APNO CREAM - ALL PURPOSE NIPPLE OINTMENT FOR BREASTFEEDING

If you have general tenderness or even trauma from a specific feeding, over the counter nipple creams such as lanolin cream,  Motherlove Nipple Cream or Bamboobies Nipple Balm are very effective.  But if you have ongoing soreness which cannot be resolved by a corrected latch, Dr Jack Newman has formulated an all-purpose nipple ointment or APNO cream that is a life-saver.

Copied with permission, the information below is essential in getting a prescription written for this cream as it does contain ingredients not found in any over the counter formulas.

There is a link in the information below or you can search for the term "compounding pharmacy near me" in order to locate a pharmacy that can make the formula once your doctor has written the following RX:

Mupirocin ointment 2%, 15 grams
Betamethasone ointment 0.1%, 15 grams
Add miconazole powder to a concentration of 2% miconazole
Combined yield about 30 grams
Directions:  Apply sparingly. Do not wash or wipe off.

Here is to nursing in comfort,
Tanya

THE “ALL-PURPOSE NIPPLE OINTMENT” OR APNO

We call our nipple ointment “all purpose” since it contains ingredients that help deal with multiple causes or aggravating factors of sore nipples. Breastfeeding parents with sore nipples don’t have time to try out different treatments that may or may not work, so we have combined various treatments in one ointment. Of course, preventing sore nipples in the first place is the best treatment and adjusting how the baby takes the breast can do more than anything to decrease and eliminate the breastfeeding parent’s nipple soreness. Please note that the “all-purpose nipple ointment” is a stop gap measure only and that the definitive treatment of sore nipples is to help the baby latch on as well as possible.

See these other information sheets: Sore Nipples, Latching and Feeding Management.

THE APNO CONTAINS:

1. Mupirocin 2% ointment. Mupirocin (Bactroban is the trade name) is an antibiotic that is effective against many bacteria, including Staphylococcus aureus including MRSA (methicillin resistant Staphylococcus aureus). Staphylococcus aureus is commonly found growing in abrasions or cracks in the nipples. Mupirocin apparently has some effect against Candida albicans (commonly called “thrush” or “yeast”). Treatment of sore nipples with an antibiotic alone sometimes seems to work, but we feel that the antibiotic works best in combination with the other ingredients discussed below. Although some mupirocin is absorbed from the gut when taken by mouth, it is so quickly metabolized in the body that it is destroyed before blood levels can be measured. Most of it gets stuck to the skin so that very little is taken in by the baby.

2. Betamethasone 0.1% ointment. Betamethasone is a corticosteroid which decreases inflammation. By decreasing the inflammation, the APNO also decreases the pain the breastfeeding parent feels. Most of the betamethasone in the ointment is absorbed into the skin by the parent, so that the baby takes in very little.

3. Miconazole powder to a final concentration of 2%. Miconazole is an antifungal agent, very effective against Candida albicans. Because it is added as a powder, the concentration of miconazole can be increased to 3% or even 4% or decreased to less than 2%. We feel 2% is the best concentration for most situations. Fluconazole powder to 2% may be substituted for miconazole and so can clotrimazole powder to 2%, but I believe that clotrimazole (Canesten) irritates more than the other drugs in the same family. Miconazole cream or gel cannot be substituted for miconazole powder as the compound will usually separate. Where miconazole or any of the above mentioned drugs (fluconazole, clotrimazole) are not easily available as powders, it is better to use only the mupirocin and betamethasone ointments mixed together than add a cream or gel or nystatin ointment for example. By using a powder, the concentration of the other two ingredients is not as decreased as they would be if another ointment were used for the anti-fungal agent (for example, nystatin ointment). Thus, in the above preparation the concentration of the betamethasone becomes 0.05% (due to combination with the mupirocin) and the mupirocin concentration is decreased to 1%.

Note that nystatin ointment, which we used to use and which decreases the concentration of the other ingredients, is far inferior to miconazole and also tastes bad.

I write the prescription this way:

1. Mupirocin ointment 2%: 15 grams

2. Betamethasone ointment 0.1%: 15 grams

3. To which is added miconazole powder to a concentration of 2% miconazole

Total: about 30 grams combined. Apply sparingly after each feeding. Do not wash or wipe off.

