Falle,
Fissured, infected nipples greatly increase the risk for mastitis.

Verity Livingstone and L. Judy Stringer
The Treatment of Staphyloccocus Aureus Infected Sore Nipples: A 
Randomized Comparative Study
J Hum Lact, Sep 1999; 15: 241 - 246.

Since maternal-infant separation and labor analgesia increase the risk 
of incorrect sucking and incorrect sucking increases the risk of nipple 
damage, fissured nipples are common in our culture.

Lennart Righard MD, Margaret O. Alade RN, BSC, MS (1992)
Sucking Technique and Its Effect on Success of Breastfeeding
Birth 19 (4), 185–189.

In addition, infants with ankyloglossia (tongue-tie) are poorly 
recognized and if untreated triple the risk of weaning in the first week 
of life.

  Lori A. Ricke, Nancy J. Baker, Diane J. Madlon-Kay, and Terese A. DeFor
Newborn Tongue-tie: Prevalence and Effect on Breast-Feeding
J Am Board Fam Pract, Jan 2005; 18: 1 - 7.

Obviously we need to reform maternity practices and start treating 
tongue-ties that cause breastfeeding difficulty. While we work on that, 
there are other strategies that I have found helpful: give the baby 
correct input for latch (skin to skin against mom's trunk for stability, 
chin on breast, philtrum to nipple); allow the baby additional time to 
bring his tongue down (don't push the baby toward the breast, if baby 
does it himself, his tongue is more likely to be in the right place); 
and if mom's nipples do become sore, encourage her to wash them with 
mild soap and water twice a day to reduce the number of organisms that 
could potentially travel up the ducts to cause mastitis.

The other risk factor for mastitis is overfull breasts or a plugged duct 
that is not drained. They are also best prevented by helping to 
calibrate moms milk production correctly and allow the baby unrestricted 
access to the breast to promote good drainage.

Best wishes in your studies.
Catherine Watson Genna, IBCLC  NYC

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