Nikki is the only poster to respond to Lara's post about the lack of
research evidence that physiology is a major cause of low milk supply or
lactation failure in overweight women.  Lara was posting in response to
someone else who asked whether, in light of a limited amount of research, we
should be giving specially tailored anticipatory advice to overweight women,
and the gist of her answer was 'no'.
First let me make clear I agree with Lara and I'm grateful to her for
pointing out the many areas that ought to be explored or at least considered
in thinking about what obstacles fat women face in general and with regard
to breastfeeding in particular.  Please refer to her post for the complete
rundown as I can't do it justice here.  I'm writing 'fat' because Lara did,
and I found it refreshing to see someone just calling it 'fat' again, and
not 'body mass challenged' or 'larger' or some other euphemism.
Nikki writes about how it is to work in a hospital that is understaffed for
the task, and to have to care for morbidly obese surgical patients.  Really,
her post points up some of the things Lara wrote about: that fat women are
more likely to have interventions in childbirth, because there is an
attitude of distrust of their bodies and even of their ability to
simply live their lives.
I don't think Lara was thinking primarily of people who are unable to stand
unaided and need wheelchairs to visit Disneyland on a good day.  Plenty of
us are more voluptuous than the average supermodel with her BMI of about
14, and a BMI of 31 before the age of 65 gets you labeled 'obese', if I'm
not mistaken.  If you do the math you may discover you are already
borderline.  There are LOTS of women in this group having babies.  (In
places with CS rates over 30 percent, it's not just the fatties getting
sectioned either!)  I think Lara's point was that there are plenty of
reasons why breastfeeding fails under modern obstetrical care, and being
slim is no guarantee that you'll do any better, and we would do well to put
ourselves in the position of the fat women and think how tempting it is to
breastfeed when you already are made to feel you have no right to enjoy your
body or even to expect it to perform normally, and certainly shouldn't
expose others to the horror of your flesh just because your baby is hungry.

I guess my point is, you don't have to be extremely obese to feel as though
you ought to loathe your body, and yourself, for not being thin.  It's not
fat people's fault that hospitals are understaffed or that they lack the
equipment to be able to give safe good care without breaking the backs of
the carers.  You could argue it is partly the hospitals' fault, because they
have been in collusion with the formula industry for so long that they are
now reaping the fruits of sabotaging breastfeeding, in the form of a higher
proportion of the population being overweight.  We need to work with our
unions to get better working conditions so we can give adequate care to
everyone on our shifts.

Rachel Myr
Kristiansand, Norway

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