For our European Lactnetters:

In searching for articles and other information on Raynaud's syndrome of the nipple, I came across this reference:


Ned Tijdschr Geneeskd. 2009;153:B343.
[Diagnostic image. A breastfeeding woman with a painful, blue nipple].
[Article in Dutch]
Velstra B, Bijlsma TS.
SourceSpaarne Ziekenhuis, afd. Heelkunde, Hoofddorp, The Netherlands. [log in to unmask]

"Abstract
A 32-year-old breastfeeding woman presented with a painful, blue nipple due to Raynaud's syndrome."


I am wondering whether this is a close-up color photograph and has any further information about the cause and treatment in this woman's case. When I saw the words  'Diagnostic Image' my first thought was that some radiologic or ultrasound picture was taken during (and maybe before of after) the vasospasm. 


I am curious to get a professional opinion about whether the article has anything to contribute to the understanding of my colleagues and me, and therefore whether it's worth seeking someone who would kindly translate it and send a copy of the picture. In particular, it might be valuable in continuing education. 


Permission to post: A local first-time mother had some wrong expectations from "old wives tales" which she had internalized, ("Oh, yes, it's going to hurt some at the beginning"). This was despite going to LLL meetings with S-I-L who had a baby with TT problems several months earlier, and who therefore promptly loaned her my copies 
of WABF and Cathy Watson Genna's book. All this is also despite having a grandmother-in-law (moi;-) who 
wanted to be supportive but not appear to be "too nosy" or "too pushy", since there was no visible damage to the nipple and she only "confessed" to pain after much questioning. Therefore, this vasospasm, plus a TT and lip-tie 
were not recognized until the baby was 3 weeks old. 


TT and liptie were released at 4 weeks. I am still wondering whether the TT might have been incompletely clipped. But the dentist (a good friend of both me and the LLLL) is not willing to recheck it till all the CST options have been exercised. Baby is now 7 weeks old. Mom has had one course of long-acting nifedipine(30 mg.) but it didn't seem to do much but give her obviously rosy cheeks, and she felt her 6 week check-up was rushed and she didn't assert herself for another Rx. She has been advised to increase her B vitamins, especially B6, but I have not checked personally to see what her actual dose of B6 is daily.  My gut feeling is that other concerns are taking precedence.


Various local referral sources for CST either refused to take her insurance, despite cash being offered instead, and openings have been several weeks behind for other practitioners. Baby has had one supposed "cranio-sacral treatment" with a bodywork therapist /infant massage practitioner. It didn't seem very impressive, though it was not much different from successful treatments I have observed in the past, done by an osteopath. There was not only no discernible change in the feeling of the latch, but mom in fact had the impression that baby was actually biting down a little bit more afterward. 


I am not too expert in assessing suck function, (due to failing to try it on every efficient suckling baby I see to gain more experience). But there still seems to me to be some gum compression, and  baby's tongue motion seems s/w uncoordinated to me. I have encouraged an even more upright position for feeding the bottle, but old habits die hard. 
So even when I watch great-granddaughter dear being given a bottle, something seems a little awry with her swallowing. But there is a limit past which I feel I dare not go lest it be felt as criticism.


Many suggestions have been given, and laid back nursing in particular was encouraged. But due to her strong feelings of modesty, living situation with relatives in a 2 story dwelling, with the recurrent decisions of whether to take baby upstairs or stay downstairs to nurse and/or pump with a Lactina upstairs and an Avent downstairs, general baby care, going up and down steps and desire in the evening to protect her modesty around a very sensitive F-I-L who makes it his business to give her her space, (my son, see WABF vignette preceding chapter 7). At least in the daytime, she mostly prefers to sit crosslegged on the couch in front of the TV to nurse. She seems resistant to suggestions about pillows or positions other than cradle hold. 


Latch has been thoroughly explained and observed and supervised by me and by a friend IBCLC/LLLL. Printed sheets have been provided, yet held to a limit, because that doesn't seem to be her best learning mode what with sleep patterns effected by the baby and daddy's 2nd shift hours and gradual resumption of social life, errands, doctor's visits, etc. They are preparig to move to their own apartment in 2 weeks and she is feeling that it's time to include more than baby care and feeding and pumping in her life.


Mom has now discontinued direct breastfeeding because she feels she has "given it her all" and "nothing seems to help." Pumping does not hurt. Just for observations' sake, I asked her to do RPS to see if it would produce an MER. (In my experience thus far, RPS always does produce an MER within 90 seconds or less, without fail. But I don't want to ask her to try it more than the one time recently that she reported doing RPS starting very gently. She said it DID in fact hurt her. That is very hard for me to figure out, because IME when RPS is done for other mothers, primarily in the early weeks to displace edema, any discomfort has always been easily avoided by using less pressure for a longer time period. Even though RPS is not touching the nipple itself, obviously it is stimulating the nerves right under the areolar skin that are on their way to the underside of the nipple to enter the center of the nipple. I am curious to search further about the microanatomy of the nerves around the blood vessels in the nippleareolar complex.


I have frequently made sure she knows how impressive it has been to watch her and her efforts, and reassure her what a good job of first time parenting they have both been doing. I also make sure we talk about other things like cute baby clothes, family happenings, etc. I have felt it important not to seem pushy or intrusive or chance causing any extended family (S-I-L) friction (because the other great-granddaughter in the family is still EBF at 6 1/2 months with no solids yet)! 


Her supply is down quite a bit due to "relief" when she gave herself permission to stop direct breastfeeding, and not realizing (despite frequent repetition and encouragement to pump for shorter periods more often) that the frequency of milk removal, and not waiting for the feeling of fullness, has a great deal to do with the continued production of milk. She is down to debating whether to wean completely, or to continue partial pumping, feed EBM and supplement with formula. 


There is another craniosacral consult next week, this time with a chiropractor, and she has asked me to go with her. I have taken the Health-e-learning course "Mammary Constriction Syndrome" by Edith Kernerman, and hope for a chance to discuss that and the possible value of a session or two on mom herself with the chiropractor. Mom seems to feel resistant to that idea "because none of her bones or joints hurt."   


Feel free to chime in with any other thoughts and suggestions.


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

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