Lactation for the rest of us - induced lactation and supporting queer and trans parents with Jacob Engelsman

This week I’m delighted to be joined by American IBCLC Jacob Engelsman, whose new book, ‘Lactation for the Rest of Us’, is out now. 

Jacob and I talk about inducing lactation, for birthing parents and non-birthing parents, the drugs and supplements that are used to aid milk supply in different parts of the world, the mental health aspects of breastfeeding for queer, non-binary and trans people, and alternative ways to feed your baby.

This episode is intended for members of the LGBTQ community, anyone interested in induced lactation and listeners who want to be better allies and supporters.

Jacob Engelsman is @jacobibclc on Instagram

My latest 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 - 

Get Jacob’s book Lactation for the Rest of Us here https://uk.jkp.com/products/lactation-for-the-rest-of-us

B J Woodstein, The Road to IBCLC https://www.waterstones.com/book/the-road-to-ibclc/b-j-woodstein//9781946665737

Lindz Amer, Rainbow Parenting https://www.goodreads.com/book/show/61885086-rainbow-parenting

AJ Silver, Supporting Queer Birth https://uk.jkp.com/products/supporting-queer-birth

And competency workshops https://queerbirthclub.co.uk/workshops/

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

Transcript

This transcript is AI generated.

[00:00:00] Emma Pickett: 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 too. Join me for conversations on how breastfeeding Breastfeeding is amazing and also sometimes really, really hard. We'll look honestly and openly at that process of making milk. And of course, breastfeeding and chest feeding are a lot more than just making milk.

I'm really pleased to be joined today by Jacob Engelsman, who is an IBCLC from Atlanta, Georgia in USA. And he has a background as a professional child carer and a doula. And he's also an author. So one of the reasons we're talking today is because his new book is coming out from Jessica Kingsley Press.

It's called Lactation for the Rest of Us, a guide for queer and trans parents and helpers. And it's published this month in the UK and available for sale, if not right now, very soon because it's coming out in February. So he's an IBCLC who specializes in supporting non gestational parents with induced lactation.

As well as supporting queer, trans and non binary parents with all aspects of their feeding journeys. Thank you so much for joining me today, Jacob. I really appreciate it. 

[00:01:33] Jacob Engelsman: Thank you so much for having me. 

[00:01:35] Emma Pickett: So you said something at the beginning of your book, which I would love to read here. You said in your introduction, I think in one of your first chapters, you said, I'm writing with the assumption that you are already a person who strives to be an ally.

And I think that's the spirit in which I would like our conversation to take place today. We're not here to educate people about the existence of trans parents and queer families. We're assuming everybody is here because this is either their own parenting experience. Or if it's not directly relevant to their own parenting experience, they're here because they're looking to support others, whether as a family member or friend or lactational professional or, or somebody who wants to learn.

Can I start by asking you about your journey to writing your book? 

[00:02:18] Jacob Engelsman: Yeah, of course. So I feel like at a certain point, the book kind of, it kind of became inevitable that I was going to, that I was going to write a book because I started. Okay, so even like way back when in my youth, like I've always been one of those people who are just like really good with babies and like even I, I spent a solid, uh, chunk of my life in what you might call a grubby punk rock phase and I was still the guy who like, Would just volunteer to babysit my, my punk rock kids, friends, babies.

And we would just hang out downtown with a baby on my hip. So I've always been one of those people. I've always known that I wanted to work with infants specifically. Um, and I've always known that I didn't want to go to med school. That was, that was not gonna be on the table for Jacob. So I, you know, spent a lot of time figuring out kind of what my options were.

And I learned about things like doulas and postpartum doulas and lactation consultants and how to successfully be like a male nanny, um, make a career out of that. So when we moved to Atlanta, my spouse got a job at a university here. So we moved here about eight years ago and I just decided that it, that it was time to, Focus that part of my life, right?

Like I really want to take care of babies. I've kind of just been floating around from service industry job to service industry job, but you know, it's, it's time to focus on what I actually want to do. So I, I Googled just like Atlanta doulas, Atlanta childcare, found some people, emailed them and. you know, just had coffee and lunch with a bunch of different people, um, to figure out how I could make that happen.

I did some doula trainings, um, a postpartum doula training, a birth doula training. Uh, and then I met a lactation consultant. Uh, Christy at Breastfeed Atlanta, who just offered me a job as her secretary, right? Like cleaning pump parts, scheduling consultations, um, filing insurance claims, that sort of thing.

But it, you know, kept me in the loop. I met a bunch of other, uh, lactation and birth professionals. I met a lot of parents. And after about six months, she was like, You should really just like become an IBCLC. You're here all the time anyway. You you're super interested. You've learned a lot. You should just go through the, you know, get your credits, do your training, your clinical hours.

You know, you work at a clinic, so it won't be a problem. 

[00:05:10] Emma Pickett: Fantastic. So did you do the mentor pathway with her then? Yeah, we did pathway three. Okay, brilliant. 

[00:05:16] Jacob Engelsman: And, and of course, I didn't realize at the time that clinical hours are the big, are the, are the stumbling block for most people. I didn't really realize until much later how lucky I was that clinical hours were just being handed to me.

But it was as I was doing my lactation education and just like reading all of the books I could find, um, you know, I was learning that there's all of this information that's super relevant to queer and trans parents, right? To non binary and, and trans masc people who give birth and have questions about lactation.

Um, uh, non gestational mothers who want to induce lactation. Um, you know, and you hear a lot about that in terms of like adoption and stuff, but none of it was like geared towards the LGBT community. And so I kind of, like, even before I'd completing my training, like, I, I had a Google Doc of like, I need, like at some point in my life, I'm going to write this book.

Like this book, if this book doesn't exist in five years, I'm going to write it. 

[00:06:19] Emma Pickett: Yeah. A gaping hole, essentially, from the very beginning, you can see that. That huge hole that was the shape of your book and and not to say there won't be more books to come because this is A you know, there's more of a conversation whether it's your book or someone else's book But so you you were already writing it from the very beginning of your practice Yeah, 

[00:06:36] Jacob Engelsman: and like I had the wherewithal to know that like I have no business writing this book yet but once I've done the training once I've got my hours, you know, and I'm a more established professional.

