Howdy!  

Moms permission to post....a situation that we are working our way through, and need some additional perspective please.  

First-time mother of a 10 week old baby who is feeding on demand.  Consult in week 1 resoved basic latch problems.  In week 3, new nipple pains quickly identified as vasospasms and resolved with cloth bra pads, warm packs as needed, etc.  (Wool pads were strongly recommended.)  Symptoms intensify every time external weather turns cold (for a few days - down here deep in the heart of Texas) and resolve on warm days.  Pain always described as a burning on surface of nipple, beginning in later half of feeding. Vasospasm almost always visible. Pain usually persists for several minutes.  No referral pain into body of the breast. No nipple distortions. No nipple trauma or damage visible.  No output problems nor weight gain issues.  Mom has a Rx of nifidepine in her home but has refused to take it "because I do not like medicine." 

In Week 9 (incidentally, a cold, cold weather week), mom reports all symptoms intensified to point that when pains began at every feeding, she would tense up so severly in her shoulders that a headache would start.  The headache would persist for about one hour every time and resolve without medication.  (She has never switched to wool bra pads and admits she has not been faithful to apply warm packs because she has not always seen white areas of vasospams when hurting so, she did not think that heat would help at those times.)  In desperation, she tore open a nipple shield that she had received at her baby shower and began to use it six days ago.  Baby sucking well, swallowing milk, acting content, wetting 4 or many more diapers per day as before, but has suddenly begun to sleep for 6, 7 or 8 hours each night.  Mom has been awaking with "full breasts" but not waking baby since prior experience was that baby always awakened mom so, mom thought baby must not be hungry.  (She is planning to attempt feeding tonight if/when this should reoccur.  She confirms that she is not sleep training or otherwise trying to schedule her baby.)  Mom reports all pain, thus tension, and thus headaches have ceased with use of shield but she does not want to have to keep feeding her baby using a shield.  

Anybody ever come across this particular problem before?  I am wondering if the friction of the tongue on her nipple might be triggering the vasospasm...?  Which is why the shield has helped?  And, the headache??? Purely related to the tension versus hormonal?  Any other non-Rx options to control symptoms (other than sending her to the tropics for the rest of the winter)?  

I would appreciate your thoughts on this one. Thank you!

Cheers,
Shannon Sanford, RN, IBCLC
www.BasicsforBreastfeeding.com

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