Simple help for painful nipples in breastfeeding women

Many breastfeeding women experience painful nipples and this is a common reason for stopping. That’s a great shame as it can be a lovely, as well as beneficial, experience and leading authorities such as the World Health Organization recommend that babies should be exclusively breastfed for the first six months. If you, or a woman you’re supporting, is experiencing nipple pain from feeding then you’re probably wondering what’s the best thing to do. We tend to do several things when making choices about our health – we seek advice from others, including friends and family, health professionals and online communities; we might (think twice!) ‘Google’ it; and we look at the shelves in the local chemist to see what products promise.

Nipple shields and box

Did the pretty box help sell Dr. Wansbrough’s celebrated Nipple Shields’ to our great-grandmothers?
Credit: Wellcome Library, London.

There’s nothing like a common problem to spawn a whole industry of products offering solutions. If you are a breastfeeding woman who’s feeling sore, should you part with your money for glycerin gel dressings, ointments, or breast shells with lanolin? How do you know if you should trust the claims? You might like to know the latest independent evidence on this to help you decide.

Here it is, from a new Cochrane review, which set out to bring together the best available evidence from trials of treatments for painful nipples in breastfeeding women. There were four trials, all of which included teaching all the mothers about correct positioning. In addition, they evaluated five interventions: glycerine pads, lanolin breast shells, lanolin alone, expressed breast milk, and an all-purpose nipple ointment.

 Here’s what they found

  • Applying nothing, or expressed breast milk, may be as good or better than applying an ointment, such as lanolin, for both nipple pain and healing
  • Regardless of the treatment, for most women, nipple pain reduced to mild levels 7 to 10 days after giving birth

 How good is the evidence?

breastfeeding

Nipple pain usually gets better within ten days

The trials were well-designed randomized controlled trials, but they were small and they compared different things, so overall there isn’t enough good evidence to allow confident conclusions about any particular treatment. Women should be encouraged by the finding that nipple pain resolves for most within ten days.

Avoiding nipple pain

Poor latching or positioning can cause nipple trauma so it’s important that new mums are helped to get going with breastfeeding from the start. Earlier Cochrane reviews have showed that this help can come from health professionals and/or peer supporters. Face-to-face support and scheduled, rather than reactive, visits to support breastfeeding make success more likely.

Old problem, old solutions?

It seems, then, that solutions that are as old as the problem itself, time and our own milk, are possibly the best. Did women always know this? I spent some years looking at aspects of women’s health through letters, diaries and medical books from the 16th and 17th centuries. They reveal a lot about attitudes to breastfeeding and a bit about the practicalities.

Medical men hotly debated whether mothers should feed their own babies or hire wet-nurses, what breast milk was made from (many thought converted menstrual blood), if the early milk we know as colostrum was suitable nourishment and whether it was alright for breastfeeding women to have sex. Women, meanwhile, must have quietly shared their knowledge about it in conversation with each other, but some of this they recorded in household ‘receipt’ books and in their diaries.

V0039253 A woman breastfeeds a baby and other children stand around hAlice Thornton recorded in her diary the troubles she had with breastfeeding and then, in 1660, her delight at being given “the blessing of the breast as well as the womb” when she was able to feed her son William. He died after two weeks and she breastfed her next child for an unusually long period. A generation before Alice, Elizabeth, Countess of Lincoln, felt so guilty about hiring wet-nurses to feed her babies (a common practice amongst the upper classes) that she wrote a small pamphlet encouraging women to breastfeed their children. She attributes her feeding choices to poor advice, distaste for breastfeeding, failure to recognize it as her duty and ‘being overruled by another’s authority’, probably that of her husband.

 How did they promote successful breastfeeding?

A standard element of breast care after birth was to apply warm cloths, to ease pain, keep out cold and prevent milk from curdling. Medicines and topical treatments were sometimes used to encourage milk flow and products were often chosen for their association with milk or milk-producing animals, such as powdered cows’ hooves and udders, dairy products and milky-veined plants.

Friction was thought to stimulate milk production (ouch!) but more commonly suggested were ointments made of greasy substances such as butter, applied warm on a piece of lint. Advice was given on getting the baby to latch on, though I rather hope Isaac Archer’s attempt to help his wife overcome the difficulties by trying to get a puppy to latch on was unusual. Pain and infection was often mentioned. Nipple shields were used and nipples painted with all manner of substances from ox marrow to leaf gold! Reminders of the importance of good hygiene were rather cancelled out by recommendations to apply animal dung, the hot excrement of a child or leaves steeped in the woman’s husband’s urine!

If breast milk itself was used to treat painful nipples, it didn’t make it into the records I came across, but this simple treatment could well have been tried by women whose experiences are now lost to us. Perhaps they too could have told us that time itself is a very good healer. It can be hard to do nothing, when doing ‘something’ can make us feel more in control, but sometimes it’s the best thing of all.

Featured image:  Credit: Wellcome Library, London A woman lying down breast-feeding her baby. Etching by F. Bartolozzi after G. Guercino.

Links:

Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD007366. DOI: 10.1002/14651858.CD007366.pub2. 

Dyson L, McCormick FM, Renfrew MJ. Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001688. DOI: 10.1002/14651858.CD001688.pub2.

Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001141. DOI: 10.1002/14651858.CD001141.pub4.

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Sarah Chapman

About Sarah Chapman

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Sarah's work as a Knowledge Broker at Cochrane UK focuses on disseminating Cochrane evidence through social media, including Evidently Cochrane blogs, blogshots and the ‘Evidence for Everyday’ series for nurses, midwives, allied health professionals and patients. A former registered general nurse, Sarah has a particular interest making evidence accessible and useful to practitioners and to others making decisions about health. Before joining Cochrane, Sarah also worked on systematic reviews for the University of Oxford and the Royal College of Nursing Institute, and obtained degrees in History from the University of Oxford and in the history of women’s health and illness in early modern England (MPhil., University of Reading).

3 Comments on this post

  1. Could you tell me who the artist is who drew the sketch you used to go with the article please?
    Thanks, Jenny Richardson.
    BfN Breastfeeding Supporter and Tutor. (And artist.)

    Jennifer Richardson / Reply
  2. I’d like to share a tip to address sore nipples (that lasted far longer for me than the 10 days mentioned here, by the way) that finally worked like a charm after my first baby was born. The La Leche League peer counselor I called suggested that my problem might be mostly positional, and she was so right.

    Here’s what she advised: prop lots of pillows on your lap, and pretend you have an imaginary belly button directly between your breasts. Position the baby on his/her side so that the baby’s real belly button is “attached” to your imaginary belly button (this will feel and look like the baby is propped way too high, but trust me – this works!) To nurse, baby merely turns the head slightly at a comfy height that eliminates any pulling/pressure on the sore nipple.

    The relief was almost instantaneous! Thank you, 38 years later, La Leche League!!

    Carolyn Thomas / Reply

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