title: Obese women experience multiple challenges with breastfeeding that are either unique or exacerbated by their obesity: discoveries from a longitudinal, qualitative study.
abstract: Obese women are at risk for shorter breastfeeding duration, but little is known about how obese women experience breastfeeding. The aim of this study was to understand obese women's breastfeeding experiences. We enrolled pregnant women in upstate New York, who were either obese [n = 13; body mass index (BMI) ≥30 kg/m2] or normal weight (n = 9; BMI 18.5-24.9 kg/m2) before conception and intended to breastfeed. A longitudinal, qualitative study was conducted from February 2013 through August 2014 with semi-structured interviews during pregnancy and at specific times post-partum through 3 months. Interviews were audio recorded, transcribed and analyzed using content analysis. Themes that emerged in analysis were compared between obese and normal-weight women. Differences were identified and described. Prenatally, obese women expressed less confidence about breastfeeding than normal-weight women. Post-partum, obese women and their infants had more health issues that affected breastfeeding, such as low infant blood glucose. Compared with normal-weight women, they also experienced more challenges with latching and positioning their infants. Breastfeeding required more time, props and pillows, which limited where obese women could breastfeed. Obese women also experienced more difficulty finding nursing bras and required more tangible social support than normal-weight women. In conclusion, obese women experienced more challenges than women of normal weight; some challenges were similar to those of normal-weight women but were experienced to a greater degree or a longer duration. Other challenges were unique. Obese women could benefit from targeted care prenatally and during the hospital stay as well as continued support post-partum to improve breastfeeding outcomes. © 2016 John Wiley & Sons Ltd.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
authors.forename: Christine D
authors.initials: CD
authors.lastname: Garner
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
authors.forename: Shanice A
authors.initials: SA
authors.lastname: McKenzie
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Devine
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA.
authors.forename: Loralei L
authors.initials: LL
authors.lastname: Thornburg
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D009035:Mothers; D009518:New York; D009765:Obesity / Q000503:physiopathology*; D049590:Postpartum Period; D036301:Qualitative Research; D012944:Social Support; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: breastfeeding; breastfeeding confidence; breastfeeding support; maternal health; maternal obesity; qualitative methods