Janna,
   Wow, these cases are so hard because you have a willing mom, a willing
baby, just not a willing body.  My usual words of encouragement in these
instances and others where mom is doing all she can but "it ain't workin",
include permission to quit and when to know it is time.  For this particular
instance, I would probably help her to accept that the lack of breast
development and change through her life and pregnancy may mean she is one of
the extremely few women who will not be able to provide only her milk for
nourishment, but she can absolutely nurse her baby for as long as she
desires.  I don't feel good about moms who really will not make enough milk
nursing and then bottling.  If they are going to use bottles (as opposed to a
feeding device at the breast), I encourage bottle feeding at the breast first
and nursing afterwards for comfort and to sleep.  This way the baby is not
frustrated and hungry at the breast and the last memory is of mom's breast
not the bottle.  I talk about bottle feeding imitating breastfeeding, etc.  I
also tell them that when the day comes that they dread the pump, dread the
feeding, resent the baby or themselves, it is time to stop.  Nothing is more
important than the relationship between mother and child--not even her milk.
 When trying so hard to make it work and seeing no improvement starts to
cause the relationship to suffer, it is time to stop do anything that causes
this.  Perhaps that means no more pumping and just do both and enjoy the
baby.  Each mom needs to decide that for herself, but we as care providers
may need to listen with an open mind and help her know when she is there.
Like we have said here many times before, nursing is more than just the milk
and that needs to be validated for moms who cannot provide the milk.

Just one story>  A mom had no breast change during teen years to speak of
(barely and A cup), zero change during any of her three pregnancy, never
never felt milk come in even when she was not going to nurse anyway.  Baby #3
comes along and mom wants to nurse this one last baby.  Unfortunately, no
milk.  Okay, a few drops sometimes even enough to fill a spoon, but never
enough to fill a baby.  So, mom and I discuss what is it about nursing that
she wants.  Obviously after formula feeding 2 children she does not see it as
an evil, she just wants what she sees with me and mine.  So, we talk about
how to bottlefeed with nursing attitudes and continue nursing as long as baby
shows interest.  Now, the mom has a nursing toddler and was able to have what
she wanted--a nursing relationship.

Pam MazzellaDiBosco, IBCLC     Florida, USA

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