Nipple pain/blanching - please help

[littlemimosa]

Hello, im new here and desperate for some support. I'm bf-ing my 3 week old baby (2nd child) and am having lots of pain, mainly on one side. I started getting blanching/vasospasm/Reynauds 3 days ago (i knew what it was as i had it with LO1, tho i think it's worse this time). Both nipples blanch after a feed but one side is bearable and the other is excruciating. It's mainly when latching but the stinging and deep breast pain continue after a feed for ages. I considered thrush but as it's really on one side only & we have no symptoms i've dismissed that idea. Have been prescribed Nifedipene 2 days ago but dont think it's had any effect yet... (also it's giving me awful headaches - anyone had this?). The latch is 'ok' but the nipple is inverted so it's tricky anyway. This prob doesn't help matters. So really am asking if anyone has experience of this, do you have any advice and has Nifedipene worked for anyone? Thank u in advance.

mimosa - this has lots of info on vasospasm//Reynauds and self help treatments as well as medical options (the Nifedipene you mention and it states headaches as one of the side effects ).

This also has information about vasospasm/Reynauds.

It may be worth seeing a breastfeeding counsellor/IBCLC to see if baby's latch can be improved as that may help the pain especially as you mention it is one sided though the vasospasm is both sided.

Thanks for the advice and links TruthSweet. Really helpful. I think i do need to get the latch looked at on the left side. The vasospasm is on both sides it's just extra painful on the left, probably down to the inverted nipple and damage i think (though there are no cracks, bleeding etc?). I have had a bf counsellor round to the house who was really good but think i'll speak to her and ask her to come back and have another look. Latch definitely needs tweaking but not sure where to start. You'd think i'd know as i breastfed LO1 for 10 months but alas, no.... Anyone else got any pearls of wisdom?

I think I used to get this, and that a hot water bottle used to help.

I had it with dd1, not as bad as this though. But feeding in a very warm room and keeping as covered up as possible really helped. As well as hopping round the room after the feed, cupping my nipple and cursing loudly. It got better as the weeks went by. Oddly enough, I hardly had it with dd2, but she was a better feeder and it was a very hot summer. Hope you find a solution.

Have you tried biological nuturing positions for feeding in or deep latch technique (also known as 'the flipple' and 'exaggerated latch' for google-ability!)?

Vasospasm can happen when the nipple is being compressed against the baby's hard palate rather than the juncture of the hard and soft palate (which is much further back in the mouth), this can cut of the blood supply or reduce it to the point of vasospasm when the feed is over. The above mentioned can help get a deeper latch which may avoid the vasospasm though it may take a little time for the full effects to be felt.

Does your nipple looked squashed or mis-shapen post feed? That's often a good starting point to see if the latch could be made deeper.

Ps don't discount thrush out of hand, it does sound possible...

I'm currently feeding ds (2 weeks) and this happened me about a week ago. I was crying during latching. I realized I would give up if this continued, so I took a step back and expressed for 1 day and let DH feed him, as the fear of pain was becoming a real barrier. My nipples were cracked and bleeding and ds brought up one feed which was completely red as it was mainly my blood. I then spoke to my midwife and started again, essentially. We went to bed for a day, just me and baby, and I paid serious attention to latch. This is dc3 and I've fed all of them and I think I couldn't accept I was getting latch wrong. We are now feeding really well and nipples have healed. I had that stabbing deep pain you describe, which is why I replied, I can still feel the memory of the pain. Hope it goes ok.

Thanks ladies. Yes, I have been keeping warm and using wheat pads after a feed. Does help. Yes I've tried biological nurturing. The bf counsellor I saw suggested it a week into feeding and it really helped. I'm thinking that I perhaps got a bit lazy with the latch after that and caused the damage after I went back to the cradle hold. I'll give it another go. Yes my left nipple does look squashed after a feed (whereas my right looks symmetrical), sort of lipstick-like! Not good I know. How can I get round it?? dontlaugh, that sounds horrific about the bleeding! Gawd. How anyone breastfeeds after all the pain I don;t know.... I may also take your advice and express off that side for a day or so and see if i can give it chance to heal then get back to a proper latch. Thanks for all this great advice...wish i'd come to MN earlier :-)

Are there wounds or cracks on your nipples then mimosa?

Pumping won't help heal vasospasm pain if it's caused by a less than ideal latch, it may exacerbate it as you would be giving feeds by bottle which use a very different tongue action to bfing so when you went back to bfing directly you could have a baby who had issues swapping between the two different types of tongue action (or even one who preferred bottle feeding to bfing).

If it's the left nipple that's causing the worst pain then it's sounds like latch is exacerbating the vasospasm (you said you had it with your 1st DD - what happened? did it get better at any point?).

This is a good resource for deep latch technique or perhaps try this and see if it works for you!

TruthSweet, no, I've no cracks or wounds. It's just incredibly tender, kind of burns and itches too. Yes, i see what you're saying about bottles. Hmmm. If I remember rightly, it wan't as bad with LO1, I just took Vit B6 and suffered through it and it eventually went away (can't remember when though). Also back then the pain was more 'even'! Not worse on one side or the other. Just off to look at your links. Thanks so much. Regarding thrush.... I've had this pain for 3 or 4 days now, wouldn't it have transfered to the other side by now?

Definitely sounds like thrush to me, and I've certainly had it on only one side at a time.

Yes it would have transferred by now as thrush is highly communicable. It's fairly easy to get thrush and vasospasm confused as thrush can CAUSE vasospasm, so a lot of the symptoms are the same. Thrush wouldn't be one sided unless you were bfing twins/siblings and they had permanently assigned breasts but even then it wouldn't be too hard to move thrush spores from one side to the other (though it may delay transmission).

