I need some help from the Wise Ones,

I saw a nursing couple yesterday that I couldn't do much for, and hate to
see this one get away.  The baby is almost three weeks old, 10lbs 6 oz at
birth, almost two weeks late, c-section cause he got stuck.  Mom very
motivated, her first baby.  Mom reports very sore nipples, no visible
damage but nipple pink ( mom part indian so rest of nipple and areola are
pretty dark) describes pain as burning but baby has no sx of thrush( so
forget getting a Dr to tx around here) and nursing has always been painful,
mom has no hx of yeast in past.  Baby was 11lbs 8 ounces at 2 1/2 weeks.
Baby nurses every 4-5 hours!   Baby has high palate, and has a very noisy
disorganized suck, won't open mouth wide at all, small upper lip.
Listening to baby eat is very uncomfortable to hear and baby seems bothered
by whole thing.  No flairing nostrils or color changes during feeding. No
tongue-tie noted.  Appears to cup finger when assessing oral anatomy but
didnt do it long enough to be sure.   I thought maybe mom has overactive
letdown but she doesn't leak at all!  Wants to pump and bottlefeed if pain
can't be eliminated.  Has pumped ( didn't feel it was gushing out) and
bottlefed twice is getting about 5 ounces (every three hours) and still had
to give about two ounces of supplement.  Doesn't spit up at all.  Can't
believe a two week old's tummy can hold that much but may explain why he
can go so long between feedings.  Here is what I advised:  try very hard to
get baby far back on areola, practice openning mouth wide, do suck on
finger between feedings, go to one side nursing to see if overactive
letdown or oversupply is contributing to suck problems, feed more
frequently during day to avoid long marathon nursing sessions, follow
standard sore nipple care plan, consider pumping or hand expression to
achieve let down before latching, pump and feed with alternative device
(mom chose bottle) when nursing too painful.  What else can we try?  Mom
was so pleased that pumping didn't hurt that she will not keep the
breastfeeding up for long unless we can improve this kid's technique.  Any
suggestions welcome.

TIA

Lori Werrell, IBCLC
Leonardtown MD