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. 2020 Sep 18;9(9):CD006946.
doi: 10.1002/14651858.CD006946.pub4.

Treatments for breast engorgement during lactation

Irena Zakarija-Grkovic  1 , Fiona Stewart  2
Affiliations

Treatments for breast engorgement during lactation

Irena Zakarija-Grkovic et al. Cochrane Database Syst Rev. .

Abstract

Background: Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. Various treatments have been studied but little consistent evidence has been found on effective interventions.

Objectives: To determine the effectiveness and safety of different treatments for engorgement in breastfeeding women.

Search methods: On 2 October 2019, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies.

Selection criteria: All types of randomised controlled trials and all forms of treatment for breast engorgement were eligible.

Data collection and analysis: Two review authors independently assessed trials for eligibility, extracted data, conducted 'Risk of bias' assessment and assessed the certainty of evidence using GRADE.

Main results: For this udpate, we included 21 studies (2170 women randomised) conducted in a variety of settings. Six studies used individual breasts as the unit of analysis. Trials examined a range of interventions: cabbage leaves, various herbal compresses (ginger, cactus and aloe, hollyhock), massage (manual, electromechanical, Oketani), acupuncture, ultrasound, acupressure, scraping therapy, cold packs, and medical treatments (serrapeptase, protease, oxytocin). Due to heterogeneity, meta-analysis was not possible and data were reported from single trials. Certainty of evidence was downgraded for limitations in study design, imprecision and for inconsistency of effects. We report here findings from key comparisons. Cabbage leaf treatments compared to control For breast pain, cold cabbage leaves may be more effective than routine care (mean difference (MD) -1.03 points on 0-10 visual analogue scale (VAS), 95% confidence intervals (CI) -1.53 to -0.53; 152 women; very low-certainty evidence) or cold gel packs (-0.63 VAS points, 95% CI -1.09 to -0.17; 152 women; very low-certainty evidence), although the evidence is very uncertain. We are uncertain about cold cabbage leaves compared to room temperature cabbage leaves, room temperature cabbage leaves compared to hot water bag, and cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. For breast hardness, cold cabbage leaves may be more effective than routine care (MD -0.58 VAS points, 95% CI -0.82 to -0.34; 152 women; low-certainty evidence). We are uncertain about cold cabbage leaves compared to cold gel packs because the CIs were wide and included no effect. For breast engorgement, room temperature cabbage leaves may be more effective than a hot water bag (MD -1.16 points on 1-6 scale, 95% CI -1.36 to -0.96; 63 women; very low-certainty evidence). We are uncertain about cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. More women were satisfied with cold cabbage leaves than with routine care (risk