Pumping up your supply? Or trying to dry it out? There are natural herbs and supplements that can do both. This postpartum doula wants to make sure you’re using the right ones.

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Illustration by Brittany England

Will it boost my milk supply? Will it hurt my milk supply? Is it safe to take while breastfeeding or pumping?

These are the postpartum questions that rule your every move when breastfeeding. And given that so many babies are born every year, year over year, you’d think we’d have all the answers by now. Turns out, far from it.

Prescribed and over-the-counter medications require medical oversight, and your doctor will be able to inform you risks and benefits of taking an Rx, based on labeling guidelines from the Food and Drug Administration (FDA).

But when it comes to teas, tinctures, supplements, and herbs, that’s another story. Your OB-GYN will, frankly, probably have no idea. And it’s not their fault.

“The problem with supplements is that because they are not regulated by the FDA, there is not a lot of incentive to study them or fund studies,” says Los Angeles–based OB-GYN physician assistant Kristy Goodman, of The OBGYN PA. As a result, “most of these things in practice are pretty anecdotal. Results are so variable, it’s hard to tell if it’s helpful or not.”

When a patient asks her about a particular herb or supplement, Goodman tends to defer to trial and error if there is no known or obvious harm. Her motto: If it works, great. If you experience negative symptoms, stop.

“From my experience in women’s health, there are a lot of providers who, if they don’t know the answer to something, their default — especially with pregnancy and postpartum — is a ‘no.’ I hate that approach because prohibiting people from trying things can also be harmful. Everyone is so risk averse in obstetrics. We don’t want to get sued or blamed. There is so much anxiety with the unknown when it comes to new moms.”

Therein lies the rub. For all of our collective medical wisdom, much of it doesn’t apply to the fourth trimester. We’re left with an amorphous blob of “see what happens,” which can be frustrating and scary because postpartum is when we are incredibly vulnerable, overwhelmed, and in need of guidance. In sum: Uggggggh.

Here’s the good news, though. There are a few things we know kinda, maybe, possibly for sure, and I’m going to walk you through each one right now.

Make way for moringa

“I’ll be honest, I’m leaning away from recommending fenugreek these days because I’ve discovered moringa,” says Gina Boling, IBCLC, clinical director for the Breastfeeding Center for Greater Washington.

“It’s been used in lactation around the world for many, many years, but in the last 5 years it’s started getting more attention in North America,” she notes. “Anecdotally, I’ve seen it do amazing things for some of my clients. It’s my favorite supplement.”

The Moringa Oleifera plant has been studied in animals, and it’s touted for its robust nutrient content and its antioxidant and anti-inflammatory effects, according to a 2017 review. Though more studies on humans are needed, one small study on breastfeeding mothers found no adverse side effects.

You can find moringa in tea, in capsule form, or in powder form, which Boling says can easily be added to a morning smoothie. It’s also referred to by its Filipino name, malunggay.

Let’s hear it for lecithin

Whether soy- or sunflower-based, lecithin supplements can be used to help milk flow, and it is “considered safe through pregnancy and postpartum,” Goodman says.

Just like its role in food products, lecithin acts as an emulsifier, preventing milk from coagulating in the duct. Boling typically recommends it for clients who have chronic plugged ducts or mastitis.

Sayonara, sage

Of all the debatable ingredients, there’s one everyone agrees on: sage. “This is the only herb I know that reduces milk,” says Ilana Stanger-Ross, a registered midwife in British Columbia and the author of A is for Advice. “Sometimes if we have someone who doesn’t want to breastfeed, or is giving a child up for adoption, we recommend sage tea along with other things.”

Mother of three Katie M. can attest to its potency: “I made the mistake of using sage tea when I had an oversupply — one small cup — and almost lost my supply. I learned that my body reacts faster, and to a greater extent, than others. While some moms need entire bottles of sage tea daily to make their supply go away, I needed only one cup! Knowing your body is critical and trying things for yourself is important as well. What works for one does not work for all.”

