Raynaud's of the nipple - help for breastfeeding mothers
Raynaud's of the nipple - help for breastfeeding mothers
Raynaud's of the nipple most commonly affects breastfeeding women, but also occurs in pregnant women, and may also affect women who have never been pregnant. It is more common in cold climates, and can be hereditary. Women who have Raynaud's of the fingers and toes will often develop Raynaud's of the nipple when they start to breastfeed. Raynaud's occurs in up to 22% of women (Olsen and Nielson, 1978
If the vasospasms are due to the cold only the term Raynaud's disease is used, and if they are secondary to another condition then the term Raynaud's phenomenon is used. If the vasospasms are due to poor latch only then the condition is not Raynaud's, but is just described as nipple vasospasm or blanching.
During vasospasm the nipple typically turns white, purple, and then pink as blood low in oxygen, and then high in oxygen enters the nipple. As different blood vessels can constrict for different lengths of time, it can be possible to see all three colours in the nipple at once. Pain typically occurs as blood re-enters the nipple, at the end of the event, with the pain lasting up to several minutes.
I have found that damage to the nipple can occur if a child latches onto a constricted or white nipple during a vasospasm event. The constricted nipple does not stretch well, and the internal, and sometimes external, damage can cause high levels of pain during latching and sometimes also with milk let down. Raynaud's can also cause a mild, continuous pain, or breast sensitivity, which sometimes starts a few days before the vasospasm events start to occur.
After the first vasospasm event, vasospasm is likely to continue to occur with each feeding or exposure to the cold, with treatment typically taking a week or two for the events to subside. Vasospasm events may last from a few minutes to continuously if the nipple is not warmed. Pain can be described as being in either the nipple or the whole breast.
Vasospasm most commonly occurs on both nipples, but I have found that it may be limited to one, and which nipple is affected may change over time. It can be triggered solely by the cold, extreme changes in temperature (such as going outside on a cold day), high emotions, leaving nipples to air-dry after breastfeeding, damage to the nipple caused by poor latch or similar, or a combination of factors. Raynaud's can recur with subsequent pregnancies and breastfeeding. Some medications have been associated with vasospasm including oral contraceptives. Fibromyalgia, rheumatologic diseases, endocrine diseases, and prior breast surgery have also been associated with Raynaud's phenomenon (kellymom webpage).
Raynaud's is often misdiagnosed as poor latch, as pain can occur when feeding, external damage may be present, and it may not hurt every time you breastfeed. This can be a very frustrating diagnosis for the mother, as trying to repeatedly latch the baby to get the perfect latch' can result in intense pain every time. Raynaud's is sometimes also misdiagnosed as thrush, and I have had nipple damage misdiagnosed as a milk bleb. Broken capillaries and ducts due to Raynaud's can bleed into the surrounding tissue. When a milk duct is damaged a white ring can form around the duct, looking like a milk bleb. These "bleb's" do not need to be opened up or cleared, but can be left to heal.
Management of Raynaud's
Raynaud's disease is a condition that is typically managed, not cured. I've listed all sensible management options that I am aware of below. No single option will work for every woman. Many women will use a range of management options, with methods used changing with the season, how badly they are being affected, pregnancy, and breastfeeding of a newborn or an older child.
Women should discuss all medical, herbal, and supplement management options with their health provider to ensure they are appropriate for them.
Keeping Warm
To prevent vasospasms occurring, dress warmly, especially when going outside in winter. Breastwarmers, which insulate the breast, or woollen breastpads can be used to keep the breasts warm.
Never allow the nipples to air dry. The evaporation of milk and saliva causes the nipple to quickly cool, causing vasospasm. As soon as the baby comes off the breast the breast should be covered. If the baby is repeatedly coming off, then just covering the nipple with your hand will suffice. If feeding is finished then cover the breast up immediately. Ensure that all bras and breastpads have either a wool or synthetic fabric against the skin - cotton must be avoided, as it feels cold when wet. If you have cotton bras then use breastpads with a synthetic or wool liner. I note that during vasospasm phases some women find their nipples become sensitive to some fabrics such as wool, in this case synthetic, stay-dry, fabrics, such as microfibre should be used against the skin. Breastpads should be changed as soon as they become wet. Lanolin barrier cream or olive oil can help stop the nipple from air-drying, the cream or oil should be warmed in your hands before being applied.
When vasospasm occurs, repeatedly squeezing the nipple will help blood flow back into this area. Doing this immediately will limit damage to the nipple caused by a lack of blood, and will improve recovery times. Gently squeezing the nipple to ensure it is not constricted prior to latching will help ensure that secondary damage to the nipple does not occur. The Nbci website recommends massage of the chest muscles, these are below the collar bone and above the breast.
