Nipple pain, damage, and vasospasm in the first 8 weeks postpartum

Could Photobiomodulation help lactating women and their newborns?

During the first several weeks following lactation, nipple pain frequently prevents mothers from continuing breastfeeding. To evaluate the efficacy of using Photobiomodulation (PBM) versus anti-inflammatory topical cream, on inflamed nipple, and the effect on milk production. This study was carried-out on 50 breastfeeding women with nipple pain and fissure. Our patients were divided into two groups ; study group (Group I): 25 patients received 12 sessions of PBM using Diode laser for a period of 4 weeks, 3 sessions per week every alternative day, and controlled group (Group II): 25 patients used Anti-inflammatory topical cream. Regarding inflammatory signs in both groups, Group I showed a significant decrease in redness compared to Group II at the 3rd and 4th week, and a significant decrease in nipple fissure and pain at the 3rd week. There was a significant increase in milk amount reflected on the infant's weight. We concluded that PBM was more effective in decreasing nipple pain, inflammation and subsequently milk production and infant weight than topical anti-inflammatory creams.

Diagnosis and management of a herpes nipple infection that resulted in neonatal HSV encephalitis

We present a case of a primigravida in her 30s who had a caesarean delivery of dichorionic diamniotic twins at 33 weeks of gestation. Her postpartum course was complicated by a herpes simplex virus (HSV) infection of her nipple, found after her neonates were diagnosed with HSV encephalitis. She was evaluated at her 3-week postpartum visit and reported that her neonates were concurrently admitted to the neonatal intensive care unit with disseminated neonatal HSV-1. The patient and her partner were in a monogamous relationship with no known history of HSV. Physical examination demonstrated a vertical fissure on the face of her right nipple and a small cluster of vesicles on her left hand. PCR swabs of the lesions were positive for HSV-1 at both locations. The patient was started on oral valacyclovir 1000 mg two times per day, topical acyclovir ointment applied 4-6 times per day and mupirocin ointment applied 3 times per day to her breast with resolution of her breast lesions. She was able to continue expressing her breastmilk with the help of a pump and then resumed breastfeeding once her infection was cleared. Her infants recovered after prolonged parenteral antiviral therapy with age-appropriate development at follow-up.

An evaluation of patient comfort levels during expression with a modified pumping program: a prospective proof of concept study

Introduction

This study aimed to assess if the implementation of a gentle transition of vacuum mode into a breast pump suction pattern commonly used to initiate milk production would improve user comfort while expressing during the first four days postpartum.

Methods

This prospective study was conducted at OLVG hospital in the Netherlands in two sequential phases. Breastfeeding patients delivering >36 weeks gestation with an infant aged ≤96 h old and a clinical indication to express milk with a breast pump were recruited. Intervention group 1 (n = 40) used a hospital-grade electric breast pump with a standard breast pump suction pattern. Intervention group 2 used a hospital-grade electric breast pump with a modified breast pump suction pattern (n = 40). The primary outcome was an objective assessment of comfort as measured by participants' need to reduce vacuum level during the 20 min test session. Secondary outcomes included the total expression volume (ml) in 20 min pumping.

Results

The study found that the primary outcome of comfort was significantly improved with the modified breast pump suction pattern compared to the standard pattern (OR 1.29, 95% CI 1.08 to 1.6) with 86% vs. 67% of participants not needing to reduce applied vacuum levels. The amount of milk expressed did not differ significantly between phases (group 1: 7.6 ml (2.7-25.5 ml), group 2: 12.0 ml (1.2-31.5 ml), p = 0.43).

Discussion

This study is the first to demonstrate an improvement in user comfort driven by the implementation of gentle transitions in vacuum modes in a commonly used breast pump suction pattern. Research into this novel population combining both pumping and breastfeeding in the first days after birth offers new unique insights on the requirements of breast pump suction patterns.

Trial registration

Registered on clinical trials.gov NCT04619212. Date of registration November 6, 2020.

Breastfeeding-related Pain, Sensory Over-responsiveness, and Exclusive Breastfeeding at 6 Months: A Prospective Cohort Study

BACKGROUND

Exclusive breastfeeding (EBF) is recommended for the first 6 months of life, yet EBF rates at 6 months (T3) in most developed countries are low. Painful and nonpainful sensory stimuli processing is linked, and while pain has been suggested to restrict breastfeeding, its coupling with sensory over-responsiveness (SOR) in relation to breastfeeding has not yet been reported.

OBJECTIVE

We aimed to explore whether breastfeeding-related pain, SOR, and general pain sensitivity predict nonexclusive breastfeeding (NEBF) at T3.

STUDY DESIGN

In this prospective study, participants were recruited at 2 days postpartum (enrollment). For the assessment of breastfeeding-related pain, participants completed the visual analogue scale and the Short-Form McGill Pain Questionnaire at enrollment, and at 6 weeks after birth. At T3, they completed the Pain Sensitivity Questionnaire and the Sensory Responsiveness Questionnaire-Intensity Scale and then provided information about their breastfeeding status. Participants were divided into two groups accordingly: EBF and NEBF.

RESULTS

A total of 164 participants were reached at T3: EBF (n = 105) and NEBF (n = 59). The incidence of SOR was significantly higher among NEBF compared with EBF participants (25.4% vs. 11.4%; p = .020). Between enrollment and 6 weeks after birth, 72.3% of the EBF participants had reported a ≥30% pain reduction, compared with 44.8% of the NEBF participants (p = .001). Logistic regression modeling revealed that both breastfeeding-related pain reduction and SOR predicted NEBF at T3 (p < .001), indicating a 3.2 times (p = .001) and 2.5 times (p = .041) odds ratio for NEBF, respectively.

CONCLUSIONS

SOR and sustained breastfeeding-related pain predict NEBF at T3 and may emerge as substantial breastfeeding barriers.

Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations

OBJECTIVE

to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women.

METHODS

a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied.

RESULTS

115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area.

CONCLUSIONS

assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.

Determination of the effectiveness of beeswax in preventing nipple pain and cracks in primiparous breastfeeding mothers: A randomized controlled trial

OBJECTIVE

Beeswax is a natural ingredient used effectively for wound healing. This study aimed to determine the effectiveness of beeswax and breast milk in preventing nipple pain and cracks in the early postpartum period.

MATERIALS AND METHODS

This non-blinded, randomized controlled trial was carried out between November 15, 2019, and April 1, 2020, in the postpartum clinic of a state university hospital and at mothers' homes. Ninety primiparous mothers meeting the inclusion criteria were randomly divided into beeswax (n=30), breast milk (n=30), and control (n=30) groups using simple randomization. Mothers in the beeswax, breast milk, and control groups were assessed for nipple pain and cracks on postpartum days 1st, 3rd, 5th, 7th, and 10th.

RESULTS

On postpartum day 10, nipple pain and cracks occurred highest in the control group (%53.3), whereas nipple pain and cracks were encountered least in the beeswax group (%20,0) on postpartum observation days. The differences between the groups in terms of nipple cracks and pain severity were statistically significant (p < 0.05, p=0.004, and p=0.000, respectively).

