RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

MRS. VIJAYALAXMI
I YEAR M. SC NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
YEAR 2012-2014

H.K.E.S. COLLEGE OF NURSING

SEDAM ROAD

GULBARGA-585105

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 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE-II

SYNOPSIS PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE MRS. VIJAYALAXMI
CANDIDATE AND HKES. COLLEGE OF NURSING SEDAM ROAD,

ADDRESS GULBARGA, KARNATAKA

2 NAME OF THE HKES. COLLEGE OF NURSING SEDAM ROAD,

INSTITUTION GULBARGA,

3. COURSE OF STUDY AND FIRST YEAR MASTER IN NURSING

SUBJECT OBSTETRICS AND GYNAECOLOGICAL NURSING

4. DATE OF ADMISSION 11-07-2012

5. TITLE OF THE TOPIC “A COMPARATIVE STUDY TO ASSESS THE

EFFECTIVENESS OF CABBAGE LEAVES
APPLICATION AND COLD APPLICATION TO
RELIEVE BREAST ENGORGEMENTAMONG PRIMI
POSTNATAL MOTHERS AT SANGMESHWARA AND
BASWESHWARA HOSPITAL GULBARGA.”

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6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION

“BREAST MILK IS NOT ONLY THE BEST BUT MUST FOR THE INFANTS”
-WHO, 2005

Pregnancy and the mother hood is a very precious gift of God almighty for women. It is an unexpressable
experience that women come across during her life time. In Indian culture motherhood is a respectful event
mother not only give birth to the baby but also nurtures the baby by giving the breast milk which is readily
available.

Breast feeding is an important and pleasurable event in women’s life. Breastmilk is a complete healthy
supplement ,Which nurtures the baby during its milestone approaches and helps in growth and development.

Breast feeding should be initiated within first half an hour after birth the first milk is the most suitable
food for the new born. It is thick and yellow colored .The shastras call it as “Peyusha” (equal to ‘Amrit’ . the
‘liquor of life’)and the western science uses the word colostrums. It is the infant’s first immunization. Customs,
superstition, traditions and ignorance sometimes deprive the child from getting this benefit.2

Due to improper breast feeding techniques, breast feeding mothers will be facing problems like breast
abscess, mastitis, sore nipples, cracked nipples and breast engorgement. In Karnataka 986 deliveries were
recorded to be conducted with caesarean section in the year 2007. Among this 45%-50% have been reported with
the complaint of breast engorgement.11 Breast engorgement is a well-known problem but poorly researched
aspect of lactation.3 Breast engorgement is defined by the medical dictionary as congestion and distention with
fluid. The lactation literatures defines it as a swollen breast, caused by the buildup of milk during breast feeding
and is often referred to as swelling and distention of the breasts and can be a painful condition. This is a common
physiological problem for lactating mothers that is caused by the sudden increase in the volume of the breast
milk due to lymphatic and vascular congestion with interstitial edema during the first two weeks of breast
feeding. The reason why the breast engorgement occurs in the first two weeks of post-partum is that the mother
and the baby are adjusting to the process of demand and supply .i.e if the milk production is increased too rapidly
this may exceed the capacity of the breast alveoli to store it.4

Most of the post natal mothers experience breast engorgement in the early days of breast feeding these
mothers will have severe pain, nipple tenderness, and fissures of the nipple and infection which can all result in
subsequent cessation of breastfeeding. Breast engorgemnatent can be characterized by low grade fever and
absence of systemic symptoms. The breasts feel warm to touch and appear shiny and it can be quite painful for

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some women when the breasts become hard. Throughout the world, breast engorgement is one of the main
reasons why women stop breastfeeding, or suffer from a reduced /short duration of Breastfeeding.6

Breast engorgement in primi post natal mothers can be seen and measured by various methods, so as to
identify the degree of engorgement some of the methods are measurements of chest circumference changes and
thermography. Ferris and Riedel have also proposed the use of a pressure gauge to measure skin tension1 and
Whittel Stone six point breast engorgement scale,7 as a way of evaluating and measuring breast engorgement.

