I understood cabbage to be effective for swelling, for example for the
swollen and  engorged breast, for the potential bruise, for the muscle
sprain, for the post operative jaw.  Why then do we worry about
continuos use of cabbage drying up the milk?  I don't believe that is
the way it works.  Cabbage seems to reduce swelling, not milk supply.
Prolonged engorgement reduces milk supply. If the breast is swollen, the
ducts are compressed and milk can't flow.  This is an emergency, for the
present baby and for subsequent baby(s).  Mom's aveoli may be
permanently damaged.

I think cabbage should be applied, left on until wilted, and replaced
with fresh leaves as close to 24 hours a day as possible, until milk is
able to flow and/or the swelling is reduced.  Wash the leaves, pat dry,
then crush the leaves enough to make it flexible enough for close
contact on application to the breast. Do the crushing just prior to
application with a rolling pin or other suitable object. I've read
crushing releases the active ingredients so I wouldn't do it ahead of
time. Remove the hard spines in the bigger leaves. Large leaves are
easier to use.  I can't really use more than the outer 1/4 or so of the
head of cabbage before the leaves get too small.  Refrigerate the whole
head of cabbage if convenient but don't overly worry about that aspect.
I've read one should use the head forming type of plain smooth, green
cabbage, not red, not savoy, not crinkle leave types.

I find it easiest to place the leaves in a spiral pattern, starting at
the outer margins of the swelling, overlapping slightly and moving in
toward the areola.  Mom and I together can usually keep the crushed
leaves in place, they sort of cling to each other.  Then after the
entire breast is wrapped I hold the leaves in place with a home made
"bra" by using a cotton T-shirt tied in to a sort of halter top since
the mom rarely has a real bra that fits her engorged breast(s).  Mom
should have the T-shirt on prior to application of the leaves, then it
can be pulled down, tucked in under the breasts and tied off to the side
to make it snug enough to hold the leaves.  I use rubber bands to tie
the shirt.  I suspect a nice "tube" top would also work well.

I keep the cabbage off the areola and nipple but I don't have a good
reason for this other than that is what I have read to do.  Does anyone
have a rational for this practice.  Areolas get swollen too.

I also use intermittent ice compresses over the cabbage (these I leave
on no longer than 20 minutes), anti-inflammatory drugs as prescribed by
MD, and q 2 - 3 hour massage (massage, stroke, shake a-la Marmet)
followed by pumping with hospital grade electric pump and/or manual
expression and/or baby nursing - whichever is least traumatic and most
effective at eliciting a let down and removing milk.   I believe a good
let down helps to move milk as it may push the compressed ducts open.
Maybe syntocinon would be helpful, if it were available.  I avoid heat
in the initial treatment period, even before pumping.  We don't use heat
on sprained ankles, nor do I believe we should use it on severely
engorged, non milk flowing post partum breasts.  I reserve moist heat
treatment prior to pumping until swelling has been somewhat reduced.  If
engorgement is one sided I have mom elevate the engorged breast by side
lying on the unaffected side periodically.  If it is bilateral I have
her lay flat periodically and use pillows on both sides to hold up arms
which can push in and support the breasts in an elevated position.
Remember elevation is a standard treatment to reduce swelling elsewhere
in the body.

I haven't tried recommending the doc prescribe diuretics although that
too is intriguing. I also haven't tried epsom salt water soaks but may
in the future.  I'd love to hear more on other's thoughts/practices,
most especially your thoughts on cabbage reducing milk supply if applied
too long and cabbage on nipple/areola and other practices to reduce
swelling.

Carla (in Maryland but going to Pennsylvania tomorrow if I ever get
off-line and pack)