CONCLUSION

Beeswax is more effective than breast milk in preventing nipple pain and crack formation. A beeswax barrier can be used to prevent nipple pain and cracks.

Postpartum Breastfeeding Practices and Attitudes in Parents: A Randomized Study to Evaluate the Effects of Individual and Group Breastfeeding Education of Mothers and Fathers

Background Antenatal breastfeeding training is defined as the provision of breastfeeding information during pregnancy, which can be given in various ways, such as individual training and group training. The inclusion of fathers in this educational approach is associated with the initiation of breastfeeding, exclusive breastfeeding and duration of breastfeeding. However, studies involving fathers are limited. This randomized controlled study aimed to compare the effects of individual and group training given to parents and those of normal hospital practices on mothers' breastfeeding self-efficacy and fathers' attitudes toward breastfeeding. Methods The study was conducted randomly in a training and research hospital between March 2014 and September 2014 and included 180 people. Of them, 90 were prospective mothers who were in the third trimester of their pregnancy and were living with their husbands and received service from the obstetrics outpatient clinic of the hospital. The expecting mothers and their husbands were randomly assigned to three groups: individual training, group training and control group. After randomization, prospective mothers and fathers in all groups received training. In the first week, sixth week, and fourth month after delivery, the mothers' breastfeeding self-efficacy and breastfeeding attitudes as well as the attitudes of the fathers' toward breastfeeding were evaluated. Results There were no differences between the groups in terms of variables such as age, education status, family type, breastfeeding education status, and mode of delivery. There were significant differences between the scores obtained from the Breastfeeding Self-Efficacy Scale and its subscales in all three groups during the postpartum period (p <0.05). The highest scale scores were obtained at the postpartum fourth month in the individual training and control groups and at the postpartum sixth week in the group training group. There were differences between the scores obtained by the mothers and fathers during the postpartum process from the Iowa Infant Feeding Attitude Scale (p<0.05). Conclusion The analysis of all the results indicates that breastfeeding education given to parents in the antenatal period increases their breastfeeding self-efficacy and provides them with a positive attitude toward breastfeeding. However, further research is needed to determine whether individual or group training contributes to the development of breastfeeding self-efficacy and attitudes.

Nipple Vasospasm of Nursing Mothers

Background: Nipple vasospasm is a painful cutaneous vasoconstriction that nursing mothers experience after breastfeeding. Case presentations: In this case series, we present the common features and management of nipple vasospasm in nursing mothers. Discussion: The diagnosis of vasospasm relies on the doubt of physician or the breastfeeding consultant and observation of the color change of the nipple. Persistent nipple and breast pain in breastfeeding is often attributed to Candida albicans; thus, many mothers receive antifungal therapy before the diagnosis. Conclusions: Timely diagnosis also prevents unnecessary antimicrobial treatments. Precise and rapid diagnosis is crucial, as pain is a risk factor for cessation of breastfeeding and its exclusivity.

Effect of Tea Tree Oil and Coconut Oil on Nipple Crack Formation in the Early Postpartum Period

Background: The aim of the study was to determine the effect of tea tree oil and coconut oil applied to the nipples during the early postpartum period on nipple crack formation. Methods: This randomized controlled experimental research included a total of 90 women in the research sample abiding by the research criteria, with 30 each in the intervention groups (coconut oil or tea tree oil application) and 30 in the control group. Women in the intervention groups applied coconut oil or tea tree oil to the nipples on the 3rd, 7th, and 10th days postpartum, whereas the control group did not have any intervention. Data in the research were collected with the Descriptive Information Form for Mothers, Early Postpartum Period Breast Problem Assessment Form, and Visual Analog Scale (VAS). Analysis of data used the chi-square test, Kruskal-Wallis test, and Friedman's test. Results: Mean age of women participating in the research was 28.23 ± 5.21 years. The differences between the groups applying coconut oil and tea tree oil on the 3rd, 7th, and 10th days postpartum and the control group were significant in terms of incidence of nipple cracks. In addition, the difference in mean VAS points for nipple pain in the groups using coconut oil and tea tree oil and the control group was found to be statistically significant (p < 0.05). Conclusions: According to the research findings, coconut oil and tea tree oil were determined to reduce nipple crack formation and nipple pain. It is recommended to increase the use of coconut oil and tea tree oil related to breast problems in nursing care during the postpartum period. Clinical Trials Registration Number: NCT05456438.

Breastfeeding difficulties in the first 6 weeks postpartum among mothers with chronic conditions: a latent class analysis

BACKGROUND

Breastfeeding difficulties frequently exacerbate one another and are common reasons for curtailed breastfeeding. Women with chronic conditions are at high risk of early breastfeeding cessation, yet limited evidence exists on the breastfeeding difficulties that co-occur in these mothers. The objective of this study was to explore clusters of breastfeeding difficulties experienced up to 6 weeks postpartum among mothers with chronic conditions and to examine associations between chronic condition types and breastfeeding difficulty clusters.

METHODS

We analyzed 348 mothers with chronic conditions enrolled in a prospective, community-based pregnancy cohort study from Alberta, Canada. Data were collected through self-report questionnaires. We used latent class analysis to identify clusters of early breastfeeding difficulties and multinomial logistic regression to examine whether types of chronic conditions were associated with these clusters, adjusting for maternal and obstetric factors.

RESULTS

We identified three clusters of breastfeeding difficulties. The "physiologically expected" cluster (51.1% of women) was characterized by leaking breasts and engorgement (reference outcome group); the "low milk production" cluster (15.4%) was discerned by low milk supply and infant weight concerns; and the "ineffective latch" cluster (33.5%) involved latch problems, sore nipples, and difficulty with positioning. Endocrine (adjusted relative risk ratio [RRR] 2.34, 95% CI 1.10-5.00), cardiovascular (adjusted RRR 2.75, 95% CI 1.01-7.81), and gastrointestinal (adjusted RRR 2.51, 95% CI 1.11-5.69) conditions were associated with the low milk production cluster, and gastrointestinal (adjusted RRR 2.44, 95% CI 1.25-4.77) conditions were additionally associated with the ineffective latch cluster.

CONCLUSION

Half of women with chronic conditions experienced clusters of breastfeeding difficulties corresponding either to low milk production or to ineffective latch in the first 6 weeks postpartum. Associations with chronic condition types suggest that connections between lactation physiology and disease pathophysiology should be considered when providing breastfeeding support.

