Cabbage Leaves Don’t Deliver Promised Benefit for Mothers

Breast engorgement in lactating women is recognized as a common phenomenon, especially during the immediate postpartum period. It is especially common when the timing of breastfeeding is limited, the infant has difficulty latching on or sucking, or the mother is separated from her newborn (Mangesi and Zakarija-Grkovic 2016). These situations may result in incomplete emptying and engorgement of the breasts, which in turn increases the probability of pain, inflammation, frank mastitis, sore and cracked nipples, and even abscess formation (Berens 2015).

Despite multidimensional advances in clinical obstetrical and lactation specialties, the problem remains significant and consistent, and effective management continues to be elusive. One report (Hill and Humenick 1994) broadly estimated that breast engorgement affected up to 50% of all postpartum women with erythema, pain, pyrexia, tension, and resistance in breast tissue. A Swedish study (Kvist et al. 2004) put the incidence at 75% of women through 8 weeks postpartum. And it was reported in 2008 that almost 37% of women reported feeling that their breasts were overly full sometime during the first two weeks following delivery (DNPAO 2009).

Scores of therapeutic approaches have been described by groups around the world. Interventions include various approaches to milk removal, antibiotics, warm or cold packs, compression, acupuncture, massage, scraping, subcutaneous oxytocin and protease, and cabbage leaf or hollyhock leaf application. What is truly remarkable are the cross-cultural uses and recommendations in virtually every review on the subject of the topical use of cabbage leaves.

As far back as 1993, one group (Nikodem et al. 1993) differentiated between physiologic and pathologic breast engorgement. The physiologic condition was defined as normal hormone-induced lymphatic and vascular congestion combined with increased volumes of milk that resolves with nursing of the infant. Pathologic engorgement occurs when the milk is not effectively removed, which leads to very painful, swollen, erythematous, and hard breasts with suppression of milk production and vulnerability to infection. Cold cabbage leaf application to the breasts was viewed as beneficial although the postulated mechanism was viewed as “mediated by psychological mechanisms,” i.e., proactive involvement and expectation of success.

Two studies (Roberts 1995, Roberts et al. 1995) looked at cabbage leaves versus chilled gel packs and cabbage leaves chilled and at room temperature. These studies indicated essentially no difference on any outcome measure; any improvement was attributed to the placebo effect. The same group in follow-up found no differences in breast engorgement dimensions or pain between topical cabbage leaf extract and placebo (Roberts et al. 1998).

Recently, Lim et al. (2015) studied the effects of cabbage compresses and reported significantly less breast hardness compared with other conservative interventions. These authors viewed cabbage wraps as a potentially valuable adjunct in managing pain in primiparous women following cesarean birth. A similar study (Khosravan et al. 2015) found that hollyhock leaf compresses combined with other routine interventions were associated with improvements in engorgement.

Interspersed throughout the literature are speculations that chilled cabbage leaves contain a compound that is absorbed transdermally and that may reduce edema. However, there is no published or clinical evidence to support this hypothesis. Cold temperatures and compression alone are also hypothesized in virtually all reports as helpful, and cabbage leaves as vehicles for these factors may contribute to an effect. The clinical reality appears to be that most women experience improvement with time and supportive care and resumption of nursing, regardless of specific intervention (Berens 2015).

The available research was characterized in the single Cochrane Library systematic review (Mangesi and Zakarija-Grkovic 2016) as poor. This conclusion was attributed to flawed study design and the small number of subjects. The review concluded that some interventions are associated with improvement of engorgement, but there is “insufficient evidence” from any published trial to justify implementing any particular intervention.

Cabbage wraps to reduce postpartum breast engorgement appear to be popular among women participating in the U.S. Dept. of Agriculture–sponsored WIC program. The clinical evidence of this practice does not support such a practice. Hence, this marks another practice embroiled in myth rather than a practical clinical intervention. Cabbage may contain a spectrum of nutrients, yet its topical application to alleviate the common presentation of breast engorgement is without foundation.

Roger Clemens, DrPH, CFS, Contributing Editor
Adjunct Professor, Univ. of Southern California School of Pharmacy,
Los Angeles, Calif.
[email protected]