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.
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. 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.
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.
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:
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 antiinflammatory 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.
Treatments for Problems (2)
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 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. 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 that have been used to increase
milk supply are: raspberry leaf, fennel, brewer’s yeast. The
effectiveness of none of these treatments, including blessed
thistle and fenugreek, has been proved.
Treatments for Raynaud’s Phenomenon (blanching of the
nipple)
Raynaud’s phenomenon is due to spasm of blood vessels
preventing blood from getting to a particular area of the body. It occurs
in response to a drop in temperature. Most commonly, Raynaud’s
phenomenon will occur in the fingers, typically when someone goes outside
from a warm house on a cool day. The fingers will turn white and the lack
of blood getting to the tips of the fingers will cause pain. Raynaud’s
phenomenon occurs more commonly in women than men, and is often associated
with illnesses such as rheumatoid arthritis.
Raynaud’s phenomenon can also occur in nipples. In
fact, it is much more common than generally believed. It can occur along
with any cause of sore nipples, but it may also, on occasion, occur
without any other kind of nipple pain at all.
Typically, Raynaud’s phenomenon occurs after the
feeding is over, once the baby is already off the breast. Presumably, the
outside air is cooler than the inside of the baby’s mouth. When the baby
comes off the breast, the nipple is its usual colour, but soon, within
minutes or even seconds, the nipple will start to turn white. Mothers
generally describe a burning pain when the nipple turns white. After
turning white for a while, the nipple may actually turn back to its normal
colour (as blood starts to flow back to the nipple), and the mother will
notice a throbbing pain. The nipple may go back and forth between colours
(and types of pain) for several minutes or even an hour or two.
The treatment for Raynaud’s phenomenon is to fix the
original cause of the pain (poor latch, Candida etc). Almost always, as
the nipple soreness from another cause is getting better, so will the pain
from Raynaud’s phenomenon get better, but more slowly. Fixing the
original cause of the pain (improving the latch, treating Candida etc)
should be the focus of treatment. However, some mothers no longer have
pain during the feeding, or never had it at all. Indeed, some start having
Raynaud’s phenomenon during the pregnancy. If the pain is mild, there
may be no reason to treat, and reassurance is all that is necessary.
However, in some cases it is worth treating, especially if severe, and
especially if the pain during the feeding does not improve, as severe
restriction of blood supply to the nipple may delay healing.
The first choice for treatment is:
Vitamin B6. This has shown to work by trial and
error, but it does seem to work. There is no scientific evidence that it
works, but it does nevertheless. It is safe and will do no harm. The
dose is 150 mg/day once a day for four days, followed by 25 mg/day once
a day. The mother continues it until she is pain free for a few weeks.
It can be restarted if necessary.
If vitamin B6 does not work within a few days, it
probably won’t. It is then useful to try:
Nifedipine. This is a drug used for hypertension.
One 30 mg tablet of the slow release formulation once a day often
takes away the pain of Raynaud’s phenomenon. After two weeks, stop the
medication. If pain returns (about 10% of mothers), start it again.
After two weeks, stop the medication. If pain returns (a very small
number of mothers), start it again. Very few mothers I am aware of took
more than three courses. Side effects are uncommon, but headache does
occur.
Handout #25 Treatments for Problems (2). January
2000
Written by Jack Newman, MD, FRCPC
May be reproduced and distributed without further
permission
Handout #24. Treatments for Problems 1. Revised
January 2000
Written by Jack Newman, MD, FRCPC
