Bigger Breastfeeding – Behind the Statistics

What is it?

As mammals, we’re designed to nurse our young. Breastfeeding Baby

Breastmilk is the perfect first food; attractively packaged, available on demand at the correct temperature, correct consistency, correct formulation for each stage and season, comes with no wasted packaging, food miles, additives or preservatives, and confers health benefits on both mother and baby.

Yet we and health professionals caring for us are being told that obese women

‘will need extra support with breast feeding’

(Countess of Chester Hospital policy – Information For Pregnancies With Increased BMI)

‘Obesity is associated with low breastfeeding initiation and maintenance rates. Women with a booking BMI ≥30 should receive appropriate specialist advice and support’

(RCOG/CMACE Joint Guidance – Management of Women with Obesity in Pregnancy)

which leaves many women believing they will struggle to do one of the most natural things in the world for their babies.

Why?

This is because bigger women have been shown to be less likely to start breastfeeding, and are likely to give up nursing sooner than their ‘normal’ weight counterparts. The data comes from an Australian review of 27 individual studies on breastfeeding from around the world.

A systematic review of maternal obesity and breastfeeding intention, initiation and duration (293.7 KiB)

But why would this be the case? The review unfortunately comes up with no concrete conclusions as to the causes;

The reasons may be biological or they maybe psychological, behavioural and/or cultural.

Well, that just about covers all bases, doesn’t it?! It also offers no solutions, other than ‘we need more research’, but digging around within the review are some interesting results from individual studies.

What?

Previous research has shown that the strongest indicator of likely breastfeeding is the mother’s intention to breastfeed. Strange that.

In the Australian review we find that yes, obese women breastfed less, but in two out of three studies where the mother’s intent to breastfeed was measured, obese women intended to breastfeed less!

So, having a high BMI is an indicator that you may not breastfeed or feed for as long – if you didn’t want to in the first place! Not quite the case of bigger women struggling with breastfeeding, as we might be led to believe.

Why bigger women are less inclined to breastfeed is unknown, but surely telling bigger women that they’re less likely to breastfeed when the studies already show is that if you’re bigger you’re less likely to consider breastfeeding, could perpetuate the problem? There’s nothing like telling someone they’re going to fail to stop them from trying in the first place…

This also means that later statistics on the links between increasing BMI and decreasing breastfeeding are pointless on an individual level, if the difference is a ‘choice’ rather than due to some inherent deficiency the fatter you get.

Delayed milk production?

There is some talk of a link between obesity and delayed milk production in the review. Three out of five studies found a link, stating that delayed milk production was found in 33% of obese women, compared with 16% of ‘normal’ weight women. However, all of these studies were US based, and all with very small sample sizes (between 40 and 280), which renders their results less reliable. But could there also be a reason for this unconnected with maternal weight?

One medical record review in the US found that obese women were less likely to put the baby to the breast in the first two hours after birth, important for generating the hormones needed to stimulate milk production. Again the reasons for this are unclear (and unmentioned in the study) but the greater use of interventions on bigger women may play its part; caesareans in general are associated with lower rates and duration of breastfeeding, and we know that bigger women are more likely to have caesarean deliveries. There may also be links with other interventions such as inductions, and epidurals, which again are more likely in bigger mums, especially in the USA. The studies don’t seem to have accounted for this.

If not putting the baby to the breast as soon as possible after delivery is significant in affecting milk production, then it may be that the current model of care for bigger women itself is actually having a detrimental affect on breastfeeding initiation and duration rates.

Medical Conditions?

Something which may feasibly affect lactation are medical conditions, particularly Poly Cystic Ovary Syndrome (PCOS) and Diabetes, both of which alter hormone production in the body and disproportionately affect larger women.

But the only medical condition the review touches upon for which there is some evidence of a detrimental affect on breastfeeding is depression. One study found that depressed women are less likely to continue breastfeeding than non-depressed women, and another study found that obese women are more likely to experience post-natal depression.

For diabetes, the review refers to one very small study (just 38 women) which found that diabetic mothers milk seemingly transitioned from the first milk (colostrum) to ‘normal’ breastmilk later than women who did not have diabetes, but did not follow up on whether this impacted upon breastfeeding as a whole.

For Poly Cystic Ovary Syndrome, the review found an article based on an even smaller sample; just 3 cases, which hypothesised that Poly Cystic Ovary Syndrome may be associated with insufficient milk supply. To say that there is a paucity of evidence on the effects of these two conditions on lactation is to understate the situation considerably.

The best the review can manage in drawing a link between obesity and reduced lactation is via animal studies. I’ve been called a fat cow in the past, but I never expected to be compared to one!

Breasts too big?

The review mentions that historically, having large breasts was associated with producing poorer quality milk, or not enough milk. Fortunately, this appears to be an old wives’ tale, and if anything, recent research has shown that obese women were actually less likely to cite ‘poor milk supply’ as a reason for stopping breastfeeding.

One study referenced by the review found that obese women tended to have greater body image dissatisfaction compared with non-obese women, and another study found that women with increased concern about their body shape or weight were less likely to intend to breastfeed. So all the more reason to stop the negativity around bigger women breastfeeding, no?

It is suggested that having bigger breasts may lead to difficulties to latching on a baby due to nipple size, shape, and location, supporting the breast while latching on, not being able to see the nipple/areola while attempting to latch on, and the weight of the breast pushing against the baby’s chest while feeding. Again, no decent evidence to back this up, though.

