I'm worried that this post will leave me looking amatuerish, but I have a
friend with a difficult problem and and don't have local resources for
lactation help - and I'm at wits end.  She had a 7#10 oz baby boy a month
ago - induced labor and some IV narcotic.  For some reason, the nurses
didn't help get the baby to breast in the first 12 hours, and the kid never
really latched on well before discharge.  When she called me for help 3 days
later, the baby was having lots of trouble latching on.  He doesn't seem to
be tongue-tied, but he doesn't stick his tongue out to help grab the nipple
- it just stays mostly in the back of his mouth.  I worked with this mom for
hours over the next several days, helping her to get that baby latched on.
He lost a pound in the first week and stablized briefly.  Her breasts
softened and the latch seemed to get better, but the baby just "chewed" at
the breast rather than doing the long, drawing sucks (we tried different
positions, even rigged a makeshift SNS system to see if his suck would
change and try to get more fluids down since his output was poor).  After
losing another 4 oz. by the end of the 2nd week,  the FP mandated formula
supplementation, and the parents essentially stopped putting the baby to
breast (apparently he fought and screamed whenever I wasn't there to help)
and started bottlefeeding formula.  When they called me back a couple of
days later, my friend said she really did want to breastfeed, but just
didn't think it would work.  I suggested renting a pump to increase milk
supply, lots of skin to skin, and the tips I've read here.  When she was
able to pump more than an ounce or so, we put baby back to breast with the
same problem getting him to latch on well.  Even now, sometimes he'll latch
and suck, but it still doesn't seem like that good drawing suck that leads
to regular swallowing.  He'll stay attached and "chew" for 20 minutes and
more (after a few audible swallows early on, which we assume is let-down)  -
when we take him off the breast, the nipple seems well back in his mouth,
but it's not really clear that he got much of anything.  He's still being
supplemented with a couple ounces of formula after each nursing, and he even
seems to have trouble with the artificial nipple at times.  He is gaining
weight much better now and looks fine, but mom is understandably frustrated
that it is still so difficult to get him to nurse (he still fights it
frequently) and wonders if she should just give up.

My question is:  What more can I do?  How do you get a baby to "nurse"
instead of just little sucks?  We're sort of at the end of mom's rope here.

Gretchen, CNM