Treatments for breast engorgement during lactation: Cochrane systematic review
Assessed as up to date: 2001/02/08
National surveys have shown that painful breasts are the second most common reason for giving up breastfeeding in the first two weeks after birth in the UK. One factor contributing to such pain can be breast engorgement. Views differ as to how engorgement arises, although restrictive feeding patterns in hospital are likely to have contributed in the past. These differing views are reflected in the range of solutions offered to treat engorgement in breastfeeding mothers and these treatments are assessed in this review.
To determine the effects of any proposed intervention to relieve symptoms of breast engorgement among breastfeeding women.
The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. CINAHL and MEDLINE were also searched. Date of last search: December 2000.
All randomised and 'quasi-randomised' controlled trials, with or without blinding, that assess the effectiveness of treatments for the alleviation of symptoms in breastfeeding women experiencing engorgement .
Data collection and analysis
Data were extracted by one reviewer and verified by a second reviewer.
Eight trials, involving 424 women, were included. Three different studies were identified which used cabbage leaves or cabbage leaf extracts;. no overall benefit was found. Ultrasound treatment and placebo were equally effective. Use of Danzen (an anti-inflammatory agent) significantly improved the total symptoms of engorgement when compared to placebo (odds ratio (OR) 3.6, 95% confidence interval (CI) 1.3 - 10.3) as did bromelain/trypsin complex (OR 8.02, 95% CI 2.8-23.3). Oxytocin and cold packs had no demonstrable effect on engorgement symptoms.
Cabbage leaves and gel packs were equally effective in the treatment of engorgement. Since both cabbage extract and placebo cream were equally effective, the alleviation in symptoms may be brought about by other factors, such as breast massage. Ultrasound treatment is equally effective with or without the ultra-wave emitting crystal, therefore its effectiveness is more likely to be due to the effect of radiant heat or massage. Pharmacologically, oxytocin was not an effective engorgement treatment while Danzen and bromelain/trypsin complex significantly improved the symptoms of engorgement. Initial prevention of breast engorgement should remain the key priority.
Snowden Helen HM, Renfrew Mary J, Woolridge Mike
Treatments for breast engorgement during lactation
Anti-inflammatory drugs help ease the symptoms of breast engorgement.
Painful breasts are a common reason for women giving up breastfeeding. Engorgement can occur when excess milk is not removed from the breast during breastfeeding. The cells that excrete the milk become swollen, hot and painful. The review of trials found that the drugs Danzen and Kimotab are effective but oxytocin, ultrasound and cold packs are not effective in improving the symptoms of engorgement. The review also found that there was no difference between using cabbage leaves or a cold gel pack.
Implications for practice
The most effective treatments tested in this review were anti-inflammatory drugs. These are available in Japan and Italy although other countries will have their own regulations. Other anti-inflammatories may be effective although their use has not been trialed for breast engorgement. Cabbage leaves, although widely used were no more effective than gel packs in relieving symptoms.
Implications for research
Directions for future research should concentrate on measures which the mothers find useful such as cold packs, and should include trials such as comparing unrestricted feeding with standard care or unrestricted feeding versus, for example, Danzen or Kimotab or other anti-inflammatories. (Danzen and Kimotab are available in Italy and Japan respectively, but not in all countries). It also seems that the use of one breast for the intervention and the other for the treatment cannot adequately conceal the treatment from the mother. Longer term outcome measures such as continued feeding of the baby should also be considered.
Future trials on the treatment for breast engorgement should be of better quality, and include for example placebo/control groups and methods of blinding when collecting data. Trials to investigate engorgement at varying time points such as pre or post- feeding, post-weaning or following illness are also necessary.