There is plenty of information and advice available on the mechanics of breastfeeding for those who seek it, big boobed or otherwise. One often suggested solution for mums with big boobs and/or tummies who find the usual cross-cradle isn’t suitable for them, is to try alternative holds such as the unfortunately named ‘rugby ball’, or feed while lying down. For every problem there is a solution. That solution doesn’t have to be formula.

Alternatively…

If you’re looking for positive information about obese women breastfeeding, the review does find that studies in Russia and Denmark found no difference in breastfeeding duration in obese mothers; in the indigenous populations of Canada, rates of both obesity and breastfeeding are higher; and in Kuwait, higher maternal weight was actually associated with a longer duration of breastfeeding!

So if you intend to breastfeed, don’t take the scaremongering to heart. If you do encounter any problems with breastfeeding, don’t assume that it has anything to do with your size.

Breastfeeding is a skill which used to be passed down through the generations. In the past, when breastfeeding was commonplace, the support network available was huge. Unfortunately in the last few decades this was undermined, and the skill, and the community support for it, was lost to some extent, although it is slowly being rebuilt.

Like any skill, how to breastfeed needs to be learnt and perfected.

Many many women of all sizes and shapes experience niggles, but the actual number of women who are truly unable to breastfeed is estimated to be very low – perhaps as low as 4%.

There is a wealth of advice, information and support available; you can watch YouTube videos on positioning and attachment, different holds and the like; you can attend breastfeeding groups and cafés where trained helpers can support you; you can call the National Breastfeeding Helpline on 0300 100 0212; you can contact La Leche League, The National Childbirth Trust, or an International Board Certified Lactation Consultant (IBCLC) or you can read a wealth on information on the topic on the NHS webpages, Kellymom and Analytical Armadillo. The help is out there…

References

Management of Women with Obesity in Pregnancy (1.0 MiB)

A systematic review of maternal obesity and breastfeeding intention, initiation and duration (293.7 KiB)

Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study. (89.0 KiB)

Breast-feeding and its relation to smoking and mode of delivery (87.6 KiB)

Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey (929.0 B)

Baby friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeeding (88.8 KiB)

Milk lactose, citrate, and glucose as markers of lactogenesis in normal and diabetic women. (87.4 KiB)

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9 thoughts on “Bigger Breastfeeding – Behind the Statistics

  1. Thanks for this, so much rings true of my experience. PCOS, diabetes, overweight and induced at every turn I was told I’d struggle (read fail) at breast feeding but I was determined it was something I wanted to do. Despite poor NHS advice and embarrassment (theirs not mine) at the size of my breasts at week 4 we are doing ok. Yes it’s hard, but I can’t see that my size has anything to do with that.

    Would just be nice to find some clothes that allow for easy breast feeding as I start to venture out!

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    • I know! Breastfeeding isn’t easy, by any stretch of the imagination. It takes patience and perseverance and support from those around you, but by making out that we’re going to have an especially hard time I wonder how many women are put off from even trying! We had some early issues, some latch errors, a bout of mastitis, but I fed both my children past 17 months. I also donated 40+ litres to the milk bank for premature babies. They were delighted with the quality of my milk!

      I know plenty of big-breasted women who’ve had a positive attitude about breastfeeding and have been just fine. I’m sure half of it is down to confidence and tenacity, because I also know of anxious ‘normal’ breasted women who’ve struggled… they thought they’d struggle and they did. Makes you wonder. I found Google, YouTube and KellyMom to be my most useful resources, not the NHS, unfortunately.

      I do intend to get around to a breastfeeding clothes page. Really. Still waiting for that 30 hr day to materialise! I had some non-maternity cross fronted tops that did me throughout – though after nearly 4 years of breastfeeds they got a bit out of shape. Other mums swear by the ‘two tops’ method – just wear a vest top underneath whatever top you actually want to wear, pull the vest top down and the outer top up (not so tempting in the really hot weather we’re having now, though!)

      Good luck with getting out and about – it’s much easier to manage a tiny one when you’re getting out and doing things, honestly, even though it seems like it takes military planning to get anywhere the first few times, it gets easier, and they sleep so much better and more reliably if they’ve been out!

      I fed anywhere and everywhere, even as they got over a year, and never had a problem with anyone making any comment. Mind you, I was ready for them if they had – almost disappointed I never got to give my lioness roar! xx

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  2. Aw, It’s such a shame that you were let down by the very people supposed to support you, and that you now have regrets. It sounds like you got really rubbish advice and no support, no wonder you weren’t able to make it work! Well done you for expressing for 4 weeks, though, that’s tough, and a huge commitment to your little lad.
    I wouldn’t knock anyone for making an informed choice to formula feed, but when you don’t get the help you need and are forced into making a choice you don’t want to – that’s just not fair.
    I’m planning on writing a page on breastfeeding tips for the big-boobed, just as soon as someone invents that 30hr day I need to get around to it!

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  3. My son wouldnt latch on and I was told this was probably because I was too big and he was too small. I visted an NHS breast feeding clinic who tried to help (after making uncomftable remarks about my boobs) but was then told, “it just doesn’t work for some people”. To this day its the biggest regret I have about my sons early life (I expressed until 4 weeks).
    I fully inended to feed him, but I think the negativity I met, made what was so hard, even harder. This is a very interesting piece.

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  6. Great article! Can I just do a shout out for the Association of Breastfeeding Mothers and the Breastfeeding Network. The volunteers for these organisations woman the National Helpline as well as having their own helplines/running support groups etc.

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