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?

I shared the story of my daughter Hannah’s weaning at 34 months a little over 6 months ago. The post touches on the incredibly mixed feelings I felt when I made this decision. I think that this is common for many mothers who are breastfeeding older toddlers and preschoolers. On the one hand, you may not particularly enjoy nursing anymore, at least not all the time. But on the other hand, you often rely on it in many ways – to soothe tears, as a chance to sit down, or a way to reconnect with your child after a day at work. And you may also feel that your child enjoys it and relies on it, too, and fear what weaning will mean to your little one. These mixed feelings were difficult for me to grapple with, and one of the biggest personal challenges that I faced when I considered weaning.

One of the things that I discovered is that weaning is not all-or-nothing, it is a process with many steps and stages. This is especially when you’re weaning a toddler with their own thoughts on the matter. And many (if not most) people start by partially weaning, placing parameters around nursing to limit it. Night weaning is a common first step, in which a mom nurses her child to sleep and then uses other methods to help the kiddo get back to sleep if he or she wakes. Others use ‘don’t offer, don’t refuse’, in which the mother does not initiate nursing, but does not refuse the child’s request to nurse. Some people set a length of time for a nursing session or an upper limit on the number of nursing sessions each day, or decide to only nurse at home.

Hannah began sleeping through the night on her own when her last molars came in, at around 27 months. But even before that she didn’t wake much at night, and it was pretty manageable for me. So, I have never night weaned. However, I have tried most other methods.

I started off the weaning process with ‘don’t offer, don’t refuse’, because it seemed both easy and gentle to me. And it was both of those things, at least for Hannah. As for me, I discovered just how much I relied on breastfeeding in my daily life. The kid is grumpy? Breastfeed. I need to make a phone call? Breastfeed. I want to watch a TV show? Breastfeed. We’re bored and it’s raining outside? Breastfeed. The truth is that weaning was as much about me as it was about my child.

As we progressed through weaning, I found that I felt excessively irritable while I was nursing my daughter. I’ve spoken with some other mothers who felt the same way, so it seems to be normal. This is totally my own theory, but having watched a mother cat wean, I suspect this irritability is at play amongst all mammals. Whatever caused it, when I was feeling this way I found that limiting the length of a nursing session helped. I would nurse only for length of time it took me to sing the ABCs, adjusting the speed based on my feelings, and my toddler was generally fine with that.

Eventually, I knew that I did not want to breastfeed as frequently anymore. I decided to limit the number of feeds each day. I chose what I felt were the three most important nursing sessions for Hannah, and I explained the new arrangement to her. And she pretty much understood. As for me, I was pleasantly surprised to find that limiting the number of nursing sessions made breastfeeding much more manageable for me. And I think that’s a good thing, because breastfeeding is a relationship. As a child gets older, it changes and shifts and it’s totally reasonable to make adjustments so that it works for everyone.

Partially weaning is both a way-point on the path to weaning, and a state in and of itself. Eventually all children wean somehow or another. It is an inevitability. Placing limits and experimenting with tactics can help make that process easier on everyone. However, they can also make breastfeeding itself easier on everyone. Many people find that placing a few limits on a young toddler’s nursing helps them to continue breastfeeding when they thought they were done. The counter-intuitive truth is that partial weaning can sometimes be a way to extend breastfeeding.

Weaning brings up a lot of mixed feelings. It can be confusing and conflicting and uncertain, for adults and children alike. I believe that there is no one else in the world who can tell you when, how, or for how long you should breastfeed. It is a decision that you alone can make, taking the needs of yourself and your nursling into account. You will not get a gold star if you breastfeed for 6 years, and you will not receive my condemnation if it doesn’t work out for you. The good news is that you set your own rules. Whenever and however you wean, or partially wean, or never wean, as long as you are doing your best for your children they will be OK. And that is the most important thing, really.