I need help from all you Wise Ones.

I am working with this woman, first baby, 34 weeks gestation.  Delivered on
2/2 vaginally with epidural then pitocin to augment the labor.  Her only
complication from the delivery is severe hemorrhoids.  She is Indian and her
husband stays with her, assisting her with everything.  She appears educated
and speaks English well.
The baby is in a level II nursery due to his immaturity and still does not
have a coordinated suck/swallow.  On 2/4 they placed a feeding tube to help
give the baby his feedings.
The mom had breast changes during pregnancy and when I saw her for the first
time on 2/4 I could palpate milk production.  The breast are moderate size
with very firm areola and nipples.  When I had the mom hand express her
nipples which are slightly everted, they flatten and even appear to look
inverted because the areola tissue comes up and around the nipples.
Here is my dilemma: I had her hand express on both nipples and there was NO
sign of milk.  Then I tried (which I do not like to do because of discomfort)
but I wanted to show her some milk -- nothing.  Not even dampness.  I set her
up with a double electric breast pump and there has been no sign of milk in
the flanges yet.
I assisted her with the baby and ended up with a small nipple shield so the
baby could latch.  There has been very little sustained sucking from the baby
and no milk transfer.
Today I saw her and the breast are fuller but no milk from her efforts.  She
has had no surgeries or problems with her breast.  Her mother breastfeed
without any difficulties.  She says the hemorrhoids are painful but she has a
stoic face.
Her nipples almost appear tough like s/p radiation therapy to the skin.
My impression is a problem with letdown or some very bizarre nipples.
Any help would be appreciated.
Thanks,
Ann Perry RN, IBCLC
Boston, MA

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html