Breastfeeding Supplements

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?

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  1. With my first, I worried about supply, but in hindsight, my baby was fussing because I needed to nurse more. I had taken the "feed every three hours" as the benchmark, but in real life, he fed MUCH more frequently than that. I took it as a sign of a problem, but I think now he jus tneeded to nurse more until the supply regulated itself. (I did continue to nurse, for just over a year). My daughter went through a similar phase, but this time I wasn't clock-watching and just gave myself over to nursing around the clock, and sure enough she stopped 'asking' so often and we've settled into a pattern closer to that three-hour benchmark. I hear a lot of moms say they have low supply, but I think many moms don't realize that given time and lots of nursing, sometimes supply problems are normal and will correct themselves.

  2. We live in a time where we like to throw a pill at a problem. Obviously sometimes those pills are needed, but often I think they’re relied on too much.

    I’ve thought for awhile that the perception that so many women suffer from low-milk supply is likely an incorrect one. It seems suspicious that so many women are supposedly not able to biologically provide for their children when that is what we were built to do. I am not saying that I think 100% of women should be able to breastfeed exclusively as I know legitimate issues do exist but when I personally know quite a few women who were told by their doctors that they had a low-milk supply (including myself) I question what is really going on.

    I did not take supplements – although I was told by multiple nurses in the hospital as well as a public health nurse that I “obviously could not produce enough milk, was starving my baby and I needed to supplement with formula” (I was not offered herbs or medication for myself). In fact I was not permitted to be released with my children from the hospital unless I let them supplement my baby (which I didn’t continue once home). I felt that they were jumping the gun and needed to give my body and my babies time to adjust. In the end I was right. My milk supply increased as needed. The kids figured how to latch and all was fine – without supplements.
    .-= Marilyn´s last post ..Moving Forward =-.

  3. Hi Amber,
    I never had to use supplements as my problem was over production of milk, which has it’s own set of complications. However, I’ve heard many a mother use the exscuse of “no milk or low milk” as a reason not to breastfeed. And you are so right about the support needed, especially in the early stages of breastfeeding your first child. I did fine in the hospital nursing my first born every 1.5 to 2 hours but was still accused by a nurse of not wanting to feed my baby because I wasn’t nursing her everytime she came into the room! With my second baby I had a mid-wife, left the hospital 2 hours after giving birth and they came to see me the next day at home. It was wonderful to be trusted with the care of my own child without someone monitoring my mothering and telling me when I was “allowed” to go home with my baby. But I digress, because of course these supplements are available for a reason and not all of us have the luxury of having a year at home with our babies (i.e. in the US they have maybe 6 weeks, maybe a little more off from work). I have a few friends that wanted so badly to give their children breastmilk that they were pumping at work and still seeing their supply drop off. It’s really too bad that domperidome is not available in the US where it is truly needed.

  4. Amber,
    An absolutely spot on article. I think there is a larger underlying problem in the US (I can’t speak for Canada), the lack of support for the family. There is a lot of lip service by certain groups, but where are the home health aides that you see in the UK and other parts of Europe? Where is the investment in paid parental leave? My mother was shocked to hear that no one was going to come check on how we were doing once we brought our daughter home from the hospital. We struggled, correction, I struggled with breastfeeding. I have a metal box in my left breast the size of a computer mouse. The scar tissue around it we believe impeded the supply although I did get some production.

    After an emotionally draining battle I was able to exclusively breastfed my daughter until she started solids at six months and continued to breastfeed until she was 13months old when I was down to an ounce or less in production. No supplements helped.

    What would have helped? More community support and dedicated paid parental leave. I started back at work part time from home when she was 3 weeks old and more office time starting at 5 weeks. This was not the ideal situation. It was stressful and exhausting. However, our employers were supportive, as they still are, of both my husband and I having a flexible schedule. We were able to keep her at home until she was six months old.

