Lactation Complicated by Overweight and Obesity: Supporting the Mother and Newborn

Abstract

Research shows that mothers who are obese (with a BMI >30) are less likely to initiate lactation, have delayed lactogenesis II, and are prone to early cessation of breastfeeding. Black women, with the highest rates of American obesity, have the lowest rates and shortest duration of breastfeeding compared to Hispanic and white women. Women who are overweight and obese have lowered prolactin responses to suckling. Women who are obese are at risk for prolonged labors, excessive labor stress, and cesarean birth, all of which delay lactogenesis II. Lactation has a small but significant role in preventing future obesity in the mother and child. Midwifery management of obesity-related lactation problems begins with education about optimal prenatal weight gain and regular weight assessment to avoid excessive gain. Support of physiologic birth processes to avoid stress, prolonged labor, and surgical birth and limit maternal-newborn separation enhances the onset of lactogenesis II. Massage or pumping may soften and extend the obese nipple for easier latch. Infants of lactating women with prior bariatric surgery are at risk for B12 deficiency and require regular nutrition and growth assessment. Five hundred calorie per day restriction paired with aerobic exercise for intentional postpartum weight loss does not affect milk quality or infant growth.

Clinically overweight and obese mothers and low rates of breastfeeding: Exploring women's perspectives

“…Obese women tend to have larger breasts, with an excess of periareolar adipose tissue which may flatten the areola and nipple, making the nipple more difficult for the newborn to grasp. This difficulty contributes to the reduced prolactin response to suckling (Coates, 1989;Jevitt, Hernandez & Groer, 2007;Lovelady, 2005).…”

Celebrating and honouring midwifery in New Zealand

“…Obese women tend to have larger breasts, with an excess of periareolar adipose tissue which may flatten the areola and nipple, making the nipple more difficult for the newborn to grasp. This difficulty contributes to the reduced prolactin response to suckling (Coates, 1989;Jevitt, Hernandez & Groer, 2007;Lovelady, 2005 Low maternal self-esteem and selfconfidence, and reduced belief in their ability to breastfeed are two of the strongest predictors of breastfeeding cessation.…”

“…Fewer obese mothers felt that their milk supply was sufficient at one month and three months compared to normal weight women (Mok et al, 2008). This challenge has been recognised with some midwifery care plans identifying overweight and obese women as needing extra support due to their reduced perceptions of breast fullness and milk production (Jevitt et al, 2007). Research examining lactation-counselling practices used with obese mothers (Rasmussen, Lee, Ledkovsky & Kjolhede, 2006) found that the majority of health care providers surveyed neither believed that there was a difference in the success rate between obese mothers and normal weight mothers, nor advised obese mothers differently about breastfeeding (Rasmussen et al, 2006).…”

“…Fewer obese mothers felt that their milk supply was sufficient at one month and three months compared to normal weight women (Mok et al, 2008). This challenge has been recognised with some midwifery care plans identifying overweight and obese women as needing extra support due to their reduced perceptions of breast fullness and milk production (Jevitt et al, 2007).…”

“…Obese women tend to have larger breasts, with an excess of periareolar adipose tissue which may flatten the areola and nipple, making the nipple more difficult for the newborn to grasp. This difficulty contributes to the reduced prolactin response to suckling (Coates, 1989;Jevitt, Hernandez & Groer, 2007;Lovelady, 2005 Low maternal self-esteem and selfconfidence, and reduced belief in their ability to breastfeed are two of the strongest predictors of breastfeeding cessation.Low maternal self-esteem and self-confidence, and reduced belief in their ability to breastfeed are two of the strongest predictors of breastfeeding cessation (Blyth et al, 2002;Grassley & Nelms, 2008;Harris, Nayda & Summers, 2003). Low maternal selfesteem is associated with negative body image and pregnant women may be concerned about changes in their body shape.…”