Many methods for the treatment of breast engorgement have been explored like pharmacological and
non-pharmacological. Now a days most of the postnatal mothers prefer the non pharmacological methods. These
include cold cabbage compresses, cold gel pads, hot compresses and warm showers, which are used to activate
the milk ejection reflex.Further treatment methods which have been postulated include the use of therapeutic
ultrasound, breast binding, breast massage, herbal remedies, manual/electrical pump, anti- inflammatory
medication (such as serrapeptase [Danzen] which reduces swelling). Gua-Sha (massage) therapy as a form of
treatment.4

Numerous preventive strategies have been seen over the years including: restricting fluids, prenatal
expression of colostrum, prenatal breast massage, post-natal breast massage, binding the breasts, or wearing a
tight bra. Postnatal Mothers experience less severe forms of engorgement with early frequent feedings, 6 self-
demand feedings, unlimited sucking times, and with babies who demonstrate correct suckling techniques. Short
frequent feeds were shown to increase engorgement in one study, probably because abbreviated feeds (as short as
two minutes) did not allow sufficient drainage of the breasts to prevent milk accumulation.3
Many studies have revealed that cabbage leaves application is more effective in reducing breast engorgement,
among the primi postnatal mothers by increasing comfort to the breast feeding mothers and thereby to subside
further complications.

6.1. NEED FOR THE STUDY

“AS THERE IS NO SUBSTITUTE FOR MOTHERS LOVE THERE IS NO SUBSTITUTE FOR

MOTHER’S MILK”.

Breast engorgement and breast fullness are different. Breast fullness is characterised by swollen yet
compressible breast tissue. The infant is able to latch on properly and suckle effectively at full breast. Breast
engorgement is characterised by swelling heat, hardness of breast tissue, breast skin tightness, flatness of nipples,
discomfort and pain. The infant may have difficulty in latching to an engorged breast due to the hardness of
tissue, which can decrease the amount of milk transferred from mother to baby. The inability of the infant to

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transfer milk can exacerbate the engorgement. Due to varying severity of breast engorgement several methods
are used to quantify it, like thermography, the Roberts durometer and six-point engorgement scale.7

According to sample registration scheme, the female population of Karnataka in June 2009 is about 25.9
million. Field work conducted during December 2007 to April 2008 in Karnataka shows that 70% of urban
mothers and 55% of rural mothers received postnatal care. Within 2 days of delivery11. Breast engorgement
occurs in 72-85% of post natal mothers. Among every 10 mothers, suffers with breast engorgement.7

Primi post natal mothers often suffer more from engorgement than women who are nursing their second
child and third child.10Breast engorgement is a painful and unpleasant condition affecting large number of primi
post natal mothers women in the early postpartum period. During a time the mothers are coping with a demands
of a new baby it may be particularly distressing. Breast engorgement may inhibit the development of successful
breast feeding. Breast engorgement may inhibit the effective breast feeding, disinterest in breast feeding; early
supplementation cessation of breast feeding is also associated with some complications such as breast infections.
In almost all the post natal mothers irrespective of prime or multi Para mothers. It is also noticed that breast
engorgement may be or more in the first week of post-partum which has been associated with the insufficient
milk.9

A pelothora of treatment modalities for engorgement have been put forward, both anecdotally and in the
literature. Such as hot compresses, hot showers, soaking the breasts in a bowl of hot water, cold compresses after
feeding, cold packs before feedings, ice packs, frozen bags of vegetables, both hot and cold therapies, oxytocin,
protieolytic enzymes, stilbestrol, binding the breast, manual expression, lymphatic breast massage, ultrasound,
frequent feedings, alternate massage, chilled cabbage leave, room temperature cabbage leaves, and cabbage leaf
extract.3

Postnatal mothers are turning to non-medical treatments for breast engorgement, such as warm and cold
compressors, breast massage or the use of cold cabbage leaves, these non-medical interventions are receiving
increasing attention as viable treatment methods, as they are more easily available and generally easy to use
convenient and cheap as compared to medical interventions. For example, many women prefer treatment for
breast engorgement with chilled cabbage leaves, the effect is stronger and effect quickly. Thus determing
treatment of breast engorgement becoming increasingly important one with non-medical intervention, cabbage
leave treatment, has become increasingly popular as it is cheap, easily available natural remedy which some
studies found to be effective.4

As a researcher I came across to see many primi post-natal mothers with breast engorgement in my UG
and PG clinical in postnatal wards, many postnatal mothers were suffering from breast engorgement due to
improper feeding techniques. So as a researcher the thought clicked in my mind to take a topic on breast
engorgement to relive it, by using non-pharmacological methods as it is convenient to mothers of all economic
groups. As a partial fulfilment of my post-graduation studies
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6.2. REVIEW OF LITERATURE

