A comparison of the effectiveness of two methods of nipple care

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial

OBJECTIVE

To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education.

METHOD

Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05.

RESULTS

A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05).

CONCLUSION

It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.

The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio

The availability of breastfeeding support resources, including those provided by Baby-Friendly Hospitals, International Board Certified Lactation Consultants, breastfeeding counselors and educators, and volunteer-based mother-to-mother support organizations, such as La Leche League, are critically important for influencing breastfeeding initiation and continuation for the mother-child dyad. In addition, the emergence of community support options via information and communication technologies such as Skype and Facetime, social media (e.g., Facebook), and telelactation providers are providing mothers with a new range of support options that can help bridge geographic barriers to traditional community support. However, telelactation services that use information and communication technologies to connect breastfeeding mothers to remotely located breastfeeding experts require reliable, affordable, high-quality broadband connections to facilitate interaction between mothers and their support resources. The purpose of this paper is to explore the complex spatial landscape of virtual and face-to-face breastfeeding support options for mothers in the state of Ohio (U.S.), identifying barriers to support. Using a range of spatial and network analytics, the results suggest that a divide is emerging. While urban areas in Ohio benefit from both a density of face-to-face breastfeeding support resources and robust broadband options for engaging in telelactation, many rural areas of the state are lacking access to both. Policy implications and several potential strategies for mitigating these inequities are discussed.

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.

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.

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.

Interventions for treating painful nipples among breastfeeding women

BACKGROUND

Leading health authorities all recommend exclusive breastfeeding to six months' postpartum. While most women initiate breastfeeding, many discontinue due to difficulties encountered rather than maternal choice. One common breastfeeding difficulty is painful nipples. Research has identified poor infant positioning or latch as a common cause of painful nipples. While many different interventions designed to reduce nipple pain in breastfeeding women have been evaluated, it is unclear which intervention is the most effective treatment. An understanding of nipple pain and treatment options are needed to improve breastfeeding duration and exclusivity rates and to address systematically one of the most frequent difficulties encountered by breastfeeding women.

OBJECTIVES

To assess the effects of all interventions in the resolution or reduction of nipple pain and the impact of the interventions on other outcomes such as nipple trauma, nipple infections, breast mastitis, breastfeeding duration, breastfeeding exclusivity, and maternal satisfaction.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and scanned secondary references.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials designed to evaluate any intervention for treating nipple pain among breastfeeding women. Trials using a cluster-randomised design were eligible for inclusion. Cross-over trials were not eligible for inclusion. The following interventions were eligible for inclusion compared with each other or usual care (i.e. education only): pharmacological (e.g. antifungal creams); non-pharmacological topical treatments (e.g. lanolin); dressings (e.g. hydrogel dressings); nipple protection devices (e.g. breast shells), phototherapy, and expressed breast milk. Nipple pain in women who are feeding with expressed breast milk (i.e. women of infants in neonatal units) is associated with other methods of removing milk from the mother's breast such as manual expression and various types of breast pumps. Nipple pain and subsequent treatment is different in this unique maternal population and thus we excluded women solely feeding with expressed breast milk from this review.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion, extracted data, evaluated methodological quality, and checked data for accuracy. We sought additional information from several trial researchers.

