A mother I worked with several years ago said, "I never expected it to be so hard! The baby cried whenever I tried to nurse him right from the first. When I left the hospital, one of the nurses looked at me and said quietly, ‘Good luck with breastfeeding." this was the only hint I had that there might be problems ahead."
She spoke of feeling disappointed, disillusioned, and angry that she had not been better prepared for the possibility of problems. Many people expect breastfeeding to happen without challenges and are unprepared if they do. A good rule for the early days is to have a plan in place if things don’t go smoothly. If babies cry at the breast, or refuse to suckle, or the urine/stool output is not adequate, or they are "sleepy" at breast, or cause mothers to have nipple trauma, the mother needs specialized help. A poor start in breastfeeding can result in a poorly established milk supply and breast refusal for the baby leading to premature weaning even if the original malfunction resolves in a few days.
Predictors of a Difficult Beginnings: We can’t predict with certainty which babies will have difficulties with feeding, but some situations suggest we proceed with caution. For example:

• Difficult births
• Babies with restrictions of movement in utero (causing the baby to have range-of-motion problems or injury)
• Premature baby
• Structural issues for the baby, (e.g.; cleft pallet)
• Medical issues for mother and baby (e.g.; respiratory distress for baby, thyroid problems for the mother

For this discussion we’ll focus only on birth trauma.
Baby’s Birth Experience
The surges of labor, like loving hands, massage the baby and prepare him for his new life. When the birth process goes well the twist and turns in the birth canal and the contractions prepare him for a change from a fluid environment to breathing air. This is a journey a baby is designed to take and in most cases it goes well.
Sometimes a baby’s body undergoes some stress and strain. His natural resilience and the body’s own healing mechanism aids in resolving these issues however, there is often a period of time where the adjustments haven’t yet been made. This may take hours, weeks, or even months. It’s during this sensitive time that a baby is first learning to breastfeed. Think of tying your shoelace with a sore thumb or chewing when your mouth is numb. Unlike adults who return to doing things in their former way, newborns haven’t prior experience to fall back on. They were sipping amniotic fluid and being fed by their unbiblical cord before. Birth Position: Think about a baby in the face-down position in the birth canal, when the back of his head/neck juncture passes under his mother’s pubic bone, the baby’s head may bend backwards on his neck. Sometimes this forces the baby’s head/neck bones to get stuck. This jamming, or compression, is often maintained after birth because by ongoing contraction of the soft tissues (muscles etc.) as the soft tissues remains in a contracted state to offer protective splinting against further injury. He may cry and struggle when his head is moved and he may focus on the pain and not be willing to suckle or suckle ineffectively. Think of the compensation’s you use when you have a stiff neck.
First Stage Problems: The time from the beginning of labor to full dilation—can also present problems. Picture the baby on his waterslide where the opening of the slide is blocked. He would be stopped and pushed from behind by the movements of the contractions. If strong contractions begin without enough cervical dilation, which can happen in induced birth for example, or when the baby’s head is not in a favorable position, or when mothers hips/pelvis is out of alignment, the baby is forced downward onto the unyielding cervix and pelvic bone. This head/neck trauma can effect his early experiences of nursing. A good rule of thumb is that if the birth causes lingering soreness for the mother it does for the baby too.
Second Stage Problems: The period from full dilatation of the cervix to birth-- Problems can occur if the labor is too fast and the baby doesn’t have enough time in second stage. If it’s too slow, such as when a mother is told to "hold back, don’t push because the doctor is not here." his head and body get squashed as he gets stuck in one place.
Birth Aids: Forceps and suction can cause distortion of the head, stretching or compressing the cranium and it’s contents. Drugs used in labor: Drugs also have effects on the mother and baby. Mother’s sensations are numbed so she can’t help the baby on his journey, For baby, the difficulties can range from strain or injury from a protracted birth process, not being alert or excessively sleepy (not helpful when he should be interested in learning how to suckle) to causing his temperature to rise, which often puts him on the road of medical workups and takes him away from his mother. Cesarean Birth: While cesareans may be necessary they intervene in the normal course of labor. Like a deep-sea-diver coming out of the watery depths to quickly, the baby is suddenly pulled from his watery home in an instant. He can experience difficulties as his body is forced to shift gears with little or no transition time. The baby missed either misses out on the natural progression of passing through the birth canal or if the normal delivery has been attempted, but not successful, the baby may have already experienced the problems associated with a labor not progressing well.
Resolving the Trauma: Watching the baby carefully for cues can help a mother choose a comfortable nursing position for her baby, even if it is unconventional. Sometimes being careful of the baby’s position as he nurses is the only intervention needed. If the difficulties don’t resolve in a few hours referrals can be made to address the underlying difficulty. A breastfeeding specialist and other specialist such as a and craniosacral therapists (CST), occupational therapists (OT), physical therapists (PT), osteopaths (DO), chiropractic or massage therapists (depending on what areas were affected by the trauma) can help both mother baby resolve birth trauma freeing them from restrictions that hamper breastfeeding. Preventing The Trauma: Some difficulties can’t be avoided, however there are preventative measures that can be taken. For example, a woman with back pain during pregnancy would benefit by seeing therapists as mentioned above to be sure her hips are in alignment and her pelvis not tilted so the baby’s "waterslide" will offer a clear passage.
Taking birth preparation classes such as Bradley™ or Lamaze, or Hypnobirth™ helps a mother learn to use her body’s surges or contractions to assist the baby in this passage. Active particapation in labor helps avoid epidurals and other medications that can slow labors progress and affect the baby’s ability to suckle affectivity. Arranging to have a doula (birth assisitant) and/or midwife who remains with the mother throughout labor also help labor to progress.
When breastfeeding includes difficulties a mother was not prepared for, and she lacks the resources for resolving them, she may carry grief and blame for a lifetime. Recognizing the situations that challenge the baby and having resources for overcoming them can benefit the family long past the weaning years.

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