Heather, When you receive the study and digest it, please let us know your conclusions. <There is quite an old study (1984) which I haven't read but seen referenced which says a short bedside teaching intervention in hospital improves bf incidence at one month (Jonson CA, Garza C, Nichols B, J Nutr Educ 1984; 16:19-22).> "Positioning" still means many different things to many different people, I fear. I know that in 1984 I thought I knew a whole lot about putting babies to breast. I certainly didn't know then what I know now! At the time, it was thought that most of the compression of the sinuses was accomplished with the jaws, and many diagrams back then show the tongue not covering the lower jaw. I even have such a diagram that depicts it this way in an article by Edward Newton (the OB-GYN who is the son of pioneer lactation researchers Niles and Michael Newton). In 1984, I myself was very "hands-on", concentrating mainly on teaching moms to soften the areola so the baby could "grasp" it better. In the process, more often than I realized at the time, I was triggering MER prior to putting the baby on the breast. That in itself, was a help. Some of the things I did then work just as well now as they did then. Some of them, I am even deliberately emphasizing more now than I did then. But the paradigm of the off-center latch with the tongue coming out over the gums, and covering more of the areola than the upper lip/jaw covers was a whole new set of insights for me. When I could finally humble myself to put away my own biases and preconceptions long enough to open my mind to that key difference is when it finally "hit" me what everybody must have been referring to when they said "positioning" was so important. (As you quote that splendid article in the BMJ in a later post, Heather: "As such, the experience of shame helps to explain why improvement which ought to be a 'no brainer' is generally such a slow and difficult process.") So many comments on "positioning" that I have seen in professional articles speak mainly of the position of the baby's BODY in relation to the position of the mother's BODY (not shouting, just trying to emphasize). Though positioning of the mouth is greatly effected by the relative positions of the mother's and the baby's bodies, in the long run, it is specifically the "positioning" of the mouth on the breast that is the important component. Bodies can be "positioned" exquisitely with mouths still positioned quite ineffectively on breasts. I often think of this when moms say to me "They (hospital staff, MD's office staff, etc.) checked my "positioning" and said it was ok.", when it's obvious to me from observing the mother and baby that no one really had a clue. That is still not generally well-understood today. It may not have been well-understood by those making that 1984 study. If not, then their use of the word "positioning" would have had a totally different meaning from today's use of the word as it refers primarily to the relationship of the lower jaw/tongue to the areola/breast, the off-center latch. Or maybe they did know, and it has taken nearly 20 years for the word to spread! Jean ************ K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html