I didn't want to, you know, Dunning Kruger myself where I'm like, I've been doing this for six months. I should write a book, but it's like, all right, let's, let's give this some years, uh, learn, learn everything I need to learn. Um, but yeah, you know, like I had an outline for it for like, we do a chapter on this, do a chapter on that.

Um, and of course my book looks totally different than the original outline. I'm sure 90 percent of books look totally different than the original outline. 

[00:07:16] Emma Pickett: Yeah, and you, and you came to Jessica Kingsley Press who are, so we're publishing buddies, high five. Um, so Jessica Kingsley Press published my last two books.

They also publish Catherine Stagg's book on twins and triplets and AJ Silver's book on supporting queer birth. So it's a, it's a natural home for your book to be at Jessica Kingsley Press and how did you find working with them? 

[00:07:36] Jacob Engelsman: It's interesting that you mentioned AJ Silver because that's actually exactly how I ended up.

With Jessica Kingsley Press is I had a copy of that book and I was like, who published supporting queer birth? And I was like, I should send that to them. And they immediately, they were like, yes, we want your book. Please look, if anybody's going to want this book, it's those people. 

[00:07:55] Emma Pickett: Yeah, yeah. They're working really hard on being inclusive and lots of different ways and neurodivergence and, and, you know, queer families and everything.

So they're just a fantastic group of people to work with. I'm glad you came to them for sure. So I'm mindful of the fact that one of the things I could do in this, the next, you know, 50 minutes or so is suck all this information out of you and take all your expertise and, and I don't necessarily want to do that because I want people to buy your book.

So please tell me if I'm poking too hard and taking too much information out of your brain, but it would be great to get some insight from you in some of the different areas that you touch on in your book. Can we start by talking about inducing lactation? Um, so still in 2024, there are people who literally don't know that inducing lactation is possible.

Um, you know, whether it's single parents or co parents, you know, people literally don't even know it's an option for non gestational parents to induce lactation. I know that you support lots of different families to induce lactation and you support them throughout their journey. But can you give us a little bit of an insight?

What are some of the things you might talk about with someone in their first consultation if they come to you and say, I'm thinking about inducing lactation? 

[00:09:04] Jacob Engelsman: The immediate questions are have you ever been pregnant at all for any amount of time? Because even if somebody's pregnant for six weeks there's still like some changes to the breast tissue that are going to be, you know, more or less permanent.

But you know, also if you had a child and, you know, sometimes people are like Oh, like I, you know, had a child, but it was 20 years ago and, and we're having a new baby. And I'm like, like 20 years ago, like that counts that absolutely, you know, and, and how did, how did lactation go with your first child? And there is a certain point where we're talking about lactation, inducing lactation or re lactating.

It's one of those things that I think sometimes sounds like. really pedantic and there's no, there's no like real cutoff, but with a lot of professionals that I speak to, there seems to be a general agreement that if the last time you lactated was within three years, you'll probably have a much easier time.

Uh, as opposed to if you've never lactated or if it's been a really long time, then you might follow an inducing lactation protocol as opposed to, that's the thing is when you're re lactating, sometimes you can just start pumping and you'll start producing milk. So yeah, so the first thing that I talk about is, is somebody's history with lactation if, if they have one at all.

Um, and then we talk about What specific goals you have in mind, you know, do you, are you happy to be producing any milk at all, or do you really want to be the sole source of calories for your child? Are you hoping to go 50 50 with someone, um, and you're both producing half the milk for the child, which a lot of parents It sounds like a really good idea and you know, it's it's the most equitable thing a person can do But as any parent will tell you you don't have a lot of control over how much Your infant eats and where they're getting those calories from any any couple who wants to go 50 50 It's like you probably aren't going to you know It's not going to be as cut and dry as as all that 

[00:11:28] Emma Pickett: And then also obviously there's different choices that people might make when it comes to whether they want to You know, take hormones or go down the kind of Newman Goldfarb protocol route.

Or, and one of the things you talk about in the book is obviously some of the choices people can make around galactagogues, whether it's medications or herbs, what are some of the popular choices that you find people using in America? And I particularly wanted to ask you about Dom Peridone because it's my understanding that you can't use Dom Peridone in the States in the same way you can in Canada or other parts of the world.

What's the situation with, with Dom Peridone at the moment? 

[00:12:00] Jacob Engelsman: Right, so Domperidone, for people who don't know, Domperidone is actually a gastrointestinal medication that was discovered to have the side effect of Encouraging lactation. It's not FDA approved for lactation. So, you can be hard pressed to find a doctor who will write you a prescription.

Um, it's almost exclusively used, like, in surgeries. And, and to be clear, like, when we talk about Domperidone being used in that way. So, let me back up for a second. What it's, what it's primarily used for. is when somebody is under anesthetic. Domperidone is what they use to keep you basically from vomiting while you're under anesthetic.

Because, you know, your entire body relaxes, that's a risk, so they use Domperidone for that. And then it was later discovered that it also encourages lactation. Now that's intravenously, um, and then, you know, once it was discovered to encourage lactation, they, you know, lower dose pill forms. Um, but the FDA just never, uh, decided to go with that.

Um, there are some concerns about, uh, cardiac arrhythmia, but if you don't have a history of cardiac problems, and also we're talking about, you know, much lower doses, um, in pills as opposed to, as opposed to intravenous. So, it's not available in the United States for that purpose. The reasons are a little suspect.

Um, however, say what you will about social media. Um, one of the big benefits is that it's actually super easy to get Dom Peridot in the United States. Not as easy as getting other things, but. There are definitely ways to do it, um, and in many cases, you can literally just drive to Canada, uh, see a doctor and get some.

I'm not sure offhand if it's available over the counter in Canada, or if you do need a prescription, but either way, I've known of many people to just do that. 

[00:14:14] Emma Pickett: Yeah, I guess, I'm aware that we're both IBCLCs who aren't registered nurses or doctors, so we don't want to give the impression that we're handing it out like sweeties or suggesting it's right for everybody, but it is, there is quite an established protocol which does suggest it can be a useful tool.

