Author Name:
Dr Jack Newman MD, FRCPC

Biography:
Dr. Jack Newman is a Toronto pediatrician who has practiced medicine since 1970. In 1984 he established the first hospital-based breastfeeding clinic in Canada, at Toronto's Hospital for Sick Children. He now holds breastfeeding clinics in several hospitals in the Toronto area. Jack is a consultant with UNICEF's Baby Friendly Hospital Initiative and is a popular speaker at breastfeeding conferences across North America and beyond. He is the father of three children, all breastfed.

Article:
The following describes the use of some treatments for breastfeeding mothers who are having various problems.

Cabbage leaves for engorgement

Severe engorgement about the third or fourth day after the baby is born can usually be prevented by getting the baby latched on well and drinking well from the very beginning. (See handouts #1 Breastfeeding—Starting Out Right and 1b The Importance of Skin to Skin Contact, as well as Protocol to Increase Breastmilk Intake by the Baby. See also www.thebirthden.com/Newman.html for videos to help use the Protocol). If you do become engorged, please understand that engorgement diminishes within 1 or 2 days even without any treatment. Continue to breastfeed the baby, making sure he gets on well and nurses well. However, if you should get engorged to the point of severe discomfort or if the baby is not able to take the breast, cabbage leaves seem to help decrease the engorgement more rapidly than ice packs or other treatments. If you are unable to get the baby latched on, start cabbage leaves, start expressing your milk and give the expressed milk to the baby by spoon, cup, finger feeding or eyedropper and get help quickly.

1. Use green cabbage.
2. Crush the cabbage leaves with a rolling pin if the leaves do not accommodate to the shape of your breast.
3. Wrap the cabbage leaves around the breast and leave on for about 20 minutes. Twice daily is enough. It is usual to use the cabbage leaf treatment two or three times or less. Some will say to use the cabbage leaves after each feeding and leave them on until they wilt. Some are concerned that such frequent use will decrease the milk supply.
4. Stop using as soon as engorgement is beginning to diminish and you are becoming more comfortable.
5. You can use acetaminophen (Tylenol™, others) with or without codeine, ibuprofen, or other medication for pain relief. As with almost all medications, there is no reason to stop breastfeeding when taking analgesics.
6. Ice packs also can be helpful.
7. If you are one of the women who gets a large lump in the armpit about 3 or 4 days after the baby’s birth, you can use cabbage leaves in that area as well.

Herbs for Increasing Milk Supply

It is quite possible that herbal remedies help increase milk supply. There are several drugs that obviously do increase milk supply, and of course it is reasonable to assume that some plants and herbs might contain similar pharmacological agents. Almost every culture has some sort of herb or plant or potion to increase milk supply. Some may work as placebos, which is fine; some may not work at all; some may have one or more active ingredients. Some will have active ingredients that will not increase the milk supply but have other effects, not necessarily desirable. Note that even herbs can have side effects, even serious ones. Natural source drugs are still drugs, and there is no such thing as a 100% safe drug. Luckily, as with most drugs, the baby will get only a tiny percentage of the mother’s dose. The baby is thus extremely unlikely to have any side effects at all from the herbs. Two herbal treatments that seem to increase the milk supply are fenugreek and blessed thistle, in the following dosages:

Fenugreek: 3 capsules 3 times a day
Blessed thistle: 3 capsules 3 times a day, or 20 drops of the tincture 3 times a day

The tincture container states that blessed thistle should not be taken by nursing mothers, presumably because of the tiny amount of alcohol the mother would get. There are some preparations of both herbs that are labelled “not for use by nursing mothers”. Don’t worry about this; these herbs are safe for the mother to take because so little gets into the milk. Teas also seem to work, but to take enough to make a difference, you will be drinking tea all day and night, since the amount of the herbs you get is much less.

 Fenugreek and blessed thistle seem to work better if you take both, not just one or the other.
 Fenugreek and blessed thistle work quickly. If they do work, you will usually notice a difference within 3 to 4 days of starting taking them. If not, they probably won’t work.
 Fenugreek is often sold as a combination with thyme. Do not buy this combination, but try to get the capsules with fenugreek alone.
 Herbal remedies are not standardized, so though the bottle of fenugreek, for example, may say that it contains 405, 505, 605 or 705 mg/capsule, we do not really know how much of the active ingredient you are taking. Fenugreek has a distinct smell. If you cannot smell it on your skin, you are not taking enough, even if you are taking three capsules three times a day.
 Fenugreek and blessed thistle seem also to work better in the first few weeks than later. In fact they tend to work best in the first week. Domperidone works better after the first few weeks. (See handouts 19a and 19b Domperidone 1 and Domperidone 2 for more information.)
 You can take fenugreek and blessed thistle together with domperidone if you feel they are helping. If you take the herbs and domperidone, take domperidone at the same time, 3 tablets three times a day.
 If you are ready to stop fenugreek and blessed thistle, you can probably stop suddenly, or wean off over a week or so.
 Fenugreek does not cause low blood sugar. Where this rumour came from is unknown.

