Many breastfeeding moms have concerns over low milk supply and end up weaning prematurely. Because of this, nursing moms and those caring for them often look to medications or herbs that claim to increase milk production. But do any of these herbs or medications work, and are they safe?
What are galactagogues?
A galactagogue is any supplement that is believed to increase milk production. These can come in the form of a prescription drug or an herbal supplement.
When it comes to prescription galactagogues, they all work through a similar mechanism. Commonly prescribed galactagogues include metoclopramide and domperidone, though domperidone’s usage is restricted in the United States due to concerns over certain side effects. These drugs block dopamine, which increases prolactin. Prolactin is one of the main hormones responsible for milk production, but it’s not the only one. And unfortunately, there are no studies showing that testing prolactin levels (to see if they are “low” or increase with the use of a galactagogue) is helpful or has any correlation with a good milk supply. For many of the herbal galactagogues, we are not sure how they work.
What about herbal supplements?
Many herbal supplements claim to increase milk supply, and many have been commonplace in some cultures for hundreds of years. Some of the more mainstream ones include fenugreek, milk thistle, oats, goat’s rue, blessed thistle, and barley, among others. They may come in the form of a tea, pill, or as an ingredient in a recipe for “lactation cookies,” for example.
Is there evidence that they work?
Unfortunately, not really. This is mainly because many of the studies that have looked at galactagogues have had many problems: the sample size was too small (some only include 6 women); are not considered high quality; had too many women drop out to make the data useful; and many didn’t account for the placebo effect (that is, a mom thinks her milk supply is increased because she knows she is taking a galactagogue when really it hasn’t changed at all). Anecdotally, many women report an increased milk supply with galactagogue usage, so when other options have failed, they may be worth trying under close supervision.
Can they be harmful?
Yes. Herbal supplements are not regulated, so their doses can vary even from pill-to-pill in a single bottle. They can also be contaminated with other herbs not listed on the bottle, and overall we lack data about how they may affect some moms and babies. The prescription galactagogues can cause problems too: domperidone can cause dry mouth, headache, cramping, and heart arrhythmias, which may be fatal, and metoclopramide has been associated with anxiety, sedation, and involuntary movements and restlessness.
So what should I do if I am worried about low milk supply?
The most important piece of advice is not to assume your milk supply really is low and to not start self-medicating with galactagogues before being evaluated. Check in with a lactation consultant as soon as possible, and if low milk supply is diagnosed, other interventions should be implemented first. These include increased feeding frequency and pumping, lots of skin-to-skin, cutting out unnecessary formula supplementation, making sure baby is latching and transferring milk appropriately, and ruling out some medical causes of low milk supply (such as thyroid disease)—and these are just a few.
Nothing has worked, and I want to try a galactagogue. What next?
If you’ve tried everything listed above, and either you or a medical professional want to start a galactagogue, a few key points should be considered. Make sure no drug interactions exist and that you are well aware of the risks of usage and warning signs of side effects. Only use them as directed, and do not increase a dose above what is recommended. Closely follow up with your doctor or lactation consultant to make sure baby is gaining weight appropriately and you are not showing signs of any concerning side effects. Be aware that herbal does not mean safe, and only use supplements from reputable suppliers.
- The Academy of Breastfeeding Medicine
- Clinical Protocol #9: Use of galactagogues in initiating or augmenting the rate of maternal milk secretion
- First Revision January 2011.
RA Lawrence and RM Lawrence
- Breastfeeding: A guide for the medical profession
- 7th edition.
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