3Current day knowledgeThere is little in the American literature regarding the use of herbs in general, and almost no research on herbal galactogogues at allOur basic knowledge comes from Commission E (Germany), oral & written tradition, and anecdotes
4Many resources flawed; not all animal studies can or should be extrapolated to humans, as plant actions can vary on different animalsMany report isolated in vitro study results without consideration of actual in vivo experience: thus, some herbs experienced as galactogogues may be “contra-indicated” due to theoretical concerns not proven in vivoJudging an herb by individual constituents does not take into account the possibly ameliorating effects of its other constituents
6herb XDRUG INTERACTIONS Due to the cardioactive chemicals in this herb the following drug interactions are possible: interference and/or antagonism with antiarrhythmics; antagonism of beta-adrenoceptor blocking drugs; potentiation of cardiac glycosides and increased risk of hypokalemia; when combined with depolarizing muscle relaxants there is a risk of arrhythmia; interference with nitrates and calcium-channel blockers; may increase the potential terfenadine has to cause arrhythmias.SIDE EFFECTS (Possible adverse effects and/or overdose effects) Allergic reactions.WARNING Large doses can cause headaches and diarrhea.REFERENCES 1. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum, 1988,OATS!
7Understanding the issues While there is some regulation of herbs, quality/potency can still vary, especially with non-standardized products.Standardized vs Non-standardizedPart of plant used or % of parts in mix used (Different parts can have different effects)Freshness of herbTime on shelf (limited life)light exposureSome brands more reliable than others.
8Potential toxicities are not well understood Potential for allergic reactions often overlooked; ie, chamomile is related to ragweed, therefore not recommended to those with ragweed allergiesOpinions vary between experts
9Targeting: the unconsidered problem We don’t know a lot about how many of the galactogogues actLittle research has been done on reputed herbal galactogogues to analyze how they may work (exception: Farnsworth)Are they boosting prolactin, or another part of the equation?Inherent difficulties of researching galactogogues
10Underlying problems may vary; does the herb even affect the problem system… Or are we simply guessing our target and hoping to hit the right one?
11Dosing: No such thing as “the right amount” Potency varies by manufacturerPotency can vary by batchExperts vary on recommendationsMost pkg instructions based on generic use, not lactationLittle info on therapeutic dosages for lactationTitrate to need
12Teas Tinctures Capsules Cover to steep Crush seeds Can use sweeteners Strengths varySome dosed by weight, others by standardsCapsulesCheck capsule size (mg/grams); many suggested dosages do not specify mgs.
13Best reference aid Herb ratings: A- no safety issues identified; generally considered safe when used appropriatelyB- May not be appropriate for self-use by some individuals, or may cause side-effects if misused. Seek reliable safety and dose info.C- Moderate potential for toxicity, mainly dose relatedD- Use only with supervision of knowledgeable physicianE- Avoid. Toxic plant with no justifiable medical use.By Sheila Humphrey RN IBCLC
15Anise seed (B) Pimpinella anisum NOT star aniseActions: anti-spasmodic, mildly estrogenic, expectorant, carminative, aromatic (Handout: Indexing Herbs by Action)May also be helpful for MERParts used: seed“Culinary use”
16Not for use in pregnancy Safety:USA: GRASUK: General sales list Canada: approved as an OTC drug France: Traditional Medicine Germany: Comm E approved as an OTCNot for use in pregnancyTea: 1-2 tsp crushed seeds in 1 c water, cover & steep 10-20min, x/day.Tincture: 3ml 2-3x/day
17Caraway seed (A) culinary use… Carum carvi Actions: appetite stimulant, anti-spasmodic, expectorant, carminative, emmenagogue, astringentParts used: seedHas been used for infant colicSafety: considered safe by FDAOften combined with other herbsTea: 1-2 tsp/5oz water, steep min, 5-6x/dayTincture: 3ml TIDCarum carvi
18Coriander- Coriandrum sativum Seed of cilantro plantPopular galactogogue among Chinese and Indian mothersDiuretic, nutritive, anti-flatulent, anti-diabetic (mild)1 heaping T seeds to 1 mug of hot water, steep min, take 3-5x per day. Can sweeten as desired.
