A Case for Using Galactagogues as a Last Resort for Increasing Milk Production

By Megan Hartless

One of the most common questions I receive by email or Facebook message from mothers seeking breastfeeding support is, “What can I take, eat, or drink to increase my supply?” The Internet contains countless articles, blogs, advertisements, and testimonials about using galactagogues to increase milk production in breastfeeding mothers. A galactagogue is a food, drink, medication, or supplement that is ingested by the mother with the intention of increasing the amount of milk produced. The concern I find with answering this type of inquiry is that most of the time, mothers are looking for a quick and easy way to boost supply, when there may either be an underlying problem related to milk production that needs to be addressed, or the mother may already have an adequate milk supply.

In addition, while there is certainly a great deal of anecdotal evidence of the use of some foods or supplements successfully increasing milk supply, little research exists supporting the effectiveness of galactagogues to increase milk production. This makes it difficult to be confident that their use is safe or effective. The Academy of Breastfeeding Medicine has noted the need for research in the area of galactagogues stating, “There is a clear need for well-designed, adequately powered, randomized controlled trials using adequate doses of galactagogues in populations of women in which both the experimental and control groups receive modern, appropriate lactation support.” This lack of research leaves mothers who seek to increase milk production through galactagogues vulnerable to potential unknown interactions with other medications they may be taking, other unknown safety risks, or simply wasting money on useless supplements in the hopes of correcting a problem that can often be addressed without consideration of galactagogues.

If you are in a situation where you are seeking to increase your milk production, the first and most important thing to determine is whether you are truly not producing enough. Many mothers expect that their supply will be abundant and feel that they are not making enough milk, when they actually have a perfectly sufficient supply. Some mothers will find that while their babies seem to be satisfied after feeding, they are unable to ever express very much when pumping. It is important to note that the amount of milk you are able to pump does not necessarily correlate to the amount that you are producing. No pump can remove milk as efficiently as your baby can, and you may be transferring significantly more while feeding at the breast than you are while pumping.

To determine whether you are making enough milk, examine your baby’s weight gain and diaper output. By the fourth day of life, your baby should be having at least four to six wet diapers per day, and this should continue as your baby grows. In the first few weeks, babies should have at least two to three yellow, seedy stools per day. However, after the first month or two, the frequency of bowel movements will start to vary more by each individual baby, with some having multiple bowel movements each day and some having only one every few days. Your baby’s health care provider can confirm for you whether your baby’s weight gain is sufficient at your well baby visits. If you have concerns, however, you may consider seeking assistance from an IBCLC, or International Board Certified Lactation Consultant, who can help you assess whether your baby is getting enough milk. You can find the nearest IBCLC at ILCA. You can find more information on whether your baby is getting enough milk on the Breastfeeding USA website or the Ask Dr. Sears website.

If your baby is not gaining enough weight and/or is not producing enough urine or stool, don’t simply jump to the conclusion that you are not producing enough milk. There can be a number of explanations for why a baby may not be gaining weight as quickly as expected, many of which are easily addressed. If you are unable to determine the problem, this is a good time to contact a Breastfeeding USA Counselor or an IBCLC. Please see the end of this article for information on finding someone who can help.

Before turning to galactagogues, the tactics below may be useful in helping improve a reduced supply or a perceived reduced supply due to other breastfeeding issues.

