Galactagogues (substances used to increase milk supply)

Galactagogues are foods, herbs or medications that can help to increase breastmilk supply. The use of a galactagogue requires consultation with a Lactation Consultant and/or Health Care Provider.

At least 95% of Mothers are able to produce more than enough milk for their baby(ies) i.e. twins, especially when accurate support and information is obtained. The majority of Mothers who think that they have a low milk supply problem, actually do not. For example, a normal growth spurt in baby, can seem as though the milk has “dried-up.”

Galactagogues only work when breastmilk is being removed frequently and effectively from a Mother’s breasts. When all factors contributing to a low supply have been identified and addressed, then galactagogues may help to speed up the process.

10 Possible Causes of Low Milk Supply (not a normal situation – Mother/Baby should be screened by a professional for these conditions.)

1. Insufficient Glandular Tissue

Although very rare, some women’s breasts don’t develop normally (for various reasons) and may not have enough “milk-making” ducts to meet their baby’s needs. Ducts do grow during each pregnancy and breastfeeding stimulates the growth of more ducts and tissue, so this may be less of a problem with a second or third baby. There are certainly steps you can take to maximize your milk production (these might include pumping and taking a prescription medication–talk to your doctor and a breastfeeding expert) but you may also need to supplement with formula. It’s worth the effort to continuing breastfeeding, though, as even a small amount of your milk will help support your baby’s immune system, brain development and nutritional needs.

2. Hormonal or Endocrine problems

Perhaps you have Polycystic Ovary Syndrome (PCOS), a Low or High Thyroid, Diabetes, Hypertension (high blood pressure) or Hormonal problems that made it difficult for you to conceive. Any of these issues may also contribute to low milk production, because making milk relies on the hormonal signals being sent to the breasts. What can you do? In some cases, treatment of your health problem will help you to boost milk production, although supplementation may be needed. A visit to a breastfeeding clinic or Lactation Consultant can help you find an approach that will work with your specific condition.

3. Previous Breast Surgery

Breast surgeries can be done for both medical and cosmetic reasons. Breast reductions or enhancements, for example, are increasingly common. Nipple piercings can also be considered a kind of breast surgery and may damage milk ducts in the nipple. How much these surgeries affect breastfeeding varies widely, depending on how the procedure was done, how much time has passed between the surgery and the birth of the baby and whether there were any complications that might have caused scarring or damage to the breasts. Some women, especially those with breast enhancements rather than reductions, may be able to exclusively breastfeed without any difficulty. Others will need extra help and may have to supplement.

4. Using Hormonal Birth Control

Many Mothers who breastfeed and take Birth Control Pills find their milk production doesn’t change, but for some, any form of Hormonal Birth Control (the pill, patch or injections) can cause a significant drop in their milk. This is more likely to happen if you start using these contraceptives before your baby is four months old, but it can happen later as well. The first step to increasing your milk supply again is to stop the medication, but talk to your doctor before you do and be prepared to change birth control methods.

5. Taking certain Medications or Herbs

Pseudoephredine (the active ingredient in Sudafed and similar cold medications), methergine, bromocriptine or large amounts of sage, parsley or peppermint can affect your milk. If you find your supply has dropped, and realize you have taken one of the medications listed here, ask your doctor about an alternative treatment for your cold or health ailment. Increased breastfeeding and possibly pumping will help you build up your milk production again.

6. Sucking Difficulties or Anatomical Issues in Baby

The problem may lie with your little one; it may be difficult for him to get the milk from your breasts. He may, for example, have a tongue-tie. That means the thin membrane of tissue at the bottom of his mouth is holding the baby’s tongue too tightly, so that he’s not able to use it properly to extract the milk. (A baby doesn’t really suck the milk out of your breast, he uses his tongue to help compress the breast and push the milk into his mouth.) In many cases this is fairly easy to see, but for some babies the restricting membrane is at the back of the tongue and harder to identify. Check to see if your baby is able to stick his tongue out (over his bottom lip) and that he touches it to the roof of his mouth when crying. If your baby is tongue-tied, the membrane can be clipped by a doctor and the baby’s ability to breastfeed will improve quickly. Other problems can also cause sucking difficulties (such as cleft lip and cleft palate), so if you suspect your baby isn’t feeding well, check with an expert or your doctor.

