I am a passionate advocate for breastfeeding. I am glad that, today, most mothers attempt to breastfeed. In Canada the breastfeeding initiation rate is 90% and climbing. Health organizations are doing a good job of communicating that ‘breast is best’, and mothers are listening – we all want the best for our babies, after all. Sadly, though, breastfeeding rates fall off dramatically in the early days and weeks. One of the big reasons given for this drop off is mothers who report that they do not have enough milk.
When low milk supply is suspected, people often turn to supplements to increase milk production. Herbs such as fenugreek are known galactagogues that have been used for centuries. Even oatmeal and beer are reputed to increase milk production. Some teas are sold almost as preventive measures – drink this and you are helping to ‘ensure’ and ‘protect’ your supply. And I have to admit, I have mixed feelings about the way some supplements are promoted and sold.
The thing about breastfeeding is that it often involves guesswork. You don’t know how much milk, exactly, your baby is getting. You don’t know, necessarily, if your baby is getting foremilk or hindmilk, or if it’s coming fast or slow. So you resort to counting diapers and checking weight gain and monitoring the frequency and length of feedings. And in the midst of this, it’s easy to become worried. Even I sometimes worry about whether my kids are getting ‘enough’. Babies can be unpredictable and fussy, and milk supply is often the first culprit that people look to whenever a baby is out of sorts.
In this situation, I wonder if the widespread marketing of supplements does a disservice. I fear the implication that mothers need to take a herb or drink a tea in order to breastfeed successfully, or that somehow low milk supply is more common than it is. I worry the prevalence of supplements amplifies concerns over milk supply that many mothers are naturally prone to feel. And beyond herbs and teas, here in Canada doctors often prescribe the medication domperidone to increase milk supply. Anecdotally, many prescribe it as almost a preventive measure whenever a mother faces breastfeeding struggles.
There certainly are mothers who legitimately struggle with low or no supply. Physiological causes can inhibit a mother’s ability to produce milk. Moms who experience separations and are pumping may struggle with keeping their supply up. There are a whole host of reasons that someone may not be able to quite keep up with a baby’s demand. And in those cases, I say thank heavens that supplements and medications are available. If fenugreek or domperidone enable you to feed your baby breast milk when you otherwise couldn’t, that’s a great thing.
In fact, this raises a whole other issue. Domperidone, which is generally considered the safest and most effective prescription medication for increasing milk supply, is not available in the US. The FDA has in fact warned against its use for this purpose. There is concern about heart arrythmia, although research indicates that the risk is statistically insignificant when taken orally by otherwise healthy patients. While it is possible for US patients to get domperidone from compounding pharmacies, this is difficult and so most Americans do not have access to the drug. I’m not sure this situation is any better, because there certainly are situations where galactagogues are helpful.
Knowing that galactagogues are sometimes necessary, however, does not mean that their widespread use is good. Thomas Hale, the respected author of Medications and Mother’s Milk, has written about the use of domperidone. He says that it is effective, and very safe. However, he also says that there is a tendency to overprescribe, and prescribe at higher and higher doses. Not only do higher doses increase the risks, but the effectiveness does not appear to increase when you increase the amount that is taken.
In the early days of breastfeeding mothers and babies often struggle to figure out the basics of this new relationship. Sometimes problems arise that seem related to milk supply, but aren’t at all. Like, say, a baby’s latch isn’t good and so the baby isn’t feeding effectively or gaining weight. This isn’t related to the mother’s supply, so taking something to increase supply isn’t terribly helpful. But even so, hearing from a health care provider that you need to take this supplement to increase supply can create an ongoing concern, and harm your confidence.
I am not sure what the answer is. It’s clear in my mind that moms need better support and information. They need people who will sit down with them and take the time to figure out and address their problems. They may need access to breastfeeding supplements. But more than that, they need time and sensitivity, not just a solution in a pill. If you are in this position, where can you find support and information? La Leche League offers online information and forums, and you can talk free of charge to a leader in your area. You can find a Lactation Consultant near you, who may even be willing to visit your home. Or you can check out the excellent information on Kellymom. And this book is a fabulous resource for anyone who wants to increase milk supply.
No matter how a mother feeds her baby, she needs sensitivity and support. I would never judge those who face legitimate issues and are unable to make a go of breastfeeding, or exclusive breastfeeding. We’re all just doing our best, after all. I really think the world would be a better place if we acknowledged that, and offered new families real help instead of just lip service.
What about you? Have you used breastfeeding supplements? Do you think I’m blowing the whole thing out of proportion? Or do you share my concern that their widespread promotion leads to a perception that low milk supply is more common than it really is?