Cracked Nipples Research Articles

Safety and effectiveness of lanolin-based cream to prevent cracked nipples in the early postpartum period

Introduction. According to WHO, 98% of women in the world are capable of full lactation, however, only 35% of infants in the world get exclusive breastfeeding for the first 6 months after birth. Wounds and ulcers of nipples are common causes that lead to 95% of women refusing to breastfeed. Aim of the study. To evaluate the efficacy and safety of the lanolin-based cream to prevent cracked nipples in women in the first 30 days after delivery. Materials and methods. The population consisted of 128 patients in the early postpartum period, randomized into 2 groups depending on the features of breastfeeding and the method of prevention of cracked nipples: Group I – 99 patients who received lanolin-based cream with individual consultation on breastfeeding; Group II – 29 patients who did not receive the cream. Examined substance – nipple cream, composition: 100% lanolin; pharmacotherapeutic group: antiseptic. The cream has keratolytic, antiseptic, wound healing effect. Method of application and dosage: externally, after each feeding (or as needed), the cream was applied to the nipple and areola, the cream does not require removal before applying to the child’s chest. Results of the study and discussion . Evaluation of efficacy and safety was carried out on the basis of clinical data, complaints, objective data and the results of cytological studies in a comparative aspect - before the cream was applied and one month after its application. Conclusions. Correction of breastfeeding disorders in combination with a cream based on 100% lanolin has reduced the frequency of clinical manifestations to zero, and most importantly, to preserve exclusive breastfeeding for patients under observation. The studied cream is harmless for the child and effective in preventing cracked nipples.

Maternal satisfaction with breastfeeding in the first month postpartum and associated factors

BackgroundBreastfeeding success has been measured based on its duration, disregarding satisfaction with the maternal experience. Studies to investigate maternal satisfaction with breastfeeding are rare, especially in Brazil, and little is known about their determinants. The aim of this study was to measure the level of satisfaction with breastfeeding in a group of women in the first month of their child’s life, and to identify factors associated with higher maternal satisfaction.MethodsA cross-sectional study nested within a cohort was conducted with 287 women recruited at two (one public, one private) maternity services in the city of Porto Alegre, southern Brazil, from January to July 2016. Women residing in the municipality who had given birth to a healthy singleton born at term, were rooming in, and had initiated breastfeeding were randomly included. During the week after the child was 30 days old, women were interviewed at their homes to measure the level of maternal satisfaction with breastfeeding, using the Maternal Breastfeeding Evaluation Scale (MBFES), validated for use in the Brazilian population. Associations between maternal satisfaction and explanatory variables were estimated using multivariate Poisson regression with robust variance in a four-level hierarchical approach. Satisfaction level was categorized using as cutoff point the median score obtained with the MBFES. Women with scores equal to or above the median were considered to have higher levels of satisfaction, whereas those scoring below the median were considered to be less satisfied.ResultsMaternal satisfaction with breastfeeding in the first month postpartum was high, with a median score of 124 on MBFES, close to the maximum score (145 points). The prevalence of more elevated levels of satisfaction with breastfeeding was higher among women with brown (pardo) and black skin color (prevalence ratio [PR] 1.33, 95%CI 1.05;1.69), those who lived with the partner (PR 1.75, 95%CI 1.05;2.94), who planned to breastfeed for 12 months or more (PR 1.48, 95%CI 1.02;2.17), and who did not report low milk supply (PR 1.47, 95%CI 1.03;2.10) or cracked nipples (PR 1.29, 95%CI 1.01;1.65).ConclusionsThe factors associated with maternal satisfaction with breastfeeding in the first month postpartum include individual factors and maternal expectations, family constitution, as well as breastfeeding-related problems.

Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial

BackgroundBiological nurturing is a neurobehavioral approach to breastfeeding support that encourages women to breastfed in a relaxed, laidback position. This approach has the potential to reduce breast problems (e.g., sore nipples), making good latch easier and thus facilitating the initiation of exclusive breastfeeding. However, its effects have not been adequately investigated in a real-life situation. The aim of this randomized controlled trial was to assess the effectiveness of biological nurturing, compared to usual hospital practices, on the frequency of breast problems and on the prevalence of exclusive breastfeeding at discharge from the maternity ward, after 1 week, and at one and 4 months.MethodsOpen randomized parallel controlled trial carried out in a third level maternity ward (IRCCS Burlo Garofolo, Trieste, Italy) between March and December 2018. Two-hundred eight women who planned to give birth at the hospital and who expressed the intention to breastfeed were enrolled during pregnancy and randomized to receive breastfeeding support following either the biological nurturing approach or the usual care protocol based on the WHO/UNICEF 20-h course, in use at the hospital. The primary study outcome was the incidence of breast problems during hospital stay, defined as the presence of one or more of the following outcomes, collected separately: sore nipples, cracked nipples, engorgement and mastitis. The primary analysis was performed by intention to treat. The follow up lasted 4 months.ResultsOne hundred eighty eight out of 208 women (90.3%) were included in the analysis, 90 allocated to the biological nurturing group and 98 to the usual care group. At discharge from the maternity ward, biological nurturing significantly reduced the risk of breast problems (Relative risk [RR] 0.56, 95% Confidence Interval [CI] 0.40, 0.79), including cracked (RR 0.42, 95% CI 0.24, 0.74) and sore nipples (RR 0.59, 95% CI 0.40, 0.88). No statistically significant difference was observed for exclusive breastfeeding at discharge and up to 4 months. No adverse events occurred.ConclusionsThe biological nurturing approach applied in the real-life situation of a third level hospital was effective in preventing breast problems.Trial registrationClinicaltrials.gov NCT03503500. Date of First Submission: 28 March 2018.

Non-nutritional "paramedical" usage of human milk - knowledge and opinion of breastfeeding mothers in Poland.

The objective of this study is to understand knowledge, attitudes and practices of non-nutritional breast milk use among lactating women in respect of skin diseases and other frequent ailments. The study, in the form of a questionnaire, spread on social media, was targeted at breastfeeding women. The questionnaire consisted of questions regarding the knowledge of non-nutritional usage of human milk, its use in practice, subjective opinion on the observed results and inclination towards future use. Chi-square tests and c-Pearson coefficients were used for statistical calculations. A total of 1187 responses were acted upon. In the study group, 879 women claimed to have knowledge of non-nutritional use of human milk in respect of skin and most common ailments, whilst 688 of them claimed to use at least one usage. The most frequently, breast milk was used for: care of cracked nipples, care of healthy skin, treatment of diaper dermatitis and treatment of neonatal acne. A correlation between duration of breastfeeding (p < 0.05) and gestational age (p < 0.05) and practical use of non-nutritional human milk was found. The study showed a great enthusiasm of mothers in respect of using breast milk for non-nutritional purposes, including the treatment of skin diseases and other common ailments. However, given the scant studies determining possible concerns surrounding these methods, there is a requirement for parental education with emphasis on the need for prompt medical examination and pertinent treatment.

The Effect of the Beeswax-containing Barrier on the Prevention of Nipple Crack

The Effect of the Beeswax-containing Barrier on the Prevention of Nipple Crack

Description of 101 cases of nipple cracks and risk factors via case–control study in eight units of a perinatal network

Nipple crack are a frequent complication of breastfeeding, causing pain for the mother and feeding difficulties for the baby with the risk of early cessation of breastfeeding. The characteristics of nipple cracks have rarely been described. Treatment varies according to the period of breasfeeding and the maternity ward. Eight maternity wards in a perinatal health network in western France followed up maternal nipple cracks. The cracks were described and their treatment was noted. The variables regarding the mothers, delivery conditions, health of newborns, and their ability to breastfeed were analyzed. Each case patient was matched with a control patient who was in a room adjacent to the case patient. Case–control analysis was univariate, followed by multivariate analysis via logistic regression (SPSS 20.0) with adjusted odds ratios (aOR). In all, 101 cases of women with nipple cracks were studied. The cracks were predominantly located in the upper external quadrants as well as in the central part of the nipple. There were no lateralization effects (right or left). The most frequent treatments after breastfeeding were oils, hydrophilic gel, and maternal milk. Compared with the 101 controls without cracks, the features associated with cracks in multivariate analysis were fair skin (aOR=1.92 [1.01–3.60]; P=0.04), history of nipple cracks (aOR=11.38 [3.69–35.13]; P=0.0001), first breastfeeding (aOR=4.21 [1.27–13.86]; P=0.018), and normal weight or no obesity (aOR=0.33 [0.14–0.75]; P=0.008). Two more specific analyses were performed in primiparous and multiparous women. In conclusion, the practitioners learned to describe nipple cracks and analyze their treatments. Knowledge of the risk factors should enable practitioners to propose active prevention to mothers with fair skin, a history of cracks, or a lack of experience in breastfeeding by helping them to breastfeed during the first days of their infant's life, especially for primiparous and overweight or obese women.

