Fortunately I haven't had any need for them with either of my babies, but medicated nipple ointments can be a life line with you have yeast or bacterial infections. It can be a little confusing to figure out what to get and not always easy to get it, so I thought I'd summarize a few options below.*
While the most common cause of pain with breastfeeding is a bad latch (and this is the first thing to get help with, since it often can be fixed really quickly), sometimes there are other causes, like bacterial or yeast infections.
In those cases, it can sometimes be pretty hard to tell which it is, and that's where 'all purpose nipple ointments' can come in handy.
The most commonly cited one comes from Dr. Jack Newman, a Canadian doctor and breastfeeding expert. His is a prescription, compounded ointment mixed from the following ingredients:
- Mupirocin 2% ointment (15 grams)
- Betamethasone 0.1% ointment (15 grams)
- To which is added miconazole powder so that the final concentration is 2% miconazole.
"This combination gives a total volume of just more than 30 grams. Clotrimazole powder (not as good as miconazole) to a final concentration of 2% may be substituted if miconazole powder is unavailable, but both exist (the pharmacist may have to order it in, but compounding pharmacies almost always have it on hand). Using powder gives a better concentration of antifungal agent (miconazole or clotrimazole) and the concentrations of the mupirocin and betamethasone remain higher. Sometimes we will add ibuprofen powder to a final concentration of 2%.
The ointment is applied sparingly after each feeding (except the feeding if/when the mother uses gentian violet). “Sparingly” means that the nipple and areola will shine but you won’t be able to see the ointment. Do not wash or wipe it off, even if the pharmacist asks you to. The APNO can be used for any cause of nipple soreness ("all purpose nipple ointments"), not just for Candida (yeast). Use the ointment until you are pain free for a few days and then decrease frequency over a few days until stopped. If you are not having less pain after 3 or 4 days of use, or if you need to be using it for longer than two or three weeks to keep pain free, get good help or advice."
Sometimes it's not possible to find a doctor who will prescribe Dr. Newman's ointment. In those cases a mother could ask her provider for a prescription for Bactroban:
- 2% ointment
- Contains Mupirocin, which is antibacterial and antifungal (probably better than nystatin)
- Apply sparingly, do not wash off
- Rated L1 (lowest risk) in Medications and Mothers' Milk
For an over the counter version, Dr. Thomas Hale, of Medication and Mother's Milk suggests this combination. I took this from Dr. Hale's presentation notes at a breastfeeding conference:
- 1% hydrocortisone ointment
- Polysporin ointment or triple antibiotic ointment
- Optional: miconazole cream
- Apply sparingly after feedings, do not wash off
Kellymom also has directions on using a salt water rinse after nursing to help speed healing of damaged skin.
* This information is provided for educational purposes only, and is not intended as a medical advice. Consult your healthcare provider for medical advice appropriate to your situation.
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