Clinical
Case Study
The Use of MotherMates
Hydrogel Dressing to Prevent Nipple Soreness in Lactating Women
Catherine
M. Chalmers, MSN, RN, WHNP, IBCLC
Northeast
Health System, Beverly, MA
Abstract
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.
Introduction
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.
Materials
MOTHERMATES 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 MOTHERMATES dressing does not contain any internal
scrims, film or fabric backings that limit conformability or compromise
moisture vapor transmission rates. The MOTHERMATES dressing manages leakage
by absorbing fluid and allowing moisture to evaporate, reducing the risk
of macerating healthy breast tissue.
Methodology
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 MOTHERMATES 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.
Results
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. (Fig. 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.
Discussion
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.
Conclusion
These findings indicate
that the use of MOTHERMATES 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.
References
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.
See
also: Lansinoh
Cream for Breastfeeding Mothers
See
also: LilyPadz:
No Leakage, No Lines
