Exploring psychological factors associated with breastfeeding in women with a BMI ≥ 30 kg/m²

Abstract

Objective

Women with a BMI ≥ 30 kg/m² are less likely to initiate and maintain breastfeeding compared to normal-weight women. Psychological factors have been linked with breastfeeding, but their influence on women with a BMI ≥ 30 kg/m² experiences needs further exploration. The aim of this study was to investigate whether psychological factors are voiced by women with a BMI ≥ 30 kg/m², and how these factors influence their breastfeeding.

Design

A secondary analysis of eighteen semi-structured interviews with women with a BMI ≥ 30 kg/m² who had breastfed.

Main outcome measures

Deductive thematic analysis was used to apply a framework of psychological factors to the data, and investigate the extent to which they feature within the women’s breastfeeding experiences.

Results

All psychological factors were reported as part of women’s experiences. Planning to breastfeed, planning short durations and having high confidence, factual and social knowledge positively influenced initiation and maintenance. Believing in their ability to produce nutritionally adequate and sufficient milk, that breastfeeding would assist weight loss, and that others around them approved of breastfeeding also had a positive impact. Novel relationships between psychological factors were found.

Conclusions

Psychological factors influence women’s breastfeeding experiences. A model of breastfeeding in women with a BMI ≥ 30 kg/m² has been developed, and can inform future intervention development.

Keywords:

• Breastfeeding
• psychological
• experiences
• obesity
• body mass index

Disclosure statement

No conflicts of interest to disclose.

Box 1 Recommendations for care.

Recommendations for care developed from the model:

• Women with a BMI ≥ 30 kg/m² should be encouraged to plan to breastfeed during pregnancy for initially short durations, but to continually review and extend these plans in line with the WHO recommendations (2017).

• Positive benefits of breastfeeding should be promoted only when accompanied by realistic information about breastfeeding experiences, to promote planning, initiation and maintenance.

• Women with a BMI ≥ 30 kg/m² who wish to lose weight should be informed and supported to do so safely whilst breastfeeding.

• The benefits of attending breastfeeding support groups should be discussed with women with a BMI ≥ 30 kg/m².

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available. Ethical approval was not gained for data sharing.

Additional information

Funding

This paper was supported by the Economic and Social Research Council under Grant [Number ES/J500094/1].