Nipple vasospasm: That tingling isn’t thrush

Has your nipple looked waxy or dull white after feeding or pumping? That’s because the blood vessels have gone into spasm and are not letting blood through. Vasospasm occurs when there is exposure to cold, an abrupt temperature drop, vibration, or repetitive motion in the affected area. The arteries go into spasm and stop letting blood through. There is a disorder called Reynauds that make peoples experience this in their fingers and toes on a more routine basis. When it happens in the nipple it really HURTS. Some say it feels like fire or ice. Others describe it as a pinchy, slicing feeling, or pins and needles. The nipple often turns pale and become painful right after the baby unlatches. It often gets misdiagnosed as thrush but will not respond to medications. So if you’ve been on multiple rounds of medications for thrush and it’s not working, you may actually be having vasospasm.

It can simply be caused by a bad latch, but can have several other culprits. For people prone to vasospasm, the repetitive action of feeding or pumping in combination with the abrupt drop in temperature when baby unlatches or the pump stops is enough to trigger the spasm.

The two main ways to help: massage and heat.

🤲🏼Gently massaging, rubbing, or pinching the nipple helps. Immediately cover your nipples with your shirt/bra/nursing pad, then gently rub or massage them through the fabric.

🌞Heat is important because of science: evaporation is a cooling process. When liquid turns to gas, it uses heat energy from its surroundings to transition. When milk and saliva evaporate off your nipple, the skin and surface tissue cool rapidly, causing the vasospasm.

🌞To slow evaporation, place heat on your nipple as soon as baby unlatches. Use dry heat like a lavender pillow, microwaveable rice/barley/flax pack, hand warmer/Hot Hands (like you use in snowy climates for skiing), or a heating pad can help. Leave heat on for a few minutes until the pain subsides.
🌚Avoid anything wet on the nipple as this promotes evaporation.
🌝Wear wool nursing pads between feedings

Unfortunately, there isn’t a lot of good quality research about treating breastfeeding nipple vasospasm no. Much of what we know is taken from other vasospasm research, or applied from anecdotal evidence. You should always consult your primary health care provider before making any changes to your health, such as adding a supplement, taking medications, or making big lifestyle changes. At a basic level:
🌻Watch for a deep latch every time
🌻Have baby assessed for tongue tie
🌻Check your flange size. If you’re maxing our the suction on the pump, your flange is too big. When too much areola is drawn into the tunnel, the areola swells shut around the nipple and causes the spasm. Using too small a flange does the same: cuts off blood flow to the nipple tip.

Other tips to reducing vasospasm:
🌸Avoid nicotine and medications that cause vasoconstriction (such as pseudoephedrine, beta blockers).
🌸Limit or avoid caffeine
🌸Some research indicates hormonal birth control pills increase the risk of vasospasm.
🌸The main supplement that seems to help with vasospasm is vitamin B6. Dr Jack Newman suggests 100 mg of B6 twice day, as part of a B vitamin complex. If your B vitamin contains 50 mg of B6, you’d take two of them, twice a day. If it contains 25 mg of B6, you’d take four of them twice a day.
🌸Calcium plays an important role in blood vessel dilation. Magnesium helps in calcium regulation. Supplementing with cal/mag often helps with vasospasm.
🌸Being active helps prevent their vasospasm. An active lifestyle can keeps blood circulating through your body.
🌸The internet is full of conflicting opinions on if ibuprofen is a vasoconstrictor or vasodilator. Regardless, it sometimes turns up to treat/prevent vasospasm. If you have regular vasospasm, the risks of longterm ibuprofen use most likely outweigh the potential decrease in vasospasm. It may be OK for occasional vasospasm. Discuss regular ibuprofen use with a healthcare provider.
🌸For chronic, painful vasospasm that does not respond to breast-feeding help, some doctors may prescribe a short course of a blood medication called Nifedipine.

Cautions of the Haakaa and other similar silicone breast “pumps”

The Haakaa and similar manual pumps are extremely popular. I used one for the first few months after Peach was born. They typically suction on the opposite breast while feeding to collect “leaking” milk. It’s not an actual pump, but it does create a vacuum that removes milk from the breast. Like any product, it can be a wonderful tool or inadvertently cause problems.

⭐️Caution: milk collected in a tool like this tends to be “drip milk”, meaning high water content and low fat. It can be good to relieve engorgment or pull off milk if baby is sleeping longer, but you’ll want to mix it with other pumped milk to ensure a good fat content.
🌀Use hand compression while it collects or hand express after to help pull fat into that milk.

⭐️Caution: more so than breast shells or milk collectors that passively sit in the bra, the suction adds extra stimulation and can increase milk supply, to the point of an oversupply. The extra milk pulled off during feeding tells the body that baby is REALLY hungry and eating all the milk that is actually feeding the freezer. The body makes more and more milk. This can result in an overactive let down which causes baby to cough, choke, and pull off the breast while you spray milk in their face.

