Hi Marie,

I'm morbidly obese and I can say that I've never had any problems in 
terms of the reported prolactin issues.  I do think this is very rare, 
and only found in clinincal studies!  One of those factors that does 
exist, but isn't common in day to day experience.

Latch can be a huge issue if you have pendulous breasts, as you can't 
see your nipple without touching your breast!  And penduous breasts new 
to breastfeeding are best not touched heavily by mother's own hand - I 
started pulling in one side of my breast after a couple of days, and got 
tingling, then numbness, as I was straining the milk ducts by flattening 
them down.  Latching on with breasts you can't see the ends of, with a 
screaming and wriggling hungry baby, almost put us in the divorce 
courts.  The worst moment was when I hit on the sure fire method of 
using a mirror, with my husband saying left a bit, right a bit - fire.  
Mirrors and dyslexic Mummy... not a good option.  We laugh now, but it 
really didn't nearly kill us.

I'd suggest you prep your friend on baby led latching, and let the baby 
get on with it, and get your friend to keep well meaning 'latch advice' 
out of her way from the moment of birth.  This is one area where she 
really does need to find her own path, and the 'classic' holds are 
likely to cause her great stress - for she has two moving objects to 
bring together, her baby and her breast.

At birth, I'd go for the prone position, so the nipple is centred 
upwards from centre of the breast, and is in a good place for the baby 
to find it - exactly like the breast position on this video:  (all the 
way at the end).   http://breastcrawl.org/video.htm

This second video shows the process well, and is useful, but for the 
truly pendulous breast, if she gets things working with the utterly 
prone position - I'd stick with it for a while.  Mine did a perfect 
latch on by himself at birth - we'd placed him on my chest and he just 
did it.  The problems came when I tried to do stuff like I was being 
told to.  I do support a lot of women with pendulous breasts, and they 
do report lying more prone, and letting baby do the work for the first 
two to three weeks, until skill levels build, is the least stressfull 
way.  (That's both Mama's skill levels, and baby's.)  
http://www.ameda.com/breastfeeding/started/latch_on.aspx

Print resources showing same:  
http://www.breastfeeding.asn.au/bfinfo/bla.html      
http://www.biologicalnurturing.com/pdf/Poster%20for%20web%20site-locked.pdf

If the baby comes out disorganised, and isn't self-latching, my favoured 
position was what we call the 'rugby' hold here, which I think is the 
'football' hold in the USA.  Baby is down by your side, supported by 
pillows and your arm, and you raise the baby's head up to meet your 
breast, keeping baby supported by pillows or your arm, once latching is 
achieved.  It is one way to bring baby up to the breast, without 
interfereing too much with your own breast.  You need to be fully 
supported and comfortable semi-reclined.  How reclined depends on how 
tall mother is, and how long baby is.

And tell you friend there are huge advantages to floppy breasts once 
breastfeeding in well underway.  Those pendulous breasts can stretch a 
long way and still be suckled on, and it affords the mother a lot of 
freedom on position and movement when feeding is underway.    She will 
thank the System Overlords for them, when others around her are 
complaining that their babies are on-off-on-off all the time looking at 
stuff.    Pendulous breasts are so much more flexible.  It's incredible 
how far they can go, when a latched on toddler falls off the bed!   :-)

I'd also advise her to get a good and supportive nursing bra - they can 
be found,  I went for the Goddess 0511, which was too big at first!  (No 
financial interest)   This site may be useful to here:  
http://www.plus-size-pregnancy.org/PlusMat%20Clothing%20FAQs/PlusMat_Nursing.html

Babies love fat mamas - warm soft and squishy skin _everywhere_.  :-)

Morgan Gallagher


Marie Merritt-Reed wrote:
> Hi, my name is Marie and I am a nursing student at Ivy Tech Community 
> College. I have a close friend who is obese, and expecting her first child in 
> Febuary. I am wondering if her weight will have any affect on her plans to 
> breastfeed. 
> I did some research on the matter, and I found that one study had observed a 
> failure to initiate and also to sustain lactation in obese and/or prepregnant 
> overweight women. A couple of possible factors seemed to affect this 
> outcome. One factor was that being overweight or obese possibly made the 
> mechanics of latching on and proper positioning of the infant difficult. 

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