I was a lay midwife for 12 years before I took the plunge and went to
nursing school, worked in the hospital, and recently became a CNM. I used
to joke with my friends that it took working in the hospital for me to see
very many breastfeeding problems.  The reality was that yes, occasionally
some of my home birth clients had breastfeeding problems but not nearly as
high a percentage. Part of this may be due to the fact that moms didn't
have medications on board (I would say the vast majority of women giving
birth in the hospital have one med or another by the time they are done).
Part of this may have been due to the relative non-interference with mom
and babe after birth. If baby was breathing and doing okay (and it nearly
always was), it went on mom's belly where it stayed until mom was ready to
let it go. Mom and baby were not separated. Generally babies were nursing
within an hour after birth. My midwife partner and I  stuck
around until baby had nursed the first time, the mom had urinated and had
a shower, things were tidied up and the family was comfortable, and it was
clear that mom and baby were stable.  No one got excited if the baby went
several hours without nursing the first day if the baby had nursed well
after birth (we didn't have any little charts to fill out for the nursery
or to feel paranoid about). We advised mom that if the baby was busy
sleeping that she should follow suit, and warned to expect that when the
baby woke up it would nurse bunches.  We always followed up with phone
calls and home visits in the next several days until it was clear that
everyone was settled in and we weren't needed.

I must say that when I saw breastfeeding problems in home birth moms, they
tended to be more serious. I did see a few babies with serious weight gain
problems. One had a heart defect that wasn't diagnosed until the baby was
several weeks old (she looked great at birth, sounded great and was in no
apparent distress -- she was seen by a ped within 24 hours and several
more times in the weeks that followed because she seemed to tire easily
when nursing and wasn't gaining). Actually, it was my frustration with the
unusual but frustrating situations where the moms had trouble getting a
baby to latch on or a baby that didn't gain well that motivated me to
learn how to provide more expert help with breastfeeding.

Ione Sims. CNM, IBCLC