Supporting LGBTQ+ families

The breadth of experiences that people from the LGBTQI+ community go through cannot possibly be covered in one episode, but today we’re making a start on how to support the community with lactation in its many forms.

I’m speaking to BJ Woodstein IBCLC, who is also a doula, an academic and a translator, about the many choices open to Queer parents, including induced lactation, feeding after surrogacy and SNS chest feeding, as well as the discrimination that many face during medical care and in the workplace.

Follow BJ on Instagram @‌bjwoodstein
Her website is www.bjwoodstein.com

And her book, We’re Here! A Practical Guide to Becoming an LGBTQ+ Parent by B.J. Woodstein - PraeclarusPress

My new book, ‘Supporting the Transition from Breastfeeding: a Guide to Weaning for Professionals, Supporters and Parents’, is out now.

You can get 10% off the book at the Jessica Kingsley press website, that's uk.jkp.com using the code MMPE10 at checkout.

Follow me on Twitter @MakesMilk and on Instagram  @emmapickettibclc or find out more on my website www.emmapickettbreastfeedingsupport.com

Resources mentioned in this episode - 

Some listings and resources mentioned here (US focused): Our Favorite Queer and Trans-Centered Resources for Families and Birth Workers — Birthing Advocacy Doula Trainings (badoulatrainings.org)

UK directory here: The Great LGBTQ UK Business Directory! http://lesbemums.com

This podcast is presented by Emma Pickett IBCLC, and produced by Emily Crosby Media.

Transcript

Emma Pickett  00:00

Hi. I'm Emma Pickett, and I'm a lactation consultant from London. When I first started calling myself Makes Milk, that was my superpower at the time, because I was breastfeeding my own two children. And now I'm helping families on their journey. I want your feeding journey to work for you from the very beginning to the very end. And I'm big on making sure parents get support at the end to join me for conversations on how breastfeeding is amazing. And also, sometimes really, really hard. We'll look honestly and openly about that process of making milk. And of course, breastfeeding and chest feeding are a lot more than just making milk. 

Emma Pickett  00:46

Thank you very much for joining me for today's episode, I'm with the lovely BJ Woodstein, who's an author, academic translator, doula, IBCLC, and lots of other things besides. She lives with her wife Fie, and their two children in Norfolk. And she's the author of We're Here, A Practical Guide to Becoming an LGBTQ plus Parent, published by Polaris Press. I can't say that word, but I'll try and say that word. In this conversation, we're going to be talking about breastfeeding, chest feeding and infant feeding for queer families. And we've only got an hour, we're not going to pretend to be able to describe a universal experience. Obviously, you can do PhDs in this subject, let alone try and cover it in an hour. We've got lots of different families we're talking about every family is different. But hopefully, we're going to share some information that will be useful for families and those that support them. Thank you very much for joining me today, BJ.

BJ Woodstein  01:38

Thank you for having me.

Emma Pickett  01:39

So can I just start with the language check. I've heard you speak at the ABM conference. And I've read your work. And I know that queer is a word that you embrace yourself. Are you okay with me using that word? Is there anything you'd like to say about that word queer or, or language generally, before we get started?

BJ Woodstein  01:55

Yeah, I mean, a lot of LGBTQ people don't like the word. So I appreciate that you have checked to see what I'm comfortable with. I really like the word queer for myself, for a couple of reasons. One is that it has been used in such pejorative sense before. So I'd like that I'm reclaiming it, and using it in a positive way for myself. I also like that it's really inclusive. It's kind of this overall umbrella term, instead of having to choose something that maybe doesn't feel quite right, like maybe lesbian or bisexual or whatever it might be. I can say queer, because it covers quite a lot of aspects of my personality and my life.

Emma Pickett  02:35

Yeah, the sort of LGBTQ plus Where do you where's there's a plus stop? Which letters do you include? It seems like you know, if you don't use some letters, other people are going to feel discounted, are you saying bisexual pansexual. So I'm happy to use that word. If you are too great. Let's move forward with that. Thank you. So it is actually, as I said, in the introduction, very hard to make any generalisations about what queer families might experience is there's obviously a huge range of how families are made and people's biology and people's choices. Tell us about why you wanted to write your book, We're Here. 

BJ Woodstein  03:06

It's the book that I wish had existed when my wife and I were thinking about starting our family, there was so little information available about what our options were. And I also was aware that living here in the UK, our options were different than say somebody living in Italy or someone living in the US. And again, they were different depending on what region you lived in, in the UK. So I wanted to kind of demystify things for other queer individuals and families. And so here is kind of your one stop package, all the options listed here, to the best of my ability with some stories from families about how they did it, and why they made those decisions. With my hoping that this will kind of guide you on your way. I wished somebody had said to me in fi, okay, well, you know, as a two woman household, you can do X, you can do Y you can do Z, here are the pros and cons of each of those approaches when it comes to making your family and that's kind of was the impetus for the book.

Emma Pickett  04:07

Yep. So one thing I just gonna state for the record is I think we sometimes as a society slip into assumptions that we can ask queer families about how they had their children and, and you know, they don't get privacy by default, because everyone says, Oh, how, you know, sperm donor? Did you know The donor bla bla bla bla bla, how did you pick? It doesn't get asked all those questions. So I'm not going to ask you a single question about about your choice and your choice with fi but let's talk hypothetically about a lesbian couple in the UK. Let's say they're both cisgender female, they want to start their family. What are their options in the UK? What are sort of people's common choices?

