“At the end of the feeding, everything begins. The nipple becomes white and starts hurting. It hurts a lot and I don’t know what it is. Then, when I am in the shower or on outside if it is cold, the pain reappears. What can it be?

What this mother is describing is an ischemia of the nipple, a lack of blood supply that can cause a lot of pain. The ischemias occur for many diverse reasons and are not all treated in the same way.

There are mainly three causes for why a mother may suffer a transitory ischemia of the nipple, some related to pain and an incorrect latch and another related to previous issues with poor circulation.

Phenomenon or Raynaud Syndrome

When we talk about Raynaud Syndrome, we refer to a condition that occurs in cold temperatures or strong emotions that cause vascular spasms. The blood vessels are temporarily stretched and blood flow is blocked in the extremities: the fingers and toes, ears, nose and also the nipples.   

This reaction to the cold or stress is stronger in people that suffer from Raynaud Syndrome. The blood vessels stretch more and faster than usual. This is known as an “episode”.

During an episode, the fingers and toes change color. They can go from white to blue then to red. They can also feel cold and numb due to the lack of circulation. Once the episode is over and the blood flow returns to normal, there can be a sharp pain, tingling in the nipples. In about 15 minutes an episode is over and the pain disappears. 

Normally, when a breastfeeding mother suffers from an episode, it can occur in the nipples. The nipples after a feeding change color and can hurt intensely.  In these cases, the treatment with a vasodilator medication is the most effective meanwhile drinking something hot while placing heat over the nipple and areola after breastfeeding. 

Ischemia caused by fear

When a mother is afraid to breastfeed because they find it painful, they have cracks or have had a negative experience; they may secrete large amounts of catecholamine (the fear hormone) that can cause circulatory disruption. This may then cause ischemia of the nipples.   

In these cases, the cause of the pain or fear must be resolved, accompany and help the mother to relax and help her avoid an episode of ischemia by doing some of the following:

  • Talk with her while she breastfeeds
  • Listen to music she likes while breastfeeding
  • Drink something hot and ensure she is comfortable
  • Massage the shoulder blades while she is breastfeeding

As less pain and tension are felt during breastfeeding, the episodes of ischemia will resolve themselves. 

Ischemia due to compression of the nipple

When the baby breastfeeds, the mother’s nipple is elongated in their mouth and settles in between the baby’s hard and soft palates, protected by the baby’s tongue and gums.   

But if the baby is nursing in a poor position or has a bad latch, the nipple suffers compressions or trauma that stop blood flow. When the nipple leaves the baby’s mouth, it looks deformed, similar to the tip of a lipstick, and causes the mother a lot of pain and the nipple may look white or blue.

Correcting the poor position and/or latch is vital to avoid that from happening. Until then, applying heat to the area of the nipple and areola will help.

That heat can be applied with the hand, holding and squeezing the breast towards the ribs. Also hot compresses or heating pads can be used.

In any case, it is recommended to reach out to a breastfeeding support group to review the baby’s latch and position while nursing.


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