Vasospasm: pins and needles in the nipple

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.

Nipple shield weaning

Did you use a nipple shield to help your baby latch? Want to transition baby off the shield? First, weaning from the shield is your choice. If you like it and it’s comfortable for you, don’t feel pressured to get rid of it before you and your baby are ready. There are risks associated with shield use, like the potential for decreased milk supply. But if that’s the only way your baby will latch right now, give yourselves time and grace to keep trying as baby gets older and more proficient at the breast. As always, if you’re really struggling to get off the shield, find a knowledgeable lactation consultant to help you with the process to make sure something else isn’t going on with baby’s latch.

💡You can always start with the shield on and take it off after your first let down once baby is not as hungry or use it on the first side and offer the second side without it

💡Start by trying without the shield once a day during daylight hours when baby is happy and not too hungry. Catching baby with early hunger cues is imperative. If they’re crying and really hungry, try a different time

💡Start in skin to skin. Taking a bath together can help. Try to be as relaxed as possible

💡Try to erect and evert your nipple. Use reverse pressure softening (RPS, see highlight reel), a pump or stimulate your nipples with your hands before attempting to latch

💡Help baby latch with laid back nursing, supporting the breast in a “C” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible. A baby that can’t feel the breast can’t latch to the breast.

💡Hand express to get your milk flowing so baby gets instant satisfaction and reduce the work

💡Relax and be patient. Babies can feel your energy. The more you can see it as fun practice, the less pressure you’ll put on yourself and your baby

💡Try a nipple shield weaning system like this one from Back to Mom (24mm) or Lacteck (small/20mm).

Slacker boob

Did you know? Around 70% of women produce more milk in the right breast. Which means 30% make more in the left. It is VERY common for one side to produce more than the other. Some times double on one side. We don’t know why. This is not a reason to neglect one side. You want to make sure you rotate which breast you offer first. Babies may prefer one side over the other for various reasons:

👶🏽They like to lay with their head in a certain direction or their body is uncomfortable in the opposite position

👶🏿They prefer the flow (one side may flow faster or slower than the other)

👶🏼They may prefer the flavor (YES!! Milk can taste different form each breast during the same feeding!!)

If you want to help balance out a slacker boob:

🔆Offer the slacker first more often. 

🔆End on the slacker can also help, especially if baby just wants to use you like a pacifier. 

🔆Pump the slacker side during or after feedings can also help stimulate more milk production

🔆Make sure you have the correct sized pump flange on the slacker side. Our nipples can often be different sizes and using the wrong sized flange can drop supply on that side

🔆Hand expression on that side at random times of the day even for a few minutes will jump start increased production. 

🔆If it’s positional from your baby (they only want to lay cross cradle to the right and not the left, experiment with other positions like football or side lying to help baby compensate for their body. If your baby prefers one side of the other from a positional perspective, consider taking your baby for some infant bodywork like chiropractic or craniosacral therapy.

What’s up with my baby biting, gumming, chomping, hitting, pulling and pinching the nipple/breast while breastfeeding?

Babies are masters at breastfeeding. They will exhibit all kinds of behaviors at the breast that will make you question if you have any milk and wonder what’s wrong with the baby. Most babies discover they have power and control over the breast and that different behaviors get different things. Biting, tugging, gumming, pulling, patting, chomping, shaking the nipple and breast are normal infant behaviors. Repeatedly latching on and off can also be normal when it doesn’t happen all the time. They happen during growth spurts, cluster feeding and teething. And may increase when baby discovers they can get a reaction from you for them. These behaviors increase or decrease the flow rate of milk and help stimulate supply and let down during growth spurts and teething.

What can you do? Stay calm. Most likely it’s normal and will change with time. Lots of skin to skin time between feedings can help keep baby calm and will naturally increase your supply during growth spurts. Using breast compressions while feeding can help increase flow and help trigger let downs. If baby is teething, give plenty of opportunity to chew and bite on appropriate toys and food items outside of nursing times. If baby is biting to slow flow, try a laid back position and make sure you’re not promoting an oversupply from over use of the Haakaa or pumping at sporadic times. Continue to watch for wet and dirty diapers and know that usually these behaviors are normal and don’t last.

If baby is having these behaviors all the time and isn’t making the amount of wet and dirty diapers you would expect, schedule a lactation consultation immediately.

Low Milk Supply

There are people that will struggle to or never make a full milk supply. From 1 month to 1 year, exclusively breastfed babies average 25oz of breast milk per day. True low supply means making less than this when the breasts are stimulated at least 8 times in 24 hours. Chronic low milk supply is linked to either a greater health concern or something out of your control which you cannot change or fix with cookies, teas or even medications and pumping. 