If somebody was using that protocol, can you just talk us through what happens if someone is going to use like the Neumann Goldfarb protocol, for example? What's the sort of typical time frame that someone would go through and what would they need to do? 

[00:14:43] Jacob Engelsman: Yeah, so for the Neumann Goldfarb protocol, um, and I don't, uh, I don't have it.

You know, the exact numbers on hand, but it's basically the, the first step is to try to trick your body into thinking you're pregnant. So you do that by taking birth control pills, uh, skipping the, uh, what's they, what do they call it? The, the sugar pills for the week. 

[00:15:07] Emma Pickett: Yeah. The, the week of nothingness. Yep.

Yep. 

[00:15:10] Jacob Engelsman: Um, so you skip that, you take, uh, you take birth control pills for, they usually say like three months ish. You don't have to go the entire six months. And then the day you stop taking them, you start pumping to convince your body that now you have a hungry baby. And this is the other trick that I, I sometimes have difficulty when I'm talking to patients because I feel like there's this tightrope walk of Making very clear like exactly how much pumping you're going to have to do because it's a lot but without Being discouraging, you know, or it's like, oh, okay You're gonna have to pump every you know Like eight times a day or like every three hours without without more than a six hour gap at night And it you know 20 minutes aside and sometimes people's eyes get like real big and they're like, oh Oh, oh, no, 

[00:16:13] Emma Pickett: I have it.

I have a job. Hang on. Yeah. How does that work? Yeah, it's intense, isn't it? And actually, some people, as you talk about in your book, some people don't necessarily want to go down the hormonal route. I mean, I work with a lesbian couple who wouldn't want to go near a birth control pill. It's just not part of their, their natural environment.

And they wanted to just use the pumping route. If somebody is just going to pump, do you find that they are as successful as somebody who may go down the sort of medications route? 

[00:16:39] Jacob Engelsman: You know, you don't have to start pumping necessarily eight times a day. You can start lower. and kind of acclimate your body and your schedule to, to incorporating these pumps in and seeing, you know, what time of day works for you.

It's just eventually you have to get up to that eight times a day. But I know there's a lot, lot of people talking about feeling like touched out and Yeah, they just feel like all they're doing is pumping when you just start doing it that much all of a sudden but if you can Incorporate, you know one pump at a time, you know Every couple of days or every week add one more then when you get up to the eight times a day It may not seem as daunting 

[00:17:29] Emma Pickett: Yeah, that makes sense And, and, but not necessarily with the expectation of producing a full 100 percent of an infant's milk supply, I mean, you talk, I know it's really hard to say what's going to happen because everyone's so different, but one of the things you talk about in your book is, is that how sometimes people perhaps need to start out with the expectation that they'll produce milk for their baby, but not necessarily a full milk supply.

How do you handle that conversation sensitively? It's tough. 

[00:17:57] Jacob Engelsman: It is. And I think it's just a question of of framing what the word success means, because it's a word that I feel like everybody uses in, in talking about lactation. We're all using that word, but we all mean something different when we say that word, because really what successful is when you're talking about lactation.

is having an experience that feels good to you. So, if you have the idea that success is only providing X percent of the milk that your baby needs, and then you can't do that, right? If you, if you're really set on 100 percent and you're only feeding your baby 50 percent of their calories, you might not feel successful, right?

You've, you could be feeling bad about that. But the fact that you're feeding your baby 50 percent of your calories from their calories from inducing lactation is another person's roaring success. 

[00:19:03] Emma Pickett: Yeah. Yeah. 

[00:19:04] Jacob Engelsman: So it's really, a lot of it is just frame of mind. 

[00:19:09] Emma Pickett: Yeah. And actually, I guess before baby comes, you may not know what success is going to feel like until that baby is, is there in your home, in your arms, and, and sometimes that success is going to change along the way.

I think that's also an important point. One of the things, um, we talked about Domperidone, but I didn't get your ideas about other herbs. Are there any other particular herbs or galactogogs that are popular with the families you work with? 

[00:19:30] Jacob Engelsman: I feel like the most popular thing right now is Fenugreek, which is, uh, a, a, Spice used a lot in Indian cooking, but people take like fenugreek pills or just take large quantities of it to increase their milk supply, which I has a kind of a side effect of like making people smell like maple syrup.

[00:19:55] Emma Pickett: Yeah, yeah, Fenugreek's interesting. The UK, probably about 10 years ago, it was very, very popular. Lots of people were taking it. Um, you know, even sort of cis people doing their bog standard not induced lactation, lactation journey, were taking it. But it's fallen out of favor in the last couple of years. I think people are more worried about thyroid interactions and blood sugar interactions, and it seems to be some people are not always finding it's positive for milk supply and actually dropping milk supply occasionally if they do have any thyroid issues.

So I'd be interested to know, um, whether you're going through swings and roundabouts in your sort of population that you're working with as well. Um, I guess maybe within juice lactation it's different because if you're doing it before you're feeding a baby, perhaps it works in a slightly different way, you're just switching on the prolactin maybe in a different form.

Um, maybe the issues aren't necessarily the same. Any other particular popular herbs? I hear people talking about Moringa, I don't really understand how that's being used. Is that something you ever come across? 

[00:20:55] Jacob Engelsman: Yeah, so Moringa is pretty popular right now, but it's, I feel like a lot of Galactagogues work basically because they're just like nutrient dense, and you're probably going to be producing more milk or producing milk easier if you're getting all of your vitamins and minerals.

So, like, a lot of leafy greens are really, um, I'm given to understand are really high in like, folate, for example, or folic acid. So if you're not getting enough of that in your day to day life, and then you start taking the, the herb supplements, like it's very much. You know, it's like taking a multivitamin where like now it's nothing to do with moringa and lactation specifically.

It's just now you're getting all of your herbs and or your, uh, vitamins and minerals. So your body's producing milk more easily. 

[00:21:52] Emma Pickett: Yeah, that makes sense. And I guess we're not going to have many research studies funded by large companies looking at these issues and removing all these variables, all these things need to be revealed over time.

