Booby Trap Series: Coneheads and caputs: How extra force in birth can affect breastfeeding.

This is the 13th in a series of posts on Booby Traps,™ made possible by the generous support of Motherlove Herbal Company.

Ever touch your baby’s fontanel and marvel at how flexible a baby’s head is?

Babies’ heads are made to be pliant and move during birth.  It’s what’s required to twist and turn through our pelvises.

But when extra force is required to help a baby make that journey, the result can be breastfeeding difficulty.

In The Impact of Birthing Practices on Breastfeeding, Linda Smith reports on a pattern of infant related behavior which is seen in otherwise normal, healthy babies.  This pattern includes:

  • Babies who can latch but not suck
  • Babies who can only feed in one position or posture
  • Babies who cannot smoothly coordinate sucking, swallowing and breathing
  • Babies who appear to suck, but cannot obtain milk from a full breast

Linda reports that, “Evidence is accumulating that poor sucking has strong associations with epidural anesthesia/analgesia, forceps delivery, vacuum extraction, induction of labor, cesarean delivery, and/or long, difficult labor, especially with occiput posterior positioning.  The baby may have visible cranial or postural asymmetry secondary to these interventions or may appear to be normal except for feeding.”  [emphasis added]

How does extra force, in either a vaginal or cesarean birth, affect breastfeeding?

A complex interplay of bones (22 of them) nerves (6) and muscles (60) are required to allow a baby to breastfeed.

When forceps or vacuum are used to assist delivery in a vaginal birth, or when force is applied to the baby’s cranial base in a cesarean birth, pressure is placed on these bones, nerves, and muscles.

Pressure can cause obstructions in movement and/or coordination.  Any obstruction, whether from the compression of a nerve, shaping of a bony structure, pain from bruising, or restriction of muscle movement, has the potential to limit the baby’s ability to breastfeed.

The result may be visible, like caputs (swelling of the soft tissue on the top of the head), forceps bruises, torticollis (muscles pulling the head to one side), or asymmetry of the jaw, face or head, or may be invisible except in feeding behavior.

For a baby with torticollis, it may feel fine to feed in a position which is consistent with his ‘head tilt,’ but very uncomfortable in another.  For a baby with a misaligned jaw it may be very difficult to latch on to the breast.  For a baby whose facial nerve is compromised, the baby may not be able to even feel the breast in her mouth.

But if extra force is sometimes necessary, what’s the Booby Trap™ here?  It’s the fact that few people acknowledge that force can affect breastfeeding.  And fewer still know how to help moms when breastfeeding is impacted.

If you suspect that the extra force required to birth your baby might be impacting his ability to breastfeed, we encourage you to seek help from a board-certified lactation consultant.  She may be able to refer you to an allied health professional – a chiropractor or cranio sacral therapist – who can provide further help.

Was extra force required to deliver your baby?  Did he or she have a caput, a conehead, bruises or other injuries, or torticollis?  Did these things affect breastfeeding?


11 thoughts on “Booby Trap Series: Coneheads and caputs: How extra force in birth can affect breastfeeding.

  1. this is fascinating. My son was right occiput posterior as well as oblique, resulting in cesarean delivery. He refused to latch onto the breast for the first 2 1/2 weeks of his life for no reason at all that we could see. He was examined by doctors and LCs and declared healthy. Finally with a lot of patience and after seeing 4 different LCs he latched on for the first feeding when he was bout 2 1/2 weeks old and we were finally bottle and finger-feeder free by the time he was a month old. it was crazy and they never did give me a good reason as to why!


  2. Wow! I had no idea. After 4 hours of pushing and using the vacuum 7 times, my baby was born. He did have bruising and even some scabbing afterwards, but thank God he was okay otherwise and latched on right away and started gaining weight right away. I have to wonder how many women do not know about this tho and just assume they are doing something wrong?


  3. I had an unmedicated natural birth …however…it was my first birth…and I pushed for 2.5 hours…and he came out very coneheaded…and then had a terrible latch for over a month…now I wonder if they are connected. Very interesting! Thank you for the article.


  4. my baby had a fractured left clavicle but she had a good suck despite that and her tongue and lip tie. and also despite my flat nipples! I’m still working on latching her deep enough but she is growing well 🙂


  5. I hate the posts that say my kid didn’t have a problem, so this can’t be true, so I’m trying to avoid that here. (Ex. the ones that often say my kid was fed formula and never had an ear infection, never had stomach issues, and was valedictorian of her class, so the studies that claim these things are affected by breastfeeding are nonsense! Those really get me going.) So I’m trying not to do that here. My situation was the following: induction when labor did not progress fast enough, epidural, long & difficult labor, followed by the need for a forcep assist. My daughter had very slight bruising that went away within a day. She nursed like a champ from day one. Again, not to say that each of these don’t affect breastfeeding, just lucky that it didn’t in my case. I think a lot of that is a testament to the wonderful lactaction consultants my hospital employs!


