Babies modulate the relative amounts of positive and negative pressure
they use in sucking depending on milk flow.  Less milk flow might cause
the baby to increase the pressures, which is tough on the nipple.

What I would advise for this mom:
Reverse pressure softening before latching.  Use a very asymmetrical
latch, so that the large nipple is less of an issue.
Pump a bit after feeding to help improve supply.  Engorgement is a sign
that baby is not getting as much milk as they should, especially with
the low weight gain and few stools (stools are far more important than
urinations for tracking sufficiency of intake).
Warm water and soap cleansing of damaged nipples twice a day to reduce
risk of mastitis, soothies between feedings (they can really help mom
hang in there), and the effect of hydrogels in healing my dad's leg
after surgery for compartment syndrome made a believer out of me - he
was supposed to need skin grafts, but 6 mos of moist wound healing using
amorphos hydrogel and he healed perfectly without any surgery.  I have
before and after photos if anyone has a really strong stomach!
Wide based nipple if bottle is needed.  Cue the baby for a good gape.
And finally, have her see an IBCLC who is good at sucking issues to make
sure that nothing is going on in that little mouth that shouldn't be.
Catherine Watson Genna, IBCLC  NYC

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