Other herbal treatments that have been used to increase milk supply are: raspberry leaf, fennel, goat’s rue, brewer’s yeast, alfalfa and many others. The effectiveness of none of these treatments, including blessed thistle and fenugreek, has been proved. Remember! Herbal treatments are only part of the solution to “not enough milk” (see protocol to increase breastmilk intake by the baby). See also the website www.thebirthden.com/Newman.html for videos on how to latch a baby on, how to know the baby is getting milk, how to use compression, how to use a lactation aid, as well as information sheets on breastfeeding.

Lecithin

Lecithin is a food supplement that seems to help some mothers prevent blocked ducts. It may do this by decreasing the viscosity (stickiness) of the milk, by increasing the percentage of polyunsaturated fatty acids in the milk. It is safe, inexpensive, and seems to work in some cases. The dose is 1200 mg four times a day. There is more to preventing blocked ducts than taking lecithin. See handout #22 Blocked Ducts and Mastitis.

For information on “all purpose nipple ointment”, gentian violet, grapefruit seed extract, vitamin B6, nifedipine, and nitroglycerin paste, and fluconazole, see the handout Treatments for sore nipples and sore breasts #3b, or the handouts gentian violet and fluconazole.

Questions? (416) 813-5757 (option 3) or drjacknewman@sympatico.ca or my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA)

Handout #24. Miscellaneous treatments. January 2005
Written by Jack Newman, MD, FRCPC. © 2005

This handout may be copied and distributed without further permission,
on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated
Breastfeeding—Starting Out Right

Breastfeeding is the natural, physiologic way of feeding infants and young children, and human milk is the milk made specifically for human infants. Formulas made from cow’s milk or soybeans (most formulas, even “designer formulas”) are only superficially similar, and advertising which states otherwise is misleading. Breastfeeding should be easy and trouble free for most mothers. A good start helps to ensure breastfeeding is a happy experience for both mother and baby.

The vast majority of mothers are perfectly capable of breastfeeding their babies exclusively for about six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated hospital routines based on bottle feeding still predominate in too many health care institutions and make breastfeeding difficult, even impossible, for too many mothers and babies. For breastfeeding to be well and properly established, a good start in the early few days can be crucial. Admittedly, even with a terrible start, many mothers and babies manage.

The trick to breastfeeding is getting the baby to latch on well. A baby who latches on well, gets milk well. A baby who latches on poorly has more difficulty getting milk, especially if the supply is low. A poor latch is similar to giving a baby a bottle with a nipple hole that is too small—the bottle is full of milk, but the baby will not get much. When a baby is latching on poorly, he may also cause the mother nipple pain. And if he does not get milk well, he will usually stay on the breast for long periods, thus aggravating the pain. Unfortunately anyone can say that the baby is latched on well, even if he isn’t. Too many people who should know better just don’t know what a good latch is. Here are a few ways breastfeeding can be made easy:

1. A proper latch is crucial to success. This is the key to successful breastfeeding. Unfortunately, too many mothers are being "helped" by people who don’t know what a proper latch is. If you are being told your two day old’s latch is good despite your having very sore nipples, be sceptical, and ask for help from someone else who knows. Before you leave the hospital, you should be shown that your baby is latched on properly, and that he is actually getting milk from the breast and that you know how to know he is getting milk from the breast (open mouth wide—pause—close mouth type of suck). See also the website www.thebirthden.com/Newman.html for videos on how to latch a baby on (as well as other videos). If you and the baby are leaving hospital not knowing this, get experienced help quickly (see handout When Latching). Some staff in hospital will tell mothers that if the breastfeeding is painful, the latch is not good (usually true), so that the mother should take the baby off and latch him on again. This is not a good idea. The pain usually settles, and the latch should be fixed on the other side or at the next feeding. Taking the baby off the breast and latching him on again and again only multiplies the pain and the damage.

