Making more milk - Galactagogues - Evidence Based Babies

Making more milk – Galactagogues

What is a galactagogue?

A galactagogue is a substance that is believed to increase the milk supply. There are both herbal and pharmaceutical galactagogues available. It’s important to note that research regarding the effectiveness and the safety of galactagogues to both the mother, baby and the milk supply itself, lack severely. More research is needed.

Just like any other medicine, galactagogues, both pharmaceutical and herbal may hold side effects and dangers to mother and baby, some may even reduce the milk supply. When used, it’s best used with the help of an International Board Certified Lactation Consultant (IBCLC) and a doctor.

Do I need a galactagogue?

Probably not. Galactagogues are best left for use as a last resort to mothers with a real low milk supply who has done everything possible to establish a sufficient milk supply or for adoptive mothers. Most mothers have enough milk, though they may have a perceived low milk supply. A perceived low milk supply is when a mother who does have enough milk, believes for whatever reason that she doesn’t.

A real low milk supply will have a cause, whether it’s issues with breastfeeding management, anatomical issues or medical reasons in either the mother or the baby. Some of these have very easy solutions that doesn’t even involve any medicine, others may involve medicine, but not a galactagogue.

If you believe you may have a real low milk supply, it’s best to contact an International Board Certified Lactation Consultant (IBCLC) to help assess your situation and provide you with the best possible solution, and when decided on trying a galactagogue in the presence of a true low milk supply, to use the best possible one as safely as possible.

Popular galactagogues

Metoclopramide

Metoclopramide is an anti-sickness medicine. It has been found to increase serum prolactin and therefore has an off-label use as a pharmaceutical galactagogue. A meta-analysis of 5 placebo-controlled studies concluded that 2 weeks of metoclopramide caused no increase of serum prolactin over placebo, but 3 weeks of treatment did. A more recent meta-analysis concluded that metoclopramide was of no benefit as a galactagogue in the mothers of preterm infants. A third meta-analysis of 8 trials involving 342 lactating women with a preterm or full term infant found that metoclopramide increased serum prolactin but did not increase milk supply. The clinical value of metoclopramide in increasing milk supply is questionable.

The side effects of Metoclopramide include:

Postpartum mothers are at a relatively high risk for postpartum depression and metoclopramide can cause depression as a side effect.

Long-term use of metoclopramide also increases the risk of tardive dyskinesia.

Other reported side effects in nursing mothers include tiredness, nausea, headache, diarrhea, dry mouth, breast discomfort, vertigo, restless legs, intestinal gas, hair loss, irritability and anxiety.

Domperidone

Domperidone is a medication used to treat nausea, vomiting, indigestion and gastric reflux. Its off-label use is a pharmaceutical galactagogue. Domperidone is believed to increase Prolactin levels, the hormone responsible for producing breastmilk. Some small studies have found that it can increase breastmilk, especially in mothers with low prolactin levels. Though it’s important to note that this comes with a range of possible side effects.

The side effects of Domperidone include:

Maternal side effects of domperidone reported in galactagogue studies and cases reported to the FDA include dry mouth, headache, dizziness, nausea, abdominal cramping, diarrhea, palpitations malaise, and shortness of breath.

Surveys of women taking domperidone for lactation enhancement found gastrointestinal symptoms, breast engorgement, weight gain, headache, dizziness, irritability, dry mouth and fatigue were the most common side effects reported.

Mothers with a history of cardiac arrhythmias should not receive domperidone and all mothers should be advised to stop taking domperidone and seek immediate medical attention if they experience signs or symptoms of an abnormal heart rate or rhythm while taking domperidone, including dizziness, palpitations, syncope or seizures.

Fenugreek

Fenugreek is an annual plant in the family Fabaceae. The galactagogue effect of fenugreek may be primarily psychological in humans. However, animal studies indicate that fenugreek might work primarily by increasing insulin and oxytocin secretion. Evidence for a galactagogue effect is mostly anecdotal.

A limited number of published studies of low to moderate quality have found mixed results for fenugreek as a galactagogue. A meta-analysis of controlled studies found fenugreek to have a mild galactagogue effect and an unknown safety profile. Some evidence indicates that fenugreek might be more effective in the first few days postpartum than after 2 weeks postpartum. Some studies have found no results at all. There have been incidents of fenugreek causing a reduction in the milk supply.

The side effects of fenugreek include:

When used as a medicinal, it is generally well tolerated in adults, but gastrointestinal side effects such as nausea, vomiting, diarrhea and flatulence may occur.

Liver toxicity has been reported, both taken alone and in herbal combinations that included fenugreek.

Allergic reactions, exacerbation of asthma, and a 14% decrease in serum potassium have been reported.

Fenugreek may cause lowering of cholesterol and blood sugar.

It can also interact with warfarin to cause bleeding.

Oats

Oats, formally named Avena sativa, is a type of cereal grain from the Poaceae grass family of plants. Some people swear by it that oats have increased their milk supply, but there is no research that proves this. There may be reasons why oats may increase the milk supply.

Why it may work:

It could purely be a placebo effect.

Oats are naturally high in nutrients such as iron, magnesium, zinc and fiber. Research has shown that mothers with low iron levels may have a decreased milk supply. With oats being high in iron, it may provide the needed nutrients to a mother and therefore increase the milk supply. It’s important to note that it’s not oats itself that increases the milk supply, but rather the nutrients it offers. It will also only be effective if the mother has low levels of those specific nutrients.

There are many more known galactagogues, but the research severely lacks to not only prove its efficiency but also its safety. With some showing severe side effects. It’s important to rather see an International Board Certified Lactation Consultant (IBCLC) to help assess your individual situation for the cause of the low milk supply and then help with a possible solution or referral when needed. Most low milk supply cases are only perceived, and in this case, the only thing needed is more breastfeeding education.

Signs of a real low milk supply

Natural ways to increase the milk supply:

Frequent feeding

Seeing as breastfeeding is a supply and demand system, the more demand there is for milk, the more milk the breasts will supply. Frequent feeding will signal the breasts to make even more milk. This is the very best way to increase your milk supply.

Adequate amounts of water and food

It is a well-known fact that breastfeeding mothers need an additional 300-500 calories per day while breastfeeding. So, ensuring your body receives enough calories, will ensure the best supply possible. The same goes for hydration, a well hydrated body will be more than able to produce milk. When dehydrated, the milk supply may be reduced. Studies have found that it’s best to drink to thirst and check for signs of hydration.

Skin-to-skin care

It has long been known that having your baby in skin-to-skin care often helps increase your milk supply. This is due to the hormone oxytocin being released and also due to the fact that skin-to-skin care encourages babies to breastfeed more frequently.