by Anne Smith, IBCLC

All during my adolescent years I dreamed of having larger breasts, and my best friend and I (both six feet tall and bearing a striking resemblance to Olive Oyl) even did those silly exercises bust building exercises that never worked but just made us feel silly ("We must, we must, we must increase the bust…the bigger the better, the tighter the sweater, the boys depend on us...").

I remember being so depressed when I read somewhere that your breasts didn't grow anymore after you reached age sixteen, and at age seventeen, I barely filled out an A cup. I figured that was it, but little did I know that my breasts would get significantly larger while I was pregnant and lactating - all the way up to a C cup! Aside from the cosmetic advantages, it was wonderful to realize that those same breasts that I had always wished were larger could work just fine, thank you, and after successfully nursing six babies, I no longer fantasized about being a D cup. Now that my nursing days are over, I am once again back to an A cup, but I no longer complain about it. I just hunt through all the lingerie racks trying to find 38 A bras that will fit me.

Over the past twenty-five years of working with nursing mothers whose breasts came in an amazing variety of shapes and sizes, I have discovered that breastfeeding can present special challenges for the large breasted woman.

Breast milk production is a function of the glandular tissue inside the breast as well as the baby's appetite and suckling ability. The fatty tissue is what gives the breast its rounded shape and protects the internal structures from injury. The amount of fatty tissue and the size of the breast are not related to the ability to produce milk, so small breasted women are just as capable of adequate milk production as the more amply endowed.

The mother with large breasts (DD or above) may find that she has to experiment a little to find positions and techniques in order to have a more successful breastfeeding experience.

Here are some suggestions that I have found helpful:

• Find a nursing bra that really fits. Small- breasted women don't need as much support as larger breastfed women, so finding a supportive bra is more of a priority for the mother with larger breasts. Breast size will increase during pregnancy, but by the last trimester, the majority of prenatal growth has occurred and that is a good time to purchase nursing bras. It is impossible to predict exactly how much larger your breasts will get when your milk comes in, but you can estimate that you will be a size or two larger in both cup and band size. It may help to get a back extender to use during the latter stages of pregnancy or the early stages of engorgement, because this can easily be removed as your size changes. Your ribcage expands during the last months of pregnancy, and the extender may help make you more comfortable during this stage. Start out with only a couple of bras, and invest in more once the initial engorgement has subsided and you reach your long-term nursing size. Good nursing bras are expensive, and you don't want to end up investing in a drawer full of bras that don't fit anymore after the first couple of weeks of nursing. You should try to avoid under-wire bras if possible (they can press against breast tissue and cause problems with plugged ducts and mastitis) as well as tight athletic bras. Bras that are too loose can also cause problems for large breasted women. The best option for obtaining a comfortable, supportive bra is to have it fitted by a professional, but this isn't always possible. Many maternity stores don't carry a large range of sizes, so you may have to order one instead. Plan to order far enough in advance to allow time for returns if the fit isn't' just right. The best online resource I have found for nursing bras is birthandbaby.com. Go to the home page and look under "breastfeeding". Click on "nursing bras" and you will go to the family resources page. They have an excellent selection of bras in a wide range of brands and sizes, along with detailed information about how to fit and order the bras.

• Experiment with different positions. The traditional cradle hold is the most popular position, but the football hold generally works better for women with larger breasts. In this position, the baby is tucked under your arm and you have better control of the baby's head as he latches on, as well as more freedom of arm movement. Be sure to use lots of pillows to bring the baby up to your level, rather than having to lean over him. You also want to support your back with pillows as well. Raising your knees with a footstool also helps (Medela's Nursing Stool is ideal for this). It is difficult to learn how to position your baby by reading a book, so spend some time at La Leche League meetings if you have the opportunity. You'll get the chance to see real live babies in action in a comfortable situation where only other mothers are present. Medela has an excellent video called "Breastfeeding Your Baby: A Mother's Guide: Positioning" that shows a variety of nursing positions. It's available from many LLL group libraries, and in our area, Blockbuster Video offers it free as a public service. You may find it useful to "practice" different positions before your baby arrives, using a baby doll or stuffed animal. While this isn't the same as nursing a real live wiggly baby, it can give you an idea of how to use pillows for support, and help you get a feel for which positions might be most comfortable for you.

• Make sure to support the breast while nursing. Using the "C" hold is often effective. The optimal C hold involves using your outside hand (the one on the same side you're nursing from) to support your breast. Put your palm gently under the breast, with your thumb curved around the top and side, forming a "C". Be sure to keep your finger and thumb well behind the areola, because if your fingers are in the way, your baby can't compress the milk sinuses effectively. This can cause soreness as well as keeping him from obtaining the hind milk that he needs to grow. Some mothers find that rolling up a washcloth and placing it under the breast during the feeding provides extra support. You may need additional support only while you are getting the baby latched on, or you may need to support the breast throughout the entire feeding. Once your baby is older and has better muscle control, you may find that you don't need as much support as you do in the beginning.

• Pay careful attention to latch on. You need to make sure that your baby takes a good portion of the areola (the dark area surrounding the nipple) into his mouth, and not just the nipple. Milk is stored behind the areola in pockets (lactiferous sinuses) and the baby has to compress these pockets in order to breastfeed effectively. Babies have tiny little rosebud mouths, and if your areola is large (some are the size of a saucer), then you need to make sure he opens wide (like a yawn) before you pull him in to you to latch on. Most of the areola should be covered, but it's not necessary for him to take all of it in his mouth.

• Gently massage your breasts while you are nursing. Large breasted women have more tissue that can become engorged or lumpy, and massage can help insure that the milk ducts are being emptied adequately.

• Set up a nursing station in the areas where you will be spending a lot of time (usually bedroom and living room). Get all the supplies you will need together so you don't have to move once you get settled: pillows, diapers, wipes, change of clothes, towel or cloth diaper for leaks or spit up, nursing pads, change of crib bedding, bottle of water, remote control, book to read, etc. A comfortable recliner is a wonderful investment. You will spend many hours nursing in it, and you deserve to be as comfortable as possible!

• Try to find a way to nurse while you are sleeping with your baby. Newborn babies nurse a LOT during the night, and you will get a lot more rest if you can learn to nurse comfortably while lying down. Many mothers find this the most difficult position to master, but in my experience, large breasted women find it easier than women with small breasts. The article on "Nursing After a Caesarean Section" has info on nursing lying down, and so does the Medela video.