NO SUBSTITUTIONS

If possible, it is best to get the prescription filled at a compounding pharmacy. You can find a list of compounding pharmacies by going to http://www.pccarx.com/. Click Find a compounder at the top, then add relevant information.

HOW TO USE THE OINTMENT:

1. Apply sparingly after each feeding. “Sparingly” means that the quantity of the ointment used is just enough to make the nipples and areola glossy or shiny.

2. Do not wash it off or wipe it off, even if the baby comes back to the breast earlier than expected.

HOW LONG SHOULD THE OINTMENT BE USED?

Any drug should be used for the shortest period of time necessary and the same is true for our ointment.  The all-purpose nipple ointment is a stop gap measure.  If the breastfeeding parent still needs the ointment after two or three weeks, or the pain returns after the breastfeeding parent has stopped the ointment, the parent should get “hands on” help again to find out why the ointment is still necessary. The most important step for decreasing nipple pain is still getting the “best latch possible.” Sometimes a tongue tie has not been noticed and is a reason for continued pain.

Some pharmacists have told breastfeeding parents that the steroid in the ointment will cause thinning of the skin if used for too long. While this is a concern with any steroid applied to the skin, we have not seen this happen even when breastfeeding parents have used it for months.

Updated by Dr. Jack Newman, June 2017

The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.

This information sheet may be copied and distributed without further permission on the condition that you credit International Breastfeeding Centre and it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!

Dr Newman's Guide to Breastfeeding, 2014 Revised

Hygeia Fit Breast Pump - Breast Pump Replacement Parts

We were recently contacted by a mom looking for larger flanges for her Hygeia breast pump.  If you have the Hygeia EnJoye or Hygeia EnDeare breast pump, Hygeia breast pump parts are available at Lactation Connection. 

Please note that the Hygeia Evolve and FIT Pro use different parts! The accessory kit for the Hygeia Fit Pro which also works with the Hygeia Evolve is pictured below.

You can find the personal accessory kit and Hygeia Fit Pro breast pump parts here. Again, this kit also works with the Hygeia Evolve breast pump. 

In addition, the original Hygeia FIT breast pump you may have received through insurance called the Hygeia Fit (pictured below) does not work with the other Hygeia brand breast shields so you will need specific breast shields which are sold as Hygeia Fit 24mm Breast Shields or Hygeia Fit 28mm Breast Shields. 

Additional replacement parts are available for the Hygeia Fit Breast Pump including the Hygeia Fit Backflow Protectors, Hygeia Fit Duckbill Valves and the Hygeia Fit Tubing.  

For those looking for extra bottle for the Hygeia Fit breast pump, the following bottles are compatible:

Motif Luna Bottles

Spectra Bottles

Ameda Mya Bottles (not compatible with Mya Joy bottles)

Please note that the Hygeia Evolve and FIT Pro use different parts as well! The accessory kit for the Hygeia Fit Pro which also works with the Hygeia Evolve is pictured below.

You can find the personal accessory kit fand Hygeia Fit Pro breast pump parts here.

Happy pumping!
Tanya

Spectra Breast Pump Carrying Bag for Spectra S2, S1, S9, Synergy Gold and S3 Breast Pump

Although Spectra breast pumps are lightweight, their round shape can make it hard to decide which breast pump bag will fit your Spectra best.  We've curated the best breast pump bags for you!  Here are some great options at affordable prices.

JuJuBe Breast Pump Convertible Bag

We are always amazed at the design details that go into JuJuBe bags.  Not only is the JuJuBe breast pump carrying bag large enough to hold your Spectra breast pump and accessories, there are soft lined pockets for cell phone, a key fob attachment so you can always find your keys, lightly lined interior to make it easy to find all your tiny parts and extra pockets for everything else!  This bag has a staging pad for your breast pump parts that converts to a changing pad or even a makeup mat!

Landuo Breast Pump Backpack

This breast pump backpack bag provides a perfectly organized space for you to shuttle your breast pump to work, events or anywhere! The side zippered pocket of the bag opens to fit and access all standard breast pumps. This backpack is designed with a side cooler compartment for 4 bottles and ice packs. Additional pockets for organization, tablet, cell phone and more. The front flat zips open making a perfect staging area for your pump parts. Backpack style makes it easy to carry and access your pump and clips allow you to attach to a stroller as well. This breast pump bag fits most breast pumps and accessories including Spectra, Motif, Medela and Ameda. 

