P3.B027: Lactation practices in sexual and gender minority parents: A scoping review

Background: Sexual and gender minority (SGM) parents have unique biological and psychological constraints when it comes to nursing their newborns. Counseling SGM parents around lactation can be challenging for healthcare professionals (HCP) who are often unfamiliar with lactation practices that can be offered to this patient population. In this scoping review, we aim to summarize published work describing lactation practices in SGM parents.

Methods: Four databases (MEDLINE, CINHAL, Scopus and PsycInfo) were searched for relevant articles published between 2015 and 2024. Search terms included “sexual and gender minority”, “lgbt*”, “2slgbt*”, “lesbian”, “gay”, “same sex”, “transgender”, “nonbinary”, “intersex*”, “queer”, “gender fluid”, “gender nonconform*” and “lactation”, “human milk”, “donor milk”, “breastfeed*”, “chestfeed*”. Relevant articles were selected and synthesized into our scoping review. Articles were excluded if they did not discuss lactation practices in at least one parent identifying as SGM or were written in languages other than English and French.

Results: Our search yielded 419 articles which were screened by two independent reviewers. A total of 35 articles were included in our scoping review (Figure 1). The 35 studies included 12 literature reviews, 2 book chapters, 7 qualitative studies, 1 cross-sectional study, 1 mixed study, 7 case studies and 5 case reports. 21 articles describe practices in transgender males, 14 in transgender females, 10 in same-sex female couples, 5 in non-binary individuals and 1 in a same-sex male couple.

Four themes emerged from our analysis: Lactation induction methods, psychosocial factors affecting lactation, modified feeding techniques and alternatives to chestfeeding.

The most common theme (n=21) described lactation induction methods. Most employed a modified version of the Newman-Goldfard protocol. Adaptations included different time of initiation, duration and cessation of hormone therapy based on patients’ gender identity. Some added alternative herbal supplements to their protocols and recommended a variety of chest manual expression schedules.

Fourteen articles described psychosocial factors affecting lactation. A number of parents suffered from gender dysphoria and from the language surrounding pregnancy. To manage gender dysphoria, some SGM parents initiated testosterone (n=6) and chest binding (n=4) while concurrently nursing. Twelve articles mentioned the impact of chest masculization surgery while nursing, some discussing the psychological impact of delaying gender-affirming surgery in order to nurse.

Six articles described modified feeding techniques. Given the varied anatomy of the chest within this population, modified positions must be used to optimize infant latching. Cited alternatives include the “cross-cradle” and “sandwich” technique.

Six articles described alternatives to chestfeeding, including the use of formula to supplement nursing. Human milk donation through peers was also discussed with their associated risks (n=3).

Conclusion: This study summarizes existing literature describing diverse lactation practices in SGM parents. Our findings can help HCPs counsel and support SGM parents wishing to nurse their newborns.