World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) Baby Friendly Initiative work has promoted breastfeeding globally and brought it once again to the forefront. However certain groups such as mothers with overweight and clinical obesity are often unable to experience the benefits of breastfeeding. A 2014 study demonstrated that only 82.2% (vs 86.4%) of women with obesity are likely to start breastfeeding and only 44.4 % (vs 53.8%) are likely to breastfeed for at least 6 months (1). Overall, women who have clinical obesity have “lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight” (2).
These women are thus unable to experience the numerous benefits of breastfeeding, which not only include cost savings but preventative health benefits such as a decreased risk of common infections, protection against certain cancers, diabetes, and the development of the maternal-child bond which promotes closeness and connection (3). From the obesity perspective, breastfeeding has benefits for both the mother and the child. Breastfeeding mothers tend to lose their pregnancy weight quicker (3). Early research indicates that breastfeeding can promote a healthy weight in children and that breastfed children tend to have a lower BMI later on in childhood (3) (4).
Why are mothers with obesity less likely to breastfeed?
Several important links are being researched, but the two most significant factors seem to be delayed lactation and a stressful labor & birth experience. Obesity was found to be an independent factor in delayed lactogenesis with “delayed” defined as breasts being “noticeably fuller” after 72-hr postpartum” (2). Difficult labor and especially cesarean birth prevented the crucial first skin-to-skin contact, a proven strategy with numerous benefits, which posed as a barrier to initiating breastfeeding for obese mothers (2). These women also described facing practical barriers such as challenges in choosing the right nursing top and “social barriers due to their body size and shape which reinforced the idea that breastfeeding was not for them” (1). Due to the medicalized nature of some women’s pregnancies and being deemed “high risk” by their providers can create a sense of a lack of control and can further impact breastfeeding initiation (1).
What can be done to promote and sustain breastfeeding for this group of women?
Strategies which sustain breastfeeding in this group are twofold – ensuring support networks during pregnancy and after birth and promoting a sense of control. Professional support from physicians and care providers can go a long way. One study found that there is a definite link between health care professionals’ support of breastfeeding and subsequent breastfeeding initiation and duration (2).
Many women also reported, “that they had needed a ‘cheerleader’, and that seeking professional support had provided encouragement and reassurance that breastfeeding was for them,” (1). So, what does this kind of support look like? Starting early with conversations about optimal prenatal weight gain and periodic weight checks can be beneficial in preventing excessive weight gain (5). Having regular check-ins can also help reduce the risk of complications that can be linked to stressful labor & birth. Furthermore, providers should seek to increase their knowledge around how to support women with obesity to breastfeed (2). One such way is to promote a breastfeeding-friendly environment in both clinics and the hospital, limit maternal-newborn separation as much as possible, and create breastfeeding plans attuned to the individual women’s needs (2).
Lastly, addressing the social stigma around breastfeeding is important. One way to achieve this is to be aware of the obesity stigma and to provide sensitive care by using gentle and inclusive language (2). It is well-demonstrated that women with a higher BMI tend to face numerous challenges in their breastfeeding journey. Ultimately, we as health care providers have a responsibility to support these women to achieve their breastfeeding goals, tackle obesity as a medical issue, and create environments that promote breastfeeding for all women.
For more information regarding pediatric obesity, visit OMA’s pediatric resources page.