June is Pride Month, a time to commemorate the 1969 Stonewall riots and celebrate the LGBTQIA+ community. Originally published in 2016, this piece by Guest Blogger, Nikki Lee RN, BSN, MS, IBCLC, CCE, CIMI, ANLC, CKC remains relevant in the spirit of identity, acceptance, inclusion, and progress.
Diana West BA, IBCLC, LLL, is a co-author of many important works, (the 8th edition of the Womanly Art of Breastfeeding, Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, Breastfeeding after Breast and Nipple Procedures, The Clinician’s Breastfeeding Triage Tool, and The Breastfeeding Mother’s Guide to Making More Milk) , as well as the sole author of Defining your Own Success: Breastfeeding after Breast Reduction Surgery and editor of her father’s autobiography, In the Line of Duty. In addition to her websites, she is well known as an educated, lively, and passionate public speaker. Our Milky Way blog is grateful for the chance to interview Diana about her research article, “Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: a qualitative study,” co-authored with Trevor MacDonald, Joy Noel-Weiss, Michelle Walks, MaryLynne Biener, Alanna Kibbe and Elizabeth Myler.
The universe works in wonderful and mysterious ways. Several years ago, Diana received an email from a would-be author asking her to read a book that he had written. There was something special about this letter that captured her attention. In it, Trevor MacDonald, a trans man wrote of reading her book Defining Your Own Success: Breastfeeding After Breast Reduction Surgery, and then of being inspired to chestfeed his own child.
As the right of all people to their own identity is one of her core values, Diana entered into a relationship with Mr. MacDonald, first as a mentor guiding him towards publication, and then as a friend, sharing a room with him at an ILCA conference, and then as a collaborator, working together.
He was appreciative of and patient with her respectful approach; he taught about this new world, where an untold number of people struggle without help, staying underground as they fear the judgments of the helping professions.
They thought of publishing a case study but changed their minds to do a research study instead. While they initially envisioned a quantitative study, after consulting with others, including Canadian Professor Joy Noel-Weiss, they decided to do a qualitative study. Dr. Noel-Weiss helped them to see that the data in a qualitative study would be richer, giving insight into the motivations behind lived experience; this would be far more valuable than evaluating numbers.
After developing research questions and obtaining clearance from an ethics committee, the merry band applied for a modest CHID (the Canadian version of the US’s National Institutes of Health) grant. In an amazing affirmation of the value of this research, they received $100,000, far more than they had requested, because the agency was so impressed with the topic!
The 3 goals of their study were: to understand the lived experience of the transgender men who chose to birth and to chestfeed, to understand the barriers they encounter, and to provide guidance to healthcare providers.
Many breastfeeding helpers came of age and into their avocations in the 1970s, when women were fighting for autonomy and rights to freedom in birth and breastfeeding. Today, some feel that trans men are encroaching on women and their feminist perspectives. This is why trans women were banned from a women’s festival in Michigan. Instead of saying, “These are more women who have been denied dignity” they were seen as men who were encroaching on a woman’s needs for equality of choice. However, gender identity is not binary, i.e., only male or female.
A cisgender person, one who identifies as the gender manifested by their genitalia may not be absolutely and always female or male. Gender identity is fluid. We may feel more male on some days, more female on others, and there are days when we feel neuter. There are mutational variations of hormones that create variations on gender. Babies are born with ambiguous genitalia. There are cultures where people can be recognized as 2-spirited. Gender, identity, and sexual preference are complex traits, there is a wide range of variation, and consequently, people don’t all fit into a neat “either/or” category.
Thirty-three years ago, I met a great fiddler named Gary. Gary was the most crass and obnoxious man that I ever met. It was impossible to have a conversation with him without his making some gross joke or sexually slanted comment. I didn’t like to be with him, because he was such a cad. He lived in the South; I lived in the North and didn’t have contact with him very often.
Fast-forward 25 years, when I run into Gary at a fiddler’s convention. Only now Gary has breasts, is wearing a dress, earrings and make-up and wants to be known as Marie. We had an amazingly open discussion, where I got to ask all the questions I wanted to ask and she answered them all. She told me that all the deeply difficult work, all the family disruption (before transitioning, she had married and had 2 children), and all the medical and surgical interventions were worth it, as now she felt complete and comfortable in her own skin for the first time in her life. All was well except for one thing, family and friends continued to use the wrong pronoun; myself included. I got annoyed with her for being annoyed with me when I kept using male pronouns; I said to her, “Gary, I’ve known you for 33 years as a male and it is hard for me to switch gears quickly enough for you.”
