Understanding how to support breastfeeding behaviour in women with a BMI ≥30kg/m2

The World Health Organisation (WHO, 2016) considers breast milk to be the most nutritious food an infant can receive, and, therefore, recommend that all infants are exclusively breastfeed for the first six months. However, in the UK, the number of women following this recommendation is low, with lower rates amongst women with a Body Mass Index (BMI) ≥30kg/m2 (Scott-Pillai et al., 2013). As the number of women of childbearing age with a BMI ≥30kg/m2 is steadily rising (Public Health England, 2015), it is vital that we develop an understanding of how this population makes decisions about infant feeding practices, in order to better support breastfeeding behaviours.
Therefore, a qualitative interview study was conducted, investigating what could be learnt from the experiences of women with a BMI ≥30kg/m2 who had breastfed. Understanding what contributes to women’s success can aid the design of interventions to improve breastfeeding rates for this population. This was a novel approach, as previous research had focused on identifying and eliminating the barriers for cessation, but had been ineffective in changing behaviour. Ethical approval was received from The University of Manchester (ref: 15453). Women with a BMI ≥30kg/m2 who had breastfed were recruited through several online avenues, and eighteen telephone interviews were conducted in December 2015 - March 2016 (mean interview length = 41.56 mins, SD = 8.32). A thematic analysis revealed two themes: ‘personal control over breastfeeding behaviour’ and ‘realistic expectations of the breastfeeding journey’. To achieve breastfeeding success, women described the importance of feeling in control and having the appropriate information and support to form realistic expectations and normalise breastfeeding behaviours. However, the women highlighted that the provision of these factors in current care falls short, highlighting the need to develop a psychological intervention.
To aid intervention development, a systematic review of the literature has been conducted, to identify relevant psychological factors which are associated with breastfeeding behaviours in this population. The review found that planning to breastfeed, believing in breast milk’s nutritional adequacy and sufficiency, believing that others preferred breastfeeding as an infant feeding method, and knowing others who had breastfed were associated with breastfeeding behaviours. However, many of the factors identified were examined by very few studies, and measurement of both factors and breastfeeding behaviour was not robust. Therefore, firm conclusions could not be drawn in terms of intervention development.
In conclusion, it is clear that women with a BMI ≥30kg/m2 are consistently less likely to breastfeed than their normal-weight counterparts. These studies have furthered our understanding of contributors to breastfeeding success in this population, but more research is needed in order to develop effective interventions.