Barbara Wilson-Clay has described my thoughts on attachment exactly.
In Australia, the UK, and Canada (Jack Newman at least) the standard
teaching is to extend the neck *a little* and keep the nose out of
the breast. In practice however, I never look at or think about the
neck angle.

The single most useful technique I have ever learnt about
breastfeeding is to move the baby's body (which faces and is wrapped
around the mother) in the direction of his bottom so the mouth is
just short of the nipple. The baby reaches forward and just gets the
top gum over the nipple, with the tongue against breast tissue.
(Barbara describes this in more detail).

I have been doing this for about 8 years with dramatic results in
terms of achieving better latch, relief of discomfort, etc. Over the
years I have refined my technique and my instructions to mothers,
but it is essentially the same. While I know it works extremely well,
I don't know what it actually does inside the mouth, in fact it
doesn't make sense.  How can a baby latch onto breast tissue with the
nipple "only just in the mouth" and still have the nipple reach to
the junction of the hard and soft palate?  Surely centering the
nipple would make this easier to achieve? I don't know the answers
(yet) but I am sticking with what works well.

I vote for ignoring neck flexion/extension and just get babies
latched on to breast tissue, with the tongue and lower jaw well over
the sinuses so they can milk the breast effectively, the nose clear
enough to breathe, and the eyes able to look at mother.  I bet our
ancestors were not into measuring neck angles.

Ros Escott BAppSc IBCLC
Tasmania, Australia