The risk-risk trade-offs: Understanding factors that influence women’s decision to use substances to boost breast milk supply

Abstract

Galactagogues are foods, herbs or medications thought to support or increase breast milk supply. The use of galactagogues during lactation is becoming increasingly common despite limited evidence regarding effectiveness and safety, and no definitive recommendations for use in clinical practice. The aim of this study is to explore factors influencing women’s decisions to use galactagogues during lactation. Twenty-two semi-structured interviews were conducted in October and November 2019 (over the telephone or in person) with participants located in most Australian states and territories, including metro and regional areas. Interviews were audio-recorded, transcribed verbatim and thematically analysed using NVivo. Analysis revealed that following a concern about breast milk supply, the decision to use galactagogues was influenced by three core and interrelated domains: access to and quality of breastfeeding support, maternal agency and determination to provide breast milk. Women revealed many problematic experiences with health care professionals that left them feeling dismissed and confused due to provision of inconsistent and insufficient information that was sometimes at odds with their desire to provide breast milk. In this instance, some women turned to galactagogues to regain agency. A range of broader dimensions influencing decision-making also emerged. These were separated into categories that emphasise distinctions relating to breast milk supply, which included: maternal emotional wellbeing, social norms and pressures, concerns about infant development, maternal physical health and lactation history, as well as those relating specifically to galactagogue use, including: desire for a guaranteed/urgent response, risk-risk trade-off, acceptance and trust, and accessibility and cost. In understanding the complexity of decision-making concerning these substances, we identify opportunities to improve breastfeeding counselling and support. We recommend that support be individually tailored to manage conflicting information, adopt communication styles that encourage trust and processes that enable shared decision-making to enhance or restore maternal agency. There is also considerable need to address evidence gaps regarding the effectiveness and safety of commonly used galactagogues, so that women can be appropriately counselled about potential benefits and harms.

“Fear of stopping” vs “wanting to get off the medication”: exploring women’s experiences of using domperidone as a galactagogue - a qualitative study

“…Issues around inadequate communication may also reveal a tension between the value women place on advice from experts versus peers or other trusted sources. Although some participants mentioned the value of peerreviewed evidence as important in their practices and decision making [30] we cannot conclude whether this practice was unique to this cohort as many of them were employed in health or research related fields and therefore had different insights and possibly differing health literacies compared to the general population. However, regardless of education levels and professions, women readily discussed beliefs and engaged in practices that were informed by details garnered on social media or through peers, highlighting a mixed response in terms of where information came from and how women valued and interpreted that information.…”

“…This analysis represents a sub-study of a larger project exploring women's awareness, use, and experiences of using substances and other medications for boosting breast milk supply [8]. Data collected from this project have been previously utilised to examine factors that influence women's decision to use substances to boost breast milk supply [30].…”

“…Overall, interviews were conducted with 22 women, which included an additional two pilot interviews conducted to test and refine the interview guide. The interviews utilised a semi-structured interview guide, a copy of which has been previously published [30]. GZ conducted all of the interviews.…”

“…Of the 22 participants, four interviews were conducted in person, two with videoconferencing software and the remaining 16 interviews were conducted over the phone as per the participants preference. These original 22 interviews were used to address the aims of a larger study that investigated factors influencing women's decision to use substances to boost breast milk supply [30]. Among these 22 participants, 15 indicated that they had used domperidone and their interviews were eligible for inclusion in the analysis to address the aims of this paper.…”

Use and experiences of galactagogues while breastfeeding among Australian women

“…Commonly reported galactagogues include dietary or herbal supplements, for example, oats or fenugreek, and pharmaceutical treatments such as domperidone [10]. Anecdotally, recent studies demonstrate widespread awareness and use of there is increased promotion of dietary galactagogues such as lactation cookies [11,12]. An examination of widely promoted recipes and commercially available products indicates that lactation cookies contain highly variable combinations and quantities Internet searches outline a variety of ingredients, including oats, brewer's yeast and flaxseed.…”