Um, yeah, more research needed with galactagogues for sure. And that's 

[00:22:05] Jacob Engelsman: kind of the thing with herbs and, uh, and supplements is, at least in the United States, they're not regulated like how food is. Like there's no, there's no real standards to how much active ingredient is in your, your Fenugreek or your Moringa.

So, uh, consistency of product can, can be an issue, right? Depending on where it was grown, like it did your Moringa come from the target or from somebody who grew it in their yard is those are, you know, two very different products. It's really hard to say what. Depending on where you live and, you know, just like your own community, how well any given galactagogue is going to work for you.

Yeah, when supplements aren't regulated like, uh, like how drugs and medicine are. Oh yeah, I'm sorry, I think I said food earlier, but yeah. Like how medicine is. There's no real standards for it, so. Which isn't necessarily a bad thing, you know. It makes them more readily available, more easier to, you know, easier to use.

But. You know that Tylenol bought in Vermont and Tylenol bought in California are the exact same thing, whereas the herbs from those two places are going to be very different products. 

[00:23:31] Emma Pickett: Yeah, yeah, that's an important point. Thank you. One of the things that I appreciate in the book is that you talk about Induced lactation and the experience of that after birth.

So I think so much, you know, you google an article and you're gonna get all the Antenatal stuff you're gonna get the stuff about pumping and and you know taking the birth control pill But there's very little discussion of what happens after the babies are here And I really like the fact that you share parent stories and I want to talk to you a minute about Rebecca's story particularly, but talking sort of hypothetically, let's imagine we've got two parents, two co parents, one's given birth and their partner has been working to induce lactation, they've done months of pumping.

They both plan to feed their baby. Maybe they are a couple that are aiming for the sort of roughly 50 50 thing. What would that first week post birth look like if both parents wanted to to maximize their lactation? How would you, how would you have that conversation with, with that couple? 

[00:24:30] Jacob Engelsman: So one thing about inducing lactation, uh, which a lot of people don't realize is that when you're inducing lactation, you're not going to be making colostrum.

Uh, colostrum, is this like nutrient rich precursor to milk, but it's only made when a body has expelled the placenta. So a lot of people, when they're inducing lactation, kind of the first milk they get is, is clear. I think a lot of people assume that that's colostrum, but it, it's not, but it's still, you know, it's still milk and it still counts and you should still use it and feed it to your baby.

But colostrum is like super, super good for babies and it has tons of, uh, antibodies. Which is of course very important for tiny little neonates So I would definitely recommend that for the first few days the parent who gave birth to the baby do like all of the Breastfeeding and and the other parent just you know, keep pumping as they have been just to make sure that the baby is getting that colostrum and then once Mature milk is what it is sometimes called.

Um, kind of like regular milk, uh, starts to come in Then talk more about how you're going to divide up the feeding schedule and It is one of those things where it's just so So personal and there's so many variables that You know, I think Like the best advice is to just like talk about it a lot But I I do kind of feel like to to try to set a schedule ahead of time is It's just setting yourself up for frustration 

[00:26:19] Emma Pickett: yeah, I mean one of the things that you share in your book is Rebecca's story and and she talks about the journey that her and her partner went through and and particularly the art the concept of jealousy and and Rebecca described how it was something she'd Didn't have a chance to really prepare for because he wasn't expecting it and a partner wasn't expecting it.

I'm not expecting you to remember every single parent you wrote about in your book because there were Rebecca's story? Can you talk us through what happened with that couple? 

[00:26:46] Jacob Engelsman: Yeah, so, so Rebecca did the the Newman Goldfarb protocol, um, and she reported that she did it like, you know, to, to a T and everything went basically like as well as could be expected.

She said that she ended up producing like 30 ounces a day, which, 

[00:27:02] Emma Pickett: wow, yeah, um, that's a Guinness Book of World Records induced lactation for Hall of Fame. That's amazing. 

[00:27:08] Jacob Engelsman: Right. Right. Um, yeah. And, and of course everybody was very, was very excited. But then when, uh, her wife gave birth, um, kind, kind of the excitement for sharing the experience kind of turned into Like, uh, like a jealousy and possessiveness of the baby and, and she didn't like the idea of somebody else feeding her baby, even though the entire nine months previous, you know, she had been entirely on board and even like afterwards, you know, it's, it's some years later now, like she recognizes that that was, you know, totally, totally unlike her and she can't even really like explain it.

necessarily like why she felt that way, um, or like what, where those feelings came from. Um, and none of the, they spoke to several professionals who had never really like. Now, a lot of the professionals hadn't had much experience with inducing lactation to begin with. So, you know, take, take that for, for what you will, uh, and how unique this is, but as best as anyone can figure, like it is kind of a, it was kind of a variation.

Or like a, maybe a, a specific version of like postpartum depression or maybe even, you know, not even full on postpartum depression because they did say she took the, the Edinburgh test and did not turn up depressed, but you know, just like a variation of baby blues or, or, you know, some, some sort of hormonal, I don't know.

fluctuations. And I think it's important that, you know, I think a lot of times, uh, particularly women's experiences are written off as like being hormonal, but, you know, especially in terms of, of birth and childcare and, you know, the, the immediate postpartum period. Hormones are like wildly fluctuating and, you know, it's, I don't think we should be, you know, writing people, you know, writing off people's experiences as like, Oh, they're just being hormonal.

But we can also acknowledge the fact that like, okay, this is probably a reaction due to fluctuating hormones and, you know, not to take it personally. 

[00:29:43] Emma Pickett: Yeah. They're not taking it personally. That's, that's a skill if you can do it. I mean, I'm, I'm imagining that Rebecca felt an enormous sense of loss while also trying super hard to empathize with her wife as well.

I mean, it's, there's a heck of a lot going on at a very intense time in, in their relationship. So I'm glad that they had your support to, to try and work through some of that. So in the end, Rebecca didn't really end up co feeding in the way that she'd expected. 

[00:30:10] Jacob Engelsman: Not for very long now. And of course, just to be clear, I didn't actually meet, uh, talk to Rebecca until, until after all of this had happened.

[00:30:18] Emma Pickett: Okay. Okay. 

