Use of herbal and food galactagogues to support breastfeeding in Aotearoa New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science, College of Sciences, Massey University, Palmerston North, New Zealand

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Background: Galactagogues are substances used to increase breast milk production and support breastfeeding. Women in many countries use herbal and food galactagogues to address perceived insufficient milk production (PIM), but little is known about how they are used in Aotearoa, New Zealand (Aotearoa NZ). This thesis aimed to explore galactagogue use in Aotearoa NZ, to explore the relationship between mothers’ perception of milk supply and galactagogue use, and to investigate the influence of a Saccharomyces cerevisiae yeast-based supplement (SCYS) on breast milk and breastfeeding. Method: A mixed-methods approach was used, consisting of a qualitative study followed by a cross-sectional survey and a randomised placebo-controlled trial (RCT) on the effects of SCYS on breast milk and breastfeeding. The qualitative study conducted in-depth interviews with mothers (n = 22) and postnatal healthcare professionals (n = 16) to explore experiences of and attitudes to herbal and food galactagogue use. The qualitative study informed the development of the questionnaire used in the cross-sectional survey (at baseline for the RCT) and the weekly and follow-up surveys. Seventy-two women responded to the baseline survey, and 68 completed the RCT. Galactagogue use and PIM before the RCT were investigated at the baseline. Breast milk samples were collected to compare human milk oligosaccharide (HMO) concentration change from baseline to the endpoint. Participants’ perceptions of milk supply, feeding status and infant anthropometry were measured before and after the intervention. Results: Women in Aotearoa NZ used herbal and food galactagogues to increase breast milk production, maintain milk supply and/or quality, and support breastfeeding generally. Galactagogue use was not associated with PIM among the cross-sectional survey respondents, who mostly had solid and positive perceptions of their milk supply. Although significantly more women in the SCYS group perceived the intervention as increasing their milk supply compared with the placebo group, SCYS had limited effect on mothers’ perceptions of milk quantity and quality or infant behaviours and no effect on HMO concentration change. There were significantly smaller numbers of women in the SCYS used formula at six months postpartum compared with the placebo group. Conclusion: A wide range of herbal and food galactagogues were used in Aotearoa NZ to support breastfeeding. The prevalence of galactagogue use among women who experienced PIM or if galactagogue use prevents PIM needs to be evaluated further in a large representative sample. The SCYS may positively influence breast milk supply other than the placebo effect and, therefore, supports breastfeeding. An RCT in a bigger sample investigating the effect of SCYS on breast milk production and another RCT at the initiation stage of lactation are required in the future.
maternal health, infant nutrition, public health nutrition