19Dill (A)- Anethum graveolens Actions: anti-spasmodic, diuretic, carminative, emmenagogue, anti-inflammatory, aromaticParts used: seedUsed in “gripe water”May help with MERContraindicated for low sodium dietsOften combined with other herbsculinary use…
20Tea: 2 tsp/8oz water, steep 10-15 min, 2-3x/day Dill culinary useTea: 2 tsp/8oz water, steep min, 2-3x/dayDecoction: Steep ½ c dill seeds in water overnight; boil until very dark in color, strain. Drink one cup of this a day.2 tsp seeds on meal
21Actions: Liver, anti-spasmodic, diuretic, aromatic, estrogenic (weak) Fennel Seed (A) Hale L4Foeniculum vulgareActions: Liver, anti-spasmodic, diuretic, aromatic, estrogenic (weak)Parts used: seedNote: has toxic look-alike relatives!For gastrointestinal disordersOne source suggests may promote milk ejection; another suggest may have bust-enhancing propertiesAlso studied for anti-hirsutism propertiesculinary use…
22Not recommended during pregnancy culinary use…Possible side effects: allergic reactions, dermatitis Fennel oil can be toxic. Avoid.Hale: L4 due to concerns regarding estrogenic property effects on lactationSafety: One European case report of 2 infants who reportedly became weak and lethargic when mom ingested 2 qts of tea daily made from fennel, licorice, galega. However, plants never ID’d.Not recommended during pregnancy
23culinary useTea: 1-3 tsp freshly crushed seeds per 8oz water, steep min, 2-6x/dayTincture: 3ml X 3
24Fenugreek (B) Hale L3Trigonella foenum-graecumActions: Stimulate breast growth, digestive aid, hypoglycemic, expectorant, emmenagogue, anti-inflammatory, hypotensive, demulcent, diaphoreticParts used: seedculinary use…
25Source of iron?May have hypotensive and thyroid supporting propertiesMost studied of all lactogenic herbsU.S. listed GRAS (generally regarded as safe) when used in moderation
26Mother’s sweat and urine usually smell like maple syrup Possible side effects: diarrhea (mother or baby), stomach upset, hypoglycemia, allergy. Could worsen asthma. Contraindicated for pregnancy. May lower cholesterol.Research Issues:Difficult to create placeboForm/brand to testEthics of withholding help
27Capsules: 2-4 540-650mg caps 3-4x day Dosage:Capsules: mg caps 3-4x dayMax 6gms/day (Frank Nice) BUT some people have used up to 4 qidTea: 1 tsp seeds/8oz water, steep5-10 min, x2-3. If seeds crushed, use ¼ tspTincture: 1-2ml TIDOften combined with Blessed Thistleculinary use…
28Shatavari (B) Asparagus racemosa Also known as “hundred husbands” Found in Africa, India, Australia, AsiaConsidered “the strongest” herb for female issues, is used for infertility, prevent miscarriage, increase milk supply, increase breast tissueDiuretic, nutritive, laxative. Mucilaginous.Considered “anti-oxytocic” for uterine contractions during pregnancyAsparagus racemosa
29“Regularizes” menstruation, dysmenorrhea and fertility H.S. Puri, Rasayana: Ayurvedic herbs for Longevity & Rejuvenation“Regularizes” menstruation, dysmenorrhea and fertilityPregnancy: “used for proper breast development, embryonic growth & to rid genital of diseases.”Powder form only first 8 mosOil for vaginal swab 9th mo for elasticity, “easy and painless delivery”5-10gm asparagus powder with warm milk recommended for pregnancy/lactation
301-2 tsp root powder stirred into warm milk 1-2x a day Or one capsule twice a dayConsidered safe for pregnancy and lactation
31Non-culinary herbal galactogogues Alfalfa (A-plant) Medicago sativaActions: estrogenic (weak), nutritive, may stimulate appetite.Parts used: leavesNutrition: High in chlorophyll beta carotene, calcium. Contains vitamins A,B1,B6,B12,C,E, K1 along with potassium, phosphorus, iron and zinc.
32Said to increase supply in cows non-culinarySaid to increase supply in cowsReport of presence of “TRH-like material” which may in turn stimulate prolactin releasePossible diuretic and pituitary function support propertiesPossible side effects: allergies, diarrhea. May lower cholesterol. Avoid with lupus or rheumatoid arthritis.
