Can you breastfeed a “big baby”?
In Australia, 92% of babies are born with a “normal” birthweight between 2.5kg and 4.5kgs (5.5 pound and 9 pounds)
Just 7.2% of all babies are considered to be low birthweight (birthweight less than 2.5kg)
Around 1% of babies are classed as high birthweight (birthweight of 4,500 grams or more).
Many mothers in the past were told they wouldn’t be able to produce enough milk for their “big baby” and some are still given this advice today.
Several factors can contribute to high birth weight. For example:
the baby's parents' height and stature
if the baby is a boy (baby boys tend to be larger than baby girls)
having older siblings (the chance of fetal macrosomia increases with each pregnancy)
a previous pregnancy in which the baby was large
a gestation of more than 42 weeks
if the mother has diabetes during pregnancy
if the mother gains a lot of weight during pregnancy or is obese
if the mother is aged 30 or older
In some cases, larger-than-normal birth weight doesn't have a clear cause and can't be explained.
Can birthweight have any impact on breastfeeding?
When we consider than the recommended minimum for breastfeeding is two years and the average weight of a two year old is around 10.6 - 13.9kg (23.3 – 30.7 lbs) for girls and 11.1 - 14.6 kgs (24.4 – 32.2 lbs) for boys, clearly breasts can produce enough milk for even the largest newborn baby!
While at least two years is considered the minimum age for weaning, breastfeeding for 3 or 4 years is typical for humans, chimpanzees and gorillas!
So why have mothers been told they need to formula feed because they cannot make enough milk for their baby?
High birth weight is associated with babies of mothers who have had gestational diabetes. Gestational diabetes mellitus (GDM) is a pregnancy condition commonly caused by hormones from the placenta blocking the mother’s insulin (hormone that moves sugar from our blood to our cells so it can be used to make energy) and generally goes away after birth.
Potential breastfeeding challenges associated with Gestational Diabetes include:
Delayed lactogenesis (mature milk coming in) in approximately one-third of mothers who had GDM
Perceived insufficient milk supply
Increased breastfeeding of infants who have experienced higher blood sugar levels in the womb
Babies whose mothers are known or suspected to have gestational diabetes might be managed differently in hospital. Sometimes medical advice is to give babies additional feeds until their mother’’s milk transitions from colostrum to mature milk. While traditionally infant formula has been used, in recent years mothers have been supported to collect colostrum in the final weeks of pregnancy, freeze it and bring it with them to the hospital to be used if their baby needs to be supplemented.
In the past, mothers may not have been fully informed about why their baby was being given infant formula and they might have interpreted that to mean their baby couldn’t or shouldn’t be breastfed. Some babies are admitted to Special Care for observation and mothers might feel anxiety about their milk supply and believe they are not making enough milk. The small volume of expressed colostrum typical in the first days is very low compared to a standard formula feed. Mothers who have started out mixed feeding (breastfeeding plus formula) are likely to continue once discharged from hospital. Without the right information and support, these mothers might struggle to maximise milk production.
Does it “run in the family”?
Family folklore has a lot to answer for when it comes to breastfeeding confidence.
“Ooh, I had big babies and I couldn’t breastfeed them!” might have been your mother or grandmother’s experience however such recollections are often inaccurate and we have come a long way with breastfeeding management since then! There is also an element of brag factor when big babies are born and exaggerations can expand over time. Babies consuming large volumes of formula or starting solids extremely early were often considered great achievements rather than the red flags for poor health they really are.
Breastfeeding is extra important for mothers AND babies after gestational diabetes.
There is growing evidence that breastfeeding can offer some protection for mothers who experience gestational diabetes. One study showed that for women who had gestational diabetes, breastfeeding was associated with a lower rate of type 2 diabetes for up to 2 years after childbirth. How long you breastfeed also affects your chance of developing type 2 diabetes. In one study, breastfeeding for longer than two months lowered the risk by almost half. Breastfeeding beyond five months lowered it even more. Breastfed babies have lower risk of developing type 1 diabetes and becoming overweight or obese later in life, which is a risk factor for type 2 diabetes.
Mothers of high birth weight babies can be confident they can breastfeed. Those who have experienced gestational diabetes should be supported to establish breastfeeding and be given a clear plan for reducing supplementary feeding.