BJ Woodstein  04:40

Yes, thanks so much. I'm as well for not asking because I often feel like people do assume that we are going to be the case and we'll tell everything about our lives. And I kind of feel like actually it's our children's stories to share if they choose to. So if you were hypothetically a cisgender two woman, household you You have lots of options. Of course you could foster or adopt, you could have a known donor. So that's where it's a friend or relative who donate sperm to you. And if it's a relative, you usually would implant the sperm in somebody who is not related to that person. So, you know, it's the brother of Person A, and it goes into Person B, for very obvious reasons. If it's a friend, you Ando so if it's a relative, you kind of need to work out a contract in advance, saying what your expectations are in terms of contact, what kind of relationship are there going to be sleepover visits is the child going to know, lots of details to sort out there, you can also go for an unknown donor. But even within that, you have your options, you could go to your local fertility clinic, and they will give you only a few choices, you fill in a form, you might say, my spouse has black hair, I would like the sperm donor to have black hair and the search through their database and find maybe three for you to choose from. Or you can equally go to a fertility clinic or stay at home and you can order sperm from one of the sperm banks abroad. Most commonly in the UK, people go to Denmark, because there's a really big sperm bank in Copenhagen. And you can have that shipped to your clinic or to your home, if you want to do at home insemination. There's also a really big sperm bank in California that you can choose from. And if you do that, you can then visit their options with an options you can also pay extra and choose somebody who's willing to be contacted when the child hypothetical child turns 18. So within all of these options, you kind of have to have this big conversation about what are we looking for here? Does biology matter to us? How much does it matter? You know, so do you want it to be like a brother who donates the sperm? If it's going to be someone we know? What kind of contact are we looking for? If it's somebody that is an unknown sperm donor? are we hoping that our child could one day have contact? Or does that not matter to us? So a lot of conversations that you need to have while deciding.

Emma Pickett  07:12

Yeah, and I know that obviously, there are there are going to be times when couples are going to face discrimination. Particularly, you know, trans and non binary families are going through a lot of difficult times in the UK at the moment. What are some of the I don't want to dwell on the negative because there's a story about lactation and families being created positively. But I think it's important to highlight discrimination is out there, what is what are some of the discrimination that families that you spoke to have have faced within the UK, particularly trans and non binary families,

BJ Woodstein  07:41

the very first thing I would say is that it is still a postcode lottery. So depending on where you live, you will get different kinds of treatments. And trans and non binary people I've spoken to, in particular have mentioned, GPS not being supportive, not being willing to then refer them on. And the thing is, is that if you don't have the money yourself to pay for fertility treatment, you need to go through your GP and get referred for the NHS. And that partially depends on where you live. It also partially depends on your GP, and what they're willing to say. Many GPS will say you have to have been trying to make a baby at home for six months, or 12 months before we'll refer you. But in certain situations, that's simply not possible. If you're taking hormones, for example, and that might be effects your eggs or your sperm, depending on what organs you've got. Or if you know, for example, in the case of two women, you can try all you like at home, and you're not going to produce a baby. So there's that kind of gatekeeping discrimination, then you have the case of going to a clinic, and they're there to make money. So they're thinking about, Okay, well, how likely is this person going to get pregnant, and they might encourage people to change hormone dosages, they might not want to deal with a certain clinic, somebody I spoke to said that they were a queer couple, don't get more detail from that. And they went and the clinician said to them, I don't like you people, but we have to accept your pink pound, you know, that was actually sent to them. So then you're kind of dealing with that and people's own prejudices, their own biases, their own desire to make money and wanting to have really good results for the clinic. Also, many people don't understand the specific needs of queer individuals and queer families. So you know, they might say that you need to lose weight, or they might say you need to be off your hormones. And that can really cause a lot of issues for people in terms of mental health, too. So all sorts of kind of gatekeeping issues, I would say really, oh, and one other thing is that many clinics are very careful to do lots of blood testing. So, for example, when my wife and I went even though I was going to be caring for They insisted that my wife get blood tests to show that she didn't have HIV that she didn't have other conditions because they felt to a child couldn't come into a home like that. And that is something that happens to a lot of LGBTQ plus people. It feels very intrusive and very uncomfortable. Oh, and I've also spoken to people who have noticed on the records that clinics have written, you know, diagnosis, same sex couple, or diagnosis, trans man, that's not a diagnosis, that's a descriptor. You know, it's not like we're, you know, we're going there with a particular condition. That would be maybe a diagnosis like PCOS. being queer is not a diagnosis. 

Emma Pickett  10:39

Yeah, good. Okay. Okay, I wish I could say that those stories were few and far between. But in 2024, this is this is still happening. So our focus today is on lactation. That's what we're gonna be talking about today and breastfeeding and breastfeeding. So let's go back to the hypothetical cisgender. lesbian couple, they are both going to be parents and some people might be surprised to know that both of them could potentially breastfeed. Even Even someone who's never lactated never historically given birth, can you talk us through what's known as induced lactation? And what are some of the sort of pros and cons and and the couples that you've supported? How do they kind of make the decision about whether induced lactation is right for them? That's a big question. 

BJ Woodstein  11:24

It's amazing. Ya know, it's I just find it endlessly fascinating and exciting that actually, there are so many options. People often think that if you're queer, your options are sort of closed down. But in the world of lactation, I would say we've got in some cases, more options than cisgender and straight people, which is really cool. So if in our hypothetical situation, we've got two women, and they both want to breastfeed, and let's say they use the terminology, breastfeed rather than just feed or body feed or nurse or something, but just for the sake of the ease of our conversation was like breastfeed for now. So one who is not carrying the baby can go through the protocol, there's a very standardised protocol about taking hormones, and starting to try to express milk, ideally, using an electric pump, because that is more powerful in many cases than a manual pump. And it's something that is usually recommended that you start some months before birth, so that your body is starting to get ready. Many people do find it easier to kind of get that going when the baby's here, because you know, to be saying, okay, take your hormones and start expressing milk. And you know, your wife is only, you know, five months pregnant. It feels very hypothetical, it doesn't feel concrete. And it can feel like, wow, this is a lot of effort to be sitting here, you know, using a pump several times a day, when there's no baby who's getting you know anything from me. So it's usually recommend you start in advance. But understandably, some people choose to start a little bit later. One of the things that I find very interesting is to think about the ethics of the situation, if you know that one of the two mothers is going to be the primary feeder, then it might make sense in that situation, for that person to start kind of exclusively breastfeeding the baby, so that her supply is there, and so that she gets into a routine. And then you can add in the other mother, especially as I said, if she's not planning on doing it in a primary fashion, however, if they are planning to share it, or the other mother is the one who intends to be the primary breastfeed her, then you do have to rethink that situation. So it's important for them to talk in advance about what they're planning to do and why. Another related option for them, which is also a form of sharing feeding, is if the one who is not gestating right now has previously given birth. Either she can relax ate it, which is a lot easier, in some ways. If she has stopped lactating, or if she's already feeding a baby or a toddler young child, she can simply start putting the new baby to her breast as well. And one other thing we've been talking about kind of induce lactation and re lactating but I've also spoken to people who had kind of spontaneous lactation. So non induced lactation where it was kind of this moment of I didn't just take the baby, but here's the baby, my hormones have gone crazy. I'm so like, thrilled and in love with this baby and my breasts are producing milk. And some people have gone with that and encouraged that and other people have said, that's not really for me, and they've decreased their milk supply and not fed. And so those are some of the choices they have. 