33Dosages1-2 tablets or capsules 3-4x/dayTea: 1-2T dried leaves/5oz water 2-4x/dayTincture: ½- 4ml 4x/day1T dried juice powder 2x/dayHomeopathic alfalfa: 6 tablets per day (KM)Can be combined with homeopathic Lactuca virosa
34Blessed Thistle (B) Hale L3 Cnicus benedictusBlessed Thistle (B) Hale L3Actions: appetite stimulant and digestive aid, hormone balancer, cholagogueParts used: leaf, stem, flowerOften used in conjunction with fenugreekReputed to “increase the flow of milk”Avoid during pregnancySafety: considered nontoxic
35Tea 1-2 tsp crushed seeds in 5oz water (bitter) 5-6x/day non-culinaryDosage:Tea 1-2 tsp crushed seeds in 5oz water (bitter) 5-6x/dayTincture: 1-3mls 2-4x/day1-3 caps ( mg) 3x/day when combined with fenugreek or up to 6g total if used alone (per Commission E)
37Oil (A) reputedly increases creaminess of milk 2-5ml x3 OR1000mg 1-4x/dayLeaves (C) reputed to help milk supply, but must be used judiciously as large amounts can cause liver damage2 tsp dried herb x3
38Chasteberry - Vitex agnus castus (B) Actions: Hormone balancer, tonic non-culinaryChasteberry - Vitex agnus castus (B)Actions: Hormone balancer, tonicReputed to “normalize” pituitary function, used for luteal phase insufficiency (“shift” in ovarian hormones in favor of progesterone), irregular cycles, PMS. Promotes fertility. May help MER?Parts used: fruit
39Sometimes used for PCOS Reputed to “modulate” Prolactin levels1943 Study found increase in milkproduction in 80% of 125 patients.1957 controlled trial of 817 patients claimed that avg milk production 3X that of controls
40Conflicting info:“May bring on milk flowearly” if used in pregnancy.hypoprolactinemic agent,suppressed lactation in ratsIn men, small dose(120mg/day) increased PRLwhile large dose (500mg)inhibited it.May take time for effectsto kick in?
41May interfere with Reglan Tea: 1 tsp ripe berries infused in 8oz water min; drink 3x/day (bitter)Capsules: 2-“00” per day or 30-40mg/day (Humphrey)Tincture: 1ml x3 or up to 5mls daily (1:5 conc)
42Goat’s Rue (B) – Galega Officinalis Actions: stimulate breast growth; milk; diuretic; hypoglycemic; emmenagogue; diaphoretic;Parts used: dried aerial partsContains galegin, upon which phenformin was basednon-culinary
43Reputation for causing breast growth French dairy farmers noted 35-50% increase in output of milk in their herdsPopular among French nursing mothersControversy: toxicity in sheepNo reports of problems in human usePeripheral Receptor Sensitizer?
44Dosage: No consensus, but consider taking with food Goat’s RueDosage: No consensus, but consider taking with foodTea: 1 tsp leaves/5-8oz water,steep min, 3-5x/dayTincture:2.5ml X 4 (Wise Woman Herbal)3-4ml x 4 (Mechell Turner)1-2ml x3 (MotherLove)1 tsp in 8oz water TID (LowDog)Capsule: 1 cap 4x/day (Motherlove)
45Ixbut- Euphorbia lancifolia (C) From Ix (woman) and but (increase in flow or volume)Ancient Mayan galactogogue used when milk supply insufficient.non-culinaryPopular back in the 1940’s, still occasionally used byrural women in Guatemala. Also found in SE Mexico,Belice, El Salvador and Honduras.“Said to double the quantity of milk given by cows thateat it.“ High amounts appeared to cause decrease afterseveral days……. Moderation important?
