Misinformation about chestfeeding is swirling online. Here's what that actually means

Earlier this month, several media outlets claimed that the Centers for Disease Control and Prevention (CDC) updated its guidance on breastfeeding to include information about chestfeeding. However, as Snopes recently reported, information about chestfeeding has been on the public health agency's website for years. In an email to Salon, Belsie González, a CDC media officer, confirmed that despite the claims in headlines of many conservative outlets, there was no "update to guidance." 

"Since 2018, CDC has provided information on our website for transgender people who are considering breastfeeding or chestfeeding their infants," González said. "Guidance on this issue, including a clinical protocol, comes from the Academy of Breastfeeding Medicine – a global organization of doctors that educate health professionals on breastfeeding."

Yet misinformation persisted claiming that chestfeeding was potentially dangerous to infants. Politicians got involved as Sen. Roger Marshall, R-Kan. wrote a letter to the CDC expressing concerns about how medications used to induce lactation could be dangerous. What led to the attention on chestfeeding remains unclear, yet misinformation is still circling. 

What is chestfeeding?

According to the CDC, chestfeeding is "a term used by many masculine-identified trans people to describe the act of feeding their baby from their chest, regardless of whether they have had chest/top surgery (to alter or remove mammary tissue)."

Jennifer Smilowitz, a faculty affiliate with the University of California, Davis Department of Food Science and Technology, further elaborated to Salon via email: "Chestfeeding is also a general term that can include nursing at the breast/chest, using a tube attached to the nipple to feed the baby infant formula or donor human milk or even non-nutritive sucking for comfort."

It's common for both cisgender women and transgender individuals to do what Smilowitz described and it can be called either chestfeeding or breastfeeding — whatever the person prefers. Sometimes, when waiting for a person's milk supply to come in after birth, a lactation consultant might recommend using a tube and attaching it to a nipple shield to feed the baby formula or pasteurized donor milk. This method will keep the baby suckling at the breast and stimulate milk synthesis. Adoptive parents have also sought out ways to breastfeed or chestfeed despite not including a birthing person.

Dr. Andrea Braden, an OB-GYN and board-certified lactation consultant, told Salon via email that "chestfeeding came around when we needed another term for lactation that did not formally exist."

"Breastfeeding is the old familiar umbrella term for all things breastfeeding and lactation. It was the only term we had for a long time," Braden said. "However, as a transgender person, we have found that there are words that do not adequately describe their lived experience in their gender identity, so someone who identifies as a man may find the term breastfeeding to not properly describe feeding their baby with their own human milk."

However, Braden said for a transgender woman, it might be preferable to say breastfeeding.

"There can be confusion where someone who was assigned male at birth would like to lactate," Braden said. "That is often still called breastfeeding because someone who is a transgender feminine person finds it very affirming to be able to do something that is feminine like breastfeeding."

Induced lactation

Indeed, as the CDC notes, an individual does not need to give birth to breastfeed or chestfeed. This is possible through a medically guided process called "induced lactation." Lactation occurs after someone has given birth because a combination of the delivery of the placenta and a newborn suckling at the breast results in a dramatic rise in prolactin, the hormone that makes human milk. Those who haven't given birth need to experience that rise in prolactin another way.

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"Induced lactation requires a combination of hormonal treatments (estrogen, progesterone) and sometimes the intake of medications or herbs that may help produce milk. These are called galactagogues," Smilowitz said. "Closer to the time when the baby is born, patients are then instructed to pump their breast/chest to encourage the production of prolactin. Different clinics or providers may follow different treatment regimens, but this is the general gist of induced lactation."

Smilowitz said that the success of producing sufficient milk for an infant via induced lactation depends on many factors, and it might not work for everyone. She pointed to a Cleveland Clinic explainer on the process. Many medical providers rely on the Newman-Goldfarb protocol to successfully induce lactation and feed their infants which require patients to take a birth control pill.

As Katelyn Burns wrote in Them in 2018, induced lactation in a non-birthing person is nothing new.

"In online forums and on social media, trans women have long shared anecdotal accounts of methods used and success achieved in lactating and feeding their children," Burns wrote. "As far back as 2010, Dr. Christine McGinn, a trans surgeon who specializes in gender reassignment surgery, appeared on the Oprah Winfrey show in a sensationalized segment that revealed she had both fathered her children and was the sole parent to breastfed them."

A successful case was published in Transgender Health in 2018 documenting a 30-year-old transgender woman whose partner was pregnant but was uninterested in breastfeeding. The patient hoped to take over the task when their baby was born. After following the basic framework of induced lactation, which included using a galactogogue called domperidone, the patient (who had no gender-affirming surgeries such as breast augmentation) was making 8 ounces of breastmilk a day, two weeks before the baby's due date. The patient successfully exclusively breastfed the baby for six weeks. At that point, however, the patient began "supplementing breastfeedings with 4–8 oz of Similac brand formula daily due to concerns about insufficient milk volume," the study reports.

"It's possible with a medical regimen and clinical support, transgender women can successfully induce lactation and provide milk to their infants," Smilowitz said. "There have been 3 reported case reports that reported successful induced lactation and only one recently showed that their milk delivered 'normal' levels of macronutrients."

From a physiological perspective, cisgender men "do not have the hormonal repertoire required to produce milk," Smilowitz said, adding that testosterone can suppress lactation. However, both sexes are born with the basic breast structures at birth — it's the hormones that make the difference.

"The conditions exist," Dr. Jack Newsman from The Newman Breastfeeding Clinic and International Breastfeeding Centre, and co-author of the book "Dr. Jack Newman's Guide To Breastfeeding," previously told Salon. "Men have milk-producing tissue in their breasts normally."

Are there risks to chestfeeding?

Smilowitz said there are no known risks to the infant, and research is still needed to understand how different physiological states influence lactation. However, decades of study have demonstrated that exclusive human milk feeding in the first six months of life is beneficial to the infant. Smilowitz emphasized that even a little bit of human milk is better than none at all.

"One risk to chestfeeding could be low milk production, but that's not exclusive to chestfeeding," she said.

As far as induced lactation goes, one potential risk could be the emotional stress experienced from it being unsuccessful. 

"Induced lactation (in non-gestational parents) may not be as successful in individuals who have undergone chest surgery because either their mammary gland tissue which makes milk has been surgically removed and/or the mammary ducts which transport the milk have been removed or damaged during surgery," Smilowitz said. "Induced lactation in individuals who have not undergone a chest surgery are likely to have higher chances in producing milk because they have more milk-producing cells and intact ducts."

Smilowitz emphasized this is extremely understudied and warrants extensive research to fully understand the impact of chest surgery on successful induced lactation.

As far as domperidone goes, the Food and Drug Administration (FDA) warned against using it to induce lactation in 2004. This was because there could be cardiac risks to the person taking it. In 2014, a report published by the American Academy of Pediatrics (AAP) emphasized that there's been a history of "mothers inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants."

However the AAP also reports "This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants."

Furthermore, the CDC did note domperidone "is associated with QT prolongation in children and infants." Notably, these were not breastfed infants, but babies who received oral administration of domperidone. 

According to the National Library of Medicine, withdrawal symptoms for individuals who take domperidone can consist of insomnia, severe anxiety and depression have been documented in some individuals taking high doses of domperidone daily. Domperidone is not approved by the FDA in the United States.