🗝Low milk supply that can be increased with time and support:

  • 💡Taking certain prescription medications with a side effect of dropping milk (Sudafed, Benadryl, antibiotics)
  • 💡Baby not feeding efficiently from lack of oral motor skill or tongue tie
  • 💡Taking certain prescription medications with a side effect of dropping milk (Sudafed, Benadryl, antibiotics)
  • 💡Not feeding or pumping enough, especially over night
  • 💡Scheduled feedings or over use of a pacifier
  • 💡Birth. Many medications designed to help you labor and deliver actually inhibit baby from latching and feeding effectively for hours to days after birth. Hemorrhage or birth trauma can also cause low supply in the beginning
  • 💡Supplementing, especially in the two weeks after birth

🗝Reasons for chronic low milk supply that may NOT increase even with maximal support:

  • 💡Breast or nipple surgery, augmentation, reduction, trauma
  • 💡Insufficient glandular tissue (IGT). Breasts never developed during puberty and look tubular or widely spaced. Signs of IGT include breasts did not grow in puberty, or increase in size during pregnancy. No engorgement in the week after birth
  • 💡Uncontrolled or undiagnosed thyroid disorder
  • 💡Uncontrolled diabetes
  • 💡Hormone or endocrine disorders, including severe PCOS
  • 💡Hormonal birth control placed/used too soon after delivery
  • 💡Nipple piercing that scars shut instead of staying open

There is a mistaken belief that prescription galactagogues, teas, or herbs can cure ANY chronic low milk supply. Before self-prescribing or taking Domperidone, Reglan, fenugreek, or any other lactation supplement, consider having your serum prolactin levels tested and a full evaluation by a skilled lactation consultant. Continue to follow @lalactation in Instagram or see my videos on YouTube for strategies of breastfeeding with chronic low milk supply.

Do I need to give my breastfeeding toddler cow’s milk or switch to cow’s milk when they turn one?

If you’re still breastfeeding into toddlerhood, no. The World Health Organization recommends breastfeeding until 2 years old. After 2, you can wean to water and table foods or to any kind of milk per your family’s choice. If you’ve decided to wean between 1-2 years, yes and no. Cow’s milk provides a convenient source of a lot of nutrients, including calcium, protein, potassium and vitamin D that are important for building bone and brain development. But if your toddler won’t drink it, has an allergy or intolerance, or your family follows a vegan lifestyle, a well-planned diet can provide these nutrients too. According to the USDA, children ages 2-3 need two servings of dairy per day (milk, yogurt, cheese, or calcium-fortified non-dairy beverage), children age 4-8 need two and a half, and kids 9+ need three. Can you use a milk alternative such as soy, almond or oat? Yes, but they’re not one-for-one swaps. For instance, almond and rice milk have only 1 gram of protein per serving, compared to 8 grams in cow’s.

When choosing a non-dairy milk, make sure it’s fortified with calcium and vitamin D. Homemade versions won’t have this fortification. Shake milk substitutes well before serving, the calcium settles on the bottom. Look for varieties labeled “unsweetened” as many milk alternatives contain lots of added sugar! If you’re choosing not to offer your toddler cow’s milk, make sure they’re getting a wide variety of fruits, vegetables, beans, grains and protein to get them the vitamins, minerals, fats and protein they need for growth. When in doubt, discuss nutrition with a pediatric dietician

Milk is a very convenient source of calcium, but not essential. It is recommended that a 1-3 year old child have 700mg (2-3 servings) of calcium per day. Eating a diet rich in beans, tofu, spinach, kale, broccoli, kiwi, figs, brown rice, oatmeal and certain fish such as salmon can give your child just as much calcium as drinking milk. No one ever “has” to drink milk. Human milk contains less calcium than cow’s milk, but the calcium in human milk has over twice the bioavailability of the calcium in cow’s milk. Increasing your calcium intake does not increase the calcium in your milk – your milk always has the right amount of calcium for your baby. Getting adequate calcium in your diet is recommended because if you’re not getting enough, your body will take calcium from your bones to provide to your baby, making you more prone to bone fractures. However as soon as you wean, your body regains bone mass and your bones will actually be stronger than before. 

Human milk averages 5.9-10.1 mg/oz calcium. 67% of this calcium is absorbed by the body. 

Whole milk contains 36.4 mg/oz calcium. 25-30% of cow’s milk is absorbed by the body.

Infant formulas contain 15.6 mg/oz calcium; toddler formulas contain 24-27 mg/oz calcium. Extra calcium is added to infant formulas because of the lower bioavailability of the calcium from formulas as compared to human milk (they aim for baby to absorb the same amount of calcium as would be absorbed from breastmilk).

