Basics for La Leche League Leaders
Cynthia Good Mojab, MS
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
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.
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).
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).
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.
T. Lactational pharmacology. In M. Walker (ed.). Core Curriculum for Lactation
Consultant Practice. Sudbury, MA: International Lactation Consultant Association,
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
N. and Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, IL: LLLI, 1997.
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
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