After hearing this story, Diana gently suggested,
“Oh yes you can, and here is why. For a trans person to come out to the world as someone who is a different sex than the world has known them before, is one of the most difficult situations imaginable. It is difficult to be brave enough to be one’s true self out in the world. Acceptance is what is craved, in order to have dignity. When we who are cisgender do not recognize that change, we are denying that person their dignity. We can make the effort to honor the pronoun they choose. Everybody has the right to the pronoun of their choice. It is simply a matter of respectfully asking them what pronoun they prefer.” (This means adding new terms, understanding, and words to our vocabulary.)
Diana goes on to say, “We don’t know people’s paths, and we don’t know their hurts. When we accept people choosing the path that meets their needs, we recognize their right to be who they are. “
She paraphrases Mr. MacDonald in saying that many people find the concept of being transgender disturbing because they picture themselves having to act and dress differently than their true selves. But really, it is the trans folks that have had to act differently to who they really are until they transition. Putting it another way, was there a day that you consciously chose to be cisgender? Or, do your feelings about your gender identity flow from a place inside you, where the truth of who you are has always lived?
Society is presently a challenge, as there is anger about trans gender. Some people believe that sexuality is a choice and manifest their fear in attacks that fill our feeds and screens. The rudeness and brutality of the Internet and the rhetoric of today’s political debates is painful to those struggling for recognition. It behooves us all to post and tweet with courtesy and respect.
Science and technology have made possibilities real that were hitherto unimaginable. Think of the suffering that has gone on for millennia, where differently gendered folk could only dream of the pharmacy and the surgery that would enable them to have their physical bodies match their inside spirits. Today, these dreams can come true; now, everyone in society needs new skills and new understanding to catch up to the new reality.
Another barrier is the public attitude about children who are being parented by trans men. Diana responds,
“Children raised with love and respect and healthy growing environments, have the best chance to be wonderful adults. We don’t have to be perfect parents; the only ideal for a parent is deeply loving a child and taking care of them. There is NOTHING about being transgender that precludes them from being a good parent. In fact, they may have more understanding to teach about the importance of treating everyone with dignity.”
Most trans people are not activists as they are too busy living their lives. The trans experience is really about self-actualization, a concept younger folks may not yet appreciate.
So far, what is most helpful is social support from family and friends. (This is true for breastfeeding too!) The people who donated a lot of the milk that Mr MacDonald used to chestfeed were Mennonites and Mormons. Although they knew who he was, their priority was on feeding the child human milk, and they didn’t judge him nor withheld their gift.
As healthcare professionals, we need to become transliterate, so that we can be helpful and respectful to anyone that we care for. This means educating ourselves so that our clients don’t have to explain everything over and over again with each one of us. The new research article has great information about how healthcare professionals can help transgender clients more effectively. Diana also has a FAQ on her website to aid the transgender person in finding the help they need for birth and breastfeeding, and for healthcare professionals to educate themselves.
Ask about preferred pronouns and “what would you like your child to call you?” There is no need to apologize for what we don’t know; “I want to be helpful, how can I help?” is a lovely way to start a discussion. People make mistakes; those who are transgender understand this. Our responsibility is not to be stuck on our mistakes, and to make the transition to helping and not to impose our own struggles. We also want to avoid overcompensating to prove how cool and current we are.
If transgender issues aren’t comfortable for you, remember that as healthcare professionals, we are ethically bound to take care of people that we may not like. We have an obligation to provide best care; this requires only an intention of respect. We need to treat people in a humane way, as we should be treating ourselves.
Grammar is another stumbling block, as language locks old societal attitudes into our unconscious, where they are negative influence on our interactions with others. Diana says, “ ‘They’ has been a plural noun; we have to let go of old grammar rules and use ‘they’ as a singular noun.” (Facebook is doing this.) This will get rid of the gender binary view, and bring us forward into the 21st century. Language is a dynamic, changing thing; language change fuels our intention and is manifested in our actions.
A mistake that I made in this interview was to talk about the “transgendered” This noun is similar to the term “colored”, it is a subtle way of expressing the terrible attitudes towards “those people who are different to and inferior than us.” Diana encourages the use of the word “transgender”.
Diana reminds us that of the need for acceptance, dialogue and welcoming all points of view; she is collaborating with transgender speakers to introduce her talks on that topic. Her goal is to be a cisgender Ally; the capital ‘A’ is intentional and reflects the importance of a new social advocacy role in supporting human rights. Her dream is for all people to become self-actualized and lead the best and healthiest lives possible.
We applaud Diana for breaching this barrier, and educating us about human rights. We can use this information in our own communities, and together, build an inclusive and respectful world.