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The Effectiveness of Olive Oil to Prevent Sore Nipple on the Breastfeeding Mother

Authors:
  • Universitas Muhammadiyah Kudus
The Effectiveness of Olive Oil to Prevent Sore
Nipple on the Breastfeeding Mother
1st Ika Tristanti
Health Faculty
Universitas Muhammadiyah Kudus
Kudus,Indonesia
ikatristanti@umkudus.ac.id
2nd Shinta Dwi Kurnia
Health Faculty
Universitas Muhammadiyah Kudus
Kudus,Indonesia
3rd Lailatul Farikhah
Health Faculty
Universitas Muhammadiyah Kudus
Kudus,Indonesia
AbstractThe coverage data of exclusive breastfeeding in
the world was 39% and it was estimated to be 36% in poor and
developing countries. Many women didn't give exclusive
breastfeeding because of sore or blister on their nipples. The
incidence of sore nipples was 11-96% of all breastfeeding
mothers in the world. The aim of this study was to determine the
effectiveness of olive oil to prevent the sore nipples on
breastfeeding mother. This study used a quasi-experimental
post-test only non-equivalent control group design to see the
differences of the effectiveness of olive oil to prevent the sore
nipples by smear on the intervention group nipple. The smear
frequency was twice a day for 10 days. This study was conducted
on June - September 2019 in Kudus. The population of this study
was all breastfeeding mothers in Kudus. The intervention and
control group consist of 15 respondent. The sampling technique
use consecutive sampling. The data collection use observation
sheets. The data analysis use the Mann Withney test. Result:
13.3% of 15 respondents on intervention group got sore nipple.
On the control group, there were 53.3% of 15 respondents got
sore nipple. The p value of Mann Whitney analysis result was
0.022. It is lower than alpha (0.05). It shows that the application
of olive oil on the nipples of breastfeeding mothers was effective
to prevent the sore nipple. Conclusion: olive oil can prevent the
sore nipple on the breastfeeding mother.
KeywordsOlive Oil, Nipple, Breastfeeding
I. INTRODUCTION
Midwifery care on postpartum period is the important
thing to prevent the maternal death. About 60% incident of
maternal death was happened on the postpartum period. They
were caused by postpartum bleeding, eclampsia, infection
and other. The incident of postpartum infection consists of
reproductive organ infection (uterus, vagina, cervix, etc),
breast infection and other). However, breast infection was not
cause the mother death but it made the uncomfortable
condition and bother the exclusive breastfeeding process.
Breast milk was a main foundation for the baby’s growth,
especially on the golden period (1000 first day of their life).
But exclusive breastfeeding in Indonesia only 47%. There are
three main causes of the low coverage of exclusive
breastfeeding: 1) giving early meal (before 6 months of
baby’s age), 2) the low level of mother’s knowledge about
breastfeeding and 3) less of the family support
system(especially from husband). A new breastfeeding
mother usually worry about their capability to breastfeed.
They feel not competence to give direct breastfeeding. They
feel their breast milk is not enough to fulfill the demand of
their baby. On the four or five day after labor, most of the first
mother have some problem related to breastfeeding process.
They feel uncompetence to giving breast milk, they feel sore
on their nipple because of the nipple blister, they feel tired
because of labor process and take care their baby. Those
problems can affect to their breast milk production so the
volume is very low. Need to give attention ,support and
information for the mothers so they don’t be panic to face of
breastfeeding period.
World Health Organization (WHO) recommends
exclusive breastfeeding for babies in the first six months of
their age. It means only breast milk for babies in their first six
months life without other meal or drink. Exclusive
breastfeeding can prevent the babies from respiratory disease,
gastrointestinal disease, allergy and other disease. It is very
effective to decrease mortality child in the poor and
developing country.The coverage of exclusive breastfeeding
in the world was still low (39%), and in the poor and
developing country was 36%. [1][2]
Many problems cause the low coverage of exclusive
breastfeeding such as the low level of mother knowledge
about exclusive breastfeeding, busy, back to work, sore
nipple, feel less production of breast milk.[3][4].
