#209 Is that cabbage in your bra? Cabbage leaves for breast engorgement

CLINICAL QUESTION

QUESTION CLINIQUE

Are cabbage leaves effective in managing breast engorgement due to breastfeeding?

BOTTOM LINE

RÉSULTAT FINAL

Women report higher levels of satisfaction with cabbage leaves than either routine care or cold gel packs (with an extra 1 in 4 and 1 in 6 reporting satisfaction, respectively). Cabbage leaves reduce pain (by ~1 point out of 10) and hardness (by ~0.4 points out of 6) associated with breast engorgement compared to usual care. Cabbage leaves likely do not need to be chilled.

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EVIDENCE

DONNÉES PROBANTES

Randomized controlled trial (RCT) of 227 breastfeeding mothers with engorgement, comparing application of cabbage leaves, cold gel packs, and routine care (education by lactation consultant).1 Interventions were applied for two hours, then 30 minute break, then applied two hours again.

Versus routine care:
- Cabbage decreased pain at 30 minutes, one and two hours by ~0.4-1 (on 10-point scale).
  - Bordering on clinically meaningful.
- Cabbage decreased breast hardness by 0.2-0.4 (on 6-point scale).
  - Likely not clinically detectable.
Versus gel packs:
- Cabbage decreased pain at two hours after second application by 0.5, other time points no difference.
- Cabbage decreased hardness at two hours after second application by 0.4, other time points no difference.
No difference in breast feeding rates at three or six months.
More women were satisfied or highly satisfied with cabbage (99%) than routine care (70%) or gel packs (81%), Numbers Needed to Treat (NNT)=4-6.
Limitations: Unblinded, inconsistent endpoint evaluations, number of women benefitting not reported.

Systematic review of various interventions found three RCTs of 101 women:2

One RCT: No difference in chilled versus room temperature cabbage.3
One RCT: No difference in chilled gel packs versus chilled cabbage; 2/3 of women preferred cabbage (worked quicker), the other 1/3 preferred gel (lasted longer).4
One RCT: No difference between cabbage extract cream and placebo.5
Limitations: Unblinded, small sample sizes.

Context:

Leaves can be chilled in fridge for one hour or freezer for 15 minutes.1
Cabbage leaves are inexpensive, widely available, are the appropriate shape, and have no known harms.
Other treatments including hot/cold packs, acupuncture, and acupressure also poorly studied.2 Patient preference should guide therapy.