Emma Pickett  14:45

Yeah, oxytocin is an amazing thing. Your body just going Whoa, baby in the house. Let's just go.

BJ Woodstein  14:51

And actually, you know, we've heard cases of men spontaneously lactating as well and choosing to feed their baby too. So it's not it's not only for women. 

Emma Pickett  14:59

Yeah, yeah. So you mentioned that hormonal protocol, which I know is that the Newman Goldfarb protocol. Thank you. So, no, no, I mean, I tell you totally fair enough, we can't go into detail on everything. And in that protocol, people take a hormonal contraceptive pill to sort of mimic the hormones of pregnancy. And then the idea is you stop taking that and then you start taking a drug, which is usually on paradigm which are going to stimulate prolactin hormone. And you do that all the way through while you're expressing breast milk. So So one couple I worked with, you know, as as a lesbian, she'd never taken birth control, she'd never taken hormonal contraception, the idea of taking the combined contraceptive pill did not feel comfortable that was just felt very alien to her. And she didn't want to use any hormonal contraception at all she really just wanted didn't even want to use don't Paradine just wanted to use a breast pump is that an option is that going to be less successful? If somebody does that?

BJ Woodstein  15:52

I think the research suggests that it generally is slightly less successful. But that doesn't mean it's not an option. And especially I would say, if you wait until the baby's here, and you've got that kind of hormone, natural hormone, from seeing your baby, getting to smell their clothes, getting to look at them. And you know, if you're away from them looking at pictures of just like we would advise for anybody, you know, expressing milk that can work, it's just that it's a little bit easier if you help it along the way with hormones. And I do think Emma, it's really important for us to mention, you know, our sort of hypothetical example is to women, who are who identify as lesbians and who are cisgender women. But it's also very possible for trans women to go through this protocol. And I worked with a couple where they were two women, one was trans and it was really important for her. She She described as kind of validating of her womanhood to breastfeed, and so she started the protocol, some mums before, and actually really enjoyed the process. Because it was a way of preparing for their baby's arrival, and was able to produce not a full supply, she was not the primary feeder, and she went back to work relatively quickly after the baby was born. But she was able to produce some milk and to feed the baby at her breast some of the time and that was really special for her. 

Emma Pickett  17:14

Yeah, yeah, I think there. There are always myths floating around on social media. I think one of the myths that's been floating around in the last few weeks and months is that if a parent induces lactation, their milk is somehow going to be inferior, there GALACTA sales are going to operate in different ways somehow will be full of hormones, do we have any evidence to suggest that milk is inferior if someone's induce lactation?

BJ Woodstein  17:34

No. I mean, for one thing, there's not been a huge amount of research, but what research we do have has not suggested that in any way and in fact, people have been using will use the technical term, the Newman Goldfarb protocol for quite some time. Initially, I think it was developed for adoptive parents. And nobody was ever saying, Oh, if you're, you know, an adoptive parents, you know, your milk isn't as good. Nobody was ever saying that. It's only when it relates to queer people, that there's this kind of concern. So there's been no research to suggest that and in fact, it'd be really interesting to see somebody researched the nutritional quality of milk from different parents and how that milk was produced. Because there might be some, you know, we know that your milk is different depending on your baby, and kind of how often your feeding and for babies ill. And it would just be fascinating to know if there are any differences. 

Emma Pickett  18:22

Yeah, I mean, we know that the volume of milk that you produce can can control things like your protein content and your sodium content. So I guess there's going to be some variation there, in the same way that people feeding toddlers kind of go into that kind of weaning milk phase. And as their volume drops their milk constituents change, but I don't think we'd ever argue that smaller volume is harmful or going to be hurting. 

BJ Woodstein  18:42

But it's not as good and that you shouldn't be, you know, feeding your baby or something like that. 

Emma Pickett  18:47

No, yeah. And it could well mean if there are two parents and one of them's induce lactation, that baby gets to be exclusively human milk fed in a way they may not otherwise. I mean, you talked before about the sort of primary feeder and the secondary feeder for family are not exactly equally co feeding. One of the things that that I've talked about with couples is the importance of those very early days, and having really explicit conversations that you can't necessarily have an advanced because you don't know how you're going to feel. So baby blues, for example, or that sort of hormone or rush that comes, you know, day four, day five, you know, you're gonna have a wobble, you're going to worry about who you are, as a parent, you might worry about your milk production. You know, you need to make sure that you can have really honest conversations with your partner in a way that doesn't leave them feeling like you know, their milk supply is lesser or less important. You know, we want to make sure that the the mom who's given birth is able to develop their milk supply fully and this is likely to be a family with breast pumps, I'm gonna be guessing it's, you know, we're gonna be protecting everyone's supply. We're gonna be making sure that, you know, mastitis isn't a risk and blocked ducts aren't going to be a risk. So this is probably a family who's been pumping through the end of pregnancy, and then using the pump to protect everybody is breastfeeding breastfeeding journey once baby's here as well?