The early breastfeeding problem and make the high
incidence of exclusive breastfeeding drop out is sore
nipple/nipple wounds. The incidence of sore nipple was 34-
96% from all breastfeeding mother. It was predicted that 80-
90% breastfeeding mother has a little sore nipple on the early
breastfeeding period. If it is not treated well,26% will be
worst (erythema, oedema)[5]
The wrong baby position and incorrect attachment of
baby's mouth to the breast were the most cause of sore nipple.
Another cause of sore nipple are using the bottle,
engorgement, primipara, abnormally of nipple, using the
breast pump, abnormally of tongue and baby's mouth. The
incidence of sore nipple was 11-96%. Sore nipple was very
difficult to be healed because it will be repeat as long as
breastfeeding period.[6]
Advances in Social Science, Education and Humanities Research, volume 535
Proceedings of the 1st Paris Van Java International Seminar on Health, Economics,
Social Science and Humanities (PVJ-ISHESSH 2020)
Copyright © 2021 The Authors. Published by Atlantis Press SARL.
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Incorrect attachment can be done if the areola doesn’t
good enter to the baby’s mouth. The areola doesn’t attach to
the palatum so the baby’s tongue can injure the nipple. On the
engorgement case, breastmilk difficult to get out because
breastmilk duct was blocked. It make the baby suck more hard
so their tongue injure the nipple. Same condition on the case
of abnormally of tongue and baby’s mouth. The friction of the
breast pump to the nipple can cause the nippl e wound. If the
nipple wound doesn’t treat properly it can be infection on the
nipple and breast.
Sore nipple can make uncomfortable condition and bother
the psycological condition of the mother.It can disturb the
sleeping time, mood, sleep quality and bonding attachment.
However,the mothers should continue giving their breastmilk
to their baby.[7]
Although sore nipple make the mother feel
uncomfortable, but they usually delay to get treatment.They
delay it until the wounds getting worst[8]
Lanolin and vitamin A ointment usually used to treat the
sore nipple. Lanolin make the nipple skin moisture. Lanolin
help the drug absorption. The using of vitamin B complex
(Dexpanthenol ) make the skin nipple moisture, keeping soft
and skin elasticity. Peppermint increase the wounds nipple
healing, skin tissue flexibility, prevent blisters.[5]
Olive oil is one of kind oil that cheap and easy to get. Olive
oil began use in mediterranean a long time ago. Olive oil
make the skin more moist and dry skin healing. It is caused
by antioxidant and antimicroba content of olive oil.[9]
Olive oil consist of flavonoid,antioxidant,antibacterial,
anti fungus. Olive oil is used to treat the skin infection such
as dermatitis, diaper rash,psoriasis and wound healing. Olive
oil contain of Omega 3, it can be anti inflammatory and make
the wound healing faster.[10]
Based on the utility and beneficial of olive oil, then we can
use the olive oil to prevent the sore nipple. The using of olive
oil to prevent the sore nipple has been done but the study
about that still a little bit.
The aim of this study was to identify the effectiveness of
olive oil to prevent the sore nipple on the breastfeeding
mother. II. METHOD
This study uses a quasi-post-test only non-equivalent
control group design experiment. This study look the
differences of the effectiveness olive oil use to prevent sore
nipple between intervention and control group. All
respondents were applied olive oil on their nipple twice a day
as long as 10 days after labor. While,all respondents in the
control group were not applied olive oil on their nipple. The
inclusion criteria were breastfeeding mother , on the 10 days
early period after labor, want to apply olive oilon their nipple,
no history of olive oil allergy. The sampling technique uses
consecutive sampling. The number of subjects of this study
were 15 respondents in each group. This study held in the
Kudus Regency on June - September 2019. Treatment to the
intervention group were smearing olive oil on the nipple and
areola 2x / day for 10 days at the early period after labor.
Collecting data by using observation sheets. The data was
analyzed by using Mann Withney test.
