Wow. That is a tough situation. Is this the first baby? She may never
have gotten a good latch or basic good positioning. The tongue-tie of
course may need to be revised, and depending on if family agrees to
see a practitioner. The baby may need some CST and again depending on
family's willingness and finances.

I would be very worried about milk transfer, wt gain, especially with
use of the unfamiliar shield. I would be very worried this mother
would get mastitis, making this situation even worse. (As I know you
are worried about too). I think mother has to allow those nipples to
heal, at least a day or two. She can certainly hand express and cup
feed. She can express right before a feeding, or even if she has
extra, as you know ebm can be left out several hours depending on room
temp. In winter the temps will be colder, of course. Mother can use a
manual pump or if you can get one, a pedal pump, if electricity will
not be used.

Nipple care can be soap and water cleansing several times a day, maybe
with saline rinses. Some recommend coconut oil, instead of antibiotic
ointment, that may be more in line with family's beliefs. Mother
should have scrupulously clean hands when handling or applying
anything to nipples. Alot will depend on, I think, the way this family
is approached, respected, and brainstorming for ideas that will work
within their culture.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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