Pills, Potions, Cautions - What Are The Risks of These Medications to Increase Milk Supply?
In my work as a lactation consultant, I often see women taking all sorts of pills to boost their milk supply.
As I delve deeper, I discover that rather than explore and address the possible range of reasons for perceived or real low milk supply – from inappropriate breastfeeding advice and baby issues such as poor latch, ineffective sucking, tongue tie, low oral muscle tone, to maternal medical conditions such as breast surgery, retained placenta, postpartum haemorrhage, PCOS, Diabetes, Thyroid conditions and insufficient glandular tissue (IGT) or lifestyle issues such as alcohol and smoking or birth control pills - many of these women have been prescribed medication.
Often the advice to take supplements, medication and herbs has come from health professionals. So it must be safe, right? And natural – that is, herbs – must be better than prescription, right? Actually there can be potentially harmful side effects from both natural and prescription medications currently being advised for breastfeeding mothers to increase breast milk supply.
According to the Academy of Breastfeeding Medicine, a US based organisation of physicians specialising in breastfeeding medicine, “emerging data suggest that we should exercise more caution in recommending drugs to induce or increase the rate of milk secretion in lactating women, particularly in women without specific risk factors for insufficient milk supply.”
Just as with any medication, whether herbal or pharmaceutical, women should be advised of all possible contraindications so they can weigh up risks versus benefits and make choices accordingly. It is particularly important when you are breastfeeding or pregnant that you are aware of any side effects that may be harmful to yourself or your baby.
Natural is not always better
Fenugreek, a herb commonly used in curries and chutney, is widely suggested to breastfeeding mothers who are concerned about their milk supply. Because fenugreek is ‘natural’ most women assume it’s fine to swallow a few capsules when milk supply feels a bit low. However, the dosage of a few seeds added to a curry that is shared between family members, is significantly different to capsules eaten several times a day by a single person.
As well as there being no accurate regulation of dosage and concentrations in capsules, some of the conditions that can contribute to challenges with milk supply, such as thyroid disorders and pregnancy (yes you can get pregnant while breastfeeding) can also mean it is unsafe to use fenugreek. For instance, medicinal doses (not the amount used in curries - that's fine) are considered a uterine stimulant and have been used to induce labour so it’s not a safe way to boost a milk supply that may be affected by pregnancy hormones.
If you have a thyroid disorder, fenugreek can influence the conversion of T4 into T3, the active thyroid hormone that your body uses. This means you could end up with more severe symptoms of hypothyroidism (and reduce milk production!). Fenugreek reduces blood glucose levels so women with diabetes or prone to hypoglycaemia may experience hypoglycaemia when they use fenugreek. If you have diabetes, use fenugreek only if you have good control of your blood glucose levels. Also, closely monitor your fasting levels and after meal levels.
Fenugreek is in the same family as peanuts and chickpeas, and may cause an allergic reaction in mothers who have a peanut or chick pea allergy – some women have reported increases in asthma symptoms as well as squirmy, irritable babies. Mothers have also reported babies with tummy pains and green frothy poos. Although tummy pains may be caused by fenugreek, green frothy poos may be a symptom of foremilk imbalance as a result of ‘oversupply’ which begs the question – did the mum need fenugreek to increase her supply in the first place?
Sonya says: “I recently read pinky's blog on herbs given to new mums to increase supply. I was one of these mums and I took them daily up until I read your article when I began to question if all stomach issues I was having could be related. So guess what, I stopped taking them and 3 surprising things happened. Firstly I stopped having terrible wind and needing to run to the toilet every morning. Baby stopped having horrible wind and explosive poos. And best of all my supply is fine, no issues at all. I originally visited the CHN for advice on how to stop the bottle feeds the midwives suggested in hospital. I was told I would need to increase my supply to do this and to take the herbs and pump.”
Can Prescription meds increase milk supply
Prescription medications should also be regarded with caution. Commonly prescribed medications for low milk supply include Metoclopramide (brand names Reglan or Maxalon), and Domperidone, also known as Motilium.
These medications are generally prescribed to aid gastric disorders such as heartburn, nausea or slow gastric emptying, but one side effect is that they increase prolactin levels – and this is the hormone responsible for milk production. That’s why they are prescribed ‘off label’ (in higher doses) to induce lactation in breastfeeding women.
Studies into the efficacy of medications to increase milk supply are scarce but according to those evaluated by The Academy of Breastfeeding Medicine, Reglan (Maxalon) didn’t show any benefits. And, if you have a previous history of depression, there is a high risk of serious psychiatric side-effects associated with Metoclopramide (Reglan/Maxalon). These include depression, anxiety and mania to psychosis and suicidal ideation.
While only 2 studies of Domperidone were accepted for evaluation by the Academy of Breastfeeding medicine, these showed positive effects on milk supply in mothers of premature babies, while another small study showed that some mothers seem to be ‘responders’ and others ‘non responders’.