MAIN RESULTS

We included four trials of good methodological quality involving 656 women in the review. The four included trials evaluated five different interventions including glycerine pads, lanolin with breast shells, lanolin alone, expressed breast milk, and an all-purpose nipple ointment. All studies included education to position the infant at the breast correctly as part of routine postpartum care to both treatment and control groups.Pooled data existed only for the comparison of lanolin versus usual care. We did not pool data for other outcomes due to either heterogeneity in outcome measures or differing interventions.There was no evidence that glycerine gel dressings or breast shells with lanolin significantly improved nipple pain. One trial found no clear differences in nipple pain (at one to three days, four to five days, or six to seven days' post-treatment) between women who applied lanolin or nothing to their nipples. In contrast, the same trial found that women who applied expressed breast milk had significantly lower perceptions of nipple pain following four to five days of treatment than women who applied lanolin. However, this beneficial effect was not maintained after six to seven days of treatment. There were no group differences in nipple pain perceptions at any assessment between women who applied expressed breast milk and women who applied nothing. Women who applied an "all-purpose nipple ointment", in comparison to women who applied lanolin, had no improvement in nipple pain after seven days of treatment. There was insufficient evidence that glycerine gel dressings, lanolin with breast shells, lanolin alone, expressed breast milk, or all-purpose nipple ointment improved maternal perceptions of nipple pain.Overall, there was insufficient evidence to recommend any intervention for the treatment of nipple pain. However, one important finding was that regardless of the treatment used, for most women nipple pain reduced to mild levels after approximately seven to 10 days' postpartum. The provision of anticipatory guidance regarding usual time to pain reduction may be a useful strategy in assisting women to continue to breastfeed and to do so exclusively. The overall quality of the evidence for the primary outcome of nipple pain as assessed using GRADE was of low quality, mainly because single studies with few participants contributed data for analysis.

AUTHORS' CONCLUSIONS

There was insufficient evidence that glycerine gel dressings, breast shells with lanolin, lanolin alone, or the all-purpose nipple ointment significantly improved maternal perceptions of nipple pain. The results from these four trials of good methodological quality suggested that applying nothing or just expressed breast milk may be equally or more beneficial in the short-term experience of nipple pain than the application of an ointment such as lanolin.The quality of the evidence for this review did not lead to robust conclusions regarding the objectives assessed. We included only four trials, incorporating 656 women, in the review and all four trials compared varying interventions, participants, study outcome measures, and standards of usual care. The methodological quality of the included studies was good but the overall quality of the evidence for the primary outcome of nipple pain was of low quality, mainly because single studies with few participants contributed data for analysis.

Comparison of the effect of human milk and topical hydrocortisone 1% on diaper dermatitis

Diaper dermatitis is one of the most common skin problems in infants and children, affecting between 7% and 35% of infants. This randomized clinical trial compared the efficacy of hydrocortisone 1% ointment with that of human breast milk in treating acute diaper dermatitis in infants ages 0 to 24 months. Infants with diaper rash were treated with either hydrocortisone 1% ointment (n = 70) or human breast milk (n = 71) for 7 days. Improvement in the rash from baseline was seen in both treatment groups on days 3 and 7; there was no significant difference in total rash scores on days 3 and 7. Treatment with human breast milk was as effective as hydrocortisone 1% ointment alone. Human breast milk is an effective and safe treatment for diaper dermatitis in infants.

Prevention of and Therapies for Nipple Pain: A Systematic Review

OBJECTIVE

To review the literature on nipple pain and to delineate effective strategies for the prevention and treatment of nipple pain in breastfeeding mothers.

DATA SOURCES

Computerized searches on MEDLINE, Pre-MEDLINE, CINAHL, and the Cochrane Library.

STUDY SELECTION

Articles from indexed journals relevant to the objective were reviewed from January 1983 to April 2004. Preference was given to research-based studies in English.

DATA EXTRACTION

Data were extracted and organized under two headings: prevention of nipple pain or trauma and treatment of nipple pain or trauma. The Critical Appraisal Form by J. Briggs was used to extract the data from research-based articles.

DATA SYNTHESIS

The health benefits of breastfeeding for mother and infant are well documented; however, nipple pain is a common reason reported by women for the early termination of breastfeeding. Several studies have compared various treatments for either the prevention of or treatment for nipple pain. These treatments include warm water compresses, tea bag compresses, heat, application of expressed mother's milk, lanolin, vitamin A, collagenase, dexpanthenol, hydrogel therapy, glycerin gel therapy, moist occlusive dressing, education regarding proper latch-on and positioning, and no treatment.

CONCLUSIONS

No one topical agent showed superior results in the relief of nipple discomfort. The most important factor in decreasing the incidence of nipple pain is the provision of education in relation to proper breastfeeding technique and latch-on as well as anticipatory guidance regarding the high incidence of early postpartum nipple pain.

