Galactagogue Basics for La Leche League Leaders 

by Cynthia Good Mojab, MS

Galactagogues are prescription drugs, herbs, or foods that increase milk supply. Mothers sometimes ask La Leche League Leaders to suggest a prescription galactagogue (e.g., domperidone [Motilium] or metoclopramide [Reglan, Maxolon]) or to provide information on herbal galactagogues, such as fenugreek, blessed thistle, milk thistle, fennel or goat's rue. Because of health and liability issues, Leaders often have questions about how they should handle these situations.

Prescription and herbal galactagogues are commonly used in the US when inducing lactation or relactating, especially among adoptive mothers. A mother might use a galactagogue after poor breastfeeding management results in decreased milk supply. A mother might also use galactagogues when she is pumping long term because she is working outside the home, has an ill, hospitalized, or premature baby, or has a baby born with a congenital disorder that impacts breastfeeding (e.g., cleft palate, Down syndrome). Some mothers automatically drink "Mother's Milk Tea" (a blend of herbs thought to increase milk supply) from the first day of lactation simply because they are breastfeeding. Herbal galactagogues are used around the world. The evidence for their effectiveness is often historical use.

Prescription galactagogues are drugs. Leaders cannot prescribe or recommend any drug. "Only a licensed medical professional can prescribe or recommend a drug to a breastfeeding mother or evaluate the safety of a drug for an individual mother and baby" (Mohrbacher & Stock 1997). Leaders also cannot prescribe or recommend herbs. "Over-the-counter medications are also drugs", including herbal products used as galactagogues (Hale 2002). "LLL liability insurance covers Leader responsibilities only. It is beyond the scope of Leader responsibility to suggest herbs for the treatment of medical conditions, although reliable information about an herb may be shared. Leaders who are also professional herbalists will need to keep these two roles separate when working with a mother" (Humphrey 1998).

Herbal galactagogues, like drugs, can produce side effects. "Because herbs may be potent, they should not be used casually. If the mother would like to explore this possibility, suggest she contact someone knowledgeable in their use" (Mohrbacher & Stock 1997). Herbal galactagogue preparations may have other ingredients. "Herbal teas that promise to increase a mother's milk supply may also contain other active ingredients and should be taken in moderation" (Mohrbacher & Stock 1997). Herbal teas commonly used to increase milk supply may have side effects. "'Mother's Milk' tea is a blend of herbs that many generations have believed will increase a mother's milk supply. The mix of herbs in this tea–fennel seeds, coriander seeds, chamomile flowers, lemongrass, borage leaves, blessed thistle leaves, star anise, comfrey leaves, and fenugreek seeds–is free of caffeine, but taken in excess it can have possible side effects, including vomiting, vertigo, insomnia, and restlessness" (Mohrbacher & Stock 1997). An herbal galactagogue may or may not work for any given mother or for any mother. "Although several hundred plants have been described in ethnobotanical literature as galactagogues (increasing the secretion of milk), only a handful of plants have been investigated" (Humphrey 1998).

Galactagogues, herbal or prescribed, are not cure-alls. They should not be used as the first step to correcting problems with insufficient milk supply. All other factors should be addressed first, including correcting latch-on, positioning, and sucking problems, increasing the frequency of breastfeeding or pumping, using switch nursing, using breast compression, expressing milk after breastfeeding, etc. Leaders can help a mother make an informed choice about prescription or herbal galactagogues by helping her frame questions for her health care provider, helping her explore her feelings about what she wants to do, providing her with information and resources, and supporting and encouraging her to accept responsibility for her and her baby's health and well-being (Mohrbacher & Stock 1997). Leaders should not hesitate to contact their APL with questions about prescription or herbal drugs–including galactagogues.
 

References

Hale, T. Lactational pharmacology. In M. Walker (ed.). Core Curriculum for Lactation Consultant Practice. Sudbury, MA: International Lactation Consultant Association, 2002.

Humphrey, S. Sage advice on herbs and breastfeeding. LEAVEN. June-July 1998, 34(3):43-47. Available online at: http://www.lalecheleague.org/llleaderweb/LV/LVJunJul98p43.html

Mohrbacher, N. and Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, IL: LLLI, 1997.
 

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Cynthia Good Mojab, MS, is Research Associate in the Publications Department of LLLI, is a member of the LLLI Editorial Review Team for The Breastfeeding Answer Book (3rd edition), has been a La Leche League Leader in Oregon since 1998, and is a private researcher and author. Most of her publications can be accessed online via her website, Ammawell (http://home.comcast.net/~ammawell). Cynthia recently gave a presentation, "Common Uses of Common Galactagogues," at an LLL Chapter Meeting. She lives in Oregon with her husband and their five-year-old daughter
 
 

© La Leche League International, 2002. All rights reserved. Reprinted with permission from Patchwork Pages of La Leche League of Oregon. This article was first published in Patchwork Pages, Spring 2002, pp. 2-3. Note that this document is for personal use only. Please do not reprint this item or distribute it further without written permission from La Leche League International.