Association of Milk Secretion Volume with Nipple Pain: A Prospective Hypothesis Verification Study

Background: Many mothers stop breastfeeding due to nipple pain, which is experienced when the baby sucks the mother's nipples during breastfeeding. Objective: To verify how nipple pain during breastfeeding is associated with nipple perfusion and volume of milk secretion. Study Design: Prospective hypothesis verification study. Methods: Fifty-nine lactating women who delivered at term were enrolled. The CS Probe S and laser Doppler ALF21 were used to measure perfusion, and PowerLab 2/26 and LabChart 8 were used to analyze perfusion. The difference in the infant's weight (g) before and after breastfeeding was used to measure milk secretion. Results: The participants' mean age (± standard deviation) was 30.88 ± 3.77 years. Although 80-90% of participants had proper breastfeeding posture and infant attachment, 34 (57.6%) and 30 (42.4%) mothers experienced nipple pain on postpartum days 1 and 4, respectively. For postpartum days 1 and 4, the group with nipple pain exhibited significantly less nipple perfusion than the group without pain. Milk secretion was lower in the group with nipple pain on postpartum day 4 than in the group without pain, although this was not statistically significant. The reduction in nipple perfusion did not differ significantly between the high (75%) and low secretion groups (25%) and between the nipple trauma and nontrauma groups. However, the low secretion group and nipple trauma group had larger reductions in nipple perfusion. Conclusion: Assessing the amount of milk secretion can provide a new perspective on preventive care for nipple pain and trauma.

The Effectiveness of Aloe Vera on Relief of Irritation and Nipple Pain in Lactating Women: Systematic Review and Meta-Analysis

Background. Aloe vera is one of the herbal products with anti-inflammatory, antioxidant, moisturizing, bactericidal, anti-viral, and anti-fungal effects that were used to relieve pain and irritation. The aim of the current systematic review and meta-analysis is to determine the effect of Aloe vera on the relief of irritation and nipple pain in lactating women. Methods. A search was carried out in four English electronic databases including Scopus, Embase, PubMed, and Web of Science until November 2021. All clinical trials that assessed the effect of Aloe vera on the relief of irritation and nipple pain in lactating women were included. The study’s risk of bias was assessed using the Cochrane risk of bias checklist. Study heterogeneity was determined using the I2 statistic and publication bias using Begg’s and Egger’s tests. Results of the random-effects meta-analysis were presented using standard mean difference (SMD) with 95% confidence intervals (CIs). Data were analyzed using STATA software version 16 MP. Results. In total, 7 articles with 1670 subjects were included in the meta-analysis. Overall, we found a positive impact of Aloe vera on reducing breast pain (pooled SMD= −0.45; CI= −0.83, −0.07, $P$ value <0.02) and irritation (pooled SMD= −0.48; CI= −0.64, −0.32, $P$ value<0.001) in lactating women. There is a high heterogeneity among pain studies (I2= 86%) but was low within irritation studies (I2= 26%). Conclusion. Our result showed that Aloe vera can be considered a choice for relieving breast pain or irritation in lactating women compared with routine care or another treatment. Considering the limited number of studies conducted on this topic and the low sample size, future studies with a larger sample will be required to draw better conclusions.

Initiating and Supporting Breastfeeding: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives

Exclusive breastfeeding is recommended for children for the first 4 to 6 months of life, with complementary foods added thereafter. It is the most ecological way of protecting the child's and mother's health. Training of health professionals is required to avoid transmitting inconsistent information in 3 areas: 1) implementing these 3 predictors: safe skin-to-skin, first breastfeed, and rooming-in 24/7; 2) teaching and monitoring: i) early signs of waking and feeding rhythms, ii) positioning and latching, and iii) signs of effective transfer; and 3) referring women to specialized support services if difficulties arise (eg, inadequate milk production, pain, cracked nipples, engorgement). Breastfeeding should continue during mastitis or an abscess. Ultrasound-guided needle aspiration is beneficial in treating an abscess. Précis: Information is provided to enable health professionals to better support breastfeeding and help women with the most common difficulties, thus promoting breastfeeding initiation and duration.

A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series

BACKGROUND

Lactation consultants frequently advise adjustments to fit and hold (or positioning and attachment) with the aim of optimising intra-oral nipple placement. However, approaches to fit and hold vary widely, with limited evidence of benefits, and effects of fit and hold on infant tongue movement have not been examined. The aim of this preliminary study was to investigate whether a gestalt breastfeeding intervention alters tongue movement, using measurements from ultrasound imaging to determine nipple placement and intra-oral nipple and breast tissue dimensions.

METHODS

Ultrasound measurements were conducted in five breastfeeding dyads, infants aged 4-20 weeks, while feeding in their usual or 'standard' position and again after brief application of gestalt principles of fit and hold. Four of the mother-baby pairs, who had received comprehensive lactation support, reported persisting nipple pain. Three of these infants had difficulty latching and fussed at the breast; three had been diagnosed with oral ties. A fifth pair was breastfeeding successfully.

RESULTS

Ultrasound demonstrated that the distance from nipple tip to junction of the hard and soft palate decreased, intra-oral nipple and breast tissue dimensions increased, and nipple slide decreased after a brief gestalt intervention.

CONCLUSION

These preliminary findings suggest that changes in fit and hold impact on infant tongue movement and contour. Further research investigating short- and long-term outcomes of a gestalt breastfeeding intervention in larger cohorts is required.

Re-thinking lactation-related nipple pain and damage

Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple-areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple-areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.

Do Maternal Stress and Depressive Symptoms in Perinatal Period Predict the Lactation Mastitis Occurrence? A Retrospective Longitudinal Study in Greek Women

Background: The aim of this study is to investigate whether symptoms of anxiety and depression disorders in women during the perinatal period predict the occurrence of lactation mastitis. Methods: This is a retrospective longitudinal study of 622 Greek women who were monitored from pregnancy until the first year postpartum (during the period January 2015–May 2018). The Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal Anxiety Screening Scale (PASS) were administered at four time points: (a) 24th–28th gestation week, (b) 34th–38th gestation week, (c) 6 weeks postpartum, and (d) 12 months postpartum. Multivariate binary logistic regression analyses were performed. Results: Results showed that (a) increased EPDS (p < 0.02) and PASS (p < 0.05) scores during the last period before birth, (b) increased EPDS score at 6 weeks postpartum (p < 0.02), (c) PMS symptoms (p < 0.03), (d) traumatic life events during the last year (p < 0.03), and (e) the existence of a history of psychotherapy (before pregnancy) (p = 0.050) appear to be the psycho-emotional factors that can predict the possible occurrence of lactation mastitis in a breastfeeding mother. Conclusions: The association between women’s poor mental health and the occurrence of a physical health problem, such as lactation mastitis, is recognized. This study highlights the important role of early and timely detection of perinatal mental health disorders.

The effect of vernix caseosa in preventing nipple problems among early postpartum women: A randomized-controlled single-blind clinical trial☆

BACKGROUND AND PURPOSE

Vernix caseosa, a natural substance similar to mother's milk with protective effects on the skin, might be effective in preventing nipple problems. The purpose of this study was to examine the potential efficacy of vernix caseosa compared to the conventional use of mother's milk in the prevention of postpartum nipple problems.

MATERIALS AND METHODS

This randomized, controlled, single-blind experimental study involved 64 primipara mothers who underwent cesarean section and were randomly and equally divided between the vernix caseosa group and the mother's milk group. All mothers received nipple care four times daily during the first postpartum week. Data were collected using personal information and nipple monitoring forms.

