Comparison of the barriers and enablers to breastfeeding by pre-pregnancy body mass index: A mixed-methods study

This mixed-methods study investigated the barriers and enablers to breastfeeding for women with high prepregnancy BMI from the perspectives of women and midwives, compared to women with normal BMI. Women recruited from a public Australian health service completed a survey in pregnancy (n=67) and postnatally (n=43) about breastfeeding intentions, barriers, enablers and support preferences. Midwives (n=13) employed at the health service participated in a focus group. There were no significant differences in infant feeding intentions, initiation and duration by BMI group. Women with high BMI were significantly more likely than women with normal BMI to report barriers to breastfeeding, including difficulties breastfeeding while in paid employment (high BMI: 76.3% vs normal BMI: 50.0%, p=0.029), and breastfeeding complications such as their baby being unable to latch to the breast (high BMI: 48.1% vs normal BMI: 11.1%; p=0.048). The midwives perceived that women with high BMI often have unrealistic breastfeeding expectations. Women with high BMI would benefit from further breastfeeding support and education.