Let me add my voice to say that the very best things you can do right now are to find another LC to work with your DIL and to spend your time praising her, assuring her that things can go well, and generally being a doula type helper for her.  

I have widely spaced conical shaped breasts myself (a friend in high school informed me they'd never seen pear shaped breasts before they saw mine), yet the only milk supply problem I ever had, including when I was using an old fashioned rubber nipple shield for 3 weeks with my first (a long unrelated story) was over supply.  I think perhaps one of the advantages that LLL Leaders used to have was that we rarely saw what a mother's breasts looked like and so spent most of our time encouraging good nursing practices without worrying about the mother's breast shape.  If a baby truly wasn't gaining it became evident pretty quickly, but the only mom I ever knew who didn't develop a full supply had perfectly normal looking breasts (she was a close friend so I made home visits with her).  

This baby is not losing weight, and while .8 oz is not a lot of milk to transfer in a feeding, it doesn't strike me as totally odd that a newborn, especially one with tongue tie might not transfer more than that in an evening feed.  After all there's got to be some reason why babies so often cluster feed in the evening. The relatively slow rate of gain might or might not be problematic.  The baby isn't still losing and appears to have gained at least an ounce since discharge.  Babies who are really in trouble are losing weight, not gaining or staying the same at this age.  Moreover, you have the problem that Jack Newman talked about at our LLL conference last year.  This baby has been weighed on at least 3 (most likely 4) different scales.  When you're dealing with just ounces and trying to figure it out in ounces it's very easy for slight differences in scales to muddy what you're actually seeing.  Clearly, if this were a baby who was now gaining an ounce a day you'd be seeing some indication of that even with different scales, but what if he stopped losing at day 4 and has only gained say a half an ounce a day, but the initial weighing was off, or he's gotten weighed after he just voided, etc.  It would be really easy to miss any gain at all.  Give it another couple of days as long as the diaper count looks ok and then weigh him again.  Normal weight gain can be as little as 4 ounces in a week.  It's devastating for parents to be told that the situation is terribly serious when they've been doing their best and all the indications they were given at the hospital (including checking diaper count etc) seem normal.

I know how hard it is to be objective when it's your own grandchild.  It was really hard for me when my daughter was dealing with what seemed to be quite clearly oversupply and she was reluctant to block feed in the first month.  Moreover once she decided to, her physician (very pro-breastfeeding, but not an IBCLC) sort of poo-pooed the idea that it might be oversupply despite the symptoms. It took weeks for her to have the confidence to try it again. That was with my own daughter with whom I already have a very close trusting relationship. If it had been a daughter-in-law I would have tread even more lightly. I spent a lot of time tiptoeing around in the first months of my granddaughter's life until my daughter had her own feet solidly under her.  She can listen to my advice a lot more easily now than she could in the first couple of weeks.  With her mother-in-law things have been far more difficult  The MIL doesn't understand breastfeeding or biological  nurturing and has done and said things that have really damaged her relationship not only with my daughter, but with her son as well.   I know how great it can be to have a good relationship with your mother-in-law because mine was a gem, but I've also seen how difficult the MIL/DIL relationship can be and the bulk of the responsibility for making it a good one really lies with the older woman.  I suspect my own MIL bit her tongue on a lot of occasions in the early years of our relationship.

Please remember when you're looking at her somewhat widely spaced breasts that they aren't necessarily any more abnormal than mine or a lot of other women's (I can fit my hand between my breasts as well).  It's really easy to be thinking that you're looking at a zebra when really it's just an oddly marked horse.  The important thing right now is for her to get her milk supply calibrated at the highest level she can for her and to either get the tongue tie clipped or find positions that make it easier for the baby to transfer milk.

There may indeed be some genuine  breastfeeding issues here, but there are reasons why doctors don't treat family members.  It will be easier for another IBCLC (and there are some good ones in MA) to be objective, and it will be easier for your daughter-in-law to not feel judged by her.  What she needs from you right now is your love and support.  No one is going to let that precious grandbaby starve, but his mommy needs you to assure her that you have confidence in her ability to mother her baby.  If she and your son feel like you're undermining them at this point, it's going to be a long road ahead for all of you to repair the damage that some poorly considered words and actions can do at this point.

Please keep us posted and feel free to vent here.  Better to express your fears to us than to cause unnecessary anxiety with the young parents.

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