  5. Great, practical, balanced post as usual!
    .-= Christine LaRocque´s last post ..Revelations for a new decade =-.

  6. I never had to consider supplements, even though I had a C-section with Angus and was warned this could affect my milk supply (honesty, I think I could have fed a village). I don’t know anyone else who was offered supplements either, and in some cases they might have been useful. I agree with those who say there’s a wider problem of lack of support and information for new mothers. One of my friends got mastitis and was told to STOP nursing, which is the exact opposite of what you should do. I’ve heard horrible stories on both ends of the spectrum — lactation consultants berating sleep-deprived women who are having trouble breastfeeding, and doctors discouraging breastfeeding, not to mention the occasionally hysterically prudish public. I think most of the problems associated with breastfeeding are larger symptoms of a screwed-up society. But I guess that’s another post.
    .-= Allison´s last post ..***********Can I borrow a cup of sugar and your new year’s eve party please? =-.

  7. I remember after having my son being bombarded with hype… he was loosing too much weight (the kid weighed 9lbs 10 oz at birth loosing a few ozs wasnt’ the worst thing in the world!) But I was tired, my body sore, I was a new mother… with a new great resposibility. I breastfed exclusively and when he was about 10 days old I got some More Milk Plus from Mother Love… after two doses I felt like I had enough milk and let it go. My nipples were sore and I did have thrush, but I can’t honestly say if I needed supplements or not, but it did make me feel better somehow. And feeling better eased my hormones and the milked flowed like a river…
    Now, I am foster mother to a six month old… and bottle feeding is really strange to me. Although I find it important to stick to a regime of formula servings… I cant use it as a guage for how she’s doing like I could with my son (who would nurse differently if he has a sinus cold or a belly ache, or was growing.. or content).
    I do have a breast feeding question though: What are your thoughts or knowledge on hormone IUD’s in breastfeeding mother’s? Do the hormones go through breast milk and have an effect on the baby? Thanks for your help!
    .-= Shannon´s last post ..What’s Happening …….. Wednesday =-.

  8. I have taken fenugreek and blessed thistle as I was desperate for my milk to come in after an emergency cesarean and was comfortable with herbs as I grew up with a herbologist mother. Hard to say if they helped but it made me feel like I was at least doing all I could – so it was comforting. It bolstered my confidence if anything, but that could have been because of my background.

    Supply is now not an issue for me but my friend has been plagued with ‘low milk supply’ and they would not let her leave the hospital without her tiny underweight baby being established on the bottle. The pediatrician told her that there was no such thing as nipple confusion and that introducing the bottle was not an issue. However, then the baby did not want her breast and she resorted to pumping and supplementing her ever decreasing supply with formula. She was also given domperidone which did not seem to help – but who knows really. I certainly can’t presume to know the issue but it seems like to me that a tiny underweight baby paired with terrible breastfeeding support during their long hospital stay was the problem. The breastfeeding relationship was off to a rough start and it would have been very hard to recover from.

    I fully agree with you 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.” This is exactly what we all need!!

  9. I did supplement in a way. I drank nettle tea (alot!!!!), raspberry tea, mother’s milk tea, and took alfalfa tablets leading up to my son’s birth. I also ate oatmeal. I did all of this up until I realized I had too much milk, which was mostly foremilk. My milk finally settled into a manageable supply around the time was son was 6 weeks old. I nursed him until he was 2yrs old and never had troubles with under supply like my mother, sister, and grandmother. I am not sure if they truly had under supply or not. But I wanted to make sure I had enough milk and sure enough out of my family of No MILKERS I ended up with way too much! I am not sure which of the supplements helped the most but when I took the alfalfa, mother’s milk tea, or oatmeal I did end up feeling engorged to some degree after the 6 week mark. I had to cut all these out esp. when I was trying to wean him due to me having surgery.

    If I became pregnant again I would probably do the same as before, except no mother’s milk tea. The rest of them had other benefits on my health and well being, and were not just for the purposes of having milk. Nettle helped reduce swelling, provided additional minerals/vitamins, and made me just feel better. It may have helped leg cramps too. I still take it regularly but in capsule form. Alfalfa is great for heartburn and possibly for leg cramps not to mention minerals/vitamins. Very cheap stuff too :)Oatmeal was a quick easy meal/snack that I added molasses to for extra iron.

