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

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