Use of traditional GALACTAGOGUES in breastfeeding support during emergencies - yes or no?

Hi Isabelle,

Traditional galactogogues are everywhere. In my view they mostly have no impact (or at most they have a negligible impact). What I have seen is the effort spent trying to get or not having the traditional galactogogue have a really negative impact on breastfeeding. Women can also rely on the galactogogue to make more milk rather than the core practice of milk removal/breast emtying. What I've also seen in emergency responders bring their own traditional galactogogue into a situation- which is totally pointless and again detracts. And finally, I've seen mothers who have been provided with their traditional galactogogue (milk is a common one- which presents it's own issues) feel more confident and able to breastfeed. So it's complex! I don't think that we should be reinforcing that galactogogues are necessary to breastfeed but neither is it appropriate or helpful to tell women that these substances are likely useless if she strongly believes that they are. The way I approach it in breastfeeding counselling when mothers are very keen on the galactogogue is to try to put it in context- give her information about how lactation works and the paramount importance of milk removal in driving milk production. If she has access to her traditional galactogogue I will provide her with empathy about how  that must give her confidence but may also say something to provide her with a way of being OK if it's not available, some anticipatory guidance. For example, I might talk about how milk for example is a nutritious food and that it can give mothers energy which helps them to care for their child and so if milk is not available at some time in the future, other food can fill that gap and breastmilk production will continue just fine so long as she keeps breastfeeding her baby. If she does not have her galactogogue available and is anxious about it, I will again provide empathy and might provide some information about how different galactogogues are used in different places and again depending on what is available suggest that a food that she does have access to might be able to fill that gap- while again emphasising the importance of frequent breastfeeding in driving milk production. You might find some info in the following paper helpful- it's about prelacteal feeds rather than galactogogues but it provides an example of adjusting a traditional belief to improve health outcomes. I think there's some relevance here. Dörnemann J, Kelly AH. ‘It is me who eats, to nourish him’: a mixed-method study of breastfeeding in post-earthquake Haiti. Maternal and Child Nutrition (2013) 9(1):74-89. doi: 10.1111/j.1740-8709.2012.00428.x.

I hope this is helpful.

Hi Karleen and Isabelle,

You have posted good questions and responses!

The use of "natural" galactogogues is common and culturally acceptable in many countries during normal circumstances too. Some women (my close family members too) swear by the ones that have proved helpful in increasing their milk production, black cumin (kali jeera) being one of them. Generally we are empathetic during counselling, and do not actively discourage the use of the natural galactogogues. As you will agree, there may be a psychological effect - mother feeling better since she is actually taking something to increase her milk production, and as long as she continues to breastfeed exclusively, we are happy! However, I must confess that I do feel rather uncomfortable when mothers are prescribed "chemical" galactogogues, as I seen/ heard some rather worrying side-effects. There is another risk - mothers often tend to continue these medicines for a longer duration than what has been advised. In emergency settings, I would think that one needs to be even more careful, since access to knowledgeable health professionals is scarce. 

Best wishes

Rukhsana

Dear Isabelle,

within nutrition causal analyses Link NCA we tend to document galactogogues and prelacteal feeds, which are shared with us during the qualitative inquiry. Most of recent Link NCA studies include a mention of these to a various degree, depending on how much the community relies on these foods/liquids to boost the breastmilk production and/or supplement breastmilk for various reasons. However, within our work we do not attempt to prove whether cited galactogogues or prelacteal feeds have a positive or negative effect on the health of a mother or that of her child (such question would be referred for further research beyond our scope of work) but rather explain why they seek them. From what I have seen across multiple contexts, mothers usually deploy these practices with the best interest of a child in their mind while some may be more useful/nuisible than others so I would say that all need to be considered within the context, in which they are used.

In case you would like to get more info on documented galactogues and prelacteal feeds from Link NCA studies, my colleague Carine Magen coded all Link NCA studies in NVivo last year and so we should be able to extract relevant data for you rather easily. 

Kindest regards,

Lenka