It is not unusual to see babies who will not latch even if they do not have
tongue ties.  Your client probably has a multi-faceted problem.  The first
is that infants whose mothers have C-Sections or epidurals or other narcotic
analgesics like Stadol or Nubain have difficulty using their tongue and
other oral muscles to transfer colostrum or milk.  I see this all the time
in our highly epiduralized and C-Sectioned Moms' infants.  Usually the
infants "wake-up" (detox) between 12-48 hrs depending on the dosage of meds,
crying, etc.  Did you know that many of the narcotics like Fentanyl are very
lipophilic?  They have an affinity for the CNS and increased crying leads to
decreased O2 saturations and increased affect of Fentanyl on CNS.  It makes
the problem even worse!  Ever wonder why some babies just either cry at the
breast or sleep in a 'shut down' mode?  Many are having difficulties
transitioning from one state to another, smoothly.  When the infant
'detoxes', these situations improve.  Unfortunately, by then, infants may
have increased jaundice, discouraged Mom's, and pediatricians who are
pushing supplimentation.  In the early days of infants who will not latch
on, breast compression or expression of colostrum can be given to the infant
on a demitesse spoon---the kind that ice cream samples are given on---very
tiny.  This works especially well for the tongue tied infants avoiding the
problem of bottle feeding flow issues not to mention the issues with formula
feeding.  

The second problem of tongue tie sounds like it was a most obvious problem.
 IT's too bad your pediatric surgeon didn't free up the tongue enough.  Did
the infant nurse directly after the procedure?  Hearing those swallows is
usually the proof in the pudding.  Also the flat nipples might have
benefited from using a pump or nipple everter just prior to attempting to
nurse.  Hopefully, your clieint is faithfully pumping to maintain her milk
supply the whole time until some of these problems can be worked out.  

Wishing you successes on this difficult situation!!!

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