A mother with a 2 week old baby  initially presented with  mastitis in 
her right breast. She also had sore nipples on both breasts.She had been 
started on antibiotics but the mastitis was not resolving and her 
nipples were still sore for the entire feed as well as afterward.
On observing her feed, I noted the baby was not latching correctly and 
her positioning needed to be altered slightly from transitional/cross 
cradle hold through to a cradle hold. 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 and suggested she use heat 
following a feed and  reducing her caffeine intake.
 Her mastitis was in the outer quadrant of her right breast and had not 
resolved despite being on antibiotics for 48 hours. I recommended she 
use cold packs before a feed and talked about the importance of good 
drainage from that breast when feeding. The mastitis resolved within the 
next 24 hours with these suggestions.
She contacted me a few days later to give me an update. 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.
 Changing nursing positions over the next few days didn't change the 
situation.The mother rang saying she couldn't bear the pain any longer 
and was thinking of giving up and using formula. I was puzzled as to why 
the right nipple was still blanching. 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.
This mother was amazed how quickly  breastfeeding went from a painful 
experience to a pleasurable one with such a slight change. The icing on 
the cake for me in this case was that the mother was a doctor. Now, she 
can not only empathize with mother's painful experiences of 
breastfeeding, but she will refer mothers to a lactation consultant 
rather than suggest  formula.
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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