Working form my own experience here with a persistent cracked nipple,  
though my situation is not quite the same.

I had a crack that was caused by my overzealous unplugging of a  
plugged duct.  I tried over the counter polysporin/ lanolin/ soaking  
with olive oil (thought it was a persistent bleb at the time) off and  
on and the crack took 3 months to heal.  Through that time nursing was  
somewhat painful.  I had another crack, again caused the same way as  
the first, when Anna was 10 months old.  I finally saw my GP after  
about 2 months, who prescribed bactroban ointment.  I spoke to another  
friend who is also a GP and she suggested that in addition to the  
ointment, I try using a piece of plastic wrap over the nipple to  
create a moist healing environment as well as using heat.  By this  
time the crack had worsened due to my baby biting me while teething  
(she popped out 3 teeth in a week) and I started getting nipple  
blanching which was very painful.

With the use of heat, bactroban, and some saran wrap, the crack healed  
in about 10 days.  I was impressed how the plastic wrap helped.  It is  
cheap, most people have some in the kitchen and it stays on without a  
bra.  It also keeps the antibiotic ointment where it belongs and  
prevents it from getting on your clothes.  I mostly used it at night  
and used it when I remembered in the day, allowing time for my nipple  
to get some air.  I would also like to thank Dr Leeper here at lactnet  
who suggested a heating pad on warm over clothes after feeds to help  
get vasospasm under control.  It helped and was soothing.

Cordelia Merritt  RN BSN IBCLC


ate:    Thu, 18 Dec 2008 13:48:14 -0600
From:    laurie wheeler <[log in to unmask]>
Subject: persistant sore nipples

Hi Sarah,
Poor mom!
Here are some things I am thinking of to help this mom, in no certain  
order.
Check for tongue tie, even though she's mostly sore on one side.
Check for signs of torticollis, where baby would have difficulty  
positioning
on one side and possibly clamping down, with face/neck muscle tone  
issues.
Possible CST or chiropractic for baby to help if clamping down or for  
tight
muscles.
I am a big proponent of washing wounded nipples with a mild soap 2-3x  
per
day, rinse with warm water or warm salt water and pat dry with clean  
cotton
cloth. Then applying an antibiotic ointment, in addition to oral  
antibiotics
for wounds not healing. Gel pads seem to work well for my clients with
wounds. These are for moist wound healing.
Make sure not only is baby latching with a wide gape but being held  
close
throughout the feeding, so there is no stretching, pulling, etc.
I believe also a good diet, possibly vitamins will help with wound  
healing.
If signs of Raynaud's phenomenon, warmth applied as soon as nipple is
released.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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welcome

------------------------------

Date:    Thu, 18 Dec 2008 13:48:36 -0600
From:    dheffern <[log in to unmask]>
Subject: keeping everyone on the same page

If your facility, like where I work, has trouble with different staff
members giving different instructions to the mom about when to feed her
baby, you might want to use our poster.  Since we wanted everyone  
=93on =
the
same page,=94 the art department created a poster that gives the =
impression of
an open book. The left page talks about feeding cues, the right page =
talks
about other things we want the parents, the grandmas, and *the staff* to
know and follow.  We call it the =93Book on Breastfeeding=94 poster.  
We =
have it
laminated and it hangs in all 78 postpartum rooms (and I think maybe  
in =
the
L&D rooms, too).  Eventually it would be great to get it into the clinic
exam rooms.  We=92ve been using it for the past year and a half, and =
it=92s been
a great help for both parent and staff education. Having it hanging on =
the
wall sends a clear message that this is what we believe.
=20
Some might disagree with the final bullet point about =93it=92s time  
to =
feed
your baby if. . . .he hasn=92t breastfed in the past 2-3 hours=94  
since =
timing
is less of a focus now.  We had to put that in to get it past Nursing
approval.  But it=92s okay.  We just tell the mom to get baby =
skin-to-skin if
it=92s been 2 -3 hours and then to follow the baby=92s cues.  We have =
problems
with moms wanting to send the baby to the nursery for the night, so the
final bullet point on the right is our attempt to address that it=92s =
not
going to let her get any more sleep.
=20
You can take a look or download it for your facility from the =
=93resources=94
page of  the Missouri Breastfeeding Coalition website at HYPERLINK
"http://www.mobreastfeeding.org/"www.mobreastfeeding.org. Click on
=93resources=94 and scroll down.  If you decide to use it, please send =
me an
email privately, so I can notify the hospital administration.  This is =
from
a Sisters of Mercy hospital with a mission to serve, and they like to =
know
where they=92ve been helpful.
=20
Debbi Heffern, RD, IBCLC
[log in to unmask]
St. Louis, MO, USA
=20

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