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.