Dear LactNetters,
       I have come across a situation that is puzzling to me.  Mom gave
permission to post to you for ideas about what is going on here.
       Mom came to my office with 5 wk old who just wasn't gaining
appropriately.  We worked on various things, but I suggested she pump after each
breastfeeding session to help build her supply more quickly, so baby would be more
interested in being at breast.  Mom winced at the suggestion.  She said that
using the Pump In Style really caused her pain, and she did not think she could
stand to pump so frequently.  She said the pump caused her nipples to turn
purple.
       I had her bring the pump in to the office.  I was worried that the
pump was producing too much suction, and I have a gauge that I check suction
levels with.  First, I checked the pump at maximum with the gauge, and it was as
it should have been:  220 mm pressure.  Then I asked mom to pump a little, so I
could see if there was something about her technique that could be improved.
  Her nipples did entirely fill the nipple shaft of the breastshield/flange,
so I put an XL flange on it.  Didn't matter.  On the very first suck, no
matter what shield we used, her nipples turned a very deep purple.  And mom
complained about how it hurt.  Each time we stopped, after only a few sucks with each
size flange, the face of each nipple turned completely white 2-3 seconds
after removing the pump.  Mom says that's what always happens.  The colors are
right for Raynaud's, but the order of the change is backwards.
       Not knowing what's going on here, I suggested she try my demo Avent
ISIS (manual) pump, thinking she could better control how much suction was
applied and how quickly.  Even though her nipple was a tight fit in the silicone
"petals" of this pump, the nipple did not change color and she experienced no
pain.  More importantly, she immediately got squirts of milk with each suck of
the ISIS pump, when she barely got drops from the Pump In Style.
       She does not experience pain or color change when baby breastfeeds.  I
suggested she ask her doc if he had any ideas about this, but she goes to a
military clinic and none of the docs or midwives there had even heard of
Raynaud's of the nipple, much less this possible "reverse Raynaud's".
       Although we've found a way for this mom to pump, and her baby is now
nursing much better and gained 8 oz. this week, we're still curious about
what's going on with this color change.  Any ideas?
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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