Laurie, positioning is very important.  And let me agree that women all
over the world do *not* put the baby to the breast the way I, or others,
suggest they do in the clinics we run and yet most do fine.  Then what's
the story?

First of all, most women have lots of milk.  And if you have lots of
milk, then any position may do, though there are limits to adaptability.
Let me also assure you that women in Africa and India and South America,
where positioning is very different from what we teach, *do* get sore
nipples and *do* have babies who do not gain well.

The better the latch, the better the baby gets milk and the less likely
the mother is to get sore.  If the mother has a low, but adequate
supply, the baby will do okay with a good latch, but may gain too slowly
with a poor one.  If the mother has a good milk supply, but the baby
latches on poorly, the mother may get sore, the feedings may be long and
frequent and so on.

In many societies, having a baby at the breast much of the day is
expected.  In Western society, if the baby is at the breast more often
than two hourly, everyone is on the mother's case.  And in Western
society it is considered bad form to spend a lot of time with your
baby--he mustn't control my life sort of thing.  And when mothers can
afford the alternative, they often go over to it for just these reasons.
In poorer countries many mothers have no choice because of the cost, but
just watch what happens when and if they become more affluent.  They
will go over to the artificial stuff in a flash, because breastfeeding
has the undeserved reputation of hurting and taking a lot of time,
*because* babies are latching on poorly.

Jack Newman, MD, FRCPC