Even in mainstream circles we're starting to heat more about skin-to-skin contact with babies being good for them.  Is it really that big of a deal?  What are the benefits?  How exactly do you do skin-to-skin?

​The Science
The Cochrane Review, which looks at all studies combined, states that skin-to-skin contact after birth: "...appears to benefit breastfeeding outcomes, and cardio-respiratory stability and decrease infant crying, and has no apparent short- or long-term negative effects. Further investigation is recommended."  One of the reasons they say it needs to be studied more is that the definition of what constitutes skin to skin contact varies with hospital procedures.  Is five minutes enough?  If baby is dried off, the cord cut, APGAR scores assessed, and then baby is given to mother for unlimited skin to skin does that confer the same benefits?  In my own experience, our local hospitals say they practice skin to skin, but the procedure is to place baby on mother's chest pretty quickly, but then remove baby for procedures and swaddling within a few minutes.  Mother is later handed a baby burrito, and many women would not think to remove the blanket if not encouraged to.  I've also heard it said that cheek-to-cheek is the same as skin-to-skin, but this is clearly not the case.  In these studies skin-to-skin means baby in a diaper or naked on mom's bare chest and covered in a blanket.

This study found that babies stayed warmer, breastfeeding rates were improved, and the placenta delivered faster in those who held their babies skin to skin.  Another found significantly improved breastfeeding in the hospital, which is so nice when mothers don't have to worry about it after giving birth.  It is now well-known that homebirthing mothers have much higher breastfeeding rates in the weeks after birth, and the immediate and prolonged skin-to-skin contact is a very logical reason why this might be the case.  There have also been documented improvement in bonding even a year after birth for those babies held skin-to-skin right after birth. 

​Missed Opportunity?
​An amazing discovery is that skin to skin is not only beneficial right after birth.  It can actually help improve breastfeeding in an older baby having problems.  Almost all the babies held skin to skin when not latching on in the first 4 months ended up latching successfully and for longer.  Only a third of those not held skin to skin ended up latching.  So if there was some problem right after the birth that kept mother and baby apart, getting skin-to-skin ASAP will help "make up" for the lost time.  This is often the first thing suggested for a dyad having bonding or breastfeeding problems even at older ages. 

It's the Natural Thing
I want to say what an easy intervention this is, but in reality, aren't all the clothes and blankets that get between mother and baby the intervention?  In reading these studies, they all referred to skin-to-skin as the intervention because it's not the usual way things are done in the hospital.  Shouldn't these studies have been done before they started removing babies and swaddling them to determine if it were any better?  It's an important lesson to remember.  We need to make sure doing the "unnatural" thing is actually better in some way before we assume it is.  Chances are, when we interfere there will be unintended consequences.

​But it Takes Time!
​Not sure how you're going to handle many hours of skin-to-skin contact with your baby while running errands and having lots of visitors in the first weeks?  I can't either, which should suggest that you should be in your house without visitors at the beginning.  It's not what our culture seems to value, but it's very important for the long-term physical and emotional health of both mom and baby to get off to a good start.  Your friends, extended family, and responsibilities will all be there once you've recovered and bonded with your baby.  It's taken me many babies to realize this myself, so as I lay here snuggled with my baby only in a diaper asleep on my chest and covered with a blanket, take my word for it, you won't regret time spent skin-to-skin!

Galactagogues are herbs, foods, or medications that are supposed to increase a breastfeeding mother's milk supply.  Probably the most popular herb for this purpose these days is fenugreek.  Before putting anything into your body please understand the pro and cons.

Uses and Forms
Fenugreek is most often taken as capsules.  The dose usually recommended is 1-2 g three times a day. 

​It can be taken as a tincture, the dosage being 3-5 dropperfuls three times a day depending on how much of an increase you need.

​It can also be drunk as a tea made with the whole seeds.  To make the tea, cover 1-3 tsp. of seeds with boiling water and let it steep for 10 minutes.  This can be drunk 3 times a day.

