Dear Friends:
Another study that studied hydrogel and lanolin was the Blair study,
published last year in Breastfeeding Review Vol11(2) 2003 ("The relationship
between positioning, the breastfeeding dynamic, the latching process, and pain in
breastfeeding mothers with sore nipples"); the same authors (Blair, Cadwell,
Turner-Maffei et al) also published "Pain Reduction and Treatment of Sore
Nipples in Nursing Mothers" in J Perinatal Ed 13(1) 2004, 29-35.
Mothers in this study found hydrogel to be more soothing to nipple
soreness than lanolin cream and shells, although the difference wasn't significant.
However, a key part of the Blair study was that there was a third group that
used no product at all, and received only assessment, education and corrective
interventions. All groups received assessment, education and corrective
intervention. All were exclusively breastfeeding.
The results of this study showed that all groups had reduction in nipple
soreness and improvement in nipple healing. There was no significant
difference between the groups, meaning that products made no more difference in
resolution of soreness and improvement in healing than only improving latch and
positioning.
If mothers are not educated and supported in learning about correct
positioning, wouldn't it be natural for them to assume that it is the product that
makes the difference? Wouldn't that explain them purchasing product for a
month after delivery? Wouldn't that explain them being "gun-shy" about
breastfeeding without product?
What the Hollister study does show is that a one-hour prenatal
breastfeeding class is insufficient to prevent nipple soreness, no matter who teaches it.
I am saddened that the assumption in the Hollister study is that mothers
can't receive "extensive breastfeeding education" once their baby is born. The
authors of that study ask, "Although certainly ideal, is extensive patient
education truly realistic in today's health care setting?" (p.492)
Do we accept that good education in other situations in hospitals, such
as with dressing changes and ostomies is not realistic and provide alternatives
to good care? This is a rationale behind overuse of nipple shields.
Mothers in the Blair study all had nipple soreness to begin with; mothers
in the Hollister study were enrolled because they were breastfeeding and
assumed to become sore.
It is also sad to accept that mothers don't breastfeed exclusively and
that they use pacifiers routinely. While we know those things are true, I
believe that all of us here are working to make a difference in both those
conditions. Is the answer is for mothers to buy product, and be ignorant of all the
factors that promote nipple soreness?
A company that manufactures the product and profits from it, is not free
of influencing the results of a study about that product. This is the reason
for disclosure.
At the same time, it is valuable to see that hydrogel pads now have
support from two studies showing that mothers find them more soothing than other
methods, although neither study considered what Ziemer reported. Ziemer found
that mothers were soothed with cool, wet compresses.
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct Faculty Union Institute and University
Film Reviews Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative
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