I agree with the previous poster who mentions that a 48 year old primip might mean there has been difficulty in having a baby before, and whatever reasons underlie this, could also affect her milk production.

I would not do anything differently from how I would approach any woman with low supply.  I would try one measure at a time rather than throwing the whole toolbox at her at once.   Same principles guide this as guide any breastfeeding plan: feed the baby and protect supply.  

Since she had a cesarean it is unlikely that there is any retained placental tissue.  Not impossible, but highly unlikely, as part of standard procedure, after manually removing the placenta, is to inspect the entire uterine cavity, including swabbing it with sterile compresses, before suturing.  

The fact that she had a CS may also mean that she was separated from the baby for a time after the birth, and it almost certainly means that she was given fluids intravenously.  Relative fluid overload seems to delay lactogenesis two, particularly if the baby is prevented from being 'on the job and working overtime' to get things going, and in my experience this is often the case after CS.  Mother's incision makes continuous skin-to-skin uncomfortable, and if she has any edema to speak of, the baby will not be as effective at the breast.

Conclusion: too early to say whether this is simply a moderate delay in what will prove a normal course of breastfeeding, or the first sign of a more comprehensive problem requiring long-term supplementation.  Most women appreciate hearing this, and they really appreciate it if there is someone who will be following them as long as it takes to solve it.  Wish her luck, and stay optimistic.  Even if she never makes all the milk the baby drinks, if she hangs on for a while the baby may fall in love with the breast for all the other reasons and they can enjoy that for as long as they like.

Rachel Myr
Kristiansand, Norway

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