"There is significant evidence that breastfeeding can be quite challenging, when somebody is overweight". Is there? Where?

[GwendolineMaryLacedwithBrandy]

This is in the literature that I've just found for my hospital. I had a disastrous experience with bf with DD and so this time am attending an antenatal bf and colostrum harvesting "workshop". Was looking for info.

This is the first I've heard that being overweight affects breastfeeding . Does it?

i'm rather overweight, and have ebf both mine, been feeding now for 4.5years straight!
If you get gestational diabetes then it can be hard initially, but otherwise I don't see why its a problem.

I seem to remember that excess fat can affect hormonal balance. And it can affect positioning of course.
Not a good idea to co-sleep when very overweight either.

WTF?

I've fed three babies for a total of 48 months altogether. I am a size 22 with a 38H chest. The ONLY impact my weight has had on breastfeeding is that I generally used a pillow to feed with as it was more comfortable for me to have them supported and I could then use one hand to stop them being totally flattened by boob. Having said that you could be a size 12 with a G or H cup chest and have the same issue.

Can you link to the literature - sounds crap! How are things generally birthwise btw?

Well I was told I had GD last time (since turns out I didn't) and the difficulty I had was with them refusing to offer bf support and instruction and insisting I formula feed. Hence the preparations this time. Have told them in no uncertain terms that I wish to try everything possible to bf and they've told me about these classes.

And I have v large breasts which makes it trickier, but that's not the same as being overweight. My size 8 friend has the same chest size as me. I've just never heard this before.

'Not a good idea to co-sleep when very overweight ' - why not? Does weight affect your natural instincts then? Obviously co-sleeping if you have sleep apnoea would be unsafe but I'm at a loss to know why not otherwise.

Bollocks I'd say. I'm a similar size to northernlurker and ebf both of mine, PLUS I had GD with DD2. Why do they print these things? Just another reason not to bother?

Debka - I would say it is all part of a growing tendency in the NHS to stigmatise overweight pregnant women so much that there's a refusal to believe they can achieve anything without intervention. You're pregnant - you MUST have a GTT so we can intervene in your pregnancy, you're giving birth - we must tell you where you may do that and how you may do it and now apparently you've given birth, you can't possibly b/feed - we'll intervene with that too!

Of course I may just be paranoid.......

I'm trying to link but it's a PDF that's automatically downloading...

It's Epsom and St Helier, Cedar Clinic, "Being Overweight and Pregnant"

It's the second google result.

I have no experience of this but was interested and had an internet searching session. It seems there may sometimes be an issue with depressed milk supply as a result of low prolactin levels which seem to be correlated with a high BMI. More here napah.ca/asp/news/articles/why_overweight_women_face_breast-feeding_problems.asp

It certainly doesn't seem to be a significant body of evidence. In fact it seems to be rather poorly researched. It's certainly no bar going by everyone's experience.

Ok have to go and put dd3 to bed - will be back. Found the leaflet and have some comments!

What utter bollocs!

I am fat. I also had GD when pregnant with DS3 and now have type 1 diabetes and am 29 wees pregnant.

I've breastfed two children continuously for the past three and a half years, only stopped last month when DS3 self weaned.

The only issue i've ever encountered was when DS3 was a nb, he couldn't latch properly as my milk didn't come in as such because it was already there, feeding DD iyswim.

Utter bollocks.

I had GD this time and I found the midwives pitifully informed about how to BF a newborn to try and keep blood sugar up. They also thought giving formula was the first option if my baby had low blood sugar.

I was meant to be on an insulin/glucose drip in labour as I'd be insulin dependant, but they didn't do it. After the birth I was anxious for my DD to feed ASAP as I knew that and skin to skin would help with blood sugar. A second midwife was about to try literally shoving my DD to the breast until I told her to leave me to it. I got DD to feed and then after they made me wait to feed her again so they could check her blood sugar and it was then borderline I just insisted on feeding as often as I could get her to and also hand expressed colostrum to syringe feed her in between. The midwives clearly thought I was nuts, but DD's blood sugar stayed well within normal limits after that so I didn't care.

Oh, and BF was no harder than when I wasnt overweight and didn't have GD. I'm still BF and DD is about to turn 6 months.

Find out as much as you can yourself would be my advice.

Just putting DD to bed. Will be back too, this is extremely interesting.

the only thing i can think of is that it's harder to get baby positioned correctly or something?

I am overweight & have G sized norks with nipples that only know what my feet look like I use a pillow (thru penny bits) and use my hand to hook my boob up. Not dignified/yummymmyesque but now onto DC2 so it works!!!

I'll preface this with the fact I am overweight (size 18) so not being size-ist.

I think the not co-sleeping if you are very very overweight (morbidly obese for e.g.) is because your sense of where your body is (if you shut your eyes you know where your legs are, whether your arms are up or down etc) doesn't really extend to all parts of you (esp. fleshy parts). So if you have a very large stomach or very fleshy arms you might not be aware of the exact position of your flesh in relation to your baby if you were co-sleeping.

Sorry for the repeated 'flesh/fleshy' I just can't think of an alternative word at the moment.

