I am the one who posted about washing nipples to prevent thrush.  I got this
insight when I worked with a primip who had a baby with one of the worst
cases of thrush I'd ever seen.  She had no problem with sore nipples.  I
puzzled over that, and in discussing what she was doing, learned that she
had a compulsive disorder that led her to shower 3-4 times daily.  I
hypothesized that she was literally rinsing the spoors off her intact skin
before they had time to penetrate and begin breaking down the nipple tissue.
Subsequently, rinsing off after feeds has become one of my main suggestions
IF mom has had abx  postpartum OR IF baby is showing signs of thrush or
yeast diaper rash. It is a benign prophylactic method, and while I haven't
kept any kinds of specific records, my sense of things is I have fewer moms
progress to sore nipples since I've been suggesting this.

Additionally, if the skin is already broken, I now always suggest a mild,
gentle cleansing regimen.  The first aid for breaks in the skin elsewhere on
the body is cleansing and the use of topical abx if the skin fails to heal,
becomes reddened and irritated, and the level of pain increases.  I have a
teething puppy who bites me every day.  One of those bites has already
become infected to the point where I had to take an oral abx.  Bites are
dirty wounds because mouths (even a sweet baby's) are full of bacteria.

All protocols and interventions should have a rationale and should be
specifically applied to individual situations.  There should be some
research based evidence to justify the action (I cite Verity Livingston's
work with mastitis) and some clinical basis (my own experience observing
what seems to help prevent escalation of sore nipples and acquisition of
thrush).  Washing, rinsing, or application of medications is pointless if
the skin is intact and there is no sign of thrush.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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