Pat wrote:
"I ask you to assume that I don't know anything about how to do
this. Tell
me how you would go about helping this baby to learn to suckle at
the
breast effectively."
Pat, the day I can assume you know nothing about this is the day I
put away my shingle and retire!

Anyway, here goes:
First I would encourage her to use breast compression as soon as she
sees any sign of baby pausing longer that to just catch his breath.
If that doesn't get him nursing longer, I might suggest "super
switch nursing", changing sides as soon as he begins to slow down
(Watch for any indication of too much foremilk).
Have you considered a supplementation at the breast (SNS, Starter
SNS, Dr. Jack's bottle/tube set up, syringe and tube, peridontal
syringe)?  She would have the supplementing tube in place, but not
"turn it on" until baby appears ready to quit at the breast.
What is she using to bottlefeed?  Using something like the
"breastbottle" or Haberman feeder would reduce the differences
between breast and standard bottle.  With Haberman, she can vary the
flow, slowing it down briefly from time to time.  Perhaps baby
"quits" at breast when there's a slowdown in the flow.  With a
bottle, baby always gets "X" amount of milk for "Y" amount of effort
until it's empty.  For some babies this may be the aspect of "nipple
confusion" that gives them the problem.  Next choice might be
fingerfeeding.  Perhaps cup feeding so baby must get any sucking
satisfaction at breast only.
No pacifier, tip of mom's finger or perhaps a knuckle if she insists
on giving something other than breast for comfort sucking.
As to your comment about the "cast of thousands" who I see as
hovering over the mom.  Can she convince them she needs to be in a
quiet room alone with baby or her milk won't "let down".  Or some
kind of excuse why she needs to do this alone for now-any excuse the
others will buy, even if it involves a little exaggeration or slight
stretching of reality
Of course, on your part, massive doses of reinforcement and
reassurance for what she's doing-something she may well be missing
from the others around her.  I think moms in stressful situations
need at least twice as much positive reinforcement as they are
getting negative reinforcement!

Hope there's a little something you can use out of this.
Winnie

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