7. Not Feeding at Night

There are many books and programs that offer sleep-training methods to get babies to sleep longer at night without waking for feedings. While these techniques can work for some families, the loss of those night feedings can mean problems with weight gain for some babies. Why? Mothers vary a lot in how much milk they are able to store in their breasts between feedings. With no feedings overnight, their milk supply starts to drop. The level of prolactin (the hormone that signals the breasts to make milk) is also higher during night feedings, so the lowered overall prolactin can also contribute to a drop in milk. It’s hard to resist the lure of more sleep, but for many mothers, those nightly feedings are essential to keep milk production high. If you have started sleep training and find your milk supply going down, consider reintroducing one or two night feedings.

8. Scheduling Feedings and/or using a Pacifier Between Feedings

Your breasts make milk continuously, but the rate at which milk is made depends on how empty they are. You’ll make more milk when your breasts are close to empty and less milk when they are already filled up. When your baby is feeding infrequently, because you have put him on a three- or four-hour schedule for example, or because you are giving him a pacifier to stretch out the time between feedings, your breasts are fuller for longer periods of time. That means milk production slows down. When babies are breastfed in response to their cues, they tend to have shorter, frequent feedings and this means the breasts are emptier most of the time and so they continue to produce plenty of milk. Sucking is considered a feeding cue while breastfeeding.

9. Birth Medications or Jaundice

Mothers don’t always realize that medications used in labor, such as epidural anesthetic or Demerol, can affect the baby’s ability to latch on and breastfeed effectively. Some studies show these effects last as long as a month, depending on the medication used in the epidural and the length of time the mother received it. Jaundice, a common condition in newborns, can also make your baby sleepier than usual, so that he doesn’t wake up to nurse as often as he would otherwise. In both cases, you may need to pump your milk to build up a good supply. Once your baby has cleared the medications from his system and the jaundice has been treated, he will probably begin nursing well and you’ll be able to reduce and eventually stop pumping.

10. Supplementation

Especially in the first couple of weeks, supplementing with formula tricks your breasts into producing less milk. “In the early weeks, the breasts’ capacity for milk production is calibrated in response to the amount of milk that is removed,” says lactation consultant Diana West. “If less milk is removed, the breasts assume that less milk is needed, so the capacity is set at a lower point.” When your baby is given formula supplements, she naturally eats less at the breast, and the breasts respond by making less milk. If supplementation is necessary, pumping as well as breastfeeding can help to promote a higher volume of milk production.

If your baby is showing signs of not getting enough milk please see your Lactation Consultant or other breastfeeding expert who can help you figure out and treat the cause of your low milk supply.

Galactogogues

While there are many substances that have been used by Mothers for centuries that are claimed to help them make more breastmilk, there is limited scientific evidence to prove their effectiveness. Many cultures have special foods that are thought to enhance milk production. These vary and may contain active ingredients to fulfill this purpose. However, they have not been formally studied. This article provides the current best available information on a few common galactagogues.

Prolactin is a woman’s main breastmilk producing hormone. Most medications that act as galactagogues work by increasing Prolactin levels.

PHARMACEUTICALS:

Metoclopramide (Maxolon; Reglan)

Metoclopramide is a prescription drug used to treat gastrointestinal disorders. Metoclopramide has been used for nearly three decades to increase breastmilk production. However, it crosses the blood-brain barrier, unlike Domperidone. This means that Metoclopramide has the potential to cause central nervous system side effects such as restlessness, drowsiness, fatigue and depression. *NOTE: The drug Reglan (Metoclopramide,) commonly used to increase breastmilk production, can also cause depression. An obvious risk factor for Postpartum Depression!

Domperidone (Motilium)

Domperidone is a prescription drug used for decades for gastrointestinal disorders. There have been a couple of quality scientific studies done which show that Domperidone appears to be an effective galactagogue too. Studies suggest that Domperidone has few side effects.

Domperidone, an Introduction

Domperidone (Motilium™) is a drug that has, as a side effect, the increase of milk production, probably by increasing Prolactin production by the pituitary gland. Prolactin is the hormone that stimulates the cells in the mother’s breast to produce milk. Domperidone increases Prolactin secretion indirectly, by interfering with the action of dopamine, whose action is to decrease the secretion of Prolactin by the pituitary gland. Domperidone is generally used for disorders of the gastrointestinal tract (gut) and has not been released in Canada for use as a stimulant for milk production. This does not mean that it cannot be prescribed for this reason, but rather that the manufacturer does not back its use for increasing milk production. However, there are several studies that show that it works to increase milk production and that it is a relatively safe drug. It has been used, for several years, in small infants who spit up and lose weight, but was replaced until a few years ago by cisapride (Prepulsid™) (cisapride has since been taken off the market because it can cause serious cardiac problems). Domperidone is not in the same family of medication as cisapride. Another, related, but older medication, metoclopramide (Maxeran™, Reglan™), is also known to increase milk production, but it has frequent side effects which have made its use for many breastfeeding mothers unacceptable (fatigue, irritability, depression). Domperidone has many fewer side effects because it does not enter the brain tissue in significant amounts (does not pass the blood-brain barrier).