III. RESULT AND DISCUSSION
TABLE I. THE INCIDENCE OF SORE NIPPLE ON BREASTFEEDING MOTHERS
Group
Variable
Intervention
Control
Sore nipple
2
13.3%
53.3%
normal
13
86.7%
46.7%
Total
15
100%
100%
Source: Primary Data, 2019
Based on Table I. In the Intervention group, there were 2
respondents (13.3%) had sore nipple and 13 respondents
(86.7%) have not sore nipple. In the control group, there were
8 respondents (53.3%) had sore nipple and 7 respondents
(46.7%) have not.
There were two factors that affect to the breastfeeding
process. They were internal and external factor. The internal
factors were mother's experience, attitudes and self
confidence. The external factors were socio-economic
conditions, traditions, attitudes of health workers, family
support and maternal-infant health conditions. If one or many
factors not support, they will affect the sensitivity of
breastfeeding mothers who have sore nipples. Breastfeeding
mothers who have sore nipple need more attention to increase
their self confidence. If there were no attention for them, they
will stop to give exclusive breastfeeding to their baby [11]
The breastfeeding method consists of correct attachment,
positions and direct contact to the mother's body. The
attachment of baby,s mouth to the areola and nipple is the
main role of the breastfeeding success. The right position of
suckling, good attachment to the breast, effective
breastfeeding technique is the key to proper breastfeeding
techniques.[12]
Incorrect of attachment and position of the baby's mouth
to the breast were the main causes of sore nipple in the first
ten days after labor. Sore nipples start on the third to seventh
days after labor, the peak severity occurs on the third day after
labor. Other researchers, said that besides the incorrect
breastfeeding , the cause of sore nipple were using of nipple
protectors, nipples less exposed by sunlight and air, less
frequency and duration of breastfeeding. Sore nipple did not
heal easily because the mother must continuously feed her
baby. Sore nipple as the way of secondary bacterial and
fungal infections that trigger breast infections[13]. It is
estimated that friction of the nipple with the baby's tongue
and the strength of the baby's suction are related to the
occurrence of sore nipple[14]
Sore nipple or nipple wound was a sign of breast infection
or inflammation (mastitis). The bacteria that causes mastitis
are Sthapylococcus aureus and Streptococcus agalactie. The
bacteria or fungi enter by the wound on the nipple. Most
causes of sore nipple infections by fungi is caused by Candida
albicans so it make nipple very painful.This condition getting
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785
worst by dry skin on the nipple and shiny. This condition
getting worst if the mother doesn’t keep the personal higyene
well. Before breastfeeding , the mother should wash their
hand first, but in the reality most of the mother forget that.
The dirty hand can transmit the bacteria or fungi cause the
infection. The bacteria or fungi that enter through the wound
will attack the mammary gland and become inflammation
then infection.
TABLE II. THE EFFECTIVENESS OF OLIVE OIL TO PREVENT SORE NIPPLE
N
Mean
p value
Intervention Group
15
12.50
0.022
Control Group
15
18.50
Source: Primary Data, 2019
Based of Table II. Mann-Whitney test results obtained p-
value of 0.022 with a significance level of p <0.005. It means
the application of olive oil on nipples and areola is effective
to prevent sore nipples. Treatment of blasted nipples can be
done pharmacologically and non-pharmacologically.
Pharmacological treatment includes antibiotics, anti-fungi.
While non-pharmacological treatment uses lanolin,
peppermint, compresses (warm compresses, hydogel
compresses, tea compresses), the use of putting protection,
photo therapy and the application of breast milk.[15]
Good lactation management such as the accuracy of
attachment of baby's mouth,correct breastfeeding position
were considered the most appropriate method to prevent sore
nipples.
Blister of the nipples were caused by wrong attachment
and positions and considered as a trigger for mastitis. Nipple
damage usually occurs early in the breastfeeding period.
Sores on the nipple were the entry points for several
microorganisms that cause mastitis, including
Staphylococcus aureus.
Treatment of sore nipple should be adjusted to the cause.