RESULTS

The incidence of nipple pain, rashes, and an abnormal appearance was similar in both groups on the first day postpartum (p = 0.132, p = 0.516, and p = 0.132, respectively), and none of the mothers had nipple cracks. On the seventh day, mothers in the vernix caseosa group had significantly less pain (p = 0.042), significantly reduced rash (p = 0.048), significantly higher satisfaction (p = 0.023), and no nipple cracks.

CONCLUSION

Nipple care with vernix caseosa is more effective than with mother's milk in preventing postpartum nipple pain, rashes, and cracks.

Breastfeeding Practices and Problems Among Obese Women Compared with Nonobese Women in a Brazilian Hospital

Background: Women who are obese have lower rates of breastfeeding initiation and duration and are less likely to breastfeed exclusively compared with women who are not obese. To develop programs to improve breastfeeding practices among this group of women, we investigated the association between maternal obesity and breastfeeding practices and problems in the first days postpartum. Methods: We analyzed medical records from postpartum women at a rooming-in maternity ward in State of São Paulo, Brazil, between 2016 and 2018. We included those who had intended to exclusively breastfeed, had given birth to a singleton and were admitted to rooming-in. We analyzed exclusive breastfeeding and nonexclusive breastfeeding each day of hospitalization and the presence of breastfeeding problems, comparing women in the obese category (body mass index [BMI] ≥30 kg/m2) to normal and overweight women (≥18.6 to ≤29.9 kg/m2). Results: Two hundred and twenty-four postpartum women participated, including 86 women in the obese category. More than 50% of women with obesity reported a breastfeeding problem in the first and second postpartum days (p = 0.026 and p = 0.017, respectively) compared with the 41% and 38% nonobese group. Children of obese women were 2.8 times more likely to have poor latch during breastfeeding (95% confidence interval [CI]: 1.29-6.10) compared with the nonobese group on the third day. Conclusion: Maternal obesity increased the probability of breastfeeding difficulties and nonexclusive breastfeeding at discharge. Professionals need to support breastfeeding techniques in the days immediate after delivery to improve breastfeeding outcomes for mothers with obesity.

Prevalence of Nipple Soreness at 48 Hours Postpartum

Background: Although most women start breastfeeding after delivery, difficulties often arise. One of the main reasons is nipple soreness, which contributes greatly to early cessation of breastfeeding. A soreness evaluation through validated scales, performed by health care professionals during the first few days, can contribute to improve breastfeeding and support for the mothers. Research Aim: Knowing the prevalence of nipple soreness during breastfeeding at 48 hours postpartum at the Infanta Cristina University Hospital (Madrid, Spain) through a cross-sectional descriptive study. Materials and Methods: The study took place between February and March 2019. A survey of 58 postpartum second day mothers was conducted including the Visual Analogue Scale (VAS) and Lactation Assessment Scale (LATCH) score for breastfeeding assessment. A descriptive analysis of secondary variables and subsequent bivariate inferential was performed for 95% confidence interval (CI). Results: The prevalence of nipple soreness observed is 97% (95% CI = 92-100%). It was found, significantly (p = 0.001), that the higher the score on LATCH, the lower the score on VAS and therefore the less pain. We found a relationship between women who were in skin-to-skin contact with their babies for 2 hours without interruption after birth and a higher pain score (p = 0.046). No other associations were found between VAS and other variables such as parity, type of birth, artificial milk supplements for the newborn, or using a pacifier. Conclusions: The high percentage of nipple soreness detected highlights that breastfeeding can be unpleasant in the first days after delivery. It is important to include in clinical practice the assessment of nipple soreness and the effectiveness of breastfeeding using validated scales.

The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis

Background

The importance of breastfeeding for maternal and child health is agreed upon worldwide. However, lactation-related nipple problems are common and are important factors affecting breastfeeding. Multiple studies recommended laid-back breastfeeding, but they are of various levels of quality, and the results are inconclusive.

Methods

We systematically searched the following twelve databases from inception to January 28,2020: Cochrane Library, EMBASE, Medline, Ovid, PubMed, Web of Science, CINAHL, Scopus, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang, and VIP. All studies regarding laid-back breastfeeding or biological nurturing were considered, regardless of whether they were randomized controlled trials. Two trained investigators independently evaluated the quality of the selected articles and screened the data. All the data were analysed separately using Review Manager Version 5.3 and STATA/SE Version 15.1.

Results

A total of 12 studies involving 1936 groups of postpartum women and their newborns were included. The results of the meta-analysis showed that nipple pain (RR = 0.24; 95% CI 0.14, 0.40; p < 0.00001), nipple trauma (RR = 0.47; 95% CI 0.29, 0.75; p = 0.002) and correct latching position (RR = 1.22; 95% CI 1.11, 1.33; p < 0.0001) in the experimental groups were all better than those of the control groups, and the differences were statistically significant (p < 0.05), which indicates that the laid-back position has a positive effect on maternal breastfeeding. However, the results of position comfort showed that there was no statistical significance between the two groups (ES = 0.09; 95% CI -0.63, 0.81; p = 0.798).

Conclusion

Compared with traditional breastfeeding positions, the laid-back position has been proven to be related to a decreased incidence of nipple pain and nipple trauma and is seemingly conducive to the use of the correct latching position. It is suggested that the laid-back position is helpful in solving lactation-related nipple problems and can be recommended as a position for breastfeeding. However, no significant difference in position comfort was found between the two groups based on the current evidence, and further studies are still needed to validate these results due to the limitations of the included studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03714-8.

Postpartum Nipple Symptoms: Risk Factors and Dermatologic Characterization

Background: Nipple discomfort inhibits breastfeeding goals, particularly between 0 and 8 weeks postpartum (PP), and yet the specific dermatologic entities that contribute to nipple soreness have not been clearly delineated. Moreover, there remains a lack of evidence-based guidelines for nipple symptoms and skin diseases. Methods: A survey was distributed to 6-8-week PP women, 18-50 years of age, with an intent to exclusively or partially breastfeed ("at the breast" or "pump"). The study aimed to characterize nipple skin symptoms (pain and itching) and lesions (eczema, redness, cuts, or wounds) and any association between these nipple problems and past dermatologic history, breastfeeding outcomes, and the ability to meet her breastfeeding goals. Results: Findings paralleled Centers for Disease Control and Prevention (CDC) statistics with a 25% decline in breastfeeding rates between birth, 86.3% (189), and 6-8 weeks PP, 64.5% (145). By 6-8 weeks PP, exclusive "formula" and "exclusive feeding at the breast" showed the largest increase (+16.4%) and decrease (-22.9%), respectively. Although no significant difference was found in comparison of nipple problems to feeding methods or skin history, women who reported pumping or PP redness/eczema had higher odds ratios of a change in feeding practice, history of eczema, and sensitive skin. Strong pumping intentions were also associated with the highest risk of unmet breastfeeding goals. Conclusion: Regardless of feeding method, product, or provider use, PP nipple problems predominantly arose between 1 and 3 weeks PP. Clinical Trial Registration number 201901737.

