The Use of Maternimates™ Hydrogel Dressing to Prevent Nipple Soreness in Lactating Women
Catherine M. Chalmers, MSN, RN, WHNP, IBCLC Northeast Health System, Beverly, MA
This clinical employed a case study approach to examine the effectiveness of a hydrogel dressing in preventing nipple soreness in lactating mothers. Ten mothers were asked to evaluate the level of nipple pain experienced as the result of breastfeeding within 24 hours of birth, as well as 3 days and 7 days following birth. The study measured the subjects’ pain intensity, as well as the ability of the hydrogel dressing to bring relief and promote healing.
Nipple soreness is a common occurrence among breastfeeding women. It has been reported that up to 96 percent of all women experience some degree of nipple pain or trauma in the early weeks of breastfeeding (Cable et al, 1997). This can become particularly pronounced on the third post-partum day as breasts fill to the engorgement stage of lactogenesis (DeCarvalho et al, 1984).
Hydrogel dressings are typically used as primary dressings for many types of chronic and acute wounds where light or moderate absorption is required. These include dermal ulcers, donor sites, first and second-degree burns, incisions and dermatologic procedures. Hydrogel dressings provide a mechanical barrier to contamination and abrasion (friction) while maintaining a moist, wound-healing environment.
Maternimates™ Hydrogel Dressings are sterile, polyurethane-based hydrophilic hydrogel pads that provide cool, soothing relief upon application. These dressings are available in round disc shapes that enable them to conform well to the breast. And, unlike other hydrogels, the Maternimates™ dressing does not contain any internal scrims, film or fabric backings that limit conformability or compromise moisture vapor transmission rates. The Maternimates™ dressing manages leakage by absorbing fluid and allowing moisture to evaporate, reducing the risk of macerating healthy breast tissue.
Ten women entered the study in the hospital and completed it at home. Four of the ten had epidural anesthesia during labor. Two of the subjects entered the study with some nipple trauma that occurred before the intervention of a lactation consultant. One subject had a latex allergy. Another subject had a history of sensitive skin and asthma.
To limit the individual variation of infant positioning and latch problems which are most commonly associated with nipple soreness, each participant had a one-hour education session with the same board-certified lactation consultant. A thorough review of positioning and latch techniques were reviewed, as well as an evaluation of the baby at the breast.
All participants were given three-inch Maternimates™ dressings to apply to both breasts between feedings within 24 hours of delivery. Before nursing, each participant removed the dressing, rinsed it with warm water, and patted it dry. Then each participant placed the dressing on the liner that it came packaged in and stored it in the refrigerator to cool the dressing while they nursed the infant. Before reapplying the dressing, all participants rinsed the breast with warm water and patted it dry. They also checked the dressing to make sure it did not appear milky or cloudy, which might suggest protein accumulation. If this occurred, they were instructed to discard it and use a new dressing. Most participants used two sets of dressings over the course of one week.
Each study participant was asked to identify pain intensity using a numeric pain intensity scale or verbal descriptor scale which allows for easy discrimination between high and low levels of pain. (Pugh et al. 1996) A five-point scale, with five as the highest level, was chosen for this study because it has been found to be easy to complete and item omission is least frequent with this form. (McGuire, 1984) (Nagata, et al. 1996). In addition, patients were asked to rate the dressing’s comfort using a rating scale of one through five, one being the least comfortable and five being extremely comfortable.
Upon entry to the study, pain scores ranged from 1-4, for an average rating of 2.2. Patients self-assessed their pain on the third post-partum day and the seventh post-partum day, both during and between feedings. On the third day, every patient scored lower levels of pain, with an average of 1.85 during feedings and 1.65 between feedings. (Figure 1) On the seventh post-partum day, patients also experienced a lower pain score both during and between feedings with a score of 1.3 and 1.2 respectively. (Figure 1) Previous studies have shown that it can take up to 12 days to show an improvement in nipple pain reduction (Zeimer et al, 1990).
In addition, seven of the ten participants rated dressing comfort a five (extremely comfortable) on both the third and seventh post-partum day, while three participants rated the dressing a four (moderately comfortable) on both the third and seventh post-partum day, for an average rating of 4.7. (Figure 2)
Finally, a ranking scale was used to determine how long it took patient nipples to heal. Of the seven women who did have some nipple soreness or trauma at the outset of the study, five patients said that their nipples healed within two to three days, while two patients said that their nipples healed within two days. No previous studies have shown patient relief of symptoms this soon after breastfeeding initiation.
At no time during the study period did any of the patients develop bacterial or fungal infections, nor any rashes, reddening, cracking or other manifestation of nipple soreness.
A case study model was used for this clinical to generate performance information about the use of a hydrogel dressing for the treatment and prevention of nipple soreness in breastfeeding mothers. Case study design research is a useful approach to demonstrate the effectiveness of a specific, therapeutic technique and provide detailed, descriptive information. (Burns and Grove, 1993). In this study, patients experienced an overall lower pain rating, a shorter inflammatory phase of wound healing (as measured by self report pain scale) and unanimously selected the highest comfort rating.
Further controlled studies using a large, heterogeneous population that compares the effectiveness of the hydrogel dressing to an alternative product or no product will define the effectiveness of hydrogels even more clearly.
These findings indicate that the use of Maternimates™ Hydrogel Dressings provided a safe, effective, treatment for limiting nipple soreness in breastfeeding women. The dressings’ moist wound healing properties were an aid in reducing pain and promoting nipple healing, without an increased risk of infection. Because of the dressings’ cool, soothing nature, patients found the dressings to be very comfortable and easy to use. Furthermore, every patient continued to use the dressings as a preventive measure and indicated they would recommend them to other lactating women.
- Burns, Nancy and Grove, Susan K., The Practice of Nursing Research Conduct, Critique and Utilization, Second Edition, W.B. Saunders, 1993.
- Cable, Bonnie et al., "Nipple Wound Care: A New Approach to an Old Problem." Journal of Human Lactation, 1997;13 (4):313-318.
- DeCarvalho, Manoel, Roberston, S., Klaus, M., "Does the Duration and Frequency of Early Breastfeeding Affect Nipple Pain?" Birth, 1984;11(2):81-84.
- Hewat, Roberta, et al., "A Comparison of the Effectiveness of Two Methods of Nipple Care," Birth, 1987, 14 (1).
- McGuire, Deborah B., et al., "The Measurement of Clinical Pain," Nursing Research, May/June 1984;33(3): 152-156.
- Minchin, Maureen K., "Positioning for Breastfeeding," Birth, 1989;16(2): 67-80.
- Nagata, C., et al., "Choice of Response Scale for Health Measurement: Comparison of 4,5 and 7-Point Scales and Visual Analog Scale," Journal of Epidemiology, 1996;6(4): 192-197.
- Pugh, Linda C., et al., "A Comparison of Topical Agents to Relieve Nipple Pain and Enhance Breastfeeding," Birth, 1996;23(2): 88-93.
- Ziemer, Mary M., et al., "Evaluation of a Dressing to Reduce Nipple Pain and Improve Nipple Skin Condition in Breast-feeding Women," Nursing Research, 1995;44(6): 347-351.
|9403||Kendall™ Hydrogel Breast Feeding Pad, 3" (7.6 cm)||1 pair/package, 5 packages/box, 5 boxes/case|
NOTE: Maternimates™ Hydrogel Breast Feeding Pads and Kendall™ Hydrogel Breast Feeding Pads are trademarks for the same product. Maternimates products are sold exclusively in the United States by Hollister Incorporated under the Ameda ComfortGel™* brand and Kendall is sold exclusively outside of the United States by Covidien.