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

Gabriella Zizzo,Lisa H Amir,Alice R Rumbold,Vivienne Moore,Luke E Grzeskowiak,Jennifer Yourkavitch

doi:10.1371/journal.pone.0249599

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.

Highlights

Supporting breastfeeding is a public health priority, based on the well-established benefits of breastfeeding for maternal and child health [1,2]
A key finding is the range of problematic interactions women had with health care professionals regarding breastfeeding support, that resulted in feelings of being dismissed and the provision of conflicting information, that was sometimes at odds with beliefs about breastfeeding
Our findings reveal a range of broader dimensions influencing decision making which are highly individualised and interlinked with other dimensions as well as the core domains

Summary

Introduction

Supporting breastfeeding is a public health priority, based on the well-established benefits of breastfeeding for maternal and child health [1,2]. There are very high rates of initiation of breastfeeding worldwide (>80% of mothers in most countries), rates of breastfeeding decline markedly in the first few months after birth [2], most notably in high-income countries This occurs for a multitude of reasons, reflecting breastfeeding difficulties and insufficient access to lactation support and postnatal care, as well as broader family and social support, access to paid maternity leave and social and cultural norms about infant feeding [3]. One of the most common reasons cited for early cessation of breastfeeding is perceived low or insufficient milk supply [9,10,11,12] This should be managed initially by the provision of breastfeeding counselling and support [13], when concerns persist, substances known as galactagogues are often recommended [13,14]. Women have used herbal or food preparations such as fenugreek, fennel, oats and brewer’s yeast and other local botanicals, in this way [16,17,18]

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