Proceed with Caution: Fenugreek and Breastfeeding

What is Fenugreek?

Fenugreek (Trigonella foenum-graecum) is an herbal supplement that is claimed to be useful for a broad range of various conditions, without any substantial scientific evidence, from baldness, constipation, and heartburn to diabetes, cholesterol and erectile dysfunction.  The focus here, is the widely held belief among lactation advisors, nursing mothers and other birth professionals that fenugreek helps to stimulate milk production and supply. 

The fact is, there is not enough evidence to suggest that fenugreek is effective for any use. Of the few studies that have been done, they have been small and inconclusive.  So, does the fact that there is no data or research mean that fenugreek has no benefit?  No, not inherently.  Similarly, just because it is an herb and “natural”does not mean that it is safe.

Milk Supply and Galactagogues

First, let’s explore the idea of increasing milk supply.  Initially establishing supply is a specific and balanced dance of hormones and receptors that begins the moment the placenta is delivered.  Milk supply is determined by the removal of milk from the breasts and the interplay of prolactin (which produces the milk) and oxytocin (which releases the milk).  Frequent nursing is directly associated with greater infant weight gain. (DeCarvalho)1

As Americans, we often look to something outside of us to find a solution, often that’s in the form of a pill, whether prescribed or purchased at a health food store.  Often, the answers lie within us or in behaviors such is the case with breastfeeding. It is far more effective for a mother struggling with supply to work with a lactation professional and look at all aspects of her nursing relationship.  For example: How often is the baby being fed?  Is the mother expressing her milk and how?  How much milk is being removed from her breast at each feeding (determined by weighing baby before and after a feed)?   Most important is a mother’s confidence.  With desire, confidence and early breastfeeding support, a healthy, rewarding nursing relationship with a sufficiently plentiful supply is more likely. 

Millions of women across nations and generations, living under impoverished conditions, famine, holocaust and natural disasters, are able to produce and supply their infants with their own human milk regardless of the mother’s nutritional status.  Advice that guides nursing mothers to drink more to be able to produce more milk is erroneous: “Encouraging women to drink excessively has no effect upon lactation, either in terms of yield or composition of milk.” (Dearlove)2  Healthy eating and balanced nutrition are good advice throughout the life cycle, however, this directive during lactation benefits the mother and her long term health but does not impact milk supply.

Is there really such a thing, then, as a galactagogue, an external substance believed to increase milk supply?  The American Heritage Medical Dictionary defines galactagogue as “an agent that promotes the secretion and flow of milk.”  Many elements that are believed to help milk supply are based in cultural lore and not supported through research.  In a literature review of galactagogues, Anderson and Valdes3 concluded that “If mothers are provided education and practice techniques that support lactation physiology, galactagogues appear to have little or no added benefit.”  It has long been purported that fenugreek is a galactagogue, but it has never been proven to help milk supply and may have worrisome side effects.

Side Effects

Some reported side effects of fenugreek include diarrhea, gas, indigestion, heartburn and unusual smelling skin and urine (like maple syrup).  More serious, but more rare, side effects can indicate internal bleeding such as black, tarry or bright red stools, or vomiting blood or can indicate a bleed in the brain (hemorrhagic stroke) such as vision or speech changes, severe headache or weakness or numbness in the arms or legs.  As with any herbs, always be aware of allergic reactions. 

It’s important to note that fenugreek is a legume and those who have peanut allergies may experience a cross-reaction.  Dr. Frederick Leickly, an allergist, writes in his blog about a study published in the Journal of Allergy and Clinical Immunology (JACI) which concluded that a sensitization to fenugreek was believed to have been caused by a peanut allergy in patients.  He also noted in his practice a reverse effect, “that the fenugreek may have worked in the opposite direction – fenugreek exposure causing sensitization to the other legumes,” meaning it is possible that the use of fenugreek may create an allergy to peanuts or other legumes. 