If it is caused by bacteria, the treatment by antibiotics. If it is
caused by fungus, it is treated by antifungals. If it is caused
by dermatitis, it must avoid irritating factors and the use of
corticosteroid creams and warm compresses may be needed
for ease the pain[16]
An effective method to prevent sore nipple cannot be
found with certainty. Olive oil is easy to get and cheap. Olive
oil contents of antioxidant and anti-microbial. It was used to
heal wounds. Olive oil is safe for newborns.[17]
Olive oil as we know it is the result of direct squeezing of
olives, which is a fruit that is rich in oil content. Olive oil is
the only oil that can be consumed immediately after the olives
are pressed. Compared to other oils, olive oil is very rich in
Monounsaturated Fatty Acids (MUFA) which are efficacious
to reduce high cholesterol levels. Olive oil contains a number
of diphenol compounds, such as hydroxytyrosol (HT) and
oleuropein (OE) in high amounts, which is up to 800 mg per
liter. Those compound is a strong antioxidant, and also can
make olive oil is not easily oxidized and becomes rancid like
other vegetable oils when stored for long periods of time.
Olive oil is obtained from olives which are processed into
a paste. The paste is stirred slowly until the oil dots are fused
into concentrate. Then, the oil is extracted by means of a press
or by centrifugation techniques. This is where various types
of olive oil are obtained, for example light olive oil, virgin,
extra virgin and others. These different types of olive oil refer
to differences in the processing process. For example virgin
and extra virgin olive oils are processed organically with a
cold pressing system. There is also pure olive oil, also known
as refined olive oil, which has gone through the process of
adding chemicals. The types of olive oil that are widely
available in the market: Extra Virgin Olive Oil. It is produced
from the first extract or blackmail process through the cold
press process. Meaning that the olives do not undergo a
heating process such as being dipped in hot water, and
without chemicals. The price of Extra Virgin oil is more
expensive because it comes from olives with number one
quality. The vitamin and mineral content is still natural and
complete so that it can be consumed directly. The color of this
oil is usually greenish, has a special aroma and flavor, with
acidity levels of less than 0.8%. This oil is not good for
sauteing or frying because the boiling point is very low. Extra
virgin olive oil is better consumed by drinking or used as a
mixture of foods such as salads or boiled vegetables.Pure
extra virgin olive oil does not change physically even though
it is placed in the refrigerator for days. There will be no visible
layer of frozen oil on its surface. Many kinds of olive oil, such
as: Virgin Olive Oil, Fino olive oil, Pure olive oil, Extract and
Refined Olive Oil, Extra Light and Light Olive Oil, Pomace.
Virgin olive oil is produced through a cold press process but
from a second extract or juice. Higher acidity. This type of
olive oil can be consumed directly or used as salad dressing.
Fino Olive Oil is a mixture of Extra Virgin and Virgin. Pure
Olive Oil is refined olive oil. The price is more economical
and affordable compared to the price of extra virgin but the
nutritional content is lower. Virgin olive oil is added to add
and strengthen flavor. This type of oil is golden yellow and
can be used for cooking, such as a mixture of cooking and
sauteing. Extract and Refined Olive Oil. Although it is
produced from the first juice, this type of olive oil is
chemically processed to improve its poor quality. Chemicals
are added to neutralize the strong taste and high acidity. To
strengthen the taste of oil, virgin olive oil is added to it. Extra
Light and Light Olive Oil is the result of refining olive oil
extracts or juice from low quality. The color of this oil is clear
yellow with the softest taste and aroma among others. Prices
are priced for both types of oil is quite cheap. The quality of
these two types of oils also varies, can be recognized based
on differences in aroma, taste and color. Pomace is not thrown
away but is able to be reprocessed. This type of olive oil is
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chemically processed and virgin oil is added to strengthen the
taste. Usually used as raw materials for cosmetics, shampoo,
soap and others.