Skip CBD and essential oils to be on the safe side

These are two completely separate things, but CBD and essential oils are both super trendy — and controversial.

There is promising research about the positive effects of CBD oil, yet it’s unclear what impact ingestion would have on pregnancy or during lactation. Cannabidiol, the active substance in CBD, has not been specifically studied, yet according to the NIH, it has been detected in breast milk.

Essential oils are equally complicated. They’ve been used for ages, are derived from botanicals, and many people swear by them.

On the flip side, they are extremely concentrated versions of those natural ingredients, have known adverse effects, and are of particular concern for topical and diffused applications in pregnancy and postpartum (until children reach age 6 for some oils).

“When anything becomes trendy, I become wary,” Stanger-Ross says. “There is no cure-all. It makes sense to be cautious, especially when we’re dealing with a newborn baby.”

Pass on peppermint

When I was newly pregnant, my OB-GYN mentioned I should avoid peppermint tea, in addition to all of my other beloveds: blue cheese, sushi, unpasteurized green juice.

Overwhelmed and overjoyed, I never asked why; I simply took her word as fact. But now I know! Menthol is to blame. Why? Who knows. Literally. The studies are all inconclusive. (Though one report from 2014 does note that peppermint has the potential to dry up milk supply.)

Anecdotally speaking, Boling says if you’re struggling with supply, or trying to establish your supply, it’s best to avoid peppermint. That said, a cup or two shouldn’t spook you. Tea is generally a much gentler way to road-test something versus capsules, which can contain up to 10 times the dose of tea.

Fenugreek is a mixed bag

Fenugreek gave me terrible stomach pains!” says Emily F., mother of one. No wonder. It’s probably the most widely known and widely used galactagogue (substance used to increase milk supply), yet “it has more side effects than any other option,” says Boling.

“If you have a sensitive stomach, it can cause diarrhea, gas, or GI issues,” she notes. “It may lower thyroid hormones, and the same with blood sugar. If you have any blood sugar issues or diabetes, you want to avoid it.”

The data (there actually is some!) backs that up. According to one small study of 85 breastfeeding women who used fenugreek, 45 percent reported an adverse reaction. (That’s huge.)

It is also worth noting that fenugreek is part of the legume family. While it’s unknown if it causes any cross-reactions, those allergic to peanuts, chickpeas, and legumes should proceed with extra caution.

Goat’s rue to the rescue?

Goat’s rue is a plant native to the Middle East, and it is purported to not only help with lactation but digestion, the adrenal glands, and the liver. You’ll find it as its own supplement or mixed into milk-boosting blends with other galactagogues.

Unfortunately, most of the studies done on goat’s rue have been small, not randomized, or poorly controlled — generally of very bad quality. So, while research doesn’t clearly support using goat’s rue, it may be worth a try.

The National Institutes of Health reports, “In general, goat’s rue is well tolerated, but it might cause hypoglycemia, so caution should be used in women taking antidiabetic drugs.”

Whatever you are going through, know this: “Herbs are secondary to milk removal,” Boling says.

“You have to have effective removal of milk to make supply. If a mom is struggling with supply, they should see an IBCLC [International Board Certified Lactation Consultant] for help,” she suggests. Perhaps you need a supplement of some kind, but it could also be a mechanics issue (think: positioning and latch).

You may balk at this advice, wondering, but what about my doctor?

Physician assistant Goodman actually agrees with reaching out to a lactation specialist: “A lot of providers, myself included, are not trained a lot on [postpartum topics]. So unless you pursue [postpartum] in particular…well, I would never say I have the level of knowledge a lactation consultant does. Recognize that [your OB-GYN] doesn’t have the same training as someone who trains and sees hundreds and hundreds of lactating women does.”

\Mandy Major is a mama, journalist, certified postpartum doula PCD(DONA), and the founder of Motherbaby Network, an online community for postpartum support. Follow her at @motherbabynetwork.com.