46ixbutClaimed “to cause milk to flow after it has ceasednormally, or even in women who have not given birth toa child……. That aged grandmothers, after taking Ixbut,have been able to suckle newly born infants throughwithered breasts….”Aerial parts used– leaves and branchletsTypical “dose” tea made from 5 leaves or sectionsof stem (~ 5gms) and 1 cup of water, 3x/dayDehydrated leaves high in calcium?Pozo 1949 study: no changes in breast volume ormilk composition noted, only milk volume.Galactagogue properties appear higher in Novemberbefore plant blossomedEuphorbia family (esp. hirta) has many reputedgalactagogues, but toxicity concerns haveprecluded common use
47Marshmallow root (A)Actions: diuretic; expectorant; anti-inflammatory; demulcent; mucilaginousParts used: root and leafNutrition: calciumGalactogogue effect not direct, perhaps synergistic; one herbalist uses it “when baby isn’t gaining weight well”May help counteract loose bowel effects of alfalfa, fenugreek, blessed thAlthaea officinalis
48Tea: 1T root powder/ 5oz water, let stand 30 min; drink immediately. Tincture: 1-4 ml 3x/dayCapsules: up to 4 caps 3x daily
49Milk Thistle (A) Actions: Liver, demulcent; cholagogue Contains silibinin, silydianin, silychristinParts used: seeds or leavesMechell Turner says leaves are used for milk supplyPossible side effects: mild laxative effect, diarrhea, mild allergen.Silybum marianum
50Milk thistleTea: 1 tsp freshly crushed seeds in 5oz water, steep min. 5-6x/dayTincture: 3-5ml 3x/dayCapsules: two 500mg 3x/day
51Nettle (A) Actions: astringent, diuretic, tonic, hypotensive. Parts used: aerial partsFor gastrointestinal disordersHigh in chlorophyll; also Vit C, ironPossible side or overdose effects: gastritis, edema, burning sensation of skinUrtica dioica, urens
52Tea: 2-3 tsp herb in 1c water; steep 10 min, 2-3x/day Leaf Tincture 2.5-5ml 3x/dayCapsules: mg 3x/day
53Red Clover (B) Trifolium pratense non-culinaryRed Clover (B) Trifolium pratenseActions: anti-spasmodic; expectorant; estrogenic (weak) stomachic; cholagogueParts used: flower headUse in pregnancy considered controversialUse non-fermented only
54DosageTea: 1-3 tsp herb in 5oz water; 3x/dayTincture: 2-6 ml 3x/day
55Red Raspberry (A) Rubus idaeus Astringent, tonic, parturientParts used: leaves, fruitNutrition: vitamin A, B complex, C, E, calcium and iron, phosphorous, potassium.Galactogogue effect uncertain; one source says it is believed to lower supply long term, but may help if used short term (<1wk)Other sources say it “increases the flow” and “enriches” the milk, use tea to aid milk ejectionnon-culinaryTea: 1 tsp leaves/5oz water, steep 5-10 min, 2-4x/dayTincture: 3-4mls 3x/dayCapsules: 3-300mg caps 3x/day
56Saw Palmetto (A) Serenoa repens Historical use includes for treatment of “underdeveloped breasts,” “a galactia;” “increased lactation;” “breast enlargement.”Parts used: fruitNutrition: The leaves have a very high content of vitamin A as well as moderate amounts of vitamin D, vitamin C, various B vitamins, iron, silicon, magnesium, zinc, and manganese.
58Vervain: Verbena officinalis (B) Actions: nervine, anti-spasmodic, diaphoretic, hypotensive, hepaticReputedly oxytocic and uterotonicParts used: aerial partsMore often found in combinationsDosage:Considered safe in appropriate dosages; not for pregnancyTea: 1 tsp per 5oz water steep 5-10 min, drink 3x/dayEuropean Infusion: 30-60g herb in 1 qt boiling water; steep minTincture: 2-4ml 3x/daynon-culinary
59Handouts: Herbs by family, Herbs by similar action Others on the horizonAshwagandha (C)Black Cohosh (B) hypotensiveChickweed (A) thyroid, ovarian cystsDandelion (A) diureticHops (A) diuretic; bust enhancement?Licorice (B) another aromatic herbOat Straw (A) iron; diuretic; pituitaryHandouts: Herbs by family, Herbs by similar action
60Commercially available herbal galactogogue tinctures More Milk, More Milk Plus (Motherlove Herbal): Blessed Thistle, Nettle, Fennel; plus adds Fenugreek. MM+ now 1:3,or also in glycerin form.More Milk Special Blend (Motherlove Herbal): adds goat’s rue to More Milk Plus (1:5)More Milk Two (Motherlove Herbal) : Raspberry leaf, Nettle, Alfalfa. Considered safe for use during pregnancy.