  6. My first son was born posterior after 12 hours of natural labor and 3 hours of pushing. I was unable to push him under my pubic bone because he was such a large baby (10 pounds 3 ounces, no gestational diabetes). I had to have a vacuum and forecep assisted delivery. Grant had a very pronounced conehead and bump/bruises on his cheekbones from the foreceps. I also believed that he had torticollis because he favored turning his head one way (still does, but it has gotten better) but the doctor does not believe it to be torticollis. Thankfully we’ve never had a problem nursing, but did have a problem with a flat spot due to Grant’s stiff neck.


  7. Yes! My baby, breech and born by csection after spontaneous labor, had horrible torticullis. Only a CST and wonderful Chiro saved us from months of physical therapy and loss of our breastfeeding relationship!


  8. These issues are the ones I deal with primarily now in my Private Practice. As a Lactation Consultant I found I needed to educate myself and develop the skills needed to not only support parents as they struggle with the breastfeeding issues that you mentioned in your article but also I needed to develop the skills needed to simply recognize what the problem was. Far too many of us IBCLC’s are lacking in education on this issue and that is a problem because these birth injuries (what I feel they are) are now far to common – in fact, they seem to be the new Norm. I believe it is important for every Lactation Consultant (or anyone – including Doctors – who works with babies in any capacity) to learn how to recognize the signs and symptoms of structural dysfunction in the baby.

    As parents, we need to ask the IBCLC we seek help from what their experience is within their practice. Many IBCLC’s end up specializing – some can see a structural (muscular) issue or tongue-tie without ever laying a hand on the child, but have never worked with a baby with Down Syndrome or a cleft palate. Some are highly skilled with birth defects (cleft palate/lip, down syndrome) but would miss a tongue tie or torticollis. And others are highly skilled with nutrition, gut damage and allergies… It is important for parents to know what to ask, and if they find someone who does not have the experience needed, to know how to ask for a referral.

    This article is great because it is pointing out an ever increasing problem with our medical model of birth, and is encouraging parents to really look at and pay attention to the issue – and most importantly: GET Help!

    Thank you!


  9. I was so fortunate. I had a home birth and my son got stuck. He was in transverse arrest and I ended up pushing for 6.5 hrs. When he was finally born, he crawled up my stomach and immediately latched on and began to nurse. We never had any difficulty breastfeeding. I had so much support though and feel very blessed.


  10. This was definitely our situation when our third child was born in February. My labour was quick and at the end my daughters head was out but not the rest of her. This caused some concern since the rest of her body didn’t just fall out, our midwives had to really pull on her head and push on my stomach at the same time. In the process I lost a lot of blood. I didn’t realize how much these 2 issues (trauma for baby and mothers blood loss) would of impacted our breastfeeding. Due to my blood loss my milk was delayed by a day or two in coming in, causing our baby to drop quite a bit of weight…. First stress. And we learned a few weeks later when she wasn’t gaining well that her poor feeding, and need to only feed well when sleepy and in a lying down position was partially from the ” pain” she seemed to have feeding that came partially from her trauma at birth. We did cranial sacral therapy which I think helped us. And allowed her to feed lying down as often as possible.

    We’re doing great now, at almost 6 mths old and exclusively breastfeeding, we made it through these challenging times. I can’t thank my husband enough for the support he gave me in this process!


  11. I found this post really fascinating, thanks!

    My first baby was lying at a slight angle (an oblique lie), but her head was mostly in the right position, so my midwife recommended we go for a natural labor and delivery. After 2.5 hours of pushing, however, it was clear that my baby’s temple – rather than her crown – was trying to get through, and no amount of trying to reposition her was going to get her out vaginally. After the c-section, she had a cone head, but on the side or her head. Poor kid – she was stressed out and screaming from the moment she was born, and I just couldn’t get her to calm down enough to nurse. Eventually, a nurse checked her blood sugar, found it to be very low, and recommended we give her sugar-water. Now, I know that’s controversial, but it totally worked. It took the edge off her hunger, and the next time I tried to latch her, she went right on and we never had any nursing problems after that.

    Now, when baby #2 wanted to come out at that same angle (must be something about my physiology), I skipped the labor and went straight for the c-section. Not having spent hours banging her poor little head against my pelvic bone, this one was not frantic and screaming, and she had no nursing problems at all.


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