BJ Woodstein  20:02

Absolutely. The kinds of conversations that you're recommending that people have are so important. And in some cases, it might be useful for them to see an ibclc before birth or to maybe from the National breastfeeding helpline or whatever, you know, they can they they feel they can fit into their schedule and within their means. Because you don't always know the conversations you need to have. Yeah, until, you know, until it's the time I mean, actually, it relates back to what we were saying before about choosing adoption, known donor, you know, unknown donor, because people don't know how they're going to feel, they might think, hey, it's great to have a known donor, some a couple I've worked with, use the brother of one of them. And they thought it was an excellent plan, a way of keeping it within the family, he would be involved. And then the mother who carried has actually said she's regretted it every single day since because they see him so often. And she didn't want that kind of relationship, and she feels she's got less control over the child, but you don't know until you're in the situation, how you're going to feel. So maybe having a guided conversation, as I said, with an ibclc, or maybe a counsellor. So you're thinking about those kinds of really difficult issues.

Emma Pickett  21:09

Yeah, this there's a feeling stuff and there's emotion stuff. And there's also the practical lactation stuff. So so everybody, even the heterosexual male female couples, so wouldn't it be great if my husband could breastfeed, that would be the dream, but we don't want day three, you know, mother who's given birth to be sleeping all night long and her partner to be breastfeeding through the night even, you know, let's imagine her partners, amazingly successful induce lactation, loads of milk is able to breastfeed a newborn on day three, you know, that whole night of of the birth mother not feeding is not Plan A, I mean, that is going to that is definitely not not not going to be ideal for, you know, their lactation moving forward and helping their milk come in, etc. So it's also important that lactation consultants having that conversation can feel comfortable having that conversation and, and, you know, to say that it's not dismissing the partner who is inducing lactation or not implying that they aren't, they are lesser than it's just about knowing how hormones work, knowing how an actor Genesis works, knowing what prolactin needs, and just having the sort of fact so everybody can make a really informed decision. And I have worked with one couple who thought they were going to do and just lactation and very quickly realised it didn't feel comfortable. And, and the the emotions were not what they were expecting, post birth and, and it didn't last more than a few days, which and I think we have to be open to all options and all all possibilities. Absolutely. And equally, if somebody who's, you know, in a lesbian relationship does not want to induce lactation and is not their bag, you know, that is absolutely their right, if

BJ Woodstein  22:45

you have somebody and they don't want to induce lactation, and as you said, that's absolutely their choice. They still can do, you know, nice chest to chest skin to skin contact, and that can include the baby suckling on their nipple, if that feels comfortable for them as a couple, and I have spoken to people who've done that, you know, like, oh, you know, the one who's breastfeeding is having a shower, baby is crying, let's put baby to the breast. Yeah, she's not getting anything out of it, or he's not get anything out of it. But that doesn't matter if the baby is enjoying the process of suckling. So, you know, that is certainly an option too. 

Emma Pickett  23:17

Yes, all options. There's so many different things that so many don't realise, and

BJ Woodstein  23:22

we haven't even covered them all yet.

Emma Pickett  23:27

A little advert just to say that you can buy my four books online. You've Got It In You, a positive guide to breastfeeding is 99p as an e book, and that's aimed at expectant and new parents. The Breast Book published by Pinter Martin is a guide for nine to 14 year olds, and it's a puberty book that puts the emphasis on breasts, which I think is very much needed. And my last two books are about supporting breastfeeding beyond six months and supporting the transition from breastfeeding. For a 10% discount on the last two, go to Jessica Kingsley Press. That's uk.jkp.com and use the code MMPE10, Makes Milk Pickett Emma 10. Thanks.

Emma Pickett  24:13

Okay, let's change hypotheticals for a moment. Let's talk about a gay couple who are both cisgender male, they're using surrogacy or adoption to make their family and they want to give their baby human milk. What are the options for them in the UK? 

BJ Woodstein  24:30

Well, so if they're let's start with the surrogacy example. They have the option of asking the surrogate, whether she would provide milk so she would then have to express and I have heard from people who've decided to do that for say, six weeks or for several months and that is a conversation they have to have there is usually some sort of remuneration, you're not technically allowed to pay for surrogacy or you know, somebody producing milk for you or anything like In the UK, but you are allowed to cover expenses. And so if somebody is expressing milk for you, there's a way that you can call it, you know, because it's labour, we know it's labour. So then you can cover their labour expenses and the, you know, the pump, they have to buy breast milk bags, or whatever it might be. But that's a conversation, not all surrogates would be willing to do that. So if that's not an option for you, you can go and get donor milk. Now, we know that there are both formal and informal networks in the UK for donor milk. And we I think, is ibclcs would always be really cautious about the informal networks of milk. And I have to say, personally, I've donated milk and formally, so I'm quite familiar with that world. But whether somebody wants to take a chance on it, that really has to be their their choice, and you have to feel that you can trust the person, you know, if the person says, you know, I eat such and such, and I take the supplements, and I don't drink and I don't do drugs, you know, can you trust them? How well do you know them? So that that is a choice to get the milk informally, or to go to a formal milk bank, which isn't always easy. Even though there's been an increase to I think how much people are donating to milk banks in the UK in recent years. I mean, I think that has been something that's been really exciting to see, my understanding is that they try to keep it for premature babies, babies with certain needs. And so maybe a little bit harder for that gay male couple to access milk in that way.

