Overweight Moms Need Support to Prevent Breastfeeding Problems
By now, everyone is very familiar with the recommendation from pediatricians and other health experts that breastfeeding during the first year of life is best for both mother and baby in terms of nutritional quality and prevention of long-term chronic diseases. Some women have more difficulty than others with problems with breastfeeding, including those who are overweight, obese, or have very large breasts.
A Queensland University of Technology (QUT) survey found that simply understanding the benefits of breastfeeding was not enough to initiate the practice in some moms. The most important factor to successful breastfeeding was having support from both professionals and from family and friends.
"Ensuring that new mums get the support they need to cope with the often difficult task of breastfeeding is essential to boosting breastfeeding rates and increasing the length of time women breastfeed,” said Joy Parkinson, PhD candidate and lead study author.
Here in the US, two presentations will be given at the Experimental Biology 2010 meeting in Anaheim CA this week as part of the scientific program of the American Society for Nutrition. Scientists from the University of Connecticut, Hartford’s Hispanic Health Council, the Hartford Hospital, and Yale University will speak about their findings that peer counseling and support can substantially improve breastfeeding success among high-risk women, including those who are obese.
Breast size does not affect milk production, which is a function of the glandular tissue inside the breast as well as the baby's appetite and suckling ability. However, women with large breasts, DD or above, may find difficulty in comfortable positions and techniques which cause a less successful breastfeeding experience if not given resources to help prevent problems.
Dr. Donna Chapman, Assistant Director of the Center for Eliminating Health Disparities among Latinos (CEHDL) and colleagues studied 154 women recruited during pregnancy who were overweight or obese (BMI greater than 27) and hoping to successfully breastfeed. Seventy-six comprised the “intervention” group, which received home visits during late pregnancy and in the first few months after birth where they were offered help for breastfeeding problems and provided breast pumps to those who needed them.
In the control group, those who received educational material but no long-term support, 46% of women had stopped breastfeeding by 8 weeks postpartum. Of those who received intensive counseling, only 33% stopped. In addition, the babies of the mothers who received extra counseling were 3.5 times less likely to be hospitalized during their first 3 months of life related to conditions such as respiratory infections and fever.
Among the many other reasons for encouraging obese women to breastfeed, researchers from Kaiser Permanente in Northern California found that mothers who breastfeed their children longer are significantly less likely to develop metabolic syndrome, a cluster of heart disease and diabetes risk factors more common in obese people.
For women with large breasts who wish to breastfeed, Anne Smith, BA, IBCLC offers the following advice:
1) Find a nursing bra that really fits and is supportive. Breast size will increase during pregnancy, but by the last trimester, the majority of prenatal growth has occurred and that is a good time to purchase nursing bras. It is impossible to predict exactly how much larger your breasts will get when your milk comes in, but you can estimate that you will be a size or two larger in both cup and band size. Start out with only a couple of bras, and invest in more once the initial engorgement has subsided and you reach your long-term nursing size.
2) Experiment with different breastfeeding positions. The traditional cradle hold is the most popular position, but the football hold generally works better for women with larger breasts. In this position, the baby is tucked under your arm and you have better control of the baby's head as he latches on, as well as more freedom of arm movement. Be sure to use lots of pillows to bring the baby up to your level, rather than having to lean over him. You also want to support your back with pillows as well. Raising your knees with a footstool also helps.
3) Make sure to support the breast while nursing. Using the "C" hold is often effective. Using your outside hand (the one on the same side you're nursing from) to support your breast, put your palm gently under the breast, with your thumb curved around the top and side, forming a "C". Be sure to keep your finger and thumb well behind the areola, because if your fingers are in the way, your baby can't compress the milk sinuses effectively. This can cause soreness as well as keeping him from obtaining the hind milk that he needs to grow. Some mothers find that rolling up a washcloth and placing it under the breast during the feeding provides extra support.
4) Pay careful attention to latch on. You need to make sure that your baby takes a good portion of the areola (the dark area surrounding the nipple) into his mouth, and not just the nipple. Milk is stored behind the areola in pockets (lactiferous sinuses) and the baby has to compress these pockets in order to breastfeed effectively. Babies have tiny little rosebud mouths, and if your areola is large (some are the size of a saucer), then you need to make sure he opens wide (like a yawn) before you pull him in to you to latch on. Most of the areola should be covered, but it's not necessary for him to take all of it in his mouth.
5) Gently massage your breasts while you are nursing. Large breasted women have more tissue that can become engorged or lumpy, and massage can help insure that the milk ducts are being emptied adequately.
6) Set up a nursing station in the areas where you will be spending a lot of time (usually bedroom and living room). Get all the supplies you will need together so you don't have to move once you get settled: pillows, diapers, wipes, change of clothes, towel or cloth diaper for leaks or spit up, nursing pads, change of crib bedding, bottle of water, remote control, book to read, etc. A comfortable recliner is a wonderful investment. You will spend many hours nursing in it, and you deserve to be as comfortable as possible!
7) Good breast hygiene is important, because women with large breasts are more likely to have problems with skin irritation or infections due to the folds of skin underneath their breasts. Many skin problems such as yeast and heat rash are aggravated by moisture, and the area under the breast is prone to these infections. Wash your breasts daily with water (not soap) and dry them thoroughly, paying special attention to the area underneath the breast. You may want to use your hair dryer on the cool setting to make sure the area is completely dry, especially during warm weather.
8) If you choose to use a breast pump, you should be aware that the breastshields and flanges (the funnel shaped pieces that fit over your nipple/areola) are designed for the "average" sized breast. Women with very large breasts or areolas may need a larger flange. Medela makes a PersonalFit flange kit that comes with two different size flanges for larger breasts, and this makes it possible for women with all sizes and shapes of nipples to pump comfortably and efficiently.
9) Get professional help quickly when needed from an International Board-Certified Lactation Specialist (IBCLC). The hospital where you gave birth or your OB/GYN office is likely to have a referral source to get specialized attention so that you can successfully breastfeed your baby.