As we settle into a very cold winter here in Ireland, I’m finding more and more clients are reporting nipple pain that is unrelated to latching problems. Generally, when I’m taking their history, I ask whether they have noticed any colour changes in the nipple. If the mother says yes, that prompts me to enquire if she usually suffers from the cold. For example, does she get white fingers that are painful during the winter? A very high proportion say that they do. Generally, women who experience painful extremities in the cold find that when they are breastfeeding they experience some nipple/breast pain too as this is another extremity.

 

What is Raynaud’s?

Raynaud’s is a disorder, whose symptoms are usually brought on by cold or stress. This cold or stress causes the arteries of the extremities to vasospasm or constrict. It typically effects fingers and toes but may also effect lips, ears, nose and the nipples (Hanson-Dispensa 2014). Typically, the extremity will turn white/and or blue then red when the extremity is warmed (Raynaud’s Association 2014).

 

In the USA it is estimated that 5 – 10% of the population has Raynaud’s. Here in Ireland, that rate is in the region of 235,000 to 470,000 people. The incidence of Raynaud’s is the same as the documented rates of tongue tie.

 

Vasospasm

Here are some pictures of vasospasm. It can also be associated with latching issues so in some of these images you may notice that there is some distortion of the nipple shape after feeding.

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                                   First Steps to Addressing Vasospasm – Raynaud’s

If you feel that you may be having difficulties with breastfeeding as a result of Raynaud’s and vasospasm, it is really important to have a full lactation assessment by an IBCLC to out rule other issues that may be causing the pain.

 

Vasospasm can be concurrent with latching and tongue tie issues or can be the sole cause of nipple and shooting breast pain. The best indicator of whether sucking issues are at play or whether vasospasm alone is involved is the presence of a normal nipple shape post feed.

Vasospasm is also often confused with ductal thrush. The reason for this is it is also a side effect of diflucan / fluconazole, the medication used to treat candida in the milk ducts. However, I have only seen true ductal candida less than 5 times in 12 years as an IBCLC.

 

                          Top 10 Tips to Help Ease the pain of Vasospasm – Raynaud’s

I have heard many tips and tricks over the years. Below you can find some of the tried and trusted techniques from my community on social media.

  • Don’t air dry the nipples! Vasospasm is exacerbated by extremes of temperature. Cover up straight away once the feed has finished. Have a breast pad ready to cover up as soon as the baby unlatches.Wrap up. Many mothers report that keeping their whole body warm helps more than simply concentrating specifically on their breasts.Avoid exposure to the cold. Little things we don’t normally think of can make a noticeable difference, for example eliminating sudden temperature changes by ensuring the bathroom is pleasantly warm before undressing for a shower, etc.
  • Warm, dry heat pads provide good relief. Consider purchasing reheatable handwarmers to pop in your nursing top or bra. Lambs wool  or bamboo breast pads  retain heat better than disposable ones.
  • Ibuprofen is a better choice of pain relief than paracetamol as it is an anti-inflammatory and can also relieve nerve pain.
  • Cut down on your tea or coffee intake – or cut it out altogether! Caffeine constricts blood vessels and only makes vasospasm worse.
  • When the nipple turns white try pinching or gently rubbing blood back into nipple. This can help shorten the cycle of vasospasm.
  • Check that the cup size in your bra is large enough. If it is too small, it may bend or fold the nipple which cuts off circulation. It is possible to make donut-shaped rings which prevent this from happening.
  • Performing some pectoral stretches and light massage can help improve blood flow to the breast, which in turn eases the effects of vasospasm.Vasospasm 2_Page_1 (1)
  • Acupuncture and osteopathy are two forms of complementary therapy which can be really helpful in providing relief from painful breastfeeding caused by vasospasm – Raynaud’s. They’re also a great way to mind yourself too!

 

 

Dietary Supplements

Supplements that may help include:

  • Fish oil capsules, which contain essential fatty acids or evening primrose oil, with gamma linoleic acid, may improve blood vessel relaxation.

 

  • Vitamin B6, Magnesium and Calcium have all been shown to provide relief to mothers experiencing pain from vasospasm – Raynaud’s.

Dr. Jack Newman, an expert doctor in this area, recommends these dosages .

 

  • While it is best that natural methods are used to treat the pain associated with Vasospasm – Raynaud’s and to reduce the effects, as a last resort medication can sometimes be prescribed. Nifedipine 30 – 60 mgs daily in a sustained release dose can be used successfully in these extreme cases. My experience of prescription medication has been mixed. I’ve had some mothers who found it absolutely wonderful, while others got tension headaches as an unwelcome side effect.

 

Although there is no quick fix for vasospasm – Raynaud’s and the pain it can cause during breastfeeding, generally mothers establish what works for them and are then able to manage the pain of vasospasm insofar as possible. The good news is that as usually as a baby gets older, the condition generally improves and doesn’t cause as much torment!

If you’re having particular difficulties with what you think may be vasospasm – Raynaud’s while breastfeeding, don’t hesitate to contact me and we will see how we can best help to improve the situation for you.

 

Many thanks to Lisa Marasco IBCLC  and Catherine Watson Genna IBCLC for giving permission to use their images.

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