Julie,
My first instinct in trying to imagine this scenario is, keep that baby skin to 
skin much more than two or three times a day! Is that really what she is 
doing? She is relying mostly on the pump to do the job, and is too stressed 
out to have the baby at the breast? Forgive me if i had missed something 
about this dyad in a previous post.  Her best bet may be nothing more than 
the LLL standard 48-hour cure protocol, if she would allow it.
Also, what about setting her up with a mini-SNS or Lact-Aid or french 5 (a la 
Jack Newman) to supp this baby while at breast - even if it weren't pumped 
milk - if she understood this to be a temporary situation to get back 
to 'normal', could she handle that? When dealing with this kind of situation, i 
try to 'meet' the mom where she is emotionally, and let her know of her 
choices that she can actually handle at this time, and maybe they aren't 
perfect according to what we know.  Maybe pumping, bf, bottling, etc is just  
too much, but if she were given permission to use whatever she can handle in 
a feeding tube, at the breast, for just a few days, to get over the 'hump', 
then she can work through it and get back to 100% bf.  I'm sure i will catch 
some heat for this philosophy, but i've been in the trenches with so many of 
these moms for so many years, that i've learned that our best ideas may be 
just too much, and we end up losing them. (sorry for the preaching). 
Living in a somewhat rural area myself, i understand how hard it is to actually 
get with all these moms - however, i've learned the hard way that much can 
be missed by relying on the phone.  She may not be forthcoming as you need 
her to be.  
If she wanted to be proactive in other ways, what about herbs? 
So, these are the rambling thoughts that have come tumbling out, i don't 
know if they are helpful, but this case obviously hit a nerve, as i am usually 
quite happy to 'lurk & learn'! LOL.  Methinks she owes you some more info 
about what's really going on around her as well, and how it may be affecting 
her.
Good luck!
Alicia Burgett, IBCLC in private practice, and getting grumpy due to the heat!

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