Exploring Breastfeeding Influencers for obese mothers: The experiences and perceptions of five clinically obese women and their midwives

Abstract

What are the barriers and facilitators to exclusive breastfeeding for women with a BMI equalling or exceeding 35kg/m²? A qualitative interpretative inquiry.

Breastfeeding is established as beneficial to both mothers and infants in terms of short-term and long-term health, or as normalising to the susceptibility of numerous conditions of poor health. Obesity is counted amongst these. A significant proportion of lactation research demonstrates exclusive breastfeeding as protective against obesity for the infant, and various explanations are put forward, such as; milk and gut microbiome species and diversity, comparative initial weight trajectories and impact on future BMI, and comparative satiety development. However, international and New Zealand trends of obesity prevalence are noted to be increasing; and obesity discourse, medical discourse and the World Health Organisation position on causes and consequences of obesity continue to be discordant, with the understanding of obesity as caused by energy in, versus energy out disequilibrium, being challenged.

Current research continues to pursue directions which demonstrate obesity to be linked to infant experiences which influence infant gut microbiome, including mode of birth, feeding methods and skin-to-skin; and intrauterine environment – referring to the fetal inheritance/epigenetic inheritance theory. Notably, studies examining the influence of epigenetic heritance propose that infants born to obese mothers begin with a disadvantage in terms of health trajectories, considered to stem from the intrauterine environment and experiences; are at a higher risk of caesarean birth and of receiving breastmilk substitutes than infants born to non-obese mothers.

This study aimed to examine the breastfeeding experiences of obese client participants, and breastfeeding support experiences of midwives who have cared for obese clients, to learn more about what were considered breastfeeding influencers, facilitators or barriers, within the maternity journey. A secondary aim of pursuing this research was to apply findings to the study site to see if a review of breastfeeding knowledge or support practices offered to obese women was indicated.

The initial study design utilised Facebook as a means of contemporaneous data collection. Due to low recruitment, the design was modified to include one-to-one semi-structured interviews, and midwives were included as participants. Data was analysed using interpretative phenomenological analysis, and five themes were identified reflecting the participants’ experience of their maternity journey, and how breastfeeding was understood to interrelate with other maternity experiences.

Five main themes emerged during data analysis. These included communication, normality and autonomy, the midwifery partnership, the experience of intervention, and how intervention was understood to affect lactation. Communication was interpreted as the core theme for all participants, and this underpinned experience of normality and autonomy (defining oneself as a normal woman, and the ability to make decisions regarding one’s maternity journey). How participants interpreted the themes of normality and autonomy, and their experience and interpretation of communication went on to influence their experience of the midwifery partnership and interventions in pregnancy, intrapartum and breastfeeding support. No theme in isolation was definable as either barrier or facilitator to exclusive breastfeeding, but developed as such, through the context of the experience.

The ability to define oneself as a ‘normal woman’ and the ability to participate in one’s own care were either encouraged or discouraged through how communication was interpreted throughout the entirety of the maternity journey and hence were key findings of this research. Analysis of participant narratives revealed that it was through communication that these themes were interpreted. The midwife participants demonstrated awareness of these themes and related them further to the experience of the midwifery partnership, and how these factors, along with the social construct of obesity, underpinned communication with obese women, and the midwifery partnership.

Through data analysis the researcher noted considerable disparity between emerging themes and the research reviewed in the literature review. As this study was heavily focussed on models of care delivery and organisation at the study site, I question whether the disparity is reflective of the gap between research and practice. The aim of this study has been to identify breastfeeding barriers and facilitators for obese women and their midwives, and the purpose of doing so was to glean whether current service warranted further examination. From the themes which emerged in this study, I suggest that the approach to the maternity care of obese women, including language and communication styles as an area worthy of further examination.