Vasospasm, also known as Raynaud’s phenomenon of the nipple, is where the nipple turns white when the baby latches off, then turns blue or bright red before returning to its normal colour. This is accompanied by extreme pain for the mum, that can be described as sharp stabbing, or throbbing pain. It may not happen immediately after the baby latches off. For some women, it happens when they pop their bra back over the still erect nipple post feed. They feel a burning pain, look down and the nipple tip is white, then turns blue/red and the pain eases.
So what causes Vasospasm
When we get cold or aroused, the skin around our nipples gets crinkly and wrinkly looking doesn’t it? This wrinkling of the skin is in fact muscular tissue that helps our nipples to become erect so that it is easier for the baby to latch on. However, for about 20% of women of childbearing age (Wilson-Clay & Hoover 2013), this mechanism causes the mother problems, and here’s why:
1) The baby’s lovely warm mouth latches off, leaving a wet nipple exposed to the cold air.
2) The muscles around the nipple immediately contract in reaction to the cold, causing lack of blood flow to the nipple, which makes it turn white and causes extreme pain for mum.
3) As the muscles slowly relax, blood starts to re-enter the nipple, therefore it turns blue, then red, and the pain starts to subside. For some women this pain is mild. For others it is excruciating.
So what can I do?
If you are having vasospasm, the first things to consider would be to stop smoking or taking caffeine as these can contribute to vasospasm. Next, you need to be prepared for when baby latches off. The following strategies are worth trying and seeing which one works best for you:
1) Squeeze your nipple at the nipple base to encourage blood to flow back into the nipple. This can stop the pain immediately.
2) Warmth is key. Place your warm palm immediately over your nipple (after baby latches off) until the nipple is relaxed again (no longer wrinkly).
3) You can use a warm, plug in pad/pack and pop that over your nipple immediately after latching off. Alternatively you can use a hairdryer on low, or a warm dry cloth.
4) Consider getting the latch reviewed by a Lactation Consultant – your baby may be clamping down on your breast around the nipple which can contribute to more intense pain.
5) La Leche League also suggest keeping warmth constantly over a nursing pad for 7-10 days, which may end vasospasm for good (Wiessinger et al 2017).
If these strategies aren’t working and the pain is so extreme that breastfeeding is becoming unmanagable, you can talk to your IBCLC and GP about Vitamin B6, calcium, magnesium, or a short term prescribed medication that may help. Procardia, is a medication that treats high blood pressure and is shown to be effective for treating vasospasm without side effects, and transfer via breastmilk to baby is not significant (Wambach & Spencer 2021)
Vasospasm can occur without a person having Raynaud’s phenomenon, which is a condition whereby there is decreased blood flow to the extremities (usually the fingers, ears, nose toes, knees and nipples) that causes those extremities to turn white in response to cold, stress or emotional upset. Raynaud’s phenomenon is also associated with Lupus, rheumatoid arthritis, and hypothyroidism. There is also a link between vasospasm and breast or nipple surgery, as nerves and tissues may have been damaged (Anderson 2004 cited in Wilson-Clay and Hoover 2013).
For further information on Nipple pain and care see Nipple Pain
Wiessinger D. West D. & Pitman T. (2017) The Womanly Art of Breastfeeding (8th Ed). La Leche League International. The Random House Publishing Group, USA.
Wilson-Clay B. Hoover K. (2013) The Breastfeeding Atlas (5th Ed). LactNews Press, Manchaca, Texas.
Wambach K. & Spencer B. (2021) Breastfeeding and Human Lactation (6th Ed). Jones and Bartlett Learning, Burlington, MA.