Lano-no? Do lanolin and other creams really help sore nipples?
“Here, this is like magic cream.” The midwife smiled as she handed me a sample sachet of lanolin, the recognisable purple branding leaping out at me. I was experiencing painful feeding, and it appeared that the answer was “magic cream” at least, according to the staff at my local maternity unit. They explained how sometimes nipples just need some time to toughen up and get used to the constant use of breastfeeding. Exhausted and in pain, I gladly accepted several of these tiny purple sample packets and slathered the contents on my cracked nipples, desperate for relief. I was frustrated and upset when it ended up making absolutely no difference to my pain.
Since those hazy, sore days of early breastfeeding I have learned a lot, and one of those things is that there is no such thing as a “magic cream” for sore nipples. Before you throw a tube of nipple balm at me in outrage, lets dig a bit more into WHY sore nipples are such a problem – and then we can talk about why that means no amount of cream is going to solve the issue.
Sore nipples are caused by something being a little “off” with your baby’s latch. On the roof of your baby’s mouth they have a hard palate at the front, and a soft palate near the back. You have the same – have a feel if you like. The hard palate is bony, whereas the soft palate is more like a cushion. If your baby doesn’t have a deep latch, you’re going to find your nipple being pinched up against that hard palate, causing pain and damage. If the nipple is in the correct part of your baby’s mouth, cushioned by the soft palate – then you will not usually feel pain.
If we assume that nipple pain and damage have a cause (usually a shallow latch) then it becomes natural to ask, “so what does nipple cream do to help?” It isn’t going to make your baby’s latch better, that’s for sure!
Well, the evidence from a Cochrane review in 2014 tells us that putting something moist on your nipple after feeds might help a little bit with nipple healing BUT the thing that really helps is getting support with baby’s latch. The evidence also explains that if you’re not getting help with overcoming the root cause of your pain, nipple cream (or any other balms etc) will not aid healing. Simply, this is because the nipple is being damaged every single time you put your baby to the breast, whether there is a barrier of lotion or not. It’s a bit like putting a plaster over your finger and then going at your finger with a knife. The plaster won’t provide any protection!
A lot of people will say that they personally found nipple balms to be helpful, and I want to be clear that there is nothing *wrong* with using them, it’s just that they’re not addressing the underlying problem, and unless you do that, they aren’t actually going to help. One of the reasons people think cream helps is because of the passing of time. Pain will often resolve as a baby gets bigger and as your milk supply settles down (often around the 4-6 weeks point.) This is because a bigger baby and less full breasts makes it easier for little one to get a deep latch. People often assume that it just takes that long for your nipples to toughen up and that the nipple creams and lotions help while you’re waiting for that to happen. Sadly, this is unlikely to be the case. The nipple cream gives you something to do – something that helps you to feel more in control of a really difficult situation, but it isn’t doing anything special or magic in regard to healing damage.
In fact, the most up to date evidence tells us that letting a drop of human milk dry on your nipple is just as effective as creams for soothing sore nipples after feeding. And the wonderful thing about that is it’s free! (Dennis et al, 2014)
The thing I find most frustrating about the sale of nipple creams, is the cost. In the UK a tube of the most popular lanolin-based balm costs around £12 - That’s around 22AUS. And there is NO evidence that it is any more effective than your own breastmilk, a dab of coconut oil, or even some petroleum jelly. Somehow lanolin and other balms have cornered a market that shouldn’t even exist, because the gold standard practice for healing sore nipples is to address the cause of the pain, not to simply try to mask it with false promises of a magic cream. In fact, recommending cream over meaningful support smacks of a medical system that isn’t educated on lactation or how to appropriately support it. Going back to my plaster analogy above – you wouldn’t want a medical professional to simply whack a plaster over an almost severed finger. You’d expect appropriate care to fix the wound. Handing out nipple cream is not helping to fix anything – except possibly pausing your cries for help while you’re distracted with it.
And this leads us into a deeper discussion – unethical or simply unhelpful products with no scientific evidence behind them being marketed at breastfeeding parents. It’s not just creams for your nipples. Ask Google about low milk supply and you will be inundated with lactation cookies, smoothies, teas, and supplements that all claim to “help” with breastfeeding or milk supply. They are always overpriced, and even those with known active ingredients in them have such low volumes of those ingredients that there is no way they can actually help milk production. This is another example of selling mothers products that play into fears instead of offering meaningful support to allow parents to reach their feeding goals.
Gabrielle Palmer, Author of The Politics of Breastfeeding says it best:
“The current use of brand power... is not driven by the quest to improve nutrition but to manipulate the psychological perceptions of the consumer in order to maximise profits.” (Complimentary Feeding; Nutrition, Culture and Politics)
We know that formula companies spend a lot of time and money trying to sell their products where they are not wanted or needed. We often don’t realise that breastfeeding “friendly” brands are doing the same thing. While it is completely ok to drink a lactation tea, eat a lactation cookie, or use lanolin, please also ask yourself who is profiting from your purchase in the longer term? Do you need a smoothie or cream from a big brand trying to make a profit... or do you need skilled breastfeeding support, which you can access for free through your local and national support services?