Here is another issue that I would love people's opinions on, too. Went to the last ILCA conference and this was debated in a session. I used to tell mother's that it can be normal in the first few days that when the baby latches to the breast you might feel some tenderness but then the feeling should go away and you should not feel anything other than tugging. The moderator said that she feels that this may not be true. She has noticed that even when mother's state that it goes away after a few seconds, when the baby comes off the breast their is usually compression and redness. Now I think she might be right. Anyone else see this too? Wondering if I should change my scripting. I have really noticed a huge improvement in this lately by using the laid-back position. Finding moms often don't even have that initial tenderness. 

I want to also thank everyone for their great feedback on the nipple cream issue. I'm so thankful that I have a place to get such great feedback from wise practitioners. I see many people are as concerned as me about this idea that new mother's now have that they can't breastfeed without lanolin cream and that it's going to cure their sore nipples. It's also very concerning that many healthcare providers are also in agreement with this idea. One good point that was brought up by several people was that moist wound healing is the best way to go for any large wound. A large, deep wound would best be treated with moist wound healing and this has been demonstrated by many studies in the medical community. These studies are usually done on things like pressure ulcers though. I feel though that this does not necessarily translate to a situation in which a mother has only a small laceration, abrasion, bruising or some redness and tenderness. And in that situation, research has not shown that hydrogel dressings or lanolin cream improve healing time or mother's sense of perception. Several people brought up the idea that it may have a placebo effect and provide psychological comfort for the new mother and perhaps it could be beneficial that way. 

Sometimes I feel like a broken record with new mother's who say, well I guess soreness is normal but I bought some lanolin cream.... Or coconut oil or whatever. I'm just looking forward to the day when mother's and healthcare providers begin to understand that these creams are not going to fix the problem. They need to fix the cause first! And right now I'm just not seeing any understanding of that among patients. It was also brought up that research needs money to take place, so it's going to be hard to get research that is non-profit funded. That's very true. But I'm just saying that we would have a problem with a formula company putting out research that says that it's formula is great for babies. But we have less of a problem with a company funding research that says that it's nipple cream or breast pump is great? That doesn't make sense to me. Also, another great point is that using these creams often delays mother's calling an LC for support. I definitely see that too. They have having latching problems but instead of calling for help, they've often gone through a variety of these creams because they really think they are going to fix their soreness. Then we're weeks in and now there's been significant damage. Part of this thinking is also our society wanting a quick fix and simple solution for something that is more complex. For me, I just feel I can't recommend these creams any longer without some proof they work when I see so many downsides of their use. Thanks for all your great feedback!
Tricia Shamblin, RN, IBCLC

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