For serious vasospasm problems increased heat can be provided from heated wheat packs or hand warmer systems. Large wheat packs keep warm for longer, however smaller, shaped, wheat packs will stay in place better. Reusable and disposable hand warmer systems can be purchased from outdoor stores. The reusable systems provide one hour of heat, and then need to be boiled for five minutes to recharge them. The disposable systems provide up to eight hours of heat. Great care needs to be taken in using any heat source near babies or while sleeping. Heat sources should be encapsulated to ensure they are well insulated from both mother and baby's skin to prevent burns, and the disposable hand warmer systems should be protected from leaking milk.
Use of breastwarmers and heating systems can increase milk supply, and may also help mothers who suffer from mastitis or blocked ducts. However, an increase in milk supply can lead to engorgement and a milk oversupply problem for some women. Mothers who experience engorgement may need to pump for comfort, and mothers with an oversupply problem should be informed how to treat this. Some women with Raynaud's also suffer from Erythromelalgia, where sensitivity to heat occurs, heat treatments will be inappropriate for these women.
General Suggestions
Keep all rooms you are using, including the hallway, warm in winter. At night, having baby in the same room, and keeping this room heated can help.
Exercise will improve your circulation and helps some women.
"Training' of the blood vessels to constrict and relax by turning the shower from warm to not so warm may help.
Avoid all products that contain caffeine, nicotine or other vasoconstrictive drugs.
Herbal Treatment
Some herbs help stimulate circulation; these include ginger, cayenne pepper, and cinnamon. Herbal preparations such as "winter warmth", tablets, or simply including these ingredients in your cooking helps some women. Ginkgo Biloba may also be of help (Muir et al 2002).
Medical
B6 vitamin supplements help some women. There are no studies supporting this, but it does appear to help (DrJackNewman website). The recommended dosage is 150-200mg/day for four days, reducing to 25 mg/day until the mother has been pain free for several weeks. Any improvements generally occur within the first few days of taking this supplement. Vitamin B6 can affect milk supply in some women, making this option most suitable for women with an established milk supply (baby older than three months) or an oversupply of milk. Women with a young baby or a low milk supply should feed their baby on demand and monitor wet and dirty nappies for the first week or so after starting these supplements.
If vitamin B6 does not work then nifedipine tablets, a prescription drug, may be considered (Kahan 1982). Nifedipine is typically used to treat raised blood pressure, and prevents vasospasm occurring by reducing smooth muscle tone in arteries. Treatment is usually a two-week dose, with future attacks treated with an additional course of tablets. Treatment can be unsuitable for women with low blood pressure, and side effects can include headaches. Women may need to reduce the dosage to avoid headaches, or increase it to treat the Raynaud's. Nifedipine does cross into breastmilk, however no harmful effects to the infant are known.
Half a glass of red wine a day can help some women, however it should be noted that heavy alcohol use is associated with an increase in Raynaud's. The link to this research is here: http://www.arthritis.org/smoking-raynauds.php Women wanting to try this treatment should try half a glass of red wine, once a day, just after feeding your baby, at a time when you know you won't need to feed your baby for half an hour at a minimum, or one hour if you are smaller than average. This delay will allow your body to process the alcohol.
Given that moderate consumption is the key, the benefit may be derived from giving the blood vessels a rest. Some mothers find that their nipples seem to progressively constrict, with each episode getting worse, as it builds on the last vasospasm. Having a rest, a chance to relax and heal, is just what they need.
For pregnant women, the current recommended safe limit of alcohol is no alcohol at all. If a pregnant woman wanted to try this remedy, I would strongly suggest they consult with their Doctor first. This remedy may not be suitable for women whose babies feed very frequently, women with a history of alcohol abuse, or women suffering postnatal depression.
Calcium (2000mg per day) and magnesium (1000mg per day) supplements can help some women if they are deficient in these minerals (Belch et al, 1985).
Pain relief tablets such as Ibuprofen may help, however they should not be taken continuously over long periods of time.
Recommended websites:
http://www.kellymom.com/bf/concerns/mom/nipple-blanching.html
http://www.breastfeedingonline.com/articles.shtml
Your midwife, lactation consultant, or a la leche league leader can provide further help for women with Raynaud's.
If you have suffered from Raynaud's I would love to hear from you as to what treatment methods you have tried, and what has worked for you, so this article can be added to over time. I can be contacted at tara@summerwarmth.co.nz.
Female Hair Removal - What's The Best Method For You? Female Hair Loss – Find Out About Its Causes and How to Prevent It Naturally Get Bigger Breasts Fast How to Increase Breast Size Effortlessly and Safely Breast Surgery - Some Reasons for Undergoing the Procedure Undergoing Male Breast Reduction to Get the Firm and Sculpted Chest You Desire An Average Breast Size-Secrets To Making Her Scream With Delight What Causes Male Breasts? The Most secure Breast Enlargement Strategy within the Industry The Different Breast Procedures in Cosmetic Surgery Is Breastfeeding in Public Still Okay? The Proper Way of Warming Breast Milk in urdu How to Reduce Your Heavy Breasts and Prevent Sagging of Breast