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Pithia N, Grogan T, Garg M, Kesavan K, Calkins KL. A Pilot Single-Site Randomized Control Trial: Investigating the Use of Donor Milk in Late Preterm and Term Infants in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e2427-e2435. [PMID: 37647913 DOI: 10.1055/s-0043-1771261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE We aimed to study donor milk (DM) supplementation when mother's own milk (MOM) was unavailable in term and late preterm infants (LPIs) admitted to the neonatal intensive care unit (NICU). We hypothesized that this study would be feasible, defined by the rate of consent, diet adherence, and study completion. We further hypothesized that compared with formula supplementation, DM supplementation, for no longer than 7 days from birth, would be associated with an increase in breastfeeding attempts and the percentage of MOM (MOM%) without adversely affecting growth. Breastfeeding attempts and MOM% were assessed over 48 hours at the end of the intervention, which was defined as NICU discharge or at the end of supplementation, whichever came sooner. STUDY DESIGN This was a pilot study (n = 32). Infants with a gestational age > 34 weeks admitted to the NICU were included. Infants were randomized to one of two groups: human milk (MOM + DM) or formula (MOM + F). RESULTS The consent rate was 52%. Adherence to the study diet was 97%, and completion was 100%. When the MOM + DM group was compared with the MOM + F group, there was no difference in breastfeeding attempts (median [interquartile range]: 3.5 [1.5-6] vs. 1.5 [0.5-4] times, p = 0.1) or MOM% (60 vs. 59%, p = 0.9). Weight and length at multiple time points were similar when the groups were compared. CONCLUSION A study randomizing term and LPIs in the NICU to DM or formula when MOM was unavailable is feasible. It remains unclear if DM improves breastfeeding success in this population. KEY POINTS · A study that randomizes term and late preterm infants in the NICU to DM or formula supplementation when mother's own milk is not available is feasible.. · It remains unclear if DM compared to formula supplementation improves direct breastfeeding.. · In general, growth was similar in infants who received DM or formula as a supplement..
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Affiliation(s)
- Neema Pithia
- Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the University of California Los Angeles Children's Discovery and Innovation Institute, University of California Los Angeles, Los Angeles, California
| | - Tristan Grogan
- Department of Medicine, Statistics Core, University of California Los Angeles, Los Angeles, California
| | - Meena Garg
- Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the University of California Los Angeles Children's Discovery and Innovation Institute, University of California Los Angeles, Los Angeles, California
| | - Kalpashri Kesavan
- Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the University of California Los Angeles Children's Discovery and Innovation Institute, University of California Los Angeles, Los Angeles, California
| | - Kara L Calkins
- Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the University of California Los Angeles Children's Discovery and Innovation Institute, University of California Los Angeles, Los Angeles, California
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Schwab I, Dresbach T, Ohnhäuser T, Horenkamp-Sonntag D, Scholten N. Pressure to provide milk among mothers of very low birth weight infants: an explorative study. BMC Pregnancy Childbirth 2024; 24:134. [PMID: 38350865 PMCID: PMC10863276 DOI: 10.1186/s12884-024-06315-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Pump-dependent mothers of very low birth weight (VLBW, < 1500g) infants experience specific challenges achieving sufficient milk supply in the neonatal intensive care unit (NICU) and are therefore less frequently able to achieve (exclusive) breast milk feeding. Stress due to the limitations on participating in the infant's care may contribute to this problem. Some explorative studies suggest that pressure to provide milk may be an additional stressor in mothers. However, the type of pressure to provide milk perceived by mothers of VLBW infants has rarely been examined. METHODS A retrospective and anonymous questionnaire was conducted with mothers of VLBW infants aged 6 to 24 months at the time of data collection. Quantitative data and written comments were used to examine the mothers' perceptions. Descriptive and bivariate tests (Spearman´s rho, Pearson's chi2) were performed to show correlations between pressure to provide breast milk, parental stress (PSS:NICU: role alteration subscale), milk volume, and maternal factors. Pressure to provide milk was measured through two self-developed single items to differentiate between internal and external pressures. RESULTS Data of n = 533 mothers of VLBW infants was analysed. More than 70% of the mothers agreed that they pressured themselves to provide milk for their infant. In contrast, 34% of the mothers agreed that they felt pressure from outside to provide milk. Higher milk volume 14 days post-partum was significantly correlated with higher internal (Spearman´s rho = 0.2017, p = 0.000) and higher external pressure to provide milk (Spearman´s rho = 0.2991; p = 0.000). Higher PSS:NICU parental role alteration scores were significantly correlated with more internal (Spearman´s rho = -0.2865, p = 0.000) and more external pressure to provide milk (Spearman´s rho = -0.1478; p = 0.002). Milk volume 14 days post-partum and the PSS:NICU were not significantly correlated (Spearman´s rho = -0.0190; p = 0.701). Qualitative analyses highlighted these results and enhanced the bidirectional relationships between maternal pressure to provide milk and milk volume. CONCLUSIONS Especially internal pressure to provide milk is perceived by many mothers, being mutually dependent on milk supply and parental stress. Pressure to provide milk may be an important factor to decrease maternal stress in the NICU and, therefore, lead to more positive pumping and breastfeeding experiences. More research and validated instruments are needed to adequately measure pressure to provide milk with its different psychological, social, and environmental dimensions.
