In the moist wound healing post, I discussed a number of peer-reviewed clinical studies that examine whether using dressings or creams to prevent nipples drying out helps them to heal more quickly (short answer: it doesn’t). While I was researching the post, I came across a ‘clinical case study’ on a hydrogel dressing manufacturer’s website, purporting to show the effectiveness of their product. As it is not really research, it wasn’t included in the moist wound healing post, but as it very much tries to appear as if it is, I thought it would useful to write about it anyway.
In the ‘study’, 10 women were supplied with hydrogel dressings within 24 hours of giving birth, and asked to wear them continually on both breasts when they weren’t feeding. Their effectiveness was measured, on the third and seventh days of wearing them, by asking the women to rate the levels of pain they experienced whilst they were breastfeeding, and in the time in between feeds. The scores, displayed in a rather unorthodox graph (where the between and during feed measures are inexplicably joined together with a line), appear to show that the dressings caused pain levels to gradually decline.
Of course, the fact that pain scores are lower on day 7 than day 3 does not necessarily mean the dressings are effective – the chances are, this would happen anyway. To demonstrate that the dressings cause the ratings to go down more quickly than usual, the paper Ziemer et al, 1990, is cited as evidence that without treatment it can take up to 12 days for nipple pain to improve. I have read this paper, and am a little surprised at the way the results have been interpreted: it actually reports that for the majority of women, nipple pain peaks on day 3, and declines thereafter1. If we assume that the ‘1990’ in the main body of text was in fact an error (there is no Ziemer et al, 1990, in the references at the end) and they actually meant to say Ziemer et al, 1995 (which is listed) the citation becomes even less appropriate. I have read this paper as well, and can tell you that the study that it reports ended at 7 days, and is therefore unable to say anything about nipple pain at 12 days2. There are numerous other studies not mentioned in the article that show that mean pain scores start to decline significantly within – who’d have thought? – 7 days of giving birth3.
The article concludes by saying:
The dressings’ moist wound healing properties were an aid in reducing pain and promoting nipple healing, without an increased risk of infection.
The observant among you will have spotted that neither wounds nor infections were monitored, so this claim is, of course, completely unfounded. It may also be wrong: research that has examined using hydrogel in a controlled setting reports that it may in fact delay wound healing and make mothers more vulnerable to infection4. Unsubstantiated or inaccurate statements about the effectiveness of a product are perhaps to be expected from a company trying to sell it. What is truly frustrating about this item of pseudo-science, however, is that it is endorsed by a midwife, lending it legitimacy. When women start breastfeeding they are often feeling stressed and vulnerable. If they can’t rely on health professionals to give them accurate, unbiased advice at this time, then it’s a pretty depressing state of affairs.
August 15, 2009 at 6:53 pm
[…] of Midwifery August 15, 2009 — Elizabeth Jay A few weeks ago, I talked about a ‘clinical case study’ posted on a medical supply manufacturer’s website, apparently demonstrating the benefits […]