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Subject:
From:
Tricia Shamblin <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 25 Sep 2016 11:33:43 +0000
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As someone who suffered with terrible soreness for 6 weeks with her first infant I would be happy to recommend anything that helps to reduce early soreness with breastfeeding. From personal experience I know how excruciating that can be. In hindsight though I'm sure the problem was that I did not have her latched on well to the breast. I was young though and had absolutely no idea what I was doing with breastfeeding. Thankfully I think the baby finally figured it out more than me. However, I'm having more and more trouble recommending these creams and an aid to reducing soreness until I see some more evidence that they actually work. I agree with the posting below, I would like to see some research information that we can be sure is free of bias as well. Outlined below are my main problems with these creams:
1. Possible interference with infant's sense of smell. We now know that the infant uses all its senses to find its way to the breast including the senses of smell and taste. Could these creams interfere with these senses? Peppermint oil definitely has a strong scent. The montgomery glands secrete an oil that lubricates skin, gives off a scent to attract into to nipple and secretes antimicrobial factors that help reduce risk of infection. What happens when we cover this with an oil? Even a natural one? The answer to this question is unknown at this time. 
2. Possible impact on the infant's gut microbiome. We know that these early colostrum feedings are so important for many reasons including colonizing the infant's intestine with good bacteria and keeping it away from microbes that aren't supposed to go in it's gut. Could there be a possible impact to the intestine of introducing substances which the infant was not meant to ingest at this time? Anything the mother puts on her nipples the baby eats. An LC wrote once that she doesn't recommend Motherlove because it still has many ingredients that wouldn't pass her "toast test." If she wouldn't spread it on her toast and eat it, she wouldn't recommend that a mother use it on her nipples. Very wise, I think.
3. Potential allergic reactions. It is possible to be allergic to anything, even natural things. The early exposure to allergens in formula such as dairy, soy and corn have been shown to increase risk of allergic sensitization, could early exposure to substances in these creams also increase risk of allergic sensitization? There have been many case reports of allergic reactions to these creams in the infant's mouth and mother's breast.
4. There is not any conclusive reasearch evidence supporting their use. The Cochrane review that was recently cited in this thread reviewed research (though definitely not comprehensive research) and concluded that there was no evidence that these creams and hydrogel dressings speeded healing time or reduced the mother's perception of pain. The APNO ointment actually had the very least evidence to back it up. One study showed no improvement. The lanolin cream and hydrogel dressings each had one study showing an improvement and one study that didn't show an improvement. The APNO ointment had nothing showing any improvement. 
5. First do no harm. I can't in good conscience recommend something that doesn't clearly have evidence to back it up knowing that when we recommend treatments without evidence of benefit, there is always the potential risk of harm. 
6. Increased risk of mastitis and thrush. There was a study that showed women who used these creams had an increased risk of thrush and mastitis. It seems to me that when you have an open wound, that a warm, moist environment is going to create a breeding ground for bacteria.
7. Bias in research studies. Too often there is the problem that the research study supporting the use of a product has been funded by the manufacturer of the product. We understand how this impacts research from formula companies about the formula they are selling. But how many of us are aware that study about lanolin cream funded by lansinoh, or the fact that 15 out of the 25 studies about how great breast pumps are, were funded by the companies manufacturing the breast pumps. I'm increasingly worried about researchers being free of bias when they are paid by the companies whose products they are researching. I'm so glad that ILCA and IBCLE are taking a stand on this serious problem. How can we believe the accuracy of this research if there is the possibility of bias?
8. New parents are heavily targeted by advertisers. Breastfeeding women in the United States have really clearly gotten the message from manufacturers of commercial companies that they "need" these nipple creams to be successful at breastfeeding. It's been a long time since I've seen a new breastfeeding mother that doesn't already have a stash of various nipple creams and seems to feel they are essential for her success. I'm curious if this happens in other countries now too? Or is it just America with our unbridled capitalism and greed, in which advertisers take full advantage of telling expectant parents that they need a laundry list of items to be successful parents. What role have LC's played to be complicit in this marketing to mothers? How many of us have given out coupons and product samples for these creams and should we be doing it? What message does it send if "the professionals" are promoting these products to our new mothers? Went to the last ILCA conference and have to say that I was somewhat disappointed by plethora of these products for sale at the conference and all of the product samples in the bag we were given by the conference planners... 
9. I think that dry wound healing may work better than moist wound healing. Maybe I'm wrong but I think about what happens when you get a cut on your finger and you put ointment and a band-aid on it. It doesn't heal. It won't heal until you take the band-aid off and let it be open to air and scab up. So the tissue can begin to regenerate under the scab. It seems me the better choice would be to have the mother take off her bra and rub some expressed breastmilk on her nipples after feedings. At least with this method there is no possibility of harm.
10. Lastly, I think my biggest problem of all with these creams is that they really take the focus off of finding out the true cause of what is creating the soreness. How many of us work with nurses who say things like, "well, the mother was having some soreness, so I gave her some lanolin cream...." If I had a dollar for every time I heard that I would retire tomorrow. It's not just the nurses and doctors, but the parents as well. These creams have really effectively sold the idea to the parents that they are the miracle cure for soreness and there use is keeping the mother's from understanding that pain during breastfeeding is not normal! I feel like all I do now is recite the mantra - nipple creams are not going to cure the soreness, we need to find the cause.... Whether it is due to improper latching, tongue tie, Reynaud's or whatever, the cure is not the nipple cream but the mother's and the staff do not seem to understand that. 
I'm really thinking seriously about recommending that our hospital stop carrying any nipple creams in any form. I know this may cause some patient dissatisfaction though and I'm worried about the possible backlash, but I can't in good conscience recommend non-scientific products anymore. When I originally posted this question on a BFHI email, I did have someone write back and tell me that she got rid of them at her hospital and the result was that the nurses finally began to understand that they weren't the cure for sore nipples and they began to make more of an effort to help the mother get the baby latched on well. I would really love to hear from anyone who has stopped using these creams at their hospital or in their practice and what has been the result. Also. I would love to hear back from LC's in other countries, too. Do you use these creams there? Are they used in your hospitals? What are your thoughts on this topic? Thank you very much. I'm really looking forward to getting other people's opinions on this topic. 
Tricia Shamblin, RN, IBCLC


Date:    Tue, 13 Sep 2016 16:06:40 -0400
From:    Sheila Dedrick <[log in to unmask]>
Subject: Re: Nipple Creams and Especially Lanolin

Frank,
Where will this be available for purchase. Also, you mentioned the efficacy studies. Can you please post what studies have been done?
Thanks so much,
Sheila


   

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