Guide to Galactagogues

Chances are that if you’ve ever had a baby, you’ve faced some of these agonizing anxieties: am I making enough milk?, is my baby getting enough milk?, is my baby gaining weight properly?, etc… While these questions may or may not be unfounded, we’ve all spent time wondering where we even start to look for answers.  Thankfully the options are plentiful, from basic body mechanics, to herbal support, all the way to off label prescriptions. So let’s die in and review the risks, benefits, and the mechanisms that make them effective.

Body Mechanics

Before jumping headfirst into costly supplement regimens, consider making an appointment with a recommended lactation consultant, or purchasing a scale for doing weighed feedings at home. This involves weighing your naked infant just before a feed and just after a feed. The increase in your baby’s weight will reflect how much your baby has eaten. Being able to visually see that your baby has taken in three to five ounces in a single feed may help calm your anxieties. Other emotional physical adjustments include skin to skin, breast compression during feeds, wearing loose fitting bras, shirts, and tank tops, and more frequently offering the breast. These simple adjustments can make breastfeeding not only more effective, but more comfortable. Comfort is a major part of breastfeeding. To produce adequate milk we need hormones like oxytocin and prolactin to be excreted which trigger milk production and flow. In situations where we feel physical, mental, or emotional discomfort, our bodies are more likely to excrete stress hormones. Stress hormones will always impede milk production and flow. Restricting breast tissue with too tight bras or clothing also signals to the body that it doesn’t need to produce as much because the ducts are confined and unable to transfer milk as easily.

Lactation Diet

Let’s say adjusting body mechanics shows some improvement, but the boost didn’t quite get you over the hill. Now would be a good time to look into dietary additions. Oats, brewer’s yeast, raw nuts, and leafy vegetables are all wonderful options for supporting and increasing milk flow. Adding brewer’s yeast and oats into a cookie, brownie, or breakfast bar recipe has shown great success and comes highly recommended. Just be sure that you’re maintaining a healthy sugar intake. It is entirely possible to incorporate these items into low sugar options as well. Brewer’s Yeast is hypothesized to be effective because of the many nutrients it can replenish in a nursing parent’s body. These nutrients include Vitamin B, easily digestible proteins, amino acids, and chromium. All of which support milk production. Fair warning though, many have reported uncomfortable gas, bloating, and headaches with the routine use of brewer’s yeast. Similarly, oats support lactation with their high source of iron. This super food can be especially helpful if you experienced excessive blood loss during or just after delivery. Oats are also thought to lower stress levels based on its hot and soothing nature. Unless you’re gluten intolerant, there are no reported risks of using oats to boost supply.

Herbal Boost

Herbal supplements are where we tread lightly until footing is sure. Not only can supplement regimens be costly (though arguably worth it if they work),they each affect individuals so differently. Where one person reports incredible results with fenugreek, another reports decreased supply and horrible digestive issues. Of all the herbal supplements, we’ll go over the most popular ones.

Fenugreek: Fenugreek is a plant that has white blossoms, stands about two feet tall, and its blooms contain small golden seeds. The seeds are what we’re after. While studies as recent as 2018 ensure its efficacy, this herbal supplement comes with a long list of side effects that are responsible for its recent decline in use. These side effects include diarrhea, gas, an off putting maple syrup smell, fussiness in baby, and even low blood sugar. While not everyone will experience this, it is widely reported. It’s also important to note that researchers still aren’t entirely positive why fenugreek works. The hypothesis? The plant contains phytoestrogens which closely mimic human estrogen and this supports the production of prolactin. It’s unknown mechanisms and long list of side effects make this supplement one you should tread lightly with, but not one you have to cross entirely off the list. If the side effects of fenugreek prove to be intolerable Milk Thistle is a very similar supplement with less side effects that may be worth looking into.

