and weeks following the birth. We look forward to having a lifelong friendship with her and her family, and it's important for us that our son knows her and understands how he came to be in the world.  After our son was cleaned up and tested he was given to me. I had informed the hospital I intended to breastfeed. With some tips from our lactation consultant our son latched easily. Everything seemed to be going well the first few days and I was exclusively breastfeeding. Weighted feeds showed he was taking the appropriate amount of milk when he fed.

A big stressor was maintaining supply as a newborn does not eat much. So I pumped as often as I could while still caring for our newborn. Heading to the pump and leaving our newborn with my husband after an hour-long feeding session was hard, but I was very paranoid about not making enough milk for our child. On day 4 we discovered he was approaching too much weight loss (about 5% off his healthy birth weight) and I began to panic. In inducing lactation, my baby’s well being was always paramount in my thinking and to imagine I may have caused him too much weight loss devastated me. To me there was one cause - I was not making enough milk. 

Looking back I think I was going about the feeding all wrong – I was obsessed with intervals between feeds, and even if he was still hungry, I was taking him off the breast before he was done as I thought my breasts were empty, or avoiding putting him back on until I thought I was ready. I realize now that this is exactly the wrong thing to do! But at the time it's what we did.

We had plenty of expressed milk frozen so we began supplementing with that. His weight stabilized and started to climb. Out of an abundance of caution we also began to mostly skip breastfeeding in favor of me pumping and then bottle feeding him the expressed milk. It provided my very anxious self a sense of control that was otherwise lacking to know exactly how much he was eating. We also supplemented with frozen breastmilk and formula. In the early weeks, still believing I wasn’t making enough, I started to use more and more formula, and I started to hate pumping more and more. I was nervous for each breastfeeding session thinking “would this be the last time” our son would latch.

When our son was 5 weeks old my husband was set to go back to work and I prepared to begin taking care of my son alone during the work day. The prospect of trying to pump while taking care of a 6 week old seemed overwhelming - any time I could put him down I wanted a break not to pump! I consulted again with Serena Meyer RN IBCLC about how to pump less and breastfeed more. She encouraged me to just try breastfeeding only for one day and see what happens. If he loses weight you know you need to supplement, if he doesn't then you can just breastfeed. 

So I breastfed for a day without supplementing and the next day he gained about 10 grams. So a little low on weight gain. We decided to supplement with a bottle or two of formula a day (also this gave me breaks so my husband could take some feedings!). I stopped pumping completely and happily. Our son was steadily gaining weight and was hitting developmental milestones early. Over the following weeks my husband began to have more and more trouble with the bottle and it became a battle for him! Often my husband would bring the baby to me to calm him down and breastfeed him. Also our son started going to sleep earlier without that last night feeding. Eventually we just gave up giving him the bottle and starting at about week 9 he became exclusively breastfed again.

I thought I might list some of the challenges as well – my libido was greatly reduced since I started pumping regularly and has become non-existent since my son was born. The domperidone exacerbated the IBS like symptoms I experience, but it has been manageable.  Being the only person who can feed the baby is a lot of stress. It was amazing having a 2-3 hour break when my husband could still watch the baby and feed him bottles. I don't get that now. But the baby sleeps longer at night, so that's a plus. 
As of week 15 he is steadily gaining weight and looks to be on pace to double his birth weight by the end of Month 4. He is a happy smiling little fellow with good neck control and the ability to roll from belly to back. He also loves making eye contact – the special smiles and eye contact we share when he's on the pillow and about to latch are absolutely the most love I have ever felt in my life. I'm so thankful to be able to breastfeed and I'm in debt to our lactation consultant Serena Meyer and the doctors I have worked with. And of course we are also in debt to the surrogate mother and egg donor without whom our son would not exist.

LC Addendum: Any medical information in this article does not constitute advice, you should always contact your own Dr about any medications and before you adjust your hormone therapy yourself. -Serena Meyer RN IBCLC