Based on the information you gave us, I have a few thoughts.

Latch and nipple injury- I know you have explained to her how it should look
and feel, but have you done some hands on demonstration? I know many on this
list like to take the hands off approach, but given the language barrier a
little demo can go a long way.
I also think someone should assess the baby's oral cavity to see if there is
any reason for the injuries.

Nipple pain after feeding- given that she experienced this kind of pain when
she was pregnant, I would refer her to doctor of breastfeeding medicine, or
an IBCLC that is also an MD to see if there is anything else going on.

Baby's behavior 30- 40 min. after feeds- I have to disagree with you. Almost
everything you said points out to a supply issue:
*Baby is 75- 80 % ABM fed.
*She didn't nurse for 3 days before you saw her. (Did she express milk?
Normally a mother with a good supply would not be able to go 3 days w/o
nursing or expressing; she would be engorged and in a lot of trouble.)
*Mother is working and not expressing milk during the day. Supply is bound
to be affected. To what extent it'll be affected, and how long it will take
to decrease can change from mother to mother. But it will be affected.
*You said she can express 3 oz. after baby hadn't been fed for a few hours.
How many hours are we talking about? It makes a difference if it is 2-3
hours or 5-6 hours.

The reason I asked about the shape of her breasts is because it can help
shed some light on issues of supply. (Please refer to the Breastfeeding
Atlas by Kay Hoover and Barbara Wilson -Clay for pictures of insufficient
glandular development and more).
Taking a full medical history as well as information about early lactation
(on set of lactogenesis II,etc.), baby's birth weight, discharge weight, and
all other weights since birth is necessary to help you get an insight into
what is going on.

It could be that supply was there, but due to mismanagement or other reasons
it went down. She can try and take herbs (she should be familiar with
fenugreek since she is originally from India)
If she can't / won't express while she is away from her baby, supply will
suffer; however I have seen many mothers who were able to successfully
breastfeed their baby before and after work. Again, every woman's system is
different, and some women are able to do that for a while, while other
mothers notice a great decline and baby's refusal to nurse.

I am worried about this mother's future nursing for a few reasons:
Possible lack of support from family and friends.
Perceived low supply (justifiable or otherwise).
Breast/nipple pain.
She will be traveling a long distance very soon. (Could add stress.)
All these factors can be a challenge.
Good luck with this case.
Best,
Ayelet



-- 
Ayelet Kaznelson
CLC, IBCLC, RLC
Los Angeles CA.

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