In Mosby’s Handbook of Herbs and Natural Supplements, by Linda Skidmore-Roth, it states that Fenugreek “may cause reduced absorption of all medications used concurrently.”  This could cause harm in a mother taking medication for thyroid function, blood pressure or birth control pills. 

Traditionally, fenugreek has been used to stimulate labor, so it could potentially cause preterm labor or miscarriage if taken during pregnancy.  Fenugreek is classified as category 4 for pregnancy which is defined as “no increase in frequency of malformation or other harmful effects on the fetus from limited use in women.  Evidence of increased fetal damage in animal studies exists, although the relevance to humans in unknown.”  It is classified as a category 2A for breastfeeding which is defined as “compatible with breastfeeding.”

As with all herbs, fenugreek has not been tested or verified by the FDA for safety, effectiveness or purity; there have been cases when herbal supplements have been contaminated with toxic metals or other drugs.  There is no official standard or oversight of manufacturing.

Conclusion

It is not fully known whether fenugreek can harm a nursing infant and it is not proven to have any positive effect on milk supply or nursing.  Focusing on breastfeeding support and education as well as working with nursing moms to empower them and build confidence are effective ways to help a mother establish and maintain a nursing relationship.

Leah DeCesare, www.MothersCircle.net

1. De Carvalho, M et al: Effect of frequent breastfeeding on early milk production and infant weight gain.  Ped 72(3) Sep 1983.

2. Dearlove, J C & Dearlove, B M: Prolactin fluid balance and lactation.  Br J Obstet Gyn 88:652-54, 1981.

3. Anderson and Valdes, 2007, A Critical review of Pharmaceutical Galactagogues.  Breastfeeding Medicine, 2(4), 229-242.

Choose Trust, Not Fear

I just spent four days at a convention with women of all ages and I had the opportunity to spend some time talking with groups of college women.  What struck me about my conversations with these young women was their unanimous and overarching fear of pregnancy and childbirth.  It saddens me that the sole message these women have received is one of anxiousness, fright and actual terror.  In many ways it is no surprise given the culture of childbirth in the U.S. today, the media portrayals and the widely held belief that giving birth is dangerous and miserable.

These future mothers did not have a sense of joy or a confidence in themselves or their bodies to grow and nurture a baby let alone to deliver it!  One young woman confessed that she does not think her body can hold a baby while another announced she wanted nothing but a Cesarean.  Where is the other side of this story? 

I’ve observed so many expectant or laboring mothers struggling with their fear of giving birth, their fear of pain and their fear of the unknown.  The necessity of feeling secure while giving birth has been well documented from Grantly Dick-Read’s (1890-1959) Childbirth Without Fear to current day studies showing the incompatibility of the stress hormone (adrenaline) and the love hormone (oxytocin which is needed for uterine contractions).  Fear clearly works against labor progress.

These women want families, they want babies, but they have already developed an image of birth as being surgical, traumatic and terrifying. 

It is therefore vital to nurture new mothers when they have experienced fear messages from young ages.  These discussions have driven me to begin working with college-aged women to help them gain a trust in their bodies, to build a confidence in themselves, and to see another possibility for birth. 

Is 41 weeks enough time to overturn decades of mistrust of one’s own body?  The support of a doula, someone who values and honors the miracle of a woman’s body to grow and birth a baby, is critical.  The constant presence of a doula who cherishes birth, who nurtures the mother (and father/family) and who can encourage relaxation and calm over fear is profoundly valuable – but young women and expectant mothers must also consciously work to trust their bodies and to trust birth.  Through education, practiced relaxation and other techniques, push back against the cultural insistence of fearful childbirth.  Surround yourself with people who have a positive view of birth, invite only those who have a peaceful effect to your birth and protect yourself from fear-provoking stories, words, comments or advice. 

Nerves are normal, questions of the unknown are expected – but believe in the capabilities of your body, learn as much evidence-based information that you can.  Consciously, actively work to whittle away any fears and decide to surrender to the process of birth.  As Ina May Gaskin, renowned author and midwife, says, “Your body is not a lemon!”   Choose trust not fear.