ratio (RR) 1.42, 95% CI 1.22 to 1.64; 152 women; low certainty), or with cold gel packs (RR 1.23, 95% CI 1.10 to 1.38; 152 women; low-certainty evidence). We are uncertain if women breastfeed longer following treatment with cold cabbage leaves than routine care because CIs were wide and included no effect. Breast swelling and adverse events were not reported. Compress treatments compared to control For breast pain, herbal compress may be more effective than hot compress (MD -1.80 VAS points, 95% CI -2.07 to -1.53; 500 women; low-certainty evidence). Massage therapy plus cactus and aloe compress may be more effective than massage therapy alone (MD -1.27 VAS points, 95% CI -1.75 to -0.79; 100 women; low-certainty evidence). In a comparison of cactus and aloe compress to massage therapy, the CIs were wide and included no effect. For breast hardness, cactus and aloe cold compress may be more effective than massage (RR 0.66, 95% CI 0.51 to 0.87; 102 women; low-certainty evidence). Massage plus cactus and aloe cold compress may reduce the risk of breast hardness compared to massage alone (RR 0.38, 95% CI 0.25 to 0.58; 100 women; low-certainty evidence). We are uncertain about the effects of compress treatments on breast engorgement and cessation of breastfeeding because the certainty of evidence was very low. Among women receiving herbal compress treatment, 2/250 experienced skin irritation compared to 0/250 in the hot compress group (moderate-certainty evidence). Breast swelling and women's opinion of treatment were not reported. Medical treatments compared to placebo Protease may reduce breast pain (RR 0.17, 95% CI 0.04, 0.74; low-certainty evidence; 59 women) and breast swelling (RR 0.34, 95% CI 0.15 to 0.79; 59 women; low-certainty evidence), whereas serrapeptase may reduce the risk of engorgement compared to placebo (RR 0.36, 95% CI 0.14 to 0.88; 59 women; low-certainty evidence). We are uncertain if serrapeptase reduces breast pain or swelling, or if oxytocin reduces breast engorgement compared to placebo, because the CIs were wide and included no effect. No women experienced adverse events in any of the groups receiving serrapeptase, protease or placebo (low-certainty evidence). Breast induration/hardness, women's opinion of treatment and breastfeeding cessation were not reported. Cold gel packs compared to control For breast pain, we are uncertain about the effectiveness of cold gel packs compared to control treatments because the certainty of evidence was very low. For breast hardness, cold gel packs may be more effective than routine care (MD -0.34 points on 1-6 scale, 95% CI -0.60 to -0.08; 151 women; low-certainty evidence). It is uncertain if women breastfeed longer following cold gel pack treatment compared to routine care because the CIs were wide and included no effect. There may be little difference in women's satisfaction with cold gel packs compared to routine care (RR 1.17, 95% CI 0.97 to 1.40; 151 women; low-certainty evidence). Breast swelling, engorgement and adverse events were not reported.

