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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. (See handouts #1, Breastfeeding—Starting Out
Right and 1b, The Importance of Skin to Skin
Contact, as
well as Protocol to Increase Breastmilk Intake by the Baby.
See also videos to help use the Protocol).
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 or if
the baby is not able to take the breast, 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.
1.
Use green cabbage.
2.
Crush the cabbage leaves with a rolling pin if the leaves do not
accommodate to the shape of your breast.
3.
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. Some are concerned that such frequent use will
decrease the milk supply.
4.
Stop using as soon as engorgement is beginning to diminish and
you are becoming more comfortable.
5.
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.
6.
Ice packs also can be helpful.
7.
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 s
upply
It
is quite possible that herbal remedies help increase milk
supply. There are
several drugs that obviously do increase milk supply, and of
course it is reasonable to assume that some plants and herbs
might contain similar pharmacological 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 not
work at all; some may have one or more active ingredients.
Some will have active ingredients that will not increase
the milk supply but have other effects, not necessarily
desirable. 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:
3 capsules 3 times a day
Blessed
thistle:
3 capsules 3 times a day, or 20 drops of the tincture 3
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. There are some preparations of both herbs that are labelled
“not for use by nursing mothers”.
Don’t worry about this; these herbs are safe for the
mother to take because so little gets into the milk.
Teas also seem to work, but to take enough to make a
difference,you will be drinking tea all day and night, since the
amount of the herbs you get is much less.
- Fenugreek
and blessed thistle seem to work better if you take both,
not just one or the other.
- Fenugreek
and blessed thistle work quickly. If they do work, you will
usually notice a difference within 3 to 4 days of starting
taking them. If
not, they probably won’t work.
- Fenugreek
is often sold as a combination with thyme.
Do not buy this combination, but try to get the
capsules with fenugreek alone.
- Herbal
remedies are not standardized, so though the bottle of
fenugreek, for example, may say that it contains 405, 505,
605 or 705 mg/capsule, we do not really know how much of the
active ingredient you are taking.
Fenugreek has a distinct smell.
If you cannot smell it on your skin, you are not
taking enough, even if you are taking three capsules three
times a day.
- Fenugreek
and blessed thistle seem also to work better in the first
few weeks than later. In
fact they tend to work best in the first week.
Domperidone works better after the first few weeks.
(See handouts 19a and 19b Domperidone 1
and Domperidone 2
for more information.)
- You
can take fenugreek and blessed thistle together with
domperidone if you feel they are helping.
If you take the herbs and domperidone, take
domperidone at the same time, 3 tablets three times a day.
- If
you are ready to stop fenugreek and blessed thistle, you can
probably stop suddenly, or wean off over a week or so.
- Fenugreek
does not cause low blood sugar.
Where this rumour came from is unknown.
Other herbal treatments that have been used to increase
milk supply are: raspberry leaf, fennel, goat’s rue,
brewer’s yeast, alfalfa, nettle tea and many others.
The effectiveness of none
of these treatments, including blessed thistle and fenugreek,
has been proved. Remember! Herbal treatments are only part of the
solution to “not enough milk” (see protocol to increase
breastmilk intake by the baby).
See
also videos on how to latch a baby on, how to know the baby is
getting milk, how to use compression, how to use a lactation
aid, as well as information sheets on breastfeeding.
Lecithin
Lecithin is a food supplement that seems to help some
mothers prevent blocked ducts. It may do this by decreasing the viscosity (stickiness) of
the milk, by increasing the percentage of polyunsaturated fatty
acids in the milk. It
is safe, inexpensive, and seems to work in some cases.
The dose is 1200 mg four times a day.
There is more to preventing blocked ducts than taking
lecithin. See
handout #22 Blocked Ducts
and Mastitis.
For
information on “all purpose nipple ointment”, gentian
violet, grapefruit seed extract, vitamin B6, nifedipine, and
nitroglycerin paste, and fluconazole, see the handout
Treatments for Sore Nipples and Sore Breasts #3b, or
the handouts gentian violet and fluconazole.
Questions?
(416)
813-5757 (option 3) or
drjacknewman@sympatico.ca or
my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate
Breastfeeding Book of Answers in
the USA)
Handout
#24. Miscellaneous treatments.
January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This
handout may be copied and distributed without further
permission,
on
the condition that it
is not used in any context in which the WHO code on the
marketing of breastmilk substitutes is violated.
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