Into the Mother’s Circle

May is International Doula Month and the month we celebrate Mothers!

I feel so grateful to do the work that I do; it is a blessing and an honor to support mothers and families, to welcome women into the Mother’s Circle.

The name Mother’s Circle has many meanings to me – it’s an embrace, safe arms around a family.  It is holding a space for moms and babies.  It is joining a community of women across generations and cultures and connecting mothers throughout history, around the Earth.  Mother’s Circle evokes an image to me of nurturance, compassionate envelopment and hands joining together – hands holding to buttress one another, to validate one another, to nourish one another in silent, expansive unity. 

Being a mother is so complex and contradictory – it is the deepest love, profound joy and intense frustration – it is special relationships and connection to another human being like no other.  It is overwhelming, emotional, physical, tiring, energizing, exhausting and invigorating.  It encourages us to explore our bond with this other person and our individuality from him/her; it leads us to reflect on our own mother, our own upbringing, our values, dreams, and goals for our families and ourselves.  Motherhood implores us to see ourselves anew, to be strong within ourselves beyond what we may have believed possible.

Mother, Mama, Mommy, Mom … we have a place of honor, prestige, great influence and great responsibility in a child’s life.  Becoming a mother is becoming a master balancer – balancing giving of yourself and giving to yourself.  Spending time alone, nurturing your spirit and body, living in the knowledge that caring for you is caring for your child(ren).  The title of Mother, Mama, Mommy does not replace the woman you are; let the role enhance you, add to you, give to you instead of detracting or diminishing. 

Trust yourself.  Honor yourself.  Bask in the glory of the Mother’s Circle.

The Value of Postpartum Support

What does Postpartum really mean?  Is the work of postpartum completed in six weeks?  Two months?  Five months?  Is there a “right” time to have mastered your new role as parent or your new role as parent of two, three, twins?

Postpartum, the time period often defined as the time it takes for the uterus to contract (involute) back to it’s prepregnancy size or six weeks, really lasts much longer and involves so much more than the physical restoration of the uterus. 

The disparity between expectations and the reality of a newborn can leave parents feeling out of control of their lives. Even with appropriate expectations, for example, adding a second or third child to the family, the time intensive requirements of caring for a newborn can clearly be challenging. 

Before the addition of a baby to your family, you have control over how you spend your time in working, leisure, sleeping, self-caretaking and other activities.  It is hard to anticipate how dramatically that will change after your baby arrives and hard to imagine just how overwhelming that can be to new parents.

A day in the life of caring for a newborn consists of:

  • at least five hours feeding your baby
  • about two hours changing diapers and clothing and bathing your baby
  • about four hours rocking, comforting and walking with your baby
  • about two hours admiring, cuddling and “playing” with your baby

All of which totals about 13 hours before Mom or Dad have showered, eaten a bite of food or slept a wink.  Parents need support and help after the birth of a baby.

The disparity between expectations and the reality of a newborn can leave parents feeling out of control of their lives. Even with appropriate expectations, for example, adding a second or third child to the family, the time intensive requirements of caring for a newborn can clearly be challenging. 

New parents need to be nurtured and cared for themselves in order to best able to care for their newborns.  The help from grandparents, sisters, neighbors and friends is a valuable support system for new parents.  In our generation and culture of families spread far apart, grandparents who may still be working and neighbors and friends who are busy with their own commitments, it is easy to see a gap in this support.

Postpartum doulas can help bridge the gap and help get new families off to a confident start.  Postpartum doulas main focus is on nurturing mothers, fathers and babies.  Emotional support, breastfeeding guidance, tips on physical comfort measures, practical household help (such as laundry, tidying, meal preparation and sibling care) as well as teaching parents basic soothing techniques and infant care are all part of a postpartum doula’s care.  The doula supports the family in a non-judgmental, gentle way helping them to feel confident in their new roles.