Remarks

• In making this recommendation, the Guideline Development Group acknowledged that the evidence was insufficient to conclude on the added value of cabbage-leaf cream, cold cabbage leaves, cold gel packs, warm herbal compress and breast massage over usual breastfeeding counselling and support for the treatment of breast engorgement during breastfeeding, which were often incorporated into the control arms of the trials evaluated.
• Some women may find that the non-pharmacological interventions evaluated relieve breast pain and hardness and may choose to use these methods. Women should be informed that it is unclear whether these treatment options for breast engorgement have adverse effects, due to a paucity of data.
• In this context, responsive breastfeeding (63, 64) refers to the mother responding to her baby’s cues, as well as her own desire to breastfeed. Responsive feeding is distinct from demand feeding, as it recognizes the reciprocal mother–baby relationship and benefits of breastfeeding beyond the alleviation of hunger.
• All women should be advised of common breast conditions associated with lactation, such as sore or cracked nipples, engorgement and mastitis, and encouraged to report any signs and symptoms to their care providers.