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揑t hurt.? 揗y baby was too sleepy to nurse.?揑 didn抰 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抯 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抯 ability to breath, suck and swallow properly; the mother抯 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. Of course, your birth may not go as planned. But why make the beginning of your parenting journey extra challenging? After all, you wouldn抰 set out on a vacation driving with a flat tire? And if nursing goes well in the first few days, you抣l 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抣l be to nurse.
2. Find out what your practitioner抯 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 2005 the national c-section rate was at an unprecedented high with almost 1 in 3 women giving birth surgically. 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抯 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 http://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抯 post-partum policies are. Immediate skin-to-skin contact and being able to have your baby 搑oom-in?with you increases breastfeeding抯 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抳e never been around nursing mothers. Visit http://www.lalecheleague.org or call 847-519-7730.

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 揂 Good Birth, A Safe Birth observe, 揑f you don抰 know your options, you don抰 have any.?/p>

In the end, remember that birth itself is not the end of your journey as a mother. It is a beginning. If you find yourself with an unplanned C-section, a difficult recovery, or nursing challenges of one type or another, help is available. Express your concerns to your doctors, midwife, nurse, or doula. A good lactation consultant can offer especially invaluable help, (look for the credential of IBCLC ?International board certified lactation consultant). In fact, you may want to find one ahead of time. Make that the ninth thing you can do before the birth!