I agree that this case sounds like pretty typical of severe engorgement.
Some things to keep in mind -

-- Moms who have had pitocin or a c-section may have the severe edema type
of breast swelling that defies pumping. Indications would be a mom with
swollen ankles, hands, and breasts. I find that nothing much "cures" it
until their bodies can resolve the edema. Reverse pressure softening works
on the areola area for latch-on.
-- Moms who are this engorged may need to pump one breast at a time on low
suction with her helper doing some gentle massage or breast compressions to
help the milk flow out.
-- Medela's normal size flange is small for a lot of women. If she has
"larger" nipples, she may not be able to pump well on the regular size
flanges. I find that about 50% of my WIC clients with premature babies need
the larger Ameda flanges, and Ameda's regular flange is bigger then Medela's
regular flange.
-- I can't recommend enough that LCs take along a Baby Weigh Scale to do
test weighing before and after nursing. And to be able to see what the exact
weight is that day. This would tell give you a much clearer picture of what
baby is able to do at the breast.
-- And I agree with Rachel that this sounds like a baby who never really did
well at breastfeeding (the lack of diapers, the severe engorgment, the
lethargy).

Kathy Eng, BSW, IBCLC
Houston, TX

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