Basically, the use of olive oil for cooking is more
beneficial than ordinary cooking oil. The content of omega 9
or oleic fatty acids reaches 80%. This figure is 10% more than
palm oil. Unlike trans fats and saturated fats, oleic acid -
including a type of unsaturated fat Mono Unsaturated Fatty
Acid - can increase good cholesterol, thereby reducing the
risk of coronary heart disease. Not only that, olive oil also
contains linoleic acid (omega 6) - including Poly Unsaturated
Fatty Acid (PUFA) - which can smooth skin and cell walls.
However, due to the high content of PUFA, olive oil tends
to be less stable when heated. That is why olive oil is better
used disposable, namely as edible oil, oil for food spread and
sauteing, not frying. If used for frying or cooking at high
temperatures, the ingredients can be damaged and can
increase bad cholesterol in the body.
These antioxidant compounds also function in protecting
the body from free radical attack if you consume olive oil.
Not only that, for those who suffer from gastritis or gastritis,
olive oil can help the activation process of bile and pancreatic
hormones so as to eliminate the symptoms of the ulcer or
gastritis.
Another advantage of olive oil is that olive oil can be
heated to a temperature of 220 degrees Celsius before being
converted into its trans form, while other oils have been
overhauled at a temperature of 180-190 degrees Celsius.
The wound healing phase in a wound process is through 3
phases or 3 stages of wound healing, namely:
A. Inflammatory Phase
This inflammatory phase will last from the wound until about
the fifth day. Disconnected blood vessels in the wound
suffered will cause bleeding and the body in this case will try
to stop it by vasoconstriction, contraction of the end of the
broken vessel (retraction), and hemostasis reaction.
Hemostasis occurs because platelets coming out of the blood
vessels stick together, and together with the fibrin tissue that
forms, clots the blood that comes out of the blood vessels.
Meanwhile an inflammatory reaction occurs. Mast cells in
connective tissue produce serotonin and histamine which
increase capillary permeability resulting in fluid exudation,
inflammation of inflammatory cells, accompanied by local
vasodilation which causes edema and swelling. Clinical signs
and symptoms of inflammation reaction become clear in the
form of reddish color due to dilated capillaries (rubor), warm
temperatures (heat), pain (dolor), and swelling (tumor).
Cellular activity that occurs is the movement of
leukocytes through the walls of blood vessels (diapedesis) to
the wound due to chemotaxic power. Leukocytes secrete
hydrolytic enzymes that help digest bacteria and wound
impurities. Lymphocytes and monocytes which then appear
participate destroy and eat wounded feces and bacteria
(phagocytosis). This phase is also called the slow phase
because the reaction of the formation of new collagen is small
and the wound is only linked by very weak fibrin.
B. Proliferation Phase.
The proliferation phase is also called the fibroplasia phase
because what stands out is the fibroblast proliferation process.
This phase lasts from the end of the inflammatory phase until
about the end of the third week. Fibroblasts are derived from
undifferentiated mesenchymal cells, producing
mucopolysaccharides, aminoglycine asama, and proline
which are the basic ingredients of collagen fibers that will link
the wound edges.
In this phase the fibers are formed and destroyed again to
adjust to the tension in the wound which tends to shrink. This
property, together with the contractile nature of
myofibroblasts, causes traction on the wound edges. At the
end of this phase the strength of the injured strain reaches
25% of normal tissue. Later, in the process of ending the
strength of collagen fibers increases due to intramolecular and
intermolecular bonds. In this phase of fibroplasia, the wound
is filled with inflammatory cells, fibroblasts, and collagen,
forming a reddish-colored tissue with a smooth-surfaced
surface called granulation tissue. The wound epithelium
consisting of basal cells detaches from the base and moves to
fill the wound surface. The place is then filled by new cells
formed from the process of mitosis.
The migration process can only occur in a lower or flat
direction, because the epithelium cannot migrate to a higher
direction. This process only stops after the epithelium touches
each other and closes the entire wound surface. With the
wound surface closed, the process of fibroplasia by forming
granulation tissue will also stop and the maturation process
will begin in the interim phase.