⭐️For some the focus shifts from what the baby is doing to what the other breast is/isn’t doing. Instead of enjoying baby, you’re obsessed with the silicone bobble dangling from your boob. And an active baby may kick it off and make a mess.

⭐️Those who don’t drip a lot it may wrongly believe there is something wrong with milk supply and have unnecessary concern. This is especially true if you were used to high yield in the first weeks after birth and once your supply regulates you only see drops collected. Many panic at this drop when that’s actually normal.
🌀Accounting for every drop may make you feel like you’re failing at feeding. Even if baby is getting plenty of milk and feeding fine.

⭐️For those with a true low supply, the Haakaa may be taking milk from the other breast that baby actually needs to grow. Sometimes baby needs that milk and not the freezer.

On the flip side, the Haakaa and other silicone pumps can be a wonderful tool. They can be a huge relief to reduce engorgment. Did you know you can suction two of them on while you’re in the shower to reduce engorgment and help keep milk moving? Or collect last minute milk before you leave for work? I’ve found they help pull out colostrum while baby is feeding better than an electric pump. they’re super handy for getting rid of a plugged duct or nipple blebs. For someone with a low milk supply, this tool could be the difference between supplementing your own milk vs formula. It can mean freedom from an electric pump while creating a stash for going back to work. Some see this as their way of giving back through milk donation. It is a fabulous tool to use for hand expression. It’s just the right shape and size for hand expressing milk when you don’t have an electric pump or don’t want to drag a pump with you. It’s easy for traveling, with no extra parts to lose or clean.

Understanding the tool is the most important thing. If you have an overactive let down and choking baby, consider reducing your Haakaa use. If you’re struggling with an oversupply, know that the Haakaa may be your problem. If you’re 4-6 months into your journey you may not collect as much as you used to when baby was 2 or 3 months old.

How do babies suck at the breast?

Breastfeeding babies tend to move through 3 sucking stages:

• Stimulation: A quick, light suck often done at the beginning of a feeding to stimulate a let down. The tongue cups the breast and baby’s lower jaw moves up and down while the tongue moves quickly. Breastfeeding hormones are released when nerves close to the nipple are triggered, and milk will usually begin to flow within 1-2 minutes. This may be mimicked by the “massage” or “stimulation” mode on your pump.

• Active feeding. Once the milk lets down (milk ejection reflex), baby should swallow every 1-3 sucks. This is active feeding. The lower jaw moves up and down rhythmically and drops just a little lower when the swallow actually happens. You might hear the swallow sound like a “puh” or “kuh”. Baby may take occasional breaks during active feeding to catch their breath. This is the “expression” or slower mode on the pump

• Flutter sucking. Towards the end of the feed, sucking slows down, jaw movements get less pronounced, there are fewer swallows, and baby may fall asleep or unlatch. Some call the fluttery sucking movements at the end of the feed “flutter sucking”. It’s a form of comfort nursing to help baby transition to sleep. Minimal milk is being transferred at this time and it’s ok to unlatch your baby is you are no longer hearing baby swallow.

Babies may alternate between these sucking phases several times during a single feeding. By changing the settings in your pump several times during a feeding session, you can get the pump to mimic how a baby would feel at the breast, triggering your body to let down and make more milk for the pump. If newborn baby is always using a stimualtion or flutter suck and you’re not hearing many swallows, work with an IBCLC to help figure out why and get baby feeding efficiently at the breast.

What bra should I buy for breastfeeding?

Pregnancy affects levels of estrogen and progesterone in your body. These hormones get the breasts ready for lactation and are responsible the breast changes you may experience. Estrogen stimulates growth of the breast duct cells and generates the secretion of prolactin, the milk making hormone. Prolactin stimulates breast enlargement and milk production. Progesterone supports the formation and growth of milk-producing cells within the glands of the breasts. In the 2nd trimester, estrogen levels continue to rise. Milk ducts continue to develop, making the breasts feel heavy or full. Some need to purchase a larger bra at this time as you can increase one cup size or several. A few days after birth when milk transitions from colostrum to mature milk, breasts can engorge and grow even more. For several weeks, breasts will feel full between feedings and soft after feeding. Eventually they will feel soft all the time and start to shrink back to pre-pregnancy size. Some breasts will stay large and some will shrink back significantly. Sometimes one can reduce in size and the other stay large.

I usually recommend not purchasing a bunch of bras while pregnant. You don’t know what size you’ll end up being and may waste money on expensive bras you won’t wear. Bralettes, nursing tanks with built in shelf bras, or soft wireless bras that have a lot of stretch can be helpful while your body is constantly changing. Once you’re several months into nursing, breasts may stabilize in size until you completely wean. Now it’s time to be re-measured for the support your girls deserve.