Fennel: Fennel is similar to fenugreek in the way that it contains natural estrogen like properties that raise prolactin levels. While it’s unlikely that fennel alone will raise milk levels quantifiably, when used in combination with other galactagogues it does seem to show improvements. However, fennel is a rather finicky herb and carries some rare, but worth mentioning risks. In some cases parents with a history of seizure activity may want to avoid the use of fennel as it has shown to increase the risk of seizure. Many babies that drink milk boosted with fennel may be more likely to fall asleep at the breast as it tends to make babies a bit more drowsy. Finally, fennel also carries a risk of lowering blood sugar which should be weighed carefully by parents with a history of hypoglycemia or other metabolic conditions. All in all this herbal supplement is likely a safe option for increasing milk supply, though taking too much fennel has shown to decrease milk supply.

Goats Rue: Goat’s rue is a personal favorite of mine. As a mother with insufficient glandular tissue, I saw so much improvement with this supplement because it doesn’t just work as a prolactin boost, it facilitates the growth of new breast tissue! Goats rue is a plant related to the pea family and has shown many lactation benefits. Particularly useful for parents that have insufficient glandular tissue, previous breast surgeries, are trying their hand at relactation, or are simply just seeking a general boost in milk supply. Unlike the supplements above, goats rue has actually shown to stabilize blood sugar as well. However, goats rue should NEVER be ingested as a fresh plant as it is very toxic and considered poisonous in its live form. Skip this one when you plant your garden and leave the formulation of this supplement to reputable sources.

Off-label Prescription Use:

The use of prescription medication for low milk supply most certainly isn’t new, but you may want to regard it as a last ditch effort. While these medications have shown promise, not all of these medications and their long term effects have been thoroughly researched. This is not to say that prescription medication should be avoided altogether, but more so to stress that the decision to use them should be a highly informed one. The medications most commonly used for milk production are considered dopamine antagonists (like Domperidone and metoclopramide), anti-psychotics (like reserpine, sulpiride, and thioridazine), and medications that work with blood sugar and the pituitary gland (like metformin). Of these medications we will cover the two most researched and most common, domperidone and metformin.

Domperidone: This medication was developed for the treatment of nausea and stimulation of movement within the gastrointestinal tract. Throughout its on-label use it was also found to raise dopamine levels in the brain and in turn it raises prolactin levels. Soon this medication was being prescribed for the off-label purpose of increasing milk supply. This medication has been, and is currently, a widely researched medication for this use. However, side effects of this medication include breast tenderness, galactorrhea, itching, breast enlargement, dry mouth, and menstrual irregularities. Increased milk production will usually be noted within 48 hours of use and is generally considered safe.

Metformin: This prescription shows milk production improvement in a particular group of people and will not be for everyone. For parents with a history of polycystic ovarian syndrome, gestational diabetes, diabetes, and general insulin resistance metformin may be particularly helpful as it helps stabilize the pituitary gland and the hormones it secretes and creates more consistent levels of blood sugar. Hormone regulation is a paramount part of breastfeeding. Without this the production of milk will be inconsistent, and oftentimes insufficient. If you have concerns with your postpartum hormone levels and how they’re impacting your breast milk production, it is always worth running a blood test to check these levels and addressing them from an individual aspect.

But, what if that doesn't work?

If you’ve found yourself reading this article you’re likely sitting in so much uncertainty. You could try every single thing on this list and still struggle with low supply. First, it’s okay to keep trying. If exclusive breastfeeding is your goal, keep going.  It’s also okay to protect your mental well-being and decide that breastfeeding isn’t something that aligns with you anymore.  Second, I want to tell you breastfeeding is not an all or nothing sport. You don’t have to regard formula as the enemy. Low supply doesn’t mean you won’t ever be able to breastfeed. It means you may need a little help. That can mean that help will only be needed for a couple weeks, or maybe you and formula will team together to keep baby thriving and also maintain the bond of breastfeeding. 

With low supply can come feelings of failure or resentment towards your own body. Put that burden down and listen for a moment, the fact that you’re here reading these words is proof of what an incredible parent you are. You’re not giving up at the first sign of struggle, you are here making a ten mile list of vitamins and recipes, you are here learning about the plants and herbs that might help your body produce more and more, you are here reading through side effects and likely thinking “I can deal with that if it helps my supply enough”.  How lucky your baby is to have such a dedicated and determined parent. Try to be gentle with yourself.  Thank your body for all it’s doing for both you and your child. 

This blog post was written by a former Tranquility by HeHe doula.