Body image and breastfeeding maintenance – a comparison of obese and healthy weight postnatal women

Background. Breastfeeding promotes maternal and infant health. Obese women have lower breastfeeding initiation and maintenance than healthy weight women. The influence of psychosocial factors on breastfeeding, including body image and post-childbirth psychological well-being are often not considered in research. We aimed to investigate these issues for women after childbirth in hospital, and 6-8 weeks later, studying the impact of body image and psychological distress on breastfeeding maintenance at 6-8 weeks, comparing obese and healthy weight women. Methods: A longitudinal semi-structured questionnaire survey measured demographic and biomedical factors around childbirth. Body image and psychological distress were assessed within 72 hours of birth and by postal questionnaire at 6-8 weeks, for 70 obese and 70 healthy weight women initiating either exclusive (breastmilk only) breastfeeding or mixed feeding (including formula milk) in hospital. Breastfeeding status was assessed at 6-8 weeks. Results. Obese women were less likely to exclusively breastfeed in hospital and maintain breastfeeding. Body satisfaction was lower overall in obese women, but all women had low body image satisfaction around childbirth, which reduced further by 6-8 weeks postnatal. Better body image was related to maintaining breastfeeding at 6-8 weeks, and lower postnatal psychological distress, although education status was the most significant predictor in the final model. Body image mediated the relationship between weight and breastfeeding maintenance. Discussion. Self-image can have an important influence on health behaviour. Body satisfaction should be explicitly discussed in relation to breastfeeding. Normalising post-childbirth bodies, encouraging women to focus on ‘function’ over ‘form’ may be a useful strategy.