Raynaud’s of the nipple most commonly occurs in pregnant or breastfeeding mothers, but can also occur in women who have never been pregnant. Like Raynaud’s in other parts of the body, it is a condition that can usually be managed and, when triggers can be avoided, the vasospasm events will reduce or stop.
Women who have Raynaud’s of the fingers and toes may develop Raynaud’s of the nipple when they become pregnant or start to breastfeed. This does not happen to all women with Raynaud’s in other body parts, but these women should be aware of this condition, and should take precautionary measures where possible.
Estrogen appears to be a factor in Raynaud’s; it affects how we react to the cold. The increased levels of estrogen in women directly after puberty, in pregnant women, and in woman who have recently given birth may explain why these women develop Raynaud’s of the nipple.
Young women with this condition often complain of symptoms after swimming, and may avoid this sport. Pregnant woman may or may not suffer with each pregnancy depending on environmental factors and hormone levels. In breastfeeding women symptoms often start between a week to a month or so after birth. Many women who do not suffer from Raynaud’s elsewhere in their body develop Raynaud’s of the nipple when they start breastfeeding.
Breastfeeding is a particularly challenging trigger for Raynaud’s. Waving a cold, wet nipple around in front of a baby’s nose for minutes at a time, trying to get them to latch, the evaporation of saliva/milk from nipples, using cold, wet breast pads, and getting up in the middle of the night can all be a recipe for disaster. Specific triggers for Raynaud’s of the nipple can include leaving nipples to air-dry after breastfeeding, damage to the nipple caused by poor latch, and previous breast surgery. Vasospasm events typically occur after feeding has finished, or on any other exposure to the cold.
Some women have nipple vasospasms that are due to poor latch only. Improving the baby’s latch will solve this problem. This condition is not Raynaud’s, but is just described as nipple vasospasm or blanching. Raynaud’s of the nipple in breastfeeding women is often misdiagnosed as poor latch, thrush or milk blebs. If the mother is not given the right information it is very likely she will stop breastfeeding due to severe pain. If a nipple is severely constricted it may not let milk down, and the mother may be forced to start supplementing her baby.
Breastfeeding women can suffer damage to their nipples if their baby latches on during a vasospasm event, or while the nipple is constricted, as the nipple will not stretch well. The breast should be warmed, or the nipple repeatedly squeezed to help blood flow back into this area prior to latching. Some women find that pumping their milk is less painful than breastfeeding. Pumping may also be used to give mothers a break to get their Raynaud’s under control.
Keeping Warm
Women with Raynaud’s of the nipple should never let their nipples air-dry. For breastfeeding women, as soon as the baby comes off the breast it should be covered. 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. At night, having your baby in the same room with you, and keeping this room heated can help.
Products to keep women warm include breast warmers that insulate the breast, wool breast pads, stay-dry breast pads with a microfleece top, and merino bras. Products to provide heat include wheat packs (large to cover all the breast area, or small to fit inside a bra), oxidising packs (use the hand warmer size), and battery heated vests. A hot wet flannel in a zip lock bag can also help if nothing else is available.
Great care needs to be taken when using any heat source near babies or while sleeping. Mothers should be aware of the risks they take, and take steps to minimize them, such as encapsulating the heat source in either a thick sock or specially made cover to prevent burns.
Use of breast warmers and heating systems can increase milk supply in breastfeeding mothers, although this may lead to engorgement and milk oversupply. These issues can be managed by using methods such as one-sided feeding for milk oversupply. A lactation consultant can provide further help for these issues.
Herbal and Medical Treatments
There are a wide range of supplements, herbs, and prescription drugs that are suggested for people with Raynaud’s. Women should discuss the use of all such treatments with their healthcare provider first. Pregnant and breastfeeding women need to consider the possible risk of these substances on their babies. Particular issues for pregnant and breastfeeding women include the following:
- Vitamin B6 supplements can reduce milk supply in some breastfeeding women.
- Nifedipine is generally considered safe for breastfeeding women, but it is not generally prescribed for pregnant women.
- Nitroglycerin ointments or sprays are unsuitable for pregnant or breastfeeding mothers.
Other Sources of Help
Midwives, lactation consultants, or La Leche League leaders can provide further help for breastfeeding women with Raynaud’s of the nipple. Attending breastfeeding support groups, such as La Leche League, can also help encourage women to continue breastfeeding. There may not be other mothers in the group who suffer from this condition, but many will have had problems of a similar magnitude that they have overcome, and may provide the support that is so important for women having trouble breastfeeding.
Tara Hills is a mother who has Raynaud’s of the nipple. She has a webpage (www.summerwarmth.co.nz) providing information and products for women with this condition.