 Reviews related to breast engorgement

 Reviews related to the treatment of breast engorgement

Reviews related to breast engorgement

A study was conducted on 600 post-natal mothers at Swaroopa Rani Neheru and Kamala Neheru
memorial hospital Allahabad to know the complications associated with breast in the post-natal period and to
promote early breast feeding and to teach advantages of demand feeding. The results of this study showed that
20 % mothers had breast complications, 43.33% had breast engorgement, 15.83% had cracked nipples, 10 % had
retracted nipples, 8.33% had cracked and sore nipples 7.5% had cracked and retracted nipples, 7.5% had failed in
lactation, and 3.3% had breast had breast abscess. Hence the researcher felt to teach the post-natal mothers on
prevention and management of breast complications helps for successful breast feeding.13

The rate of breast engorgement is between 20-85% reported in the literature based on numerous
definitions and are usually limited in the first few days of post-partum. Such reports describes engorgement is
peaking between day 3 and day 6 declining thereafter. However data from unpublished matters suggest the
mothers actually experience more than one pack of engorgement and that engorgement may continue for long
as10 days and more.12

A study was conducted on a sample of 114 breast feeding mothers on breast engorgement: pattern
selected outcome. For 14 days following birth, 114 breast feeding mothers rated the level of breast engorgement
twice daily. Using a six point engorgement scale individual engorgement ratings were plotted by intensity over
time to provide a visual display of each subject’s management experience 4 distinct patterns of breast
engorgement emerged mother experienced either a bell shaped pattern, a multi model pattern, a pattern of intense
engorgement, or a pattern of minimal engorgement. Characteristics of mother and infants, and feeding frequency
were similar across the 4 breast engorgement patterns.8

Reviews related to the treatment of breast engorgement

In 2008 a quasi-experimental study was conducted in post natal ward of the All India Institute of Medical
Sciences (AIIMS) New Delhi. The study compared a total of 60 mothers. 30 in the experimental group and 30 in
the control group. The control group received alternate hot and cold compresses and the experimental group
received cold cabbage leaf treatment for relieving breast engorgement, both treatments that is hot and cold
compresses and cabbage leaves applications were effective in decreasing breast engorgement and pain in post
natal mothers. Cold cabbage leaves hot and cold compress were both equally effective in decreasing breast
engorgement. 14

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 A study was conducted in maternity center at Coimbatore; Tamil Nadu on breast feeding post-natal
mothers on effectiveness of cabbage leaves applications to relive breast engorgement. After analysis the
researcher concluded that application of cabbage leaves relieved the breast engorgement and promoted the
mother and baby a sense of well- being.1

A study was conducted to assess the effectiveness of cold application to the engorged breast of breast
feeding mothers. Mothers in the experimental group over the breast bags and halter at specified times through
the day as a means of applying cold to the breast , mothers in control group followed routine hospital
procedures. Mothers who wore the cold pack experienced significantly less pain, significantly fewer signs and
symptoms of breast engorgement.15

A comparative study on chilled cabbage leaves and chilled gel packs in reducing breast engorgement.
selected a group of 34 lactating women with breast engorgement used chilled cabbage leaves on one breast and
chilled gel-packs on the other for up to 8 hours, there was no difference in the post treatment ratings for the two
treatments. Mothers reported a statistically significant drop in pain with both treatments; 68% obtained relief
within one to two hours the majority of mothers preferred cabbage leaves. The researcher concluded that cabbage
leaves is effective in reducing breast engorgement.16

A comparative study on chilled cabbage leaves and room temperature cabbage leaves in reducing breast
engorgement. Reviewed the study with 28 lactating women with breast engorgement used chilled cabbage leaves
on one breast and room temperature cabbage leaves on the other for a two hour period. There was no difference
in the post treatment ratings for the two treatments; mothers reported significantly less pain with both treatments.
The researchers concluded that it is not necessary to chill cabbage leaves before use.17

A double-blind experiment with a pretest/posttest design on 39 post-natal mothers. 21 participants

received a cream containing cabbage leaves extract, while 18 received placebo cream, the placebo cream group
received equal relief to the treated group, with the two groups showing no difference on all out-come measures.
However, mothers perceived both creams to be effective in reliving discomfort.18

A study was conducted to determine the efficacy of Bromocriptine to versus breast binders as inhibitors
of postpartum lactation. 50 post-partum patients were randomly given either Bromocriptine or breast binders for
inhibiting lactation. The breasted binder group had a high incidence of symptoms of the first week postpartum;
these symptoms rapidly decreased by the second week. Bromocriptine successfully suppressed the breast
problems in virtually all of the patients who took the drug correctly. The researchers concluded that
Bromocriptine is effective in reducing breast engorgement and symptoms.19