Pain reduction and treatment of sore nipples in nursing mothers

Health-promotion goals include increasing the duration of breastfeeding because of its irrefutable advantages to the mother and baby, society, and the environment. However, many mothers experience painful, sore nipples during breastfeeding and stop nursing before they intended (Livingstone & Stringer, 1999). The experimental trial described in this paper randomized 94 breastfeeding women with sore nipples into three treatment groups. Midwives practicing in hospitals in Latvia assessed the participants' breastfeeding practices, then gave the mothers individualized education and corrective interventions using a guided documentation form, the Lactation Assessment Tool (LATtrade mark). In addition, two groups were instructed to use commercial products on their breasts and nipples: breast shells and lanolin cream for one group, and glycerin gel therapy for the other. Nipple pain during breastfeeding was rated by the mothers on a 5-point verbal descriptor scale at each visit, and pain at the start of treatment was compared to pain at the last visit. Analysis of variance (using Fisher's Exact Test) determined that no significant differences existed between the groups: F(2, 86) = 1.34, p > .05. Almost all of the mothers experienced nipple healing, as assessed by the midwife. Mothers in the glycerin gel group were more satisfied with their treatment method, but this finding was not statistically significant. The results of this study indicate that effective care and perinatal education for nursing mothers with sore nipples should include assessment of breastfeeding positioning and latch-on, as well as education and corrective interventions using a guidance tool, whether or not commercial preparations are used.

Comparing the use of hydrogel dressings to lanolin ointment with lactating mothers

OBJECTIVE

To evaluate the use of hydrogel dressings for the prevention and treatment of nipple soreness in lactating women as compared with the common intervention of lanolin ointment. The hypothesis was as follows: Participants using hydrogel dressings as a preventive measure for nipple soreness will experience greater pain relief and a lower rate of nipple wounds as compared with the control group. The secondary hypothesis was that the reduction of nipple soreness in the treatment group would produce a longer duration of breastfeeding as compared with the control group.

DESIGN

A multicentered, prospective, randomized controlled clinical trial evaluating a sample of 106 lactating mothers.

SETTING

Study sites were the University of Alabama Medical Center at Birmingham (an inner-city teaching hospital) and Northeast Health System (a community hospital in Beverly, Massachusetts).

PARTICIPANTS

Participants were older than age 18, fluent in English, and had an operational telephone in the residence. Other inclusion criteria were singleton, vaginal deliveries; no prior breastfeeding experience; and written informed consent.

INTERVENTIONS

Participants were randomized to either the lanolin ointment or the hydrogel dressings group and received instructions specific to their assignment. All participants received breastfeeding education provided by a board-certified lactation consultant.

MAIN OUTCOME MEASURES

During the initial 12 study days, participants identified pain intensity using a numeric pain intensity scale and verbal descriptor scale. Subjective data were collected via self-reported skin assessments of the bilateral breasts, nipples, and areolae. Breastfeeding duration was established by a follow-up telephone call at 2 months.

RESULTS

The hydrogel dressings group had significantly greater reduction in pain score mean values at baseline, on study Day 10, and on study Day 12 in comparison to the control group. Participants using the hydrogel dressings discontinued treatment sooner than participants in the lanolin ointment group. The lanolin ointment group had eight breast infections, whereas the hydrogel dressings group had none.

CONCLUSION

Hydrogel dressings are a safe, available treatment that provided more effective pain management for nipple soreness than the common intervention of lanolin ointment.

Management of nipple pain and/or trauma associated with breast-feeding

OBJECTIVE

The objective of this systematic review was to present the best available evidence related to the management of nipple pain, post childbirth in breast-feeding women. The specific objective of the review was to determine the effectiveness of interventions used by and for breast-feeding women to prevent and/or reduce nipple pain and trauma.

SELECTION CRITERIA

The review considered all studies that included women who breast-fed with or without painful or traumatised nipples of any aetiology post childbirth.Interventions of interest were: (i) interventions aimed to prevent or reduce pain and/or trauma to nipples post commencement of breast-feeding; and (ii) treatments for painful or traumatised nipples post commencement of breast-feeding.The primary outcomes of interest were those related to the prevention and treatment of nipple pain and/or trauma in women post childbirth, in terms of:This review considered randomised-controlled trials (RCT) that evaluated the effectiveness of interventions and treatments associated with breast-feeding practices. In the absence of RCTs other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion in a narrative summary to enable the identification of current practices and possible future strategies.