Emma Pickett  26:31

Yeah, yeah. So the hearts milk bank, is one of the milk banks in the UK that historically has given milk to the community. And the charity, Human Milk Foundation was set up to enable that to happen because people don't get you don't you never pay for human milk as a family in the community. And that community provision just kind of comes and goes, depending on what milks available, and we know what's going on with the organisation. And it isn't it isn't necessarily straightforward, but it's there's never any harm in asking, there's never any, when I'm absolutely seeing what the capacity isn't having that conversation and, and there is milk that is donated, that that isn't suitable for premature babies, but could go to full term babies, which is going to be the situation here. So it's always always worth having that conversation. You mentioned, you know, knowing a donor is great if you do have that trusting relationship with your informal donor that, you know, there's going to be an element of trust there already. One of the things that I was talking about with Julian Weaver who's one of the cofounders of hearts melt bank is you can actually ask for blood testing as well, people it's very something rarely that happens in an informal donor situation. But you know, the same blood tests that are done for formal donors, you could have those blood tests done for informal donors as well, if that was something you're worried about. You can also pasteurise milk in a home setting, there are a guidance for doing that on online. You know, I'm an ibclc, too. And that's not something we can necessarily advocate people do. But if people inform themselves about the risks, that's definitely an option. You mentioned that surrogacy is different in the UK, compared to the US it does seem to be on Instagram. The gay couples who are travelling around with human milk and insulated bags, you know, they seem to have you know, a lot of human milk flying around. It looks like it's easier for couples to access here is that because of the surrogacy agreement being different how? So the rules in the UK are you can't pay somebody to be a surrogate. Presumably, that means that the surrogacy situation in the UK is very different and very much smaller. And in the EU and the US, how is it different?

BJ Woodstein  28:25

Well, so I am not an expert on it. But my understanding is that you can hire somebody in another country, as well. And then you it does cost a lot more because you are treating it, I think is employment. But some other countries have started saying no, they don't want it to be done like that, because they're worried that understandably worried that women are being taken advantage of. But one of the things that I would say about the United States is as we know, it's very much a pumping culture. So that has pros and cons in and of itself. But it means that for some people wanting to access pumped human milk, potentially in the informal system, it can be a lot easier. I mean, I don't know if you you must have read Trevor MacDonald's book. And in it, he, you know, talks about the kind of experience of going all over Canada, basically all over certain regions of Canada, looking for donor milk to feed his baby and the kind of generosity of people and I think that is because it's so much more common to pump and to build up your kind of milk stash that it feels easier than to kind of provide that for other people. 

Emma Pickett  29:29

Yeah, and I guess if you are using a surrogate in the States, who's an American surrogate, who perhaps has already given birth herself to her children, she's probably much more comfortable with pumping and you know, people pumping going back to work at like three or four weeks, whereas in the UK, it's just like, going to be less familiar. Maybe. Yeah, that's a good point. Mentioning Trevor, I know that when Trevor McDonald was just feeding his own child, he used an SNS or a supplementary nutritional system, and that's not something that all trans dads may feel comfortable doing and There's obviously a whole range of different experiences here. And we're not implying that a trans dad should stress a chest feed. But that was Trevor's choice. And, and Trevor went on to become the lecture leader in Canada. Can you talk us through what an SNS is and how it works and what the options are for chest feeding.

BJ Woodstein  30:15

The SNS is something that, I guess we could, in simplest terms, since we're talking or the magazine, it could be described as a tube that you can tape or attach to your chest, or your breasts, depending on how you refer to that area. And it has a bag or container where you put the milk. And some people do put formula in there. But you can also put, you know, your own milk, if you would rather not, you know, if you want to express and feed that way, you can put donor milk, you can put your partner's milk, you know, you can put some other milk in there. And then you can feed the baby at your chest. And I mean, actually, you know, it's something that is relevant to non queer people as well, somebody that I was supporting who was a straight woman, she needed to use that because her milk supply was rather low. So she was using formula in there. But she put her baby at her breasts because she was using it as a way of stimulating her own milk supply. So it can work in other situations too. So if you wanted to use that, it's often for the experience of feeding out the chest or the breast and it's if you perhaps feel that your milk supply is low, you know, if we're going to be very explicit, I suppose some trans men have had chest surgery. And this is a whole issue in and of itself that not all trans men are warned or given accurate information by their doctors before chest surgery, about how it could impact their breastfeeding or chest feeding journey later on. And also, I've spoken to some trans men who said, even if I had been told that I wouldn't have cared because I just really wanted the breast tissue gone. So in those cases, sometimes they realise actually, I want to feed my baby at my chest, but I'm not able to produce the supply or I don't have enough, you know, of the mammary tissue. And so this is a way of making it work for them in pregnancy. 

Emma Pickett  32:07

Do transmen have more breast tissues, or chest tissue developing? Because of pregnancy hormones? I'm guessing there are people who've had top surgery who then find new growth? I mean, is that is that an uncommon experience?

BJ Woodstein  32:24

Yes. From what my understanding is, I'm not sure it's universal. But I think it's certainly common, I think it does depend on the kind of surgery you've had, how much has been removed. And the issue or an issue there is that it can lead to increased feelings of gender dysphoria, which is understandable, because if you are a man, and suddenly you are developing breasts, or developing breasts for the second time in your life, that can feel really upsetting. Because, you know, in our society, even though people joke about man boobs, or things like that, we generally think of breasts as being something for women. And so if it's something for women, why is that happening to your body when you're a man, so that can cause issues. And in depression, I said increased gender dysphoria concerns about body and being seen as the man that you are. So it is challenging. And related to that. Some men use a binder or a chest binder to kind of keep that tissue down. And especially if they're finding that it's growing, but that is a little bit tricky, because you know, we've already spoken about mastitis, you don't want to do anything to be kind of compressing the tissue and causing additional problems in that area. So if somebody came to you and said, Oh, I want to use a chest binder again, now that I've given birth, but I'm also chest feeding, you might want to have a conversation about okay, what material are you using for that chest binder? How tight Are you keeping it? How many hours a day? are you ensuring that you're not, you know, squeezing that tissue so much that you are going to get blocked ducts? 

Emma Pickett  33:59

Yeah. And obviously talking about symptoms of mastitis and you know, potentially could get very, very unwell and also reducing milk supply because that compression the body mistakes that as messages of encouragement and milk supply will be reduced as well. I guess one of the things like we said before, is it people aren't necessarily going to know how they feel until they're in that moment. And I don't know. I can't remember what Trevor McDonald said in his book about his pregnancy experience. Did he always know that he wanted to chess feed was Do you remember that?