Ensure that you are following your baby’s feeding cues. Babies can’t speak, but they are excellent communicators. Once you learn to “speak” their language, your baby will let you know when he wants to breastfeed, as well as when he is finished. Feeding on demand – or when your baby cues you that he wants to feed – is one of the most important things you can do to ensure you are feeding him frequently enough. Breastfeeding works on supply and demand, which means that when you feed your baby, your breasts receive the “message” that they need to make more milk. If you feed baby when he is hungry and until he indicates that he is full, your breasts will “know” how much milk to make. Conversely, if you schedule feedings or limit the amount of time your baby spends eating from each breast, your baby may not get the amount of milk he needs, and your body will not receive the signal that more milk needs to be produced.
Crying is a late sign of hunger in infants. Babies will give cues such as bringing their hands to their mouths and opening and closing their mouths as they begin to become hungry. They will generally then move into fidgeting or trying to position their bodies to access the breast and rooting (moving his head toward you when touched). Responding to these early cues will help to ensure that baby is fed when hungry. In addition, babies will usually continue to nurse on one breast until they are finished with that side. They will either unlatch or change from swallowing milk to non-nutritive sucking. At this time, you can offer the other breast, and baby will feed until he is full. There are exceptions, particularly in the early days when babies may fall asleep at the breast, even when not quite finished eating. Usually, baby will cue you both when he is hungry and when he is full.
Feed your baby frequently. Nothing is better at signaling your body to make more milk than feeding your baby. Every time your baby breastfeeds, your body learns. Both removal of milk from the breast and stimulation of the nipple by suckling tell your body that more milk will be needed to continue feeding your baby. If you feel that you may not be producing enough milk, try putting baby to the breast more often. Feedings need not be limited to after waking or before sleeping, or any other time when your baby shows obvious hunger. Offering the breast often will allow your baby to feed as often as she needs, and the more frequently she breastfeeds, the greater your supply will be.
Make sure that you have a good, deep latch. Latch. is a topic that could be (and has been) discussed in its own article. For a variety of reasons, it is crucial that the baby has a deep latch with a good amount of breast tissue behind the nipple in his mouth. First, a poor latch can lead to pain for mom. A small amount of discomfort in the early days for the first few seconds of breastfeeding is normal, but pain that lasts after the first few days or lasts throughout the feeding or between feedings is not. Toe-curling pain is never normal and should be addressed immediately. A suboptimal latch can also lead to poor milk transfer and cause reduced milk supply.
If you are concerned that you may not be getting a good deep latch, a breastfeeding professional or volunteer Breastfeeding USA Counselor can be helpful in assisting you to improve it.
If you are pumping, make sure that you are pumping often and long enough. If you are pumping while away from your baby, make sure that you are doing so at least once for every missed feeding whenever possible. Pumping less frequently can lead to lowered milk production. In addition, make sure that you are draining the breast as completely as possible. Make sure not to stop pumping before the milk stops flowing. In addition, continuing to pump after the milk slows to a trickle can be helpful. Remember, breastfeeding works on supply and demand, and continuing to pump for few minutes after the milk has slowed significantly helps to signal your body that it needs to produce more milk.
Try using breast massage and compressions. The use of breast massage and compressions can be helpful in removing more milk from the breast when you breastfeed or pump. The more milk that is removed, the more you will make. For more information, see Nancy Mohrbacher’s article To Pump More Milk, Use Hands on Pumping. While it specifically addresses pumping milk for premature babies, the techniques translate nicely to pumping for full-term and older babies and can be used in feeding at the breast, as well.
Keep an eye on your stress level. Stress can negatively impact your milk supply and inhibit your letdown. Take some time to relax. Have a warm bath, let dad or a friend care for the baby, even for twenty minutes, so that you can do some deep breathing, yoga, or take a walk around the block, lie down and close your eyes, or whatever is a good stress buster for you. Make sure to get adequate sleep, napping whenever your baby does, as well.
Enjoy some snuggly time with your baby. Spending some time skin-to-skin can help boost your milk supply. Undress baby down to her diaper and hold her close to you. Take the opportunity to relax, take a break, and snuggle up while she naps and you catch up on a great book or those DVR episodes of your favorite shows that you’ve been saving.
Eat well and drink plenty of water. While there is not a great deal of concrete evidence that caloric intake or even intake of water has a direct effect on milk supply, it is important to nourish your body to make sure you are able to nourish your baby. Many mothers report feeling thirsty when they nurse and have water or their favorite non-caffeinated beverage handy.
Avoid supply killers. Some medications can be particularly detrimental to your milk supply, such as hormonal birth control and decongestants. In addition, caffeine, alcohol, and smoking can all reduce production. Even some herbs like sage, peppermint, and parsley, when taken in large quantities, can affect production. If you are not sure whether a medication you are taking can reduce supply, you may want to visit the National Institute of Health’s LACTMED database.

Keep in mind that none of these solutions will work overnight, and none are magic wands. Allow time to determine if a given tactic is making a difference. When you have questions, find a breastfeeding support person who can help counsel you through the process.

Finding a Breastfeeding Support Person Breastfeeding USA has counselors in many areas who are volunteers, eager to help with most normal breastfeeding issues. To find the Breastfeeding USA Counselor nearest you, visit https://breastfeedingusa.org/content//breastfeeding-counselor-locations.

Occasionally, a breastfeeding question or concern is more complex or requires evaluation for potential medical intervention. In these cases, you may want to seek an International Board Certified Lactation Consultant (IBCLC). You can find the IBCLC nearest you at ILCA.

Additional links to breastfeeding professionals and volunteers can be found at KellyMom.

If You Decide to Use Galactagogues
Galactagogues really may work for some moms, and you may decide to use them but, hopefully, not as a first line of defense. They can simply mask the problem instead of offering a solution. Not all galactogogues are the same. An IBCLC can help you find the reason why you are not making enough milk. Whenever taking a medication or supplement, be certain to consult with a health-care professional regarding the safety of the medication, making sure to disclose any other medications you may be taking to avoid negative drug interactions. If you decide to consume foods or drinks that you have heard increase your supply, be sure to do so safely, and don’t expect a miracle from a bowl of oatmeal, a “lactation cookie,” or a sports drink.

Megan Hartless

Megan is Director of Financial Aid at a community college in rural Virginia. She is a Breastfeeding USA Counselor and member of the Breastfeeding USA Applications Team, with an educational background with a BA in Psychology and an MFA in Theater Pedagogy.