Marie and Stacey, I see women with edema of the areola, very soft nipple tissue, with difficulty getting the nipple to protrude. Baby may be eager at the breast, but cannot latch. I also see it come in waves - 4 out of 5 women on the floor with the same problem. I often wonder if I can track it back to the same anesthesiologist - or the same nurse. I was just talking to an OB who expounded on the virtues of vacuum extraction over forceps. I told her that I frequently see babies after vacuum extraction who are irritable, can't latch and don't like to be moved even as little as being held in the arms of someone who is breathing. When I described that these babies seem to do better in a flat side-lying position where they don't need to support their heads or be moved, the OB was concerned. She thinks maybe the practitioner is getting a little rough - and she learned how to do vacuum extraction in Canada. So perhaps some of the birth effects we are seeing have to do with the practitioner, and not necessarily with the intervention itself. First course of action would be to show practitioners that there is a cause and effect - we don't want to take away their toys, just teach them how to use them properly. Jeanne Fisher Austin, TX