C. Remodeling Phase.
In this phase, the maturation process consists of re-absorption
of excess tissue, shrinkage in accordance with gravity, and
finally re-forming of newly formed tissue. This phase can last
for months and is declared to be over when all signs of
inflammation have disappeared. The body tries to normalize
everything that has become abnormal due to the healing
process. Odema and inflammation cells are absorbed, young
cells mature, new capillaries close and are reabsorbed, excess
collagen is absorbed and the rest shrinks according to the
existing strain. During this process scar tissue is produced that
is pale, thin, and limp and easy to move from the bottom.
Maximum shrinkage is seen in the wound. At the end of this
phase, the appearance of skin injury is able to withstand
stretches of approximately 80% of normal skin ability. This
is achieved approximately 3-6 months after healing.
Olive oil has four other important components namely
peroxide, anisidin, iodine and aldehyde. These components
carry antimicrobial properties in bacteria and fungus and have
the ability to increase blood flow while accelerating the
growth of skin tissue. In addition, olive oil can be used for
prevention as well as for treating wounds. Olive oil contains
polyphenol compounds. Polyphenols are phytochemical
compounds that are naturally able to protect body cells from
damage caused by free radicals and remove toxins from the
body. Vitamin E contained in olive oil is very high. Vitamin
E is useful for anti-inflammatory, anti-oxidant, helps to
nourish, moisturize and soften the skin. So, the olive oil can
help to heal the wound faster.
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787
IV. CONCLUSION
Sore nipples make uncomfortable on the breastfeeding
mother. The pain can disturb the continuity of exclusive
breastfeeding. Olive oil contains several active substances
that are able to moisturize, prevent dryness, treat wounds.The
use of olive oil by smearing on nipples in the morning and
evening on a regular basis is recommended to prevent sore
nipple especially early in the breastfeeding period.
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Full-text available
Article
Introduction: Poor positioning of the child in relation to the breast and improper suckling are the main causes of nipple fissure. Treatment options for nipple fissures include drug therapy with antifungal and antibiotics, topical applications of lanolin, glycerin gel, creams and lotions, the milk itself, hot compresses, and silicone nipple shields. Studies involving light-emitting diode (LED) therapy have demonstrated anti-inflammatory properties, the enhancement of the wound repair process, and the control of pain. As it does not cause discomfort, is relatively inexpensive and may impede the discontinuation of breastfeeding, phototherapy could be a viable option for the treatment of nipple fissures. Aim: The principal objective of the proposed study is to evaluate the effectiveness of LED therapy for the treatment of nipple fissures in postpartum mothers. Materials and methods: One hundred patients treated with a medical diagnosis of bilateral nipple trauma classified as nipple fissures or cracks will participate in the study, randomized into 2 groups: The control group will receive orientation regarding breast care and adequate breastfeeding techniques. The experimental group will receive the same orientation and phototherapy sessions using a device developed especially for the treatment of nipple trauma. Both groups will be followed up for 6 consecutive weeks.
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Objective: To objectively describe changes to nipple skin and classify signs of nipple trauma in breastfeeding women during postpartum week 1. Methods: This study was conducted in two phases. Phase 1 was an observational prospective study of breastfeeding mothers in which data were obtained from photographs and digital images of nipple skin and analyzed to anatomically classify signs of nipple trauma. In Phase 2, the reliability of signs identified in Phase 1 was verified with the cooperation of eight clinical midwives. Results: A total of 776 images of 50 breastfeeding mothers were obtained daily. The signs of nipple trauma included erythema, swelling, blistering, fissure, and scabbing. Purpura and peeling were identified only with photographic image analysis. Scabbing and blistering were classified as damage to the dermis, and erythema and swelling as damage to the epidermis, based on anatomical evidence and the mothers' subjective experiences of pain intensity. Erythema and swelling were observed from day 0, with erythema most frequently observed. For inter-rater reliability of the five signs of nipple trauma, Kendall's coefficient of concordance ranged from 0.46 (moderate) to 0.85 (almost perfect). Reliability was high for fissure, substantial for blistering and scabbing, and moderate for erythema and swelling. Conclusions: Image analysis revealed five signs of nipple trauma. Erythema and swelling were the most frequently observed signs during postpartum week 1. However, the agreement rate was lower than that for other signs, suggesting the possibility of conflicting interpretations in clinical evaluation.
