Seconding Cindy Garrison's post about trying to figure out the differences in milk flow and the baby's body positions between the breast and bottle.  

  What are the mother's goals here?  And yes, pumping is a lot of work -- she has a right to be tired.  Pumping a good short-term transitional plan, more manageable in the early weeks when other people are helping and making a fuss about the new baby, but at three months, no one is bringing over casseroles.  Everyone is stuck with the pump when they're at work, but mothers don't want to pump in the short hours when they can be with the baby.

If exclusive pumping is the goal, provide resources to try to make that more doable, including getting her tuned into the books and on-line forums to get practical ideas from other mothers on that difficult route.  When someone is stressed, she might not be able to get past "all or nothing" thinking.  If she is so discouraged she's ready to chuck the whole process, maybe helping her come to a more manageable goal --  it's better for this baby to continue getting some breastmilk than none.

If breastfeeding is the goal -- Is the baby still happy to get on the breast or will there be a process of wooing the baby back to the job? 
 One thing she may be overlooking is that babies change every day -- if she stopped feeding at the breast at one month because of the vomiting -- well, his digestive tract has had two months to mature (with growth factors in her hard-won breastmilk).  And if forceful let-down was part of the issue, the supply has probably calmed down.  If she needs the nipple shield as a bridge between bottle and breast for the non-latching baby -- his mouth is a lot bigger and he has more strength and finesse, and it might not be painful to use. (I've seen clamping babies create terrible damage wit the shield.  And I would suspect that the nipple shield that "tore her up" was too small.  I tend to go for the biggest shield a baby can manage, usually the 24 mm, to promote the idea that they have to hold a wide mouthful).

Yes, a somewhat reclined position would probably be helpful, with the milk flowing "uphill."  Or side-lying, to play up how restful breastfeeding can be!
 If baby has a somewhat sensitive digestive tract, maybe even going back to a newborn sequence of starting with him upright and letting him organize and think -- "yeah, stomach feels ok," and let him turn down toward the breast before easing him down.  He ends up somewhat upright/diagonal, body stable and planted, with chin up, with room to move the jaw.  (Sometimes bigger babies end up sort of squished if the mother doesn't evolve from newborn positions -- it's hard for anyone to drink smoothly with their chin tucked down.)  To compete with the firm oral signal of all these bottles, he might need a nice exaggerated "sandwich" of breast tissue to trigger active sucking.

I'm a little alarmed about "mediocre" weight gain. What does that mean?  Sometimes when babies are just scraping by on weight gain, they are not very vigorous feeders.   At three months, the three ounces you mentioned is not a big meal.  A breastfeeding baby can easily have lots of little meals (the norm in many cultures) but, because bottles are a lot of work, it seems unlikely that this baby is getting ten 3-ounce bottles across the day and night.   Is he self-limiting how much he takes at a time?  

Offering more questions than answers….

Margaret Wills, IBCLC, Maryland, USA

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