  10. You are so right – when only 5% or less of mothers are actually incapable of making an adequate milk supply, the problem seems to rest more in knowing how to bf efficiently/correctly rather than increasing supply.
    Unfortunately (in the US at least), most moms first turn to their doctors/pediatricians for advice, and they aren’t usually trained in the best ways to help. In fact, when I was scared about a possible supply problem, my pediatrician immediately suggested supplementing with formula (as well as Mother’s Milk tea, etc.).
    A lot of moms don’t know about or utilize LC’s, if they are even available.

    Great post!!
    .-= Dionna @ Code Name: Mama´s last post ..Breastfeeding on Sesame Street =-.

  11. Excellent post, as usual Amber, and something that’s been very much on my mind recently.

    I started taking Mother’s Milk supplements two months ago, because I could no longer pump enough while I was at work to fill even a single bottle for my 11 month old. I’m still not sure why this happened, as I had been pumping enough before. Nonetheless, the supplements didn’t really help me get my milk production up at all, and since they are expensive, I stopped taking them after about six weeks. The only thing that really got my milk going again was being home with my son for two weeks over the Christmas holidays and being able to feed him on call… which is exactly why, I think, many mothers, especially American mothers, have trouble breast-feeding: because they can’t be with their babies.

    So many of my friends and family in the U.S. have had to return to work just six weeks–or less– after giving birth. That’s just inhumane. I couldn’t even *sit down* comfortably six weeks after giving birth, let alone sit down at a cubicle for 8 hours a day. I don’t see how a woman in that situation could breast-feed exclusively for the first six months as her pediatrician recommends if she has to go back to work so soon. How can anyone possibly pump that much, especially when pumping is so much less efficient than a suckling baby (or so I’ve found)?
    I feel like my government (I’m American, though I live in Canada) has used the existence of breast pumps and breastfeeding supplements as a free pass to avoid offering humane maternity leave. I feel like they’re saying: Oh, you don’t have to feel you are sacrificing you baby’s best interests by going back to work because you can pump! And if you have trouble pumping, then just take supplements! And if that doesn’t work, well, it’s not our problem. When what women and babies really need is just to be together. …
    OK, I’ll step off my soapbox now. Really great post, Amber.
    .-= Sarah´s last post ..Santa Baby =-.

  12. Great post and comments. I feel that your concerns are valid. I briefly took fenugreek and domperidone when my son was maybe 6 months old because I had gotten lazy about pumping and wasn’t doing it often/long enough, which seemed like it lowered my supply. I can’t really say if the supplements helped or if it was just a return to diligent pumping (only while away from baby) that helped. The one thing that always increased my supply was drinking extra water.

    I find it interesting that so many people have such awful breastfeeding support in hospitals and from their doctors. I’ve given birth in three hospitals with three different docs/midwives. I got excellent support with No. 1 and 3. With No. 2, the medical professionals I was dealing with were pretty neutral on the issue, though I’m not sure how helpful they would have been if I’d been having trouble.
    .-= Recovering Procrastinator´s last post ..Not me! Monday =-.

  13. I’ve mentioned this before, but I had NO problem with making enough milk. In fact, over-engorgement and firehose letdowns were my issue. Poor babes were drenched before they could latch!
    I found there was lots of support for moms that needed help producing but no help whatsoever for the flip side of the lactating coin. Socially it isolated me as the letdowns came in torrents that drenched my clothing, I literally slept with bath sheets wrapped around my breast (what little sleep I got) and they were sopping wet to the matress! Eventually I found out that fresh cabbage leaves could be placed on the breast to inhibit lactation…. again not a socially comfy thing to have veggies in my bra. Until it all regulated I was basically house bound.
    .-= *pol´s last post ..Travelling Light? =-.