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Introduction: Traumatic nipple is among the most common problems of the breastfeeding period which leads to early cessation of breastfeeding. The study aimed to compare the effects of the lanolin, peppermint, and dexpanthenol creams on the treatment of traumatic nipples. Methods: This double-blind randomized controlled trial was carried out on 126 breastfeeding mothers. The mothers had visited at the health centers and children's hospitals in Sanandaj City. The selected participants were randomly divided into the following three groups of lanolin, peppermint, and dexpanthenol cream groups. Nipple pain was measured using the Store scale while trauma was measured with the Champion scale. Analyses were carried out through the Kruskal-Wallis test, Chi-square, ANOVA, and repeated measures ANOVA by using SPSS software ver. 13. Results: The result showed that the mean score of nipple pain and nipple trauma at the prior to intervention stage, third, seventh, and fourteenth days of intervention was not significantly different between three groups. But, repeated measures ANOVA showed a significant difference in comparison of the four time periods of intervention in each group. Conclusion: RESULTS of this study revealed that the lanolin, peppermint, and dexpanthenol medicines had similar therapeutic effects on traumatic nipple.
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Background: Infants of breastfeeding mothers with persistent nipple pain have been shown to apply stronger vacuums to the breast and transfer less milk during one monitored feed. This may be associated with differences in the movement of the tongue. The aim was to analyse the intra-oral nipple shape and movement of the tongue of infants of mothers with and without nipple pain. Methods: Breastfeeding infants of mothers with or without nipple pain were monitored using ultrasound and intra-oral vacuum during one breastfeed. From cine clips of the ultrasound scans measurements were made of the depth of the intra-oral space between the hard-soft palate junction (HSPJ) and the mid-tongue; the distance of the tip of the nipple to the HSPJ; and nipple diameters from the tip to the base. Results: During nutritive sucking, tongue movements of infants of mothers with nipple pain resulted in a smaller intra-oral space (p = 0.040) and restricted nipple expansion compared to controls (p < 0.012). Stronger baseline and peak vacuums compared to controls were confirmed (p = 0.002). Conclusion: In these mothers, nipple pain was associated with restricted infant tongue movement. Ultrasound may complement measurement of intra-oral vacuum in monitoring treatment strategies in breastfeeding women experiencing nipple pain.
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To demonstrate that pain affects the goodness of breastfeeding. Seventy-nine patients were interviewed regarding satisfaction in breastfeeding, tiredness, uterine pain, nipple and other pain, and analgesic use at day three and at first, second, third, and fourth week after birth. Data regarding the mode of delivery were recorded from medical charts. Milk formula supplements, bottle use, pacifier use, and nipple shields use were considered as variables suggesting unsuccessful breastfeeding. At third day after delivery, it appeared that analgesic use was significantly associated with milk formula supplementing, bottle use, less satisfaction in breastfeeding, and more tiredness. At first week after delivery, the presence of pain differing from nipple and uterine pain, was more likely associated with milk formula supplementing, bottle use, pacifier use, less satisfaction in breastfeeding, and more tiredness. At third week after delivery, nipple pain was directly related to tiredness, while it increased the odds of adding milk formula and using a bottle. Pain affects the goodness of breastfeeding.
