Pillow is behind the sheet set.  They are not as fluffy as anticipated. but not hard and overstuffed like the old foam stuffed ones I had for company.  These pillows are medium as stated, thin but not flat thickness. (something my guests always ask for).  For my guest rooms I like purchasing in 4's.  With two pillows provided, each guest should find a happy outcome.  One of my daughters is allergic to actual down The other goes for the down pillow. These are not equal to soft down but better than just foam or just lumpy fiber. They are perfect for my needs. (in the ivory shams) directly behind the sheet set.