When my fourth baby was born, a friend gifted me a vintage 2nd edition copy of ‘The Womanly Art of Breastfeeding’. First published by La Leche International in 1963, this book was revolutionary. At a time when breastfeeding was widely considered old-fashioned and distasteful in Western cultures, and mothers were persuaded by doctors to use formula from birth, ‘The Womanly Art of Breastfeeding’ provided not just information about breastfeeding management, but encouragement for women whose desire to breastfeed was taboo and defiant. And its influence was far-reaching; a group of Australian mothers who sent away for a copy of the book founded the Nursing Mothers’ Association of Australia (later to become the Australian Breastfeeding Association) not long after their copy arrived from the USA. ‘The Womanly Art of Breastfeeding’ is now in its 8th edition and has never been out of print.

La Leche League International now organizes advocacy, educational, and training related to breastfeeding in 89 countries worldwide. But in recent years, some branches of LLL have begun to deliberately move away from matri-centric language in favour of gender neutral terminology in the name of ‘inclusive’ support:

An article published on the LLLI website in January 2019 indicates that LLL has now moved beyond removing women from their language, to removing mothers from the breastfeeding relationship altogether. In this piece, titled “Gender Identity in the Art of Breastfeeding”, Laura Jessup argues that lactation is beneficial for all parents and seeks to normalise induced lactation in fathers and trans identified males while making a series of tenuous claims about the benefits of male milk human milk for babies.

When this article was shared by La Leche League International on their Facebook page, comments were heavily moderated (some commenters went as far as requesting that LLLI discipline any leaders who posted negative comments). The prevailing view in the remaining comments was supportive of the article and praised LLLI for their inclusivity.

Because I’m not a member of LLL, I am not in the least concerned about being chastised for negative comments about this piece, or for pointing out the absurd and reckless position LLLI are taking by promoting the idea that men can breastfeed and that infants consuming drug and hormone induced male breast secretions is fine and normal. But more than that – I’d like to take this opportunity to go through the article paragraph by paragraph, because I think such a fine example of Orwellian genderspeak deserves a closer look, don’t you?

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A transman gives birth. A transwoman, chromosomally XY, induces lactation. A parent identified as female at birth has a condition called androgen insensitivity syndrome, so is genetically male but appears female. What does it mean to be a woman? Is gender even binary? If not, this spectrum of sexual orientations and gender identities creates implications for breastfeeding.

A biologically female person had a baby. A biologically male person underwent a regimen of synthetic hormones, drugs and pumping which resulted in milk secretions. And now, an appeal to intersex conditions which ignores the repeated requests of intersex advocates not to be used as props for transgender activism. Followed by the mysogynist trope that womanhood is mysterious and unknowable, the conflation of sex and gender, and the conflation of sexual orientation with sex role stereotypes.

Questioning these assumptions about gender also asks that we deconstruct our understanding of motherhood, as well as our definition of breastfeeding. Is breastfeeding only associated with women? What is breastfeeding? Parents who produce little or no milk, but who latch the baby to the nipple and comfort the baby at the breast, are they “breastfeeding”?

Now let’s pretend that because gender is a social construct, breastfeeding is also a social construct, and not a series of material and biological events in the reproductive life of an adult human female.  And substitute the word ‘parent’ for ‘mother’ as if lactation is something which happens to both mothers and fathers interchangeably.

Early medical writers such as Aristotle and the Corpus Hippocraticum reported male lactation. In contemporary literature, we see male lactation in Louise Erdrich’s The Antelope Wife, a novel in which a solitary soldier cares for an abandoned infant by putting the baby to his chest. He begins by rubbing animal fat on his nipple to make it more comfortable when the baby sucks ravenously. Eventually, the soldier begins to produce milk. An interviewer asks Erdrich about the scene,”

“A man nursing a baby in The Antelope Wife?”

Erdrich replies, “What’s strange about that? There are several documented cases of male lactation. It’s sometimes uncomfortable for me to read that scene in front of mixed audiences. Men get upset. But I think it’s a great idea. It would solve about half of the world’s problems.” In the novel, the baby grows strong and healthy. Even tiny amounts of milk from the man provide some nutrition and significant immune support.

Male lactation is typically the result of illness or a medical condition, of obvious interest to early medical writers. Now let me tell you about how I read a work of fiction about a baby who grew strong and healthy when breastfed by a male character and that’s how I know everything I believe about this is true.

During the Triassic period more than 200 million years ago, breast tissue evolved from modified sweat or sebaceous glands. It is an ancient reproductive feature, pre-dating placental mammals. These ancient reproductive features produced a nutrient-rich milk-like secretion and evolved in both females and males.

Also it’s true because DINOSAURS you guys.

Males of some species spontaneously lactate. The male Dayak fruit bat is a mammal that routinely lactates, but many mammals, such as male goats and neutered cats are often observed lactating, especially when around newborns.

Did I mention bats? Cats! Goats! We can almost probably definitely extrapolate this to humans!

