Tips from Leaders who have helped large-breasted mothers enjoy breastfeeding
From: LEAVEN, May-June 1989, pp. 35-37
Ed. Note: We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
"I never felt I could be a good nursing mother, as I was so uncomfortable with my big breasts. I was afraid I would be too self-conscious to nurse in public. However, as soon as my baby started to nurse, I felt good about my breasts for the first time in my life; finally they were useful." These are the words of one large-breasted mother reflecting on her breastfeeding experience. She is fortunate to have overcome her negative feelings about her large breasts so that she could have a positive nursing experience.
Large-breasted women have special breastfeeding problems that Leaders can help them resolve. In addition to recognizing that some large-breasted women have strong negative self-images, Leaders should be aware that positioning her baby at her breasts can be difficult for the large-breasted woman. Also, large-breasted women may have to contend with stretch marks that itch; heat rashes under and between their breasts; nursing bras that never fit properly; not having a free hand while nursing; and difficulty nursing discreetly in public.
The size of the breast is primarily determined by the amount of fatty tissue it contains. Since the fatty tissue is in no way an active contributor to milk production or transportation, the amount of fat or size of the breast is no indication of the quality and quantity of milk that will be produced," according to Margaret Neville and Marianne Neifert in Lactation: Physiology, Nutrition, and Breastfeeding. While breast size does not determine whether or not a woman can breastfeed successfully, proper positioning can be especially awkward for the large-breasted woman.
Leaders can help large-breasted women by explaining proper positioning as described in THE WOMANLY ART OF BREASTFEEDING and LLLI Publication No. 107, "Positioning Your Baby at the Breast." If the mother does not have a copy of THE WOMANLY ART OF BREASTFEEDING, send her a copy of No. 107 so that she can read and see the illustrations of proper positioning techniques.
Some large-breasted mothers have difficulty lifting their babies up to their breasts because their breasts almost touch their laps as they sit down. Leaders can suggest that these women place a rolled diaper or folded receiving blanket under the breast for support, lifting it high enough for the baby to latch on to the nipple. Supporting and lifting the breast also helps to keep the breast from covering the baby's nose, enabling baby to breathe and swallow properly.
Many large-breasted women need to hold their breast with fingers underneath and thumb on top throughout the nursing session. This maneuver, in addition to keeping their breasts off the baby's chin and nose, also keeps their nipple in the baby's mouth. Otherwise, the weight of the heavy breast applies pressure on the baby's mouth, making it difficult for the baby to keep the nipple in his mouth. Furthermore, the mother's nipple can be hurt when it falls out of the baby's mouth. As Anita Claire Coleman, from Ohio, said in a 1985 article in Ohio Circle, "The mother with large breasts should (be cautioned) not to lean over her baby while nursing; the baby can slip off the milk reservoirs and will only be compressing his jaws around milk tubing near the nipple. He will not get as much milk, and he may damage the mother's nipples."
Some large-breasted women also have large areolas and nipples. To release the milk in his mother's breast, the baby needs to compress the lactiferous sinuses (also called milk sinuses or milk reservoirs) located under the areola. Therefore it is important for the baby to grasp all of the nipple and as much of the areola as his mouth allows. Leaders need to encourage mothers with large areolas and nipples to be especially patient and wait until the baby opens his mouth wide as if he were yawning. This enables the baby to take all of her nipple and as much of her areola as his mouth can hold. Although the tiny baby may have difficulty latching on to the large nipple and areola, with careful positioning and patience most babies can suck efficiently.
Neville and Neifert suggest that large-breasted mothers "vary their nursing positions to make the nipple more accessible and to ensure complete emptying of all duct system."
Many mothers with large breast feel comfortable using the cradle lap position, nursing while lying down, using the sit position, or using the football hold. Leaders can explain these nursing positions to the large-breasted mother to help her avoid sore nipples caused by improper positioning.
In the cradle lap position, the mother is sitting down with her knees bent and feet elevated. The baby is positioned on his side on top of a pillow with his legs curved around his mother. The mother gets her baby to open his mouth wide and latch on to the breast and then reclines about 45 degrees, rolling her baby towards her and curling his body around her body. In this position, the weight of the baby's head is on the breast, making it more difficult for the baby to pull off the breast. The baby's head is tilted forward for comfortable swallowing while still allowing for breathing space.
