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I personally don't think it is nipple confusion so much as nipple preference. In the beginning, babies have to work to get the milk out of the breast harder than they would for a bottle so some times they refuse the breast if they've been given a bottle since the bottle is easier. After the milk comes in breasts get engorged and sometimes baby will have trouble latching until some of the milk is expressed so that can be troublesome too. Some people have inverted or flat nipples so that can be hard for a baby to learn to latch onto as well. A bottle nipple doesn't change, is relatively easy to latch onto, etc so babies can start to prefer a bottle nipple since it is easier to get what they want. So many bottle manufacturers are trying to make an option that is as similar shaped, textured, flow, etc to the breast to help prevent or circumvent that possible preference. That is why many times people are told to not give a bottle or pacifier until breastfeeding is well established, usually by 6 weeks of age or so. Some babies don't develop this preference and have no problem transitioning from breast to bottle and back.

So, as I understand it, nipple confusion occurs when a baby is exposed to both boob and bottle, expects them to work the same way, and gets confused/frustrated when they don't. Usually what I hear about is how the bottle is easier, and the baby doesn't have to latch correctly or suck as hard to get milk out, and the baby expects the boob to work the same way which can lead to nursing problems or not wanting to eat unless it's from a bottle.
Most women don't NEED to supplement with formula till your milk comes in (I mean, formula wasn't an option till the 20th century, and kids did fine)- you'll start producing colostrum right away, and your baby (in the vast majority of cases, though there are exceptions) will do fine on just colostrum till the milk comes in. (Also, remember that newborns only eat tiny amounts at a time) For women who don't want to supplement with formula, but may be having nursing difficulties, there's also the option of using a pump (your hospital should have one for you to use there) and then feeding the baby what you pump. We used a finger syringe to give LO colostrum that I pumped when we were having trouble getting him to latch properly. We also gave LO a bottle of formula in the hospital because both he and I got so frustrated trying to nurse that I think we both psyched ourselves out. Would he have been ok without the supplementation? Yeah, I bet he would have. Did it seem like a huge deal at the time? You betcha. (I cried). Did it create any lasting problems with nursing? Nope. In retrospect, is it something I care about? No way.
Our lactation consultant encouraged us to give LO one bottle a day (preferably pumped breastmilk) from the very beginning to a.) get him used to a bottle and b.) keep me sane. There were times when we'd do more like 2 or 3 bottles a day and I think he did start to prefer the bottle and was fussier about nursing, but then we'd just cut out bottles for a few days and he'd deal. As for whether babies are hungry right away... if you want to BF, it's great to try to do so right away (they say to give it a try that first hour after birth). But if your baby doesn't really want to eat much at all that first day, it's not really a big deal. Our lactation consultant, pediatrician, nurses, etc. were all kind of like "yeah, we don't really worry about how much they eat on Day 1, as long as [if you want to BF] you're trying to get them on and latched and eating." They only got worried if a baby wasn't starting to eat regularly on Day 2. (At least in my experience)

I agree with the others, it's kinda a nipple preference. We introduced bottles of pumped milk at 2 weeks and didn't have any trouble with her taking a bottle or going back to the boob. She has an obvious preference for the boob but she's never cried about it or refused a bottle for any long period, and now she prefers spoons so we don't even bother with the bottle most of the time.

When they're first born I'd avoid giving a bottle because the nipple stimulation from nursing helps your milk come in and if baby knows they get fast flow from bottle while they're just getting drops of colostrum it could set up a bad cycle of you not getting enough stimulation, which delays milk coming in or lower production. Those first couple weeks are important in establishing a good supply. For us I lucked out because baby loved to nurse, so even though she wasn't getting much out the first couple days she still nursed a lot and that helped things along.

Like others said, we had an issue with nipple preference. My milk didn't come in right away so we had to suppliment with formula. My baby just got too lazy for the nipple, because it's so much easier to get the milk from the bottle.

We ended up doing a whole big routine to get her back to the breast. We used breastflow bottles so it was harder to get out, and my husband would always feed her (after I nursed). He would wait until she opened her mouth before putting the bottle in, wait for her to take 5 sucks, and then pull the bottle out. Then he'd have to wait for her to open her mouth again. It was a long process, but it worked!

@skibobrown: Good point. A friend of mine has had two daughters who refused bottles completely.

I should also have made clear in my post that we fed Baby Y the formula with a dropper to try to avoid this issue.

WOw, this is a great thread. Thanks!