Jane,
I had a couplet with the same problems, she too was a smoker. Very educated
well read mom, tried everything in all the reference material we could find,
with only minimal improvement.  This was her first baby, so she had no
previous experience (good or bad) to compare too.

This too went on from birth to 4 months.  This mom had the challenge of
finishing about 2 month of school and baby was given expressed breastmilk
while she was away.
Both mom and baby were somewhat "high strung" personalities, so here's what
finally helped.
Mom routinely enjoyed some "co-bathing"  I would have her pump till her flow
slowed down a little bit before putting him to breast.  She has stored all
expressed milk for later use. She was to feed and try to anticipate his
needs. (he was very impatient if hungry) Mom would have liked to schedule his
feeds, so we had to break her thinking on this one. She nursed lying down in
a quiet room with lights dimmed.  (He was so miserable at breast with the
overactive let-down, he literally had an aversion to her breast when she
attempted to feed.)  This was so incredibly sad and made the mother feel
terrible.  I worked with her from birth through about 4 months regularly.  On
July 4, this mom called me and said baby is now 6 months and totally
breastfed. Mom and baby are so happy.  You could hear the pride in her voice
when she called.

One of the most difficult things we did was just talk about what she wanted
out of the experience. Was breastfeeding her infant a problem for her, were
there other things going on, was she able to make breastfeeding first
priority till things improved.  How did she feel about exclusively
breastfeeding till problems were resolved, etc.  She was definitely committed.

Good Luck,
Laura Burnett
Fort Worth, Texas

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