Health Canada and makers of Domperidone advise that the drug has been associated with serious heart problems that could result in death. Although the Canadian reports were based on an intravenous form of the drug in much higher doses than would be taken orally, Health Canada's safety notice says the risk of serious abnormal heart rhythms or sudden death from cardiac arrest may be higher in patients taking Domperidone at doses greater than 30 milligrams a day, or in patients over age 60, based on results from recent studies in the Netherlands and Saskatchewan. Dosage recommendations to increase milk supply vary, these are usually much higher than 30 milligrams a day.
However, according to a ‘Consensus Statement on the Use of Domperidone to Support Lactation’ written and endorsed by a number of notable Canadian health professionals: ‘this warning was based on information gathered from an entirely different population than those who would be taking Domperidone for breastfeeding purposes and is thus not generalizable to the lactating population. They advise: of primary concern is the likelihood that, based on the warning, many health practitioners will discontinue prescribing Domperidone to mothers who would otherwise require it to support and sustain breastfeeding. As a consequence, numerous babies who would have otherwise breastfed will not.’
Rhi says: “My baby was in ICU for 5 days when she was 8wks old. She had not fed properly for over a week prior to that. With the stress and no contact I'd almost dried out. Despite pumping every 3 hours I was only getting 10mls. Drs from NICU and an LC suggested motillium and a homeopathic tonic. Without them I would have had to supplement (or worse go completely to formula).”
Dr Jack Newman, paediatrician and director of the Newman Breastfeeding clinic in Toronto, explains on his clinic website: "If all mothers had the best start with breastfeeding, from the very start, having as few interventions as is reasonable during labour and birth and received good help from the beginning, most mothers taking domperidone would not have needed it."
He says, “there is no such thing as a 100% safe drug, however, our clinical experience has been that side effects of Domperidone in the mother are extremely uncommon, except for increasing milk supply. Some side effects which mothers we have treated have reported (very uncommonly) include: 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.”
Callie says: Motilium made me violently sick with cramping, nausea and vomiting and yet it was recommended from the beginning by almost every professional I saw. It rendered me useless in the care of my newborn until it was out of my system. Horrible, horrible experience at a very tough time.
The Royal Women’s Hospital in Melbourne advises, ‘taking domperidone to increase breast milk supply should only be done under medical supervision. Please tell your doctor or lactation consultant if you are taking any other medicines, as domperidone may interact with some antibiotic and antifungal medicines, and some heart medicines.’
This warning applies to mums with nipple thrush who are being treated with Diflucan.
Withdrawal side effects from Motilium/Domperidone
Recent reports have revealed serious psychiatric side effects as mothers withdraw from Domperidone -women in Canada, the U.S. and Australia say they had debilitating psychological side effects when they tried to come off the drug.
These women described extreme anxiety, panic attacks, insomnia and intrusive thoughts so severe they were left unable to function or care for their children, often for months. Some were forced to stop working or move in with family. At least one attempted to take her own life. They all say no one warned them these things could happen.
"It's very unpredictable," said researcher Janet Currie, who wrote her doctoral thesis on postpartum domperidone prescriptions in British Columbia. She says she's helped between 15 and 20 postpartum women with severe psychological side effects slowly taper off the drug in the last year.
"No one can tell you exactly in advance whether you'll have these symptoms and how intense they will be."
So, what’s a mum to do?
Firstly, if you are worried about your milk supply, check in with a lactation consultant or a breastfeeding counselor and assess whether you really do have a low supply and if a few simple management tweaks could help. Then work to increase your supply by making sure your breasts are drained after feeds, snuggle your baby skin to skin (this will help boost your oxytocin levels) and offer the breast at every subtle signal, rest, drink according to your thirst and eat nutritious foods and snacks.
Steph says: “our son was very slow to put on weight after we left hospital. Given he'd nearly returned to birth weight by the time we left hospital we were surprised at his poor weight gain at his first checkup. I also had a badly damaged nipple on one side and had asked the MCHN what I could do to help it heal.
The local MCHN had me glued to the couch for weeks to achieve ever increasing numbers of feeds per day for set lengths of time. She was convinced I had supply issues (despite damaged nipples indicating incorrect attachment and eventually told me to either start bottle feeding or get a prescription for motilium.
Lucky for me our local GP wouldn't prescribe without some investigation of his own and referred us to some online resources including Dr Jack Newman and Pinky as well as a wonderful lactation consultant who picked up that our issue wasn't one of poor supply but poor attachment, particularly on one side. If we'd gotten the right help earlier I wouldn't have had to put up with painful feeding and the guilt of watching our son fail to gain weight. Within a week of correcting the attachment issues our son was piling on the weight and hasn't looked back ."
Questions to ask your health carer
If you are advised to take medication to increase lactation ask (just as you would with any medication), what are the side effects/contraindications? What are my options? Then weigh up the risks and benefits and make an informed decision about what is best for you and your baby. And, if in doubt, seek another opinion.