"It hurt." "My baby was too sleepy to nurse." "I didn't have enough milk." All are comments new moms make every day when talking about first nursing their babies. And all are challenges that can often be avoided.

A growing body of research reveals profound connections between a woman's birth experience and her ability to get breastfeeding off to a good start. Well-known lactation consultant Linda Smith asserts that common obstetrical practices, including medical, technological, and surgical interventions, can create all kinds of problems, involving a baby's ability to breath, suck and swallow properly; the mother's comfort level, and the ability of a mother and baby to remain together immediately after the birth.

Unfortunately, childbirth and breastfeeding are typically treated as separate and unrelated events. But if you think of putting your baby to your breast as the fourth stage of labor (following dilation, pushing out the baby, and birthing the placenta) it can help you visualize this connection.

The bottom line is, the less intervention you have at birth, the less likely you are to have problems breastfeeding. So why make the beginning of your parenting journey extra challenging? After all, you wouldn't set out on a vacation driving with a flat tire? And if nursing goes well in the first few days, you'll be more likely to stick with it. Given that Americans spend an extra 3.6 billion dollars a year to care for babies fed formula, it makes sense to do a little homework ahead of time.

Here are eight things you can do to help your baby - and you - get off to the best start possible.

1. Take a childbirth education class and consider looking outside of the hospital to find one. Chose an instructor certified by a national organization (such as Lamaze, Bradley, or International Childbirth Education Association), with the freedom to present accurate and complete information. You want to be empowered to be an active participants throughout your labor, not simply prepared for what to expect in the hospital setting. The more empowered you are during birth, the more empowered you'll be to nurse.

2. Find out what your practitioner's rates are for labor inductions, epidurals, c-sections, and v-bacs (vaginal birth after cesarean) and compare the statistics between hospitals. Then chose the provider and hospital with the lowest rates. Rates for all these procedures have dramatically increased in recent years without a corresponding increase or improvement in birth weight and birth outcomes.

Does this affect breastfeeding? You bet. Epidurals, for example, can make labor less productive, setting into place a cascade of interventions, often culminating in a c-section. As of 2004 the national c-section rate was an unprecedented 29.1% and rising steadily. Studies suggest that women who give birth via c-section are less likely to room-in with their babies and are less likely to be breastfeeding several weeks later. And the less likely you are to be in pain after the birth, the more difficult it will be to focus on the needs of your baby.

3. Ask your provider how they can help you labor comfortably without using drugs. Find out if you can labor (and even birth) in a tub, if you can eat and drink for energy, and what kind of support you will have. Ask to have sporadic instead of continuous fetal monitoring. You will be more able to labor comfortably if you have the freedom to move around and it's impossible to do so when you are strapped to a machine. Remember that in most cases, the more gently you are treated, the more gently your baby is treated.

4. Locate a childbirth doula (pronounced DOO-la). Doulas offer emotional and physical support to women and provide various combinations of support before, during and after the birth. Studies show that having a doula at your birth shortens labor, cuts in half the odds of having an unnecessary c-section, and helps women feel more satisfied about their birth. Contact DONA, Doulas of North American at www.dona.org. Two other organizations that train doulas are: CAPPA - Childbirth and Postpartum Professional Association (www.cappa.net) and ALACE - Association of Labor Assistants and Childbirth Educators (www.alace.org).

5. Find out what your hospital's post-partum policies are. Immediate skin-to-skin contact and being able to have your baby "room-in" with you increases breastfeeding's success. Drying the baby, assigning Apgar scores, and doing the initial assessment typically should be done while your baby is with you. You can also delay having your baby cleaned, weighed, measured and bathed until after he or she has had a chance to nurse.

6. Request, in writing, that your baby be given no supplemental bottles of formula or glucose. Supplemental feedings of formula in the hospital have almost doubled in the past ten years, a practice known to derail nursing.

7. Attend a La Leche League meeting before giving birth, especially if you've never been around nursing mothers.

8. Overall, know your rights as a patient. You have the right to participate in decision-making involving you and your baby and you have the right to know the benefits, risks and hazards of drugs and procedures. Remember: as the authors of "A Good Birth, A Safe Birth observe, "If you don't know your options, you don't have any."

References

American Academy of Pediatrics: Breastfeeding and the Use of Human Milk. Section on Breastfeeding. Pediatrics. 2005; 115; 496-506. Accessible at http://www.pediatrics.org/cgi/content/full/115/2/496

Coalition for Improving Maternity Seravices: "Having a Baby? Ten Questions to Ask."

Gaskin, Ina May. 2003. Ina May's Guide to Childbirth. New York, NY: Bantam Books., page 165.

Kroeger, Mary. With Linda J. Smith. 2004. Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Sudbury, MA: Jones and Bartlett Publishers.

Martin, Joyce A., MPH; Brady E. Hamilton, Ph.D.; Fay Menacker, Ph.D.; Paul D. Sutton, Ph.D.; and T.J. Mathews, M.S. Preliminary Births for 2004: Infant and Maternal Health. 2004. Division of Vital Statistics. CDC's National Center for Health Statistics.

Ryan, Alan S., Zhou Wenjun, Andrew Acosta. 2002. "Breastfeeding Continues to Increase Into the New Millennium." Pediatrics. Vol. 110, No. 6. pages 1103-1109.

Barbara L. Behrmann, Ph.D. is a writer, researcher, and author of The Breastfeeding Café: Mothers Share the Joys, Secrets & Challenges of Nursing, University of Michigan Press, 2005. She is a frequent speaker around the country and is available for talks, readings, and conducting birthing and breastfeeding writing circles. The mother of two formerly breastfed children, Barbara lives in upstate New York. For more information, visit: www.breastfeedingcafe.com

The information presented on this site is intended solely as a general educational aid, and is neither medical nor healthcare advice for any individual problem, nor a substitute for medical or other professional advice and services from a qualified healthcare provider familiar with your unique circumstances. Always seek the advice of your physician or other qualified healthcare professional regarding any medical condition and before starting any new treatment.