An evidence-based nipple care pathway for new breastfeeding mothers: a Delphi study

Abstract

Only 1% of UK mothers maintain exclusive breastfeeding for the first 6 months, as per global recommendations. Early breastfeeding cessation often involves complex issues, with nipple-related injuries being a common cause. This study aimed to develop an evidence-based tool for early identification and management of breastfeeding-related nipple injuries through expert consensus. A mixed method approach was used, including a 5-stage scoping review and a modified Delphi consensus technique with 26 UK-based maternal health experts and experienced breastfeeding mothers. Consensus (80% agreement) was reached on recommendations, including the provision of realistic information, early peer support engagement and Lanolin use. Some commonly recommended practices, such as letting the nipple air dry, did not reach consensus, highlighting a misalignment between expert consensus and published guidance. This study generated evidence-based, expert-validated self-management guidance, emphasising the need for improved stakeholder engagement in policy development.