SEARCH STRATEGY

The search sought to find both published and unpublished studies in the English language. Databases were searched up to and including August 2002 and included MEDLINE, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), The Australian Breast-feeding Association Lactation Resource Centre, Dissertation Abstracts and Proceedings First. The reference lists of all identified studies were searched for additional studies.

ASSESSMENT OF METHODOLOGICAL QUALITY

All studies were checked for methodological quality using two reviewers, and data were extracted using a data extraction tool.

RESULTS

There is a plethora of research that evaluates the effectiveness of the many interventions used to prevent or treat nipple pain and or trauma for breast-feeding women. Most of the studies were heterogeneous with regard to sample demographics, interventions evaluated and outcomes assessed. For this reason the majority of the review is in narrative form, with graphical presentation via meta-view graphs of the more statistically significant outcomes. Consistent information given in education sessions to breast-feeding women would assist in identifying which type of instruction is the most effective; however, different education information was given in the studies or no details were supplied as to what education was actually given.Many of the RCTs in this review were based on small sample sizes and specific sociocultural settings. Small sample sizes limit the ability to reliably generalise findings, as there is a risk of false positive results. Furthermore, in some cases, studies did not attain statistical significance although they may have if larger sample sizes had been used. These are common limitations associated with RCTs. The authors of this review recommend full consideration be given to the sample size and study setting prior to implementation of the review recommendations in order to determine applicability to varied clinical settings. The results section highlights sample size issues for each included study.With this limited evidence, no single intervention was identified that offers a dramatic effect in terms of treating pain and or trauma in breast-feeding women. However, there is potential for some benefits for reducing pain and increasing comfort and thereby maximising breast-feeding duration.

CONCLUSIONS

In terms of prevention, warm water compresses are recommended for the prevention of nipple pain, and simply keeping the nipples clean and dry is recommended for the prevention of cracked nipples. In terms of treatment, warm water compresses are recommended for the reduction of nipple pain, and expressed breast-milk reduces the duration of cracked nipples. Hydrogel dressings were associated with a high incidence of infections and their use cannot be recommended. Systemic antibiotics are recommended if a positive culture for Staphylococcus aureus is obtained.Education for positioning and attachment of the baby to the breast for breast-feeding women needs further studies to assess whether it is more effective as a preventative measure for nipple pain and/or trauma. Warm water compresses warrant further investigation into their effectiveness in nipple pain. Studies assessing the impact of engorgement, pacifiers and feeding bottles on nipple pain and/or trauma are suggested.Further investigation of the interventions used in many of these studies could be conducted using one intervention at a time in comparison to no treatment. Specific research priorities should include RCTs to assess: (i) lanolin in comparison to no treatment; (ii) lanolin and shells in comparison to no treatment; and (iii) expressed breast-milk in comparison to no treatment.

The treatment of Staphyloccocus aureus infected sore nipples: a randomized comparative study

Sore, cracked nipples are commonly experienced by breastfeeding mothers. We have previously reported a strong correlation between sore, cracked nipples and S. aureus colonization. A prospective, randomized clinical trial was performed to compare four treatment regimes for S. aureus infected sore nipples. Eighty-four breastfeeding mothers were enrolled in the study. After 5 days to 7 days of treatment, only 8% of mothers showed improvement in the "optimal breastfeeding technique alone" group, 16% improved with topical mupiricin, 29% improved with topical fusidic acid, yet 79% improved with oral antibiotics (p < .0001). Optimal breastfeeding techniques and topical antibiotics ointment failed to heal most infected, sore, cracked nipples. Mastitis developed in 12% to 35% of mothers not treated with systemic antibiotics compared to 5% of mothers treated with systemic antibiotics (p < .005). In conclusion, S. aureus infected sore, cracked nipples should be diagnosed as a potentially widespread impetigo vulgaris and treated aggressively with systemic antibiotics in order to improve healing and decrease the risk of developing mastitis due to an ascending lactiferous duct bacterial infection.

