We support all mothers and all feeding journeys in our line of work. For some families, breastfeeding is not the right path, and knowing how to cease breastfeeding safely is something that is often not discussed. Once someone’s milk is “in”, if we don’t take the milk off, we risk engorgement, pain, blocked ducts and even mastitis. So how does one dry up their milk supply safely?
Firstly, understanding milk production is important. The breast will continue to make milk if milk is taken off regularly and thoroughly BUT the breast will make LESS milk if the breast is “run full”. We use this second rule to help dial down our milk production. Taking milk off is still needed, as this is what will prevent blocked ducts and mastitis. Essentially, we let the breasts get full by extending the time between a breastfeed or a pump, but when we do empty them, we empty them until they are soft and not lumpy. If you had been feeding your baby about every 3 hours, then you may want to try extending it until 4 hours the first day, 5 hours the next etc. Every breast is different, so we usually don’t give exact time intervals, but essentially you would wait until your breasts feel very full but not red, hot and engorged. Then you would take enough milk off to soften them. When the supply has started to fall, you can experiment with reducing how long you spend pumping as well as reducing how much milk you take off each time. Once you get down to just a few feeds or pumps a day, you are nearly there! This process will take longer than the other option which is expressing just enough for comfort only. But when we leave a lot of milk behind, we are at more risk of getting an infection. You can also wear a firm fitting crop top to add some compression to the breasts.
There are two medication options that can also be added in. One is Cabergoline, or Dostinex. This is only really useful at the very start of a breastfeeding journey. It blocks prolactin and by using this medication we are trying to stop milk coming in. It is a once-off dose only. If taken before day 3 postnatal, it can help reduce how much milk is made in the early days. It is not universally effective though, and has no role in suppressing milk production after the milk has “come in”. For women that have not yet established a breastfeeding journey, breast compression and minimal milk-removal method may work quite well and quickly, to down-regulate supply.
Once breastfeeding has been established, we can try a different medication, pseudoephedrine (the drug that used to be in cold and flu medications). This dries up secretions, including breastmilk. Again, it is not universally effective, but may help reduce supply in some women and hasten how quickly they can wean. The dose is 60mg, 1-4 times a day, for 2-7 days, and can be prescribed by your doctor. The milk that is produced while taking pseudoephedrine is safe to give to your baby.
Herbal preparations have also been shown to help reduce milk supply. These include peppermint, sage, thyme, parsley and oregano. Large doses of these are required to be consumed before an effect on milk supply is seen.
-Dr Briony Andrew