Boy this is a tuff situation.
I'm sorry to say this but here goes," This mom just doesn't get it." Smokes
1-2 packs per day AND PREGANT?  Obviously if the issue of premature
underweight babies is not a big enough reason for her to quit during pregancy
I don't know why she would quit now.

You would have to ask the Doctor if they have a problem with the nicotine in
the milk.  I certainly think that it is possible that the baby could be going
through nicotine withdrawal.  That certainly could explain the irritability
and the need for sedation.  I really find it hard to think that the level of
nicotine would be so high to say that the HM (Human milk) is "toxic".
 Perhaps the DR. would be open to giving some supplements to HM along with
the nutramigen.  I heard that in NORWAY they swab colostrum inside premies
mouths with a q-tip if they can't take the Mother's milk.

The best way to approach the smoker is with the question." Have you ever quit
smoking?"  That doesn't pressure them right off the bat and lets them tell
you their past history.  Often they have quit in the past and started again
for some reason.  You can use the fact that they quit before as reenforcement
that they can do it again.  I think that if the mom is willing to try to quit
it is OK for her to use the nicotine patches as a aid to help quit. Despite
what the PDR and package insert says, but only her treating DR can decide
this for her.  The baby may then get nicotine still but at least the baby
won't be exposed to smoke.
BTW physcians have been successfully sued for NOT telling their pregnant
mothers to quit smoking.  Unfortunately the baby has no rights similar to
this for the intrauterine nicotine exposure.