Hi all -
I emailed Cindy Turner-Maffei to ask her for her thoughts and
references on the subject of cabbage leaves, and she very kindly gave
me permission to share her response. I'm assuming this is what she was
referring to at the March of Dimes conference in Chicago.
Morgan Kennedy Henderson, IBCLC, LLLL
Wellesley, MA
Hi Morgan --
Yes, I have expressed concern about a link between cabbage and
listeria. I find this to be one area where lactation practice has not
kept pace with research.
Research about cabbage has been clear for years that there is no
documented advantage of cabbage over the use of cool gel packs. The
Cochrane review of engorgement treatments (representing the highest
level of evidence available, which can be found at
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?
cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11405948 ) summarizes
"Cabbage leaves and gel packs were equally effective in the treatment
of engorgement. Since both cabbage extract and placebo cream were
equally effective, the alleviation in symptoms may be brought about by
other factors, such as breast massage."
Listeriosis is a serious illness that comes most often from vegetables
and other contaminated foods (
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/listeriosis_g.htm )
Cabbage is one common carrier of listeria.
Here's my thinking on the subject:
Because:
1) there is no demonstrated advantage of superiority of cabbage, and
2) cabbage is often a carrier of listeria, and
3) to remove listeria, cabbage would need a thorough washing, and
ideally, cooking, and
4) women experiencing discomfort are unlikely to take the step of
washing cabbage thoroughly (and putting cooked cabbage on the breast
might be less soothing), and
5) the nipple is placed in the mouth of babies, thereby possibly
transferring any listeria or other substance on the surface of cabbage
leaves; therefore,
I'm not comfortable making (or encouraging others to make) a
recommendation of the use of cabbage for engorgement in breastfeeding
mothers.
Furthermore, women with any disturbance of the nipple/breast skin
could theoretically contract listeriosis themselves through contact
with contaminated cabbage leaves.
The other bottom line for me is that nursing the baby is the best
"treatment" we have in our arsenal. Yet, lots of energy goes to
pumping, ice, cabbage, etc, instead of getting the baby on the breast.
I have not seen a published comment about the link between cabbage and
listeria.
However, all the scientific research about cabbage for treatment of
engorgement has found no statistically significant advantage of cabbage
as an engorgement treatment (except a slightly longer duration of
breastfeeding in the Nikodem study, which the authors credit to placebo
effect). See:
• Nikodem VC, Danzinger D, Gebka N, Gulmezoglu AM,
Hofmeyr GJ. 1993. Do cabbage leaves prevent breast engorgement? A
randomized, controlled study. Birth 20(2):61-64.
• Roberts KL. 1995a. A comparison of chilled cabbage
leaves and chilled gelpacks in reducing breast engorgement. J Hum Lact
11(1):17-20
• Roberts KL, Reiter M, Schuster D. 1995b. A comparison
of chilled and room temperature cabbage leaves in treating breast
engorgement. J Hum Lact 11(3):191-194.
• Roberts KL, Reiter M, Schuster D. 1998. Effects of
cabbage leaf extract on breast engorgement. J Hum Lact 14:231-236.
• Snowden HM, Renfrew MJ, Woolridge MW. Treatments for
breast engorgement during lactation. Cochrane Database Syst Rev.
2001;(2):CD000046. Review.
Early claims for the efficacy of cabbage were supported by a series of
case reports published in the Australian brestfeeding journal (Rosier
W. 1988 Cool cabbage compresses. Breastfeeding Review 12:28-31 ). The
reports covered a range from using cabbage to reduce engorgement, dry
up milk supply, bring in milk supply, and relieve "giant hypertrophy”
of the breast; a somewhat confusing array of outcomes for a single
treatment.
Hope this is helpful to you!
Cindy
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