Lauren Breast Pump Carrying Bag

The Lauren Breast Pump Carrying Bag by Zohzo is another good choice!  Includes zip down staging area and enough room for your pump, pump parts and cooler tote inside.  This is an exceptional affordable alternative to higher priced breast pump bags.

Kiinde Anika Breast Pump Bag and Cooler Tote

Last but not least our new favorite bag, the Kiinde Anika Breast Pump Bag!  Not only is it large enough for the Spectra pump, it has it's own compartment with plug access so so you can charge your pump while keeping it in the bag.  In addition, it offers an integrated cooler compartment that will hold ice packs and up to six Specra bottles.  All for under $40!

Shop all breast pump bags at Lactation Connection!

Here is to carrying your breast pump in style,
Tanya

Spectra Breast Pump Motor Life - How many Hours Pumped on S1 S2 or S3

Have you ever wondered how many hours you have actually pumped?   Or if the breast pump you used with the last baby still has life left in it?  Spectra S Series breast pumps allow you to check how many hours you have pumped or if your pump is nearing it's 1500 hour life span.  Please note that your pump may have exceeded it's time perior warrany before it reaches it's life span.

To find the number of hours you have pumped, go to your control panel on the Spectra S1 Spectra S2 breast pump or S3 Pro Hospital Grade Breast Pump and follow these steps:

1.  Press the Power On button

2.  Press the Let Down button

3.  Press the Cycle+ button

4.  Press the Vacuum- button

5.  Press the Cycle- button

6.  Press the Vacuum+ button

7.  Press the Let Down button again

8.  Read the four digit smaller numbers between the Cycle and Vacuum numbers to see the hours.

    

This is normally where your timer displays the number of minutes you pumped during a single          pumping session. The image of the pink pump shows 616 hours of pumping time.

If you need help with using your Spectra display panel, see the image below to understand more about your controls.

Knowing how to check your motor life is a good indicator of when you need to replace specific Spectra breast pump parts such as the valves and the backflow protectors.  You should replace your Spectra valves and Spectra backflow protectors once for every 30 hours you pump.  That is like pumping three times per day for 6-8 weeks.  Replacing these two items will help you get the maxinum amount of suction from your breast pump as well as help your motor last longer.

Happy Pumping!

Tanya

Breastfeeding Travel Tips for The Holidays: Handling Crowds, Planes, Alcohol and More!

Holidays with family are priceless, but you want to keep a few things in mind to make it easier
when breastfeeding.  Here are a few tips that you may find to be a great help!

1.  Latch and Cover
Babies can be easily distracted from feeding properly when around the hustle and bustle of the holiday gatherings.  One way to keep them on task is to latch and cover in another room before joining the group.  Full feeding can keep baby happier and help you avoid clogged milk ducts.

2.  Protect Milk Supply
Families want to participate in caring for baby and it may be hard to tear the new grandbaby away from the new grandmother.  If you want to allow the feeding of breastmilk from a bottle, make sure to prepare bottles in advance, but take the time to double pump for a full 10-15 minutes to protect
your breast health and milk supply.

3.  Moderate Your Intake
Although not a popular thing to say, alcohol does get into your blood stream and while one or two glasses of wine immediately after nursing are ok.  If you don't wait an hour per drink or two hours for those two glasses of wine, we mentioned the alcohol is still in your blood and breastmilk.

4.  Nursing for Comfort
Soothing a baby on takeoff and landing can help acclimate their ears and suckling after feeding can help soothe the baby in strange situations.  Also, if your breasts feel full and uncomfortable, make time to nurse or pump to avoid clogged ducts and even breast infection.

5. Be Prepared
Plan your work and work your plan.  Make sure to pack extra breastmilk, a car adapter, extra batteries for your breast pump, a nursing cover, bottles with nipples and anything else you think you might need.

May your Christmas be Merry and your milk supply prosper!
Tanya

How to Use the Haakaa Silicone Breast Pump

Using a Haakaa breast pump might seem intuitive, but it is not your grandmother's manual squeeze breast pump!  Here are some tips on using the Haakaa.