Authors' conclusions: Although some interventions may be promising for the treatment of breast engorgement, such as cabbage leaves, cold gel packs, herbal compresses, and massage, the certainty of evidence is low and we cannot draw robust conclusions about their true effects. Future trials should aim to include larger sample sizes, using women - not individual breasts - as units of analysis.

Trial registration: ClinicalTrials.gov NCT03230760 NCT03985579.

PubMed Disclaimer

Conflict of interest statement

Irena Zakarija‐Grkovic: Irena is an International Board Certified Lactation Consultant, member of the Academy of Breastfeeding Medicine and a member of the International Advisory Council of the World Alliance for Breastfeeding Action.

Fiona Stewart: none.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Cabbage leaf treatments versus other treatments/placebo, Outcome 1: Breast pain (0‐10 VAS; higher score = more pain)
1.2
1.2. Analysis
Comparison 1: Cabbage leaf treatments versus other treatments/placebo, Outcome 2: Breast hardness (higher score = more hardness)
1.3
1.3. Analysis
Comparison 1: Cabbage leaf treatments versus other treatments/placebo, Outcome 3: Breast engorgement (measured with 6‐point engorgement scale)
1.4
1.4. Analysis
Comparison 1: Cabbage leaf treatments versus other treatments/placebo, Outcome 4: Maternal opinion of treatment: women satisfied or very satisfied
1.5
1.5. Analysis
Comparison 1: Cabbage leaf treatments versus other treatments/placebo, Outcome 5: Cessation of breastfeeding before six months
2.1
2.1. Analysis
Comparison 2: Compress treatments versus other treatments/routine care, Outcome 1: Breast pain (higher score = more pain)
2.2
2.2. Analysis
Comparison 2: Compress treatments versus other treatments/routine care, Outcome 2: Number of women with moderate or severe breast induration/hardness
2.3
2.3. Analysis
Comparison 2: Compress treatments versus other treatments/routine care, Outcome 3: Breast engorgement (higher score = more pain)
2.4
2.4. Analysis
Comparison 2: Compress treatments versus other treatments/routine care, Outcome 4: Cessation of breastfeeding
2.5
2.5. Analysis
Comparison 2: Compress treatments versus other treatments/routine care, Outcome 5: Number of women with adverse effects
3.1
3.1. Analysis
Comparison 3: Medical treatment versus placebo, Outcome 1: Breast swelling (no improvement)
3.2
3.2. Analysis
Comparison 3: Medical treatment versus placebo, Outcome 2: Breast engorgement (symptoms not subsided after three days of treatment)
3.3
3.3. Analysis
Comparison 3: Medical treatment versus placebo, Outcome 3: Breast pain (no improvement)
4.1
4.1. Analysis
Comparison 4: Cold gel packs versus routine care, Outcome 1: Breast pain (higher score = more pain)
4.2
4.2. Analysis
Comparison 4: Cold gel packs versus routine care, Outcome 2: Breast hardness (higher score = more hardness)
4.3
4.3. Analysis
Comparison 4: Cold gel packs versus routine care, Outcome 3: Maternal opinion of treatment: women satisfied or very satisfied
4.4
4.4. Analysis
Comparison 4: Cold gel packs versus routine care, Outcome 4: Cessation of breastfeeding before six months
5.1
5.1. Analysis
Comparison 5: Massage‐based therapies versus other treatments/routine care, Outcome 1: Breast pain (higher score = more pain)
5.2
5.2. Analysis
Comparison 5: Massage‐based therapies versus other treatments/routine care, Outcome 2: Number of women with moderate or severe breast induration/hardness
5.3
5.3. Analysis
Comparison 5: Massage‐based therapies versus other treatments/routine care, Outcome 3: Cessation of breastfeeding
6.1
6.1. Analysis
Comparison 6: Other treatments versus other treatments/advice/routine care, Outcome 1: Breast pain (0‐10 VAS; higher score = more pain)
6.2
6.2. Analysis
Comparison 6: Other treatments versus other treatments/advice/routine care, Outcome 2: Breast engorgement (0‐10 VAS; higher score = more pain)
6.3
6.3. Analysis