A randomized double-blind controlled trail study was conducted on the treatment on breast engorgement
with Serrapeptase (Danzen) in 1989at Singapore a total of 70 patients complying of breast engorgement. these
patients were randomly divided into two groups, a treatment group and a placebo group the e patient were

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assessed the severity of each of the symptoms and signs of the breast engorgement before treatment was
commenced, and daily for three days, during which therapy was administered. Danzen was noted to be superior
to placebo for improvement of breast pain, breast swelling and induration. The researcher concluded that no
adverse reactions were reported with the use of Danzen. Denizen is a safe and effective method for the treatment
of breast engorgement.20

A randomized controlled trail was conducted on effects on Gua-sha therapy on breast engorgement in
Taiwan. 54 postpartum women were included in the study. Result showed no statistical difference between the
two groups at base line, body temperature, breast temperature, breast engorgement, pain levels and discomforting
levels were statistically different in two groups at 5 and 30 minutes. After intervention.(P<.001). The results of
generalized estimating equation analysis indicated that, with the exception of body temperature, all variables
remains significant.(P<.0001) to improving engorgement symptoms in the experimental group than those in the
control group. The researcher concluded that Gua-sha therapy may be used as an effective technique in reliving
breast engorgement.21

PROBLEM STATEMENT

A comparative study to determine the effectiveness of cabbage leaves application and cold application to
relive breast engorgement among primi postnatal mothers at Sangmeshwara and Basweshwara hospital
Gulbarga.

6.3. OBJECTIVES OF THE STUDY.

 To assess the condition and degree of breast engorgement among primi post natal mothers by using six point
engorgement scale at Sangmeshwar hospital and Basaweshwara hospital Gulbarga.
 To apply cabbage leaves on breast engorgement among primi post natal mothers at Sangmeshwar hospital
and Basaweshwara hospital Gulbarga.
 To apply cold application on breast engorgement among primi post natal mothers at Sangmeshwar hospital
and Basaweshwara hospital Gulbarga.
 Comparison between effectiveness of cabbage leaves application and cold application on breast engorgement
among primi post natal mothers by using six point engorgement scale at Sangmeshwar hospital and
Basaweshwara hospital Gulbarga.
 To find out the association between cabbage leaves application on reduction in the degree of breast
engorgement and selective socio demographic variables.

6.4. OPERATIONAL DEFFINATIONS

Determine:It is the method of estimating the effectiveness of cold application and cabbage leaves application to
relive breast engorgement of primi post natal mothers.

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Compare: It is the difference between the cold applications and cabbage leaves application to relive breast
engorgement of primi post natal mothers.
Effectiveness: The reduction in the degree of pain discomfort after the cold application and cabbage leaves
application to relive breast engorgement of primi post natal mothers.
Cabbage leaves: Fresh cabbage leaves will be applied on the engorged breast of primi post natal mothers for 10-
15 minutes in between feedings 2-3 time’s per day.
Cold application : It is the local moist application in which few ice cubes are kept in the towel and applied on
the engorged breast for 10-15 minutes in between feedings 2-3 times per day .
Breast engorgement: Engorgement is a swelling of the breast which occurs on 2nd and 3rd post-partum day
among the primi postnatal mothers caused by expanding veins and pressure of the new milk , increased blood
supply and congestion and the primi postnatal mother will have symptoms like body temperature ,pulse rate ,
local tenderness ,hardness , swelling ,and the baby cant latch on properly on breast .
Primi mother: The mother who is given birth to the baby for the first time at Sangmeshwar hospital and
Basaweshwara hospital Gulbarga..
Postnatal mother: Post natal are the mother who are admitted in Basaveshwar and Sangmeshwar Hospitals after
the birth of a child and extending for about six weeks.

6.5. HYPOTHESIS
H1 – There will be a significant difference between cabbage leaves application and cold application to relive the
breast engorgement.
H2- There will be a significant association with the demographic variables and cabbage leaves application to
relive the breast engorgement.

7. MATERIALS AND METHODS.

7.1. SOURCES OF DATA COLLECTION.

The data will be collected from primi postnatal mothers who are admitted in postnatal wards of
Sangmeshwar hospital and Basaweshwara hospital Gulbarga.

RESEARCH DESIGN:

The research design is Non-experimental comparative study.

Group 1 – Receives cabbage leaves application for breast engorgement

Group 2 – Receives cold application for breast engorgement.

