Elizabeth Brooks writes:

"My guess is that healthcare providers, interested in learning how much
breastmilk a newborn needs for healthy growth and development, are not
going to seek the answer from a journal article in Transgender Health,
describing in great detail the lactation inducement protocol used,
successfully, in care of a transgender woman. The folks reading this
article are likely to be working with gender nonconforming
clients/patients, and will find the well-described history of this
individual woman, and the treatment plan used for her, very helpful in
advising future patients/clients."

True, while HCPs will probably not take this case study as a blueprint for infant growth and nutrition, I still don't care for the lack of clarity about volume of milk produced. HCPs will certainly want to know how success is measured, and will use volume of milk as a factor. Why would they not? Why did the researchers not report this essential info? 

Elizabeth continues:
"That this article doesn't "prove"  its assertions by including a specific
definition of, and verification of, "exclusive breastfeeding" or "shared
feeding" [if any] or "supplementation" makes it no different from the vast
majority of research that discusses lactation. Even articles in JHL and BFg
Med -- journal focuses on lactation -- are sadly lacking in defining, with
specificity, what is meant by "breastfeeding," "mized feeds," etc. "

I know - but one thing that usually does mean what it says is 'exclusive breastfeeding' :) Anyone reading it, whether a BF specialist or not, would understand this to mean 'breastmilk was the sole source of nutrition'. 

"When a published case study like this comes out, and is fairly well covered
by the mass media to boot, it continues to diminish and marginalize the
populations that self-identify as trans if IBCLCs do not respect the
results as credible."

Well....I'm not an IBCLC, and IBCLCs are only one variety of qualified and experienced and reliable BF worker. I reserve the right to ask questions, and to say 'this report has holes in its narrative' and in doing so I don't feel I am contributing to any diminishment or marginalisation. It is *good* to question - how else do we learn? Spreading *any* case report - which is what this is, with all the limitations of a case report  - 'far and wide', uncritically, is not what we do, is it? 

For the record, I don't think it is at all 'wrong' or undesirable for babies to get breastmilk in this way, in the absence of direct BF from the mother (which would always be the physiological preference)  - but I reserve my unconfined joy at this 'breakthrough' :). 

Heather Welford Neil
UK 

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