Your milk supply is considered low when there is not sufficient breast milk being produced to meet your baby’s growth needs.
Signs Your Baby Isn’t Getting Enough Milk
- you rarely hear your baby swallow while nursing;
- your baby continues to lose weight – it is normal for newborns to lose 5 to 10 percent of their birth weight in the first few days. But, after that, they should gain at least 20 to 30g a day and be back to their birth weight by day 14;
- your breasts don’t feel softer after nursing;
- your baby just doesn’t seem satisfied;
- your baby appears to have dry eyes or mouth;
- your baby is lethargic or fussy much of the time;
- your baby’s urine is very dark;
- your baby has small, dark stools after his first 5 days;
- your baby is wetting fewer than 6 diapers in a 24-hour period after the 5 days following his birth.
The most common causes of low milk supply are:
- supplementation with formula, particularly in the first several weeks;
- your baby is not latching on correctly – if your baby is not latching on to your breast correctly, he can’t get the milk out of your breasts very well. It is the most common cause of low breast milk supply;
- the use of pacifiers – for some babies, time spent sucking on a pacifier means less time for sucking on the breast;
- maternal smoking;
- thyroid conditions;
- feeding schedules – when your baby is breastfed according to a schedule, it may lead to a low breast milk supply;
- conditions from delivery of a baby, like – premature birth, Caesarean delivery, certain medicines, and stress during birth.
To boost milk production, it is recommended to:
- fit in more feeds than is usual for your baby;
- breastfeed as soon as possible;
- avoid alcohol and nicotine;
- massage your breasts;
- use medications that contain pseudoephedrine with caution;
- hold off on the pacifier;
- don’t skip breastfeeding sessions;
- be alert to feeding problems;
- make sure your baby is latched on and positioned well;
- breastfeed often.
Note – If you’re concerned about your milk supply, it is recommended to get in touch with a board certified lactation consultant or a trained breastfeeding counselor.
If you still don’t have enough breast milk for your baby’s needs, your doctor may prescribe you a medication to increase your breast milk supply. Here is a comparison between two medications that increase your milk supply:
Reglan (metoclopramide) is an antiemetic medication that is used to prevent vomiting and nausea caused by radiation therapy and chemotherapy. Aso, it is used for lactation induction and increasing a low supply of breast milk.
It was initially approved by Health Canada in 1985 for relieving vomiting and nausea caused by some medications used for Parkinson’s disease and gastric disorders.
It is also used to increase milk supply. The medication works by raising levels of prolactin, that helps increase the production of breast milk.
You should call your healthcare professional immediately if you experience any of the following side effects:
- Problems with speech;
- Rash or hives;
- Tightening of the muscles;
- High-pitched sounds while breathing;
- Muscle stiffness;
- Restlessness, foot tapping, or nervousness;
- Slow movements;
- Vision trouble;
- Uncontrollable shaking of a part of the body;
- Sudden weight gain;
- Difficulty breathing;
- Swelling of the face, eyes, lips, or lower legs;
- Difficulty with balance;
- Difficulty falling asleep;
You should tell your healthcare professional if any of the following side effects don’t go away:
- Excessive fatigue;
- Frequent urination;
Possible side effects include:
- Nervousness or restlessness;
- Skin rash;
- Problems with breathing;
- Uncontrolled movements;
- Swelling of the ankles, face, hands, feet, lips or throat;
- Mild stomach cramps;
- Heart rhythm disorders.
For increasing breast milk supply, the recommended dosage of Reglan is 10 mg, 2 or 3 times per day for 7 to 14 days.
Domperidone is usually started at a dose of 10 mg, 3 times per day.
Warnings & Precautions
Before taking Reglan, you should tell your healthcare professional if you have or have ever had:
- A blockage in your stomach or intestines;
- Kidney disease;
- G-6PD deficiency;
- Breast cancer;
- High blood pressure;
- Liver Disease;
- Parkinson’s disease;
- Heart disease.
Before taking Domperidone, you should tell your healthcare professional if you have or have ever had:
- heart problems;
- a kidney or liver disorder.
Reglan may interact in a negative way with the following medications:
- Tetracycline (Bristacycline);
- Sleeping pills;
- Narcotic medications for pain;
- Cyclosporine (Gengraf);
- Monoamine oxidase inhibitors;
- Medications for anxiety;
- Digoxin (Lanoxicaps);
- Haloperidol (Haldol);
- Ipratropium (Atrovent);
Domperidone may interact in a negative way with the following medications:
You shouldn’t consume alcohol while taking these medications or breastfeeding.
Both medications may harm an unborn baby if you use them during late pregnancy.
Bottom Line – Reglan vs Domperidone
Both drugs increase milk supply by increasing prolactin release from the pituitary gland. Also, increasing milk production after taking these drugs is actually a side effect for both of the drugs as neither one was developed to increase milk supply.
According to a 2012 study done at the University of Bristol, United Kingdom, both drugs increased the volume of milk produced by moms who are expressing to feed their babies in a tertiary level neonatal intensive care unit with significant differences.
However, since domperidone has fewer side effects (note – Reglan has many side effects such as irritability, fatigue, depression), it can be used for a much longer period of time and in much higher doses.
But, In January 2015, Health Canada came out with a statement which reiterated the need for caution when taking domperidone to increase breast milk supply. Therefore, it should be used only at the lowest dose for the shortest time.
The Take-Home Message
Your breastfeeding technique should be assessed before considering a drug option.