EMPOWERING PARENTS #3: Woman-centred language and weight-inclusive care of breastfeeding and lactating women

Neuroprotective Developmental Care (or the Possums programs) uses destigmatised language to describe women's bodies

A woman centred approach which counters weight stigma has been a fundamental part of the NDC approach to breastfeeding and lactation from the beginning of the development of the programs (and which were first delivered in the clinic in 2011). To avoid body stigma, NDC uses carefully chosen words to describe women's bodies, such as generous or delicate or petite to describe breast size, landing pad and breast-tummy contour to describe physical configurations, and goes back to the research to celebrate the wide range of anatomical and functional variation which characterises normal women's bodies.

This woman-centred NDC approach to breastfeeding medicine avoids weight or body stigma by ensuring that clinicians

• Avoid confusing health status with body weight (larger bodied people are often as healthy as smaller bodied people)

• Avoid or are very cautious about using comparative words which to describe or measure parts of the body (e.g. avoid using 'big' or 'small', avoid describing a palate as 'high'. These terms typically don't help, may accidentally indicate incompetence or inadequency, and also typically lack an evidence-based accuracy.)

• Use physical or body descriptions

  • Only when necessary

  • Which are felt to be appropriate by the unique woman or person before you in the consultation e.g. larger bodied person, generous breast. If in doubt, directly check out that the words you use are comfortable for the person before you

• Celebrate the normal wide range of anatomic variations in both women and babies

• Normalise the wide range of normal functional variation found even between women who are able to exclusively direct breastfeed with good infant weight gains

• Address the many blind spots in clinical breastfeeding and lactation support (including the fundamental role of mechanobiology) instead of blaming the woman's body or her infant's body.

Weight-centric breastfeeding and lactation support overstates the relationship between body weight and adverse breastfeeding outcomes

A study by Griffiths et al 2023 has identified that weight-centric maternity care is very common. Weight-centric maternity care over-emphasises risk and overstates the relationship between body weight and adverse pregnancy outcomes. This contributes to stigmatizing experiences and overlooks other factors that may also contribute to adverse pregnancy outcomes.

Similarly, I propose that weight-centric breastfeeding and lactation support overemphasises risk and overstates the relationship between body weight and breastfeeding outcomes, at the same time as a range of factors which impact negatively on breastfeeding outcomes, including mechanical fit and hold challenges, remain unidentified and are not appropriately managed.

Recommended resources

A woman-centred approach to weight stigma (downloadable pdf)

The body positive birth alliance

What the research tells us about the larger bodied woman and breastfeeding + supportive clinical skills. Dr Kate Rassie video presentation 11 March 2025

'Intuitive eating' in the perinatal period

Eight-week-old Jamal who'd previously been unable to feed from his generous-breasted mother has a long drink at her breast then falls asleep in our consultation

What works best for you and your baby when you have a generous breast?

PBL Advanced

Neuroprotective Developmental Care (NDC) or the Possums programs: preferred terms when communicating with parents

Handing power back to mothers and parents

NDC neurobiological model: parent empowerment

Neuroprotective Developmental Care (NDC) or the Possums programs uses de-stigmatising and woman-centred language

Woman-centred language and weight-inclusive care of breastfeeding and lactating women

NDC uses descriptive terms for anatomic features (instead of the surnames of famous men!)

Selected references

Griffiths, A et al. Listening to larger bodied women: Time for a new approach to maternity care Women and Birth, Volume 36, Issue 5, 397 - 400 [read here]

Hailu H, Skouteris H, Incollingo Rodriguez AC, Hill B (2024). SWIPE: A conceptual, multi-perspective model for understanding and informing interventions for weight stigma in preconception, pregnancy, and postpartum. Health Psychology Review. Advance online publication 1st April 2024.Doi:10.1080/17437199.2024.2333801

Hailu, H., Skouteris, H., Incollingo Rodriguez, A., Galvin, S., Hill, B. (2024). Drivers and facilitators of weight stigma among preconception, pregnant and postpartum women: A systematic review. Obesity Reviews. Advance online publication 12 Feb 2024; e13710.

Hill, B., Bergmeier, H., Incollingo Rodriguez, A. C., Barlow, F. K., Chung, A., Ramachandran, D., Savaglio, M., Skouteris, H. (2021). Weight stigma and obesity-related policies: A systematic review of the state of the literature. Obesity Reviews, 22, 11, e13333. Doi: 10.1111/obr.13333

Hill, B., Hailu, H., Jenkinson, B., Rakic, S., Nagpal, T., Boyle, J., Sheehan, P., Skouteris, H. (2023, November 1). Co-designing resources with midwives and consumers to address weight stigma in antenatal care. Faculty of Medicine, Nursing and Health Sciences Early Career Researcher Symposium 2023. Melbourne, Australia.

Jayawickrama RS, Hill B, O'Connor M, Flint SW, Hemmingsson E, Lawrence BJ. Assessing explicit weight bias among Australian health care students: Suitability of the Beliefs About Obese Persons Scale (BAOP) and the Antifat Attitudes Questionnaire (AFA). Stigma and Health. Advance online publication 2023 Oct 1. doi: 10.1037/sah0000484.

Kandel P, Lim S, Pirotta S, Skouteris H, Moran LJ, Hill B. Enablers and barriers to women's lifestyle behavior change during the preconception period: A systematic review. Obesity Reviews. 2021 Jul;22(7):e13235. doi: 10.1111/obr.13235.