From: NEW BEGINNINGS, Vol. 16 No. 4, July-August 1999, p. 120-21
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
All during my pregnancy, I looked forward to breastfeeding. I envisioned many serene moments of nursing and relaxation with my baby. I knew about difficulties and had been cautioned that the first few weeks could be challenging and even physically uncomfortable sometimes. However, I was not prepared for the intense pain and discomfort which I experienced for the first three months of my son's life. After consulting many specialists, I now know that I was experiencing nipple vasospasms. This is a condition which is particularly common in women with Raynaud's Phenomenon and which is often overlooked or misdiagnosed by lactation consultants and physicians. I hope that this description of my experience may help other women to identify this problem, should they have it, and find treatment that will prevent it from prematurely ending their breastfeeding relationship.
Raynaud's affects about 20 percent of women. It is a benign condition often characterized by sensitivity to cold in the hands and feet. Hands and feet turn white or purple when exposed to cold and may tingle, hurt, or become numb. These sensations go away with heat. Although vasospasms are most common in hands and feet, they can occur in the vascular systems of the breast and nipple. The resulting pain is intense and could easily cause someone to stop breastfeeding.
Three weeks after my son's birth I called a lactation consultant about nipple pain. After concluding that my son did not have a sucking problem she theorized that my pain might be due to a yeast infection, even though neither he nor I showed any other symptoms. I began topical and internal treatment for yeast. At five weeks the pain was deep in the breast, and my entire chest area, shoulders, and back were sore. Interestingly it was not as painful during nursing as it was at other times. I would lie on my back awake after a night feeding, experiencing throbbing pain. I consulted another lactation consultant who thought I probably had a yeast infection in the milk ducts and recommended additional treatments. After three more weeks of treatment and only slight improvement, I went to see another lactation consultant when I was visiting my parents out of town. By this time I was miserable. The pain seemed particularly bad if I was cold (the frozen food aisle at the grocery store was strictly off limits). My upper body ached, and I had the desire to wrap my throbbing chest up in a million blankets and weep.
The woman I saw in St. Louis, Diana Estep, turned my life around by asking one simple question: “Have you ever experienced circulatory problems in any part of your body?” No one else had asked me this. She went on to talk about vasospasms- the constricting of veins, often due to stress. The stress of nursing on the breast and nipple can cause these spasms, particularly in those women with a history of circulatory problems. A few symptoms had led her to ask about this: 1) The color change in my nipples: between feedings the nipples turned white and then a purplish color which my husband described as looking “bruised” 2) My description of the accompanying pain as a stinging, burning, throbbing sensation throughout the nipple and breast 3) Sensitivity to cold: the breast hurt worse when exposed to colder temperatures.
My husband wasted no time in getting on the Internet and finding an article titled “Nipple Vasospasm- A Manifestation of Raynaud’s Phenomenon and a Preventable Cause of Breastfeeding Failure" by Laureen and Carolyn Lawlor-Smith, two lactation consultants in Australia. Every symptom they described matched my experience: signs and symptoms between feeds, pain in response to a cold stimulus, color changes, and burning, tingling pain.
There are several recommended strategies for managing vasospasm pain. Some worked. Most did not. I tried always staying warm when I nursed: keeping a heating pad on one breast while nursing on the other. I tried the homeopathic suggestions, using calcium and magnesium and herbal supplements. I avoided stress and caffeine and exercised regularly. What really worked in the end was the more interventionist strategy, the prescription drug Nifidipine. This drug is often prescribed for people with angina, but has been studied and found to control Raynaud's. I tried a very low dose and saw a marked improvement within three days. Within a week, the pain had lessened dramatically. After a month I experienced no pain at all. After six weeks I was able to stop taking the drug and the pain did not return. I now have no discomfort with nursing, and I can walk down the frozen food aisle for ice cream with no problem at all!
I now feel the joy of nursing, of snuggling up together at night in the rocker or taking an afternoon break to nurse, chat, and relax. I anticipated these moments for months and now relish each one every day. My son is six months old and thriving beautifully.
I could never have made it through such a rocky beginning without the support of many people. I was blessed with a family and husband who supported me and offered encouragement even though they saw me in pain. I am particularly grateful for my La Leche League Leader, Elizabeth, who searched her own resources, referred me to lactation consultants, and offered ongoing moral and emotional support. She assured me that the vision I had was indeed possible and would he worth it in the end. How right she was!
I encourage anyone who thinks she may be experiencing nipple vasospasms to talk to her physician about treatment and management of the pain. Most importantly, find support people and don't stop breastfeeding. The pain does subside. My case was severe. This condition rarely lasts as long as it did with me. The moments you will spend joyfully nursing your baby are priceless and easily erase the difficult times at the beginning.