Cabbage Leaves, Herbs, Lecithin
By Jack Newman, MD, FRCPC

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 www.thebirthden.com/Newman.html for 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 supply

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 the website www.thebirthden.com/Newman.html for 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.

Handout #24. Miscellaneous treatments; January 2005; Jack Newman, MD, FRCPC. (c) 2005