In June of 2004, the Federal Drug Administration (FDA) in the US put out a warning against using Domperidone because of possible cardiac side effects. This unfortunate step was taken without considering the fact that the cardiac side effects occurred only when the drug was given intravenously to otherwise very sick patients. In all the years I have used Domperidone in so many mothers, I have not yet heard of any significant cardiac side effects that could be definitely attributed to Domperidone. Incidentally, the Federal Drug Administration has no authority outside the US, and even in the US, compounding pharmacies, which are not regulated by the FDA, are continuing to provide patients with Domperidone. See the information sheet On the FDA and Domperidone.

When is it appropriate to use Domperidone?

Domperidone must never be used as the first approach to correcting breastfeeding difficulties. Domperidone is not a cure for all things. It should be used only in conjunction with fixing all other factors that may result in insufficient milk supply.

Do as much skin to skin as possible with the baby, during and in between feedings.

Correct the baby’s latch so that the baby can best obtain the milk the mother has available. Correcting the latch may be all that is necessary to change a situation of “not enough milk” to one of “plenty of milk”
Use breast compressions to increase the intake of milk

If you are breastfeeding exclusively, try expressing your milk after the feedings. A few minutes of hand expression after the feedings may be very effective to increase the milk supply. Some mothers may wish to use a hospital grade pump for 10-15 minutes after feedings—this may be very effective for some and not at all for others. Do what you can. A Mother exhausted from pumping is probably no further ahead with milk production. And yes, it is not necessary to express your milk if this is a burden and makes you want to stop altogether.

Correct sucking problems, stopping the use of artificial nipples.

Using Domperidone for Increasing Milk Production:

Domperidone works particularly well to increase milk production under the following circumstances:

It has frequently been noted that a Mother who is pumping milk for a sick or Premature baby in hospital has a decrease in the amount she pumps around four or five weeks after the baby is born. The reasons for this decrease are likely many (not putting the baby to the breast early enough, no true Kangaroo Mother care, etc), but Domperidone generally brings the amount of milk pumped back to where it was or even to higher levels.
When a Mother has a decrease in milk supply, often associated with the use of birth control pills. Avoid estrogen containing, or even progesterone only birth control pills or progesterone releasing intrauterine devices (Mirena) while breastfeeding.

Domperidone still works, but often less dramatically when:

The Mother is pumping for a sick or premature baby but has not managed to develop a full milk supply.
The Mother is trying to develop a full milk supply while breastfeeding an adopted baby.
The Mother is trying to wean the baby from supplements.

Side Effects of Domperidone:

As with all medications, side effects are possible, and many have been reported with Domperidone (textbooks often list any side effect ever reported, but symptoms reported are not necessarily due to the drug a person is taking). There is no such thing as a 100% safe drug. However, our clinical experience has been that side effects in the Mother are extremely uncommon, except for increasing milk supply.
Some side effects which mothers we have treated have reported (very uncommonly, incidentally):
Headache which disappeared after a few days or when the dose was reduced (probably the most common side effect)
Abdominal cramps
Dry mouth
Alteration of menstrual periods, usually stopping them, but also breakthrough bleeding is possible.

It is usual when breastfeeding not to have menstrual periods for many months a very few Mothers who have taken Domperidone for many months, usually more than a year, have reported feelings of anxiety, sleeplessness, loss of appetite and other symptoms when they stopped the Domperidone “cold turkey”.

The amount that gets into the milk is so tiny that side effects in the baby should not be expected. Mothers have not reported any to us, in many years of use, at least not symptoms that can be attributed definitely to the Domperidone. Certainly the amount the baby gets through the milk is a tiny percentage of what babies would get if being treated for spitting up. Remember, this is a medication often given to babies for reflux.

Are There Long Term Concerns About The Use of Domperidone?

