I want to respond to Debbie Rabin's query on head position to bring chin and
tongue closer to bottom of breast (ie tissue below the nipple.)   I share a
very mutual respect for her posts which I always learn a lot from.  What we
are talking about may simply be losing in the translation, and Debbie, I'd
love to show you this trick in person some day.  I realize that  bringing
the chin in closer would seem to drop the tongue back, however baby has to
reach the tongue in any position -- this way they just don't have to reach
as far.  With the neck in a hyper-flexed position, nose gets jammed into
breast tissue, chin backs away so you can see air space between chin and
breast.  This puts jaw closure out on nipple tip.  Also, when neck is
flexed, the  nose goes forward and chin goes into neck, collapsing airways.
A slight extension of the head clears airways, relaxes the jaw, freeing it
to open wider, and I think this helps baby reach the tongue.  At least this
is how it seems to work in practice. And I am not talking about extension
which has you looking at the ceiling.  The way I teach it, the baby who is
doing this in side-lying would have head tipped so that his eyes and mothers
would be in a straight gazing line.  So if you are trying to find this head
position sitting in your chair, look at the junction of the ceiling and the
wall, not so tipped back you are staring at the ceiling.

  I have had great success with this technique -- it's saved the nipples of
many women with tongue-tied babies who wouldn't go for frenotomies or who
couldn't find a doctor or insurance coverage to obtain one. I had a mom just
yest. Para 2 with an 8 week old.  She has long nipples, and baby has tongue
which snaps back with each jaw compression due to tight lingual frenulum.
Baby could extend but not maintain extension, nor could he lift well.  She
has had chronic breast pain due to nipple trauma, and spent yada yada yada
weeks talking on the ph about thrush.  Moving baby's entire torso in the
direction of his bottom (whether side lying or in cradle hold or football)
backed off the mouth from the nipple, causing him to have to "root up" to
find the nipple.  This creates enough head extension to drive the lower jaw
in closer to the breast so the tongue didn't have to reach so far, and put
the "snap" on breast rather than sensitive nipple tissue.  It produced a
much more comfortable feed for her.  She is going to see my ENT friend, whom
we are so lucky to have in Austin, to discuss a frenotomy.

For excellent illustrations of the head position I am referring to, see
Chloe Fisher and Mary Renfrews BESTFEEDING, or Felicity Savage-King's
wonderful little blue book.

hope this helps you better visualize this technique.
Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html