Changing nursing practice through research utilization: consistent support for breastfeeding mothers

This research utilization project was designed to increase staff nurse support for four early postpartum breastfeeding practices: initiation in the delivery room, high frequency feedings, unlimited suckling time, and no supplementation. Research links these practices with lower neonatal bilirubin values and an earlier onset of lactation. An organizational approach to research utilization was taken to encourage nurses to support mothers in the desired breastfeeding practices. A before and after design was used to evaluate the extent to which the intended patient outcomes were achieved with the practice changes. The percent of infants having bilirubin tests decreased significantly. No significant differences were observed in mean bilirubin levels, incidence of hyperbilirubinemia, or lactation onset. The project promoted state-of-the-science nursing care and helped our nurses become more adept in using research to guide practice.

Does application of tea bags to sore nipples while breastfeeding provide effective relief?

OBJECTIVE

To evaluate effectiveness of water versus tea bag compresses in treatment of sore nipples during breastfeeding.

DESIGN

Prospective, randomized trial.

SETTING

Mother-infant care wards in a tertiary care teaching hospital.

PARTICIPANTS

Sixty-five primiparae with sore nipples who were breastfeeding after a vaginal delivery at 37 or more weeks gestation, who were 36 hours or less postpartum, and had combined mother-infant care.

INTERVENTIONS

Participants were assigned randomly to one of six treatment groups with one of three regimens (tea bag compress, water compress, or no compress) randomly assigned to right or left sides. Participants applied the treatments at least four times a day, from Days 1 to 5 postpartum.

MAIN OUTCOME MEASURE

Reduction of nipple pain.

RESULTS

Tea bag and water compresses were more effective than no treatment, with no statistically significant difference between the two types of compresses.

CONCLUSION

Warm water or tea bag compresses are an inexpensive, equally effective treatment for sore nipples during the early postpartum period.

A comparison of topical agents to relieve nipple pain and enhance breastfeeding

BACKGROUND

Nipple soreness is one reason why breastfeeding women wean their infants. This study examined the effectiveness of three topical agents--USP-modified lanolin, warm water compresses, and expressed breast milk with air drying--in alleviating nipple pain, and if early predictors of breastfeeding at six weeks could be determined.

METHODS

One hundred seventy-seven breastfeeding, primiparous women were randomly assigned to one of four groups. All women received education about breastfeeding technique. Numeric rating scales were used to discriminate levels of pain intensity, pain affect, and strength of sucking on day 1. Participants were interviewed by telephone on postpartum days 4, 7, and 14, and during week 6 using the same scales.

RESULTS

No significant differences were found among groups for pain intensity, pain affect, or duration of breastfeeding. Results of a logistic regression indicated that older mothers and those who were exclusively breastfeeding (no supplemental feeding) were most likely to be breastfeeding six weeks postpartum. Raw scores supported the use of warm compresses.

CONCLUSION

Further investigation is required into ways of supporting young mothers and how caregivers provide support to breastfeeding mothers in the early weeks after childbirth.

Psychological aspects of nipple pain in lactating women

The aim of the study was to assess the psychological impact of nipple pain in lactating women. Forty-eight lactating women with nipple pain completed mood scales at their first visit and following resolution of their pain, and 65 lactating women without nipple pain completed one set of mood scales. At the first visit, the mean score on the Edinburgh Postnatal Depression Scale (EPDS) in the nipple pain group was 12.4 and the control group was 7.6 (p < 0.0001). Eighteen women (38%) scored above the threshold for depression (> 12), compared to nine in the control group (14%): p < 0.01. Following pain resolution, the mean score on the EPDS decreased to 7.3 (p < 0.001); and six women (16%) scored 13 or over on the EPDS, significantly less than initially (p < 0.05). Similarly, on the Profile of Mood States (POMS), the nipple pain group scored significantly higher than control group on all mood factors (Tension, Depression, Fatigue, Confusion, Vigor [lower]), except Anger which did not reach a level of significance. After pain resolution, POMS scores returned to similar levels as the control group. In conclusion, both the EPDS and POMS indicated women with nipple pain were experiencing high levels of emotional distress. However, once the pain had resolved their distress also resolved.

