Brrrr....ouch! It's the season for Raynaud's.

Last week I was chatting with Lex, who interns with me at the breastfeeding clinic, about a marked increase we're seeing this month in the number of women coming in with the symptoms of Raynaud's vasospasm of the nipple - a treatable cause of painful breastfeeding.  Then it hit us - the weather has changed.  Read on to see if you agree with our theory.

As I've mentioned before, I run a breastfeeding clinic at my local hospital.  In the last two clinics we've seen lots of women (6 and counting) experiencing severe nipple pain who seem to have the symptoms of Raynaud's vasospasm of the nipple. 

Typically, a mother comes in for help with pain during and after breastfeeding.  Sometimes she's already been treated for thrush with no improvement.  We work together to get a really good latch.  Then, while we're chatting after the feeding she says that her nipples feel like they're burning.  We quickly check them, and they're turning white, or blue, or red - or all three, which is makes us all feel patriotic.

It also makes me suspect Raynaud's phenomenon, a sudden constriction of blood vessels which limits blood flow and causes color changes.  You may not have heard about it, but it's thought that up to 20% of women of childbearing age may experience Raynaud's. 

Typical symptoms in breastfeeding are: 

• A burning pain, felt during and sometimes after the feeding, that isn't improved by correcting the latch.
• Nipples that turn white, blue, or red (or some combination of these colors) after or in between feedings, especially when exposed to cold air.

For some women, the symptoms start during pregnancy.  And for some women, a similar reaction occurs in their hands or feet when exposed to cold. 

Before you suspect that Raynaud's may be the cause of your pain, first make sure that your baby's latch is good.  A poor latch is the most common cause of pain with breastfeeding, and compression of the nipple can cause it to blanch after a feeding.  To make sure that the latch is good, have a lactation consultant or another person who is very skilled at helping achieve a good latch help you get the baby on the breast well.  There are many causes of compression of the nipple, and a good breastfeeding support person will run through them with you.

Burning pain is also a symptom of thrush.  Because the pain is similar (though thrush doesn't cause a temporary blanching of the nipple after a feeding), they are easily confused.  One study noted that many women are repeatedly treated for thrush when Raynaud's is really to blame.  Of course, it's possible to have both, so treating for thrush may be worth considering.

Sometimes the symptoms of Raynaud's go away on their own.  If they don't, there are treatments for Raynaud's which appear to be effective.  If you'd like to seek help from your physician, I'd suggest printing out this study and this study, which discusses treatment options, including Nifedipene, a prescription medication considered to be effective.  Here are some treatment options:

• Reduce exposure of the nipple to cold, as cold often triggers a painful reaction.  When the nipple comes out of the baby's mouth, use a dry warm compress - even your hand or arm, if it's warm - to reduce the cold shock.  This page on kellymom.com for a good description of how to make a "rice sock" for a warm compress.
• Avoid nicotine and vasoconstrictive drugs.
• A vitamin B6 supplement.  See Dr. Jack Newman's handout for information on B6 supplements and Nifedipene.
• A low dose prescription for Nifedipene, a medication considered "usually compatible with breastfeeding" by the American Academy of Pediatrics.  The use of any medication during breastfeeding should be discussed with your physician.

So, what's the connection with the weather?  The vasospasm is sometimes triggered by exposure to cold, so we are theorizing that it's the cold weather that's to blame for the rise in cases at the clinic.  There is actually one study which mentions an improvement of symptoms in one woman when she went on vacation to a warmer climate.  Have any of you noticed this connection?

Of course, this information is presented for educational purposes, and should not substitute for medical advice from your health care provider.  Please see your health care provider and/or a lactation consultant for care for this or any other breastfeeding problem.

Comments

[alexandra]

Thank you! I am online at 5am trying to research the painful tingling and burning I am having since my 4am feed and have been having - progressively worse too - for the lat 3 weeks. My nipple did indeed look white after I fed. Sometimes one breast hurts, sometimes the other, and often it doesn't hurt until about a 1/2 hour after the feed and lasts about an hour or so. It is a terrible pain that feels like throbbing and very prickly and I cannot focus - it is also somewhat itchy.

I went to the doctor but there were no signs of mastitis or thrush so he told me to try warm compresses. I just tried heat and it made it worse. Now I am 'freezing' the pain and numbing my nipples with a cold freezer pak and it is getting better.