New trends in prevention and treatment of postpartum mastitis and lactostasis

Exclusive breastfeeding in the first 6 months of life is recommended by the World Health Organization, since breast milk provides the baby with all the nutrients and elements necessary for normal development and growth. In the first weeks of lactation, women can often face a number of problems, such as pain in the breasts and nipples, nipple cracks and mastitis. These problems make feeding difficult and, in some cases, lead to the cessation of breastfeeding. Mastitis is a terrible complication of the postpartum period and the basis for the cessation of lactation. Counseling and support of mothers, prevention of lactostasis, nipple cracks and teaching techniques to properly attach the child, reduce the complications of lactation. Timely diagnosis and adequate therapy of mastitis, helps to preserve breastfeeding and improve the health of the mother and child.

Mastitis and/or plugged ducts? How to differentiate, help and treat?

Mastitis is one of the most common pyoinflammatory processes that occur in the postpartum. The mastitis incidence varies from 0.5% to 33%. Due to lack of standard algorithms, approaches to diagnosis and treatment of lactational mastitis vary between pediatricians and obstetrician-gynecologists. Plugged ducts is the basic factor that predisposes a woman to plugged milk ducts, which can lead to mastitis. Unfortunately, frequently prescribed antibacterial treatment has an adverse effect on human milk microbiota and creates subtherapeutic drug concentration in milk, which leads to antibiotic resistance in infants. Effective expression of breast milk is a key method to prevent and fight mastitis and plugged ducts. Recommendations for preferred method of breast milk expression require a personalized approach, the first of which depends on the assessment of breast nipples condition. According to some reports, 80–90% of breast-feeding women develop soreness and cracked nipples, which cause delayed or missed breastfeeding. Teaching correct breast-feeding techniques can prevent the chain of these adverse events:cracked nipples – plugged duct – lactation mastitis.Ideally, a healthy mature infant with active sucking reflex, who is breastfed effectively with a good technique, may perfectly ensure a problem-free lactation period.

Taking good care of a young child is a guarantee of his health

In the review article the basic problems of children’s health of young age are considered deficiency of vitamins and minerals at breastfeeding, complexity of skin care, allergies, acute respiratory viral infections. Attention is paid to hypovitaminosis and nipple cracks in mothers during lactation, as well as to the necessity of vitamin-mineral complexes subsidizing and mammary gland skin care during this period. Proper care for a child of early age is a guarantee of his health and harmonious development. Paediatricians should promote maternal literacy in modern methods of child care, disease prevention and treatment.

Breastfeeding Self-Efficacy Score with Lactational Mastitis a Cross Sectional Study in a Family Health Unit, Sharkia Governorate,Egypt

Abstract: Background: Mastitis is an infection of the tissue of the breast that occurs most frequently during the time of breastfeeding. About 1%-3% of breastfeeding mothers develop mastitis. Engorgement and incomplete breast emptying can contribute to the problem and make the symptoms worse. Mastitis can occur with or without the presence of infection. As it progresses, mastitis can cause the formation of a breast abscess. Severe cases of mastitis can be fatal if left untreated. Objectives: To assess the prevalence and risk factors of mastitis in lactating females and to determine breastfeeding self-efficacy for cases of mastitis. Method: A cross sectional study in a family health unit in Sharkia governorate on women who gave birth to a healthy term infant, attending El- Aslogy family health unit for the 4th dose of child vaccine. Interviewed in the vaccination room for the occurrence of mastitis and its risk factors and breastfeeding self-efficacy-short form. Results: 20% of the studied lactating females developed mastitis. Three quarters of mastitis cases have no previous history of mastitis (75%), 75% suffered from nipple cracks and 70% wore bra during sleep. The mean score of Breast-feeding Self-efficacy Scale is statistically higher with non-mastitis than with mastitis (50.84 ± 8.48 versus 32.77±2.68) respectively (p<0.001). Conclusion: There is statistical significant difference between mastitis cases and female without mastitis regarding nipple cracks and breast congestion, lactating duct obstruction, wearing breast bra during sleep and using milk suction. Breast-feeding Self-efficacy Score is higher with non-mastitis than with mastitis cases.