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SAMPLING PROCIDURE:

POPULATION:

Primi post natal mothers who are admitted in postnatal wardsofSangmeshwar hospital and Basaweshwara
hospital Gulbarga.

SAMPLES:

The primi post natal mothers who will fulfill the sampling criteria.

SAMPLE SIZE:

The sample size used for the study is 50. A total of 50 primi post natal mothers with breast engorgement
were equally divided in to two groups as group 1 of 25 primi post natal mothers with cabbage leaves application,
group 2 of 25 post natal mothers with cold compress application.

SAMPLE TECHNIQUE:

Purposive sampling technique.

SETTING:

The present study is planned to conduct in postnatal wards of Sangmeshwar and Basaweshwara hospital
Gulbarga.

VARIABLES:

Independent variable- Cabbage leaves and cold application.

Dependent variable- Degree of breast engorgement

INCLUSION AND EXCLUSION CRITERIA

INCLUSION CRITERIA:
 Primi post natal mothers with breast engorgement
 Primi postnatal mothers who underwent normal as well as caesarian section
 Primi post natal mothers those who are willing to participate in the study .
EXCLUSION CRITERIA:
 Primi post natal mothers with
 Infection in the breasts
 Breast abscess
 Mastitis
 Broken skin of breasts
 Bleeding or cracked nipples.
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  Primi postnatal mothers who are allergic to cabbage leaves.
 Primi postnatal mothers with soft breasts
 Primi postnatal mothers receiving lactation suppressants.
 Primi postnatal mothers who are not willing to participate in the study.

DELLIMITATION:
 The study is limited to primi post natal mothers who are admitted in postnatal wards of Sangmeshwar
hospital and Basaweshwara hospital Gulbarga.
 Sample size is limited to primi post natal mothers.

7.2. METHODS OF DATA COLLECTION:

Data will be collected by direct interview method after obtaining consent from the samples and
authorities.

Breast engorgement will be measured by using a 6 point breast engorgement scale, before and after
application of cabbage leaves and cold application. The pre and post treatment scores of breast engorgement and
pain will be recorded after each treatment session using a numerical rating pain scale.

PLAN FOR DATAANALLYSIS:

The plan for data analysis included descriptive and inferential statistics.

Descriptive statistics.

Appropriate statistical measures will be used with the consultation of statistician.

Inferential statistics.

Appropriate statistical measures will be used with the use of consultation of statistician.

7.3 Does the study require any investigations or interventions to be conducted on patients or other
human or animal?

Yes, since it is a comparative study design the study require interventions, cabbage leaves and cold application
used as an intervention in relieving breast engorgement in primi post natal mothers.

7.4 Has ethical clearance been obtained from your institution?

Yes, permission will be obtained from concerned authority before data collection. An informed consent will be
obtained from samples. Confidentiality and privacy of the data will be maintained.

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8. REFERENCES

1. A Ruba. “Effectiveness of cabbage leaf application to relieve breast engorgement”. Nightingale nursing
times journals of India volume 5: no 9: page no 48,2009.

2. Dr. M.V. Shetty “knowledge attitude and practice of postnatal mothers about breast feeding”. Journal of
nursing 2005, April 85-86.

3. Marsha walker, RN, IBCLC ,“Breast feeding and engorgement” , from breast feeding abstract,
(serialonline) Nov 2000 , volume 20 Nov 2nd , page 11 -12.(cited on10th Oct 2012). Available from

URL:HTTP://www.lalecheleague.org/ba/nov00.html

4. SulochanaShantakumari, “Effectiveness of cold compress with raw cabbage leaves in treatment of breast
engorgement”. 2008. (cited on 10th Oct 2012) Available from www.rguhs.ac.in/cdc/onlinecdc/uplods/05-
N113-7828.doc.

5. Dr. M Gandhimati, and Dr. S Kalavati, “Exclusive breast feeding” NightingaleNursing times journals of
India volume 2: 2006 august.

6. Dr. Deseley Gail, “Effectiveness of chilled/cold cabbage leaf application on breast engorgement in breast
feeding women”.(citedon10th Oct 2012) Available from
URL:https://docs.google.com/viewer?a=v&q=cache:bfomglyCRZsJ:connect.jbiconnectplus.org/view
sourcefile.aspx?0%304693/effectiveness+of+chilled+or+cold+cabbage+leaf+application+on+breast
engorgement+inbreast+feeding women.