61Mother’s Lactaflow (Wise Woman Herbals) other combinations…Mother’s Lactaflow (Wise Woman Herbals)FennelBlessed thistleFenugreekGoat’s rueSuggested dosage drops 3-4x per day
64Commercial tincturesAncient One’s formula (B&BR): Anise, Dill, Fennel, Fenugreek. Made of kitchen-familiar herbs only, for those not comfortable with the unknown.LC’s proprietary blend (B&BR): Blessed Thistle, Fenugreek. Most commonly demanded herbs.Milk In Formula (B&BR): Blessed Thistle, Borage, Fenugreek, Goat’s Rue, Red Raspberry. When nothing else seems to be working.
65Commercial tincturesMega Milk Formula (B&BR): Blessed Thistle, Borage, Red Raspberry. For those who don’t want fenugreek.Anti-Puffy Formula (B&BR): Dandelion, Cornsilk. For postpartum edema.Let-down Formula (B&BR): Black Cohosh, Motherwort, Schizandra berries. Can also get with added fenugreek. When MER seems to be the problem, not available milk
66Combination Galactogogues in Capsules More Milk PlusFenugreek, blessed thistle, nettle, fennelDosage: capsule QID or caps TID if >175lbs or not working well after 48 hrs
67“Lactation Blend” (Vitanica**) capsules…“Lactation Blend” (Vitanica**)Fennel Seed mgNettles Leaf mgBlessed Thistle mgVervain mgHops mgOat Straw mgRaspberry Leaf mgGoat's Rue aerial parts mgChaste tree berry mgFenugreek Seed mgMilk Thistle Seed mgBorage Seed Oil mgBorage Flower & Top mgTOTAL mg per capsule mg*Recommended dosage 1-2 caps per day**formulated by Dr. Tori Hudson, Naturopath
68Baby Me Now Lactation Ease (Solaray) Fenugreek, fennel, nettleMfr reputation?????
69Nonichai Noni (leaves) Cardamom (seed) Marshmallow herb (root) Fennel (seed)Fenugreek (seed)Dosage: 2 capsules per day??????
70Gactogogue TeasMother’s Milk Tea (Traditional Medicinals): Fennel, Anise, Coriander, Spearmint, Lemongrass, Lemon verbena, Althea root, Blessed thistle, Fenugreek.Milder than tinctures, usually taken as 1-4 cups a day. Katherine Shealy finds 8 cups a day very effective.Tasty iced tea version: 6 bags MMT + 4 bags Celestial Seasonings Wild Berry Zinger to make 3 qts tea; place in water bottles and sip throughout day.
71Weleda Nursing Tea (Swiss) Swiss Formula: Nettle, Aniseed, Caraway and FennelU.S. Formula: Fenugreek Seed, Anise Seed, Fennel Seed, Caraway Seed, Lemon Verbena Leaves.Directions 1: Combine one level 5ml teaspoon to 1 cup of cold water and bring to the boil. Simmer for one minute, steep 5 minutes.Directions 2: 1 tea bag to a cup of boiling water, cover and steep 5 minutes.Drink 3 cups a day or as directed by your naturopath. swissU.S.
72Yogi Tea – Woman’s Nursing Mom Fennel, fenugreek, anise, chamomile, lavendarDirections: pour 8 oz boiling water over one tea bag and steep for 5 to 10 minutes. Gently squeeze each tea bag to fully release the active ingredients. Drink 2 cups daily to maintain milk production or 1 cup every 3 hours to stimulate milk flow.
