Lea mentioned that because the moms went to different hospitals that the commonality of mothers having used antibiotics in the hospital and nipple damage is not related to it being a "hospital-based issue".  

The control group here is NOT another hospital.  The control group here would be delivery in a free standing birthing center or at home.  Since many other factors are different, it would be hard to design such as study and it is not appropriate to make extrapolations from 3 cases anyway.

Nevertheless, it is very clear that antibiotic resistant bacteria DO accumulate in hospitals across the board -- not just one hospital or another.  This necessitates much more rigorous standards of handwashing than may be needed in the home environment when there is nipple damage.

Furthermore, it is also clear from my 10 years of experience, that many hospitals in Manhattan have too few staff and too little time to adequately cover all the women who need assistance to avoid nipple pain.  Often the volume of deliveries and the staff ratios necessitate group classes when the baby may or may not be ready to feed.  In a few hospitals staff have been trained in a 1 or 2 day course to position babies in ways that EXACERBATE nipple pain.  The RAM method is alive and well in some of the hospitals.  How is that NOT a "hospital-induced" cause of the cracking that ultimately led to the mastitis.

In any case, there is a breastfeeding medicine specialist who DOES culture milk in Manhattan when obstetricians, midwives and family practitioners are not proactive in providing this services for mothers suffering from repeated bouts of mastitis.  

Best, Susan Burger, MHS, PhD, IBCLC

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