[00:30:20] Jacob Engelsman: I don't want to, you know. misrepresent anything. Um, this is, yeah, this is all a story I got for, from Rebecca for this book. But, um, yeah, she, well, and because she was producing so much, they had a lot of, uh, freezer milk, which, uh, she ended up actually donating to some friends who, uh, members of the community who, who needed milk.

So, you know, I think. That did provide her with a sense of, uh, accomplishment, at least that, you know, even if her milk wasn't going into her baby, it was still, uh, helping other babies out there. 

[00:30:56] Emma Pickett: Yeah.

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 and Martin, is a guide for 9 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 percent discount on the last two, go to Jessica Kingsley Press. That's uk. jkp. com and use the code M M P E 10. Makes milk, pick it, Emma, 10. In America, you do have less parental leave or, or, you know, legal rights to parental leave than in lots of countries in the UK and the rest of Europe.

Do non gestational parents have rights to protect their lactation in the workplace? Do laws around pumping, I presume they don't specify whether we're talking about gestational parents or non gestational parents. Can you go back to work and say, I'm pumping for my baby, whatever the situation? 

[00:32:15] Jacob Engelsman: I'd actually looked into this and what the Fair Labor Standards Act says is that nursing workers are entitled to a reasonable break time in private space to pump at work for up to one year after their child's birth.

So people who are inducing lactation before the birth of a child, which I was, it's one of those things that I was not, you know, necessarily surprised to learn, but I was like, Oh, like, of course they phrased it that way. 

[00:32:55] Emma Pickett: Wasn't even on the radar of people in that room, the concept of inducing lactation probably.

Right, right. But I'm hoping that a sensitive employer who would like happy employees is going to be able to, to have that conversation with someone and support someone to do that and I guess the current working from home environment where people are more likely to work from home makes that a bit more likely to succeed.

[00:33:15] Jacob Engelsman: Yeah, yet another advantage to working from home. 

[00:33:19] Emma Pickett: Yeah, for sure. So, we talked about how people who induce lactation don't necessarily produce a full milk supply. And one of the things you talk about in your book is that there's not just the option of using a bottle. I love the way you talk about other ways to feed babies.

And talk us a little bit through some of the other methods that you recommend parents use. 

[00:33:37] Jacob Engelsman: It's interesting because if you, if you search for it, you can pretty, pretty readily find, like, historical artifacts of things that were clearly like used to feed babies, right? Like, like thousands of years old vessels that are, uh, it is very clearly a sippy cup shaped like an elephant.

And I love that sort of thing. But one of the, since, you know, uh, since the invention basically of, of rubber, like it changed everything. And so we have things like Baby bottle nipples, but also feeding tubes, which I know when people, when people hear about feeding tubes, you know, you think of something going like down a person's throat and into their stomach.

But one thing that we can do. is if you want to have the experience of of latching your baby and holding your baby to your chest while they eat and you know, the baby associating you with those feelings of, uh, being full and warm and comfortable. Then you can use what is referred to as, uh, usually referred to as an SNS, which is a supplemental nursing system.

It is also sometimes called an at breast supplementer. There's a few different names for them. I think some of them are trademarked. Some of them are not. But what it is really is just you have like a container of milk, usually a pouch or a bottle, with a feeding tube connected to it, and then people will often start by taping the other end of the feeding tube like right next to their nipple.

I'm given to understand that like once you get the hang of it, you can latch your baby and then just kind of squeak the feeding tube in there. And then you've got like a gravity situation, like bringing the milk down. Of course there's always tricks to it based on positioning and stuff. You know, you don't want to create too, too powerful of a siphon, but there's, so there's definitely a matter of like getting the hang of it.

But yeah, SNSs are great, especially for people who are inducing lactation, but maybe not producing as much milk as they would like. Because a baby is always going to be way more efficient at removing milk than your pump. So, you know, if you're, if you're producing some milk, not as much as you'd like, but you know, you don't want to be pumping eight times a day and feeding your baby periodically throughout the day because you know, then it basically just becomes your whole day.

You can just replace pumping sessions with latching your baby with an SNS. You got a two birds with one stone situation there. And then there, there are other ways that people will do. There's um, if some parents like very specifically, uh, don't want their babies to use a bottle because of, you know, they'll worry about something like a like nipple confusion or like babies get developing a preference for a bottle.

Um, which I understand the concern. I don't think it's as big of a problem as some people think it is, but you know, it's definitely like I can't deny other people's experiences where that has in fact happened. So if you're worried about it, um, So they might attach the feeding tube to, uh, to like your finger, like put on a rubber glove and attach the feeding tube to your finger.

Um, and then that is referred to as finger feeding. It's not often used like longterm, but if you need to feed a baby and they're, you know, we're not using bottles and. You're not the person the baby latches to then you can always do finger feeding or even like in a pinch use a Like a tiny little medicine cup or or like a spoon where it's more of a question of Kind of letting the baby like almost like a lap at the milk as opposed to like pouring the milk into the baby's mouth and again, all of these are things which require a bit of finessing and skill based on And, uh, and the child, but yeah, there's a, you know, there's history is, is full of ways that people have been getting milk into babies and some of them are super cute.

[00:38:10] Emma Pickett: Yeah. Little elephant shaped. Yeah. Yeah. I mean, cup feeding is getting really popular I think in Europe. I mean, we're seeing a lot more newborn cup feeding going on. Um, and yeah, and you, and people, I mean, you can buy fancy little soft silicon. Newborn feeding cups. You can, you know, you can use an egg cup.

You can use a shot glass if you want to. But yeah, we're seeing that quite a lot. Um, particularly in environments which are UNICEF baby friendly and, and wanting to sort of hold off on the bottles. Um, so yeah, I'd be interested to see if that continues to be popular. And then obviously in Indy you've got paddle eyes and, and devices that are non, you know, non, non teat bearing.

So there's definitely some good options out there. Okay, let's move away from talking about induced lactation for a minute. I'd love to a bit about the experience of supporting trans, masc, and non binary parents to chest feed. I'm using that term chest feed. I heard that some people prefer body feeding.

What sort of terms are you hearing families preferring to use? 