Comparison 6: Other treatments versus other treatments/advice/routine care, Outcome 3: Breast engorgement
6.4
6.4. Analysis
Comparison 6: Other treatments versus other treatments/advice/routine care, Outcome 4: Cessation of breastfeeding within 6 weeks
6.5
6.5. Analysis
Comparison 6: Other treatments versus other treatments/advice/routine care, Outcome 5: Pyrexia
6.6
6.6. Analysis
Comparison 6: Other treatments versus other treatments/advice/routine care, Outcome 6: Breast abscess
7.1
7.1. Analysis
Comparison 7: Ultrasound versus sham ultrasound, Outcome 1: Analgesic requirement
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Batista 2014 {published data only}
    1. Batista dos Santos HA, Muniz de Moura MA, De Souza MA, Nohama P. Evaluation of massage techniques and pumping in the treatment of breast engorgement by thermography [Evaluacion de las tecnicas de masaje y bombeo en el tratamiento de la congestion mamaria por termografia]. Revista Latino-Americana de Enfermagem (RLAE) 2014;22(2):277-85. - PMC - PubMed
Chiu 2010 {published data only}
    1. Chiu JY, Gau ML, Kuo SY, Chang YH, Kuo SC, Tu HC. Effects of Gua-Sha therapy on breast engorgement: a randomized controlled trial. Journal of Nursing Research 2010;18(1):1-10. - PubMed
Dehghani 2017 {published data only}
    1. Dehghani M, Babazadeh R, Khadivzadeh T, Pourhoseini SA, Esmaeili H. Effect of breast oketani-massage on neonatal weight gain: a randomized controlled clinical trial. Evidence Based Care Journal 2018;8(3):57-63.
    1. Dehghani M, Babazadeh R, Khadivzadeh T, Pourhoseini SA, Esmaeili H. Effect of breast oketani-massage on the severity of breast engorgement. Iranian Journal of Obstetrics, Gynecology and Infertility 2017;20(5):30-8.
    1. IRCT2016062728669N1. The effect of breast oketani massage on breast engorgement and neonate weight gain. en.irct.ir/trial/23201 (first received 8 September 2016).
Ingelman‐Sundberg 1953 {published data only}
    1. Ingelman-Sundberg A. Early puerperal breast engorgement. Acta Paediatrica Scandinavica 1953;32:399-402. - PubMed
Kamali Moradzade 2013 {published data only}
    1. IRCT201204065698N3. The comparison of acupressure (jianjing point) and compress (hot and cold) on breast engorgement in lactating women. irct.ir/trial/6220 (first received 6 June 2012).
    1. Kamali Moradzade M, Ahmadi M, Heshmat R, Akbarzade Baghban AR. Comparing the effect of acupressure and intermittent compress on the severity of breast hyperemia in lactating women. Quarterly of the Horizon of Medical Sciences 2013;18(4):155-60.
Kee 1989 {published data only}
    1. Kee WH, Tan SL, Lee V, Samon YM. The treatment of breast engorgement with serrapeptase (Danzen): a randomized double-blind controlled trial. Singapore Medical Journal 1989;30(1):48-54. - PubMed
    1. Tan SL, Kee WH, Lee V, Salmon YM. The use of serratiopeptidase (Danzen) for the treatment of breast engorgement - a randomised double-blind controlled trial. In: 24th British Congress of Obstetrics and Gynaecology;1986 April 15-18; Cardiff, UK. 1986:246.
Ketsuwan 2018 {published data only}
    1. Ketsuwan S, Baiya N, Paritakul P, Laosooksathit W, Puapornpong P. Effect of herbal compresses for maternal breast engorgement at postpartum: a randomized controlled trial. Breastfeeding Medicine 2018;13(5):361-5. - PubMed
    1. TCTR20180208002. Effect of herbal compress on maternal breast engorgement at postpartum, a randomized controlled trial. www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&amp... (first received 8 February 2018).
Khosravan 2017 {published data only}
    1. IRCT2014051917754N1. The effects of Althaea officinalis L leaf compress accompanied by cold & hot compresses on breast engorgement among lactating women: a randomized clinical trial. irct.ir/trial/16244 (first received 14 July 2014).
    1. Khosravan S, Moghadam HM, Mohamadzade F, Gholami M, Fadafen SAK. Effects of hollyhock leaves compress with cold and hot compress on breast congestion in lactating women. Avicenna Journal of Phytomedicine 2015;5(Suppl 1):6-7.
