Nikki and all, It is true that the Blair study showed no decrease in pain or increase in healing in mothers using Soothies or Lansinoh and that the results were comparable to the mothers who used no product. The Dodd and Chalmers study looked at a different product--a water-based hydrogel rather than a glycerin-based hydrogel. And mothers *did* report greater reduction in pain as compared with the group using Lansinoh and used the hydrogel for a signficantly shorter time than the mothers using Lansinoh. The Dodd and Chalmers study was missing a "no product" group, even though one was included in the original study design. When the study was brought before the two institutions' Internal Review Board, they decided that a "no product" group was unethical. They explained that if a product exists that decreases women's pain during breastfeeding, it would be unethical to withhold it and risk premature weaning. To clarify, the Dodd and Chalmers study is not a "Hollister study," as it took place before Hollister purchased this product for distribution. Also to clarify, the women I described as being "gun-shy" were not those in the study. These were the mothers I saw in my practice, who even after a 2-hour home visit, unlimited phone follow-up, and the option of seeing me again, tended to use the products longer than truly "necessary," just to be on the safe side. Once a mother experiences moderate to severe nipple pain, I think that's a natural reaction. And frankly, I didn't see anything wrong with that if it keeps them breastfeeding. Especially when the product is consistent with "first do no harm." The Dodd and Chalmers study followed women by phone for up to 72 days to determine if any mothers developed infections (yeast or bacterial) as a result of using these products. None of the mothers using the water-based hydrogel developed infections (even those in Alabama!) compared with 8 in the Lansinoh group. The infections in the Lansinoh group reflected an average incidence of infection and was not assumed to be caused by Lansinoh. I share your sadness, Nikki, that women do not breastfeed exclusively and that pacifier use contributes to breastfeeding problems. I agree with you that products are no substitute for good breastfeeding education. (The Duffy 1997 study we discussed in previous LN posts found that one class CAN have a significant effect on nipple trauma AND breastfeeding duration.) In my experience hydrogels can be a helpful addition to good education and help. Ros Escott, an Australian LC I greately admire, suggests we consider using a three-pronged approach to nipple treatment: 1) Remedy the underlying cause of the nipple damage, 2) Offer symptomatic relief, and 3) Assist in the restoration of skin integrity. Hydrogels can help with both 2) and 3). Research on water compresses is far more mixed. (I'd be glad to share references.) I agree that mothers should receive all the education and services they need to succeed at breastfeeding. I know from first-hand experience during my 10 years in private practice how many mothers "fall through the cracks" after they leave the hospital. Improvement is desperately needed in this area. Nancy Mohrbacher, IBCLC Lactation Education Specialist, Hollister, Inc. Distributor of the Ameda ComfortGels researched in the Dodd and Chalmers study 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. *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html