thank you so much for all the replies. yes, i definitely spent most of my time trying the position with mom reclined almost flat and baby slightly off center to the side so she could try to latch somewhat asymmetrically  for a clear nose. mom was quite self-conscious about her disproportionate nipples, so i didn't want to ask if i could try RPS on them, but i definitely wondered if what i was seeing was pooled edema! however, the leaking milk appeared to be copious and unobstructed and the breasts themselves had completely softened from the engorgement she described the day before, so i sensed that focusing on or manipulating her nipples at our 1st meeting would most likely assure it would also be our last. she wouldn't even leave them uncovered unless i specifically asked to examine them or was trying to latch the baby. also, the baby is quite the ferocious kicker and foot-digger when trying to grapple with those fleshy doorknobs, so this position spared mom's incision. however, it somehow seemed to make her actually gag more this way - i couldn't see exactly why, unless it was just the effort of maintaining neck control and strength combined w/ trying to open so wide and force a breasty meatball into a manageable shape simultaneously. she seemed to do best in football hold. she liked to brace her feet against the back of the couch and give a calculated kick right when she was attempting to latch and get a sort of "running jump" at the formidable opponent. it was quite coordinated and developmentally impressive for a 5 day old, i thought! i called yesterday to follow up and was delighted to hear that baby latched and stayed on for almost a full minute right after i left, in football hold. i'm going to investigate the large nipple shields just in case the damage doesn't heal soon or gets worse, but i really wouldn't be surprised if this determined little miss doesn't get the hang of it sooner than i would have thought possible. provided they don't nipple confuse her with bottles, that is! no fear on me not emphasizing all the skin to skin, hormones and pheromones possible - i recognize that this is a case where more kangaroo care is absolutely vital. i demonstrated a stretchy wrap and told her she should just put it on her completely bare torso and tuck baby in wearing only a diaper and go about her daily routine like this whenever she can't lie in bed and have skin-to-skin snuggles w/ her baby. 
i also recommended chiropractic adjustments for the baby, i hope that can help make a difference. i will be sure to post updates, i'm very curious to see how this one turns out.
~jacqui gruttadauria, bsw
(near detroit, michigan, usa - where my own 4 3/4 yo nursling just told me today that he'd like it if a dr. could sew my iphone onto my breast above the areola so he could play games while he nurses.)
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