Given the high incidence of nipple pain (it seems most women experience it when they start breastfeeding1), it would be reassuring to know that something can be done to relieve it. At the breastfeeding antenatal class the midwife told us that there is no evidence for the effectiveness of most nipple creams, although there have been studies showing that Lansinoh (commercially available purified lanolin) helps, and this is the one to go for if you have a problem. This view was echoed by two other midwives (one of whom gave me some sachets) and an NCT breastfeeding counsellor. You can read about my experience of using this preparation in the nipple solutions 1 journal post, but suffice to say that it didn’t work for me.
So, what is the scientific evidence for the effectiveness of lanolin? Probably the first thing to mention is that most of the big brand off-the-shelf nipple creams are simply moisturizers, and as the midwife said, there aren’t any published clinical trials supporting their effectiveness. On top of this, most of them aren’t even safe to go in babies’ mouths, so have you have to clean them off first – not ideal. This isn’t the case for Lansinoh – as it is simply purified lanolin, it isn’t a problem if babies swallow it (although this in itself doesn’t mean it’s worth using, of course).
An article looking at various topical treatments for nipple pain reviews several studies testing the effectiveness of lanolin1. When compared with hydrogel dressings (designed to maintain a moist wound healing environment), lanolin does well. In one study, women treated with lanolin reported significantly less nipple pain and were less likely to suffer from infection than those using the dressings. In another, there was no difference in pain relief, but there were still fewer infections in the lanolin group. Evidence that lanolin is a useful treatment? Not necessarily. As neither of these studies had a control group where no treatment was given, all we can tell is that hydrogel dressings are a bad idea. A study looking at the effect of heat treatment (sunshine or heat lamps) suffers from a similar problem. Using lanolin with the heat treatment offered greater pain relief than using the heat treatment alone, but unfortunately there is no way of telling whether this is better than not using any treatment at all.
In fact, the three studies in the review that compared lanolin with a ‘no treatment’ baseline showed it to be no more effective than leaving the nipples alone. There is also evidence that lanolin offers no improvement over rubbing on expressed milk (which is also reported as being pretty useless at reducing pain). The article also reports some preliminary research indicating that glycerin gel is a better treatment for sore nipples than lanolin (although a later study has found no difference between the two2.
Two further studies also deserve a mention. One provides evidence that peppermint gel is better at preventing nipple cracks and pain than lanolin or a placebo gel3. Another shows that in certain circumstances applying lanolin not only offers no improvement, but might actually make things worse4. The study compared using lanolin cream or breast milk with not using a treatment. The results showed that the appearance of nipple wounds (cracks and fissures) was the same in each group. However, the women who applied breast milk or used no topical treatment recovered significantly faster than those using lanolin.
So, it seems you may be better off ignoring the health professionals’ advice to use a lanolin cream. If you want to keep your nipples trauma-free you may want to think about using peppermint gel, or alternatively go for the inexpensive option of not bothering to treat them at all.
Having been told that my initial breastfeeding difficulties – cracked, bleeding, excruciatingly painful nipples – were quite normal (despite what the official literature said), I was looking forward to the three week deadline after which everything would be functioning as it should. I was, however, slightly perturbed by the fact that as he deadline approached, no improvement was evident. In fact, my nipples were getting much, much worse. My husband expressed genuine concern that C was going to chew one of them off! By this stage, the bleeding had stopped, but it had been replaced by deep, ulcerated gashes on the outside edge of each nipple. I dreaded feeding, and as C wanted to do so 10-12 times a day, I spent all 24 hours either in pain, or anticipating its imminent start.
The first couple of days at home were pretty breezy. Before I left hospital I was assured by two midwives that C was latching on properly – cheeks puffed out, chin pumping, ears wiggling – so I was confident we had the technique sorted. Family visited and I assured them everything was going well, demonstrating our successful feeding on several occasions. By the time I got to day four, however, things weren’t quite so easy. Accompanying the hormone-induced plunge into despair inadequately named ‘the baby blues’ (that coincides with the start of proper milk production) was a serious deterioration of my nipples.
One of the anecdotes you may have heard (particularly if you are pale) is that women with fair skin are more likely to experience sore or damaged nipples. If you have very light skin and painful nipples (as I did), it may be strangely reassuring to be able to attribute at least some of the difficulties you’re experiencing to your colouring. On the other hand, if you have dark skin and sore nipples, you may simply view this kind of statement as irritating nonsense.
The Truth About Breastfeeding 