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Background: Over 90% of women experience pain during breastfeeding initiation and lack strategies to self-manage breast and nipple pain. Guided by the Individual and Family Self-Management Theory, a breastfeeding self-management (BSM) intervention targeted women's knowledge, beliefs, and social facilitation to manage their breast and nipple pain and achieve their breastfeeding goals. Objectives: The purpose of this longitudinal pilot randomized control trial (RCT) was to test the preliminary efficacy of the BSM intervention on general and specific pain related to breastfeeding. Methods: Sixty women intending to breastfeed were approached within 48 hours of delivery to participate in this pilot RCT (30 randomized to the BSM intervention and 30 randomized to the control group). All participants provided baseline data before discharge and pain and breastfeeding measures at 1, 2, and 6 weeks. Participants in the BSM intervention group received educational modules addressing breast and nipple pain and biweekly, text-based nurse coaching and completed a daily breastfeeding journal. Results: Women in the BSM intervention group reported significantly less breast and nipple pain at 1 and 2 weeks using a visual analog scale (p < .014 and p < .006) and at 2 weeks using the Brief Pain Inventory intensity scale (p < .029), but no difference in breastfeeding duration. Discussion: The BSM intervention pilot demonstrates a positive effect on breastfeeding specific and overall generalized pain. Future investigation is needed to identify at-risk women of ongoing breastfeeding pain and develop precision interventions to sustain this beneficial health behavior for mothers and infants.
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To identify the most effective interventions to treat nipple trauma in breastfeeding mothers. Systematic literature review using the PICO strategy. The search was conducted on the electronic information systems Medline-PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), World Health Organization Library Information System (WHOLIS), Cochrane, ScienceDirect (Elsevier), Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), using standardized and unstandardized descriptors. Studies were selected if they were controlled or uncontrolled randomized clinical trials written in English, Portuguese, or Spanish. Two reviewers evaluated the studies independently using a guide, and in case there were disagreements, a third reviewer was called on to reach a consensus. Of the 496 studies located, five were included. The treatments investigated were lanolin, lanolin in association with breast protection shells, breast milk, hydrogel, adhesive polyethylene film dressings, a spray containing chlorhexidine with alcohol, and distilled water. All the groups in every study received breastfeeding education. The best outcomes for the treatment of nipple trauma used lanolin (recommendation B, evidence level 2) and breast milk (recommendation B, evidence level 2). Although one clinical study was found with positive outcomes resulting from treatment using a spray containing alcohol and chlorhexidine 0.2% (recommendation B, evidence level 2), this treatment modality should be further investigated since literature is not in favor of using antiseptic substances in skin wound treatment. Considering the treatments investigated, the most favorable evidence indicates the use of lanolin alone or in association with breast protection shells and breast milk expressed and rubbed into the nipple and areola after each feeding session. However, the results obtained in this review are inconclusive, indicating the need for further studies in order to clarify the action of breast milk and lanolin on the damaged tissues, as well as studies involving samples representative of the number needed to treat. This study provides evidence for nursing practice, thus contributing to the improvement of lactating mothers with nipple trauma care and, consequently, improving the rates of successful breastfeeding as well as the quality of life of breastfeeding mothers.
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Background: The negative outcomes associated with painful and damaged nipples have been widely documented in the breastfeeding literature. Numerous studies have been conducted evaluating topical preparations to treat nipple pain and damage with equivocal findings. No studies have evaluated the effectiveness of the increasingly popular all-purpose nipple ointment (APNO). The purpose of this trial is to evaluate the effect of the APNO versus lanolin on nipple pain among breastfeeding women with damaged nipples. Subjects and methods: A double-blind, randomized controlled trial was conducted in a large single-site, tertiary-care hospital in Toronto, ON, Canada. Breastfeeding women (n=151) identified as having damage to one or both nipples were randomized to apply either APNO (intervention group) or lanolin (control group) to their nipples according to the trial protocol. The primary outcome was nipple pain at 1 week after randomization measured using the Short Form McGill Pain Questionnaire. Additional outcomes at 1 week after randomization and 12 weeks postpartum included nipple yeast symptoms and/or mastitis, rates of breastfeeding duration and exclusivity, and maternal satisfaction with infant feeding method and treatment ointment. Results: There were no significant group differences in mean pain scores at 1 week after randomization. Women in the lanolin group reported significantly greater satisfaction with their infant feeding method and had nonsignificantly higher breastfeeding duration and exclusivity rates at 12 weeks postpartum. Conclusion: Results suggest that APNO is not superior to lanolin in treating painful, damaged nipples.