    1. Khosravan S, Mohammadzadeh-Moghadam H, Mohammadzadeh F, Fadafen SA, Gholami M. The effect of hollyhock (Althaea officinalis L) leaf compresses combined with warm and cold compress on breast engorgement in lactating women: a randomized clinical trial. Journal of Evidence-Based Complementary & Alternative Medicine 2017;22(1):25-30. - PMC - PubMed
Kumari 2019 {published data only}
    1. Kumari R. Effectiveness of green cabbage leaves (GCL) vs hot water bag (HWB) application on breast engorgement in postnatal mothers. International Journal of Nursing Education 2019;11(3):39-44.
Kvist 2004 {published data only}
    1. Kvist LJ, Wilde Larsson B, Hall-Lord ML, Rydhstroem H. Effects of acupuncture and care interventions on the outcome of inflammatory symptoms of the breast in lactating women. International Nursing Review 2004;51(1):56-64. - PubMed
Kvist 2007 {published data only}
    1. Kvist LJ, Hall-Lord ML, Rydhstroem H, Larsson BW. A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation. Midwifery 2007;23:184-95. - PubMed
McLachlan 1991 {published data only}
    1. McLachlan Z, Milne EJ, Lumley J, Walker BL. Ultrasound treatment for breast engorgement: a randomised double blind trial. Australian Journal of Physiotherapy 1991;37(1):23-9. - PubMed
    1. McLachlan Z, Milne EJ, Lumley J, Walker BL. Ultrasound treatment for breast engorgement: a randomised double blind trial. Breastfeeding Review 1993;2(7):316-20. - PubMed
    1. McLachlan Z, Milne J, Lumley J. The efficacy of ultrasound as a treatment for severe breast engorgement. In: Tenth International Congress World Confederation for Physical Therapy; 1987 May 17-22; Sydney, Australia. 1987:342-6.
Meng 2015 {published data only}
    1. Meng S, Deng Q, Feng C, Pan Y, Chang Q. Effects of massage treatment combined with topical cactus and aloe on puerperal milk stasis. Breast Disease 2015;35(3):173-8. - PubMed
Monazzami 2019 {published data only}
    1. IRCT20180508039585N1. The effect of ginger compress on breast engorgement in lactating women. irct.ir/trial/31056 (first received 15 May 2018).
    1. Monazzami M, Yousefzadah S, Rakhshandeh H, Esmaeili H, Afiat M. The effect of hot ginger compress (zingiber officinale) on the severity of breast engorgement in lactating women. Iranian Journal of Obstetrics, Gynecology and Infertility 2019;21(12):77-84.
Murata 1965 {published data only}
    1. Murata T, Hanzawa M, Nomura Y. The clinical effects of "Protease complex" on postpartum breast engorgement (based on the double blind method). Journal of Japanese Obstetrical and Gynecological Society 1965;12(3):139-47. - PubMed
Roberts 1995a {published data only}
    1. Roberts KL. A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement. Journal of Human Lactation 1995;11(1):17-20. - PubMed
Roberts 1995b {published data only}
    1. Roberts KL, Reiter M, Schuster D. A comparison of chilled and room temperature cabbage leaves in treating breast engorgement. Journal of Human Lactation 1995;11:191-4. - PubMed
Roberts 1998 {published data only}
    1. Roberts KL, Reiter M, Schuster D. Effects of cabbage leaf extract on breast engorgement. Journal of Human Lactation 1998;14(3):231-6. - PubMed
Robson 1990 {published data only}
    1. Robson BA. Breast Engorgement in Breastfeeding Mothers [thesis]. Case Western Reserve University, 1990.
Sankanagoudar 2011 {published data only}
    1. Sankanagoudar PP, Patil C, Singed K. Effect of therapeutic non-thermal ultrasound on post-partum symptomatic breast engorgement. Indian Journal of Physiotherapy & Occupational Therapy 2011;5(2):108-13.
Wong 2017 {published data only}
    1. Wong BB, Chan YH, Leow MQH, Lu Y, Chong YS, Koh SSL, et al. Application of cabbage leaves compared to gel packs for mothers with breast engorgement: randomised controlled trial. International Journal of Nursing Studies 2017;76:92-9. - PubMed

