Engorgement: The Cabbage Cure

The Cabbage Cure

 © Marie Davis RN, IBCLC (used with permission)

(Instructions for the use below)

Lactation consultants frequently suggest compresses made from green cabbage leaves to reduce swelling in moderate to severe engorgement. References to cabbage compresses for swelling and engorgement date back to the early 1800's. Cabbage compresses were used to reduce the swelling in sprains and broken bones.

Research data is sparse, but published studies, and anecdotal reports support the value of cabbage compresses in reducing breast engorgement.

cabbage.pctThe common green cabbage (Brassica capitata) is used for engorgement therapy. Cabbage is known to contain sinigrin (allylisothiocyanate) rapine, mustard oil, magnesium, oxylate and sulphur heterosides. Herbalists believe that cabbage has both antibiotic and anti irritant properties. (Lawrence and Lawrence 257-258)

It is theorized, that this natural mixture of ingredients from Mother Nature's Kitchen, helps decrease tissue congestion by dilating (opening) local capillaries (small blood vessels), which improves the blood flow in and out of the area, allowing the body to reabsorb the fluid trapped in the breasts. Cabbage may also have a type of drawing, or wicking action, that helps move trapped fluid.  In many cases, science is finding cures from Mother Nature's Kitchen can't be duplicated in the laboratory.  This may be the reason why a gel made from cabbage leaf extract was not effective in treating engorgement (Ayers, 2000; Caplan, 1999; Shifer, 1995; Roberts 1&2 1995)

In addition to the engorgement seen with lactogenesis stage II, medical providers and lactation consultants are reporting what appears to be trapped fluid (edema) throughout the mother's body after her baby is born. Edema often appears in her face, hands, lower legs, and feet.  This seems to be especially true if mother is diabetic, had a large volume of I.V. fluids and/or an epidural during labor.  Lactation consultants also report a peculiar type of swelling in the breasts of some women following an epidural during labor. This type of swelling makes the areola so firm that the baby cannot compress it for an adequate latch-on.  The only logical conclusion that can be drawn from this anecdotal evidence is: if the rest of the body visibly swells with extra fluid, so do the breasts. However, we have no current research to validate this conclusion. Women diurese  (eliminate excess body fluids) in two or three days, just as the congestion in the breast increases with lactogenesis stage II, making this type swelling a potential barrier to effective breastfeeding.  In the meantime, cabbage compresses may help with some of this type of swelling.

Cabbage compresses should always be combined with other treatment routines for engorgement.  CABBAGE IS NOT RECOMMENDED FOR INDIVIDUALS WHO ARE ALLERGIC TO SULFA* OR CABBAGE. (Please see note below regarding sulfa)

Cabbage compresses should not be used if the skin is broken (i.e., cracked, bleeding or blistered nipples etc....) If the skin is broken, place the cabbage leaves around the breast, without covering irritated skin. 

No adverse effects from using cabbage compresses have been reported. ** Some literature suggests that overuse of cabbage compresses can completely “dry up” the mother’s milk supply.  To date, no one has observed this as a result of cabbage compresses. Since they appear to work directly on trapped fluid, it is highly unlikely that cabbage compresses alone can effect milk supply.

* It is unknown were the sulfa allergy precaution regarding cabbage compresses originated, or if it is a valid warning. Cabbage does contain sulfur compounds, but these are not the same as sulfa.   However, I personally, observed and recieved a number of reports of skin erruptions following the use of cabbage compresses. At least two women who were allergic to sulfa, reacted to cabbage compresses with localized hives.  I am reluctant to discontinue the precaution.

If mom is allergic to sulfa, I recommend a patch test, prior to using cabbage compresses on her breasts:

Take a small amount of crushed fresh cabbage, put it on the delicate skin of the forearm, and wrap something around it to keep it in place. If there is no reaction in 1 to 2 hours, you can assume that mom will not react to the cabbage.

**If you experience ANY negative reaction(s) to the cabbage compresses, please email me with the details. Reactions should be well documented for future reference in lactation practice.

Instructions: How to use of cabbage leaf compresses

  1. Purchase a head of common green cabbage at the grocery store.
  2. Remove the core and gently peel individual leaves away from the center of the head pulling outward. Try to avoid tearing the leaves, but it's OK if they shred a little.
  3. Thoroughly wash the leaves.
  4. Leaves can be chilled in the refrigerator for extra benefits. Cool compresses tend to relieve swelling more effectively than warm compresses. Some women find that crushed ice placed over the cabbage leaves also helps. ***
  5. Just before use, crush the veins in the leaf with a rolling pin (or similar object), or slice off the tops of the "veins" with a sharp knife.
  6. Drape several leaves over each breast. Use enough to cover ALL the engorged tissue, including any swollen tissue under your arms.
  7. Leave the compress on until the leaves become wilted, about 20 to 30 minutes. (See Joan Fisher's tips below.)
  8. Repeat application of cabbage leaves three or four times (about every 4 to 6 hours) per 24 hours, until engorgement subsides (usually in 1 or 2 days).  If the engorgement is severe, compresses can be used as often as needed.
  9. For the mother who is not breastfeeding, continuous cabbage compresses can also be used to help reduce the swelling in her breasts.
  10. 10. Discontinue direct use immediately if skin breaks out, blisters, or becomes irritated. (Should this happen, please email me the details.)
  11. Place the leaves so they do not touch any already irritated areas, or broken skin.

