Marie Ivey <[log in to unmask]> wrote:

> While studying for the *Exam*, I was listing the major causes of delayed
> lactogenesis according to several resources. I thought of a few
> questions about obesity and breastfeeding. I had read about a possible
> association between a delay and obesity...but, what can we do in this
> situation? Should we be encouraging obese women to pump after
> breastfeeding for "insurance" (thinking stimulation and milk removal
> might help), do we "wait and see" (which I have a hard time doing), AND
> as sensitive as the subject of obesity is...how would/could we approach
> it?

I haven't yet seen any primary sources on obesity and lactogenesis that
even attempted to take into account provider prejudice or internalised
attitudes about success.  Have you?

Everyone just jumped to the conclusion that any difference must be
physiological/pathological/hormonal, instead of looking for what to me
were far more likely explanations: fat women are told all their lives
that their bodies are broken, that their bodies are wrong, that their
bodies don't work normally, that they will make their children fat, that
they really shouldn't have reproduced in the first place, and
furthermore that their bodies should never, ever be displayed or used in
public in any way.  

I don't find it at all surprising that fat women are statistically a
little less successful at breastfeeding, with these hits over and over.
And it's really no wonder that fat women might be approaching
breastfeeding with some deep-seated ideas that their bodies are less
likely to make milk normally, that they are somehow a threat to their
babies, and that lifting their shirts in public will make them more of a
pariah than they already are. How do women in a breastfeeding-hostile
society survive these extra layers of "booby traps"? We don't know:
nobody's ever looked (or if they have, as far as I know they haven't
published.)

I also didn't see these studies controlling well for birth care and
mother-infant separation, which are absolutely vital  to include! Obese
women are heavily pathologised and treated as high risk in an obstetric
environment, denied homebirth and birth centre care, turfed to tertiary
centres, sectioned near term for "big baby" or controlled GDM or just
because the OB has a feeling that something might be wrong, and their
babies are more likely to be removed after birth with the idea that the
mother "must have been" diabetic, or that they're at risk after the
caesarian or instrumental delivery the mother "had to have" because she
was fat. 

Encouraging lactation care providers to further treat larger women's
bodies and breasts as innately likely to fail until proven otherwise
doesn't seem to me to be a great way to proceed from here, with the
evidence currently on the table. That approach certainly hasn't worked
to produce better birth care either.

Lara Hopkins

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