References to studies excluded from this review

Booker 1970 {published data only}
    1. Booker DE, Pahl IR, Forbes DA. Control of postpartum breast engorgement with oral contraceptives II. American Journal of Obstetrics and Gynecology 1970;108:240-2. - PubMed
Filteau 1999 {published data only}
    1. Filteau SM, Lietz G, Mulokozi G, Bilotta S, Henry CJ, Tomkins AM. Milk cytokines and subclinical breast inflammation in Tanzanian women: effects of dietary red palm oil or sunflower oil supplementation. Immunology 1999;97:595-600. - PMC - PubMed
Gao 2018 {published data only}
    1. Gao H, Ma X, He X, Guo Y, Ding S, Yun Z, et al. Clinical study on ductal probing in treating milk stasis. Chinese Journal of Breast Disease 2018;12(3):155-9. [CENTRAL: CN-02054319]
    1. Gao H, Wang J. Study on the ductal probing of treating the milk stasis. Breastfeeding Medicine 2016;11(Suppl 1):S-12. [CENTRAL: CN-02054320]
Garry 1956 {published data only}
    1. Garry J. Estrogen-androgen preparation for prevention of postpartum breast engorgement and lactation. Obstetrics & Gynecology 1956;7:422-4. - PubMed
KCT0002436 {published data only}
    1. KCT0002436. Randomised controlled trials of myofascial release massage on breastfeeding mothers’ pectoralis major muscle for breast pain and engorgement and newborns’ breast milk intake and sleeping time. cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=8262 (first received 1 September 2017).
King 1958 {published data only}
    1. King AG. Prevention of puerperal breast engorgement with large doses of long-acting estrogen. American Journal of Obstetrics and Gynecology 1958;78:80-5. - PubMed
NCT032307602017 {published data only}
    1. NCT03230760. Acupuncture for breast engorgement during lactation: a pilot study. //clinicaltrials.gov/ct2/show/NCT03230760 (first received 26 July 2017).
Nikodem 1993 {published data only}
    1. Danziger D, Gebka N, Nikodem C, Gulmezoglu M, Hofmeyr GJ. Do cabbage leaves prevent breast engorgement? Randomised, controlled study. In: 12th Conference on Priorities in Perinatal Care; 1993; South Africa. 1993:114-6.
    1. Nikodem VC, Danziger D, Gebka N, Gulmezoglu AM, Hofmeyr GJ. Do cabbage leaves prevent breast engorgement? a randomized, controlled study. Birth 1993;20(2):61-4. - PubMed
Phillips 1975 {published data only}
    1. Phillips WP. Prevention of postpartum breast engorgement: double-blind comparison of chlorotrianisene 72 mg and placebo. Journal of the Arkansas Medical Society 1975;72:163-7. - PubMed
Roser 1966 {published data only}
    1. Roser DM. Breast engorgement and postpartum fever. Obstetrics & Gynecology 1966;27:73-7. - PubMed
Ryan 1962 {published data only}
    1. Ryan GM Jr, Brown DAJ. Intranasal syntocinon and postpartum breast engorgement. Obstetrics & Gynecology 1962;20:582-4. - PubMed
Stenchever 1962 {published data only}
    1. Stenchever MA. Evaluation of chlorprophenpyridamine for prevention of postpartum breast engorgement. American Journal of Obstetrics and Gynecology 1962;840:969-71. - PubMed

References to ongoing studies

IRCT2017062633812N2 {published data only}
    1. IRCT2017062633812N2. Investigating the effect of Commiphora mukul cream on improvement of breast engorgement of women referred to the health center of Kerman University of Medical Science in 2015-2016. //irct.ir/trial/25990 (first received 19 July 2017).
IRCT20190608043838N1 {published data only}
    1. IRCT20190608043838N1. The effect of foot reflexology on the breast engorgement lactating mothers. //irct.ir/trial/40071 (first received 19 June 2019).
NCT03985579 {published data only}
    1. NCT03985579. Influence of kinesiology taping application on severity of signs and symptoms in breast engorgement. //clinicaltrials.gov/ct2/show/NCT03985579 (first received 13 June 2019).
TCTR20181123001 {published data only}
    1. TCTR20181123001. Continuous ultrasound diathermy combined with conventional therapies versus conventional therapies alone for breast engorgement in postpartum lactating women: a randomized controlled study. www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&amp... (first received 8 November 2018).