Although large-breasted women often have more difficulty positioning their babies at the breast while sitting up, nursing lying down is sometimes easier for them than it is for small-breasted women. In the traditional lying-down position, the mother lies on her side with a pillow under her head. She positions the baby on his side with his mouth in line with her nipple. While a small-breasted mother may need to place her arm under the baby's head to bring the baby's mouth up to her nipple level, a large-breasted mother may or may not need to do this. Her breast may rest on the mattress with her nipple low enough for the baby to grasp easily. Once the baby has latched on properly, placing pillows behind his back will help support him while nursing.
Another lying-down nursing technique, cross-over nursing, can also be effective for the large-breasted mother. In this position, the mother lies on her side, places her baby on his side, and nurses from the top breast. She may need to move her bottom breast slightly to one side to position her top breast so the baby can grasp her nipple. She may also need to put her arm under her baby's head to bring him up to her nipple. With cross-over nursing, mother and baby do not need to roll over to nurse from both breasts. While nursing, the mother can stroke her top breast with gentle brush strokes from the chest wall to the nipple to encourage more efficient milk drainage.
When the baby is old enough to hold up his head, the large-breasted mother can lie on her back and hold her baby face down on top of her to nurse. This position enables the baby to grasp the nipple easily and keep it in his mouth. Also, in this position gravity lets the breast tissue fall away from the baby's nose, making it easier for him to breathe. The mother can position her baby parallel to her, with his legs falling between her legs, or she can position him lying across her with his feet falling to her side. In this position, the mother needs to make sure her baby's neck is not hyperextended.
The sit position is another position that can be used with a baby old enough to hold his head up. The baby's buttocks actually sit on the mother's thigh, while his legs straddle her thigh. The baby faces his mother's breast nursing in an upright position.
A final position especially helpful for some large-breasted mothers is the football hold. The mother should position her baby with his legs under her arm and his head resting in her hand. She may or may not need pillows to bring him up to her breast and should make sure the baby's legs are not pushing against the back of the chair or couch. With the football hold, the large-breasted mother will need to hold her breast throughout nursing to keep the weight off the baby's chin. The football hold provides good visibility of the baby's sucking and enables some large-breasted mothers to nurse more comfortably.
La Leche League Leaders also can help large-breasted mothers by explaining manual expression of milk and how to locate the milk reservoirs to aid in hand expression. Large-breasted mothers are less likely to become engorged. After milk is produced in the alveoli, it flows through lactiferous ducts collecting in the lactiferous sinuses or milk reservoirs. In some large-breasted mothers, the lactiferous ducts are longer, enabling the breast to hold more milk without becoming engorged.
However, the large-breasted mother "can become heavy and have overfull milk reservoirs. This overfullness can inhibit the baby's jaw action or can shorten the nipple elasticity, hindering the baby's ability to get a deep grasp. Before nursing during the first few weeks, she can check for overfull, tender reservoirs. Hot compresses, breast massage, and gentle, deep hand expression will make the first few minutes of the feeding more comfortable and allow the baby to achieve a deeper grasp (of the nipple)," says Coleman.
Stretch marks and Heat Rashes
In addition to helping large-breasted mothers position their babies at the breast, Leaders can be especially helpful to large-breasted mothers by suggesting ways of dealing with stretch marks that itch. While we do not recommend creams or ointments for nipples, massaging stretch marks with unscented lotion or breast cream can ease the itching. The mother should be cautioned to avoid scratching, which can lead to bleeding and infection.
Some large-breasted mothers have problems with heat rashes under and between their breasts. Taking frequent showers can help to prevent painful heat rashes from developing. If a heat rash does appear, the mother should keep the area clean, dry, and exposed to air as much as possible. Cotton nursing bras allow air to circulate better than synthetic fabrics and are especially comfortable for large-breasted mothers. Wearing cotton nursing bras also helps prevent heat rashes.
Leaders can help large-breasted mothers by giving them information about where to purchase proper-fitting cotton nursing bras, or how to make their own bras. While nursing bras in small and average sizes are very easy to find, large bras in sizes 40 to 46 and larger, and in cup sizes E, F, G, and larger, are virtually impossible to find in department and/or maternity stores. If a mother can locate these sizes, the fabrics are almost always synthetic and less comfortable to wear.
