Q&A: It hurts to breastfeed. What can I do?

I am so sorry to hear how difficult breastfeeding was for you with your first child. It is great, though, that you are trying to plan ahead now to have a better experience this time around.

Nipple pain has many causes. Trauma can occur from a poor latch, and infection with yeast or bacteria can cause pain, but a relatively common, unrecognized cause is Reynaud's, which happens when spasm of the blood vessels of the nipple cut off oxygen to the tissues, causing severe pain. Reynaud's is usually triggered by cold exposure, but cool air on a wet nipple is enough to do it for some people.

Getting help early on is a great start. Reynaud's responds to medications like nifedipine, in the calcium channel blocker family. Sometimes just keeping the nipple warm can help. Trauma can be prevented by being sure the baby always has a good latch. Breastfeeding isn't supposed to hurt, and accepting pain sometimes allows a bad latch to escalate to significant tissue injury.

My best recommendation is to find a good lactation consultant, or if possible, a breastfeeding medicine physician who can help you plan ahead so you can comfortably breastfeed your baby. Your pediatrician or OB may know a breastfeeding specialist, or you can try the Academy of Breastfeeding Medicine. Don't give up! Breastfeeding is a wonderful thing for you and your baby, and with help, you should be able to prevent problems this time around, so you can have a great breastfeeding experience.

• Can I nurse if my nipples are inverted?