Treatments for Problems.

By Dr. Jack Newman.

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.

Use green cabbage.
Crush the cabbage leaves with a rolling pin if the leaves do not accommodate to the shape of your breast.
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. Some will say to use the cabbage leaves after each feeding and leave them on until they wilt. I have not enough experience with cabbage leaves to say one way or the other, but some are concerned that such frequent use will decrease the milk supply.
Stop using as soon as engorgement is beginning to diminish and you are becoming more comfortable.
You can use acetaminophen (Tylenol�, others) with or without codeine, ibuprofen, or other medication for pain relief. As with almost all medications, there is no reason to stop breastfeeding when taking analgesics.
Ice packs also can be helpful.
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.

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.

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.
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.
An anti-inflammatory agent. Often it is the inflammation associated with infection or injury that 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 2% mupirocin ointment + nystatin ointment + betamethasone 0.1% ointment results in a similar, even better, concoction. It can also be prescribed in Canada.

How to use? Apply the ointment sparingly after 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 1. Revised January 2000
Written by Jack Newman, MD, FRCPC
May be copied and distributed without further permission.

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