It's best to be aware of the potential side effects of both natural and prescription medications designed to increase breast milk supply.
In my work as a lactation consultant, I often see women swallowing handfuls 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, through to maternal conditions such as breast surgery, retained placenta, postpartum haemorrhage, PCOS, diabetes and thyroid conditions, and insufficient glandular tissue (IGT), or lifestyle issues such as alcohol and smoking or birth control pills – many of these women have headed straight to the medicine cabinet.
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 that are currently recommended to increase milk supply in breastfeeding mothers.
According to the Academy of Breastfeeding Medicine, a US based organisation of doctors and physicians specialising in breastfeeding, “emerging data suggests 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 to then make choices accordingly. It's particularly important that you're aware of any side effects that may be harmful to yourself or your baby when you're breastfeeding or pregnant.
Natural not always best
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 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's unsafe to use fenugreek. For instance, medicinal doses (not the amount used in curries) are considered a uterine stimulant and have been used to induce labour.
As well, if you have a thyroid disorder, fenugreek can influence the active thyroid hormone your body uses. This means you could end up with more severe symptoms of hypothyroidism (and reduce milk production, too).
Fenugreek also reduces blood glucose levels, which can be a problem for women with diabetes or hypoglycaemia.
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?
Prescription medications should also be regarded with caution. Commonly prescribed medications for low milk supply include metoclopramide (brand names are 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 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).
While only two studies of domperidone were accepted for evaluation by the Academy of Breastfeeding Medicine, these showed positive effects on milk supply, but another small study showed that some mothers seem to be ‘responders’ while others are ‘non responders’. Health Canada and the makers of domperidone advise that the drug has been associated with serious heart problems. Although the Canadian reports were based on an intravenous form of the drug, 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 30mg a day. Although dosage recommendations to increase milk supply vary, these are often much higher than 30mg a day.
Dr Jack Newman, paediatrician and director of the Newman Breastfeeding clinic in Toronto, said: “There is no such thing as a 100 per cent safe drug. However, our clinical experience has been that side effects 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.”
The Royal Women’s Hospital in Melbourne advises that "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.
So what’s a mum to do? Firstly, if you're worried about your milk supply, check in with a lactation consultant or a breastfeeding counsellor to assess whether you really do have a low supply – a few simple tweaks could help.
You can also 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), offer the breast at every subtle signal, rest, drink according to your thirst, and eat nutritious foods and snacks.