2. The baby should be at the breast immediately after birth. The vast majority of newborns can be at the breast within minutes of birth. Indeed, research has shown that, given the chance, many babies only minutes old will crawl up to the breast from the mother’s abdomen, latch on and start breastfeeding all by themselves. This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Babies who "self-attach" run into far fewer breastfeeding problems. This process does not take any effort on the mother’s part, and the excuse that it cannot be done because the mother is tired after labour is nonsense, pure and simple. Incidentally, studies have also shown that skin-to-skin contact between mothers and babies keeps the baby as warm as an incubator (see section on skin to skin contact). Incidentally, many babies do not latch on and breastfeeding during this time. Generally, this is not a problem, and there is no harm in waiting for the baby to start breastfeeding. The skin to skin contact is good for the baby and the mother even if the baby does not latch on.

3. The mother and baby should room in together. There is absolutely no medical reason for healthy mothers and babies to be separated from each other, even for short periods.
 Health facilities that have routine separations of mothers and babies after birth are years behind the times, and the reasons for the separation often have to do with letting parents know who is in control (the hospital) and who is not (the parents). Often, bogus reasons are given for separations. One example is that the baby passed meconium before birth. A baby who passes meconium and is fine a few minutes after birth will be fine and does not need to be in an incubator for several hours’ "observation".
 There is no evidence that mothers who are separated from their babies are better rested. On the contrary, they are more rested and less stressed when they are with their babies. Mothers and babies learn how to sleep in the same rhythm. Thus, when the baby starts waking for a feed, the mother is also starting to wake up naturally. This is not as tiring for the mother as being awakened from deep sleep, as she often is if the baby is elsewhere when he wakes up. If the mother is shown how to feed the baby while both are lying down side by side are better rested.
 The baby shows long before he starts crying that he is ready to feed. His breathing may change, for example. Or he may start to stretch. The mother, being in light sleep, will awaken, her milk will start to flow and the calm baby will be content to nurse. A baby who has been crying for some time before being tried on the breast may refuse to take the breast even if he is ravenous. Mothers and babies should be encouraged to sleep side by side in hospital. This is a great way for mothers to rest while the baby nurses. Breastfeeding should be relaxing, not tiring.

4. Artificial nipples should not be given to the baby. There seems to be some controversy about whether "nipple confusion" exists. Babies will take whatever gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is normally producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, the baby will tend to prefer the rapid flow method. You don’t have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don’t seem to be able to manage it. Note, it is not the baby who is confused. Nipple confusion includes a range of problems, including the baby not taking the breast as well as he could and thus not getting milk well and/or the mother getting sore nipples. Just because a baby will "take both" does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented (see handout #5 Using a Lactation Aid, and handout #8 Finger Feeding) why use an artificial nipple?

5. No restriction on length or frequency of breastfeedings. A baby who drinks well will not be on the breast for hours at a time. Thus, if he is, it is usually because he is not latching on well and not getting the milk that is available. Get help to fix the baby’s latch, and use compression to get the baby more milk (handout #15 Breast Compression). Compression works very well in the first few days to get the colostrum flowing well. This, not a pacifier, not a bottle, not taking the baby to the nursery, will help.

6. Supplements of water, sugar water, or formula are rarely needed. Most supplements could be avoided by getting the baby to take the breast properly and thus get the milk that is available. If you are being told you need to supplement without someone having observed you breastfeeding, ask for someone to help who knows what they are doing. There are rare indications for supplementation, but often supplements are suggested for the convenience of the hospital staff. If supplements are required, they should be given by lactation aid at the breast (see handout #5), not cup, finger feeding, syringe or bottle. The best supplement is your own colostrum. It can be mixed with 5% sugar water if you are not able to express much at first. Formula is hardly ever necessary in the first few days.

7. Free formula samples and formula company literature are not gifts. There is only one purpose for these "gifts" and that is to get you to use formula. It is very effective, and it is unethical marketing. If you get any from any health professional, you should be wondering about his/her knowledge of breastfeeding and his/her commitment to breastfeeding. "But I need formula because the baby is not getting enough!" Maybe, but, more likely, you weren’t given good help and the baby is simply not getting the milk that is available. Even if you need formula, nobody should be suggesting a particular brand and giving you free samples. Get good help. Formula samples are not help.

Under some circumstances, it may be impossible to start breastfeeding early. However, most “medical reasons” (maternal medication, for example) are not true reasons for stopping or delaying breastfeeding, and you are getting misinformation. Get good help. Premature babies can start breastfeeding much, much earlier than they do in many health facilities. In fact, studies are now quite definite that it is less stressful for a premature baby to breastfeed than to bottle feed. Unfortunately, too many health professionals dealing with premature babies do not seem to be aware of this.

Questions? (416) 813-5757 (option 3) or drjacknewman@sympatico.ca or my book Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA)

Handout #1. Breastfeeding—Starting Out Right. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005

This handout may be copied and distributed without further permission,
on the condition that it is not used in any context in which the WHO code on the marketing of breastmilk substitutes is violated