After reading Rhoda's excellent post on blanching, I realized how
inadequate mine had been.   I agree entirely with Rhoda that this is
a type of vasospasm. ( If any of you have Raynaud's phenomenon, you will
notice that your finger(s) or toe(s) turn dead white then when the blood
flow resumes, they get very pink and warm.  When I talked about
positioning and latch I should have been more specific .  These babies
really do seem to clench their jaws and clamp down hard on
the nipple.  It also seems to be a conditioned response.  By that I
mean that it begins after a period of several weeks of nursing, and
even when the clamping has ceased. it may take several week for
the mother to stop experiencing this vasospasm.  The medical director
where I work has on two occasions prescribed nitroglycerin paste for
the mother to rub into her nipples when she has the problem, however
he prefers not to do this and to use other means such as warmth
and analgesics if needed.  ( The idea for the nitro paste came
from Dr. White at an LLLI Physician's Seminar many years ago.) Nitro
paste can cause severe headaches if the mother uses more than the tiniest
amount.  One other solution which I have tried and has occasionally
worked, is to use a primed  SNS with a small amount of EBM or
ABM , just enough to keep the baby from clamping until the MER
occurs.   However, while it may improve immediately, it doesn't seem to
go away immediately, but recedes over a period of several weeks, IF the
mother can persist that long,  And yes Rhoda, I too have seen some
mothers who just cannot continue.  I would like to know what caused it in
the first place,
since I have only seen one of these mothers early on--- the rest arrived
somewhere after two weeks post partum.

Eileen Shea, BSc, IBCLC