A retrospective analysis of debridement in the treatment of chronic injury of lactating nipples

Treatment strategies for nipple injury are mainly based on aetiology. However, some damaged nipples do not heal after the aetiology was corrected. This study retrospectively analyses the effect of debridement for treating chronic injury of lactating nipples. The medical records on nipple injury management in the authors’ department from December 2015 to January 2020 were retrospectively analysed. A total of 167 patients were enrolled and grouped based on the presence or absence of nipple debridement. The difference in the healing effect, pain relief rate and recurrence rate of nipple injury between the two groups after 1 week was examined. The cure rate of nipple injury in the intervention group (54.3%) was significantly higher than in the control group (26.7%). In addition, the complete pain relief rate in the intervention group (48.1%) was significantly higher than in the control group (23.3%). However, the recurrence rates between the two groups (36.4% (16/44) vs. 34.8% (8/23)) had no statistically significant differences. For patients with no improvement after correction of the aetiology of the in the nipple damage, debridement can improve the healing environment of nipple breakage and thus relieve nipple pain.

Associations between Maternal and Infant Illness and the Risk of Postpartum Depression in Rural China: A Cross-Sectional Observational Study

This study explored how maternal and infant illness correlated with the risk of postpartum depression in the Chinese Qinba Mountains region. In total, 131 villages comprising 435 families with infants (≤6 months old) were randomly sampled. We collected data on maternal and infant illnesses and maternal health knowledge level. The Depression, Anxiety, and Stress Scale-21 was used to measure the risk of postpartum depression. We used descriptive statistics and multivariate logistic regression for the analysis. Infant overall health status was a risk factor for postpartum depression (odds ratio (OR) = 1.90, 95% Confidence Interval (95% CI) = 1.10~3.28), whereas maternal overall health status was not correlated with postpartum depression (OR = 1.36, 95% CI = 0.55~3.39). For specific illnesses, infants experiencing over two common illnesses in the past two weeks (OR = 1.98, 95% CI = 1.13~3.45) and mothers experiencing over two common pains within two weeks after delivery (OR = 1.77, 95% CI = 1.02~3.08) were risk factors for postpartum depression, whereas infants with mild and severe stunted growth, maternal C-section, and postpartum body mass index (normal or overweight) were not correlated with it (all p > 0.050). Maternal health knowledge was an important moderator of maternal and infant illnesses on the risk of postpartum depression. In conclusion, maternal and infant illness were essential factors for the risk of postpartum depression in a poor rural region in western China, which may be mainly affected by the feeling of uncertainty of illness. Improved maternal and infant health and enhanced maternal health knowledge might alleviate the risk of postpartum depression.

Comparison of the effects of olive oil and breast milk on the prevention of nipple problems in primiparous breastfeeding women: a randomized controlled trial

We aimed to determine the effects of olive oil and breast milk on the prevention of nipple problems in this study. This study was conducted on 120 primiparous breastfeeding mothers. The mean scores for nipple pain demonstrated a statistically significant difference between the olive oil group and the control group (p = .006) and nipple damage was significantly less in the olive oil group (p = .003) on the 7^th day of the follow-up. Our results illustrated that olive oil was effective in reducing pain severity and preventing the formation of nipple crack compared control group.

The effectiveness on health education to prevent nipple trauma from breastfeeding: a systematic review

Abstract Objectives: to analyze the effectiveness on health education to prevent nipple trauma in breastfeeding compared to other interventions. Methods: systematic literature review was carried out in January 2019, according to PRISMA recommendations. The searches were conducted in Cinahl, PubMed, Web of Science, Scopus, and in the references cited in the selected articles. The studies were assessed for quality and level of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: twelve studies were selected, all conducted at the maternities. The interventions were classified in two categories: health education on breastfeeding and the use of nipple covers. Health education on breastfeeding presents a moderate level of evidence on the prevention of nipple trauma. There is a moderate to high level of evidence on the positive effects of guaiazulene, gel or peppermint water applied in the postpartum period to prevent nipple trauma. Conclusion: health education on breastfeeding with clinical demonstration is an important strategy to prevent nipple trauma and requires more than one educational approach. The use of nipple covers requires some consideration, since they must be removed prior to breastfeeding. All interventions were conducted in the postpartum period, which points out for the necessity of clinical research to prevent nipple trauma in prenatal care.

Breastfeeding and caring for children: a qualitative exploration of the experiences of mothers with physical impairments in Ghana

Background

Breastfeeding and caring for children demand time, energy and effort. Mothers with physical impairments in Ghana require special needs to be able to achieve optimal motherhood as society demands. Globally, literature on breastfeeding and caring for children among mothers with physical disabilities is limited. Similarly, there is dearth of literature on the experiences of mothers with physical impairments in Ghana. Therefore, this study sought to add to literature by exploring the experiences of mothers with physical impairments with regards to breastfeeding and how they care for their children.

Methods

Qualitative descriptive exploratory design was used. Twelve mothers with physical impairments who had been purposively sampled gave informed consent before data was collected through in-depth one-on-one interviews. Data was recorded, transcribed and analyzed inductively using the content analysis technique.

Results

Mothers with physical impairments perceived breastfeeding as difficult and expensive due to issues relating to disruption of sleep, dysfunctional limbs and the need for breastfeeding mothers to eat nutritionally balanced meals. Participants felt prejudged and discriminated at different points in their daily encounters.

Conclusion

Mothers with physical impairments have challenges. Therefore, attitudinal change should be advocated in the Ghanaian society with respect to issues concerning people living with disabilities.

Physical Analysis of the Breast After Direct Breastfeeding Compared with Hand or Pump Expression: A Randomized Clinical Trial

Background: Expressing human milk using commercially available pumps has increased. Most women use mechanical means to transfer their milk at some point during lactation. Yet, there is very little quantification of any breast tissue changes that occur when using mechanical devices to facilitate milk transfer. Objective: Women comfortable with breastfeeding were recruited to participate in a study to measure physical changes of the breast with a variety of human milk transfer modalities under close observation. Materials and Methods: Direct breastfeeding with their infant, hand expression, and mechanical milk transfer using two commonly available breast pumps were utilized over four milk transfer sessions with each participant. Each participant directly breastfed on the first milk transfer session and the remaining modalities were randomized. Measurements were taken before and after each modality using digital calipers. Participants completed a modified pain scale after each observation. Measurements taken after breastfeeding were used as the control for data interpretation for each participant. After a 20-minute rest period, breast tissue was again examined, and tissue appearance was recorded. Within-subject modality differences were calculated, and paired analysis mean difference and standard error of the mean are presented. Results: Fifty eligible women were approached with 92% participating. The "before" measurements were not significant for all the modalities. The "after" measurements were significantly different at p < 0.003 for breast pumps but not for breastfeeding or hand expressing. Many participants indicated pain with pumping. Conclusion: Mechanical pump use correlated with significantly increased length and diameter of the nipple compared with the post-breastfeeding and hand expressing dimensions. Pump use correlated with significant pain scores and resulted in localized inflammatory changes. Understanding how pumps affect breast tissue is helpful in improving experiences with breast pumps and may improve breastfeeding outcomes. Additional research is needed to better understand ramifications of long-term use of breast pumps.