1.  Wash your hands and sterilize first, but not more than 5 minutes in boiling water.  Otherwise your pump may become cloudy or you go off and forget about it. #meltdown

2.  Center the nipple to engage the most milk ducts, but reposition if you want to engage other ducts as you have more in store!

3.  Flipping the lip of the Haakaa flange is a game changer!  Not to mention, the Haaka in general is a must have for nursing moms.  After all, why let all the excess milk flowing from the opposite breast go to waste in the nursing pad?  Even if you have more milk than you need (not the case for most moms), donate the extra!  A $20 investment in a genuine Haakaa can save lives!

4.  Don't forget to use the silicone stand at the bottom and the cap or Haakaa flower stopper.  Otherwise, you might be crying over spilled milk!

5.  A picture is worth a thousand words so here is an easy to use How to Guide with pictures!

Spectra Breast Shield Flange Sizes 20MM 24MM 28MM 32MM

Not only is getting the right breast pump important, but so is getting the right breast shield flange size.  If you pump regularly, using the correct breast shield size aids in adequate milk production.  With the increasing popularity of Spectra breast pump, we want moms to have the information as to what sizes are available and how you can purchase them.

Spectra Standard Breast Shield - 24mm
The 24mm breast flange was included with your Spectra breast pump including the S1 and Spectra S2 breast pump.  If you are pumping comfortably with this flange and there is room on one side of the flange shaft for freedom of movement, the standard size works for you.  The Spectra 24MM breast shield can be purchased in the following ways:

Spectra 24MM Breast Shield - Single (breast shield only)
Spectra 24MM Breast Shield Set - includes breast shield, valve, tubing and backflow protector
Spectra 24MM Premium Accessory Kit - breast shield, valve, tubing, backflow protector, bottle set
Spectra 24MM Double Pump Kit - 2 breast shields, 2 valves, 2 tubing, 2 backflow protector, 2 bottles

Spectra Small Breast Shield -20mm
The 20mm breast flange is a good choice if you are pumping with the standard 24mm flange and there is room on all side of the flange shaft.  You may experience too much of the areola being drawn into the shaft as not to receive adequate compression of the milk sinuses if your flange is too large.  Another reason you may need the small Spectra flange is too much elasticity in the nipple causing the nipple to draw too far into a standard flange.  The Spectra 20MM breast shield can be purchased in the following ways:

Spectra 20MM Breast Shield - Single (breast shield only)
Spectra 20MM Breast Shield Set - includes breast shield, valve, tubing and backflow protector
Spectra 20MM Double Pump Kit - 2 breast shields, 2 valves, 2 tubing, 2 backflow protector, 2 bottles

Spectra Large Breast Shield -28mm
The 28mm breast flange is a good choice if you are pumping with the standard 24mm flange and there is no room for freedom of movement in flange shaft.  You may experience too little compression of the milk sinuses if your flange is too small as the nipple is filling the shaft and the areola is not being engaged for compression.  The Spectra 28MM breast shield can be purchased in the following ways:

Spectra 28MM Breast Shield - Single (breast shield only)
Spectra 28MM Breast Shield Set - includes breast shield, valve, tubing and backflow protector
Spectra 28MM Premium Accessory Kit - breast shield, valve, tubing, backflow protector, bottle set
Spectra 28MM Double Pump Kit - 2 breast shields, 2 valves, 2 tubing, 2 backflow protector, 2 bottles

Spectra X-Large Breast Shield -32mm
The 32mm breast flange is a good choice if you have wider nipples.  You may experience too little compression of the milk sinuses if your standard or large flange is too small as the nipple is filling the shaft and the areola is not being engaged for compression.  Most women who use this size note that their nipples are wide such as the width of your thumb.  The Spectra 32MM breast shield can be purchased in the following ways.

Spectra 32MM Breast Shield - Single (breast shield only)
Spectra 32MM Breast Shield Set - includes breast shield, valve, tubing and backflow protector
Spectra 32MM Double Pump Kit - 2 breast shields, 2 valves, 2 tubing, 2 backflow protector, 2 bottles

Remember, breast shield flange sizing is important for milk extraction and in turn milk production so one way to be sure to get the right size is to purchase more than one size in the single flange and then once you determine your needs, purchase more in the appropriate size.  

Best wishes for the perfect flange size!
Tanya