Background: Obese women are at high risk of early breastfeeding cessation, and health professionals (HPs) have a unique opportunity to provide them with breastfeeding support. Our objective was to describe HPs' experiences providing breastfeeding care for obese women during the prenatal, peripartum, and postpartum periods. Materials and Methods: In-depth, qualitative interviews were conducted with 34 HPs (including obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. They were recruited from a variety of settings in central New York. Interviews were audio-recorded, transcribed, verified for accuracy, and then analyzed qualitatively. Results: HPs identified obesity in multiple ways, some of which were consistent with standard cutoffs, whereas others implied extreme obesity. Nearly all HPs discussed ways they perceive obese women have challenges with breastfeeding. Some HPs described challenges as specific to obese women (e.g., limited mobility), whereas others described challenges as universal but more likely to occur among obese women (e.g., difficulties positioning the infant to breastfeed). Across professions, HPs described providing breastfeeding care for obese women as requiring more time and physical work and as being more challenging. HPs acknowledged stigma around obesity and discussed treating obese women with dignity and the same as other women. Strategies were suggested for improving breastfeeding support for obese women. Conclusions: HPs identified multiple challenges that obese women encounter with breastfeeding, as well as their own challenges with providing care. Comprehensive strategies are needed to assist obese women with breastfeeding and to alleviate strain on HPs who provide their care.

Background: Breastfeeding rates in the United States are suboptimal. Health professionals (HPs) have a unique opportunity to support breastfeeding because of the frequency and timing of their visits with mothers and infants as well as their call by professional organizations to do so. The objective of this study was to understand HPs' perceived roles and experiences with providing breastfeeding-related care. Materials and Methods: In-depth qualitative interviews were conducted with 34 HPs (obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. Interviews were audio-recorded, transcribed, and verified for accuracy; content analysis was used to identify themes using a grounded theory approach. Results: The overarching theme was discontinuity in breastfeeding care across the continuum. Most HPs relied on other HPs to provide breastfeeding care, which resulted from and contributed to problematic gaps in care that were reported. A minority of HPs attempted to bridge gaps in breastfeeding care or improve continuity. Contributing to the discontinuity were a lack of time, lack of skills, inconsistent messages, and low communication across stages of care. HPs were unsure whether their help was effective and whether required follow-up was completed. Conclusions: Despite HPs' recognition of breastfeeding as the best choice for infant feeding, breastfeeding care may be disjointed and a barrier to achieving breastfeeding recommendations. These problems should be investigated and systemically addressed in future research so that maternal-infant dyad breastfeeding care can be improved.

Obese women tend to stop breastfeeding (BF) earlier than normal‐weight women. Health professionals (HPs) are in a unique position to help obese women with BF, however, little is known about HPs’ strategies for assisting and experience providing BF care for obese women. To explore these issues, 34 HPs who care for pregnant or BF women were recruited in central New York. Qualitative interviews were audio‐recorded, transcribed and verified for accuracy; content analysis was used to identify themes. Across professions, HPs described providing care for obese women as requiring more time and physical work, and as being challenging. General strategies that HPs used included treating them the same as other women, using normalizing techniques, and treating them with dignity. The HPs disagreed about specific strategies to help obese women with BF including: discussing the benefits of weight loss, proper nursing positions and “making an air pocket” when putting baby to breast, and using nipple shields/shells. They agreed about emphasizing the benefits of BF for infant weight, that more could be done prenatally to prepare obese women for BF, and that home visits postpartum may benefit them. Providing care for obese women in a setting in which HPs feel like they don’t have enough time requires more resources. Comprehensive strategies are needed to provide consistent messages and assistance to help obese women breastfeed. Grant Funding Source: Supported by grants from NIH (5T32HD007331) and USDA (Hatch 399449)