Tender nipples at the start of a breastfeeding are normal in the first week or two. But pain, cracks, blisters, and bleeding are not. Your comfort depends on where your nipple goes in the baby's mouth. And that depends on how your baby takes the breast, or latches on.

To understand this better, use your tongue or finger to feel the roof of your mouth. Behind your teeth and the ridges, it feels hard. When your nipple is pressed against this hard area in your baby's mouth, this can cause pain and trauma.

But if you go back farther in your mouth, you'll feel where the roof turns from hard to soft. Some have nicknamed this "the comfort zone." Once your nipple reaches your baby's comfort zone, breastfeeding feels good. There is no undue friction or pressure on your nipple.

Even mothers with broken skin on their nipple can heal while breastfeeding. When the nipples reach the comfort zone, there is no undue friction and pressure.

If, after working to get a deeper latch-on, you aren't feeling better within a day, seek help from a board-certified lactation consultant (IBCLC). There are some causes of nipple pain that need other treatment.

If you have broken skin on your nipples, products that promote a healthy moisture balance will soothe your skin and speed healing. Mothers were once told to keep their nipples dry, but now moist wound healing is recommended. Helpful products include:

Ultra-purified lanolin, such as Lansinoh® Brand Lanolin. For best results, apply enough lanolin after every feeding to keep nipples moist. Ameda ComfortGel® hydrogel pads. These provide moist wound healing and pain relief. They are worn in the bra like a breast pad between feedings and/or pumpings.

A few days after your baby's birth, your milk increases or "comes in." Some breast fullness is normal then. But engorgement, which can happen in the first week after birth, goes beyond normal fullness. When a mother is engorged, her breasts become full, firm, hard, and hot and may even be painful.

Some think engorgement is caused by too much milk. But it is really caused by fluid build-up in the breast. If the milk is not drained often and well, extra blood, lymph, and other fluids build-up in the breast. Lots of IV fluids during labor can also be a factor.

TO PREVENT ENGORGEMENT:

From birth, breastfeed at least 8-12 times a day. If the baby is not feeding well, use a hospital-grade rental breast pump to drain the breast this often. Be sure when breastfeeding that your baby latches on deeply. This feels better and helps your baby drain the breast more fully. Avoid bottles and pacifiers. Keep your baby at your breast for all sucking.

TO TREAT ENGORGEMENT:

If needed, express some milk before feeding to make it easier for your baby to latch-on. Apply warmth right before feeding to aid milk flow. Breastfeed at least every 90 minutes to two hours during the day and at least every two to three hours at night until engorgement is gone. Use breast massage or compression during feedings to more fully drain your breasts. Let warm water run over your breasts in the shower. Leaking relieves pressure. If your breasts still feel full after feedings, use a breast pump to drain your breasts fully. Apply cold — gel ice packs or bags of frozen peas, wrapped in cloth — after feedings for 10-15 minutes to reduce swelling.

You may also try applying green cabbage leaves to your breasts between feedings to help relieve pain and swelling. To do this, put a chilled cabbage leaf in your bra for 15-30 minutes, two to three times per day. Using it more often may reduce milk supply. Avoid cabbage if you're allergic to cabbage or sulfa drugs, or if you develop a skin rash.

Be sure to treat engorgement before it gets painful. Severe pressure and swelling can cause breast damage. If these methods do not bring you relief, seek help right away from a doctor, board-certified lactation consultant or other knowledgeable heathcare provider.

"Are there foods I should eat or avoid while I'm breastfeeding?" No. There are no foods (such as cow's milk) that you must have. (Cows don't "drink milk to make milk.") And there are no foods you must avoid. You can eat chocolate, spicy foods, onions, garlic, broccoli, and cabbage. The key is: everything in moderation. Mothers in Thailand and Mexico eat spicy foods while breastfeeding with no ill effects on their babies. Enjoy! "Do I need to eat and drink more than usual to make enough milk?" No. Just "eat to hunger" and "drink to thirst."

"If my diet is not perfect, will my milk still be good for my baby?" Yes. Eating well is good for you. (It boosts your energy and resistance to illness.) But an ideal diet is not necessary to produce good quality milk. Nature provides first for your baby. It takes famine conditions for several weeks before a mother's milk is affected.

"How will I know if my baby is reacting to something I've eaten?" First, know that almost all babies have fussy periods. Reactions to food you eat are unusual. Your baby's fussiness is likely unrelated to your diet. If you suspect a food is affecting your baby, try avoiding it. (Cow's milk takes two weeks or so to clear.) Then try eating it again. The most likely culprits are protein foods such as dairy, soy, egg white, peanuts, and fish. Only changing your diet will tell you for sure.

"Is it okay to diet while I'm breastfeeding?" Yes. In fact, this may be the best time, as breastfeeding helps burn fat stores. But it's best to go slowly and lose weight gradually. Any diet should include at least 1800 calories/day. As with other food products, artificial sweetners are all right in moderation, one to two servings per day.

"Are there foods that will increase my milk supply?" Not that we know of. Milk supply is based on how many times each day that the milk is drained well from your breasts. The more times you breastfeed or express your milk, the more milk you will make. For information on herbal and prescribed medicines that increase milk supply, talk to your lactation consultant.

"As a vegetarian, is there anything special I need to know?" Yes. You need to either eat foods that have vitamin B12 (such as eggs or dairy) or take supplements. If you are on a vegan or macrobiotic diet or any other diet that does not include animal products, be sure to get enough B12. "What about caffeine?" As with all parts of your diet, think moderation. One or two cups of coffee (or other caffeinated drinks such as teas or colas) are not likely to cause a reaction. Unless a baby is unusually sensitive, there is no need to abstain.

"Can I have an occasional glass of beer or wine while I’m breastfeeding?" Yes. Moderate to heavy drinking is risky for your baby, but a little alcohol in the milk now and then has not been found to be harmful.

Mothers who want to avoid any alcohol in their milk can have their drink right after nursing. Research shows that alcohol passes quickly into a mother’s milk, peaking within 30-60 minutes (60-90 minutes when taken with food). But it also passes out of milk quickly. For a 120-pound woman, it takes two to three hours for the alcohol in one glass of beer or wine to leave her milk.

There is no need to pump to make your milk alcohol-free. As blood alcohol levels drop, alcohol leaves the milk.

If a breastfeeding mother has a stronger drink or more than one glass of beer or wine, it will take longer for the alcohol to pass out of her milk.

This is general information and does not replace the advice of your physician or healthcare provider. If you have a problem you cannot solve quickly, seek help right away.

Every baby is different, and your baby may not be average. If in doubt, contact your physician or other healthcare provider.