Dr. Mom blog explores how to increase breast milk supply during breastfeeding and improve lactation

Many new moms, including myself, worry about establishing and maintaining a good breast milk supply or how to increase breast milk supply. For the first few days after Madi was born, I struggled with breastfeeding so I supplemented with formula until I was able to improve her latch. Within two weeks, my milk supply increased and I was able to exclusively breastfeed. However, there are many women that struggle with their milk supply and need to consider treatment options to increase breast milk. 

There are many reasons why some women cannot establish or maintain a sufficient breast milk supply. 

Some of these include:

  • Inadequate milk transfer from mom to baby.
  • Medications that mom is taking that interfere with lactation: Estrogen containing birth control pills are the most common medication that decreases breast milk production.  Another common medication is decongestants used for the common cold.
  • Previous breast surgeries:  Some augmentations (ie: surgeries that go through the nipple) or breast reduction surgeries can affect breast tissue.
  • Obesity.
  • Preeclampsia: High blood pressure during pregnancy.

Seeing a certified lactation consultant is a common first step recommended by health care providers.  Lactation consultants will assess how you and your baby are breastfeeding and modify your techniques to ensure the baby can get enough milk at each feeding.  In many cases, breast milk production is low due to poor latch or technique.  A lactation consultant can provide suggestions for how to increase milk production naturally.

Sometimes medication is needed to help increase breast milk supply

There are two prescription medications that are used to help with milk production: domperidone and metoclopramide.  Domperidone is not available in the United States. 

Domperidone has the most evidence supporting its use. 

A systematic review concluded that a modest increase in breast milk production could be expected from the use of domperidone.  Once adequate breast milk production is achieved, the medication can slowly be tapered and stopped.  The most common side effects are dry mouth and diarrhea.  Very little of this medicine goes into breast milk and will not affect your baby.  This medicine is not safe for everybody, for example some women with previous heart problems. 

Metoclopramide is another medication also used to increase breast milk production.

A small study concluded no difference in breast milk production, so it has less supporting evidence than domperidone.  Metoclopramide can cause more side effects than domperidone including: drowsiness, tiredness, irritability and diarrhea.  Metoclopramide does get excreted in breast milk but no side effects have been reported in infants. 

It is important to know that prescription medicines should never be used to replace proper lactation support from a physician or lactation consultant.

I also often have patients ask about herbal supplements or products to increase breast milk supply. 

Fenugreek is the most common herbal product touted to increase breast milk production. 

The evidence for fenugreek is mostly anecdotal, which means that it is supported by “word-of-mouth” rather than by clinical evidence.   It also has not been evaluated for safety in breastfeeding mothers. 

The ultimate goal for all moms is to have a well-fed and happy baby.  If you have any concerns about feeding your infant, it is important to have your baby assessed by a medical professional, and to see a lactation consultant.

References:

Forinash AB, Yancey AM, Barnes KN, Myles TD.  The use of galactogogues in the breastfeeding mother.  Ann Pharmacother.  2012:46(10):1392

Donovan TJ, Buchanan K.  Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants.  Cochrane Database Syst Rev. 2012

Fife S, Gill P, Hopkins M, Angello C, Boswell S, Nelson KM.  Metoclopramide to augment lactation, does it work? A randomized trial.  J Matern Fetal Neonatal Med. 2011 Nov:24(11):1317-20.

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