BJ Woodstein  34:29

I can't remember that either. But I think that's, as you say, you know, sometimes you think it's not relevant to your life. And then suddenly, you find actually, this is something that matters to me. And certainly, you know, when I think about the people I interviewed to write my own book. There were feelings all across the spectrum. There are people who were adamant that they did not want anybody touching that part of their body. And then the baby was born and they thought, well, I'll give it a go and actually quite like this, or in some cases, well, I don't really like it, but I want to Keep doing it because it feels like a way to build our bond or it feels right. And then there were people who said, I'm not going to do it. And they didn't do it. And that was right for them too. So I think it's really, really hard to predict how you're going to feel about things in advance, especially when you've got all the different kinds of hormones and emotions in play.

Emma Pickett  35:17

Yeah, yeah. And obviously, the element of gender dysphoria, you know, on top of everything, I think, I think one thing, just from what you just said, I just was reminded that some people who are not trans non binary, don't necessarily love breastfeeding. They, you know, not everybody who feeds their children at their breast loves it, some people are doing it, because they know it's the right thing. And it's a choice that they want to make, but they don't love every moment of it. And, you know, I was talking to someone the other day, who was weaning at sort of 18 months, and I'd supported them. And they said to me, at the end, oh, God, I'm so relieved. That's done. I honestly, I'm not I'm not sure I enjoyed a minute of that. I just felt my you know, my intellectual brain told me that's what I needed to do. And I was like, wow, okay. That was wasn't something she had expressed to me the beginning. So I kind of had to reflect on that, and why I hadn't given her the space to be able to do that. But not everybody loves feeding their children.

BJ Woodstein  36:10

Oh, absolutely not. And I think lots of people have a kind of, I don't want to say love hate relationship with it. But you know, moments of really enjoying it moments of, why am I doing this, this is horrible. This is hard, or you know, feeling like it makes them you know, their skin crawl or you can assume, especially at different points in your cycle to you can feel differently. And as you say, we need to kind of give people the space to express all that and not be judgmental about how they're feeling in regard to their breastfeeding or breastfeeding experience.

Emma Pickett  36:38

Yeah, let's talk for a moment to people who are breastfeeding or just feeding supporters, people who are in the kind of Lactation Support world, if somebody is running a drop in group, and they haven't historically been very queer, supportive or queer, friendly. What are some of the things that you would want them to think about what some of the things that you think are most important?

BJ Woodstein  36:58

I mean, to start with, you could think about how you advertise your group. So are you calling it the mums and babies breastfeeding group? Or are you saying, you know, this is a lactation support group, or breastfeeding and chest feeding group or, you know, some other kinds of inclusive terminology, some people are really uncomfortable with Inclusive terminology, because they think that it means we're saying, you can't use the word that fits you best. But that's not what we're saying. We're saying add, it's additive. So you can say breastfeeding and chest feeding, you could say mums, and dads, or you could just say parents. So that would be a place to start is making it clear that you are open to everybody. And you could say that in whatever publicity material you've got, you know, this is a Lactation Group for all parents at all stages of their feeding journey. That would be the first thing. Another thing would be, you know, if you were lamb yards or name tags, or you just do introduction, really thinking about whether you could offer your own pronouns. Sometimes people say, Well, you know, my pronouns are so obvious, why should I have to say it? And it's like, well, it's not really for your benefit, it's for other people's benefit, so that they feel comfortable saying that, I'd rather you call me they or I look this way, but my pronoun is actually this or, you know, so maybe making space for Hi, my name is such and such My pronouns are, you know, whatever. Welcome to our group. What about you, you know, doing things like that, and also thinking about the way you talk about people, but not making assumptions about who you're seeing. So if, let's say two women walked in, not saying, Oh, how nice that you've brought your baby and your sister, you know, making those kinds of which

Emma Pickett  38:32

has a lot. Yeah, your sis how lovely your sisters with, you know, your sister seems to be there at two o'clock in the morning every day. That's interesting. Does your sister know all those details about birth? Your birth? Or your mother was another one that I heard someone say that that partner was called their mother. 

BJ Woodstein  38:48

I mean, yeah, a week ago, I was talking to somebody and she was saying, yes, my wife is, you know, seven or eight years older than me. But she doesn't look like my mother. And people are always assuming we're mother or daughter, just because of the age gap. So yeah, not making assumptions and asking people. 

Emma Pickett  39:03

So I know, I was sort of making light of that in a moment ago. But it's just, you know, the pick to pick a good person told the story was kind of laughing about it, but it is, it is not going to be funny at the most vulnerable time in your life, when you are walking in the door, and you've immediately got a barrier to overcome. And then you've got to have a conversation you didn't want to have you've got a it's just you know, we sort of joke about it, but it is just a grim experience. You're all your other the second you walk in the door.

BJ Woodstein  39:29

I mean, I would say that, you know, as queer people, we are used to that happening a lot. And we're used to having to explain ourselves, but as you say, it's a very vulnerable time. If you do find if you're, you know, a breastfeeding, breastfeeding supporter, and you find that you do make a mistake with pronouns or assumptions or whatever it is. It's really easy to just say, sorry, and I think people kind of work themselves up and go, oh, like, oh, I you know, I didn't mean I didn't think that I just sorry, that's all you have to say. Sorry. I will get it right. Next time and it doesn't have to be this overwrought thing.

Emma Pickett  40:03

Yeah. And centering yourself in the apology is something that unfortunately, we still see. I mean, I'm my son, who is not trans, not non binary, had long hair when he was younger. And I remember somebody misgendering him, and I said, Actually not not a problem, but it's actually a he, and she burst into tears. And I had to spend, I spent 10 minutes comforting her.

BJ Woodstein  40:23

Oh, my gosh, I shouldn't laugh at that either. But but

Emma Pickett  40:27

there was probably something going on for her there. I wasn't sure what it was. But I do often see that, that frantic over apology where people are just repeatedly saying, Oh, my God, I'm so desperate. Sorry, please forgive me. Sorry, hang on. This is not about you. Just a simple apology and moving on.