Sounds a load of crap to me. I was overweight (BMI 34) with large breasts and BF with no more than 'usual' issues. (Like the latch hurts like hell at first etc) but no issues at all to do with my weight or breast size. BF two children to 17months +.

Been and looked up your reference: What they say is "There is significant evidence that breastfeeding can be quite challenging, when somebody is overweight, so as a trust we offer a service where a midwife will teach and guide you about how to have the confidence to hand express and store your breast milk antenatally, allowing you to have the knowledge and skill when
your baby is born and a supply of milk in case you experience some difficulties with attaching your baby to the breast."

So they are saying it is latching issues. That's got to be individual issues and I can't see how your weight would affect that.

You sounds like you are doing the best you can to get the right info. Don't let that put you off.

I can assure you truthsweet i know exactly where all my flesh is, ta muchly

Ok - well the bit that says that isn't referenced at all so I would a) ignore it and b) ask at your next appointment why if there is such a lot of evidence they don't put a reference in.

I'm very disturbed by a number of things in that leaflet actually.

They note that babies born to overweight mothers have low breastfeeding rates - and yet their answer is to repeatedly reduce the woman's confidence in her ability to breastfeed. How do they propose feeding the milk expressed antenatally btw?
I take serious umbrage to 'A test to diagnose diabetes will be booked for you between 26 and
30 weeks (Glucose Tolerance Test - GTT) and a leaflet with
detailed information will be sent to you.' I think what they mean is that the GTT will be offered to you as, unless Epsom has suddenly become a dictatorship, pregnant women retain autonomy over their bodies.

Also 'If you have additional medical problems, you will be followed up
by the relevant clinician; otherwise you will continue to visit the
Cedar clinic at regular intervals.' - errr again I think they'll find that you the patient will decide what is helpful to you.

'The most appropriate place of birth for you is the Delivery Suite,
where you will receive one to one care by a midwife, but will be
additionally under the doctor?s care. The Birth Centre Use is not
applicable in your case, as it is used only for low risk pregnant
women. If you want to consider this or even the possibility of a
home birth, we will arrange a meeting with the obstetric/
midwifery team. You, also, are entitled to have access to a
Supervisor of Midwives to discuss your birth plan.' - they mean they consider the most appropriate place to be the delivery suite. They would recommend it, they can't empirically say it's most appropriate for you. I can't really begin to articulate how much that paragraph has put my back up!

I notice the research midwife's number is at the bottom. Give her a ring and ask her to send you the breastfeeding studies. The 'solution' they propose isn't going to help with attachment difficulties anyway.

AAAAAAAAAARGH! Am really cross

It's a good job I'm not having anymore dcs - I'm obviously far too bolshie!

Oh and truthsweet - with respect that's bollocks unless you are so overweight you're very unlikely to carry successfully anyway.

I had GD both times and struggled to BF with my first as he had low blood sugar and needed formula top ups for the first 24 hours. By sheer bloody mindedness I continued and fed for 10 months. With my second, had the same issue and he was actually tube fed for a day following his first breastfeed - but much more confident second time around and he took to it no problem 24 hours later - so fed for another 10 months.

I did put on more weight while feeding, mainly due to over consumption of chocolate and shortbread - but that is another story.

I was thinking of people in the 400lb plus size range so I should have made that clearer rather than just overweight - which could well be someone with a BMI of 26!

I really didn't mean to upset anyone nor imply anyone shouldn't co-sleep (hell I do and I'm certainly in the overweight of not obese category!) but was just trying to think of the rationale behind the no co-sleeping thing and failed. Sorry.

I think it is relatively harder for some people to breastfeed if you have big boobs which is more likely if overweight.

I was over weight with DS2 but dont remember it being any harder.

i do think there is a liklihood that there are a higher number of overweight people that don't breastfeed, but surely this is because of over factors such as lifestyle choices, the importance of healthy eating in your life, education etc ...

Surely they should be giving this sort of information in a positive way if it is in anyway based in evidence.

Obviously if your baby is having blood sugar issues then yes starting to breastfeed could be more fraught but overweight does not automatically = GD - though you wouldn't know that from the way some clinicians blither on. It really gets up my nose that the overweight pregnant woman is almost traeted as de facto diabetic and problematic.

When having dd3 I refused a GTT as I saw no indication for it. Dh and I had a free and frank discussion of views with the consultant (pissed him off so much he signed me back on to midwife care I think ). One of the things he said when arguing for the GTT was that it helped with labour planning. How I asked. Because we'll know you're at more risk of shoulder dystocia he cheerily replied. Ok said I - so what would you do differently then? Have you a magic way to prevent dystocia? No? Then what? Then he got flustered and blustered about intervention. So what he was basically implying was GTT would = pressure for a c-section - which really would have increased my overall risk! As it was dd3 was delivered with an episotomy like my other daughters but no other issues. She was actually the lowest birthweight of the three.

X posted as rabbiting on. truthsweet - I'm not upset, I'm outraged As far as I can see there is no rationale.

Tralala - anecdotally - the women I know who have struggled with breastfeeding have all had small norks.