  14. I work outside the home and am still breastfeeding my 16-month-old daughter 4 – 6 times a day (and 8 – 10 on days that I am home all day). I remember those early days as a new mom when I was SOOOO concerned about milk supply, and it was really stressful wondering whether or not I was doing the right thing.

    My baby was a scrawny little thing, too, so the nurses wanted me to supplement (and we did) but in retrospect I don’t think we needed to.

    What I’ve learned (and wish I could have accepted in the beginning, but needed to have the experience to understand) is that my body is more than capable of responding to my baby to make enough milk. My job as a mom is to remove any possible barriers, e.g., eat well, get lots of rest, and RELAX as much as possible about the whole thing.

    I did eat lots of oatmeal, and took fenugreek. I don’t regularly do either of those things anymore, now that Eden is a toddler and eating a lot of solids. I figure whatever I produce is what’s right for her, and we’re still going strong!

    Thanks for a great post, Amber!
    .-= Molly´s last post ..I burned my boob. =-.

  15. Allow me to preface my comments by saying that I am ill-educated on breastfeeding stats, etc. I do believe that the “breast is best” (it is nature’s way, after all!) but I would not classify myself as an advocate per se. Your post is interesting and thoughtful though so I would like to share my thoughts too.

    I think that the “breast is best” campaigning, while helpful in so many ways, may also be contributing to the large numbers of women who cite “low milk production” for why they stopped breastfeeding. It may not be an entirely true response, but it is certainly the one that receives less social scorn when faced with having to provide an answer to why you are not breastfeeding.

    As for the use of medication, I know only one person who has ever used meds to increase milk supply and she was an adopting mother. Are there stats for how widespread the use is of these meds? It would be interesting to know because I would suspect that most women “give up” breastfeeding before meds are even suggested and that only the most committed and persistent mothers are offered the option of meds when a medical professional is not sure why a baby isn’t gaining weight.

    My girlfriend, as example, just gave birth 2 months ago. Her baby lost a greater % of weight while in hosptial than the hospital considers “normal” and so the nursing staff told her it was policy to supplement with formula at that point. Unfortunately though, her son never took to her breast again after the bottle was given. This meant that after she left the hospital, she was pumping before each feed then feeding breastmilk via a bottle. Not surprisingly, given the exhaustion of a new-born, a c-section and double the amount of time required for feeding using this method, she chose to move to formula bottle-feeding. No one ever suggested to her to take a supplement, despite the fact that she has had a breast reduction surgery and is therefore at risk for low milk production.

    Anyhow … that’s my two cents! Thanks for raising an issue that I hadn’t thought of before.

  16. Oh, forgot to mention last night re La Leche league. I believe this group is by far the most helpful support for new mothers looking for breastfeeding support. I’d suggest that any new mom have a consult with their local leader immediately after leaving the hospital for the best chances of successful, long-term breastfeeding. Not only is this group accessible physically by having leaders in neighbours everywhere, but they are accessible from a financial perspective, removing the barrier of cost from lactation support. My neighbour is a leader and she gave me wonderful assistance in the early days and I know she gives countless hours of volunteer help to other women.
    .-= coffeewithjulie´s last post ..Lucky number 13 =-.

  17. I don’t think you’re blowing the thing out of proportion, and you’re raising a very important issue here. We’re not offered any supplements in my country. I drank herbal teas by the liter following the advice of my anthroposophy doctor (fennel seeds and aniseeds, and a Weleda herbal tea is also very popular over here). I was one of those true cases with low milk supply. During the two months I expressed milk for my daughter I noticed that I had plenty of milk in the morning, little in the afternoon, and almost nothing in the evening.
    .-= Francesca´s last post ..Under my tree: spinning color =-.

  18. I think milk supply can be affected by a number of factors, but diet plays an important role. When I worried about my supply while breastfeeding my daughter, I drank mother’s milk tea but had to stop because it made my baby gassy. Anyway, I don’t think you’re blowing this out of proportion. Mothers are always worrying that they’re not doing enough for their children and I think folks in marketing count on that to sell products.
    .-= Jessica´s last post ..Young Jedis =-.

