Barbara, congratulations on a good save!

I suspect your mom has always had higher flow from her right breast. I see 
plugged ducts and mastitis occasionally with an "oversupply" of milk. In 
this situation the baby clamps down on the nipple to slow the flow - which 
is what can cause vasospasm. I refer to it as "biting in self-defense" and 
what you did was the perfect thing - you had her slightly reduce the milk 
supply on the problem breast. Now the baby isn't overwhelmed any more and 
doesn't need to clamp down so the "cause" of the vasospasm goes away.

Nice job.

Gail
Gail S. Hertz, MD, IBCLC
[log in to unmask]


Barbara writes:
Subject: Nipple Vasospasm


>A mother with a 2 week old baby  initially presented with  mastitis in her 
>right breast.
snip
. When positioning and latching were
> corrected,the mother got immediate relief from nipple soreness on the left 
> breast but not on the right. At the end of the feed the nipple on her 
> right breast blanched and was quite painful but the nipple shape was fine. 
> I talked to her about nipple vasospasm
snip
Breastfeeding on
> her left breast was pain free but she was still having a lot of pain after 
> feeding as the right nipple was still blanching(there were no cracks). I 
> observed her feeding on the right breast and noted the flow was quite fast 
> and the baby was struggling to cope at the beginning of the feed.
snip
 I wondered if  she had
> overstimulated the right breast when "draining" the breast during mastitis 
> and because of the fast flow, the baby was deflecting that flow with his 
> tongue to protect his airway.  I suggested she use cabbage leaves for 4 
> hours only on the right breast to reduce the milk supply then wait 24 
> hours to see if  that improved the situation. She rang me the next morning 
> saying she no longer had any pain in the right nipple, and most 
> interestingly the blanching was no longer happening at the end of a feed. 
> I have maintained contact with her and breastfeeding is going really well. 
> She continues to have a faster flow from the right  breast than the left 
> but  there have been no further problems with her right nipple.
snip
> I am wondering if anyone else has come across nipple blanching on one 
> nipple only? I thought this was a rather interesting case and now when I 
> come across a mother with nipple blanching  I check on a possible 
> oversupply  situation. I would be interested in other peoples thoughts.
> Barbara Fletcher
> IBCLC RGON
> New Zealand

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