[00:39:02] Jacob Engelsman: Um, mostly chest feeding, I think, in my community anyway, has been kind of the accepted go to. 

[00:39:11] Emma Pickett: Okay. So I'm aware that, you know, obviously anyone who's pregnant is going to go through the experience of seeing their body change during pregnancy.

But I'm aware that, you know, perhaps when someone's had chest surgery and they experience pregnancy or, you know, they've, they've gone through this journey, it can be particularly challenging to be pregnant. Am I right in thinking that if someone's had chest surgery, they may get extra tissue growth during pregnancy?

Is that common? 

[00:39:34] Jacob Engelsman: Yeah, so that's the thing, is unless literally all of the milk ducts and milk glands have been removed, which if somebody's had top surgery, right, probably isn't the case. That would be talking more like, uh, you know, like a radical mastectomy from a, uh, medical complication as opposed to a, you know, Uh, masculinizing chest surgery.

Yeah, so unless there's some, uh, or as long as, as long as there's any milk ducts or tissue, the body's going to try to produce milk after, after the baby's born. Your, your pituitary gland doesn't know that, that those glands, other glands have been removed. So, different people, you know, have very different feelings about this.

So, some trans guys You know, are really excited to be producing like even, even if they've had top surgery, right, they're excited to be producing, you know, a small amount of milk for their baby. They, uh, see it as a really, uh, you know, empowering experience, you know, much, much like anybody does. So, uh, we can't assume that just because somebody's had top surgery means they won't want to lactate, but a lot of people who have top surgery.

have in fact had their nipples removed. Um, and in which case, you know, there's no way for the milk to get out. So lactation, A, isn't an option, but B is something the body is inevitably going to try to do. So. Uh, thankfully, you know, there are, there are medications to just like cut that right off, um, that are needed or that are, that are only I'm given to understand, uh, in the United States are only available, like.

with a prescription from a doctor, right? Like a doctor has to administer it usually just in the hospital right after given birth. But if you're planning on having a home birth or something like that, then you know, you might have to make arrangements to get that medication. 

[00:41:43] Emma Pickett: So I'm guessing the medication you're talking about, things like cabagline, I'm always bad at saying names of medication, but 

[00:41:50] Jacob Engelsman: it has 

[00:41:51] Emma Pickett: quite serious side effects.

I mean, risk of hypertension, increased risk of stroke. So, you know, you're going to have to sit down with your care provider and obviously balance up lots of different things. We need a healthy parent there as well as somebody who's feeling comfortable about, you know, their lactation. It's not an easy journey.

[00:42:08] Jacob Engelsman: And there are, of course, other, you know, the, you're not going to make a lot of milk if, you know, for example, you don't have nipples and your, your no milk is being removed, right? It's going to be uncomfortable and you can use, uh, you know, hot and cold presses and, and if no milk is being removed, then your body's not going to produce as much.

So it's not totally necessary that you have, you know, that you use, uh, cabergoline or, or whatnot. Yeah. But it's definitely another, another factor to consider. 

[00:42:40] Emma Pickett: I've actually been working with a mum in the last few years who, who, who's cis woman. She had her nipples completely removed as part of breast surgery.

And has actually been lactating. So nerves have reattached and ducts have reattached and, and, and not 20 years later, I mean we're talking sort of at seven, eight years things were reattaching. So I think sometimes the body can do remarkable things. I mean, she's adamant that her surgery was a complete nipple removal and reattachment.

Um, um, so who knows what bodies can do? It's pretty amazing. So her nipples 

[00:43:15] Jacob Engelsman: were removed and reattached? 

[00:43:16] Emma Pickett: Yes. So, so the, they weren't reattached in the same place, they were reattached in a different position, and her breast was completely reconstructed, but, um, so even with nerves severed, which is normally considered to be, you know, not gonna, that's gonna mean no lactation, because you're not gonna be able to get the milk ejection reflex, it looks like her nerves must have found their way back to each other, I don't even know how.

I don't even know how it happens. Pretty amazing. 

[00:43:40] Jacob Engelsman: I've always heard that milk ducks, um, are, are really good at like repairing themselves. 

[00:43:48] Emma Pickett: Yes. Yeah. So the, the recanalization, which is a great word, I think is, is considered more, you know, pretty standard, more, much more common, but it's, it's usually the nerves that are the problem.

Um, but oxytocin without needing that intercostal nerve message, potentially you can have the letdown happening, even if, um, You know, that nerve isn't working. Possibly that's what's happening to her. If I was a scientist, I would know how to study it and work it out. I wanted to specifically ask you about testosterone, because I think some people feel that if they are taking testosterone and they get pregnant, you know, it's not then compatible to carry on taking testosterone, but that's not necessarily true.

Is that, is that the case? 

[00:44:27] Jacob Engelsman: I feel like I use this phrase a lot, but I am given to understand that yes, that if you're pregnant. You should stop taking testosterone and if you are trying to become pregnant, you should stop taking testosterone that it's, um, uh, that it's not healthy for, like, for the pregnancy or for the, for the baby you're carrying, but I get a lot of questions about, oh, I've just given birth.

When can I start taking testosterone again? And to which the answer is, um, whenever you want is, you know, not necessarily a helpful answer because what people are, um, Often, you know, specifically asking for is like, is testosterone going to affect how much milk I produce or, you know, I want to produce less milk.

and start taking testosterone. How, you know, will that work out? Can I, can I continue, uh, making milk for my baby if I start taking testosterone? Um, so some people, you know, just have different priorities, right? Some people's priority is to get back on T. Some people's priority is to make milk for their baby.

Um, but they would like to be back on T. 

[00:45:41] Emma Pickett: Yeah. I guess your job is just to provide information wherever it's available and help people to make those informed decisions. Yeah, 

[00:45:48] Jacob Engelsman: so the interesting thing about that is that there's, I feel like there's often been this assumption in the lactation community that You shouldn't be taking testosterone while you're producing milk for your baby that at the very least it would decrease your milk production.

Um, however, in recent years, we've got, you know, a lot of, a lot of research now on people who are lactating and taking testosterone and it doesn't really look like, uh, testosterone is antagonistic to lactation. You know, some people. definitely start taking testosterone and their production drops. Um, but not, not necessarily everybody.

