firstly tea bags may be unhelpful - can cause further bleeding.
See 'A comparison of topical agents to relieve nipple pain and enhance
breastfeeding' Pugh et al (1996)

Secondly even though  the attachment may look right to you, if there is pain
and nipple damage the attachment is not right, by right I mean sufficiently
optimal to result in effective milk removal without nipple damage. For
example the "diagonal bruise at the 10:00 position" sounds like the baby was
'love biting' the areola not attaching to the breast optimally by taking the
nipple to the back of or near the hard/soft palate junction with the tongue
down and using peristaltic action to  milk the  breast. the kind of abrasion
you describe at the first breastfeed tells you something is dreadfully wrong
with the way the baby is trying to attach - not doing a very good job of it
at all - no wonder the mother feels such pain.

putting your finger in the baby's mouth may not be helpful  (can interfere
with the innate suckling ability). the baby needs to adjust to life outside
the uterus and be given time to coordinate the innate reflex ability to
suckle (other birthing factors I won't elaborate on here can effect this and
this may take time -i.e. 1 - 6 hours)

note suckling is different to sucking. sure baby can suck on your finger but
what does that tell you about the baby's ability to 'suckle' at the breast
for milk/colostrum removal and transfer?

wow you got 30 ml on pumping  at such an early stage postnatally. Baby only
needs 2-4 mls per feed in the early stages. could the mother hand express a
few drops or mils of colostrum? did anyone teach her to or offer to show her
the technique of hand expression and suggest she try it for learning
purposes or for the purpose of getting to handle her breasts for managing
the feeding even before the baby caused such painful damage.

the chances are this lady can be shown how to  hand express for 24 - 48
hours  and get sufficient colostrum to give the baby and get over the pain
and damage before it gets worse. she will need to keep  ahead of the baby's
feed needs with the collections of hand expressed colostrum

From my understanding cold is not a good idea in these circumstances. All
you may achieve is a sense of numbing in the nipple and then to try again
with the nipple numbed, the damage will occur but the lady may not feel it
and nothing useful is achieved except a further damage and bruised nipple
and areola.

I wonder what your rationale for the nipple shield was??? For extended
learning and exam purposes it may help you to read further on the use of
nipple shields  include the education needed to give to the mother, the
counseling skills to use when  offering the nipple shield  so she can make
an informed choice about it.  and as you have indicated why appropriate and
inappropriate to offer in this situation at this early stage postpartum with
an already existing damaged nipple.

nipple pain can be eased with warmth - as you may have read in the archives.
there are may other factors for example you have identified she has tender
nipples anyway.

However protecting the baby's innate reflex ability by giving uninterrupted
(note uninterrupted - means no  weighing, injecting , suctioning, wrapping
etc etc) skin to skin contact for at least 1 hour after birth and/or until
the first breastfeed is taken by the baby spontaneously  with minimal
assistance only if needed to ensure correct attachment is known to be the
most useful prevention of the type of  scenario resulting in nipple damage
you have described.

if the s-t-s contact time after birth was missed then take it up as soon as
possible now. If the mother understands and is willing to do so skin-to-skin
contact (hours at a time) can help the baby learn to feed correctly. Watch
and teach the mother to watch for the feeding behaviors of mouthing licking
hand to mouth coordination - then she will know when to take advantage of
her baby's optimal reflex feeding behaviors to attach better. this can take
the pressure off the mother to have to go through that excruciating pain
again it can give her space to decide when she may be ready to try again. In
the mean time she can express (preferably by hand for the first couple of
days) and her expressed breast milk may be finger fed (by the mother -
ensuring the mother encourages the baby to suck deeply onto her finger - no
shallow sucking), Syringe  fed, cup fed, to the baby or other creative
helpful means.

I would suggest care in rushing into the creams as a cure all for such
excruciating pain at the first breastfeed. Dr jack's  all purpose nipple
cream is often helpful for thrush isn't it? don't you think a more through
assessment at this stage would be prudent, include close follow up with
consistency allowing mum and baby to take their time to re adjust while much
observing before assuming a quick cure is around the corner.

anyway I hope some of that helps in the management of this case. Let us
know. Your scenario would surely give the examination board delegates some
ammunition!!

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