When I pump I do not have pain - so I am going to go see a lactation specialist and see about the latch. Having said that, I have been feeding for 3 1/2 months, and aside from the initial pain of feeding I was ok until about 3 weeks ago. I started getting extreme pain at the onset of the feeding and for the first minute or so, then it's manageable or not painful, followed by this increasing burning/prickling afterwards, but there was about 2 months where I did not experience this so I don't think it's the latch -- I think it may be Raynaud's because this started when it got cold here {I live in Toronto, Canada}.

I'll write in a bit to let you know what's developed. Until then, I feel relieved that there may be some explanation for this awful pain!

[Tanya Lieberman]

Alexandra,

Sorry to hear about the pain, and glad to hear that this posting gives you another idea to pursue. I've found that Raynaud's isn't that well recognized, and that the treatment can be very effective. Let me know what happens!

Tanya (motherwearblog@gmail.com)

[megan]

I am 9 months pregnant an dam suffering from this horrible syndrome. The last couple of days it has been so bad i can't even begin to describe it. I have about6-7 flare ups a day. This afternoon i had an episode every hour for like 3-4 hours. It was horrible. It makes me cry my eyes out, wondering why me???? what did i do that was sooooooo awful to deserve this pain. I told my doctor and they have kind of sumed it up to just horomones. I know know, it is not just horomones- and that it actually has a name. I'm taking BP medication as of monday- and that's when my problem got really bad. I've had that probem for over a month now- but up until this week i was able to deal with it-- it didn't make me break doen in tears.

I read that vitamin B6 might help, as well as magnesiusm and primrose oil. I'm desperate right now for a cure.

the thing is , they say it comes on when it is cold. I"m on bed rest and have been under covers the last week and still have episodes of it.

I'm scared to go out, in fear that i'll have an episode and start crying my eyes out in public. Thankfully this pregnancy is almost over, i am 36 wk 2 days.

If you have any advice for me, send it my way.

[Tanya Lieberman]

Hi Megan,

I'm really sorry to hear about your pain!

I think that you should discuss this with your doctor or midwife, and note that, because you intend to breastfeed, you'd like to develop a plan before your baby comes.

In this post I provided links to several studies about Raynaud's and breastfeeding, and I'd encourage you to print them out and bring them in when you meet with your provider. The studies note that women sometimes experience symptoms during pregnancy. It may help if your provider is less familiar with this problem and treatment options.

I'd also encourage you to identify sources of help for breastfeeding now, so you'll know where to go for help if problems do arise. Getting help early on is the most important thing.

Tanya

[megan]

Hi Tanya

I saw my doctor and begged for medicine today. I got him to reduce my intake of labaterol (sp) and also give me Nifedical-- which is supposed to help with the pain. There are both BP meds. My doc wants to make sure Nifediacal is going to help with the nipple pain b4 he takes me off of the other one.

You said you were going to give me a few links to go to-- I don't see any.

I do plan on breast-feeding-- I hope this pain either goes away once I have the baby or with the medicine.

So you think i should contact someone from LLL or another lactation consultant to let them know of my situation??

[Tanya Lieberman]

Hi Megan,

The links to the studies are in the post (above), in the paragraph that starts with "Sometimes..."

I think that everyone should have the contact information for breastfeeding support people (lactation consultants, LLL leaders, etc.) before they deliver. Having the information handy may be all you need to do at this point.

Why don't you email me at motherwearblog@gmail.com if you want to discuss this further?

Tanya

[Heidi]

Thankfully my lactation consultant had heard of vasospasms and Reynauds! It was the only thing that formula pusher was good for. After a couple of weeks on Nifedipine I was finally out of pain. Prior to the drug (I also tried vitamin B and fish oil but it just wasn't enough) I was living with a rice pack plastered to my chest.
Keep up the good work, Tanya!

[Colleen Newman]

Ugh! I have this too! And it HURTS! Funny thing is that in college my roomate and I used to joke and say, "My nipples are falling off!"

I made a comment (mostly to myself) about it the other day b/c my right nipple was killing me. My 4 year old happened to hear me (he hear everything) and said, "Will it grow back, Mama?" Oops!

Anyway, thanks for spreading the word! Glad to know there are ways to alleviate the pain.