Medications for Breast Milk Production

NeoNotes Journal Club

Highlights from the Conference on Neonatal Nutrition, Baylor College of Medicine (BCM) and Texas Children’s Hospital (TCH), Houston, TX, March 4-7, 2001.

Medications to Enhance Breast Milk Production

By: Nancy Hurst, RN, MSN, IBLC, Director of TCH Lactation Department and Mild Bank, Pediatric Instructor, BCM

Providing periodic follow-up and counseling is important to ensure compliance with frequent pumping schedule. Maintaining a pumping record and sharing that information with the nurse/consultant will allow for timely feedback and intervention. Anticipatory guidance is essential in providing realistic milk volume goals. Based on the literature and clinical observation milk volumes of approximately 850 ml. per day are average for most women of full term breastfeeding infants. Although these volumes are attainable by the preterm mother, they may be difficult to maintain given the absence of a sucking infant.

At what point should the mother/consultant be concerned about her milk volume?

Proposed guideline for attainable milk volumes by day 10 post delivery:

Ideal: > 750 ml/d

Borderline: 350-500 ml/d

Low: < 350 ml/d

For mothers whose volumes fall in the borderline or low range the following interventions should be recommended:

Practice relaxation techniques prior to pumping sessions ( i.e. massage, breathing techniques, soothing music )

Manually express a little milk prior to mechanical pumping to provide enhanced nipple stimulation

Ensure compliance with frequent pumping sessions of adequate duration

Practice periodic breast massage during pumping session

Triage/treat nipple pain/trauma

Check proper fit of pump flange to maternal nipple and/or efficiency of mechanical pump

Initiate herbal preparations, i.e. FENUGREEK 500 mg tid

Prescribe METACLOPRIMIDE for a 12 day course ( dose 10 mg tid; wean to 10 mg bid for 2 days then once a day for one day ; for multiparas, 5 mg tid )

Another medication used to increase milk volume is MOTILIUM 10-20 mg tid-qid for 2 weeks. Not FDA approved )

Others are FENNEL SEED, MILK THISTLE.

Reviewed by: Ernesto Valdes, MD

Additional Comments:

UserName:    Donna Watkins
Institution: Riley Hospital for Children
telephone:   317-274-4817
email:       dwatkins@iupui.edu
Date:        07 Feb 2002
Time:        07:31:21

The data on use of herbal remedies is minimal. None are FDA approved. What I have found is concerning for side effects to both the mother and baby. These have been associated with liver toxicity, bleeding and death. Especially the teas where the dose is specific to the amount of time it has been steeped. This has much variablity and is difficult to control. Also, Reglan has a high association with maternal depression. When the drug is discontinued the milk supply that was present prior to use of the drug diminishes dramatically. Recommendations for medications to enhance milk production should be well researched and the mother should have a full understanding of our lack of knowledge regarding dosage,and potential serious side effects prior to agreeing to take the drugs.

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