Abstract
Objectives Women with a BMI ≥ 30 kg/m2 are less likely to initiate and maintain breastfeeding compared to women with a BMI ≤ 30 kg/m2. Reasons for this disparity are not understood. Therefore, this qualitative interview study aimed to learn from women with a BMI ≥ 30 kg/m2 who have breastfed. Methods Eighteen women participated in a semi-structured telephone interview. Participants were required to have had a BMI ≥ 30 kg/m2 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/m2, 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/m2. Future work is necessary to develop suitable interventions and to investigate their feasibility.
Highlights
Breastfeeding has numerous benefits for woman and child, including reducing the risk of serious illness (Horta et al 2015; Luan et al 2013)
With the number of women with a Body Mass Index (BMI) ≥ 30 kg/m2 who are of childbearing age (i.e. 16–44 years) steadily rising (Public Health England 2015), and the amplified importance of breastfeeding for this population, develop an understanding of how this population makes infant feeding decisions, and why initiation and maintenance is low, is vital in order to better support breastfeeding behaviors
Studies have shown that women with a BMI ≥ 30 kg/m2 lack confidence in their ability to reach breastfeeding goals, experience challenges with latching and positioning, find it difficult to find suitable clothing for breastfeeding, and have few friends or family members who have breastfed (Garner et al 2016; Hauff et al 2014)
Summary
Breastfeeding has numerous benefits for woman and child, including reducing the risk of serious illness (Horta et al 2015; Luan et al 2013). The World Health Organization (WHO) recommends that all women should initiate and maintain exclusive breastfeeding for the first 6 months, and continue with complementary breastfeeding until the child is at least 2 years (WHO 2016). With the number of women with a BMI ≥ 30 kg/m2 who are of childbearing age (i.e. 16–44 years) steadily rising (Public Health England 2015), and the amplified importance of breastfeeding for this population (e.g. increased postpartum weight loss, reduced risk of childhood obesity; Vinter et al 2014; Yan et al 2014), develop an understanding of how this population makes infant feeding decisions, and why initiation and maintenance is low, is vital in order to better support breastfeeding behaviors. We currently know very little about what can contribute to and support breastfeeding initiation and maintenance in women with a BMI ≥ 30 kg/m2
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