Um, for a lot of people, it just carries on right the same. Uh, also there was an idea that taking testosterone because, you know, a lot of, uh, a lot of guys who take testosterone and inject it that that would somehow affect the milk supply or affect your baby, which also we have not a lot but some clinical evidence where it's very specifically like this person, you know is is using testosterone and then we test that the testosterone in their blood and in their milk and then the testosterone in the baby's blood.

And what it's turning up is that, um, not a lot of testosterone is getting into the milk supply. Some is, but it's not really affecting the baby's testosterone level because testosterone is not Easily absorbed by the stomach, right? Which is why people are injecting it or using creams anyway So any testosterone that the baby is ingesting they're just pooping out So it that aspect of it really seems to be just an entire non issue Now if you're using testosterone like as a cream or a patch, that's a different that's a different conversation because you know, then if you're when you're holding your baby you know, you run the risk of getting the testosterone cream on their skin.

And then that, you know, is going to be more readily absorbed. Um, like you're not even supposed to use testosterone cream if you have cats, because it can affect the cat. So. 

[00:48:10] Emma Pickett: Okay. It's interesting to know. So, so yeah, I mean, what you're talking about in terms of milk production, it's, there seemed to be such a complex interplay of, of, of hormones and, you know, people that take contraceptive pills, some people, their milk supply is completely wiped out.

Some people, their milk supply isn't affected at all. Um, you know, some people with PCOS who have higher testosterone levels seem to have fantastic milk supply. So there just seems to be such an unpredictability and I guess one of the hardest messages to give parents is We may not know until you try We may just have to find out and if it things don't go the way you want we can Do things to maybe reverse that but sometimes you just have to you know balance your mental health and your needs against everything else and And work out what what seems most sensible and just give it a go mental 

[00:48:55] Jacob Engelsman: health is so important with lactation and I feel like Often gets, uh, sidelined for, for other things, but, you know, one of the things that my, that my mentor used to say a lot, um, kind of paraphrasing here is that like, if lactation is, is negatively impacting your mental health, like, To to an extreme degree that that no amount of breast milk makes up for having a clinically depressed parent.

Right? Like if you if in order to be the best parent you can be, you need to give your child formula. Give your child formula having having a happy parent having a non depressed parent. If that's what's causing your depression, stop doing it. 

[00:49:39] Emma Pickett: Yep, I think every IBCRC should say that if they're on the side of the parent.

I think that's, that's definitely true. Although obviously mindful of the fact that for some people, getting lactation to work is beneficial for their, for their mental health too. Obviously, we're both on that page as well. One of the things that's super obvious is that this, we could have this conversation for another hour because your book talks about so many different things and we've really only touched on a couple of topics that you talk about.

But I'm a mind for the fact we're running out of time. So I just want to ask you a very practical question. We don't have enough queer and trans IBCLCs. We don't have enough people from non binary backgrounds. The IBCLC profession is historically not super inclusive. Um, and, and that's true of quite a lot of sort of birth professional areas.

If someone is listening to this and they're thinking, Oh, well. Jacob's done it. Maybe I can get into this world and think about doing lactation training. What would you want them to know about entering the sort of world of being a lactation professional? 

[00:50:35] Jacob Engelsman: Yeah, so first of all, um, don't necessarily like worry about you know, what your career has been.

Like I was, I was a pastry chef before I got into lactation. So even if you have no medical background, like, you know, it's, it's a learning process. I think one thing that's really important to know is that, um, in the United States, and I, I don't know if this is true in the UK, but I'd be interested to learn, um, legally anyone lactation consultant, right?

[00:51:06] Emma Pickett: No, sadly that's true in the UK as well. It's not protected. IBCLC is protected, but lactation consultant isn't. 

[00:51:13] Jacob Engelsman: Also, people don't know what an IBCLC is until they have to find one, right? So, if you want to start helping people, uh, you know, I would definitely get into local lactation groups, especially if you have experience, um, as a lactating parent.

You know, get into local groups, learn as much as you can and, and see if this is, you know, uh, the term that's used a lot is, is a peer supporter. Um, so if you can get into peer support, that would be really great before deciding if you want to go through the process of becoming an IBCLC, because that is, that is a lengthy process.

Um, usually, uh, takes, you know, three to five years, um, depending on, you know, what, what you're looking for. Uh, your history isn't everything. I had to take a bunch of college credits because I didn't already have those. So if you want to start helping people, you know, you don't need to be an IBCLC to help people.

You need to have some amount of experience and be willing to learn more. Um, there are lots of trainings online. Um, one is, is just called Lactation Education Trainings. Um, they do a lot of, a lot of different webinars and, and things you can watch. And there's local, there's trainings for like. Anything that piques your interest.

So if you're really, you know, if inducing lactation is something you're really interested in, there's a lot of different trainings for those. There's a woman named Alyssa Schnell has one. She, she wrote a book a while ago called, uh, breastfeeding without birthing. 

[00:52:55] Emma Pickett: Yeah. Great. Great book. 

[00:52:56] Jacob Engelsman: Yeah. So just, you know, find those books, read them.

Um, then if you do want to go through the process of being an IBCLC, um, reach out to some others because some people who already are, um, like myself included, because it is not, it's not a straightforward process. Any IBCLC will tell you that it's not a, uh, a necessarily, uh, what's the word? User friendly, uh, experience.

There's a few different routes to take and it's it's a little confusing. Um, so don't be don't be shy about asking for help We are all excited about getting other people on board. So 

[00:53:38] Emma Pickett: yeah Yeah, there's actually another queer parent BJ Woodstein has just written a book about how to become a lactation Consultant so I would sign I would sign post them to her book as well Um, yeah, that's, as you say, it's not an easy, easy procedure and, uh, and I don't and the UK particularly, it's not necessarily a job that's going to bring you a lot of money, um, because we don't have health insurance in the same way and not everyone can afford to see a lactation consultant, so you just have to know what your local market is like and talk to people about what realistically your earnings are going to look like as well.

