Ruth quoted an article: Excessive Weight Gain During Pregnancy Impairs Breast-Feeding Ability <....study findings indicate the need for additional support and education of obese women so that they "can successfully breast-feed their children."> I agree with Dr. Rasmussen's conclusion, but not for the same rationale she gives. <Normal-weight women get progesterone from the placenta, she said. After delivery that source is gone and that signals the body to start producing milk. However, fat is also a source for progesterone, so obese women continue to produce progesterone after the placenta is removed. "So it can take them longer to develop a milk supply> Progesterone is stored in fat cells, and is released, not produced, by fat cells for a longer time in women who have more fat cells. It takes approximately 8 hours for the progesterone to be fully released in women of average weight, if I remember correctly from the old TACE literature. I do not find it to be a universal truth that obese women are necessarily extremely large breasted. Different women have fat distributed in different areas. Being able to see over the curve of the breast to observe the nipple-areolar complex and its position in the baby's mouth can be frustrating to mothers with larger breasts, no matter what their overall weight is. I have to agree that it is sometimes more challenging to find comfortable ways to help with initial breastfeeding positions, etc. in very obese women. It may be partly due to difficulty assuming various positions due to discomfort in cases of operative delivery. I find it is also partly due to their upper abdominal fat making it hard to find a place to "put" the baby's body close enough to the mother so that the face is close to the breast if the mother is sitting up. So I try to teach positions other than the cradle hold. <First, she said that the areola is often much larger when a woman is obese and "it may be more difficult for the infant to compress adequately to get a good milk supply,"> The size of the areola is a skin characteristic. It's measurement may or may not be indicative of the actual depth and placement of the milk reservoirs. Of course, the mother will need the info to prop the breast with a small rolled towel etc. if the breast does happen to be extremely heavy. But these mothers often seem more likely to receive labor interventions such as inductions, C. sections etc. with all the accompanying IV fluids and anesthetics. Thus, they may experience a proportionate sequestering of excess interstitial fluid in the tissues, including the breasts. Increased expansion of the breast either from fat or interstitial fluid will tend to distort the nipple to a flatter state. All of these factors of course, make it important to teach the mother to test and reduce any subareolar tissue resistance before latching attempts. This means educating them about engorgement and teaching them fingertip expression, and if need be, teaching them to precede this with Reverse Pressure Softening to move edema out of the nipple-areolar complex temporarily. Jean ****************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html