I have worked with several moms who took Nifedipine and it usually works instantly. You need to be careful with it though. It is a pretty potent medication that can cause not only headaches but lightheadedness and fainting due to a drop in blood pressure and most post partum women are young with fairly low blood pressures to begin with. So they shoud not take this medication for the first time, when they are alone with the baby. I always advise starting it on the weekend when they will have help if they don't feel well. They should be instructed to stand up slowly and perhaps to start on a low dose. The LC may be the one giving the instructions...often doctors assume that because you are the one making the request that you have also discussed all the possible side effects with the mom. Not a good assumption, but there it is....That said, I have only had one mom who could not tolerate the side effects of Nifedipine and it has saved breastfeeding for several of my moms. I see sooooo many moms who have spasming in the early weeks of breastfeeding. Most moms report that the spasming resolves after the initial weeks of nursing even without any treatment other than heat and latch improvement. But Nifedipine can be a lifesaver. I always tell them about its existence when I see vasospasming, so that they know they have options if heat and latch improvement are not working, but most don't need it.

I generally reserve the diagnosis of Raynaud's of the Nipple for moms who experienced nipple pain prior to pregnancy and nursing. I think that nipple vasospams are really common and do not necessarily mean that the woman has Raynaud's Syndrome. Just like if your fingers turn blue because you put them in ice water it does not mean that you have Raynaud's. Early breastfeeding seems to be a trigger for cirulatory issues in so many women, most of whom are otherwise without significant circulatory issues.

Kathy Lilleskov RN IBCLC

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