  19. My younger sister had to use fenugreek early on while nursing her second. Either it did the job for her or her supply finally made it up on its own.

    I’m the sort to never have trouble. Breastfeeding #3 now, she’s nearly a year old. I’m glad they never tried to make me supplement in the hospital, as she was small (1 ounce above “low birth weight” despite being full term) and lost right up to their maximum tolerance. Then gained it all back in her first week. Plus averaging about 2 lbs a month gain for her first 4 months.

    But if you need help getting that supply up, it would be nice for doctors to recommend ways for the mother to bring up her supply rather than just say “formula”. That’s just taking the easy way out.
    .-= Stephanie – Home with the Kids´s last post ..How Do You Find Blogs to Comment On? =-.

  20. I tried EVERYTHING to increase my milk supply because I actually knew in my case there wasn't enough. Ended up taking fenugreek for a few months, not really knowing if it was working or not. Then I found out you have to take about 6 to 10 times more than I was taking in order for it to be effective, so I stopped. Anything that you have to take in such high doses makes me nervous, and I wasn't all that comfortable with domperidone so I just supplemented the missing 3 oz per day with formula. In my case, since I was supplementing so little it made no sense to ingest something that could have adverse and unstudied effects. Personally, I would only use supplements if my supply was, say, 60% or less.

  21. “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?” Yes, I do share this concern. This is a really, really, really good point.

    I worry that sharing stories of overcoming extreme difficulty can sometimes have a similar effect. My own story, which I shared on my blog, was just such an extreme case – it took us five months, and it was CONSTANT hard work to get there. I shared it with the intention of being inspirational, but I can also see why someone wavering would look at what I had to do and feel that I was nuts for going to such lengths, and think “Sheesh, if it’s going to be THAT hard? Forget it!”

    Even the promotion of good LCs can backfire in a similar way. “You mean I have to hire this expensive specialist to do something ‘natural’? Never mind.”

    It is such a double-edged sword.
    .-= Dou-la-la´s last post ..Wordless Wednesday: #mamafit =-.

  22. Just found this post, catching up….

    I have a friend who could not breast feed either of her sons, she had very low supply. She tried domperidone, and fenugreek, and had lactation consultants out the wazoo helping her (unfortunately her La Leche League consultant was very pushy and dismissive of her physical problem, calling it a “mental block”, and made her very upset), but to no avail, she ended up on formula for both her sons by six weeks, respectively.

    It devastated her, and of course, my “enough milk for triplets” situation didn’t help her feelings of inadequacy. Sometimes, even the pill, and rigorous pumping can’t help, I guess. I tried to find articles and support groups for women who had her problem, in how to cope, and how to not blame yourself, or feel bad for not giving your child the best start, all those issues that come along with not being able to breastfeed, but came up rather empty handed other than a few articles.

    Do you have anywhere I can point to? I would love to be able to share that with other breastfeeding moms I know. I think it might really help.

  23. I don’t know how I missed this post – I was a galactagogue junkie during the year that I was working and pumping. In the end, I’m not sure they did all that much to help, but I also realize now that I probably didn’t need them as much as I thought I did either. I always felt like my supply was in crisis mode, but if I was able to work away from my baby for sometimes 2-3 days at a time, and the child NEVER, EVER had to have formula, then obviously my supply was not all that bad. At one point the midwives even prescribed Reglan to me, but after I filled the ‘script, I decided I couldn’t take it. It threatens to make a person crazy, and I’m already crazy enough.

    I think I really needed to hear somebody tell me that I WAS making enough milk and that I’m not supposed to be pumping 4 or 5 gallons a day. I sat down and sometimes got 8 or 9 ounces out of ONE side – that’s pretty excellent. I didn’t think so at the time though. I could have used a few more chill pills than any more dang fenugreek.

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