Knowledge, Attitude and Intending Practice on Breastfeeding Among Clinical Medical Students in Bingham University Teaching Hospital, Jos

Background: Breastfeeding is a basic human activity, vital to infant and maternal health. A good breastfeeding advice from health professionals can influence a mother’s decision to initiate and maintain breastfeeding positively. This study is aimed at assessing clinical medical students’ knowledge, attitudes and intending practice towards breastfeeding. Method: Consecutive sampling method was used. Results: Knowledge on the definition of the term EBF was correct in 120 (69.4%) of the students, 47 (27.2%) of them got it wrong while 6 (3.45) did not known the definition of EBF. The early advantages of EBF was known by over 70% of the students and the contraindications to BF was gotten by over 60% of the students. The students’ knowledge about some false notion on not giving EBM to sick babies, cause of nipple crack and inadequacy of BF for twin deliveries were good with over 70% of them knowing the right thing concerning these. The attitude of the students towards BF was very good with over 80% of them having good attitude towards BF, however 16 (9.3%) will not BF for two years because they believe that it will make their breast to sag, while 23 (13.3) did not know if that is true and 62 (77.5%) disagree with the statement. The intending practice of BF was generally good among the students with over 90% agreeing to do initiate BF within 6 hours of delivery and practicing EBF for 6 months. The intending practice of BF was generally good among the students with over 90% agreeing to initiate BF within 6 hours of delivery and practicing EBF for 6 months. The major factors influencing decisions for EBF includes WHO recommendations 108 (48.6%) out of 222 multiple responses, closely followed by mothers who are still in school for further studies 59 (26.6%). Family advice was the least factor with only 2 (0.9%). The major factors influencing decisions for termination of breastfeeding includes WHO recommendations 75 (35.0%) out of 222 multiple responses, closely followed by mothers who are still in school for further studies 44 (20.6%. Family advice was the least factor with only 4 (1.9%). Conclusion. The knowledge, attitude and intending practice on BF by the students were good, but more needs to be done in the area of knowledge because they are the future doctors who will play an important role in educating the society on breastfeeding.

Caesarean section and lactation problems in women

Unfortunately, not every mammary gland functions in full when fulfils its main function, which is milk production for infant feeding. Most often, the technical errors during breastfeeding the baby cause nipple cracks, maceration and women stop breastfeeding. Engorgement is one of the most common problems faced during natural breastfeeding. The article highlights the issues of the physiology of lactation, discusses the problems arising during lactation, the risk factors for the development of hypogalactia, and describes the rules for using breast pumps to maintain lactation.

The prevalence of adverse postnatal outcomes for mother and infant in the Netherlands.

BackgroundIn high-income countries delivery usually takes place in a short-stay hospital setting and includes limited specific care after discharge. Perinatal system performance is therefore predominantly expressed in direct terms of delivery outcomes such as preterm birth (PTB), small for gestational age (SGA) or, in case of the mother, perineal rupture and haemorrhage. Additional postnatal complications may emerge, but their incidence is largely unknown. The Dutch obstetric system includes an 8–10 day episode of professional postnatal home maternity care. Our aim was to establish, under routine conditions, the incidence of a comprehensive set of 67 predefined complications and their predictors. A second aim was to address interaction between maternal and child complications.MethodsThe study design was a prospective cohort study of all clients of one large maternity care organization receiving home maternity care in November 2014. We combined maternal background and intrapartum and postnatal characteristics with complication data, routinely recorded by home maternity care assistants. Complication prevalence rates per postnatal day were calculated. Univariate and multivariable logistic regression were used to predict the presence of postnatal complications.ResultsComplications occurred throughout the entire episode of home maternity care and prevalence was high, with 55% of all mother-baby pairs experiencing at least one complication (e.g. cracked nipples, >10% weight loss of the baby) and 5% at least one major complication (e.g. mastitis, cyanosis of the baby). Predictive ability of maternal background and intrapartum and postnatal variables on presence of complications was moderate (max. 62.9%), even when a cumulative risk score was used.ConclusionsThe prevalence rates of maternal and neonatal postnatal complications with care as usual in high-income countries was higher than expected. Professional postnatal follow-up is to be considered in order to timely detect and manage emerging complications with minimal delay. Opportunities for risk-guided care should be investigated further. The pattern of complications in low-income countries remains to be established.