I think I think that's important to say. Sometimes it is a I think it's important to say. A privileged position to be able to go through the training and take the time to do all that without having yet having an income. So yeah, yeah, I think you say, do your research, find people to talk to. And we're always happy to have conversations with people who want to become IPCLCs.

Okay. So I'm picking your brain on that one. I want to pick your brain on one more thing, which is if somebody is listening to this and they're working on being an ally and they know they need to know more. Where would you recommend they go to get some more education, to make themselves a better ally?

Apart from reading a book, which I'm going to suggest that they do, and reading A. J. Silva's book, and I'm also going to advertise A. J. Silva's course, which she also is available in the UK, which is excellent. Um, is there anything else that springs to mind that you think is important? 

[00:54:56] Jacob Engelsman: Yeah, so, uh, I just read a book called Rainbow Parenting by, um, uh, their name is Linz Emmer, and I'm just going to spell that for you.

You can, you can do what you, what you like with the, uh, with the audio, but it's L I N D Z.

I posted on my Instagram reel about it because I feel like this book, uh, I feel like the problem with this book is that the people who are most likely to read it are people who are queer or people who have queer kids. But I feel like straight people need to be reading this book. It's, um, yeah, it's just, it's just about, like, inclusivity in childhood and, like, supporting queer kids but also, like, queer parents and, you know, things that are, that are beneficial to all kids regardless, you know, of if they like boys or girls.

So just being, it's, you know, about like being a more accepting parent. So I would definitely recommend going to the bookstore or your library to to find that book. Um, but also, you know, Just books about like being an ally. So this is my, this is my specific recommendation, right? When you go to a bookstore and you find a book about being trans or being non binary and you think like, oh well, like that book's not for me because I'm not trans or I'm not non binary.

Or books about like coming out and you're like, well, I don't need to be coming out. Okay, buy that book and read that book. Like, it's going to help you in ways that you know, the author did not necessarily intend, the author intends the book to be for non binary people, but for all the binary people who read that book, you know, you're going to get more out of it.

Well, not more necessarily, but, but different things out of it. So instead of necessarily, you know, putting the, the burden of education on on the community, you know, like go out and read the books written for the community that you want to be an ally to. 

[00:57:26] Emma Pickett: That's very good advice. 

[00:57:28] Jacob Engelsman: I do feel like there's also sometimes people feel a little bit shy to be like reading a book like that in public because like they're gonna Almost like feel like a poser.

Um, but it's like, you know, nobody's going to like, no Trans person is going to be mad at you for reading a book about trans people. 

[00:57:51] Emma Pickett: Yeah Virtue signaling is the word that comes to mind. It's not virtue signaling if your intention is good. Is it your your Doing the opposite of that, there's something authentic and meaningful behind it.

Right. 

[00:58:03] Jacob Engelsman: If you're reading that book to try to pick up somebody, that's a different story. But if you're reading that book like for the purpose of learning how to be better to the community, yeah, do that. 

[00:58:15] Emma Pickett: That's a good place to end. Although you can pick up people as well if you want to. We don't, we're not saying that's impossible.

Um, okay. Thank you so much, Jacob, for your time today. I really appreciate it. So, so I will put a link to your book in the show notes and I'll also mention some of the other resources we've talked about today. I'm so grateful for your time and I'm really looking forward to hearing about other people reading your book and learning from it.

Thank you so much for adding it to the library. Very much needed. And I look forward to hearing how it goes from strength to strength. And book number two? Are there notes? Is there a Google document for book number two? Um, 

[00:58:48] Jacob Engelsman: so I'm actually working on two other books right now. Wow, okay. Um, one is a book about, uh, a book about infant care for like written.

in kind of the same way as lactation for the rest of us where it's, you know, not assuming that the parents are a cis woman who just gave birth and their cis husband. Um, that I feel like is, is kind of a harder sell because it doesn't have a lot of new information in it. Um, it's just information being presented in a, in a new kind of way.

Um, so I've got that book and both of these books are, I've submitted to, uh, publishers. I'm waiting to hear back. And then the other one is kind of, uh, it's, it's a different tack entirely. I have interviewed some, uh, queer and trans medical professionals, um, of, of different types. So right now I've got four or five interviews done.

Um, but I, I'd love to do a lot more where basically I'm talking about education, uh, for like supporting, like how doctors and medical professionals can be supporting queer and trans patients. And like, What education they have received in that regard, their own experiences as queer and trans patients, because, because every doctor is also a patient at some point in their life and where education can kind of go from here.

Like what, what we as a community would like to be seeing in the field of how to care for, uh, special considerations for these communities. Yeah, so right now those are the two books that I'm kind of pitching around. Um, you don't have an agent, do you? 

[01:00:47] Emma Pickett: No, I'm not that grown up, I'm afraid. Jessica Kingsley feels like the hot poem for these books.

So you have you tried you're trying them as well, are you? 

[01:00:55] Jacob Engelsman: Yeah, um the Uh, so the first one basically, they were the ones who were like, the problem is that it doesn't have a lot of new information. It's just information being presented in a new way. 

[01:01:06] Emma Pickett: Sorry, that's books. I mean, there's a new, there's a new book about babies and looking after babies every flippin month.

I mean, that's not a reason not to produce, um, 

[01:01:13] Jacob Engelsman: however, there was kind of a glimmer of hope that they're like, However, if your first book sells really well, we can talk about it, right? 

[01:01:22] Emma Pickett: I mean, the world of baby books has always just been talking to people and then connecting with them in a different way. I mean, yeah, we, we might care for babies a little bit differently over the centuries, but the core of it is often similar information.

It's about, it's about connecting, isn't it? It's about connecting with people and people being heard and listened to. So yeah. Yeah. Well, yeah, we're going to go and buy your book, aren't we? People listen to this podcast and that will help. And, uh, I look forward to hearing that those are successful contracts that come about.

[01:01:48] Jacob Engelsman: Yeah, I will definitely keep everybody posted on, uh, on future works. 

[01:01:53] Emma Pickett: Yeah. Brilliant. Thank you very much, Jacob. Good luck with that. Lovely to talk to you today.

Thank you for joining me today. You can find me on Instagram at emmapicketibclc and on Twitter at 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.