Hi Anne,
Controversy can be good.  It helps us all learn.  Everyone has their own
approach based on their educational background and experiences, but only
YOU have seen this mother.  Here on lactnet, we tend to all throw in our
two cents, and it is up to the LC (or LLLL or NMC, whatever) to decide
what is worth a further look.
        If a pump helps a mother with extremely sore nipples perservere in
breastfeeding when she would otherwise wean, I certainly would rent her
a pump (and I also talk people out of renting pumps fairly often).      The
reason I suggested that the baby might have some sucking issues was that
you mentioned that the nipples were extremely sore and damaged AND the
baby wanted to nurse all the time.  In my experience, if it is only a
matter of poor positioning, the baby can damage the nipple but usually
manages to get milk, though of course not as much as if positioning were
optimal.  If the sucking is very dysfunctional, the baby usually damages
the nipple and gets very little milk, to boot.  Of course, positioning,
latch on and suck quality are intimately related, but the relative
contribution of each to the problem needs to be discerned and
rectified.  Usually I start with observing the feeding, then improving
positioning and latch, and if I still see evidence of a dysfunctional
suck, I work on that.  My lactnet posts tend to focus on suck issues,
since that is where I feel I can contribute most to the discussion.  One
of the strengths of this profession (and of Lactnet) is the diversity of
expertise.  We can be the three blind men and the elephant, fighting
over whether the elephant is a tree, a snake, or a wall, or we can
integrate our observations to perceive the whole elephant.  We just have
to be thick-skinned enough to realize that because someone else has a
different approach or opinion, it does not necessarily mean our approach
or opinion is wrong.
--
Catherine Watson Genna, IBCLC  NYC  mailto:[log in to unmask]