What can be given to a postpartum breastfeeding mother for swelling?

Management of Postpartum Swelling in Breastfeeding Mothers

For postpartum swelling in breastfeeding mothers, ibuprofen is the first-line treatment, as it is the safest and most extensively studied NSAID compatible with breastfeeding, and can be used immediately without interrupting nursing. 1

First-Line Pharmacologic Options

NSAIDs (Preferred)

• Ibuprofen is the preferred NSAID with the most reassuring safety data for breastfeeding women, transferring minimal amounts to breast milk well below pediatric therapeutic doses 1
• Diclofenac is the second safest NSAID option after ibuprofen, with small amounts detected in breast milk and extensive safe use during lactation 1
• Naproxen is safe despite its longer half-life and is widely used after cesarean section without requiring interruption of breastfeeding 1
• Ketorolac (Toradol) has low levels in breast milk without demonstrable adverse effects in neonates, making it compatible with breastfeeding 1, 2

Acetaminophen (Paracetamol)

• Paracetamol is completely safe for breastfeeding mothers, with the amount transferred to breast milk being significantly less than pediatric therapeutic doses 1
• Can be used immediately without interrupting nursing 1

Multimodal Approach

• Combining paracetamol and NSAIDs is encouraged to minimize the need for opioids and maximize pain/swelling control 1
• Use the lowest effective dose for the shortest duration 1

Non-Pharmacologic Options for Breast Engorgement

If the swelling is specifically breast engorgement (a common postpartum issue):

Cold Therapy

• Cold cabbage leaves may be more effective than routine care for breast pain (reduction of 1.03 points on 0-10 VAS) and breast hardness 3
• Cold gel packs may reduce breast hardness compared to routine care 3, 4
• Alternating hot and cold compresses can significantly reduce breast engorgement 4

Massage Therapy

• Breast massage along with routine breast care resulted in a 3.52-point reduction in pain on a 10-point VAS 5
• Massage therapy is effective for postpartum breast pain and engorgement 5

Critical Safety Considerations

Timing and Dosing

• Breastfeeding mothers should take medications after breastfeeding to minimize infant exposure 6
• All standard NSAIDs and acetaminophen are compatible with immediate breastfeeding without any waiting period 1

Special Populations Requiring Extra Caution

• Infants less than 6 weeks of age have immature hepatic and renal function, warranting extra caution with any medication 1, 2
• Preterm infants have the highest medication sensitivity and require heightened vigilance 1

Medications to Avoid

• Aspirin should NOT be used in analgesic doses during breastfeeding due to risk of salicylate intoxication and bleeding in neonates 1
• Avoid combination cough/cold products that may contain aspirin 6

Common Pitfalls to Avoid

• Do not unnecessarily interrupt breastfeeding or advise expressing and discarding milk when using paracetamol or NSAIDs—this is completely unnecessary 1
• Do not use ergometrine for postpartum management as it is contraindicated 7
• Monitor infants for excess sedation, drowsiness, or poor feeding if any medications are used 1

Anticoagulation Context

If swelling is related to deep vein thrombosis (DVT) concerns (left leg swelling is suspicious for DVT in 85% of postpartum cases due to compression of the left iliac vein) 7:

• Vitamin K antagonists (warfarin) are safe for nursing mothers as they do not enter breast milk in active forms 7
• LMWH, UFH, and fondaparinux are safe options for breastfeeding women requiring anticoagulation 7