> ...... I'm confused about the issue of the nose away from the
> breast.  I've been under the impression that proper positioning
> includes the baby's nose right up against the breast, indenting it.
> Is this now no longer recommended?  TIA, Alicia.

In Australia, at least, we have been wrapping babies around mothers,
chin to breast and nose clear, for many years now.  I had an article
on "Positioning, Attachment and Milk Transfer published in
Breastfeeding Review in May 1989 and drew diagrams to reflect that
position.

I am aware that most US literature and illustrations focus on neck
flexion and nose to breast, but I have never been convinced (or
found) that this *generally* works better. I think "nose to breast"
is popular because it reflects the concept of getting on to a good
mouthful of breast tissue. Nose to breast is more likely if the
nipple is centred. Once you change your focus to breast against
tongue, so the baby is off-centre on the areola, the nose tends to
come clear.  It is just the result of something else, not a technique
on its own.

Over the years I have heard many explanations for this different
focus in positioning and attachment.  Some say that there are more
receding chins in the UK and Australia, necessitating compensation
through positioning. Others say it is because Australians tend
towards oversupply so the positioning needs to be different.  I
doubt all this.  We are too much of a multicultural society to
generalise like this.

The bottom line is that we (LCs) should avoid dogmas and have a
broad repertoire of techniques to help each mother-baby pair find
the best solutions for them. While there are particular techniques I
commonly find effective, they don't work all the time. There is no
substitute for experience, and for forums like Lactnet where we can
share ideas around the world.

Ros Escott BAppSc IBCLC
Tasmania, Australia