”My nipple turns white after the baby comes off the breast”
The pain associated with this blanching of the nipple is frequently described by
mothers as “burning”, but generally begins only after the feeding is over. It
may last several minutes or more, after which the nipple returns to its normal
colour, but
then a new pain develops which is usually described by mothers as “throbbing”.
The throbbing part of the pain may last for seconds or minutes and may even blanch again.
The cause would seem to be a spasm of the blood vessels in the nipple (when the nipple is
white), followed by relaxation of these blood vessels (when the nipple returns to its
normal colour). Sometimes this pain continues even after the nipple pain during the
feeding no longer is a problem, so that the mother has pain only after the feeding, but
not during it. What can be done?
Pay careful attention to getting the baby to latch onto the breast properly. This type
of pain is almost always associated with, and probably caused by whatever is causing your
pain during the feeding. The best treatment is the treatment of the other causes of nipple
pain.
Heat (hot washcloth, hot water bottle, hair dryer) applied to the nipple immediately
after nursing may prevent or decrease the reaction. Dry heat is usually better than wet
heat, because wet heat may cause further damage to the nipples.
On occasion, we have had to use a medicated paste (nitroglycerine) or an oral medication
(nifedipine) to prevent this type of reaction.
General Measures
Nipples can be warmed for short periods of time after each feeding, using a hair
dryer on low setting.
Nipples should be exposed to air as much as possible.
When it is not possible to expose nipples to air, plastic dome-shaped breast shells (not
nipple shields) can be worn to protect your nipples from rubbing by your clothing. Nursing
pads keep moisture against the nipple and may cause damage that way. They also tend to
stick to damaged nipples. If you leak a lot you can wear the pad over the breast shell.
Ointments can sometimes be helpful. If you do use an ointment, use just a very small
amount after nursing and do not wash it off.
Do not wash your nipples frequently. Daily bathing is more than enough.
If your baby is gaining weight well, there is no good reason the baby must be fed
on both breasts at each feeding. It may save you pain, and speed healing if you feed your
baby on only one breast each feed. It will help to compress the breast, once the baby is no longer swallowing on his own in order to continue
his getting milk. You may be able to manage this some feedings, but not others. In very
difficult situations, a lactation aid can be used to
supplement (preferably expressed milk), so that the baby will finish the feeding on
the first side.
If you are unable to put the baby to the breast because of pain, in spite of trying all
the above measures, it may still be possible to continue breastfeeding after a temporary
(3-5 days) cessation to allow the nipples to heal. During this time, it would be better
that the baby not be fed with a rubber nipple. Of course it is also best for you
and the baby if the baby is fed your expressed milk. Use the technique called “finger
feeding” or cup feeding.
Nipples shields are not recommended for sore nipples, because, although they may
help temporarily, they usually do not. They may also cut down the milk supply
dramatically, and the baby may become fussy and not gain weight well. Once the baby is
used to them, it may be impossible to get the baby back onto the breast. In fact,
many women who have tried nipple shields find that they do not help with soreness. Use as
a last resort only, but get help first.
by Jack Newman, MD, FRCPC
