Ideally avoiding engorgement is the best approach but this is not the real
world, so we need to think about what is going on inside the breast and how
to relieve the symptoms ASAP.
Engorgement is not just the breast over full of milk, they are also congested
with lymph fluid and blood.  With this in mind, frequent emptying of the
breast will not eliminate the problem in the first 24 hours or more.  The
body needs encouragement to empty the extra lymph fluid and slow down the
blood flow to only what the breast need to make milk.
With this in mind the approach to treat engorgement is two fold: frequent
emptying of the breast and cold compacts to reduce the edema.  The use of
cabbage as the cold compact has been antidotally shown to be very effective.
What I have a problem with the JHL article on comparing chilled leaves to
room temperature, is that cabbage naturally is cool to the touch, in the frig
or out.  Cabbage are easier to use than cold packs because you don't have to
hold them next to the breast.  I tell the moms to remove the leaves once they
start to wilt, so there is no need to watch a clock.  I do not approach the
use of cabbage because of any chemical wonder but the cold aspect.  I also
advise moms to take Ibuprofen as an anti-inflammatory and pain relief for
12-24 hours.  I tell moms to avoid heat through all of this, if they need
help to get the milk to flow I prefer gentle massage, if they do use heat it
is very limited just prior to the feeding.
Ann Perry RN IBCLC
Boston, Mass

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