74“Lactare” from India Asparagus Racemosus (Shatavari) 200mg Withania Somnifera (Ashwagandha) 100mgGlycyrrhiza glabra (European Licorice) 50mgFenugreek 50mgAllium sativum (garlic) 20 mgDirections: 2 caps TID for first 14 days after delivery or as neededStudies cited showing Lactare increases prolactin, milk production, creaminess of milk
75HomeopathicsBased on the Law of Similars, or “like treats like.” Counter-intuitive to western thought.Classical approach takes in-depth consititutional history and chooses one remedy onlyRemedies are diluted until no measurable amount of source remains; can be found in 6x, 12x, 6c, 12c, 30c, 200c, L and M dilution/ potencies; typically used short term, ~ 3 daysThe greater the dilution, the more potent it is consideredBest results when prescribed by practitioner rather than self-diagnosis
76Advice from herbalist Mechell Turner, IBCLC: Do not touch the pills or tablets (remedy is on the outside of the pellet)Put the dose—usually 1 tablet or drop—into the lid of the bottle, or even a clean paper cup. (Often placed under tongue for quick absorption)Take the remedy only for the symptoms.If symptoms get worse, stop the dosage.Administer less frequently as symptoms improve.Usually do not take medicine for longer than 3 days.For emergencies use the 30C every 30 minutes to 1 hour for up to 10 doses. Then see above rule.Take the smallest dose for the shortest period of time.
77Homeopathics more commonly used for low milk supply….. *Urtica urensConsidered a good galactogogue for general use. May be useful when there is a total absence of milk or when milk supply is slow to establish without an obvious cause. May be appropriate when hemorrhage or anemia precede low milk supply.*Lactuca virosaConsidered a strong galactogogue overall, good for general useSuggested dosage 4 (30c) pellets QID or 2 (30c or 200c) BID
78Often used for sudden loss of milk related to shock and grief. *IgnatiaOften used for sudden loss of milk related to shock and grief.“I haven't seen this do much on it's own. However, when it's combined with a mild galactagogue like nettle I've seen amazing results.”-Jay Gordon’s websiteSuggested dosage: 2 (6x) tablets TID (KM)
79Helonias (False Unicorn) Ricinus communisHemorrhage or anemia preceding low milk supplyGalegaWhen anemia or poor nutrition are also variablesHelonias (False Unicorn)When caused by extreme maternal exhaustion (super mom syndrome)
80Dulcamara Agnus Castus Traditionally used when sudden loss of milk occurs after exposure to cold and damp; may be helpful when low milk supply follows milk stasis (ie, engorgement).Agnus CastusWhen low milk supply is accompanied by depression. (Note: Patricia Hatherly believes this depression could possibly be related to hormones from retained placental products, the latter of which suppress lactation.)
81Causticum Calcarea carbonica Short-term exhaustion leading to drop in milk supply, ie mother up all night with baby. Most appropriate with personality that resists rather than “rolls with the punches.”Calcarea carbonicaMay be useful when breasts are engorged and milk is not flowing, or when low supply occurs with breast infection that is associated with engorgement. May possibly have application for milk supply when thyroid function is low.
82SiliceaLow milk supply related to poor maternal diet/extreme dieting. May also be appropriate when supply problems preceded by boggy uterus after childbirth, possible retained placental products, or inflamed breast infectionRescue RemedyWhen the milk is present but not flowing and mother is stressed from pain, fear of pain, etc.Use 4 drops sublingually before nursing or pumping to facilitate milk ejection .Rescue Remedy can have a slight sedative effect, so use caution.
83Selecting galactogogues A good maternal health history is important, including any medical conditions, allergies, history of depression, current medicationsWhat is the root of the problem? Is there a lactogenic medication or herb that seems to target this issue?
85What is mother’s comfort and philosophy regarding medications or herbs? Are there institutional or HCP restrictions on what can be used? Must work carefully within framework of mother’s HCPsLook for reputable manufacturers or herbalistsRotating herbs may work better for long-term dependence
86Case Studies Case 1: Two babies, two different results Primary supply failure (but >50%) with baby #1Did research, then used herbs for #2:During pregnancy: drank mix ofHandfuls of Red Raspberry Leaf & NettleSlightly less Alfalfa and Red Clover BlossomHeaping handful of the mixture to 1qt of boiling water steeped overnight (drank iced)Postpartum Adjustments:Added hops, blessed thistle, marshmallow root, fenugreek and goat’s rue powder (1 tsp ea/qt)Drank 1qt per day~anecdotal~
87Case 2: Break through experience Primigravida age 33 presented at 8 days pp. due to no BMs in 72 hrs, “brick dust” urineBaby born at home, 8#2, now 7#00.5.Mother feeding almost constantly.Family staunch vegans, opposed to commercial formulasMildly hypoplastic type 2 breasts spaced 1-1.5” apartmild pregnancy changes only.More palpable gland in L vs RVeining moderateAreolae very largeMilk in day 4 ( by color change)
88Additional maternal hx: erratic cycles from age 13 with menorrhagia; placed on BCPs during 20’s. Cycles improved 2 yrs ago after starting vegan dietInfant Assessment: good suck, tone, alertnessFeeding observation: latched fairly wellIntake 8ccs L and 2ccs RPost pumping yielded 20ccs total; good MERInitial lactation dx: infant lack of weight gain secondary to poor supply due to inadequate glandular tissue.