In the mid-1900s a drug called Thorazine was used as an antipsychotic. It affected the pituitary gland by causing it to overproduce prolactin and subsequently induced lactation. When used in men to improve gastric motility, prolactin enhancing drugs such as metoclopramide and domperidone can also result in lactation, as can the heart medication, digoxin.

I will now completely avoid mentioning that domperidone use in men is associated with elevated risk of cardiac arrhythmia and death. Or that young women in the USA, Europe and Australia are routinely denied access to off label use of domperidone for lactation.

Men have been observed to lactate under extreme stress, after castration, when ingesting phytoestrogens, or as a result of pituitary tumors or other prolactin disruptions in the pituitary gland. Some authorities claim that nipple stimulation may be enough to induce lactation in men. Others argue that men must first experience a hormone shift. Without the growth of glandular breast tissue during puberty and pregnancy, men who begin lactating will likely produce only tiny amounts of milk.

Starvation stimulates prolactin release, which accounts for male lactation occurring in war camps. Perhaps men hold this ability to lactate as a way of comforting children during times of famine and severe crisis. Evolutionary biologists speculate that lactation in both male and female parents has adaptive value.

Watch as I casually toss around events like trauma, castration, and life in concentration camps in my attempts to make it seem like male lactation is totally normal!

How can we support parents who wish to breastfeed? Milk production is initiated by the cascade of hormones triggered by birth, but parents who do not give birth can induce lactation to make some milk.

…or here’s an idea, we can support women who wish to breastfeed by not interfering in the cascade of hormones triggered by birth, and by not removing an infant from their mother’s breast to be fed by the parent who did not give birth.

Milk production can be encouraged by effective latches, breast compression, frequent feedings at the breast, pumping, hand expression and plenty of skin-to-skin contact. Milk production can be augmented by pharmacologic and herbal galactagogues. When there is minimal or low milk production, parents can use a supplemental feeding system to offer milk through a small tube at the nipple. In this way, the baby receives milk at a parent’s chest which stimulates the milk supply at the same time.

This is the part where I completely dehumanise breastfeeding mothers by explaining how breastfeeding works without using those icky words ‘mother’ or ‘breast’.

A recently published case study reports that a transgender woman, who had been receiving feminizing hormone therapy for six years, successfully induced lactation. After one month of treatment to induce lactation, she expressed droplets of milk. After three months of treatment, she expressed each day eight ounces of milk, enough to exclusively feed her adopted newborn for six weeks. This study appears to be the first report published in medical literature of an individual, identified as male at birth, who successfully induced lactation to provide significant amounts of milk for her child.

A published case study of a trans identified male failed to provide any substantial evidence about the growth and health of the baby they claimed to breastfeed. The patient was not clinically observed expressing milk or breastfeeding the baby. The case study was authored by a clinician who is also a trans identified male.

For a transgender man, the process of lactating may cause distress—an unsettling tension between identity as male and association with feminine breastfeeding. He may be eager to resume testosterone therapy, but he may also feel pressure or a desire to provide his milk for the baby. For parents who have had top surgery, there may be limited mammary tissue, and the amount of milk production will depend on the type of surgery and the condition of the ducts and nerves involved in lactation. These parents may prefer the more gender-neutral term “chestfeeding.”

Internalised misogyny and dysphoria is highly prevalent in trans identified females, particularly during pregnancy or breastfeeding when their ability to pass as male is obviously challenging. But once again, sshhhh, just pretend that this is an issue affecting ‘parents’, as if bilateral mastectomy is surgery which anyone could have but just happens to be occurring exclusively among people who prefer to describe what they do as ‘chest feeding’.

Even drops of nonpuerperal human milk have significant levels of protective proteins such as secretory IgA, lactoferrin and lysozyme, and just the act of sucking at the breast improves facial development compared to bottle feeding. Parents know that human milk is good for the baby, but lactation is good for parents, too. Lactation involves the release of relaxation hormones such as prolactin and oxytocin, resulting in lower stress for both the baby and the parent. If breastfeeding were more broadly accepted as a human “art”—ungendered and biologically possible for all–perhaps more parents would feel at ease comforting their babies at their breast.

Here is some sciency jargon to paper over the fact that there isn’t actually much substantial evidence about the actual composition of male milk! Lactation is good for EVERYONE! All parents should lactate! Biologically possible ungendered breast comforting for all babies YEAH!

As we support all families who make milk for their babies, we can be mindful of gender inclusive language. Open-ended questions such as “what pronoun do you prefer” and “what term for feeding the baby do you prefer?” allow for welcome communication. In the spirit of inclusion, equity, and diversity, make no assumptions about gender identity in the art of breastfeeding.

So go forth, and boldly pay more attention to appearing woke and inclusive than to the fact that the vast majority of mothers don’t meet their breastfeeding goals not because of their pronouns but because women and children’s lives aren’t considered worth the investment. Pretend that inclusive breastfeeding support is mainly about making sure that we don’t speak about breasts or mothers. And whatever you do, make sure that anyone who asks questions about any of this is treated like scum – an internet pile on is good, but getting them kicked out of your organisation is even better.