Moving toward a better understanding of the experience and measurement of breastfeeding-related pain

Purpose: Despite how commonly breastfeeding-related pain is experienced in the postpartum period, and its frequent implication in breastfeeding cessation, this unique type of pain is not well evaluated nor assessed. The purpose of this study was to gain a comprehensive description and understanding of breastfeeding-related pain among postpartum breastfeeding women. Methods: This study employed a mixed methods approach using a descriptive-interpretive qualitative approach, in addition to administering the Short-Form McGill Pain Questionnaire, second version, to comprehensively gain both quantitative and qualitative descriptors of breastfeeding-related pain. Fourteen partnered and educated women living in Southern Ontario with experience of breastfeeding-related pain took part in this study. Results: The results from this study suggest that breastfeeding-related pain is often experienced as severe and distressing, and comprises various elements of pain including continuous, intermittent, neuropathic, and affective components. Conclusion: Breastfeeding-related pain is multidimensional and can be severe and distressing for women. Current measurement tools may not adequately reflect the multidimensional components of this unique type of pain, which may limit the effectiveness of health care providers to help with its identification and management.

Which Hand Position in Breastfeeding Is Better for Milk Intake: Palmar Grasp or Scissor Grasp? A Pilot Study

Objectives: During breastfeeding, there are two natural hand positions used most often by the mother to introduce her breast to the baby (palmar grasp [C-hold position] and scissor grasp). In this study, we aimed to investigate whether the milk intake is affected by the hand position. Materials and Methods: Both healthy term breastfed infants and their mothers were included in the study. Each mother-baby dyad was monitored during two feeding periods (100 mother-baby dyads, 200 breastfeeding sessions). Mothers were asked to grasp their breasts differently (palmar or scissor grasp) in each breastfeeding session. Milk intake was determined by test weighing. Results: One hundred mother-baby dyads were included in the study. There was no statistically significant difference between scissor grasp (34.60 ± 22.16 mL) and palmar grasp (38.30 ± 27.37 mL) positions when evaluated in terms of milk intake (p = 0.13). When asked what position they prefer to breastfeed at home, the majority of them (56%) stated that they preferred scissor grasp positions. In terms of breastfeeding by hand position, there was a statistically significant difference (p = 0.003) between the mothers who received breastfeeding training during pregnancy (59.2% palmar grasp position, 40.8% scissor grasp position) and the mothers who had not (29.4% palmar grasp position, 70.6% scissor grasp position). Conclusions: Our study showed that there was no difference in milk intake between palmar grasp position and scissor grasp position. The mothers should be encouraged to use the hand position that is most natural and comfortable.

Musculoskeletal Impairment: Causes of Pain with Breastfeeding Insight into 11 Cases

Objective: To determine the possible relationship between pain experienced by mothers with breastfeeding and musculoskeletal impairment commonly seen in physiotherapy practice. Evidence-based principles of the evaluation and treatment of musculoskeletal impairment used in physiotherapy practice were applied and adapted to manage pain experienced by mothers with breastfeeding. Subjects and Methods: This report describes 11 mothers referred to a breastfeeding clinic for pain with breastfeeding. Mothers were initially assessed by a physician and a nurse clinician, both International Board-Certified Lactation Consultants, to rule out causes of breast or nipple pain. When the cause remained unexplained, it was deemed musculoskeletal, and mothers were referred to a physiotherapist for assessment and treatment with manual orthopedic therapy and mobilization of the myofascial system. Results: The physiotherapist's objective musculoskeletal assessment and mothers' impression showed an improvement in the overall clinical picture after the first appointment in most mothers. Pain was resolved or alleviated by 80% in five mothers after 1-3 weekly treatments. The most useful therapeutic approach was to make afflicted mothers aware of their posture to maintain spinal alignment and avoid shear posture (lateral displacement of the trunk). Shear posture is a consequence of sitting leaning to one side. This posture is exacerbated by thoracic rotation and flexion, for example, when turning the trunk and bending over the baby while giving the breast. Conclusion: Treating musculoskeletal impairment referred pain to the breast or nipple with physiotherapy practices used in a nonbreastfeeding clientele can help alleviate or resolve pain with breastfeeding.

A combination of mupirocin and acidic fibroblast growth factor for nipple fissure and nipple pain in breastfeeding women: protocol for a randomised, double-blind, controlled trial

INTRODUCTION

Nipple fissure and nipple pain are common complaints among breastfeeding mothers. Studies found that mupirocin was effective in preventing and treating infections of damaged nipple and nipple pain. Acidic fibroblast growth factor (aFGF) plays an important role in wound healing. However, current evidence on the efficacy and safety of mupirocin plus aFGF for nipple fissure and nipple pain in breastfeeding women is inconclusive due to the lack of well-designed randomised controlled trials on this topic. The purpose of this study is to test the hypothesis that mupirocin plus aFGF is more effective than mupirocin alone for nipple fissure and nipple pain in breastfeeding women.

METHODS AND ANALYSIS

This study is a randomised, double-blind, single-centre, parallel-group clinical trial. A total of 120 breastfeeding women with nipple fissure and nipple pain will be randomly assigned to either mupirocin plus aFGF group or mupirocin plus placebo group according to a computer-generated random allocation sequence. The treatment period lasts 14 days. The primary outcome is nipple pain intensity measured by the Visual Analogue Scale on day 14 during the treatment period. Secondary outcome measures include time to complete nipple pain relief, changes in the Nipple Trauma Score, time to complete healing of nipple trauma, quality of life measured by the Maternal Postpartum Quality of Life (MAPP-QOL) Questionnaire, the frequency of breast feeding, the rate of breastfeeding discontinuation, weight change in infants and adverse events.

ETHICS AND DISSEMINATION

The study has gained approval from the Ethics Review Committee of Tianjin Central Hospital of Gynaecology Obstetrics on 22 January 2018 (approval no. 2018KY001). We plan to publish our research findings in a peer-reviewed academic journal and disseminate these findings in international conferences. This study has been registered with the Chinese Clinical Trial Registry.

TRIAL REGISTRATION NUMBER

ChiCTR1800017248.

Prevalence of nipple traumas and related factors among post-partum women assisted in a teaching hospital

Abstract Objectives: To estimate the prevalence of nipple traumas and to correlate this occurrence with socio-demographic and obstetric factors in a sample of assisted post-partum patients in a teaching hospital. Method: Cross-sectional, quantitative study of 320 post-partum patients assisted in the maternity from October 2015 to October 2016. Results: The prevalence of nipple trauma in the sample was 35.3%, and only previous experience with breastfeeding has behaved as a protective factor for trauma. No statistical associations were found with other variables. Conclusions and implications for practice: The data presented allowed us to delineate a profile of the post-partum patients assisted in a teaching hospital, as well as the characterization of the occurrence of nipple traumas. From this profile, guidelines can be established on the subject, both in the institution where the study was carried out and in other institutions, since from the literature, the need for this orientation in different contexts and institutions is identified.