Additional references

ABM 2016
    1. Berens P, Brodribb W. ABM Clinical Protocol #20: Engorgement, Revised 2016. Breastfeeding Medicine 2016;11(4):159-63. - PMC - PubMed
Acarturk 2005
    1. Acarturk S, Gensel E, Tuncer I. An uncommon complication of secondary augmentation mammoplasty: bilaterally massive engorgement of breasts after pregnancy attributable to postinfection and blockage of mammary ducts. Aesthetic Plastic Surgery 2005;29(4):274-9. - PubMed
Carletti 2011
    1. Carletti C, Pani P, Knowles A, Monasta L, Montico M, Cattaneo A. Breastfeeding to 24 months of age in the northeast of Italy: a cohort study. Breastfeeding Medicine 2011;6(4):177-82. - PubMed
Core Curriculum 2013
    1. Mannel R, Martens PJ, Walker M. Core Curriculum for Lactation Consultant Practice. 3rd edition. Burlington: Jones & Bartlett Learning, 2013.
Cotterman 2004
    1. Cotterman KJ. Reverse pressure softening: a simple tool to prepare areola for easier latching during engorgement. Journal of Human Lactation 2004;20(2):227-37. - PubMed
Foda 2004
    1. Foda MI, Kawashima T, Nakamura S, Kobayashi M, Oku T. Composition of milk obtained from unmassaged versus massaged breasts of lactating mothers. Journal of Pediatric Gastroenterology and Nutrition 2004;38:484-7. - PubMed
Giugliani 2004
    1. Giugliani ER. Common problems during lactation and their management. Jornal de Pediatria 2004;80(5 Suppl):S147-54. - PubMed
Hale 2007
    1. Hale TW, Hartmann PE. Chapter 7: Hormonal control of the lactation cycle. In: Textbook of Human Lactation. 1st edition. Amarillo: Hale Publishing, 2007.
Hauck 2011
    1. Hauck YL, Fenwick J, Dhaliwal SS, Butt J. A Western Australian survey of breastfeeding initiation, prevalence and early cessation patterns. Maternal Child Health Journal 2011;15(2):260-8. - PubMed
Higgins 2019
    1. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 6 (updated July 2019). Cochrane 2019. www.training.cochrane.org/handbook.
Hill 1994
    1. Hill PD, Humenick SS. The occurrence of breast engorgement. Journal of Human Lactation 1994;10(2):79-86. - PubMed
Humenick 1994
    1. Humenick SS, Hill PD, Anderson MA. Breast engorgement: patterns and selected outcomes. Journal of Human Lactation 1994;10(2):87-93. - PubMed
Hure 2013
    1. Hure AJ, Powers JR, Chojenta CL, Byles JE, Loxton D. Poor adherence to national and international breastfeeding duration targets in an Australian longitudinal cohort. PLOS One 2013;8(1):e54409. - PMC - PubMed
Lauche 2016
    1. Lauche R, Gräf N, Cramer H, Al-Abtah J, Dobos G, Saha FJ. Efficacy of cabbage leaf wraps in the treatment of symptomatic osteoarthritis of the knee. Clinical Journal of Pain 2016;11:961-71. - PubMed
Liu 2013
    1. Liu P, Qiao L, Xu F, Zhang M, Wang Y, Binns C. Factors associated with breastfeeding duration: a 30-month cohort study in northwest China. Journal of Human Lactation 2013;29(2):253-9. - PubMed
Mass 2004
    1. Mass M. Breast pain: engorgement, nipple pain and mastitis. Clinical Obstetrics and Gynecology 2004;47(3):676-82. - PubMed
NICE 2006
    1. Demott K, Bick D, Norman R, Ritchie G, Turnbull N, Adams C, et al. Clinical Guidelines and Evidence Review for Postnatal Care: Routine Postnatal Care of Recently Delivered Women and Their Babies. London: National Collaborating Centre For Primary Care And Royal College Of General Practitioners, 2006.
Odom 2013
    1. Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics 2013;131(3):e726-32. - PMC - PubMed
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
WHO 2003
    1. World Health Organization. Global Strategy for Infant and Young Child Feeding. Geneva: WHO, 2003.

References to other published versions of this review

Mangesi 2010
    1. Mangesi L, Dowswell T. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No: CD006946. [DOI: 10.1002/14651858.CD006946.pub2] - DOI - PMC - PubMed
Mangesi 2016
    1. Mangesi L, Zakarija‐Grkovic I. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No: CD006946. [DOI: 10.1002/14651858.CD006946.pub3] - DOI - PMC - PubMed
Snowden 2001
    1. Snowden HHM, Renfrew MJ, Woolridge M. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No: CD000046. [DOI: 10.1002/14651858.CD000046.pub2] - DOI - PubMed

Publication types

Associated data