One thought comes to mind, why is a midwife using something that needs
prescribing to use?

I would ask her to provide the research that supports this practice. It
makes no sense at all as the damage could just simply continue occurring
because of an inability to feel the attachment. Without all the other
issues such the impact on the baby.

Gwen

Gwen Moody
CNC Postnatal Care
Westmead Hospital
PO Box 533 Wentworthville 2145
Phone: 02 9845 6964, 0422212774
Fax: 02 9845 8340
Page: 02 9845 5555 - 01135
email: [log in to unmask]

>>> [log in to unmask] 26/06/2009 7:52:35 am >>>
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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