Introduction
Engorgement is the physiologic condition characterised
by the painful swelling of the breasts associated
with the sudden increase in milk volume, lymphatic
and vascular congestion, and interstitial oedema during
the first two weeks following birth.
It is caused by insufficient breastfeeding and/or
blocked milk ducts. Breast pain that interferes with
successful breastfeeding leads to abandonment of exclusive
breastfeeding (Woolridge, 2006). Numerous strategies
have been adopted over the years in the treatment
of breast engorgement. These include kangaroo care,
fluid limitation, binding the breasts or wearing a
tight bra, hot and cold compresses, application of
cabbage leaves etc. Very few researches have been
conducted to monitor the effect of cabbage leaves
on breast engorgement, even these have come up with
inconclusive and conflicting results.
A study on the effectiveness of cabbage leaves can
contribute to providing evidence for introducing the
intervention in clinical practice
The authors are : MSc Nursing student, College of
Nursing, AIIMS; Principal, College of Nursing, AIIMS;
and Associate Professor, Department of Gynecology and
Obstetrics, AIIMS, respectively. |
and
thus the present study was conducted. The objective
of this study was to assess and compare the effectiveness
of cold cabbage leaves and hot and cold compresses in
the treatment of breast engorgement.
Material
and Methods
This was a quasi experimental study, using time series,
non-equivalent control group design with multiple institutions
of treatment, done in post-natal ward in AIIMS, New
Delhi on 60 subjects during May to December 2006.
Inclusion
criteria
 Post-natal
mothers with breast engorgement
Willing
of the subjects to participate in study
Exclusion
criteria
Mothers
with allergy to sulfa drugs and cabbage
Mothers
with soft breasts; mothers receiving lactation suppressants
Mothers
with infected breasts, breast abscess, mastitis, broken
skin of breasts, bleeding or cracked nipples After enrolling
the subjects based on inclusion and exclusion criteria,
information sheet was given to them and consent obtained.
|
Identification
data and obstetric characteristics of each subject
were recorded in validated subject data sheet. The
study was conducted in two phases. In the first phase,
first 30 mothers in control group were given alternate
hot and cold compresses. The temperature of water
for hot compress ranged between 43-460C, and for cold
compress it ranged between 10-180C as assessed by
lotion thermometer.
On
completion of first phase, next 30 mothers in experimental
group were given cold cabbage leaves treatment for
relieving breast engorgement. Cabbage leaves were
refrigerated for approximately 20-30 minutes prior
to the procedure in the freezer compartment of the
refrigerator. Cold cabbage leaves were kept inside
mother’s bra for 30 minutes.
Both the treatments were performed three times a day
for two subsequent days. The intervention was done
six times on each subject. The duration of each intervention
was 30 minutes. Pre-treatment and post-treatment scores
of breast engorgement and pain were recorded after
each treatment session.
Breast
engorgement was measured using six point breast engorgement
scale and pain score was assessed using numeric rating
pain scale. The data obtained was entered into MS
Excel sheet. The statistical software STRATA was used
for analysis.
|
| Pre-treatment
Mean (SE) N=30 |
Post-treatment
Mean (SE) N=30 |
P-value |
|
| Control
group |
|
|
|
| Breast
engorgement score |
5.03
(0.7) |
2.97
(0.2) |
<0.001*** |
| Pain
Score |
6.1
(1.5) |
0.51
(0.4) |
<0.001*** |
| Experimental
group |
|
|
|
| Breast
engorgement score |
5.17
(0.7) |
3.02
(0.2) |
<0.001* |
| Pain
score |
6.4
(1.2) |
3.45
(0.4) |
<0.001* |
| *
p value significant at 0.001 level. |
|
|
| Table
1: Comparison of pre-treatment
& post-treatment scores for breast engorgement
and pain in groups |
|
|
both
were equally effective in decreasing breast engorgement
(p=0.07) as shown in Table 2. Hot and cold compresses
were found to be more effective than cold cabbage leaves
in relieving pain due to breast engorgement (p £
0.001) in post-natal mothers as shown in Fig. 2.
Discussion
This study is supported by the findings of Snowden et
al (2001) who did a review of research studies to determine
the effects of several interventions to relieve symptoms
of breast engorgement among breastfeeding women and
found that cabbage leaves were effective in the treatment
of engorgement. Roberts et al also compared the effectiveness
of cabbage leaf extract with that of a placebo in treating
breast engorgement in lactating women and concluded
that both the groups received equal relief in discomfort
and decreasing breast tissue hardness. The present study
also supports the findings of Hill & Humenick (1994)
|
| Results
The two groups were homogeneous with regard to all demographic
and obstetric variables as analysed by chi square and
Fisher’s exact test except for breastfeeding for
which adjusted analysis using GEE (generalised estimating
equations) was done. There was no difference between
the groups with regard to pre-treatment scores of breast
engorgement and pain as analysed by student ‘t’
test (Fig. 1). GEE was |
used
to compare correlated responses for post-treatment scores
for both the outcome variables between the groups and
to compare pre-treatment and post-treatment scores within
the groups. Both the treatments i.e. hot and cold compress
and cabbage leaves were effective in decreasing breast
engorgement and pain in post-natal mothers (p £
0.001) as shown in Table 1. Cold cabbage leaves and
hot and cold compress |
|
who
reported that type of delivery and parity are not critical
variables in predicting engorgement.
Conclusion
Cold cabbage leaves as well as alternate hot and cold
compresses both can be used in the treatment of breast
engorgement. Hot and cold compresses are more effective
in decreasing pain as compared to cold cabbage leaves
in relieving pain due to breast engorgement.
Acknowledgement
I thank my guide Dr. Manju Vatsa and the co-guide Dr.
Vatsla Dadhwal for their guidance throughout the study.
|
I
am grateful to the mothers who participanted in this
study and nurses of post-natal ward of AIIMS who helped
me during the course of study. I thank the statistical
department for statistical analysis and the ethical
review board for giving ethical clearance.
References
1. Woolridge M. Aetiology of sore nipples.
Midwifery. 1986;2:172–176. Available from: http://www.ncbi.
nlm.nih.gov. Accessed January 23, 2006
2. Hill PD, Humenick SS. The occurrence
of breast engorgement. J Hum Lact 1994; 10:79-86. Available
from:
http://www.ncbi.
nlm.nih.gov |
cessed
December 11, 2005
3. Snowden HM, Renfrew MJ, Woolridge
MW. Treatments for breast engorgement during lactation.
Cochrane Database Syst Rev 2001;(2): CD000046. Review.
Available from: http://www.ncbi. nlm.nih.gov. Accessed
January 2, 2006
4. Roberts KL, Reiter M, Schuster
D. Effects of cabbage leaf extract on breast engorgement.
J Hum Lact. 1998; 14:231-6. Available from: http://www.ncbi.nlm.nih.gov
Accessed January 2, 2006
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