89Follow-up 1 (4 days later) Initial Care Plan:Demand feed, breast compressionsPump min after feedsSupplement with 1.5-2oz EBM & AIMAlternate MM+ and Goat’s Rue per mfr’s instructionsFollow-up 1 (4 days later)Baby’s wt 7#5.3 up ~5oz/4 daysTest feed 10ccs R, 4ccs L, (double before)Pumped 18 ccs after feed (same)Agreed to continue current plan
90F/U 2 (1 wk, age 19 days) Baby 7#12.5, up 7oz/7days Baby taking about 2oz suppl. per feed for 14oz AIM + 7oz EBM per dayTest intake 8ccs R 9ccs L; switched to football, got 28ccs more = 45ccs totalMom reports taking both herbs 8-10x/dayBaby breastfeeds 30 min totalPumping 6-7x/day, 20-35ccs eaContinue plan
91F/U 3 (1 wk, age ~1mo) Baby wt 8#3, up 6.5oz/7days Mom still pumping 1oz each time, baby also getting additional 2-3oz/supplementMom now alternating herbs, total of 8x/day; if supply felt low, she took them togetherTest feed: baby sleepy & passive, 12ccs R only.
92F/U 4 (2 wks, age 6 wks) Baby wt 8#15.9 up 13oz/14 days Test feed: 24ccs R and 80ccs L = 104ccs!AIM downMom taking herbs 10-12x/day + MM teaMom also reported some vaginal bleeding
93F/U 5 (7wks) F/U 6 (8wks) Baby wt 9#5, up 5.5oz/8 days Mom reports avg 6oz AIM per dayMom reports periodic bleeding past month, passing of clotsTest intake: 45ccs R and 30ccs L = 75ccsSuggest monitoring timing of supplements vs “periods”F/U 6 (8wks)Baby wt 9#12.3 up 7oz/6 daysMom stopped pumpingTest feed 24ccs R and 28ccs L = 52ccsMom had not used GR for 2 days4oz AIM past 2 days vs 2-3 3oz bottles
94New pregnancy @ 7 mos; baby #1 breastfed 6 mos into new pregnancy F/U 7 (10 wks)Baby wt 10#4.3 up 8oz/15 daysMom reports using 3oz supplement in evening only; baby sleeping more and eating less at nightStooling every 3-5 days, but largeTest feed: 62ccs R 40ccs L = 102 ccsF/U 8 (~ 12 wks)Baby wt 10#14.5 oz up 10oz/12 daysMom reports supplement at 3-6ozTest feed: 38ccs R and 34ccs L= 72 ccsBaby eventually rejected supplements; gain average .5oz/day. Solids started late due to paternal preference.New 7 mos; baby #1 breastfed 6 mos into new pregnancy
95Baby eventually rejected supplements; gain average. 5oz/day Baby eventually rejected supplements; gain average .5oz/day. Solids started late due to paternal preference.New 7 mos; baby #1 breastfed 6 mos into new pregnancy
96At 5 mos: transferred 100ccs, but wt gain not quite .5oz/day
97Interesting stuffMom got tired of doing herbs all the time, so decided to try domperidone instead.At first this seemed to work, but then supply dropped and breasts “deflated,” so she added Goat’s Rue back and took them concurrently.Later on, she ran out of the Goat’s Rue for a few days and found that her breast seem to “deflate” again. She quickly got more and things returned to normalSupply was ~95% overallBaby #3……..
98Web ResourcesKellyMom.com-LowMilkSupply.orgBirth and Breastfeeding:Mongraphs by D. Hoffman, Herbal Materia Medica:Longwood herbal task force:Saw palmetto:Napralert:MOBI:Breastfeeding & herbs discussion group: