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Treatments for breast engorgement during lactation

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Abstract

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Background

Breast engorgement is a painful and unpleasant condition affecting large numbers of women in the early postpartum period. During a time when mothers are coping with the demands of a new baby it may be particularly distressing. Breast engorgement may inhibit the development of successful breastfeeding, lead to early breastfeeding cessation, and is associated with more serious illness, including breast infection.

Objectives

To identify the best forms of treatment for women who experience breast engorgement.

Search methods

We identified studies for inclusion through the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010).

Selection criteria

Randomised and quasi‐randomised controlled trials where treatments for breast engorgement were evaluated.

Data collection and analysis

Two review authors assessed eligibility for inclusion and carried out data extraction.

Main results

We included eight studies with 744 women. Trials examined a range of different treatments for breast engorgement: acupuncture (two studies), cabbage leaves (two studies), cold gel packs (one study), pharmacological treatments (two studies) and ultrasound (one study). For several interventions (ultrasound, cabbage leaves, and oxytocin) there was no statistically significant evidence that interventions were associated with a more rapid resolution of symptoms; in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment. There was evidence from one study that, compared with women receiving routine care, women receiving acupuncture had greater improvements in symptoms in the days following treatment, although there was no evidence of a difference between groups by six days, and the study did not have sufficient power to detect meaningful differences for other outcomes (such as breast abscess). A study examining protease complex reported findings favouring intervention groups although it is more than 40 years since the study was carried out, and we are not aware that this preparation is used in current practice. A study looking at cold packs suggested that the application of cold does not cause harm, and may be associated with improvements in symptoms, although differences between control and intervention groups at baseline mean that results are difficult to interpret.

Authors' conclusions

Allthough some interventions may be promising, there is not sufficient evidence from trials on any intervention to justify widespread implementation. More research is needed on treatments for this painful and distressing condition.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

Treatment for breast engorgement in breastfeeding women

Breast engorgement is when the breasts overfill with milk and the breasts become swollen, hard and painful. Large numbers of women experience this, usually in the first few days after giving birth, although it can also occur later on. During a time when mothers are coping with the demands of a new baby it may be particularly distressing. Breast engorgement may mean that women fail to successfully start breastfeeding, cause them to give up breastfeeding, or serious illness can result, including breast infection. The aim of the review was to examine treatments used to relieve the symptoms of breast engorgement. We included eight randomised controlled trials involving 744 women. Studies examined a range of different treatments for breast engorgement including acupuncture, cabbage leaves applied to the breasts, cold gel packs, pharmacological treatments and ultrasound. For some interventions (ultrasound, cabbage leaves, and oxytocin) there was no strong evidence that interventions led to a more rapid resolution of symptoms, as in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment. There was evidence from one study that, compared with women receiving routine care, women receiving acupuncture had greater improvements in symptoms in the days following treatment, although there was no evidence of a difference between groups by six days, and the study was not large enough to be able to detect meaningful differences for other outcomes such as breast abscess. A study looking at cold packs suggested that the application of cold to the breasts does not cause any harm and may be associated with improvements in symptoms, although differences between the control and cold pack groups before treatment started meant that results were difficult to interpret. The overall conclusions of the review are that although some interventions may be promising, there is not sufficient evidence from well designed trials on any intervention to justify widespread uptake of that intervention. More research is needed on treatments for this painful and distressing condition.