The manufacturer states in its literature that chronic treatment with Domperidone in rodents has resulted in increased numbers of breast tumors in the rodents. The literature goes on to state that this has never been documented in humans. Note that toxicity studies of medication usually require treatment with huge doses over periods of time involving most or all of the animal’s lifetime. Note also that not breastfeeding increases the risk of breast cancer, and breast cancer risk decreases the longer you breastfeed. Also note, in Canada, Domperidone has been used as a ‘milk-making’ medication for over 20-years

Using Domperidone:

Generally, doctors now start Domperidone at 30 mg (three 10 mg tablets) 3 times a day. In some situations we go as high as 40 mg 4 times a day. Printouts from the pharmacy often suggest taking Dmperidone 30 minutes before eating, but that is because of its use for digestive intolerance. It is true, though, that absorption of Domperidone is greater on an empty stomach. You can take the Domperidone about every 8 hours, when it is convenient (there is no need to wake up to keep to an 8 hour schedule—it does not make a real difference). Many mothers take the Domperidone for 3 to 8 weeks, but sometimes it is needed longer than that, and sometimes it is impossible for mothers to maintain their milk supply without staying on Domperidone. Mothers who are breastfeeding adopted babies may have to take the drug much longer. People taking Domperidone for stomach disorders often have been taking it for many years.

After starting Domperidone, it may take three or four days before you notice any effect, though sometimes mothers notice an effect within 24 hours. It appears to take two to three weeks to get a maximum effect, but some mothers have noted positive effects only after 4 or more weeks. It is reasonable to give Domperidone a trial of at least four, and better, six weeks before saying it doesn’t work.

One recent (2011) well designed study compared Domperidone and Metoclopramide as galactagogues. This study showed that there were no statistically significant differences between these two drugs in terms of increased milk production or side effects.
This study found that, in the women in this study, both Domperidone and Metoclopramide were very effective at increasing breastmilk production, and had minimal (and all non life-threatening) side effects.

HERBS:

Although “all natural” herbs are strong medicines in their own right, simply found in their original plant form. *Always check with your Health Care Provider and/or your IBCLC Lactation Consultant regarding the use of herbs while pregnant or breastfeeding.

Fenugreek – one of the best and strongest herbs for increasing milk production. When taken in very large amounts, Fenugreek is also used for lowering blood sugar levels, and is, therefore, not recommended for use by diabetics or those who are on strict insulin regimens to regulate their blood sugar levels. It also works on the digestive system, and in a small percentage of people, it may cause gas in either the mother or baby. Many mothers of adopted babies have successfully used this herb to help establish a breastmilk supply to feed their adopted babies. Fenugreek is not recommended for use during pregnancy as it can cause uterine activity. Fenugreek must be used with consistency for best results, otherwise it can negatively affect or decrease milk production.

Goat’s Rue – Goat’s Rue is a powerful herb for stimulating milk production and increasing the flow of breastmilk. It has been shown to increase milk production by 50% in many cases, and may also stimulate the development of the mammary glands themselves. This herb is safe for use during pregnancy. This herb is one of the main ingredients of the Nursing Tea/Nursing Tincture. It can be used as a single herb by itself, or to use along with or to add to the Nursing Tea/Tincture when something a little stronger is needed.

Fennel – this herb is great for increasing breastmilk production, and at the same time is also extremely helpful in relieving symptoms of gas or upset stomach. It is the perfect herb to take in conjunction with Fenugreek, when gas is a problem. This is also one of the main ingredients of the Nursing Tea/Nursing Tincture, as well as the Tummy Tea/Tummy Tincture which is specifically formulated for gas, colic, reflux and indigestion.

Red Raspberry Leaf – also one of the ingredients of the Nursing Tea/Nursing Tincture. It not only helps to increase breastmilk production, but it also will help the uterus recover after birth, as it is a uterine toner. Red Raspberry Leaf is incredibly high in vitamins and minerals, including Niacin (a B vitamin), which has been said to be helpful in relieving symptoms of Raynaud’s Syndrome.

Vitex – although this herb is a Prolactin-inhibitor, it has traditionally been used, and is proven in case studies, to actually increase breastmilk production in nursing Mothers. Its main function is that of balancing hormones, therefore, this herb is very helpful for women who are experiencing hormonal imbalances, such as PMS symptoms, while breastfeeding. Note: Vitex use may re-start the menses in nursing women.

Alfalfa – a great herb for increasing breastmilk production while providing the body with lots of good vitamins and minerals. It is very high in Vitamin K in particular, which helps to staunch bleeding. Many midwives encourage all their clients to take Alfalfa for at least six weeks before birth, and for several months afterwards, to help avoid hemorrhage at the birth, and to help the body recover and make plentiful breastmilk afterwards. (Alfalfa is also an ingredient in the Nursing Tea/Nursing Tincture. *Note: This herb is not recommended for use by those on blood-thinning medications due to its high levels of Vitamin K.

Nettle – a similar herb to Alfalfa. Helps to enrich the milk. (Also found in Nursing Tea/Nursing Tinctures.)

