Ask An LC: About Breastfeeding with Raynaud’s Disease

Welcome to “Ask an LC” by Melissa Yetter RN CLC

Melissa Yetter RN CLC is an experienced OB/L&D/Newborn nurse since the 70’s. She started her specialized lactation career in 1988, became a CLC in 1991, and went on to IBCLC in 1993, renewed in 1998. Due to unforeseen circumstances, she opted out of the required 10 year IBCLC recertification exam in 2003. She has always maintained CLC status. She recently recertified for CLC (Certified Lactation Counselor) in 2008. She blogs at “Stork Stories… Birth & Breastfeeding” about her experiences as a maternity nurse and lactation professional from the 1970’s to present.

Question:

“@clementinenw – Would love to see info. on dealing with Raynaud’s disease while breastfeeding. Especially if conventional wisdom doesn’t help enough.”

I hope I can be of help to you. This is a painful situation. Dealing with Raynaud’s disease is very difficult especially while breastfeeding. The question implies that this mother (whether it is yourself or a mother you are helping) has tried some conventional options to find relief. I’m not certain what has already been tried so I’ll provide you with all that I’ve found.

What is Raynaud’s?

Many people haven’t ever heard of Raynaud’s phenomenon. This condition usually affects women from about 20 to 50 years of age. This is a situation where there is an abnormal spasm of arteries supplying blood to the fingers or toes, closing off blood supply and causing numbness, burning, tingling, pain- sometimes very intense pain and a temporary loss of color (blanching, pallor, waxy white). The skin of the affected area can also turn blue from lack of oxygen. When the circulation returns, there is sometimes a temporary flushing before returning to normal. The normal skin color goes from white to red, or raspberry to normal, or white to blue to red, or raspberry to normal.

It is this biphasic or triphasic color change that helps in the unique diagnosis of Raynaud’s. The triggers which usually set off the vasospasm are cold or rapid temperature changes and sometimes emotional stress. For some women, Raynaud’s affects the nipple whether or not she may be pregnant or breastfeeding. At a conference, I heard of a family of women that never wanted to swim because of the painful blanching of their nipples. The poor young ladies thought this happened to all women and didn’t understand how other girls could stand it for swimming!

Raynaud’s of the nipple in breastfeeding women is usually described as excruciating nipple and breast pain after nursing, pumping /expressing milk and at other times when the nipple is cold or wet. It is always associated with the biphasic or triphasic color change. Sometimes the areola can also change shape while this is happening. Not all women who experience nipple blanching and pain have Raynaud’s phenomenon. However it can be misdiagnosed as nipple vasospasm for other problems such as poor latch or confused with pain from yeast or Candida albicans infections. It can also happen simultaneously with other breastfeeding problems. It is always important to get evaluated by your medical provider or Lactation professional.

What can you do?

If a breastfeeding mother has been diagnosed with Raynaud’s, there are a few things you can try to keep you as comfortable as possible. Treatment is directed towards making certain breastfeeding is optimal and reducing situations or conditions which predispose you to the symptoms. Most women with painful breastfeeding need immediate pain relief to continue breastfeeding. It then becomes very important to suggest/ offer treatment options or plan that will help alleviate the pain quickly:

• Optimal positioning and latch on techniques are crucial to help avoid / eliminate any other causes of nipple pain.
• Reduce exposure to cold … besides the climate, this includes avoiding cold stimuli and quick temperature changes of the nipple.
• After feeding, some mother’s keep a warmed cloth nearby to place on the nipple immediately after released from baby’s warm mouth. This allows for a more gradual temperature change back to normal.
• Reduce emotional stressors as much as possible.
• Avoid smoking or tobacco in any form including secondary smoke.
• Avoid alcohol use which can exacerbate symptoms.
• Avoid or limit caffeine as this can exacerbate symptoms.
• Avoid certain drugs like pseudoephedrine, beta blockers, oral contraceptives (Hale 1999).
• Some have found relief with aerobic exercise, and dietary supplements such as Evening Primrose Oil or Fish Oil over time (6 weeks) but no immediate results have been reported.
• Nifedipine, (Procardia) a calcium channel blocker, (high blood pressure medicine) has been prescribed and used to treat Raynaud’s symptoms with good results because of its vasodilator effects. (Anderson 2004)
• Anderson 2004 reports all mother’s who chose to try this medication reported prompt relief of pain.
• Nifedipine doses according to Hale for this situation would be in a sustained release form providing 30 – 60 mg per day.
• Nifedipine is listed in Hale 2008 as “L2” Safer. He lists “none” for any pediatric risks or concerns while the mother’s are on the medication. Also listed with the AAP as “Usually compatible with breastfeeding.”

Sometimes a mom may not know what exact answers to give to medical questions or the professional may not ask the right questions… therefore the diagnosis of Raynaud’s can be elusive. It may not be initially associated with her nipple pain. We as professionals need to widen our range of questions. For instance: “Does the mother have any symptoms associated with Raynaud’s phenomenon?” “Does the mother have color changes in her nipples after breastfeeding?” Taking steps like this can possibly help us pinpoint this diagnosis sooner if it is truly the case.

References:

Various links throughout post

Additional references:

Hale, Thomas: Medications and Mothers’ Milk 2008, 13^th edition; Hale Publishing, Amarillo, TX 2008

Hale, Thomas: Clinical Therapy in Breastfeeding Patients 1^st ed. Pharmasoft Medical Publishing, Amarillo, TX 1999

Center for Breastfeeding Education, Healthy Children’s Project: Course Syllabus; Lactation Counselor Certificate Training Program; Ft. Collins, Colorado; October 2008

Cadwell K, Turner-Maffei C.: Pocket Guide for Lactation Management. Jones and Bartlett Publishers, Inc, Sudbury, MA 2008

Anderson JE, Held N, Wright K. Raynaud’s phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 2004 Apr;113(4):e360-4 Abstract accessed via Pubmed.gov August 2009

Related posts:

1. Monday Musings: What Were Your Misconceptions About Breastfeeding?
2. Ask a LC: How to increase milk supply with galactogogues and over-the-counter herbs
3. How Contradictory Medication Information and Advice Wrecks Breastfeeding and Moms

Tags: Hale, latch, nipple blanching, nipple pain, positioning