7. Whittlestone, “Efficacy report of the whittlestone breast expresses as a treatment for breast
engorgement”. Prepared by health and nutrition .INC.(citedon10 Oct 2012) Available
fromURL:http://.www.whittelestone.com/documents/breast engorgement treatment.pdf

8. Hill PD, Humenick SS “The occurrence of breast engorgement”,(serial online) J Hum Lact 1994(2): 79-
86. (citedon10th Oct 2012) Available from URL:http://www.ncbi.nlm.nih.gov/pubmade/7619260

9. Mangesi L, Dowswell T. “Treatments for breast engorgement during lactation”,(serial online) Cochrane
database systematic rev.2010 September 8;(9); CD 006946. (citedon10th Oct 2012) Available from
URL:http://www.ncbi.nlm.nih.gov/ pubmade/20824853

10. Auerbach KG, Riordal J, “Breast feeding and human lactation”. Sudbury, Massachuse HS; Jones and
Bartlett, 1998;283,294-295, 431.(citedon10th Oct 2012) Available from
URL:http://www.amazon.com/breastfeeding-human-lactation-bartlett-series/dp/0763745855

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11. Project coordinator, district level, household and facility survey-3, international institute for population
sciences 2007-2008,(citedon10th Oct 2012). Available from URl: http://www.rchiips.org,access on
24/9/2010.

12. Reidal LS. “Breast engorgement”.1991. Page no 118.

13. Ganguly G, Dhawan N, Mukhrji K, Dayal M, Pandey RC. “Prevention and management of post natal
breast complications”. The journal of obstetrics and gynecology of India, 1999 April, 49(2); page no 47-
49.

14. Smriti Arora, Manju, Vatsa, Dadhwal. “A comparison of cabbage leaves versus hot and cold compress in
the treatment of breast engorgement”. Indian journal community medicine.(serial online) 2008
July;(citedon10th oct 2012); 33(3):160-162.Available from
URL:http://www.ncbi.nlm.nih.gov/pubmade/19876476

15. Robson; Beverly Anne. “Breastengorgement”1990 (serial online). Permalink (cited on10th Oct 2012):
Available from URL:http://rave.ohionlink.edu/etdc/view? acc-num=case/054750626

16. Robert KL. “A comparison of chilled cabbage leaves and chilled gel packs in reducing breast
engorgement”.(serial online) J Hum Lact.1995 March;(citedon10th Oct 2012);11(1): 17-20 Available
from URL:http://www.ncbi.nlm.nih.gov /pubmade/7718101

17. Robert KL, Reiter M, Schuster D (1995). “A comparison of chilled cabbage leaves and room temperature
cabbage leaves in reducing breast engorgement”.(serial online) J Hum Lact.1995 March;(cited on 10th
Oct 2012);11(3):191-4. Available from URL:http://www.ncbi.nlm.nih.gov/pubmade/7669238

18. Robert KL, Reiter M, Schuster D (1995). “Effects of cabbage leaf extract on breast engorgement”.(serial
online) J Hum Lact.1998; (cited on10tth Oct 2012);14(3):231-6 Available from
URL:http://www.ncbi.nlm.nih.gov/pubmade/10205435

19. Shapiro AG, Thomas L, “Efficacy of bromocriptine versus breast binders as inhibitors of postpartum
lactation”. South med journal.(Serial online) 1984 June; (cited on 10th Oct 2012); 77(6): 719-
21.Available from URL: http://www.ncbi.nlm.nih.gov /pubmade/6729548

20. Kee WH, Tan SL, Lee V, Salmon YM. “The treatment of breast engorgement with serrapeptase”.
Singapore medicine journal. (serial online) 1989 Feb; (cited on 10th Oct 2012); 30(1): 48-54Available
from url:http://www.ncbi.nlm.nih.gov/ pubmade/2688125

21. Chiu JY, Gaw ML, Kuosy, et. al. “Effects of Gau-sha therapy on breast engorgement”. Journal of nursing
Res.(serial online) 2010 March;(cited on10th Oct 2012);18(1):1-10.Availablefrom
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9 Signature of Candidate :

10 Remarks of guide :

Mrs Jessica Josline

11 11.1 Name and designation : Reader
of the Guide

11.2 Signature :

Mrs. Poornima K
11.3 Co-guide (if any) : Lecturer

11.4 Signature :

Mrs Jessica Josline

11.5 Head of the Department Reader
:

11.6 Signature :

12 12.1 Remarks of the

Chairman and :
Principal

12.2 Signature of the :

Principal

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