Toddler formulas have come on the market in recent years touting that they’re great nutrition for the 12+ month group. In reality, it’s all clever marketing. If you supplement baby with formula, there’s no need to switch to a toddler formula at 12+ months. In the second year of life, growth slows. Your toddler doesn’t gain weight or length as quickly as they did right after birth.

If you’re still breastfeeding, your milk adjusts to this based on how toddler nurses; how the breast is emptied tells your body what kind of milk to make. When breast milk is the primary diet, like in the first 6 months, your milk is made for growth and immunity. When your toddler is taking lots of table foods and nursing, your milk is made for development and immunity.

At 1 you don’t need a fancy toddler formula or cow’s milk. If you’re exclusively formula feeding, switching to whole cow’s milk is fine. While cow’s milk is a convenient source of calcium, protein, fats, and vitamin D, there’s no need to switch to that, either. As long as your child takes a wide variety in their diet and has a good source of calcium (yogurt, cheese, dark leafy greens like spinach, fortified cereals or juice, soybeans, etc), just choose what you offer your child wisely. If you’re still breastfeeding, know your child is getting good nutrition from your milk suited to their growing needs. If you’re concerned about your toddlers diet or they don’t eat a wide variety, consult your pediatrician or a pediatric nutritionist for advice and help.

Sudden breast milk supply drop

Breastfeeding going well and all of a sudden you feel like your milk is gone? Go pee on a stick. A drastic drop in milk supply when breastfeeding has been going well can be a sign of pregnancy, even if your period hasn’t come back yet. Research shows it is safe to continue breastfeeding while pregnant and does not increase the risk of miscarriage. So there no reason to wean unless you’re a high risk pregnancy (if you are told by your health care provider that you can’t have sex, you shouldn’t breastfeed. If it’s safe to have sex, it’s safe to continue breastfeeding.) If so you are not alone—far from it.

Key points to remember when breastfeeding and pregnant:

• Milk will shift from mature milk back to colostrum around 14-20 weeks of your pregnancy to prepare for the birth. Babies under 6 months may not get enough milk from the breast alone while toddler eating solids may do fine. Monitor weight gain for babies under 1 year

• Colostrum is saltier than mature milk. Some nurslings are fine with the taste shift and others may self wean

• Aim for a total of about 600 to 800 extra calories — 300 for the fetus and 300 to 500 for milk production.

• Nipples may become extremely tender during pregnancy, especially at the beginning, due to hormone changes

• Breastfeeding aversion while pregnant is normal (feelings of stress or anxiety or wanting to stop breastfeeding)

• If your toddler always nurses to sleep, you may want to find other sleep routines to make putting older one to sleep easier when you have the new baby.

• As your belly grows, you may need to experiment with new breastfeeding positions.

How to use my Spectra Breast Pump: Maximizing settings, suction and cycle levels

Different stages of pumping require different pump settings. The wonderful thing about the Spectra pumps is their cycle variability.

Check out my video on YouTube for how to set and use the Spectra pump.

Colostrum is thick and sticky. Pumps are great for stimulating milk but they’re not the best at removing it from the breast and it can be very frustrating to pump and not see anything filling the bottles. Don’t be discouraged. Stimulation is super important in the early days after birth and the work will pay off. hand expression is the key to emptying colostrum when pumping. The pump will do a good job to stimulate your hormones to make milk and your hands will help empty it.

If you’re engorged or have an oversupply, you may need to pump to relieve the pressure in your breasts. Using the pump wisely can reduce your engorgment while not causing you to make too much milk and perpetuate your problem.

You can also pump to increase milk supply by pumping for an extra 5 minutes after milk stops flowing to signal to your body that it needs to produce more milk. If you’re breastfeeding and pumping after, aim for a 10-15 minute pump. If you’re exclusively pumping, shoot for a 30 minute pump.

Whether you’re pumping at work to maintain supply or trying to increase your supply, using the settings on the Spectra can help you reach your goals. Have you played around with your settings? What works for one person may not work for another. Try alternating back and forth between the settings and play around with the suction and cycle levels. If you need to have the suction cranked to the top, you’re most likely using too large of a flange.

Everyone responds differently to pumps. Play around the settings and cycles. What works for one person may not work for every person. Make sure your suction level is comfortable and you’re using the correct sized flange. If you have to crank the suction all the way up, you’re pumping with a flange that’s too large. Pumping should be comfortable. You should not have pain or damage from pumping. If you have any pain or damage, try a different range size, shape or cushion and try lowering the suction. If you’ve been pumping on a particular set of settings and start to notice a decrease in supply or suction, change the soft pieces of the pump like the duckbill or membranes and the tubing.

