Lots of good points here, and thanks, Lara, for your
off-the-top-of-your-head list of confounding factors making it harder
to determine what is physiological and what may be social hindrances.
About helping large-breasted women, I am incredulous that anyone who
has been working in maternity care in the last decade could be
ignorant about how to help voluptuous, generously proportioned women
breastfeed. They are not exactly a tiny minority nowadays.
I think there is something very affirming for a mother when staff know
of simple tricks to make positioning and attachment easier. A
rolled-up washcloth tucked in underneath a large breast, for example -
no strange equipment, just an ordinary item that any mother has at
least one of in her home and has used thousands of times,
matter-of-factly presented for a new use as though it were second
nature, which indeed it ought to be for us by now.
My career began just before the obesity epidemic hit Norway. It was
different back in the day when our worst challenge was the woman with
tiny breasts and no body fat, because they aren't easy either. The old
instructions for how to bring a baby to breast didn't usually include
what to do if mother's arms literally are not long enough to go around
the baby if baby is at her very large breast. But those old
instructions are passé for so many reasons! Laid-back positions, with
support where necessary, work with a great range of BMIs. My respect
for, and trust in, women's bodies, has only grown stronger through my
years of experience and I make a conscious effort to communicate that
to every new mother I work with, as well as to my colleagues.  Another
thing we can communicate is about taking your own emotional comfort
seriously, and finding spaces to breastfeed where you feel safe from
unwanted gazes. Such spaces exist.
Lara, apropos confidence or lack of it, about being able to
breastfeed, it is an amusing paradox that women I meet are generally
terrified for the first day or two that they 'have no milk', but when
they are able to express a single drop that is visible to the naked
eye, they relax completely because they 'have milk'.

I joke a lot with women, because the postpartum period in the hospital
is fraught with angst and I think joking helps alleviate it ('if it
were really that dangerous, she wouldn't be joking, would she?'). Of
course I strive not to trample on anyone's personal boundaries with
humor, but I think the risk of trampling is less if you are laughing
with someone than if you are being coldly clinical. For me, it is part
of expressing how much I like mothers and babies in general, and the
mother and baby in front of me in particular. I don't often have to
pretend to like someone, either. I just take a deep breath of the
oxytocin-laden air in the room and I feel affectionate enough.

Lots of digression here, sorry about that. Time to stop, I guess!
Rachel Myr
Kristiansand, Norway

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