Rob, this case is positioning, positioning, positioning.

Baby most probably has 'enough' in mouth but it is the type of enough and
where that enough is placed that is vitally important so that baby does not
damage the nipple and can milk the breast adequately.  2 thirds breast and 1
third nipple is what you are aiming for with the tongue no where near the
nipple.  We are still nipple fixated - do you remember seeing in books and
hearing people say - "let the baby grasp the nipple"!!! Owwwch.  Baby from
this description has mouth centrally placed over breast with the bulls-eye
being the nipple in the middle. Baby needs to have tongue milking the breast
and not the nipple.  Have baby at height of where breast is *going to be
throughout the feed*.  If mother lifts her breast or takes it to baby then as
feed progresses mother's breast is bound to not be where it was first placed
to baby.  Bring baby to breastfeed not place the breast to the baby.  Is baby
coming to breast and staying at breast throughout the feed without having to
put its chin on its chest to get to the breast or having to turn its head
sideways (either way to reach the breast) both of these manoevers make it v
difficult for baby to milk the breast and swallow - ever tried swallowing
yourself doing this?  We wouldn't dreamof trying to drink a cup of tea or pint
of beer ourselves with chin on chest or head turned to either side.   If baby
has chin on its chest it is too far over to the left going to the left breast
or too far over to the right for the right breast (baby in orthodox madonna
type hold).  If mother is resting babe's head in the crook of her arm the baby
will have to put chin on chest to suck up a mouthful.  Place baby in middle of
forearm - mother's elbow naturally wants to lie at rest in line under her
shoulder socket.  Is baby lying at height of nipple?  Baby should be.
Platform of pillows or no platform depending upon where mother's nipples lie
in relation to her lap if she is sitting.  If she is small breasted baby will
need to be facing tummy to mummy .  If she is heavily breasted the nipples are
often a little out of sight from mother's eye view and they lie sort of under
her breast so baby will need to be a little more under the breast nearly lying
on its back but not quite.  Mother needs to have her back fully supported and
not sitting in a chair that compromises the position of the baby or cramps
them in any way.  However the baby is held to the breast, the baby as it comes
to the breast should have its nose/upper lip opposite the nipple before the
gaping reflex is made - yes the nose/upper lip and not the middle of babys
mouth opposite the nipple.  As the baby gapes, at the height of the gape the
mother brings the baby quickly onto the breast, if this manoever is too slow
then baby will not get the optimum mouthful.  If the nose is opposite the
nipple then the baby's tongue  will be placed on the 2thirds breast to do the
milking.  The baby you describe has got tongue placed on the nipple and so the
damage.  Finally, mother or helper not, not, not to hold baby's head in a vice
like grip - so threatening a gesture, etc, etc. but to support the shoulders
and cradle the head if necessary, let the nipple be the *only* rooting
stimulus to baby's mouth, not mother's fingers or helper's fingers touching
baby's face/cheeks/ears tickling it in any way, all this does is just confuse
the baby and he just does not know which way to turn.  Have mother strip off
excess clothing around the breast that just get in way of baby coming to
breast or use a clip of somekind - even a good old bulldog clip to hold
clothing out of the way.Again reassure mother that she won't be stripped off
for rest of breastfeeding history!  If swaddling helps keep babys hands out of
the way for these first couple of feeds getting positioning right then try
that but you want to do this only for shortterm, baby should be free at the
breast as soon as possible.
No amount of nipple resting, creams, etc., etc., will cure unless position at
the breast is sorted out.  Mother can have the most awfully damaged nipples
but if the tongue is not on them then she can feed painfree and the nipples
will heal - remember those healing lysosymes in baby's saliva and healing
property of breastmilk - have mother wash her hands before she breastfeeds
and/or wipes the cream off the top of the tube.......You will be surprised by
those who use creams bequeathed by another mother ..... how does one know that
the friend washed her hands?.....
Kind regards, Helen M. Woodman, National Childbirth Trust Breastfeeding
Counsellor, UK