Breast engorgement: patterns and selected outcomes

For 14 days following birth, 114 breastfeeding mothers rated their level of breast engorgement twice daily, using a six-point engorgement scale. Individual engorgement ratings were plotted by intensity over time to provide a visual display of each subject's breast engorgement experience. Four distinct patterns of breast engorgement emerged; mothers experienced either a bell-shaped pattern, a multi-modal pattern, a pattern of intense engorgement, or a pattern of minimal engorgement. Characteristics of mothers and infants, and feeding frequency were similar across the four breast engorgement patterns.

The occurrence of breast engorgement

This study describes breast engorgement during days 1-14 postpartum of 114 first and second time vaginal- and cesarean-delivery breastfeeding mothers. Most mothers reported experiencing their most intense engorgement after hospital discharge. Previous breastfeeding experience of the mother is a more critical variable than parity in predicting engorgement. Second time breastfeeding mothers experienced engorgement sooner and more severely than did first time breastfeeding mothers, regardless of delivery method. Anticipatory guidance by the care provider is discussed in an effort to enhance the experience of the breastfeeding dyad.

Twenty cases of persistent sore nipples: collaboration between lactation consultant and dermatologist

The nipple and surrounding area, like other areas of skin, are subject to irritation, inflammation, and infection. Twenty women with persistent sore nipples were first seen by a lactation consultant and later referred to a dermatologist. The dermatologist successfully treated 18 of the 20 mothers. A lactation consultant should be able to identify those women who will benefit from evaluation and treatment by a dermatologist.

Breastfeeding care in Ohio hospitals: a gap between research and practice

OBJECTIVE

To assess current breastfeeding care in Ohio hospitals and compare that care to research-based principles.

DESIGN

Survey.

SETTING

Ohio hospitals that provide maternity care.

PARTICIPANTS

All 141 Ohio hospitals that provide maternity care were invited to participate. One-hundred sixteen (83%) hospitals returned usable surveys completed by obstetric nurse managers.

MAIN OUTCOME MEASURE

A 38-item questionnaire provided data on hospital demographics and information regarding the care of breastfeeding mother-infant dyads.

RESULTS

Research-based practices common in Ohio's hospitals include demand feeding, breastfeeding education, and breastfeeding as the initial neonatal feeding. Common non-research-based practices include supplemental fluid administration, postpartum nipple treatments, mandatory initial nursery stays, limited sucking time, restricted maternal-infant contact, distribution of formula packs, minimal follow-up care, and the suspension of breastfeeding for hyperbilirubinemia.

CONCLUSIONS

Despite positive changes in perinatal care, a number of non-research-based practices persist in Ohio hospitals for the care of the breastfeeding mother-infant dyad.

Breastfeeding fallacies: their relationship to understanding lactation

When inaccurate information is the basis for clinical decision making, patient care is likely to be incomplete, inappropriate, and potentially harmful. We identified 17 fallacies relating to lactation and breastfeeding that exist in the professional and lay literature and that continue to be perpetuated among care providers and shared with new mothers. The inappropriateness and inaccuracy of these beliefs, and how they influence attitudes about, and practices relating to, breastfeeding, are discussed. Alternatives to these fallacies exist, and their use may contribute to more relevant care and advice giving, and to successful breastfeeding.

Functional assessment of infant breastfeeding patterns

As breastfeeding rates have increased in the United States, the need has arisen for coordinated approaches to the assessment of normal and problem situations. Since some difficulties are related to the manner in which baby feeds, guidelines are discussed for the visual assessment of breastfeeding. These include the when, why, and how of assessing seven common situations or problems: initial breastfeeding experiences, inadequate infant weight gain or low milk intake, insufficient milk supply (real or perceived), nipple problems, latch-on and sucking disorganization, high-risk situations, and the good baby syndrome.

Breast engorgement: contributing variables and variables amenable to nursing intervention

The focus of this study was to identify variables that correlate significantly with breast engorgement and that might be amenable to nursing interventions. Data on the initiation of feeding, frequency of feedings, feeding duration, rate of milk maturation, and supplementation were obtained of 54 women. These variables were found to be significantly correlated with breast engorgement.