Community pharmacists’ services for women during pregnancy and breast feeding in Kuwait: a cross-sectional study

ObjectivesThis study was designed to identify the services provided by community pharmacists in Kuwait and their views regarding self-care in pregnancy and lactation. In addition, it determined the pharmacists’ recommendations...

Clinical Quiz: The Strawberry Coloured Breastmilk

A 33 year-old Para 1 complained of strawberry coloured breastmilk for 1 day duration while expressing her breastmilk on the left breast at work. She has been exclusively breastfeeding for the past 6 months and never encountered such incident before. She also felt pain over the left breast. However, there was no lump, nipple crack,abnormal nipple discharges or fever prior to that. She expressed her breastmilk using a double mechanical electric breastpump about five times a day lasting from 10 to 20 mintues per sesion since she returned to work.

Prevalence and factors associated with cracked nipples in the first month postpartum.

BackgroundTo assess the prevalence and factors associated with the occurrence of cracked nipples in the first month postpartum.MethodsThis was a cross-sectional study nested in a cohort of mothers living in Feira de Santana, state of Bahia, northeastern Brazil. Data from 1,243 mother-child dyads assessed both at the maternity ward and 30 days after delivery were analyzed. The association between cracked nipples as reported by mothers and their possible determinants was analyzed using Poisson regression in a model where the variables were hierarchically organized into four levels: distal (individual characteristics), distal intermediate (prenatal characteristics), proximal intermediate (delivery characteristics), and proximal (postnatal characteristics).ResultsThe prevalence of cracked nipples was 32 % (95 % confidence interval [95 % CI] 29.4–34.7) in the first 30 days postpartum. The following factors showed significant association with the outcome: poor breastfeeding technique (prevalence ratio [PR] = 3.18, 95 % CI 2.72–3.72); breast engorgement (PR = 1.70, 95 % CI 1.46–1.99); birth in a maternity ward not accredited by the Baby-Friendly Hospital Initiative (PR = 1.51, 95 % CI 1.15–1.99); cesarean section (PR = 1.33, 95 % CI 1.13–1.57); use of a feeding bottle (PR = 1.29, 95 % CI 1.06–1.55); and higher maternal education level (PR = 1.23, 95 % CI 1.04–1.47).ConclusionsThe prevalence of cracked nipples was high in our sample. Most of the factors associated with cracked nipples were related to postnatal characteristics, especially poor breastfeeding technique, which could be improved to help prevent the condition.

Breast pain in lactating mothers

The number of new mothers who breastfeed has increased dramatically over the last three decades. There is a concern that the present related medical service may be inadequate. Breast pain is the most common complaint among lactating mothers who seek medical help. This study aimed to investigate this problem. Medical records of women who presented with breast pain to a private clinic run by a doctor who was trained as an International Lactation Consultant were reviewed over a period of 6 months in 2015. Most patients were self-referred after chatting online. Assessment included characteristics and duration of pain, treatment prior to consultation, feeding practices, mother's diet, and breast examination. Any site of blockage was identified and relieved. Those with persistent pain were given antibiotics. When there were signs of abscess or abscess that could not be drained, they were referred to a breast surgeon. A total of 69 patients were seen of whom 45 had been breastfeeding for more than 1 month. Pain was experienced for longer than 7 days in 22 women. Antifungal or antibacterial treatment had been unsuccessful in 31 women prior to consultation. The diagnoses were engorgement in five women, blocked duct in 35, mastitis in 13, breast abscess in six, poor positioning and latch in seven, nipple cracks in two, and skin infection in one. Oral antibiotics were prescribed to 21 patients and local antifungal treatment was given to one patient only. Blocked duct was the most common cause of breast pain in lactating mothers. Without prompt relief it is possible that it will progress to mastitis/breast abscess or the mother may discontinue breastfeeding. This may be a suitable time for Hong Kong to set up one or more public full-time breastfeeding clinics to provide a better service to lactating mothers and to facilitate professional training and research.

