Why you won’t hear me suggest galactogogues

If you spend any amount of time around lactating folks, you’ll hear concerns about low milk supply, and you’ll also probably hear suggestions such as:

  • Eat oatmeal
  • Drink lots of water
  • Bake some lactation cookies
  • Take fenugreek
  • Try a tincture
  • Drink teas with herbs to increase milk supply

These suggestions are well meaning, and may not cause any direct harm (although any remedy, even a “natural” one, may have side effects). But are they good suggestions? In my opinion: No.

Oatmeal, fenugreek, flax seed, brewer’s yeast, fennel seed, and many other foods, herbs, and medications that are purported to increase milk supply are called galactogogues (also spelled “galactagogues”), and you’ll find different things suggested in different cultures. There’s plenty of anecdotal (yet inconclusive research-based) evidence that demonstrates that they may be effective.

So what’s the problem?

For starters, using galactogogues can often be, at best, a band-aid, covering up the actual problem, which doesn’t get resolved and may cause problems in the long run. For example: A working parent is pumping at work, but finds that her pumping output has decreased and she can’t keep up with her baby’s needs. She wants to know how to increase her milk supply. The actual problem might not be her pumping output. Her pump parts may need to be replaced. Her pump motor may be dying. She may not be pumping often enough. Her baby may be getting overfed, so what she actually needs to pump is much less than is assumed. Advising that she take fenugreek to increase milk supply and fennel to improve the milk ejection reflex is not going to fix any of those things, and may make them worse (increased milk supply + inadequate milk removal = recipe for mastitis; sending too much milk to daycare may just lead to still more milk being requested later).

There are many, many reasons why a mom’s milk supply might be low. Each mom should be evaluated, and underlying factors addressed, before galactogogues should be used. The Academy of Breastfeeding Medicine protocol on galactogogue use says:

Prior to the use of a galactogogue, thorough evaluation should be performed of the entire feeding process by a lactation expert. Reassurance may be offered, if appropriate. When intervention is indicated for the dyad, modifiable factors should be addressed: comfort and relaxation for the mother, frequency and thoroughness of milk removal, and underlying medical conditions. Medication should never replace evaluation and counseling on modifiable factors.

There are legitimate applications for galactogogues, such as in cases of insufficient glandular tissue, previous breast surgeries, inducing lactation, or exclusively pumping for or nursing a baby with cleft lip or palateDiana West, IBCLC and Ask Lenore provide credible information on low milk supply and how galactogogues can help in these circumstances.

Galactogogues may cause side effects for parent, baby, or both. Fenugreek, for example, can interfere with the absorption of medication, vitamins, minerals, etc., which could even worsen the underlying factors that taking fenugreek is trying to mitigate. Fenugreek can also have an effect on blood sugar levels. It can cause stomach upset in a baby (and those who take the supplement, too), either because of more, faster-flowing milk (which is lower in fat and higher in lactose, which may be difficult for a baby to digest) or because it’s passing into breastmilk. Fenugreek is a legume, and those who have allergies to other legumes, such as peanuts, may experience cross-reactions. (Here are more details about fenugreek and breastfeeding.) It’s also possible for galactogogues to work too well; you might end up with plugged ducts or mastitis after attempts to increase a milk supply that didn’t need to be increased in the first place. Any herb or medication should be taken under the guidance someone qualified to consider drug interactions and potential side effects.

The quality and quantity of herbal preparations is not consistent, since they are not regulated. You cannot be sure if you’re using the correct—or even the same—dosage each time.

[Tweet “#Breastfeeding is the normal way to feed a human baby, no special gadgets or diets required.”]Galactogogues cost money and time. A regimen of herbs, tinctures, or teas is not inexpensive, and they must be sourced. Sure, a mom can order what she needs from, but maybe that time would be better spent on an extra nursing session or even some self-care. You can buy lactation cookies, but the mark-up is extraordinary. If you really want some and don’t have time to bake them, any old oatmeal cookie at the store will probably do. (Really, I think we should stop calling them “lactation cookies,” and just start calling them “cookies.”)

Finally, and just as importantly, suggesting galactogogues reinforces the notion that breastfeeding requires special stuff in order to work. We live in a society that values quick fixes, and it’s tempting to suggest and to use those things that will give us fast results. But this, I believe, undermines a parent’s confidence in their ability to breastfeed. Breastfeeding parents are told by various sources to eat this for the best breastmilk, avoid that to prevent fussiness, drink this to increase milk supply, and the overall message is, “You cannot make the best milk for your baby, or as much as he needs, without outside help.” I would like to see us reinforce the notion, as much as possible, that breastfeeding is the normal way to feed a human baby, no special gadgets or diets required.

Let’s turn away from the quick fixes and try to find the root of the problem. Sometimes we just need to share with each other how to tell if a baby is getting enough to eat (if your baby has enough wet/dirty diapers, is gaining weight, and is meeting milestones, you’re golden). Sometimes we need to realize that as fellow parents—and even lactation support people such as CLCs—that we are not qualified to give advice on certain topics, and it’s something that should be addressed by a professional. Overall, we need a little more trust in our bodies and a little less trust in interventions.