Effect of Breast Milk, Peppermint Water and Breast Shell on Treatment of Traumatic Nipple in Puerperal Lactating Mothers

: Nipple trauma occurs in 29–76% of breastfeeding mothers within the first postpartum week which causes pain and discomfort for the mothers to continue breastfeeding. Aim of the study: Compare the effect of breast milk, peppermint water and breast shell on treatment of traumatic nipple in puerperal lactating mothers. Research design: A quasi-experimental research design was utilized. Settings: The study was conducted in postnatal clinics at Abu EL-Matamer Central Hospital and Housh Issa Central Hospital affiliated to Ministry of Health in El-Beheira Governorate. Subjects: Convenient sample of 120 puerperal lactating mothers with nipple trauma diagnosed in their first postpartum week were selected according to eligibility criteria. The selected subjects were randomly divided into three equal study groups. Tools of data collection: Five tools were used for data collection namely: A structured interview schedule; breast feeding observation checklist; visual analogue pain intensity scale; nipple soreness rating and nipple trauma score. Results: Findings demonstrate that the mean score of nipple pain, nipple soreness and nipple trauma were significantly decreased among the breast milk, peppermint water, and breast shell groups in the seventh and fourteenth day of intervention. There were a statistically significant difference between the three groups in favor of the peppermint water group in relation to nipple pain, nipple soreness and nipple trauma in the seventh and fourteenth days of intervention. Conclusion: The study concluded that peppermint water treatment was more effective in nipple trauma healing and pain relief than breast milk and breast shell treatment. The present study revealed that the mean score of nipple pain was significantly decreased among the three interventional groups especially at the 7 th and 14 th day of intervention. The peppermint water group showed the lower pain scores in the 7 th and 14 th day of intervention respectively in comparison to the breast milk and the breast shell groups. This indicates that the peppermint water treatment was more effective in relieving nipple pain than breast milk and breast shell treatment. These results may be attributed to the fact that peppermint (scientific name: Mentha piperita) has antiseptic, calming and numbing effects and has been used to relieve skin irritations and makes it resistant to cracks (30) . Menthol affects the cell membrane, attacks microorganisms and inflammatory factors and thus prevents damage to tissue cells. Menthol also, has a pain killing activity through affecting Kap-opioid receptors and thus restrains flow and transmission of pain signals and leads to less feeling of pain (31, 32) . In this respect, Singh et al, (2011) (33) studied the antioxidant and antibacterial effects of Mentha Piperita. They concluded that peppermint oil had a strong antibacterial activity and this effect was comparable with those of gentamycin. The current findings are similar to those of Naser et al, (2017) (34) who reported that women in peppermint water group had significantly experience more mild and moderate pain and less severe pain compared to breast milk group (30% &2% vs. 26% & 6% respectively). The findings of the present study are also in line with the study of Akbari et al, (2014) (35) which indicated that the pain intensity score before treatment and day 10 after delivery, as well as the pain intensity score before treatment and day 14 after delivery were significantly decreased among the peppermint water group than breast milk group. In addition, the study of Thabet et al, (2013) (36) revealed that women in the peppermint water group experienced mostly no pain (92% The current results are also congruent with the results of at least five other researches. First , Naser et al, (2017) (34) who concluded that peppermint water is effective in the prevention of nipple trauma compared to the application of express breast milk. Second, Akbari et al, (2014) (35) who found that menthol essence could cure nipple fissures in the breastfeeding women. They added that peppermint water was effective in the prevention of nipple pain and damage. Third, Thabet et al, (2013) (36) who reported that the application of peppermint water was found to be an effective method to prevent nipple cracks. The relative risk of overall nipple and areola cracks in the control group and expressed breast milk group was higher than in the peppermint water group at 15 and 30-day post partum. In addition, at 15 and 30 days, it was observed that women in the peppermint water group were less likely to report no cracks than women in the expressed breast milk group and control group. They concluded that peppermint water in breastfeeding lactating women is associated with fewer nipple cracks and is more effective than expressed breast milk. Fourth, Abd-Elsalam S et al, (2011) (37) who found that peppermint water is effective in prevention of nipple soreness compared to tea bag or lanolin cream application after feeding. Fifth, Melli et al, (2007) (16) who reported that the women who were randomized to receive peppermint water were less likely to experience nipple and areola cracks compared to women using expressed breast milk. Women who used the peppermint water on a daily basis were less likely to have a cracked nipple than women who did not use peppermint water. They also concluded that peppermint water is effective in the prevention of nipple pain and damage. Moreover, Melli et al, (44) conducted another study in 2007 for examining the effects of peppermint gel, lanolin ointment and placebo gel on the prevention of nipple fissures. They