Jillian writes:

<Looking for some feedback...  PTP

1st time mom birthed 2 1/2 wks ago.  Poor latch in hospital and LC missed a pronounced tongue tie - recommended pumping and cup feeding because of bad latch.

Mom complained of nipple pain when pumping.  Normal nipples, no trauma or abrasions, no bruising, and pump flanges fit well.  We tried 2 other pump flanges in an attempt to resolve the nipple pain while the tongue tie was evaluated, referred, and clipped, but were unable to resolve the nipple pain.

6/6 we began transitioning baby back to breast - and I hoped the pain would abate with the reduction in pumping time.  It hasn't.  Baby now takes every feed at the breast, with the exception of one bottle at nighttime per mom's desire. (Mom pumps while Dad bottle feeds - Mom feels baby is a 'slow nurser' because he takes about 45 min to feed and requires some stimulation or breast compressions to keep him interested - they can get the pump/bottle feed done in half that time.)

At initial latch, or for the initial pumping period, her pain level is around a 9.  After about a minute, the severe pain abates, but she is still tender and sore.  There are no signs of trauma, no bruising, no signs of fungal or bacterial infection.  It does not improve with a change in positioning.  When we remove baby from the breast, there's no signs of a shallow latch.

I'm stumped.  What could be causing this ongoing nipple pain and how can we resolve it?  Mom is becoming really stressed.  She is committed to nursing for a year, but feels like if every feed is going to 1) be this painful, and 2) take this long, that she can't make it.>


I strongly urge you to consider Reynaud's syndrome ASAP.


I hope an adequate frenectomy has already been done.


Having recently had a sad situation with a loved one with Reynaud's I will assure you it wears down a mother's bravery and intention to continue to breastfeed in a big hurry unless something can be done quickly and consistently to improve the situation. Your description sounds very much like what I saw. It was my first such case, and I didn't move quickly enough.


Explain to her about observing for changes in nipple coloration, perhaps which may come in slow sequence, or fairly quick. Blanching to white, for a short or a long time, and change to a bluish (cyanotic) color at some point (restored circulation consisting of blood depleted of large amount of oxygen by constriction), or directly to a brighter red (release of constriction of blood vessels now admitting oxygenated blood.) Some note two colors only, others note periods of all 3 colors, plus periods of normal circulation/color when there is no pain.

Absolutely emphasize keeping the nipples warm, protected from even the cooling that comes with evaporation after release of latch or pump.  Warm the pump flanges! Have a folded, warm,  wet (test water on the inside of her wrist to be sure it won't burn) washcloth ready to put over the nipple immediately after it is exposed to open air after latch or pumping, and protect from even cool (a.c.) room air through clothing with pads/bras/ outergarments! (I have heard tales from folks who work in a.c. computer rooms in businesses, observing the nipples of (non-pregnant, non BF) female workers evert and show up under clothing, so even a little cooling can definitely effect the nipples.)

If any of these changes seem to be occurring, call her doctor's office prepared with a link to the most recent article from Pediatrics about Reynauds, request an Rx for Nifedipine for 2 weeks, usually starting with 30 mg. of long-acting twice a day. If no improvement, or if situation returns after improving with Rx. don't hesitate to immediately investigate repeated courses and verify through Lawrence or Hale, but I have heard 60 mg. and even 90 mg. Rx's have been given.
Don't stop at one course if it doesn't solve the problem! That the first Rx doesn't quickly solve the problem kills hope in a hurry!


A colleague had such a situation last week of a mother who had thus far lasted for 4 months. The mom reported that some self breast-massage, and then an actual standard body massage seemed finally to relieve it completely during the 4th month. (We had looked up some information about a connection with what Edith Kernerman proposes to be called "Mammary Constriction syndrome.")


If you see any of these changes, consider having the client and/or her husband document them several times with a camera if possible to catch the various color cycles for possible future professional articles. I only got one good picture of the cyanotic phase.


I think this may well have been more common all along than we realize, but because more moms are initiating BF and there is often better follow-up,  better descriptions of pain are being reported.


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC     Dayton OH

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