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Affiliation(s)
- Isabella Schwab
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, Cologne, 50933, Germany.
| | - Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, Bonn, 53127, Germany
| | - Tim Ohnhäuser
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, Cologne, 50933, Germany
| | | | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, Cologne, 50933, Germany
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Shenker NS, Nangia S. Nonprofit human milk banking: On a challenging path to global equity. MATERNAL & CHILD NUTRITION 2024:e13623. [PMID: 38204285 DOI: 10.1111/mcn.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Natalie S Shenker
- Department of Surgery and Cancer, Imperial College London, London, UK
- Human Milk Foundation, Rothamsted Institute, Hertfordshire, UK
| | - Sushma Nangia
- Vatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, New Delhi, Delhi, India
- Department of Neonatology, Lady Hardinge Medical College & Kalawati Saran Children's Hospital, New Delhi, Delhi, India
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Mathias EG, Patil DS, Kolakemar A, Krishnan JB, Renjith V, Gudi N, Swamy RS, Brand A. Barriers and Facilitators for the Donation and Acceptance of Human Breast milk: A Scoping Review. Curr Nutr Rep 2023; 12:617-634. [PMID: 37999918 PMCID: PMC10766659 DOI: 10.1007/s13668-023-00506-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW Human milk is the best source of nutrients for all infants. When a mother's own milk is unavailable, the World Health Organization suggests using donor human milk for premature neonates with or without medical complications. Exploring the barriers and facilitators for breast milk donation and its acceptability is essential for developing this intervention. A scoping review was conducted based on a methodological framework developed by Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005). A search was conducted in PubMed (NCBI), CINAHL (EBSCO), and Web of Science (Elsevier). A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form. RECENT FINDINGS We included 20 articles for narrative synthesis. Barriers and facilitators for donating and accepting breast milk were categorized under six themes: individual, family, community, workplace, health system, and policy-related. The common individual barriers were time requirements for BMD, personal dislike of the process, lack of knowledge, insufficient milk, negative opinions, and lack of information. Family stigma, negative rumors, less educated family members, and illness of a family member were identified as family-related barriers. Community-related barriers include cultural or religious unacceptable practices, societal taboos, and distance to milk banks. The major barriers identified in relation to the health system were lack of practical and psychological support, lack of information, storing and transportation issues, lack of knowledge among HCWs, and logistical challenges of creating a milk lab. The common work-related barriers were the lack of adequate time, philosophical objections, and incomprehension at returning to work. Policy-related barriers identified include the need for hygiene requirements, donation costs, and lack of standardized guidelines. Making the donation process faster, providing pick-up services for donors, and community education and male partner engagement regarding breast milk donation could help to boost the acceptability of breast milk donation.
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Affiliation(s)
- Edlin Glane Mathias
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Divya Sussana Patil
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Ashwija Kolakemar
- Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jisha B Krishnan
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Vishnu Renjith
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nachiket Gudi
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
- Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Ravi Shankar Swamy
- Imperial College Healthcare NHS Trust, London, UK
- Manipal Hospitals Bengaluru, Bangalore, Karnataka, India
| | - Angela Brand
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT), Boschstraat 24, NL - 6211 AX, Maastricht, The Netherlands
- Department of Health Information, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Shenker NS, Griffin S, Hamill‐Keays J, Thomson M, Simpson J, Weaver G. Understanding the current and future usage of donor human milk in hospitals: An online survey of UK neonatal units. MATERNAL & CHILD NUTRITION 2023; 19:e13526. [PMID: 37400943 PMCID: PMC10483937 DOI: 10.1111/mcn.13526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 07/05/2023]
Abstract
The use of donor human milk (DHM) where there is a shortfall of maternal milk can benefit both infant and maternal outcomes but DHM supply is not always assured. This study aimed to understand current DHM usage in UK neonatal units and potential future demand to inform service planning. An online survey was disseminated to all UK neonatal units using Smart Survey or by telephone between February and April 2022 after development alongside neonatal unit teams. Surveys were completed by 55.4% of units (108/195) from all 13 Operational Delivery Networks. Only four units reported not using DHM, and another two units only if infants are transferred on DHM feeds. There was marked diversity in DHM implementation and usage and unit protocols varied greatly. Five of six units with their own milk bank had needed to source milk from an external milk bank in the last year. Ninety units (84.9%) considered DHM was sometimes (n = 35) or always (n = 55) supportive of maternal breastfeeding, and three units (2.9%) responded that DHM was rarely supportive of breastfeeding. Usage was predicted to increase by 37 units (34.9%), and this drive was principally a result of parental preference, clinical trials and improved evidence. These findings support the assumption that UK hospital DHM demand will increase after updated recommendations from the World Health Organization (WHO) and the British Association of Perinatal Medicine. These data will assist service delivery planning, underpinned by an ongoing programme of implementation science and training development, to ensure future equity of access to DHM nationally.
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Affiliation(s)
- Natalie S. Shenker
- Department of Surgery and CancerImperial College London, IRDBLondonUK
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
| | - Samantha Griffin
- Department of Surgery and CancerImperial College London, IRDBLondonUK
| | - Jonathan Hamill‐Keays
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
| | - Merran Thomson
- Neonatal UnitHillingdon Hospitals NHS Foundation TrustUxbridgeUK
| | - Judith Simpson
- Neonatal Intensive Care UnitRoyal Hospital for ChildrenGlasgowUK
| | - Gillian Weaver
- The Human Milk Foundation, Daniel Hall BuildingRothamsted Institute, HertsHarpendenUK
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Sadler EM, Okito O, Soghier L. Addressing caregiver mental health in the neonatal ICU. Curr Opin Pediatr 2023; 35:390-397. [PMID: 36974450 DOI: 10.1097/mop.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW The neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals. RECENT FINDINGS Parents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes. SUMMARY To properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU. VIDEO ABSTRACT http://links.lww.com/MOP/A70.
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Affiliation(s)
- Erin M Sadler
- Division of Psychology and Behavioral Health
- Department of Pediatrics
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Ololade Okito
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
| | - Lamia Soghier
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
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Namuddu MG, Mukunya D, Nakibuuka V, Amulen E, Nantale R, Kiguli J. "It's just like a blood transfusion": perceptions on the use of donated breast milk in selected hospitals in central Uganda: a qualitative study. BMC Public Health 2023; 23:901. [PMID: 37193959 DOI: 10.1186/s12889-023-15648-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/10/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Breast milk is crucial for the nutritional and developmental milestones in the first two years of life. Uganda has recognized the need for a human milk bank as an opportunity that offers reliable and healthy milk to babies who lack access to their mothers. However, there is little information on the perceptions towards donated breast milk in Uganda. This study aimed to explore the perceptions of mothers, fathers, and health workers on the use of donated breast milk at Nsambya and Naguru hospitals in Kampala district, central Uganda. METHODS A qualitative descriptive study was conducted at Nsambya and Naguru hospitals in central Uganda. The study consisted of 8 focus group discussions (FGDs) of 6 participants each and 19 key informant interviews (KIIs) among mothers, fathers, and health workers. Participants were purposively selected. Data collected were transcribed, translated from Luganda to English, and analyzed using thematic analysis. All data were organized and managed in Nvivo version 12.0. RESULTS A total of 67 participants were involved in the study. Two main themes were identified: positive perceptions and negative perceptions. Participants linked donated breast milk to blood transfusion, believed it had nutrients comparable to the biological mother's milk, and thought it was an opportunity to avoid formula or cow milk and help babies that cannot access breast milk. However, the notable negative perceptions were; the feeling that donated breast milk is disgusting, could result in acquiring non-parental genes and traits, and that it was unsafe. Participants also feared that donated breast milk could be expensive and affect the bond between mother and child. CONCLUSION In summary, participants had positive perceptions about donated breast milk but were concerned about the potential side effects. Health workers should take extra precautions to ensure that donated breast milk is safe. The development of appropriate information and communication programs to sensitize the public about the benefits of donated breast milk will improve the uptake. Further research should focus on understanding the social-cultural beliefs regarding donated breast milk.
