This baby had lots of ABM feeds early on, and has continued to have some supp feeds of EBM, I'm assuming by bottle?  If so, IMHO, the poor guy has probably been conditioned to the firmer feel of the artificial nipples on his palate and just doesn't recognize the feel of mom.  I would never want a mom to spend an hour getting completely frazzled trying to latch.  Has this baby been tried with a silicon nipple shield?  My philosophy is that if you can get the baby to latch and transfer milk (preferably by pre and post feed weights), through a shield, but he can't do it without, then use the shield.  I prefer short term, and attempt to slip it off and relatch, but again, if he won't feed at breast any other way, and is doing well (gain, outputs, etc.) with it, it is INFINITELY EASIER for mom (and everyone else around them) to use the shield than to pump and bottlefeed.  I would recommend some additional pumping for extra stim in the early days, but as soon as things seem to be going well and supply seems well established (based on baby's well-monitored progress), mom could even d/c the extra pumping.
Too bad our systems push the bottles like they do when alternatives are available.
Happy helping!
Kay McKee, IBCLC
Langley Air Force Base
Virginia, USA
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Kay McKee

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