Learning from Women with a Body Mass Index (Bmi) ≥ 30 kg/m2 who have Breastfed and/or are Breastfeeding: a Qualitative Interview Study

Abstract

Objectives Women with a BMI ≥ 30 kg/m 2 are less likely to initiate and maintain breastfeeding compared to women with a BMI ≤ 30 kg/m 2 . Reasons for this disparity are not understood. Therefore, this qualitative interview study aimed to learn from women with a BMI ≥ 30 kg/m 2 who have breastfed. Methods Eighteen women participated in a semi-structured telephone interview. Participants were required to have had a BMI ≥ 30 kg/m 2 at the start of their pregnancy, and have breastfed and/or be currently breastfeeding. An inductive thematic analysis was used to analyze data. Results Two themes were identified: ‘personal control over breastfeeding behavior’ and ‘realistic expectations of the breastfeeding journey’. To achieve their breastfeeding goals, women described the importance of feeling in control of their behaviors, and having realistic expectations, when facing social and practical barriers. They gained this control and formed realistic expectations by seeking support and information. In particular, gaining support from other breastfeeding women with a BMI ≥ 30 kg/m 2 , and information about alternative positioning, and compatible clothing and nutrition helped women to breastfeed. Conclusions for Practice Having adequate information and support in order to feel in control of breastfeeding behavior and form realistic expectations are vital contributors to breastfeeding behaviors in women with a BMI ≥ 30 kg/m 2 . Future work is necessary to develop suitable interventions and to investigate their feasibility.

The perceptions and experiences of women with a body mass index ≥ 30 kg m2 who breastfeed: A meta‐synthesis

“…This theme describes how difficulties that many women experience while initiating and maintaining breastfeeding are exaggerated in women with a BMI ≥ 30 kg m 2 because of their weight. For example, although medical intervention while giving birth can lead to breastfeeding difficulties for all women (Rowe‐Murray & Fisher, ), women with BMI ≥ 30 kg m 2 are likely to report suffering complications and becoming separated from their infants (Garner, McKenzie, Devine, Thornburg, & Rasmussen, ; Keely, Lawton, Swanson, & Denison, ; Lyons, Currie, & Smith, ) and, therefore, perceive a lack of control over their infant feeding behaviours, which negatively impacts breastfeeding. Furthermore, although many women may doubt their ability to breastfeed (Avery, Zimmermann, Underwood & Magnus, ), women with BMI ≥ 30 kg m 2 encounter more barriers, which reduce their confidence in their body, and negatively impact their perception of their ability to breastfeed (Garner et al, ; Garner, Ratcliff, Devine, Thornburg, & Rasmussen, ; Keely et al, ; Lyons et al, ; Massov, ).…”

“…For example, although medical intervention while giving birth can lead to breastfeeding difficulties for all women (Rowe‐Murray & Fisher, ), women with BMI ≥ 30 kg m 2 are likely to report suffering complications and becoming separated from their infants (Garner, McKenzie, Devine, Thornburg, & Rasmussen, ; Keely, Lawton, Swanson, & Denison, ; Lyons, Currie, & Smith, ) and, therefore, perceive a lack of control over their infant feeding behaviours, which negatively impacts breastfeeding. Furthermore, although many women may doubt their ability to breastfeed (Avery, Zimmermann, Underwood & Magnus, ), women with BMI ≥ 30 kg m 2 encounter more barriers, which reduce their confidence in their body, and negatively impact their perception of their ability to breastfeed (Garner et al, ; Garner, Ratcliff, Devine, Thornburg, & Rasmussen, ; Keely et al, ; Lyons et al, ; Massov, ). Lastly, although gaining the right breastfeeding support is important for all women (Backstrom, Hertfelt Wahn, & Ekstrom, ), women with BMI ≥ 30 kg m 2 appear to need additional help throughout their breastfeeding journeys (Garner et al, ; Garner et al, ; Keely et al, ; Lyons et al, ; Massov, ).…”

“…Furthermore, although many women may doubt their ability to breastfeed (Avery, Zimmermann, Underwood & Magnus, ), women with BMI ≥ 30 kg m 2 encounter more barriers, which reduce their confidence in their body, and negatively impact their perception of their ability to breastfeed (Garner et al, ; Garner, Ratcliff, Devine, Thornburg, & Rasmussen, ; Keely et al, ; Lyons et al, ; Massov, ). Lastly, although gaining the right breastfeeding support is important for all women (Backstrom, Hertfelt Wahn, & Ekstrom, ), women with BMI ≥ 30 kg m 2 appear to need additional help throughout their breastfeeding journeys (Garner et al, ; Garner et al, ; Keely et al, ; Lyons et al, ; Massov, ). Therefore, the theme had three subthemes: (a) psychological reactions to medical intervention, (b) perception of body's ability to breastfeed, and (c) additional need for support.…”

“…Women with a BMI ≥30 kg m 2 are often labelled as “high risk” in pregnancy (Lyons et al, ) due to their higher risk of experiencing long labours, which result in caesarean section, subsequent infections, longer hospital stays, reduced mobility, delayed skin‐to‐skin contact, and even periods of separation from their infant (Garner et al, ; Garner et al, ; Keely et al, ). During this, women often feel disappointed about their breastfeeding experience and unmotivated to continue, as there are already numerous barriers making breastfeeding difficult (Garner et al, ; Lyons et al, ). In particular, women with a BMI ≥ 30 kg m 2 may not feel comfortable to breastfeed in the busy hospital environment, where privacy can be difficult to achieve (Keely et al, ).…”

“…In particular, women with a BMI ≥ 30 kg m 2 may not feel comfortable to breastfeed in the busy hospital environment, where privacy can be difficult to achieve (Keely et al, ). Due to this, women feel that their choice of infant feeding method is out of their control, which has a negative impact on breastfeeding initiation and maintenance (Lyons et al, ). As the likelihood of experiencing medical intervention during pregnancy and birth is higher among women with a BMI ≥ 30 kg m 2 (Weiss et al, ), these difficulties are amplified within this group.…”