Although all nursing mothers who wear bras need them to fit properly, proper-fitting bras are particularly important for large-breasted mothers. Most large bras have seams in the cups. If the bra does not fit properly, the pressure of the breast against the seam can constrict milk-making tissue and contribute to plugged ducts or a breast infection. Most large-breasted mothers are comfortable in straps that prevent cutting or grooving of the shoulders due to the extra weight of the milk-filled breasts and underwire styles that support larger breasts.
Some large department stores carry larger nursing bras in their maternity departments, but they usually have to be special ordered. Most other sources of large nursing bras also need to be mail ordered. Consequently, large-breasted women may want to order nursing bras in the last weeks of pregnancy to ensure that they will have them in time for breastfeeding. Bras purchased during the last weeks of pregnancy should have extra room both in the cup and around the rib cage.
Three mail-order companies that carry larger nursing bras are (see editorial note at end):
Designer Series, PO Box 736, North Hollywood CA 91609, (818)763-7315 carries Mary Jane bra up to size 46G; Bosom Buddies, PO Box 6138, Kingston NY 12401, (914)331-1632 carries cotton nursing bras (including the Mary Jane bra) up to size 42H or 46 G; Motherwear, Box 114 LN Northampton MA 01011, (413)586-3488 carries 100% cotton nursing bras up to size 46G.
Bosom Buddies offers many different styles and sizes of nursing bras, and their catalogue includes a chart showing mothers how to measure their breasts so they know what size to order. Motherwear offers a complete catalogue of nursing fashions.
Although not specifically a mail-order company, Cameo Coutures (9004 Ambassador Row, Dallas TX 75247) also sells bras by mail--up to size 52HH, using their own unique sizing methods--to women outside their local area. Rather than taking their orders directly by mail or phone, Cameo first refers women to their local couturiere to be individually fitted. Once the women have been fitted and are sure of their size, Cameo will take their orders. Although their bras are not designed specifically for nursing, they do feature drop flaps. Women can call Cameo at (214)631-4860 for a reference to their local couturiere.
Mothers with large breasts also have difficulty learning to nurse discreetly. They often need to pull their clothing high up over their breasts in order to see their nipples to help their babies latch on to their breast. And when large-breasted mothers open the flap on their nursing bras, their whole breast may fall out of the bra, exposing much of their breast. Linda Kutner, a lactation consultant from North Carolina, suggests a solution to this problem. She recommends that large-breasted mothers make their own bras. Mothers can buy a well-fitting, non-nursing bra and a nursing bra in the largest size they can find. While wearing the non-nursing bra, cut away a circle large enough to expose the nipple and all of the areola and then sew the flap from the nursing bra onto this modified bra. Once the mother opens her bra, only her nipple and areola are exposed, making it easier for her to nurse discreetly. This is also a solution to the problem of obtaining proper fitting nursing bras for the mother who cannot find one that fits her.
Large-breasted mothers need to practice discreet nursing so they will be comfortable nursing in public. Leaders can encourage the large-breasted mother to nurse in front of a mirror or with her husband or a friend watching to know when she is nursing discreetly and when she is not. This way she can learn to change her position or use a diaper or a blanket to cover her breasts and nurse more discreetly.
Leaders can help large-breasted mothers by being sensitive to their emotional needs and by providing them with information on how to deal with their special physical needs. With a few words of encouragement and these special tips, Leaders can help large-breasted mothers breastfeed and enjoy the most natural and effective way of satisfying their babies' needs.
Coleman, Anita Claire. "Helping the Mother with Large Breasts." Ohio Circle, Spring/Summer 1985.
Laws, Rita. "Tips for the LC Assisting Large-Breasted Mothers." Journal of Human Lactation, June 1987.
Neville, Margaret C., and Neifert, Marianne R. Lactation: Physiology, Nutrition, and Breastfeeding. New York: Plenum Press, 1983.
Riordan, Jan. A Practical Guide to Breastfeeding. St. Louis: The C. V. Mosby Co., 1983.
[Web Page Editor's Note: Some changes have occurred since the time this article was written for LEAVEN and the date it was posted to the website. First, LLLI has endorsed "Lansinoh" for healing sore nipples in the US. See LEAVEN January-February 1994, p. 3. Second, the information given about companies that sell large-sized nursing bras may have changed. We include this article because the helping information is still appropriate and useful.]