There are many teas and food products with combinations of herbs including fenugreek.  These products are difficult to compare because there are no studies on them, and it's difficult to know how much you're getting each day.  I would caution women on products like fenugreek granola bars and lactation cookies, as they are quite expensive, and you're probably not going to be eating enough fenugreek to have any effect on your milk.  There certainly would be a lot of empty calories with that fenugreek if you did!  

​Studies on Fenugreek- How do we know it works?
​There are many, many foods and herbs that have been said to increase milk supply, but what do studies show?  There aren't many studies on most "natural" remedies, and those that are done are usually pretty small.  Fenugreek probably has more studies than any other herbs, and here's what they show:

​     A study of mothers of preterm babies showed no difference between those taking fenugreek capsules and those taking a placebo.

​     BUT another study using fenugreek tea showed it did help some mothers produce more milk in the first week postpartum.  This study seemed to imply there were other ingredients in this tea, but I have no information on the dosage other than they drank it daily.

​These studies leave me with many questions, such as how effective is fenugreek used later in lactation instead of right after birth?  How does fenugreek work?  Is it cost effective?  What are the long-term effects on the children of these breastfeeding mothers?  The fact is, we don't know these answers.
     ​
The medical community is pretty unanimous in saying that fenugreek doesn't have evidence as a galactagogue at all. 

​The Academy of Breastfeeding Medicine put out a thorough paper on increasing milk supply in which it states that fenugreek has, "Insufficient evidence, likely a significant placebo effect."  Since many breastfeeding moms are not accurately measuring milk production each day they may feel like they have more milk once starting to take fenugreek since they've been told so often it has worked for others.

The Memorial Sloan Kettering Cancer Center explains several uses for fenugreek, including preventing some cancers, but says that "evidence of its potential to stimulate lactation is limited."

​So when someone tells you, as I've seen on online many times, that fenugreek is "very effective" please understand that it's certainly not true for everyone or we'd have more evidence that it works.

Side Effects
​​It's very important to understand the side effects of every medication you're taking, even if it's a herb you're taking medicinally.  While it is considered "Moderately Safe", fenugreek actually has several possible side effects mothers need to be aware of, such as:

• ​Diarrhea, in mother and baby.  This seems to be worse when starting suddenly with large doses.
• Allergic reaction especially in those who are also allergic to peanuts, chickpeas, or soy.  Keep in mind you may not know your baby's allergies and that fenugreek exposure may lead to sensitization to other legumes. 
• Some women have reported worsening of asthma.
• Can thin your blood. 
• Can lower your blood sugar.  Diabetics and those with other blood sugar issues or PCOS need to be careful and monitor their levels.
• Can lower effectiveness of other medications.  Remember, birth control is a medication, too!
• Interference with thyroid hormone levels. 
• Has been shown to stimulate breast cancer growth.
• SHOULD NOT BE TAKEN DURING PREGNANCY.  Can cause premature labor and miscarriage.
• One of the most interesting side effects is that when taken in large doses it will make your breath, sweat, and urine smell like maple syrup.  That goes for babies, too.  Some people say to increase dose until this happens, while others notice an increase at lower dosages.

​Also keep in mind that herbs are not tested by the FDA, and there are many instances of herbal supplements being contaminated with other substances or the wrong herb.  Are you absolutely sure what you're taking is fenugreek?

​Interactions
There are several known interactions between fenugreek and some medications.  Mention taking fenugreek to your and your baby's doctors, especially if you're taking large doses or taking it long-term.  We know it can interact with:

• ​Aspirin
• Ibuprofen
• Naproxen
• Warfarin and other blood thinning supplements/medications
• Metformin and other blood sugar lowering supplements/medications

Other Ways to Increase Milk Supply
​If fenugreek doesn't perform as you hoped or doesn't sound right for you - don't give up!  Keep in mind that there are plenty of other ways to increase your milk supply.  Often we look for solutions outside ourselves, but a breastfeeding relationship begins with you and your baby.  Increasing feedings (especially night feedings), breast massage and compression, pumping schedules, skin-to-skin time, relaxation, and improving baby's latch are all things that should be tried before any galactagogues, since they are risk-free and have lots of evidence that they work to increase amount of milk produced.  Please feel free to contact me if you would like more information on these techniques or how to tell if your baby needs more milk.