Friday, February 13, 2015

Nurse Charity to the rescue/ Care for Open Nipple Wounds

Care for Open Nipple Wounds
(nipples that are excoriated, scabbed, bleeding, or have pus)

OUCH!   A great latch fixes most problems, so the first step is to find expert help ASAP. (Your IBCLC needs to watch a latch or two, and check the baby's mouth for unusual anatomy).   But while you and your new cutie are learning, sometimes you get a painful latch, and within minutes those tender nips are in need of some serious TLC.  Or you got a little aggressive with the pump suction, and there are blisters or cracks at the nipple base.

Pro-tip:   Pumping should be comfortable, not just tolerable- if it is pinchy at all turn down the suction, even at the lowest setting, the pump will still work. Don't fall into the trap of suction beyond comfort will move more milk.  Pain interferes with letdown.

Once you have an open wound, there is greater risk for infection so nipple care is very important- we aim to lower your risk of infection, and support moist wound healing.  I have tried many things over the past years- this is what seems to work best.

Saline Soaks twice a day (minimum) for 3-5 minutes-  Saline helps flush the wound, promote healing, and feels great.  Just make your own.  ¼ teaspoon of SEA SALT (not table salt) in 1 cup therapeutically hot  water (not asking you to boil your nipples, that would be a bad idea- but the water should not be tepid either- good hot bath water temperature).  Make it in a small coffee cup (two if you have damage on both sides), and then lower your breast into the cup.  Some gentle pressure with your hand will allow you to seal the cup to your breast, and you can sit comfortably upright (or walk around).  Sometimes the cup becomes unsealed, a towel on hand to clean up any water spills is wise.  Twice a day is great, but you can do it more if you love it.

Now to protect from infection!

Antibiotic Ointment-  I like to use a small amount of antibiotic ointment after each feed or pump. Not picky what kind, but should be ointment, not cream (bacitracin and neosporin are what most people have at home- check the expiration date, throw away anything that looks old).  Just a little dab, and then do not wash it off.  New skin needs to be left alone, washing the nipples before each feeding can do more damage than good.  The very small amount of residual ointment will not hurt anyone.   If you have a prescription for mupirocin ointment (Bactroban), or APNO (All purpose Nipple Ointment- a combination antibacterial, antifungal, plus steroid potion) that can be used instead of the OTC options.

Gentle Cleansing- if signs of active infection are present- If you have any kind of ooze or pus (sometimes looks like yellow/greenish crust), you need to add another step.  A once to twice a day wash with mild antibacterial soap, very gently, and then pat dry.  NOTE: If the nipples are open and scabbed but do not have any oozing, you can skip this step.  Soap is very drying and can create irritation if over used.

Help!  My nipples keep getting stuck to everything and are rubbing against my clothes!

Open to Air- best course of action is to leave them open to the air as much as possible, Yay for topless parenting!  

Pro-tip: Here is the litmus test for helpful postpartum care- anyone in your home for longer than 15-20 minutes should be able to watch you breastfeed (which includes seeing your bare breasts for extended amounts of time), be cheerful and willing to scrub your toilet (or fold laundry, or run the vacuum- anything you need), and be able to provide a meal (they can cook it, they can order in, but they must provide sustenance).   Everyone else should ring the bell, leave the casserole at the door, and blow you air kisses from the sidewalk.  No exceptions. People who just want to admire/hold/coo the baby and cannot do the above need to go in a hurry.    

If that is not practical for you here are some other suggestions-

Food grade Oil-
Some coconut oil or olive oil can promote moist wound healing, and help the skin from sticking to things, go ahead and be liberal.  Do not wash it off.  The fancy things you got as shower presents also work (nipple butter, mother love etc etc etc), but I find food grade oils to be just as good, and less expensive.

Medical Grade Lanolin- same directions as above.  I sometimes get people who are allergic, and unfortunately no one sells just pure lanolin any more- they have all added emollients so it is easier to spread, but it is tried and true.

Hydrogel Dressing-   If you are using the antibacterial ointment, you can use a product call hydrogel dressing (Soothies or Hydrogel) to soothe, protect and promote moist wound healing without having the wounds stick to your breast pads or bra.  It is what we use for burns in the hospital setting.  Because it is a warm moist environment, a little dab of antibacterial ointment will help keep the bacterial levels modest (do not skip this step, studies show that hydrogels used incorrectly can increase your risk for mastitis- do not let this be you!).  The directions will tell you to wash your breast before each feeding- OVERKILL- again over washing is bad for healing wounds, so skip that step unless you see that the hydrogel dressing is crumbly, and you have some hunks on the breast.  Then of course you would rinse those bits off, and throw away the hydrogel (it has outlived it's usefulness). The pad itself is sticky and attracts lint, so do rinse the pad with water before each use. Some moms love storing them in the fridge so they can have something cool to soothe their nipples.  

Using the above methods, and a stellar latch, your nipples should look significantly better in 3 days, and be healed in 7-10 (maybe even faster).  So check in if you are struggling at the 3-5 day mark.   

*Any potion, gel pad, disposable breast pad or soap has the potential to* *cause an allergic reaction or aggravate sensitive skin*
If anything you try for 24-48 hours seems to be making things worse, please discontinue and give us a call to check in.

If you think you have YEAST, please see my guest blog about Thrush.

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