Breast milk storage

The composition and nutrients in your milk can be influenced by how you store and reheat your milk. Any containers that contact your milk should be clean and sterile. Avoid cross contamination with other foods when storing your milk in the fridge. It is acceptable to store breast milk for up to 4 days in the fridge (preferably the back, not the door, to prevent warming from the door opening). If you are going to freeze your milk try to freeze it within 24 hours of pumping it as the beneficial enzymes begin to change at approximately 25 hours. This doesn’t have to be a determining factor in the how quickly you freeze your refrigerated milk, but it’s worth it to store as soon as possible. If not used within 4 days, fresh breast milk should be transferred to the freezer in a clean, freezer-safe container and dated with the original pump time. It is acceptable to store breast milk in a freezer with an attached refrigerator for up to 6 months and in a deep freezer for up to 9-12 months, but the sooner it’s used the better. Nutrients in frozen breast milk are mostly preserved for 1 month, but after 3 months in the freezer, there is a noteworthy decline in concentrations of fats, calories and other macronutrients. Freezing kills some of the live antibodies found in your milk, so rather than freezing all of your pumped milk, feed as much fresh or refrigerated milk as possible.

• Breast milk stored in the refrigerator maintains most if it’s immune properties with break down starting after 25 hours.

• Heating breast milk at high temperatures (especially in the microwave—which is not recommended), can destroy the antibodies and other immune factors in your breast milk.

• Frozen breast milk loses some of its healthy immune factors, but not all.

The goal of breastfeeding

The goal is not to put gas in a tank to see how far it can go between top ups. It’s to teach a tiny human to listen to their body and it’s needs from an early age to help them grow and develop.

This is FEEDING. How you feed is different than how I feed. How your family feeds is unique and not how my family feeds. From what we eat, to how often we eat, to when we eat it’s such an individual process!! Some adults are grazers. They like to snack on small meals all day. They sip water throughout the day and always have a water bottle handy. Some babies are like this, too. Some adults are bingers. They eat really big meals less often. They only drink water in big glasses around meal times. Some babies are like this, too. And there’s everything in between. The goal is not to reach some magic number of ounces in a limited number of feedings because an internet blog said baby needed x number or ounces in 4 feedings a day. That can cause undo stress. The goal is to learn your unique baby’s feeding habits and help them foster those habits within your family context as they grow and develop into a bigger and bigger human.

Nipples have muscles

All mammals have nipples as they feed their live young milk from their bodies. Marsupials and eutherian mammals typically have an even number of nipples arranged in pairs on both sides of their bodies, from as few as two to as many as 19 pairs. Some 5,600-6,000 species of mammals feed their young milk, and thus have mammary glands, but not all mammals have breasts (or nipples!!). In humans, areola surrounds the nipple in a round shape and comes in varying sizes, on average 3 to 6 centimeters. It has sebaceous (oil) glands that make projections on its surface (those little bumps that form in pregnancy). Those little bumps secrete an oil that smells like amniotic fluid to help baby use smell to find the nipple to latch to. In the center of the areola is the nipple, again in a wide variety of sizes shapes and lengths, and can be 10 to 27 millimeters (mm) wide by 1 to 10 mm in height. Its skin is similar to the areola, but has no oil glands. It has 4 to 20 pores where milk can come out. The skin of the nipple rests on a thin layer of smooth muscle, called areolar muscle fibers which are distributed in two directions: radial and circular. The muscle of Sappey responsible for circular fibers and the muscle of Meyerholz, formed by the radial fibers. Contraction of these muscles is responsible for the erecting of the nipples during stimulation and breastfeeding as well as the ejection of milk from the breast.

Why do I need to transition my toddler off formula and a bottle at 12-18 months?

It is recommended that babies transition off bottles and formula at 1 year old. Why, then is it recommended to still continue breastfeeding and breast milk until 2+ years? There are several things at play: oral development and nutrition.

Breast and bottle feeding work completely different. As a baby breastfeeds, the human breast/nipple changes shape in baby’s mouth. Breastfeeding requires baby to coordinate their orofacial muscles to form a vacuum to extract milk from the breast. The back of the tongue firmly rests on the palate, which allows the tongue to shape the upper jaw, and naturally expand the palate (widening the upper jaw so the tongue fits in it perfectly). Once milk is released, the tip of the tongue pushes the breast against the front of the palate, stimulating the forward development of the front part of the upper jaw and midface. As the lower jaw moves back and forth, it stimulates forward growth of the lower jaw too. Forward growth of the jaws and face help in forming the airway. The firm nipple of a bottle does not change shape in baby’s mouth, and some bottles work on compression only where the vacuum does not need to be as strong. Cup feeding uses muscles more similarly to breastfeeding than a bottle. When we transition a baby to an open cup, we are promoting a more mature swallow and oral motor pattern. You can transition a baby to an open cup at 6 months, but should definitely try to transition off the bottle between 12-18 months for optimal facial and swallowing development.

Nutritionally human milk is constantly changing based on the age of your little one. It’s hormones, stem cells, and antibodies are tailored to meet the needs of a growing toddler. Human milk is phenomenal for development and immunity. Infant formulas are designed to meet the nutritional needs of a child on an exclusive milk diet prior to eating table food. They are designed to grow a baby from 0-12 months based on what we know those babies need nutritionally. Once a toddler moves to eating table foods, they can get all of their nutrients and calories from a balanced diet.