Domperidone (Motilium) is a drug that has, as a side effect, stimulating or increasing milk production, probably by increasing prolactin production by the pituitary gland. Prolactin is the hormone that stimulates the cells in the mother's breast to produce milk. Domperidone increases prolactin secretion indirectly, by interfering with the action of dopamine whose action is to decrease the secretion of prolactin by the pituitary gland.

Domperidone is generally used for disorders of the gastrointestinal tract (gut) and has not been released in Canada for use as a stimulant for milk production. This does not mean that it cannot be prescribed for this reason, but rather that the manufacturer does not back its use for increasing milk production.

However, there are several studies that show that it works to increase milk production and that it is safe. It has been used, for several years, in small infants who spit up and lose weight, but was replaced until a few years ago by cisapride (Prepulsid) (cisapride has since been taken off the market because it can cause serious cardiac problems). Domperidone is not in the same family of medication as cisapride and has never had the cardiac side effects that cisapride does.

Another, related, but older medication, metoclopramide (Maxeran), is also known to increase milk production, but it has frequent side effects which have made its use for many nursing mothers unacceptable (fatigue, irritability, depression). Domperidone has many fewer side effects because it does not enter the brain tissue in significant amounts (does not pass the blood-brain barrier).

(Since this is a very important drug that can assist in breastfeeding supply, read more here)

Medicinally, fennel is widely used as a digestive aid. It also has mild estrogenic properties. Fennel is sometimes used to counteract infant colic, whether consumed by the mother or given directly to the infant. The Wise Woman Herbal suggests that breastfeeding women use the seeds of fennel or any of its close relatives (anise, cumin, caraway, coriander and dill) to improve their milk supply. Although clinical evidence for its efficacy is lacking, fennel seed has enjoyed centuries of use as a galactagogue. Its mechanism of action is unknown.

Fenugreek has been used for centuries to increase the flow of milk, and was used historically as such, along with fennel, by wet nurses in the southern United States in days gone by. There are also reports of fenugreek's use as a galactagogue in Sudan, Egypt, other parts of North Africa, Iraq, and Argentina.

Fenugreek is contraindicated during pregnancy in Western herbalism, as it is a uterine stimulant. This action may be the result of a steroidal saponin called neotigogenin, which is contained in the seeds. Indeed, the effect of fenugreek upon the uterus may be related to its stimulant effect upon the milk ducts in the breast, for both are effected by the hormone oxytocin and its pharmacological relatives.

In North America, fenugreek seeds are commonly brewed as a tea, and the broth and seeds are both consumed. Alternately, they can be ground and taken in capsule form. According to popular lore, an adequate dose has been consumed when one's body smells mapley. The German Commission E monograph recommends a daily dose of 6 grams of the seeds; doses of over 100 grams can cause nausea and an upset stomach.

Lactation is the period following birth during which milk is secreted; "lactation normally continues until weaning"

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