Angie asks about research on the effectiveness of cabbage in treating
engorgement.  Forgive my length here: this is a "hot button" topic in my
research and work in developing evidence based practice.

By my reading, an anti-engorgement chemical has yet to be found.  I think
it is important to look at how relatively difficult it is to absorb
chemicals transdermally. Roberts and colleagues published another study in
JHL in 1995, "A Comparison of Chilled and Room Temperature Cabbage Leaves
in Treating Breast Engorgement."  They tested chilled vs room temperature
cabbage to look at the issue of transdermal passage of potential active
substances: "It was expected that if there were no active substances in the
cabbage leaves, chilled leaves would give greater relief than those at room
temperature.  However, it there were active substances in the cabbage, the
room temperature cabbage leaves would show a greater effect becuase of
increased chemical absorption."  The study found no difference in treatment
with chilled vs. warm cabbage.

To me the most powerful statement about the treatment of engorgement is in
the 1998 Roberts article "*Breastfeeding* had significantly more effect
than the [cabbage or placebo] cream on both perceptions of discomfort and
the hardness of the breast tissue.  The degree of relief following feeding
was stronger than that initially afforded by the cream. . ."

There can be powerful placebo effect in any caretaking intervention.  I
think it is very easy to overlook this and fixate on the substance used
rather than the act of caretaking.

Nikodem and colleagues agree: "We cannot rule out the possibility that
cabbage leaves had a direct effect on breast engorgement . . . However, we
consider that the positive effect was more likely to have been mediated by
psychological mechanisms. . We postulate that the fact that women in the
experimental group were actively involved in a procedure perceived to be
beneficial to breastfeeding may have increased their confidence and
self-esteem. . ."
Cindy Turner-Maffei, MA, IBCLC
Massachusetts, USA

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