BJ Woodstein  40:42

Yeah, I'm thinking about how to do better next time. I mean, I'm thinking of a time that somebody happened to mention my partner, and somebody said, Oh, and he did it. And I said, Oh, actually, it's a woman. And he said, Sorry, I don't know why I made that assumption. Anyway, so she and it was really simple. And we just moved on. And I really appreciated that. So as you say, just kind of doing it, not making it about yourself, and then making sure that you get it right the next time. Have

Emma Pickett  41:07

you seen some examples of really good resources or groups really sort of going out of the way as anybody you want to kind of give a shout out to? Oh,

BJ Woodstein  41:15

I kind of wish that I could. I mean, I've seen kind of some individuals who have said that, you know, I mean, ibclcs and other people who have said, you know, look, I support everybody. I've spoken to people who feel that certain areas are more open the obvious example being like Brighton, or Hebden Bridge, where there are a lot more queer people, but I have not seen, like major examples of good practice. I don't know, what have you seen a name that you think are brilliant.

Emma Pickett  41:41

I mean, we could have a whole other conversation around, where we are on the lactation space with inclusive language, there's a lot of very passionate people who, who are, who are really struggling with inclusive language and are very worried and frightened. And, and also some people who are desperately saying, I'm here, please don't ignore me, please don't dismiss me, you know, and I've historically, you know, written books that have been completely non inclusive and didn't even realise it was an issue. And I've, I think everyone's got to do better. And we've all always lactation professionals. We've always centred the people we've worked with, we've always adapted our language. You know, when a mum has said, boob, we've said boob when, you know, we've always done that. Yeah, but I think we've got this sort of transphobia homophobia now twisting up in it, that means that we feel as if we're, if we stopped doing that we're somehow supporting women by not doing that. And, you know, and there's there are, you know, there was, it's a very difficult space to have conversations in, and there's, you know, I'm not going to pretend I have all the answers, and there are other people who are more knowledgeable about this than me. But I think we do have to try and understand that there are people out there who are non binary, who are, who are trans who are wanting to feed their babies. And if we are telling them, you're not welcome, in this space, babies don't get milk. It's as simple as that. And, you know, and babies are the ones that will be suffering at the end of the day. So I wish I had an answer to how we can get to a place where everybody feels comfortable. But when we're definitely not there yet,

BJ Woodstein  43:15

we're not there. But I mean, trying to educate yourself, because you know, we all can be better allies to different groups of people in many different ways. And so that is, you know, we're human, we make mistakes, but we also keep growing and keep keep developing. And as long as we're open to new knowledge, then, you know, we're trying, we're trying the best we can I mean, I as in my role as a doula I was at a birth with a non binary client. And the midwife who was actually said to me, I'm old fashioned, I don't understand the kind of language I'm just gonna say she. and I were saying, No, my client is they can we please use the appropriate language. And my client was obviously getting kind of upset, because you can, as you know, you're vulnerable. And it's a very difficult situation in some ways. And so to have somebody continually Miss gender, you, and in the end, we had to say, actually, this midwife can't be here. And if you cannot respect the person that you are here to serve them, Please, could you go work with a different client, a lot of different midwife, we had a different midwife who was great, because they, and you know, it was fine. So if you feel as a supporter or an ibclc, that you are not the right person to work with this client. And I'm hoping you wouldn't feel that way. But if it turned out that that was the case, it's better to remove yourself from that situation, you know, to say, actually, I don't know very much about today, however, my colleagues so and so does, and so I'm going to send them in, you know, I mean, it. I think sometimes removing yourself from the situation is the best thing that you can do, unfortunately, as you say, because we're not we're not there yet. With everybody feeling comfortable with everyone else.

Emma Pickett  44:51

Yeah, yeah. I think what you said about how you know, being an allies isn't a journey you finish you don't do a course you don't take a box. You're not voted out, you know, it's always going to be ongoing. And people are still going to make mistakes, and people are still going to say the wrong thing. But it's it's really about what you do when someone is in front of you, and how you speak and and treat that person with respect. And I'm hoping everybody who who's listened to this who's caught this far is, whatever they're saying, you know, on their social media, when they're in front of somebody, I would hope everybody will be supporting an individual. But as you say, there are some people who may be need to step away from a situation so everybody can feel safe. And when parents are giving birth, and in the early stages of lactation, it's the most vulnerable time in someone's life. You know, the idea of having to deal with discrimination on top of that is just, you know, it's going to affect outcomes, it's going to affect your physicality, it's going to affect your ability to give birth, it's going to stop your oxytocin happening. I mean, they're just that client, you're talking about there who was constantly being, you know, misgendered, that's possibly going to mean they're more likely to, you know, have to have an intervention in their birth, because their levels, their stress hormones going to increase. So it's these are not just words, these are these are serious things. They are very serious. Yeah, absolutely. Yeah. Sorry, stating the obvious. 

BJ Woodstein  46:08

No, no, it's very important. And, you know, we need to respect people as individuals, and we're not all the same. And that's what's, you know, amazing about getting to know other people. But it's also a problem that we're not all the same. And that, you know, we think about how we would want a certain situation, and it's not always it's usually not what works for somebody else. 

Emma Pickett  46:25

Yeah. And milk production is also about oxytocin. And oxytocin hormone needs us to feel relaxed and supported and calm. And, you know, we're not going to be getting the milk ejection reflex, if we're sitting in front of somebody who is, you know, not respecting our partner or, you know, making jokes or asking intrusive questions. And I think also, you know, what we touched on earlier, I think sometimes allies can be overly enthusiastic sometimes. That's not often talked about, because we're busy focusing on the very negative stereotypes. But I think sometimes when someone is really over the top, oh, my God, it's fantastic that you're lesbian, brilliant. I'm the mom, my cousin's a lesbian. And this is how they're gonna have a child. And do you know, I'm so happy to work with you and let you know, Can I take your details? And can I get a be on my podcast? And I think you're fantastic. There's a, there's an extreme version, which can lead to intrusive questions. And also, I'm just, we're just a couple having a baby chill lady.