Breastfeeding weaning

There is no right or wrong age, it is completely up to you. Breast milk does not lose nutritional value (ever), so you get to decide how long you want to breastfeed. You also get to decide when you stop and all reasons for wanting to stop are valid. It is OK to wean for your emotional or mental well being and you do not have to justify your choices of how you feed your baby to anyone.

The age of your baby and how quickly you want to wean can play a role in how you wean.

Be prepared that some may experience mood changes and feelings of depression when weaning as your oxytocin and other hormones are dropping to stop milk production. If you need a specific plan to help you quickly wean, schedule a consultation with me to develop a plan that works for you.

Tips for gentle weaning:

✏️Start when your baby has already naturally started to wean, ex. only a quick snack before nap or waking up at 2am to pacify to sleep

✏️If transitioning from breast milk to formula, you can add formula to your breast milk bottles in slowly increasing amounts to make the transition easier on baby’s tummy (ex mix 2oz of breast milk with 1oz of prepared formula for several days, then mix 1.5oz each if breast milk and formula for a few days, then 2oz of formula with 1oz of breast milk)

✏️Don’t offer, don’t refuse

✏️Wear clothing that makes accessing the breast/chest more difficult.

✏️Distract child with favorite activities or offer alternatives like a favorite snack

✏️Change your routine

✏️Postpone: “After we play”

✏️Shortening the length of feeding or space feedings out

✏️Talk to your toddler about weaning. Older children (2 years and up) can be part of the process by talking to them about what is happening.

✏️Alternate between offering bottles and the breast

✏️Be consistent – this is a hard one but it can be even more confusing to your baby if you allow them to nurse one time and not the next.

✏️Lots of cuddles. Your breast/chest is more than just food but also a great source of comfort. Showing them you are still a source of that comfort despite not nursing is incredibly important

Ways to quickly wean:

⚓️Empty the breast only to comfort, trying not to stimulate the breast to make more milk

⚓️Breast gymnastics/“milk shakes” often to keep milk from sitting in the breast and clogging the ducts

⚓️Epsom salt soaks of the entire breast for soothing

⚓️Drinking 2-4 cups of sage or peppermint tea per day

⚓️Green cabbage leaves in the bra until they are soggy and then replacing the leaves

⚓️Cabocream (an alternative to the cabbage leaves

⚓️Cold packs on the breasts after feeding or pumping to reduce swelling

⚓️Starting on a hormone based birth control, especially The Pill (estrogen based) will drop supply

⚓️A last resort would be to take an antihistamine like Benadryl or Claritin-D as these are also notorious for dropping milk supply. This should be done with caution and under the direction of your primary care physician

True SELF-weaning by the baby before a year old is very uncommon. In fact, it is unusual for a baby to wean before 18-24 months unless something else going on (work, inefficient feeding, tongue tie, etc). A self weaning child is typically well over a year old (more commonly over 2 years) and getting most nutrition from solids, drinking well from a cup, and has been cutting back on nursing gradually.

Reasons a baby under a year may be perceived to self wean:

🔑Solids were introduced too soon

🔑Scheduled feedings/sleep training/pacifier use (all decrease time a baby would naturally want to be at the breast/chest)

🔑Lactating parent loses a lot of weight fast which can decrease milk supply

🔑Medications or hormonal birth control which will decrease supply

🔑Lactating parent is pregnant

🔑Baby taking lots of solids before one (human milk should be the primary nutrition source through one year of age)

Empty breasts make milk faster than full breasts

FULL/EMPTY BREASTS

While it seems counterintuitive, the emptier your breasts are, the faster they make milk. A full bread has no place to store or hold the milk, so milk production slows to prevent plugged ducts and breast discomfort. Cluster feeding on an emptier breast actually tells the body to make more milk at a faster rate!! Some incorrectly assume you have to wait for the breast to “fill up” before feeding your baby or for pumping while at work. This will eventually lead to less milk, as a fuller breast tells your body baby isn’t eating very often and to slow milk production. The more frequent you empty the breast, the higher the fat content in that milk and the faster milk is made. The longer often you wait and the fuller the breast, the higher the water content in that milk and the slower your body will make milk overall.

W atch the baby, not the clock. Breasts may feel really full between feedings in the first few weeks after birth, but they’re also not supposed to stay engorged. There will come a time when they stay soft and don’t feel full between feedings or pumping, so waiting for that as a cue to feed will also sabotage your supply. Don’t be alarmed when your breasts no longer feel full between feeding. You’re entering a new stage where you’ll still make plenty of milk for your baby as long as you’re routinely emptying that milk. Trust your body. Trust your baby.