Q&A: My nipples are sore and white, should I stop breastfeeding?
My baby is 2 months old, and I would like to breastfeed for at least another month, but find that after every feed my nipples are sore and are white. My baby feeds with my whole nipple in his mouth, and at first it was only the one nipple that discoloured, but now it is both. What is the reason for this, and do you think I should stop breastfeeding?

Lisanne du Plessis replies:

You could be experiencing Raynaud’s phenomenon, which is an exaggeration of vasomotor responses to cold & stress triggers. In 1862 Maurice Raunaud described the “shrinking or clumping” behaviour of blood vessels in appendages like the fingers and toes after being exposed to the cold or after experiencing emotional turmoil, and this has become known as Raynaud’s syndrom.

The nipples of breastfeeding mothers can also be affected in this way. This is known as the Raynaud’s phenomenon. Many breastfeeding specialists report on this preventable cause of painful breastfeeding. Raynauds phenomenon, which affects approximately 20% of women during their reproductive years, is considered to be a common condition these days.

The breast pain associated with Raynaud’s phenomenon is intense and is often confused with Candida albicans infection. It often happens that mothers suffering from Raynaud’s phenomenon are wrongly diagnosed and treated with topical or antifungal medication meant for the C albicans infection.

To correctly diagnose the Raynaud’s phenomenon, there must be other symptoms present as well – the symptoms occur when it is cold, the symptoms appear even before pregnancy or when the mother is not breastfeeding. It also goes hand in hand with several colour changes – white to blue, and then after the blood flow normalises, there could be a reddish sheen before going back to normal.

Treatment of this condition includes ensuring that exposure to cold be avoided or limited, avoidance of medication (including certain over-the-counter diet medicines and beta-blockers used for the treatment of high blood pressure and other heart conditions) or nicotine that can cause this blood vessel action.

Alternative medication that might help includes herbal treatments, aerobic exercise, and dietary supplements. Most mothers who experience painful breastfeeding need immediate relief to enable them to go on breastfeeding.

In a scientific article in Paediatrics Journal by Jane Anderson ‘et al’ from the Department of Paediatrics of the University of California, it was reported that Nifedipine, a calcium channel blocker, has been used as a treatment for Raynauds phenomenon. It causes the blood vessels to dilate and increases the blood flow to the extremities. Very little of this medication ends up in the breastmilk, and therefore is considered to be safe for use by breastfeeding mothers.

Anderson ‘et al’, recommends that healthcare workers, including paediatricians, nurses and lactation consultants, should be aware of this treatable cause of painful breastfeeding. They also advise that patients are questioned about this, as most mothers might not discuss the problem with their health care workers.

Solving the problem quickly will ensure that mothers can carry on breastfeeding without having to experience unnecessary anti-fungal treatment.

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