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.
'NATURAL' herbs in capsules is not always better
Fenugreek, a herb commonly used in curries and chutney, is widely suggested to 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. 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) 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 influences 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.
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 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). 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. Although 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, 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.
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.
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.
For natural ways to boost your milk supply check us out for all natural and organic super-food lactation cookies and brownies.