The minefield of increasing breastmilk
“My baby is not gaining weight and I have been prescribed medication to assist with milk production”
“My friend has been lovely and made me some Lactation biscuits”
“I am drinking fenugreek tea to help my low milk supply”
Is this ringing any bells for you? Firstly, I am just going to put it out there I am not dissing on the milk increasing products at all. However, I would like to break down a few examples of the products and what they can do for a lactating woman and what the woman also needs to do to ensure the product that they are taking is able to be used to the best of its ability. I have also pulled out three guidelines that can be useful to follow that help to direct the conversation and support any possible problems or concerns.
Please note that this is not medical advice and all of this information is widely available; as with all matters involving breastfeeding when in doubt please consult a lactation consultant and/or your GP.
Some products that are used and recommended are Fenugreek, Brewer’s Yeast, Oats and Motilium
Fenugreek seeds contain hormone precursors that increase milk supply. Scientists do not know for sure how this happens. Some believe it is possible because breasts are modified sweat glands, and fenugreek stimulates sweat production. It has been found that fenugreek can increase a nursing mother's milk supply within 24 to 72 hours after first taking the herb. Once an adequate level of milk production is reached, most women can discontinue the fenugreek and maintain the milk supply with adequate breast stimulation. Many women today take fenugreek in a pill form (ground seeds placed in capsules). The pills can be found at most vitamin and nutrition stores and at many supermarkets and natural foods stores. Fenugreek can also be taken in tea form, although tea is believed to be less potent than the pills and the tea comes with a bitter taste that can be hard to stomach.
Fenugreek is not right for everyone; the herb has caused aggravated asthma symptoms in some women and has lowered blood glucose levels in some women with diabetes. Fenugreek can cause stomach trouble and can give some people rampant runny poo. If you have a thyroid disorder, you risk 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.
The therapeutic amount for fenugreek for most women is ~1200-2400 mg, 3 times per day (3.5-7.3 grams/day); you are aware of when it is at this level when you start smelling like maple syrup J. Use of more than 100 grams of fenugreek seeds daily can cause intestinal distress and nausea (recommended dose is less than 8 grams per day).
What you can do while taking Fenugreek: Increase your feeding at the breast; making sure however that there is a good deep attachment and establish a good pumping program prior to taking the herb and really focus on the pumping for the first 24-72 hours, this is when Fenugreek is meant to be at its most effective. If you are taking Fenugreek for longer and you aren’t seeing a vast improvement in your milk supply then please consult an IBCLC or a breast aware physician.
Oatmeal is a good source of iron. It is known that maternal anaemia/low iron levels can result in a decreased milk supply, so it makes sense that eating something high in iron might increase milk supply in some women. Oatmeal is a comfort food for many women.
What you can do while taking Oats: As Oats are high in iron it might be useful to look at what your current iron levels are to see if you are low in this area. As a general rule it is useful to have this checked following birth especially after 6 weeks post birth; the World Health Organization (WHO) defines anaemia as a Hb level below 130 g/L in men, 120 g/L in non-pregnant women and 110 g/L in pregnant women and preschool children.
Brewer's yeast comes from a one-celled fungus and is a by-product of beer making, though it can also be grown as a nutritional supplement. A good source of iron, chromium and selenium, brewer's yeast also contains several B vitamins, though not B-12.
What you can do while taking Brewer’s Yeast: Increase your feeding at the breast and establish a good pumping program prior to taking the yeast and really focus on the pumping for the first 24-72 hours. If you are taking Brewers Yeast for longer and you aren’t seeing a vast improvement in your milk supply then please consult an IBCLC or a breast aware physician.
The hormone prolactin stimulates lactation (production of breast milk). Dopamine, released by the hypothalamus stops the release of prolactin from the pituitary gland. Domperidone, by acting as an anti-dopaminergic agent, results in increased prolactinsecretion, and thus promotes lactation (that is, it is a galactagogue). A study called the EMPOWER trial has been designed to assess the effectiveness and safety of domperidone in assisting mothers of preterm babies to supply breast milk for their infants.
To induce lactation, domperidone is used at a dosage of 10 to 20 mg 3 or 4 times per day by mouth. Effects may be seen within 24 hours or may not been seen for 3 or 4 days. The maximum effect occurs after 2 or 3 weeks of treatment, and the treatment period generally lasts for 3 to 8 weeks.
The next step
Okay so this is low down of the products that are often recommended to produce breastmilk, often my families will be taking a variety of biscuits, medicines and teas to support milk production. We have discussed what each of these medicines do for the milk production and how they support however all and any of these milk increasing products mean precisely squat if you aren’t removing the milk.
Many organisations and companies promote purchasing biscuits or teas or a combination of these items to support breastmilk, and as I said at the beginning that is fine – you do you, always – however what I would like you to stop and think about is if you are taking a tea or a biscuit or medication for low milk supply then you also need to focus on milk removal and this may need an assessment or a review.
All the biscuits, medications or teas in the world won’t help with increased milk if the milk isn’t being removed effectively. So, the question to ask is why isn’t the milk supply sufficient or stable??
There are many reasons as to why such as:
Is it your baby?
Is it birth complications?
Is it the amount of times you are having action at the breast?
In my experience it isn’t ever just one aspect of the breastfeeding experience that is to blame; there is normally a variety of reasons why the milk supply might need support.
Unfortunately, with parenting there isn’t many hard and fast rules – these little people all beat to their own drum, however there are a few “guidelines” which can direct the conversation as to what might be happening.
Guideline 1: A baby from birth needs to feed a minimum of 10 times in 24 hours for at least 30 mins on one breast and then at least 10 - 20 mins on the other if they are keen. Please note I have said at least not total. Anything less than this can lead to low milk supply, there is always going to be exceptions to the rule however in most cases this is the case. It is also a very slow process and can occur over a few weeks.
Guideline 2: A baby from birth to at least 3 months of age should have at least 5 wet nappies in 24 hours and at least 3 poos. A poo is a POO not a snarky fart that has smeared the nappy, this isn’t a poo. It is a fart that has picked up some poo on the way out. If your baby is having trouble maintaining 5 heavy wet nappies and at least three poos that are a goodly amount then you need to question the amount your baby is drinking.
Guideline 3: Check your baby’s weight weekly for the first 6 weeks and then fortnightly until 3 months of age. I am not talking about a full visit however check your baby’s bare (nude) weight. It is good to look for 25 grams per day weight gain; the reason you do a weekly weigh in is if there is any problem then you are able to address and be aware of the problem early. Where possible please access the same scales to weigh your baby, as they can be not consistent in their weight.
If your baby is not following these guidelines then please review the breastfeeding in conjunction with a trained professional such as an IBCLC but make sure that you are giving you and your baby all the information and opportunity to reach the success that you are aiming for.
Eat the biscuits, drink the tea and/or take the medication but you also have to focus on the milk removal to give yourself the best possible chance to reach the success that you are aiming for.