I routinely suggest rinsing off nipples after feeding if the skin is broken. The skin is an effective natural barrier against invasive pathogens. Intact nipple tissue doesn't need zealous washing because the integrity of the skin and the natural secretions are sufficient to protect the health of the nipple. Normal cleansing in the shower, i.e. water running over the nipples, would be sufficient. However, if I had a cut on my finger and let someone suck on that broken skin, I'd definately wash afterwards due to the fact that the mouth harbors many bacteria/fungii, and viruses. Verity Livingston has identified infectious mastitis as resulting from ascending impetigo (i.e. a staph infection of broken, contaminated nipple tissue ascends the ducts). Impetigo is treated with antibiotics and washing. When I see broken nipple skin, I suggest that the mother briefly suspend her nipples/areolae in a solution of warm water and salt (mixed to the strength of a normal saline solution) so that the nipples are rinsed after each feeding. I've been considering using mild soap, but haven't yet. I then initiate dicussion with the doctor to obtain some topical antibiotic -- and to consider oral abx if the nipple is purulent. I certainly focus on positioning and latch problem as the CAUSE, and consider the cracks the RESULT. The mother is definately advised to keep breasts flowing to avoid stasis. I'm willing to listen to argument, but given the un-cleansed nipples I have seen that are dripping pus, I don't see how one can argue against the first aid of wound cleansing when the wound occurs on the nipples. Barbara Wilson-Clay BSEd, IBCLC Austin Lactation Associates http://www.lactnews.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html