Blessed Thistle – also known as “Our Lady’s Milk Thistle”. It increases breastmilk while helping to alleviate mild forms of postpartum depression. It is a bitter herb (known as a digestive bitter), which is healthful for the liver and digestion. Although it is an effective herb for increasing milk production, it is no longer included in the Nursing Tea. Many customers found it to be too bitter and did not like the taste, therefore hesitated to use the tea. There is Blessed Thistle available as a single herb in the tincture form.
*Note: NOT Milk Thistle…easy to confuse..but Milk Thistle is for your liver, and can be harmful while breastfeeding. Please make sure you are using BLESSED THISTLE and NOT Milk Thistle!

Borage– traditionally used to help balance the adrenals as well as increase breastmilk production. It is not for use on a long-term basis, and because it contains an alkaloid that can be hard on the liver, it is not one of the herbs that is recommended for nursing mothers/babies.

Hops – used in many cultures for years to help with breastmilk production. You’ve heard women say that they “breastfed their babies on beer”? The Hops is why. Beer from other countries has Hops that are helpful, but our beer here in this country is not as effective. It is the dark German beers that tend to have the right ingredients or the right quality of Hops. Hops is not on the list of favorite herbs recommended for increasing breastmilk production, however, because it can be quite sedating and it can cause depression with prolonged use.

*I personally find it interesting to note that the same Herbs that have been used for centuries for tummy upset, (bitters) also increase Prolactin and therefore breastmilk production. It was quite by accident that the prescription medications designed for tummy upset were found to have the “side-effect” of increasing Prolactin and therefore milk production!

FOODS:

It is important to eat a well-balanced diet of fresh fruits and vegetables, whole grains and good sources of Protein.
Just like the importance of your Protein intake while pregnant, sufficient Protein intake is vital to a good milk supply.
“Protein Makes Milk!”
Please make sure you are well nourished. Now is not the time to go on a crash diet and/or fast.
Breastfeeding requires an extra 500 calories-a-day, over the normal 2000 calorie diet.

Drinking milk, does not “make milk.”

Drink plenty of water “to thirst.”
Stay hydrated!
Dark urine is a sure sign that you may not be drinking enough water.

Please continue your Prenatal Vitamins throughout Breastfeeding.

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A Galactagogue works best when a Mother has Low-Prolactin levels (i.e. When there is a genuine, not a perceived, low-milk supply issue), and after a Mother has received support and education to improve her breastfeeding or expressing technique. It will only work in conjunction with improved management of regular and efficient milk removal.

*Homeopathy is safe and effective while Breastfeeding.
Please see also: www.classichomeopath.com
www.lactation-911.com/homeopathy-and-breastfeeding/

For further information:

The Breastfeeding Mother’s Guide to Making More Milk

By Diana West (IBCLC) and Lisa Marasco (IBCLC) is a valuable book that includes a thorough section on Galactagogues.

References:

Akre, J., (1989), Infant feeding. The physiological basis. Bulletin of the World Health Organization, 67 Supplement: 1–108.
Da Silva O, Knoppert D, Angelini M, Forret P, (2001), Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial, CMAJ. 164:17-21.
Wan E, Davey K, Page-Sharp M, Hartmann P, Simmer K, Ilett K, (2008), Dose-effect study of domperidone as a galactagogue in preterm mothers with insufficient milk supply, and its transfer into milk, Br J Clin Pharmacol, 66(2):283-298.
Jones W, Breward S, (2011), Use of domperidone to enhance lactation: What is the evidence?, Community Practitioner 84(6):35-37.
West D, Marasco L, (2009), The Breastfeeding Mother’s Guide to Making More Milk, McGraw Hill, USA.
Ingram J, Taylor H, Churchill C, Pike A, Greenwood R, (2011), Metoclopramide or domperidone for increasing maternal breast milk output: a randomised controlled trial, Arch Dis Child Fetal Neonatal Ed [Epub ahead of print].
Alamer M, Basiouni G, (2005), Feeding effects of fenugreek seeds (Trigonella foenum-graecum L.) on lactation performance, some plasma constituents and growth hormone level in goats, Pak J Biol Sci, 25:28-46.
Nice, FJ, (2011), Common Herbs and Foods Used as Galactogogues, ICAN: Infant, Child & Adolescent Nutrition, 3(3):129-132.
Swafford S, Berens P, (2000), Effect of fenugreek on breast milk volume, ABM News & Views, 6(3):21.

*The information on this website does not replace the advice of your Health Care Provider.