Breast or bottle? Expectations and experience of infant feeding for women with a body mass index ≥ 25 kg/m2: a qualitative study

This study explores the experiences and perspectives of women with a Body Mass Index (BMI) ≥ 25 kg/m2 on infant feeding. Women with a BMI ≥ 25 kg/m2 have lower rates of initiating, maintaining and exclusive breastfeeding than women with a BMI < 25 kg/m2. There is limited qualitative research on this topic, particularly for women living with overweight (BMI ≥ 25 kg/m2-29.9 kg/m2). Eighteen women with a BMI ≥ 25 kg/m2 living in the North East of England and an infant under eighteen months of age participated in a semi-structured interview concerning infant feeding practices during May and June 2021. Participants were recruited through social media platforms. An inductive thematic analysis was undertaken to analyse the interview data. Two overarching themes were identified: lower confidence and a perceived negative judgement from others for living with higher weight. These themes reduced women’s confidence in their ability to breastfeed and led to negative experiences or avoidance of public feeding. Difficulties with latching and positioning in relation to body shape also reduced confidence in breastfeeding further. Due to these barriers, women felt that they required additional, tailored support to achieve breastfeeding. Improving breastfeeding support for women with a BMI ≥ 25 kg/m2 requires a whole systems approach involving education systems, healthcare professionals and the community. The impact of terminology, such as labelling a women’s pregnancy ‘high risk’, on women’s breastfeeding confidence needs to be considered further.