They didn't know preemies.
Or maybe they had plenty of preemie experience, but nonetheless brought the same one-size-fits-all solutions to every breastfeeding dilemma. The advice I received - and paid for - was the same that I found on the hundreds of websites I ended up visiting in my struggles toward exclusive nursing without EBM supplementation.
The gist I got from these lactation consultants (who I should say are in no way representative of ALL lactation consultants) was that preemie breastfeeding problems are the same as full term breastfeeding problems and should be tackled the same way. Not to mention the nagging implication that I was doing something wrong and was obviously terrible since, in the worlds of one of the LCs, "Everyone can do this."
Which, as I'm sure the experienced mamas out there know, is pure bull.
What I did not get from my lactation consultant led preemie breastfeeding experience was individualized attention that took P.'s prematurity into account or even her own pecadillos into account. Like her silent swallowing and lightning fast eating speed. Her tiny mouth vs. my honkin' rack. A weak latch that stayed weak for 18 months until she weaned herself, which saw me holding myself in silent offering at every feeding, from start to finish.
Whether these were preemie problems or just P. problems, we'll never know, but in either case, none of that seemed to matter to the women who did things like insist I repeatedly let P. go through the motions of the breast crawl. Conveniently forgetting that as a preemie, she ought to have been saving her strength. Or to just let her get hungry enough and she'll eat, as if that's how it actually works.
My guess is that what actually worked was simply time.
The time it took for P.'s muscles to grow. Time to develop the ability to breathe and swallow without aspirating. Time for neurons to develop and for reflexes to kick in. And let's not forget all that practice time and the time it took me to realize that yes, she was getting plenty in five minutes. Time that might have been better spent not going from lactation consultant to lactation consultant hearing the same advice... and the same little digs.
(Don't think that I didn't have any help, though. The NICU nurses - one in particular - were mostly amazing and had a knack for giving me confidence instead of taking it away. And a friend recommended a particular bottle that made easing off supplemental feedings so much easier since the nipple had a very breast-y shape.)