Galactagogues-what's the real deal?
Have you ever been frustrated because you feel you aren’t producing enough milk for your baby? Have you considered trying herbs or a medication? You are not alone! Many moms have the same struggle; perception of a low milk supply is one of the top concerns among new breastfeeding mothers. While we'd encourage you to work with a trained lactation professional (like us!), we also want to tell you about some common galactagogues that may be used to increase a maternal milk supply.
Herbs and Foods as Galactagogues
Throughout the centuries, and across different cultures people have used different herbs, medicines and foods to stimulate milk production. “A galactagogue is a medication or an herb [or food] believed to help initiate, maintain, or increase the rate of maternal milk synthesis” . In many cases, these work by increasing prolactin, a hormone that stimulates and increases milk production.
“Current pharmaceutical galactagogues are all used 'off label' (i.e., they are not approved for used as galactagogues) in the United States. Herbal galactagogues, by comparison, are not subject to regulation in the United States, so questions of dosage and purity are an issue” . Unfortunately, there is not enough documented research on herbal galactagogues, and “more rigorous research (well-designed, well-conducted clinical trials) is needed to determine the mechanism of action and to establish therapeutic ranges, dosages, and side effects” . It is advisable that before any mom decides to try any galactagogue (herbal or pharmacological) she should inform her primary care provider (PCP) as these have the potential to interact with other medications and foods. In our practice, we realize you may also be exposed to cultural foods or herbs as a means to increase supply. Our job is to provide you with the most up to date information and recommendations and then encourage you speak with your PCP.
Prescription Medications as Galactagogues
Currently, there are two major drugs used to induce or increase milk production, domperidone and metoclopramide (common name Reglan) both of which increase prolactin. “A Cochrane Review (Donovan, 2012) showed a modest increase in expressed breast milk when the drug domperidone was prescribed to mothers of preterm infants with a dose of 10mg 3 times a day. […] Metoclopramide, a medication known to increase prolactin levels has significant nervous system side effects (such as depression) when used to treat milk insufficiency for long periods of time” . This is why metoclopramide is prescribed and should only be used for a short period of time. “In 2011, the US Food and Drug Administration (FDA) approved the use of domperidone as an “orphan drug” for breastfeeding mothers experiencing insufficient breast milk. Domperidone has fewer side effects, although there is a concern about cardiac arrhythmia [irregular heartbeat] at very high doses. It should be noted here that lactating mothers are not typically prescribed such a high dosage and such arrhythmia was noted when the medication was given intravenously not orally. The orphan drug designation is seen by some as a first step in obtaining FDA approval for use of domperidone to treat milk insufficiency in the US” . Mothers are advised that “blood tests may be prudent to first document low prolactin levels. If prolactin is not deficient, a prolactin enhancing drug is unlikely to enhance milk production” . For more info on Domperidone, it's history and current dosage recommendations, please check out this great website by leading expert Dr. Jack Newman.
Things to Try before Herbs or Medicines
“Although not strictly a galactagogue, oxytocin nasal spray is used to stimulate milk ejection if the mother’s own letdown is inhibited by stress or pain” . There are many “factors, both maternal and infant, [that] may affect infant intake and maternal milk supply; the interrelationships of these factors are complex” . Parents should know there are always options available. There are “other measures to initiate and enhance lactation” , and we would encourage you to try these first:
Kangaroo care /skin-to-skin time
Consultation with a lactation specialist like an IBCLC
Use of proper breastfeeding technique for adequate milk removal
Activities that will increase the release of oxytocin:
Frequent breastfeeding or pumping
Prolonging duration of pumping
Increasing frequency of milk expression
Looking at a picture of the infant while pumping
Having a piece of the infant’s clothing to smell while pumping or expressing milk
Maintaining Supply through Breastfeeding Management
“After the milk supply is established, ongoing production or galactopoiesis depends on supply and demand through the emptying of the breasts by breastfeeding and pumping. […] Frequency of breast emptying and time spent stimulating the breasts are important components for developing a good breastmilk supply. Emptying the breasts should occur every 2-3 hours during the day and once or twice at night, for a total of 8-12 breast emptyings per 24 hours. The duration of each episode should be about 20 minutes” .
Seek Professional Lactation Help
True low milk supply is the exception, not the norm. Please seek help from a trained lactation professional if you suspect this is an issue with you and your baby. Everyone’s body reacts differently to different medications or herbs and great care should be taken before beginning any new herbs or medication for the safety of you and your baby. We encourage starting with the least invasive, non-pharmacological options such as skin-to-skin time and frequent milk removal as well as consulting with a lactation specialist to assess breastfeeding. Galactagogues can be a helpful tool in true low milk supply situations, but there is a lot to know before starting them. Sweet Songs Breastfeeding can help you decide and help you manage your low milk supply. We look forward to working with you on your breastfeeding journey!
 Wilson-Clay, B., & Hoover, K. L. (2013). The Breastfeeding Atlas. Manchaca, TX: LactNews Press.
 Wambach, K., & Riordan, J. (2016) Breastfeeding and Human Lactation. Burlington, MA: Jones & Bartlett Learning.
 Pearson-Glaze, P. (2015). Galactagogues. Retrieved from http://breastfeedingtoday-llli.org/galactagogues/