Thursday, March 24, 2011

Raynaud’s Phenomenon, Vasospasm, and Breastfeeding

By Michelle Schnaars

Raynaud’s phenomenon is a vasospastic disorder. Vasospasm refers to a condition in which blood vessels spasm, leading to vasoconstriction, causing discoloration of the fingers, toes, and occasionally the nipples and areola of the breast. The phenomenon is believed to be the result of vasospasms that decrease blood supply to the respective regions. It comprises both Raynaud's disease, (also known as "Primary Raynaud's phenomenon") where the phenomenon is idiopathic, and Raynaud's syndrome (secondary Raynaud's), where it is caused by some other instigating factor. Measurement of hand-temperature gradients is one tool used to distinguish between the primary and secondary forms. Raynaud’s phenomenon occurs more commonly than once believed, affecting up to 20% of childbearing women. Triggers include emotional stress and cold temperatures. Vasospasm can occur with any cause of sore nipples, and is probably a result of damage.

Raynaud's phenomenon is an exaggeration of vasomotor (refers to actions upon a blood vessel which alter its diameter) responses to cold or emotional stress. More specifically, it is a hyperactivation of the sympathetic system causing extreme vasoconstriction of the peripheral blood vessels, leading to tissue hypoxia (Tissue hypoxia is a condition in which tissue cells experience inadequate oxygen utilization due to a number of causes such as decreased partial pressure of oxygen (PO2) in a given tissue).

Vasospasm typically occurs after the feeding. The baby is removed from the breast, the cooler air comes in contact with the breast, and within in seconds the nipple turns white, and starts to burn. The nipple may return to its normal color as the blood starts to flow back to it. As the blood returns the woman may experience throbbing pain in her nipple. The pain and discomfort can last up to a couple of hours after the feeding. During this time the pain might alternate between a burning sensation and a throbbing pain. As well the color of the nipple may alternate between its normal color, white, and blue.

The pain is of concern because it can make a difference between successfully breastfeeding and not breastfeeding. Many women go undiagnosed, and give up breastfeeding, thinking they just simply can not breastfeed their baby. The woman should seek medical care, diagnoses and treatment. In most situations, breastfeeding can continue once the underlying cause has been treated. Some women may need to remain on medication during the entire breastfeeding experience. It is also important to note that not all women experience pain with Raynaud’s phenomenon or vasospasm, or the pain is mild. Pain that is experienced can be felt as burning and throbbing, occurring in the nipple, as well as pain that envelopes the entire breast, and is felt in the back. The causes can be poor latch (the baby is not latching onto the nipple and areola correctly), or Candida. Once the cause is treated, the pain from vasospasm will decrease. There is a chance the pain will continue even though the latch has been checked, and any Candida treated. If the pain continues, if it does not improve, and is severely restricting the blood flow to the nipples, then healing may be delayed. It is also important to know that Candida and poor latch are not always the cause.

There are a few things a woman can do if the pain continues: herbal medicines, aerobic exercise, and dietary supplements. After removing the baby from her breast, she should cover her breast with her warm hand to keep the colder air from coming in contact with her nipple. She should also cover her breasts when exiting the shower to keep them from getting cold; and do not ‘air dry’ the nipples, as cold air triggers vasospasm. Avoidance of vasoconstrictive drugs and nicotine that could precipitate symptoms, and pharmacologic measures is also necessary. Nifedipine is used to help with the pain. Very little of the medication can be demonstrated in breast milk and thus is safe to use in breastfeeding mothers.

Often women who are experiencing difficulties with breastfeeding need reassurance, and help identifying the problem(s). Breastfeeding incurs many benefits to both mom and baby. Breast milk has disease-fighting cells called antibodies that help protect infants from germs, illness, and even SIDS. Women should be encouraged to continue breastfeeding as they work through the obstacles.


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