A guide from my wife, who wanted to add to my blog.
Here are some suggestions that I have found helpful:
1) 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.
2) 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.
3) 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.
4) 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.
5) 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.
6) 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!
7) 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.
8) Nursing discreetly in public can be challenging for all mothers, but especially for women with larger breasts. If the football hold works best for you, you can use your diaper bag to rest the baby on (instead of a pillow). The article "Nursing Discreetly" has more tips on how to nurse in public without drawing a crowd. I personally have strong feelings about nursing mothers not feeding their babies in bathrooms, and there are lots of other options if you feel the same way. You have to do whatever is comfortable for you personally, but it is possible to nurse when you are out and about if you learn some basic tips to make it easier.
9) Good breast hygiene is important, because women with large breasts are more likely to have problems with skin irritation or infections due to the folds of skin underneath their breasts. Many skin problems such as yeast and heat rash are aggravated by moisture, and the area under the breast is prone to these infections. Wash your breasts daily with water (not soap) and dry them thoroughly, paying special attention to the area underneath the breast. You may want to use your hair dryer on the cool setting to make sure the area is completely dry, especially during warm weather.
10) Many people make the assumption that mothers with large breasts will make more milk, have more oversupply problems, and leak more than the average woman. This is simply not true. Some women produce more milk and some leak more than others, but it isn't related to the size of the breasts. If you do experience a problem with an overabundance of milk, see the article on "Oversupply: Too Much Milk" for some solutions.
11) If you choose to use a breast pump, you should be aware that the breastshields and flanges (the funnel shaped pieces that fit over your nipple/areola) are designed for the "average" sized breast. Women with very large breasts or areolas may need a larger flange. Medela makes a PersonalFit flange kit that comes with two different size flanges for larger breasts, and this makes it possible for women with all sizes and shapes of nipples to pump comfortably and efficiently.
Nursing a baby can present special challenges for the mother who is amply endowed, but with preparation and practice, there is no reason why you can't have a very successful breastfeeding experience regardless of the size or shape of your breasts.