***It is important to note: Some cultures strongly believe that placing anything cold or cool on the breast ruins the milk, and some believe that any cold exposure of a mother’s chest, ruins the milk, forever. These are merely cultural beliefs and have no basis in scientific fact. However, professionals need to be aware of these beliefs and respect the mother’s choices. If necessary, cabbage leaves could be placed on the breast at room temperature to see if they benefit the mother’s comfort and engorgement levels.

Here are some great tips about using cabbage leaves from Joan Fisher that differ slightly from my own:

  1. Put fresh cabbage leaves on after each feeding and leave them on until the next feed.
  2. Discontinue use when the leaves are no longer coming off the breast limp with beads of water on them. [Joan says, "The moms say the cabbage leaves tell them when they don't need them anymore."]
  3. Don't worry that the cabbage leaves will reduce your milk supply - they act on the fluid in the interstitial spaces (or the spaces between the cells where the swelling actually is) and does not affect the milk in the ducts. As long as mom continues regular milk removal by feeding or pumping she will continue to make milk.

Currently, I believe because more people than ever before are using cabbage leaves for treatment of engorgement, lactation consultants are gaining further clinical experience using them. Initial isolated reports of cabbage leaves completely drying up a mother's milk were wrong and perhaps a bit over cautious. We know that milk will continue to be made as long as milk is removed from the breast. That is why it is critical that cabbage leaf compresses be used along with other engorgement measures. I have found old references regarding the use of cabbage leaves for all types of swelling not related to the breast. I am convinced that the cabbage leaves themselves work only on the trapped fluid around the lactating tissue and not the milk volume in the ducts.

Some additional anecdotal remarks: I have used cabbage compresses for my family and friends on everything from sprained ankles, to wrists, and even after my daughter had 4 impacted wisdom teeth surgically removed. When we ran out on the second day, she begged me to get more cabbage. According to her, the cabbage helped so much with the pain; she didn't need the pain pills the doctor prescribed.  She also said just using an ice pack made her jaw hurt worse.  When I told the dentist, he laughed, until he saw how little swelling and bruising she had 3 days after the surgery. He's a cabbage convert :-) The dentist now recommends cabbage leaves to all his patients. He told me his clients all say how good the cabbage feels. Furthermore, he confirmed if the patient uses the cabbage compresses after the procedure, he sees very little swelling and bruising, compared to patients using traditional ice packs.

Recently, following my daughter’s arthroscopic knee surgery, we turned to cabbage compresses to help with persistent swelling, According to her; it worked as well, if not better, than the circulating ice water pad that the doctor prescribed.  We regretted that we hadn’t thought of it sooner. Perhaps the initial swelling would not have been as severe

More scientific study is needed before we can objectively say that cabbage compresses work better than other methods for reducing swelling.

Joan Fisher is a lactation consultant in Canada. [References]

Works Cited

Ayers, J. F. (2000). The Use of Alternative Therapies in the Support of Breastfeeding. Journal of Human Lactation , 16, 52-56.

Caplan, L. M. (1999). Drawing Action of Cabbage Leaves (A letter to the editor). Journal of Human Lactation , 15, 4.

Lawrence, R. A. (1999). Breastfeeding: A Guide for the Medical Profession, 5th ed. New York, NY: C.V Mosby.

Nikodem, V. ,. (1993). Do Cabbage Leaves Prevent Engorgement? A randomized Study. BIrth (20), 61-64.

Roberts, K. R. (1995). A Comparison of Chilled Cabbage Leaves and Chilled Gelpacks in Reducing Breast Engorgement. Journal of Human Lactation , 11, 17-20.

Rosier, W. (1988). Cool Cabbage Compresses. Breastfeeding Review , 12 (1), 28-37.

Shifer, P. (1995). Cabbage Leaf Enzymes (letter to the Editor). Journal of Human Lactation (11), 264-.

Siegel, J. (1994, Nov 26). Cabbage Soothes the Savage Breast. Jerusalem Post .

Smith, M. K. (2000, Jan). New Perspectives on Engorgement . LEAVEN , Vol. 35 No. 6, December 1999-January 2000, pp. 134-36


Copyright Marie Davis RN, IBCLC 1999 
Revised:  June 10,2014 

reviewed: Wednesday, June 11, 2014