BJ Woodstein  47:25

But people sometimes do think it's so exciting. And actually the one of the books that I translated most recently, which is about a trans boy, he talks about how his aunt is one of these really positive, like, I'm so proud of you doing you? And isn't it wonderful that your parents accept you? And he's kind of like, well, no, they're just being, you know, parents, as you would hope parents would be. And I'm just being me. And, you know, and it gets he finds it really annoying how over the top she is. And so yeah, people do kind of have to watch out for that kind of over enthusiastic allyship, as well. 

Emma Pickett  47:57

Yeah, well, hopefully one day, we'll get to a stage where it's all very ordinary and boring and normal and discrimination goes away. And that is the that's where we're going to be in a few 100 years, let's dream and action we can definitely do. 

BJ Woodstein  48:08

Can we mentioned a one thing that I think isn't often talked about in relation to queer people and lactation. And that's actually, Dr. Workplace. And, you know, one of my other roles is that I do consulting in equality, diversity and inclusion, and they work a lot with different companies and institutions. And I've been asked, What can workplaces do to support queer people and lactation? And I think that's a really, really good question that I hope more people would think about, because we often see, you know, breastfeeding rooms, or, you know, breastfeeding space. And, you know, it'd be a pretty simple thing to change terminology and talk about this at the lactation and expressing room or this is the breastfeeding, breastfeeding and expressing room or, you know, whatever. And also to ensure that you're able your HR person, or, or manager or whoever is in charge of these things, talks to each individual who is going off on parental leave, and asks them, what will be your needs when you come back? You know, and some trans men will not, you know, they will not be open as trans men, and it may be an uncomfortable conversation to have to disclose that information to say, well, I plan to be continuing my expressing when I return or something, but ensuring that there is space for that conversation, and also a private physical space where people can go to feed or to express and of course, a little fridge to store the milk. I think those things are really essential as well. I just wanted to get that in there. Because I feel like people often forget about the bit when you go back to work as a queer person. 

Emma Pickett  49:33

Yeah, no, thank you for highlighting that. Yeah, that's that's definitely important. I think the UK has got quite a long way to go when it comes to supporting lactation in the workplace. But if you feel you've got extra barriers on top of that, that's not going to be comfortable. Are there particular workplaces that you think of worth celebrating in the UK that you've worked with or have knowledge of? 

BJ Woodstein  49:55

No, I mean, that's, I think what I've needed to do this kind of work at the moment because it's something people We'll haven't thought about that they often act like they're doing you a big favour, like, oh, well, you know, you can go into the bathroom, you can go into the disabled toilet or something, which is problematic for all sorts of reasons. Um, or they say, like one place this an institution, a larger institution, they had one room in all their buildings, just one room for everybody. And it was like, they just called it the breastfeeding and resting room. So if you were ill, you could also go to that room. 

Emma Pickett  50:27

Oh, that's great. Yeah, we really want people with influenza to be lying next to people expressing their breast milk. That's an awesome idea. 

BJ Woodstein  50:33

And you know, one key and you had to go ask someone for the key. So you know, we still definitely have quite far to go in terms of making things more lactation friendly at workplaces. 

Emma Pickett  50:43

Yeah. Okay. Thank you for highlighting that. BJ. Is there anything else that we haven't talked about that you think is important to mention? Or any other resources that you would recommend people go to? Is there any other directories where people can find sort of birth workers and lactation supporters who are particularly queer friendly? 

BJ Woodstein  51:01

I'm not aware of one actually, I don't know, are you aware of one because it would be really interesting to know,

Emma Pickett  51:05

I'm not, which is probably my failure, because I believe them, there must be. So I'm going to do some research and see what I can find. And maybe there'll be some names, we can put in the show notes or directory names, we can put in the show notes. I'm sure it does exist, because we will not be the first people to realise this, especially at the moment, we need to make sure that we're talking to safe people.

BJ Woodstein  51:26

There are some people who do a lot of that partially because of who they are, or by dint of where they live like Zoe and Brighton who works a lot with LGBTQ people. And Stephanie in New York City and other ibclc, who does a lot with LGBTQ people. Or maybe she's moved to Hawaii now. But anyway, and that there are a couple of people who are really, who I know are kind of like specialists in it, but I don't know if directory and it would be great for us to have one. Because you know, if you are thinking about hiring a lactation consultant, or for example, in the case of me as a doula as well, it really helps to know that, okay, this person has worked with other people like me, maybe has a bit of, you know, cultural ethical knowledge about my group of people, and is going to be able to support me to the best of their ability versus this kind of unknown, I'm just gonna get to contact someone randomly and see if they've ever worked with a trans woman before you know, and that you don't necessarily want to be their first kind of test case, or you don't know what kind of response you're gonna get from them. 

Emma Pickett  52:25

Yeah, I mean, you know, in the world of Instagram, or if you're a queer, expectant parent, you will probably be following queer doulas you probably want well know, people are out there that are in your in your community. But, you know, not everybody should be reinventing the wheel. Sharon Silverstein is a doctor in North London who works a lot with induce lactation couples and, you know, prescribes Domperidone. And I know she's got a lot of experience in this space. That yeah, we need to, I'll see what else I can find to put in the show notes. Thank you very much for your time today, PJ, really appreciate it. I know we've just grazed the surface. And there'll be some people listening to this thinking, oh my god, you didn't even talk about x y Zed. Well, why didn't you talk about that. And if something really was missing, you know, this is a conversation that can happen again. It's not like it's not like there's one episode on queer people tick. We're done. We're sorted. I'm sure there are more stories to tell. And that might include stories from families and couples as well. But thank you so much for your time today. Really appreciated.

BJ Woodstein  53:16

Thank you so much for having me, Emma.

Emma Pickett  53:23

Thank you for joining me today. You can find me on Instagram at Emma Pickett IBCLC and on Twitter @MakesMilk. It would be lovely if you subscribed because that helps other people to know I exist. And leaving a review would be great as well. Get in touch if you would like to join me to share your feeding or weaning journey, or if you have any ideas for topics to include in the podcast. This podcast is produced by the lovely Emily Crosby Media.