Dawn, you or someone else supportive and knowledgeable need to see the dyad,
the sooner the better.
The fact that mother is sore to the point of bleeding and yet seeing low
milk yields would be a red flag for me, that either the pump is not good, or
she has had inadequate instruction in correct use.  If her breasts are
somewhat tubular she may find it more comfortable to use the extra insert in
the flange to place against her breast, which is supplied in the individual
user packets for some hospital grade pumps.
You didn't mention how often or for how long she is pumping.  If she is
spending less than an hour and a half a day at it, in fewer than 6 sessions,
it is unlikely she will get past the critical point for adequate production
no matter how normal her anatomy and physiology are.
In addition to correcting whatever the pump problem is, I second the posts
which advise skin-to-skin, no pressure on baby to perform, offering milk by
other means while baby is nuzzling breast, and preferably giving
supplementary feeds (which are certain to be needed for a while yet) by some
other means than bottle.  Sometimes a helper, such as the father, can be
useful to drip some expressed milk over the breast from a syringe while baby
is there.  When mother stops having frankly bloody lochia, co-bathing could
be tried too.
I have seen a couple of babies who were very late to latch and who also
seemed to get so used to cup that they just didn't figure out the mechanics
of latching, and both made the transition from cup to breast via a shield,
which in both cases the mothers found and obtained independently of any
help.  I postulate that the shield gave the palate a stronger stimulus than
did the breast, and after being used to getting sated with nothing touching
their palates, they didn't know how to get on the breast or why.
I have also seen many many babies who have had incorrect latch (not gaping
wide) be helped to see the error of their ways by a SINGLE feed by cup just
before coming to breast.  These are two distinctly different problems.  It
is the former in this case, so maybe some suck training is in order if skin
to skin and/or co-bathing don't do the trick.  My motto is start simple and
cheap with the equipment found in the home.  If she has an SNS just lying
around idle, go for it.  If all she has is herself and her baby and maybe a
bathtub, try those first.
Rachel Myr
Kristiansand, Norway

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