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The following describes
the use of some treatments for breastfeeding mothers
who are having various problems.
Cabbage leaves for engorgement
Severe engorgement about the third or fourth day
after the baby is born can usually be prevented by
getting the baby latched on well and drinking well
from the very beginning. If you do become engorged,
please understand that engorgement diminishes within
1 or 2 days even without any treatment. Continue to
breastfeed the baby, making sure he gets on well and
nurses well. However, if you should get engorged to
the point of severe discomfort, cabbage leaves seem
to help decrease the engorgement more rapidly than
ice packs or other treatments. If you are unable to
get the baby latched on, start cabbage leaves, start
expressing your milk and give the expressed milk to
the baby by spoon, cup, finger feeding or eyedropper
and get help quickly.
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Use green cabbage.
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Crush the cabbage
leaves with a rolling pin if the leaves do not
accommodate to the shape of your breast.
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Wrap the cabbage
leaves around the breast and leave on for about
20 minutes. Twice daily is enough. It is usual
to use the cabbage leaf treatment two or three
times or less.
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Stop using as soon
as engorgement is beginning to diminish and you
are becoming more comfortable.
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You can use
acetaminophen (Tylenol™, others) with or without
codeine for pain relief. As with almost all
medications, there is no reason to stop
breastfeeding when taking analgesics.
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Ice packs also can
be helpful.
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If you are one of
the women who gets a large lump in the armpit
about 3 or 4 days after the baby’s birth, you
can use cabbage leaves in that area as well.
Herbs for Increasing Milk Supply
It is quite possible that herbal remedies help
increase milk supply. There are several drugs which
obviously do increase milk supply, and of course it
is reasonable to assume that some plants and herbs
might contain similar pharmacologic agents. Almost
every culture has some sort of herb or plant or
potion to increase milk supply. Some may work as
placebos, which is fine, some may have an active
ingredient. Some will have active ingredients which
will not increase the milk supply but have other
effects. Note that even herbs can have side effects,
even serious ones. Natural source drugs are still
drugs, and there is no such thing as a 100% safe
drug. Luckily, as with most drugs, the baby will get
only a tiny percentage of the mother’s dose. The
baby is thus extremely unlikely to have any side
effects at all from the herbs. Two herbal treatments
that seem to increase the milk supply are fenugreek
and blessed thistle, in the following dosages:
fenugreek: 2
capsules 3 or 4 times a day
blessed thistle: 2
capsules 3 or 4 times a day, or 20 drops of the
tincture 3 or 4 times a day
The tincture container states that blessed thistle
should not be taken by nursing mothers, presumably
because of the tiny amount of alcohol the mother
would get. Don’t worry about this. Teas also work,
but to take enough to make a difference, you will be
drinking tea all day and night.
Other herbal treatments which have been used to
increase milk supply are: raspberry leaf, fennel,
brewer’s yeast. The effectiveness of none of these
treatments has been proved.
All purpose nipple ointment
The best treatment of nipple soreness is prevention.
The best prevention is an early start to
breastfeeding and a good latch. More than minimal
nipple pain in the first two or three days after
your baby’s birth is due to a poor latch, no matter
who tells you the latch is fine. Get help.
Sometimes nipple ointments such as Lansinoh™, Purlan™
and others can be very useful for mild to moderate
pain, but fixing the latch is still the best
treatment. Sometimes a
"good-for-all-things-don’t-know-why-it-works" nipple
ointment can also be very useful.
You may be prescribed such an ointment (which works
better than a cream). It will contain:
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One or more
antibiotics. Almost all cracks and erosions have
bacteria growing in the base. Whether they are
actually causing infection, or whether they
merely delay healing is not known. But it has
been known for many years that antibiotic
ointments help some mothers’ nipple pain get
better.
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An antifungal agent.
Candida albicans can cause nipple soreness and
cracking. Sometimes it is not easy to tell what
contribution this fungus causes to breastfeeding
mothers’ nipple soreness.
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An antiinflammatory
agent. Often it is the inflammation associated
with infection or injury which causes the most
pain. The antiinflammatory agent (a steroid)
decreases the inflammatory response.
In Canada, Kenacomb™ (more easily available) or
Viaderm KC™ (less expensive) ointments contain the
above ingredients. Ointments can also be made up
from individual ingredients. In the USA, mixing
Mycolog™ ointment with 2% mupirocin ointment results
in a similar concoction.
How to use? Apply the ointment sparingly each
feeding. Do not wash or wipe it off even if the baby
goes back to the breast within minutes. Most of the
ingredients are not absorbed from the baby’s gut and
will do him no harm. Once you are feeling better
(usually within 2-5 days), you can gradually
decrease the use of the ointment until you are not
using it at all. For some conditions, the mother may
have to use the ointment daily or twice daily to
keep pain free. This is not a problem and you may
continue the use of the ointment for weeks or
longer, if necessary.
Handout #24. Treatments for Problems. Revised
January 1998 Written by Jack Newman, MD, FRCPC
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