Do you have Reynaud's in your other extremities (fingers, toes, nose, etc)? Or is vasospasm in your nipples the only time you have had this type of pain?

Has baby been checked for tongue tie at all? Would your BFC be able to do an oral assessment on baby to see if it's a possibility?

I'm not feeding twins or siblings. No I don't have Reynauds although I've always been sensitive to cold. I get cold hands and feet in winter that are difficult to warm and am much happier when I'm warm generally. Yes this is the only time I've had this type of pain. No, we've not checked for tongue-tie. Yes I will get the BFC to check... good tip.

Sorry for the barrage of questions! Sometimes it's easier in person than over t'internet

Last one I promise! Are you using warmth straight after a feed to minimise pain? Folded up muslin that you have been sitting on, breastpad in pocket to keep warm, one of those little hand warmers for gloves (wrapped in a muslin/cloth so you don't get burned) are all good ways of getting blood flowing back to the nipple as painlessly as possible.

Hello TS, sorry went to bed last night and have had a busy day so not been able to log on... Yes I've been using a wheat pad heated in the m/w after a feed. It does help a bit. I've got hand warmers so i'll give it a go.

Well, up and down today. I'd say the Nifedipene is starting to work now as the pain has been SLIGHTLY reduced today. It's been more bearable. Also the headaches have gone - happy about both of these :-) However, I'm finding night feeds very difficult. It's a combination of me being tired and my nipples having been used all day so they are more sore than usual. I start a feed then it ends in LO getting frustrated, me getting sore and anxious and often ends in a formula or EBM top-up :-( I don't have an issue giving formula, i just got myself in a flap last night about giving bottles and how it could have affected the latch and caused all my bf problems. I muttered something about giving up bf but of course in the light of day, after a bit more sleep and a fairly painless first feed of the day, i change my mind again. Can only hope that as the pain fades this won't be an issue...Why is everything so much worse in the middle of the night??!

One more thing i forgot to say on my original post; my left nipple (the really sore one) is often very hard and 'rigid' these days. My right is still flexible and soft. Is this a Reynauds/vasospasm symptom? Thanks again x

I have blanching and vasospasm with my ds - thought it was thrush for weeks and made self miserable airing breasts and applying cream which of course made them cold and more painful. Thrush is rare in young babies unless you have been on antibiotics, so I would make sure your latch is as goos as you can get before suspecting thrush.

After weeks of dreading feeds and painkillers round the clock i Finally saw a lactation consultant who diagnosed vasospasm and helped with latch. now feeding mostly pain free unless I am lazy with latch or fall asleep and ds falls off. One tip she gave me was to drink plenty of tea. Decaf is fine too. It's warming, and also contains a chemical which helps to relax blood vessels so counteracts the vasospasm...not sure if it works scientifically but seemed to help me, and excuse for a nice cuppa while feeding makes me happy. Biscuits probably make it even more effective :)

Your symptoms sound exactly like the thrush I had, due to antibiotics after long labour. It was only on one side but both sides blanched and it was a very deep pain. It took me 6 weeks to realize what it was, creams didn't help, had to get oral medication for dd and the tablets for me plus cream and eventually it cleared up!

I also had something like this was convinced it was thrush and had treatment but made no difference. Used deep latch technique as suggested which did seem to help. After 10 weeks of pain, the feeling just went the latch still looks incorrect now ur a friend suggested it could be pain free due to baby's mouth growing who knows!

Wow, so many people with this condition, it's interesting.... Thanks for all your advice. I notice i'm getting some ladies saying a definite NO to thrush and some saying it could be. It's confusing, but my gut feeling is that I don't have thrush. (Could be wrong of course!Especially as I had antibiotics recently for mastitis) I say this because the drugs (Nifedipene) have started to kick in now (it's making my normally pale and pallid hands and feet look healthy and red! lol) and i can feel a difference already. I think what BLOSSOMBATH says is key....that if i get lazy with the latch the pain increases. Today for example my LO who gets quite bad wind, was really pulling back in pain with my nipple in his mouth (ouch). It's left me sore again and brings back the deep pain :( Anyone get the hardening nipple thing?

Leonie hope you're right about the Nifed. Can i be nosy and ask what the beta blockers are for? I also had this with LO1 and all i took was Vit B6 and the pain eventually went of its own accord. Think someone else mentioned about it improving when baby gets bigger and mouth gets larger...here's hoping!

It is intersting mimosa, particularly the whole confusion/possible confusion with thrush. I think thrush is more known about, but often wrongly diagnosed. In fact I think truthsweet may have helped me realise mine wasn't thrush all those weeks ago with lots of questions for me! (may have been another MNer, though, can't find my old thread!)

That's not to say yours isn't thrush, just my own experience. Another bit of advice from my lactaction consultant was that even if I had thrush the pain wouldn't go away while my latch was still bad and nipple getting compressed. So she advised sorting that out and if I was still getting the pain I was going to get a swab done and ask for the thrush tablets rather than just creams. But in the end the pain more or less went, so it can't have been thrush.
Maybe follow that path - see how improving latch helps before further meds.

Can't help on the nipple hardening, sorry

Mimosa - I really don't know enough about vasospasm to say if the nipple stiffness is to do with it or not. I think that's one for your BFC or a bfing helpline tbh.

Glad the nifed. is working a bit better so fingers crossed with an improved latch and some post feed warmth you can get on top the vasospasm and be in much less pain - hopefully none!