Dear Folks:
  In the latest issue of MIDIRS Midwifery Digest (Sept 1998) is a fascinating
article, with lovely diagrams,  of a case study.  The mother had previously
nursed two babies, and was a breastfeeding counselor.  Attachment looked
wonderful, but the mother became sore, with damaged nipples. The baby became
dehydrated, despite frequent feedings.  Digital exam revealed a very high
anterior arch to the hard palate. The mother improved her posture during feeds
(changing her foot support, which affected her hips and this increased her
comfort) which helped the baby have more access to the breast from underneath.
The mother kept the breasts soft with hand expression. What is very
interesting is the recommendation made to "compress the breast, opposite the
baby's nose to exaggerate the tilt of the nipple." The best way to understand
this is to see the drawings. The article was originally published in New
Generation ( a magazine that I can not find and would love to) March 1998.
   Many thanks to S. Saunders for this case study!! Warmly, Nikki