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Affiliation(s)
- Mary Gorreth Namuddu
- School of Public Health, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - David Mukunya
- Department of Community and Public Health, Busitema University, Faculty of Health Sciences, P.O. Box 1460, Mbale, Uganda
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Victoria Nakibuuka
- Department of Paediatrics, Nsambya Hospital, P.O. Box 7146, Kampala, Uganda
| | - Esther Amulen
- School of Public Health, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Busitema University, Faculty of Health Sciences, P.O. Box 1460, Mbale, Uganda
| | - Juliet Kiguli
- School of Public Health, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Hookway L, Brown A, Grant A. Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards. MATERNAL & CHILD NUTRITION 2023; 19:e13489. [PMID: 36808886 PMCID: PMC10019061 DOI: 10.1111/mcn.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
There is a paucity of literature exploring the challenges of breastfeeding sick children in hospital. Previous research has focused on single conditions and hospitals which limits understanding of the challenges in this population. Although evidence suggests that current lactation training in paediatrics is often inadequate, it is unclear where the specific training gaps are. This qualitative interview study of UK mothers aimed to explore the challenges of breastfeeding sick infants and children on a paediatric ward or paediatric intensive care unit. From 504 eligible respondents, a sample of 30 mothers of children aged 2-36 months with various conditions and demographic backgrounds was purposively chosen, and a reflexive thematic analysis undertaken. The study identified previously unreported impacts such as complex fluid needs, iatrogenic withdrawal, neurological irritability and changes to breastfeeding behaviour. Mothers described breastfeeding as emotionally and immunologically meaningful. There were many complex psychological challenges such as guilt, disempowerment, and trauma. Wider struggles such as staff resistance to bedsharing, inaccurate breastfeeding information, lack of food and inadequate breast pump provision made breastfeeding more challenging. There are numerous challenges related to breastfeeding and responsively parenting sick children in paediatrics, and these also impacted maternal mental health. Staff skill and knowledge gaps were widespread, and the clinical environment was not always conducive to supporting breastfeeding. This study highlights strengths in clinical care and provides insight into what measures are perceived as supportive by mothers. It also highlights areas for improvement, which may inform more nuanced paediatric breastfeeding standards and training.
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Affiliation(s)
- Lyndsey Hookway
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| | - Aimee Grant
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
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Gribble KD, Bewley S, Dahlen HG. Breastfeeding grief after chest masculinisation mastectomy and detransition: A case report with lessons about unanticipated harm. Front Glob Womens Health 2023; 4:1073053. [PMID: 36817034 PMCID: PMC9936190 DOI: 10.3389/fgwh.2023.1073053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
An increasing number of young females are undergoing chest masculinsation mastectomy to affirm a gender identity and/or to relieve gender dysphoria. Some desist in their transgender identification and/or become reconciled with their sex, and then revert (or detransition). To the best of our knowledge, this report presents the first published case of a woman who had chest masculinisation surgery to affirm a gender identity as a trans man, but who later detransitioned, became pregnant and grieved her inability to breastfeed. She described a lack of understanding by maternity health providers of her experience and the importance she placed on breastfeeding. Subsequent poor maternity care contributed to her distress. The absence of breast function as a consideration in transgender surgical literature is highlighted. That breastfeeding is missing in counselling and consent guidelines for chest masculinisation mastectomy is also described as is the poor quality of existing research on detransition rates and benefit or otherwise of chest masculinising mastectomy. Recommendations are made for improving maternity care for detransitioned women. Increasing numbers of chest masculinsation mastectomies will likely be followed by more new mothers without functioning breasts who will require honest, knowledgeable, and compassionate support.
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Affiliation(s)
- Karleen D. Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia,Correspondence: Karleen D. Gribble
| | - Susan Bewley
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
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