Got milk? Breast-feeding is best - unless you can't

Associated Press | 9/24/2008, 6:07 a.m.

She used fenugreek, blessed thistle, alfalfa, nettle, fennel, goat’s rue, bitter lettuce, brewer’s yeast, hops, oatmeal and two pharmaceutical drugs to increase her milk production. Nothing worked very well.

“You name it and I tried it,” said White, 32, a physical therapist from Suffolk, Va., who was forced to supplement baby Austin’s diet with formula. “I never thought breast-feeding would be this complicated and challenging.”

Almost 75 percent of U.S. babies now begin life breast-feeding, a practice that helps give them disease immunity and other benefits. Nobody knows how many women have trouble breast-feeding, but those who do run into a common frustration: Women who need help often are left on their own to sort fact from folklore.

Many doctors aren’t educated about breast-feeding problems, and there is little rigorous research to help. Health insurers, including Medicaid, generally don’t pay for lactation consultants — who are not licensed in any state. And some consultants recommend unproven, even risky herbal remedies and drugs.

A review of research on drugs used to enhance milk production, published last year in the journal Breastfeeding Medicine, concluded that such products “appear to have little or no added benefit” over good advice on breast-feeding techniques. The review found commonly cited research on two drugs — metoclopramide and domperidone — to be seriously flawed.

As for the drugs’ safety, many studies relied on casual observation of babies for side effects, or failed to mention infant safety at all.

There’s even less research on the usefulness or long-term safety of herbs, which have been used for generations and across many cultures to increase milk supply. What’s more, herbal supplements can be sold without government approval, dosing isn’t standard and some products have been known to contain toxic substances, according to the Academy of Breastfeeding Medicine.

“I’m not a big fan of herbals,” said Dr. Ruth Lawrence of the University of Rochester School of Medicine and the author of the primary medical text on breast-feeding. “They can put anything they want in that bottle. There’s no quality control.”

White didn’t notice any side effects in herself or her baby from the herbal remedies she tried. But she said she did get depressed while taking metoclopramide, or Reglan, an anti-nausea medicine that has been used “off label” to treat low milk supply. Depression is listed as a possible side effect on the package insert.

“I remember feeling like I was out of control,” said White. “I couldn’t control my emotions.”

What helped White most was a supplemental nursing system — a device that allows a baby to receive both formula and mother’s milk, by delivering formula through a tube attached at the mother’s nipple.

Most milk-supply problems can be solved by increasing the frequency of breast-feeding or by using a breast pump. These supply-and-demand methods should be tried first, according to the Academy of Breastfeeding Medicine.

Very few women have biological reasons for low milk supply, experts said. Breast surgery or endocrine problems can inhibit production, though more often the problem begins when something interferes with frequent and thorough feedings in the days after a baby’s birth.