Initial difficulties with breastfeeding technique and the impact on duration of exclusive breastfeeding

Abstract Objectives: the present study aimed to evaluate the influence of initial difficulties in breastfeeding on duration of exclusive breastfeeding. Methods: a prospective study with follow up of nursing mothers and their babies in the first six months of age. The studied population was randomly selected among the Brazilian public health system (SUS, Portuguese acronym) users in three hospitals. The breastfeeding observation protocol was used to collect initial data, which also included socio-demographic, prenatal assistance, delivery care, the postpartum period and the newborn variables. After hospital discharge, data were collected by phone. The multiple regression model was used for statistical analysis. Results: 175 mother-baby binomials were followed. Problems with breasts during the postpartum hospital stay (p= 0.030; OR=2.38; CI95%=1.02-5.48), maternal work outside home (p=0.027; OR=2.12; CI95%=1.03-4.31) and low maternal schooling level (p=0.017; OR=2.13; CI95%=1.10-4.06) were shown to be associated with the early interruption of exclusive breastfeeding before the child has completed 6 months of age. A family income lower than one minimum wage was a protective factor (p=0.048; OR=0.42; CI95%=0.17-0.97). Conclusions: socioeconomic aspects and difficulties in breastfeeding associated with problems with the puerperal breasts stood out as factors which restrict the duration of exclusive breastfeeding.

Physical health, breastfeeding problems and maternal mood in the early postpartum: a prospective cohort study

This study aimed to investigate prospectively the contribution of maternal physical health and/or breastfeeding problems to maternal mood (depression, anxiety, fatigue, irritability, confusion, vigor) at 8-weeks postpartum. A prospective study was conducted. Participants were recruited antenatally from a public and a private maternity hospital in Melbourne, Australia. Nulliparous pregnant women (N = 229), ≥ 18 years of age, ≥ 36-week gestation, singleton pregnancy and with sufficient English were eligible. Data were collected by self-report questionnaire (pregnancy, weeks 1-4 postpartum) and telephone interview (week 8 postpartum). A high burden of physical problems was classified as ≥ 3 problems (caesarean/perineal pain; back pain; constipation; haemorrhoids; urinary and bowel incontinence) for ≥ 2 time points. A high burden of breastfeeding problems was having ≥ 2 problems (mastitis; nipple pain; frequent expressing; over- or under-supply of milk) for ≥ 2 time points. Multivariate linear regression was used to investigate the relationship between maternal mood, assessed using Profile of Mood States (8-week postpartum), and a high burden of breastfeeding and/or physical health problems. Forty-six women (20.1%) had a high burden of physical symptoms, 44 (19.2%) a high burden of breastfeeding problems only and 25 women (11.0%) had both. A high burden of breastfeeding problems alone (β = 10.6, p = 0.01) or with co-morbid physical problems (β = 15.35, p = 0.002) was significantly associated with poorer maternal mood at 8 weeks. Early, effective postnatal treatment of maternal health and breastfeeding problems could reduce women's risk for poor mental health.

Quantitative Sensory Testing, Antihistamines, and Beta-Blockers for Management of Persistent Breast Pain: A Case Series

BACKGROUND

It is not uncommon for mothers to have persistent pain with breastfeeding beyond the first few weeks after birth. Persistent pain can be multifactorial, with neuropathic pain maintained by central sensitization being one dimension. Our knowledge in delineating categories of persistent pain is simple and not very sophisticated.

METHODS

We have developed and tested a Lactation Quantitative Sensory Test (L-QST) to quantify the neuropathic component of persistent breastfeeding pain. We present three case reports of neuropathic breastfeeding pain and treatment, and we discuss the potential role of histamine and catecholamines in persistent breastfeeding-associated pain.

CONCLUSIONS

The L-QST can be a useful tool to quantify neuropathic pain. Further studies are needed to test inter-observer reliability and reproducibility of this tool. Antihistamines can be considered for treating persistent pain in breastfeeding women with a history of allergy or atopy, and beta-blockers may be helpful in women with multiple pain disorders.

Analysis of questions about use of drugs in breastfeeding to Norwegian drug information centres

Background

Health professionals may advise women to either stop breastfeeding or drug treatment due to restrictive advice in drug monographs. Regional medicines information and pharmacovigilance centres in Norway (RELIS) provide free and industry-independent answers to questions about drugs and breastfeeding documented in a full-text, searchable database (RELIS database). We used the RELIS database to describe which health care practitioners sought information about medication safety in lactation, most common drugs involved, advice provided and which resources were used to provide the advice.

Methods

A random selection of 100 question-answer pairs (QAPs) from the RELIS database indexed with “BREASTFEEDING” in the period from January 2011 to December 2015 was analysed. Inclusion criteria were queries from health professionals about drugs. Questions about herbal supplements and other exposures not classified as drugs were excluded. The QAPs were manually analysed for compatibility of one or several drugs with breastfeeding, health care profession and workplace of enquirer in addition to advice and search strategy used.

Results

In the 100 QAPs there were enquires about 152 drugs. Seventy-four questions concerned a single drug, but the number of drugs evaluated varied between 1 and 16. Fifty-nine questions were from physicians, 34 from nurses or midwives, two from pharmacists and two from other health professionals. Questions from physicians contained 93 drug evaluations (61%), nurses or midwives 47 (31%) and pharmacists seven (5%). The most frequent categories of drugs were antidepressants, antiepileptics and immunosuppressants. The most asked about drugs were lamotrigine, codeine, quetiapine and escitalopram. Fifty-nine percent of the drugs were deemed safe while breastfeeding, 16% if precautions were taken and 12% not recommended. Thirty-nine percent of the drug evaluations used an advanced literature search strategy, and this was significantly (p < 0.05) more likely when the enquirer was a physician.

Conclusions

This analysis of questions to Norwegian medicines information centres about medicine use in breastfeeding indicates the need for communication about safety of drugs affecting the nervous system, primarily to medical doctors and midwives. In the majority of cases the medicine information centre can reassure about the safety of breastfeeding while taking a drug.

Electronic supplementary material

The online version of this article (10.1186/s13006-017-0143-8) contains supplementary material, which is available to authorized users.

The Effects of Different Breastfeeding Training Techniques Given for Primiparous Mothers Before Discharge on the Incidence of Cracked Nipples

OBJECTIVE

This research investigated the effects of different breastfeeding training techniques for primiparous mothers before discharge on the incidence of cracked nipples.

MATERIALS AND METHODS

This was a controlled intervention study that was carried out between 2015 and 2016 on 90 mothers living in İzmir. The mothers were divided into three groups: the demonstration-based training group, brochure group, and routine care-receiving group. The mothers in the "brochure group" were provided with breastfeeding training brochures. Mothers in the demonstration-based training group received one-to-one training using designed doll and puppet tools.

RESULTS

The rate of cracked nipples at age 2 weeks was 63.3% in the routine care-receiving group, 56.7% in the brochure group, and 20% in the demonstration-based training group. At the end of the fourth week, the rate was 30% in the routine care-receiving group and less than 10% in the other two groups (p < 0.005). The LATCH scores were higher in the demonstration-based training group than in the other two groups (p < 0.05). There was no significant difference between the groups in the percentage of exclusive breastfeeding.

CONCLUSION

The results documented that breastfeeding training based on one-to-one demonstration utilizing specially designed audiovisual tools was more effective than the other two methods in the prevention of nipple cracks.

Nipple Pain Incidence, the Predisposing Factors, the Recovery Period After Care Management, and the Exclusive Breastfeeding Outcome

BACKGROUND

Nipple pain is the most common complaint of breastfeeding mothers during the immediate postpartum period. Persistent nipple pain is associated with low breastfeeding rate at 6 months postpartum.

OBJECTIVE

To further explore the incidence of nipple pain, associated predisposing factors, time for recovery after management, and the impact on exclusive breastfeeding rates.

MATERIALS AND METHODS

Included in this study were 1,649 singleton, pregnant women who delivered and had their 1-week follow-up at the breastfeeding clinic during the period of January 2013 to December 2015. The mothers who experienced nipple pain were analyzed for the incidence, the predisposing factors, and the recovery period after care management. The breastfeeding outcome comparison of both, mothers with and without pain, was measured by the exclusive breastfeeding rate at the sixth week postpartum.

RESULTS

The incidence of nipple pain was at 9.6% by day 7. A predisposing factor of nipple pain was primiparity (relative risk = 1.8, 95% confidence interval 1.3-2.5). The reasons for nipple pain were inappropriate positioning and latching (72.3%), tongue-tie (23.2%), and oversupply (4.4%). The recovery period after care management was 1-2 weeks. There were no statistically significant differences between the 6-week exclusive breastfeeding rates of the mothers with nipple pain with treatment and the mothers without nipple pain.

CONCLUSION

Persistent nipple pain was a common problem. The active management, including early detection and treatment, would help the mothers recover within a 2-week period and there was no significant difference of exclusive breastfeeding rates between the mothers who had early care management and the mothers without nipple pain.

Factors associated to nipple trauma in lactation period: a systematic review

Abstract Objectives: To identify the characteristics associated to nipple trauma in nursing mothers and propose a theoretical model explaining in hierarchical levels its determining factors. Methods: a systematic review of the literature based on the search of epidemiological studies of factors associated to nipple trauma in the databases of Medical Literature Analysis and Retrieval System Online/Pubmed, Literatura Latino-Americana and Caribe em Ciências da Saúde (Latin American Literature and Caribbean Health Sciences) and ScienceDirect. The conduct on searching articles occurred until June 2016. Results: 17 articles were selected which investigated 27 variables and found a significant association between 16 of these variables and nipple trauma. The factors associated to nipple trauma reported in two or more studies were: mother of race/color white or yellow, primiparity, inadequate position between mother and child during breastfeeding and handling the infant incorrectly to the mother's breast. Guidance received on handling and positioning the infant during prenatal care was a protective factor against nipple trauma. Conclusions: in the theoretical model explaining the factors associated to nipple trauma in hierarchical levels, the variables classified at the proximal level were the most investigated and were identified as risk factors in selected studies, indicating that in the postpartum care period is an important protective factor against nipple trauma.

Healthcare quality in breastfeeding: implementation of the nipple trauma index

Objective

assess the efficacy of the Nipple Trauma Indicator Instrument implemented in the rooming-in facility t of a university teaching hospital as a healthcare quality indicator.

Method

exploratory, descriptive, retrospective study, with analysis of the Nipple Trauma Indicator tool of 1,691 mothers admitted in rooming-In from June to November 2012. Data were presented as absolute frequencies and percentages and statistical tests were administered.

Results

the mean rate of nipple trauma was 55.5%. The most frequent trauma was excoriation (62,2%) and the main cause was incorrect attachment of the newborn (44%). Maternal and neonatal factors associated with nipple trauma are also presented.

Conclusion

the Nipple Trauma Indicator provides a picture of breastfeeding healthcare, contributing to the construction of this quality indicator.

Breastfeeding Support in the Early Postpartum: Content of Home Visits in the SILC Trial

BACKGROUND

The Supporting breastfeeding In Local Communities (SILC) cluster randomized controlled trial evaluated whether a home visit focussed on infant feeding early in the postpartum period increased the percentage of infants breastfeeding at 4 months in low socioeconomic areas of Victoria, Australia. The visits were offered to women identified as at risk of early breastfeeding cessation after discharge home with a new baby. This paper describes the content of the home visits.

METHODS

SILC visited 1,043 women from September 2012 to March 2013, and completed a data sheet for each visit documenting topics discussed, as well as what support and resources were offered. Frequencies and percentages are presented.

RESULTS

Home visits most commonly included the provision of reassurance to women (91%). Topics discussed included general breastfeeding information (83%), supply and demand (83%), positioning (79%), and feeding frequency (78%). Newborn feeding/behavior (57%), expression of breastmilk (54%), nipple pain (41%), low breastmilk supply (41%), and the use of nipple shields (18%) were also prominent topics. The issues and support needs of women were similar across locations (rural, regional or metropolitan) and regardless of maternal parity or age. There was some variation in the resources suggested in different localities.

CONCLUSIONS

New mothers require help and reassurance independent of whether this is their first or subsequent child, reinforcing the need for support, breastfeeding information, and education about normal neonatal behavior. Key aspects of support are reassurance, normalization of infant behavior, and education.

Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial

Nipple pain and damage are commonly experienced by breastfeeding women and are associated with negative breastfeeding outcomes. Health care providers often recommend the application of lanolin to treat painful/damaged nipples, yet no randomized controlled trial has evaluated the effectiveness of lanolin on nipple pain and breastfeeding outcomes. The purpose of this study was to evaluate the effect of lanolin on nipple pain among breastfeeding women with damaged nipples. A randomized, single-blind, controlled trial was conducted at a tertiary care hospital in Hamilton, Ontario, Canada. Breastfeeding women (N = 186) identified as having nipple pain/damage were randomized to apply lanolin (intervention group; n = 93) or to receive usual postpartum care (control group; n = 93). The primary outcome was nipple pain at 4 days post-randomization measured by the Numeric Rating Scale. Additional outcomes included nipple pain measured by the Short Form McGill Pain Questionnaire, breastfeeding duration/exclusivity, breastfeeding self-efficacy, and maternal satisfaction with lanolin treatment versus usual care. The results revealed no significant group differences in mean pain scores at 4 days post-randomization. Women in both groups experienced clinically relevant decreases in nipple pain by 7 days post-randomization. Significantly, more women in the lanolin group reported that they were satisfied with treatment compared with those receiving usual care. No significant group differences were found for other secondary outcomes. While more women were satisfied using lanolin, its application to sore/damaged nipples was ineffective for reducing nipple pain or improving breastfeeding outcomes.