Dear Lactnetters

I am finding myself getting a little bit miffed about the derogatory
statements being made about Tincture Benzoin.  Lo and behold instead of
remaining academic as my original e-mails were I find myself defending it!

I worked for many years sometimes 10 hours a day, 6 days a week in the
l960's and l970's and used Tinc Benz co for fissures in midwifery practice.
It was used here regularly until the l980's by major teaching hospitals
when nipple cracks were common.  I have been a midwife since l962.  In
order to gain credibility however I passed the IBCLC exam in l995.

With the improvement of Australian breastfeeding rates (being currently the
best in the cows milk formulae invaded Western world) there is anecdotal
evidence that there has been a reduction in cracked nipples  We also have
the highest per capita ratio of IBCLC's in the world.

In my experience and from observation of clinical practice over 35 years I
did not see babies  gag. The babies were not drinking from a fresh Tinc
Benz bottle they were attaching well to a pain free mother who only needed
about two applications.  It would be difficult to carry out a trial these
days but I need your evidence that babies would gag.

PRETERM BABIES AND TINC BENZ

I too have worked in NICU in l983 and used Tinc Benz for holding strapping
on.  It was used on very tiny preterms skin, much more sensitive than
nipple tissue and quite thin.  Some of these babies are 26 weeks and weigh
800 grams and if they can tolerate it without all the supposed gagging and
skin damage (after all it is put right under their tiny little noses) why
would full term and healthy mothers have problems? .

BELOW IS A REPLY FROM Ros Escott to me on this subject.

Bev

I have done an extensive literature review on the management of sore
nipples, including critical appraisal of some very shonky studies.

I have not found a single study on the efficacy of Tinc Benz. Rather than
finding why it was withdrawn, why not look for research on whether it was
ever shown to be effective on sore nipples in the first place.

Your best source of information on its effectiveness on wounds, and why is
went out of favour, would be the dermatology and wound healing literature.

My understanding of how it works suggests that it was an early attempt at
moist wound healing in the sense that it formed a "skin" over the wound
and would therefore have reduced moisture loss. However, the alcohol base
would be drying and irritant. Adding castor oil was probably an attempt
to reduce the drying aspect, and to some extent would enhance moisture
retention by coating the nipple with oil.

I would expect both the Tinc Benz "skin" and the castor oil to be
occlusive, and that is probably why the caution to only use it on the
fissure itself and NOT the surrounding skin.  Occlusive topical don't
allow oxygen transfer and can prevent all moisture loss, leading to
maceration in the skin surrounding the wound, making it more prone to
damage. Oils tend to stay on the skin and are not useful for promoting
moist wound healing as we know it today.

My guess about why it was withdrawn and reinstated?  Despite all the
purists in the lactation world who say "nothing on the nipples but the
baby", mothers with sore nipples want to apply something and they
invariably do, even if that have to wait till they leave hospital.
Many midwives working with mothers with sore nipples also find it hard to
eschew all topical applications when a mother has painful open
wounds on her nipples. It is only natural to seek out a product that
appears to help.

I think that is why moist wound healing with a suitable lanolin product,
or with a hydrogel, has caught on. The purist line is difficult to follow
for both mothers and midwives. Besides, the Sydney study (when it is
published) will show dramatically different healing times between
nipples managed with moist healing or the dry (purist) approach.

Ros