“You just need to leave the room when you breastfeed” Breastfeeding experiences among obese women in Sweden – A qualitative study

Abstract

BackgroundThe benefits of breastfeeding for the infant as well for the mother are well-known. It is recognized that obese (Body Mass Index ≥30 kg/m2) women may have less antenatal intention to breastfeed, and shortened duration of breastfeeding compared with normal-weight women. This may result in adverse short- and long-term health for both mother and child, such as a shortened lactational amenorrhoea and decreased protection against breast cancer for the women, and an increased risk for infectious diseases and overweight/obesity among the children. Therefore, it is important to gain more knowledge and understanding of obese women’s experiences of breastfeeding in order to attain good health care. Hence, the aim of this study was to identify and describe obese women’s experiences of breastfeeding.MethodsThis is an explorative study. Data was collected 2 – 18 months after childbirth through semi-structured face-to-face interviews with 11 obese women with breastfeeding experience. The interviews were recorded and transcribed verbatim. Thematic analysis was used.ResultsThree themes emerged from the data analysis: Breastfeeding - a part of motherhood, the challenges of breastfeeding, and support for breastfeeding. The women described an antenatal hope for breastfeeding, the body’s ability to produce milk fascinated them, and the breast milk was seen as the best way to feed the child and also as promoting the attachment between mother and child. Breastfeeding was described as a challenge even though it is natural. The challenges concerned technical difficulties such as the woman finding a good body position and helping the child to achieve an optimum grip of the nipple. Another challenge was the exposure of the body connected to public breastfeeding. Support of breastfeeding was described as the importance of being confirmed as an individual behind the obesity, rather than an individual with obesity, and to obtain enough professional breastfeeding support.ConclusionsBreastfeeding was experienced as a natural part of being a mother. There were practical challenges for obese women concerning how to manage breastfeeding and how to handle the public exposure of the body. There was a need for realistic information about breastfeeding concerning both the child and the woman.

Breastfeeding experiences and support for women who are overweight or obese: A mixed‐methods systematic review

“…Quantitative and qualitative studies reported physical barriers including larger breasts, bigger areolas, and additional body tissue made infant handling and breastfeeding positions such as cradle or cross cradle more difficult (Claesson, Larsson, Steen, & Alehagen, ; Garner et al, ; Jarlenski et al, ; Massov, ). Jarlenski et al () found that significantly more women with obesity (26.5%) than without obesity (21.0%; p < .05) reported “baby had trouble sucking or latching on” as a reason for not breastfeeding to 6 months (Jarlenski et al, ).…”

“…The women in Massov's () study described perceived insufficient breast milk supply as a reason for switching to formula feeding. Claesson et al's () qualitative study described how women thought that having larger breasts might impair milk production. O'Sullivan et al () found that obesity negatively affected exclusive breastfeeding, and the association was significantly mediated by the perception of “insufficient milk” supply.…”

“…Embarrassment about breastfeeding in public was a key issue affecting breastfeeding behaviour (Claesson et al, ; Keely et al, ; Massov, ; McKenzie et al, ; Mok et al, ). Mok et al () reported that at 1‐month postpartum, a higher proportion of women with obesity (47%, n = 20) reported feeling uncomfortable when breastfeeding in the presence of others than women with normal weight (26%, n = 13), but this was not statistically significant.…”

“…Women's self‐confidence increased when health professionals paid attention to them and that they were treated as an individual rather than an individual with obesity “they looked into my eyes and saw me as I was. Nobody focused on what I looked like …” (Claesson et al, : 7). However, some women received judgemental and disempowering support from health care professionals.…”

“…Massov (, p. 27) reported one woman with obesity who experienced “rough and aggressive” treatment: “I remember the midwife coming in and almost angry that I was upset because I was having trouble doing it ….” Another woman reported her experience of midwifery support as disempowering, as rather than showing her how to attach her baby to the breast, she felt midwives “were taking over”. Lacking support from health professionals was found to be a reason for stopping breastfeeding (Claesson et al ).…”