Low Breastmilk Supply: Can Medication Help Increase Milk Supply?

Many mothers face the challenge of low milk supply during breastfeeding. While offering more frequent breastfeeds is the simplest and most effective way to increase milk supply, sometimes achieving this increase in breast milk supply may require additional support.  Together with correct positioning and attachment, for some mothers,  certain supplements and medications known as galactagogues, tcan help promote milk production.

This article aims to clarify the role of galactagogues and provide insights into their effectiveness, helping you understand how to boost your milk supply and what might work best for you.

How to tell if Milk Supply is Low?

Contrary to popular belief, low milk supply is rarely identified only through the mum’s physical condition or only through baby’s behaviour. A breastfeeding medicine doctor will take both of these under consideration to make an expert judgement.

Some signs that breastfed babies may not be getting enough milk are:

• Inadequate Diaper Output: In the first few weeks, your baby should produce 6–8 wet/dirty diapers per day. Stool should change from black, tarry meconium to greenish-yellow by day 4, and orange-yellow, seedy stool by around 1 week.
• Lack of Weight Gain: It’s normal for babies to lose weight after birth, but they should return to their birth weight by 2 weeks and continue gaining steadily thereafter. If not, consult your healthcare provider.
• Signs of Dehydration: Indicators include fewer wet diapers, no tears when crying, a sunken fontanelle, and excessive sleepiness or low energy. If dehydration is suspected, contact your baby’s doctor immediately.
• Fussy baby: If your baby is fussy during feeds, frequently pulling away from the breast, or appears frustrated while nursing, this could indicate a potential feeding issue. This may be related to positioning, latch problems, or milk supply concerns.

Other signs which may also be present are:

• Increased frequency of feedings (every hour or more often)
• Short feeds (less than 5-10 minutes per breast)
• Soft breasts (not feeling full between feedings)

However, these other signs can also be present in healthy breastfed babies as part of their natural feeding patterns. If you’re concerned about your baby’s feeding behavior, consult with a lactation consultant or healthcare provider.

What Causes Low Milk Supply 

• Latching or Feeding Issues: If your baby isn’t latching effectively, they may not fully empty the breast, which can reduce milk supply and increase the risk of infections or clogged ducts.
• Hormonal Changes: Events like pregnancy or, infrequently, the return of menstruation can cause hormonal shifts that may temporarily reduce milk supply. Taking oral contraceptive pills containing oestrogen, or starting contraceptives before the establishment of the milk supply, might interfere with establishing breastmilk supply.
• Illness or Medications: Illness or certain medications (e.g., some decongestants or hormonal birth control) can temporarily affect milk production. Consult your healthcare provider about any medications while breastfeeding. You can find some key drugs and their impact on breastfeeding here: https://www.e-lactancia.org/media/papers/DrugsBF-Austr2015.pdf
• Insufficient Glandular Tissue (IGT): Women with IGT may experience low milk supply despite frequent breastfeeding. Glandular tissue is the milk-making tissue in the breast and some mothers may not have enough of it and should be assessed properly, although breastfeeding can continue and be adapted to the situation. Read more about it here: https://www.breastfeeding.asn.au/resources/insufficient-glandular-tissue-breast-hypoplasia
• Underlying medical conditions: Conditions such as gestational diabetes, polycystic ovaries, thyroid dysfunction and history of infertility may be correlated with reduced milk supply. Consult a healthcare provider to rule these out or to adapt your breastfeeding journey
• Introducing Solids: Once solids are introduced, your baby may breastfeed less, which can lead to a decrease in milk supply. It is important to continue feeding on demand to maintain a strong breastfeeding relationship.

How to Increase Milk Supply?

If you’re struggling with the process, the most effective solutions are often the simplest. Here are some steps you can take to increase milk supply:

• Offer More Breastfeeds: The most effective way to increase milk supply is to breastfeed or pump more frequently. This helps stimulate milk production and can significantly boost your breast milk supply.
• Relaxation Techniques: Deep breathing and warmth can help encourage milk flow, 
• Monitor Latch and Positioning: Ensuring that your baby is latching properly is key to improving milk transfer and preventing milk production issues. A poor latch can sometimes lead to a drop in supply.

In most cases, low supply is due to breastfeeding technique, not a medical issue. If you’re still concerned about low milk supply and wondering how to tell if milk supply is reducing, consult with a breastfeeding doctor.What Are Galactagogues?

If you’ve tried all of the above methods and still face challenges with increasing your milk supply, galactagogues may be considered.

Galactagogues are substances or medications thought to help increase a mother’s milk supply by stimulating the production of prolactin, a hormone responsible for milk synthesis. There are a number of herbs and foods which are thought to increase milk supply (e.g., fenugreek, papaya, garlic). However, there is no conclusive evidence on the benefits of these foods. Similarly, most studies on pharmaceutical galactagoues also lack robust evidence supporting their effectiveness. Nonetheless, some medications and herbal remedies have been widely used for this purpose.

Pharmaceutical Galactagogues: Do They Really Work?

Two commonly discussed pharmaceutical galactagogues are domperidone and metoclopramide. While some studies show a modest benefit for increasing milk supply, there is no conclusive evidence to support the consistent use of these drugs for lactation. 

Reference: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011505.pub2/full 

What research has proven:

• Pharmaceutical galactagogues can increase baseline serum prolactin levels
• Drugs like domperidone and metoclopramide, which increase prolactin levels, can be  used to boost milk production

But here’s what we still don’t know:

• There does not appear to be a direct correlation between baseline prolactin levels and milk production or volume
• It’s not proven that increasing prolactin always actually enhances milk supply in women with both low or and normal levels of baseline prolactin
• It’s still unclear which population of women benefit most from this treatment, as it’s unknown whether all women with low milk supply have low prolactin levels

It’s important to remember that these drugs should only be used under medical supervision, as they can have side effects. Mums interested in these medications should consult a healthcare provider to weigh the pros and cons.

• Metoclopramide: Metoclopramide can cause extrapyramidal symptoms such as tremors and movement issues, depression and mood changes.
• Domperidone: Domperidone is associated with potential cardiac risks

While domperidone and metoclopramide are used in many countries for lactation support, including the UK and Canada, it should only be prescribed and monitored by a qualified healthcare provider who can assess individual risk factors and monitor for potential side effects. 

Conclusion

Most women are able to produce sufficient milk to meet the demand of their babies. However, some women experience a low supply, where the breastmilk does not meet their baby’s growth needs. This can be due to a variety of reasons, including underlying medical conditions in some cases. Frequent pumping/ nursing, appropriate latch and positioning, rest and hydration are the most important factors to boost breastmilk supply. For some mothers, galactogogues may be required for additional support. Pharmaceutical galactogogues such as domperidone and metoclopramide can have serious side effects. They should only be prescribed by healthcare professionals who are capable of monitoring individuals during the course of use.