A Study on post partum breast problems of mothers attending at lactation management center (LMC)

Exclusive breast feeding is essential for the physical and mental development of the child. Post-partum breast problem may produce a obstacle on the way of successful breast feeding. So this study was conducted in ICMH, Matuail to find out common post-partum breast problems. All mothers attending at LMC after delivery with breast problems were included in the study. A total 114 samples were taken. All lactating mothers who gave their consent are to be included in the study and who are not willing to participate in the study were excluded. In our study, age distribution of mother shows, 35.96% of mothers were at the age of &lt; 20 years, 58.77% were between 20-30 years and 5.26% were &gt; 30 yrs of age. Among 114 patients, 91.22% of mothers were house wife and 8.77% were working Mother, timing of initiation of breastfeeding was, 12.28% initiated within 1 hours, 78.28% were within 1-12 hours, 4.38% were within 12-24 hours and exclusive breast feeding was given to 63.15% baby and first pre-lacteal feed was given to 36.84%, among them 71.42%. Common problem was, 46.49% mother suffered from not enough milk followed by, 20.17% for poor attachment, 17.54% suffered from breast engorgement and 7.89% suffered cracked nipple, inverted nipple was in 2.63% flat and sore nipple to 1.75% and nipple infection and breast abscess was present in 0.877% mothers. Among them, 100% mother were counseled about breast feeding, 78.95% mother were taught about proper position and attachment, hot or cold compression given to 35.09%, Oketani breast massage given to 30.7% and others to 13.16%. In our study all mothers were counseled on the benefit of breastfeeding at LMC. Further large long term cohort study should be carried out to see the postpartum breast problem during lactation.Bangladesh Med J. 2015 Sep; 44 (3): 136-139

Application of Extra Virgin Olive Oil to Prevent Nipple Cracking in Lactating Women.

It is well established that extra virgin olive oil (EVOO), applied to the skin, has healing and anti-inflammatory properties. To evaluate the effectiveness of EVOO in the prevention of nipple cracking in lactating women. Experimental, prospective, randomized study of 300 lactating women, admitted to the postpartum unit of the city's general hospital (Cienfuegos, Cuba). The study was carried out in 2012. Eligible patients were randomized into two groups of 150 women. In Group 1, EVOO was applied on the nipple after feeding, and in Group 2, drops of breast milk were applied to the nipple after feeding. Clinical evaluations were made during the first week of treatment and after the first month. All women who initiated breastfeeding were considered eligible to be included in this study; breastfeeding was characterized as the moment of mother-child interaction with suction on the nipple. Efficacy was evaluated quantitatively, as the absence of cracks in the nipple during the first 2 weeks of lactation using as the proportion of women with or without nipple cracks, and if present, whether they were moderate or slight. The quantitative efficacy was 97.3% and no adverse effects occurred in mothers and newborns during the administration of EVOO. EVOO helps prevent nipple cracking in lactating women. It has been shown to have protective effects when breastfeeding presents technical difficulties. This conclusion is borne out by the frequency distribution results obtained, which reflect a significantly higher proportion of nipple cracking in the population that was not treated with EVOO. Use EVOO to prevent nipple cracking during breastfeeding by administering 3 drops on each nipple after each feeding. Decreased nipple cracking will reduce pain and enhance breastfeedinging by administering 3 drops on each nipple after each feeding, improving the health of mothers and infants.

An IBCLC in the Maternity Ward of a Mother and Child Hospital: A Pre- and Post-Intervention Study.

Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs) for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II) was preceded (Phase I) by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III). In Phase III, a significantly higher percentage of mothers: (a) received help to breastfeed, and also received correct information on breastfeeding and community support, (b) started breastfeeding within two hours from delivery, (c) reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth.