Opinions are sought on the clinical and ethical issues of a couple where
one partner seeks to induce lactation, and the other partner is carrying
twins but does not intend to BF.

As IBCLCs our ethical mandate can be summed up like this: "Provide
evidence-based information and support, so the family can make a
fully-informed decision about healthcare for the parent and child, in
consultation with the primary healthcare provider (HCP)."  That's it.  Talk
in a non-judgmental manner about the risks-and-benefits of all elements of
care for the client who has sought your advice on induced lactation.

And as a coda I'll add: IBCLCs (indeed, all HCPs) need to keep their own
assumptions and presumptions in check.

We are told "there is absolutely no way that the birthing mom-to-be intends
to breastfeed."  Yet, suggestion is made that the parent who "has undergone
lengthy and arduous fertility treatments to carry these unborn babies" will
endure "emotional stress" if induced lactation by the non-birthing partner
allows her to " 'reap
the joy' of providing their milk."

Sounds to me like this family already has clear expectations and decisions
of how post-partum infant care will proceed.  If we aren't wringing our
hands that the non-birthing parent will fail to "reap the joy" of pregnancy
and childbirth, then we shouldn't assume the one who carried the babies has
a desire to lactate. Indeed, in what few bits of literature are out there
about same-sex and trans*- couples becoming pregnant, birthing, and BFg,
the biggest take-away I have is that our cisgender, hetero-normative
cultures predispose us to binary conclusions and assumptions in healthcare
that just don't work for persons from the LGBTQI community.

So, just ask.  With an open heart and mind, so that your inquiry is
perceived as necessary for your excellent clinical care, Just Ask the
client and/or other partner their plans about birth and lactation.  You may
be able to raise issues they may not have pondered -- after all, you are
the lactation clinical care expert. And you can offer anticipatory guidance
toward that end.  But find out what they know, determine how you can help
them know more, and see if there are options they have not considered.  But
I would gently suggest you do it with as non-assumptive a frame-of-mind as
you can muster.

It is not for us to gate-keep healthcare information, nor to assume how the
client will "feel" about the course of care.  I put it this way:
"Information never nurt anyone, and parents by-and-large want to do right
by their kids."  So, offer evidence-based information and support, for the
care plan the family chooses.

If we can meet that standard, we have met our ethical obligations.

-- 
Liz Brooks, JD, IBCLC, FILCA
Wyndmoor, PA, USA

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