Brenda writes: "A midwife has started prescribing Lidocaine 2% for sore
nipples.  Her
instructions include applying the medication post-feedings and washing
nipples pre-feedings.  This concerns me.  Have I missed something in my
years as an LC...Is this a new treatment?  Is it evidenced based?  Is it
a standard of care anywhere?  Is this treatment included in anyone's
policy and procedures?"

Brenda's questions are exactly the ones that should be put to the midwife
who is engaging in this practice, since it seems to be in her procedure set.
Well and good that she realizes nipple pain is a bad thing, but it would be
better for the women she looks after if she went after the cause of the
pain, rather than the nerves that transmit it. Better because ifixing the
problem is more likely to help them to get better, and because her approach
supports the notion that breastfeeding is painful unless you use drugs to
deal with it.  She needs to be asked about it: 'I have not seen this
treatment used for sore nipples before. Would you share the references you
have for its safety and efficacy for this problem?'
or, if you are feeling especially mischievous, 'I'm contacting you to let
you know that mother XX seems to have misunderstood what the lidocaine gel
was for.  You won't believe this, but she was actually applying it to her
NIPPLES rather than her perineum!'  

We use Lidocaine 2% for mothers who have anterior tears that make them
hesitant to empty their bladders.  They slather it on wherever they are
hurting, so they can pee.  It would never occur to me to put it on sore
nipples, and if I hear a mother request anesthetic for her nipples you
better believe she will be the first person I take a closer look at on that
shift!

By contacting the midwife privately, you can show that you are open to the
idea that she has found some research evidence that has escaped the notice
of the entire breastfeeding community, and you may even enlighten her about
other, more appropriate ways of dealing with nipple pain. 

Good luck, and if you do get some references from her, be sure to post them
here!
Rachel Myr
midwife and IBCLC in Kristiansand, Norway

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