>>My questions are:  What factors do you think cause obese mothers to
breast-feed for shorter amounts of time than normal weight mothers?  Is
there any medical intervention to quicken the onset of lactogenesis in obese
mothers to help promote breast-feeding?  And finally, how often do you
personally see obese mothers have problems such as those mentioned during
breast-feeding?  Thank you so much for your time and your responses are very
much appreciated!<<

Sarah,
Factors: I can't find my file with the obesity articles right now, but I can
tell you that another Rasmussen article discusses prolactin *response* to
suckling. We already know (Hartmann, among others) that there are no direct
correlations between basal prolactin levels and milk production, but there
is a correlation with the *responsiveness* of prolactin (the spike) to
suckling stimulation, so that is a significant factor. 

Another possible etiology that has not been sufficiently explored is
underlying issues related to the obesity. For instance, did the woman become
obese from poor eating habits/overeating, or did this weight come on
suddenly despite a normal diet and exercise regime?  The latter women may
have conditions such as polycystic ovary syndrome, which brings its own can
of worms with possible hormonal interferences. If there is an underlying
metabolic cause to the obesity, fat may be a symptom but not the actual
cause. It is always important to explore a mother's health and
endocrinological background in these cases, and to consider how well
developed her mammary gland was before pregnancy, as well as breast changes
during pregnancy. Some obese women have surprisingly small breasts (with or
without significant glandular tissue), and others have very large breasts
that may be mostly fat and little gland. 

The obesity connection is very real, but the relationship to delayed
lactogenesis and/or insufficient milk supply may be multifactorial. Note:
delayed lactogenesis may actually be primary insufficient milk supply. Most
of the studies did not look long term, and so they could only state the
situation for initial lactogenesis.

Treatments: until we fully understand the problem, it is difficult to design
a treatment. Galactagogues and/or extra stimulation are our basic attempt to
push a sick engine to the limit when we don't know how to fix the engine, so
to speak.

Incidence: I am in private practice so I only see the moms who have trouble,
not the general population. I'll let others answer that one!

~Lisa Marasco MA IBCLC

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