This case may be interesting, if not useful to others.
Parents are older than usual having a first baby, very well informed about CB &
BFing, very determined to do everything RIGHT.  Baby born 3 weeks early, very
rapid L&D.  Baby lousy at nursing initially and dad taught how to finger feed
in hospital, hospital LC and Bradley instructor both refered family to me.
Right insurance, so home visits and rental pump for one month covered.

First visit: Very up tight parents, placid baby.  Didn't recognize breast,
loved finger sucking.  Changed to cup feeding and lots of skin to skin.  Baby
did attach a few times when mom flat on back and baby on top.  This was the
longest home visit I have ever done.  Family was obviously more comfortable
when I was there, it was hard to leave and hard to not take over for them.

When I was not there parents were mostly unable to get baby to nurse, doing lots of
cup feeding and pumping.  I got lots of distress calls, tried supportive
tactics but did give a fair amount of directing.

Second visit: Baby more aware of breast and intrested in attaching but lots of
random activity trying to attach which caused LOTS of stess in mom.  Baby
finally attached and nursed very well.  First attachment with assistance from
me, second on their own.

When I was not there parents were mostly unable to get baby to nurse, doing
lots of cup feeding and pumping.  etc, ditto.  Then mom got mastitis, treated
adequately and recovered but in the meantime their many very supportive friends
became very accomplished at cup feeding and baby nursing even less and
protesting more vigorously when brought to breast.

I finally had my sleep disrupted as I tried to figure out what I should have
done.  The next morning I confronted parents with my assessment that they were
not moving forward, baby was not getting enough to eat (bm's q 2-3 days), and
that I felt this had gone on long enough ( about 3 weeks) and it might be time
to choose whether to bottle or breast feed.  If choice was to breast feed then
a more directed effort needed to be made to decrease the amount given by cup
and to increase breast feeding effectiveness.  (She had some options for doing
this).  I refused to tell her what I wanted her to do and told her that I would
help her with whatever route she choose.

She choose to work harder at breastfeeding, accepted decreasing finger sucking
but decided that decreasing cup feeding was too cruel.  Baby cooperated by
nursing wonderfully for one day, but the next day was terrible.  A close friend
who is a maternity nurse arrived that night, and the three adults and baby came
to my house the following day.

The visiting friend turns out to be very supportive and well informed re BFing
and in tune with my philosophy and had some helpful ideas to add.  Baby did a
wonderful feeding while here, took both sides no problem and then put on a
scene when reattaching to second side.  Friend and I interpreted his activity
as searching, parents thought he was frantic.  Parents are still handling this
kid as a fragile piece of glass.  Baby had gained about 1/2 ounce per day since
the last time I weighed him.

Some conclusions: Finger feeding sometimes causes more trouble than it is
worth.  Cup feeding sometimes causes more trouble than it is worth.  Parenting
is very hard to learn.  A tribal support system would have been very helpful to
this family.

My thinking on this case is still developing, this is a first draft.  Thanks
for listening.           Ruth  of Verona WI