title: Health provider experiences with galactagogues to support breastfeeding: a cross-sectional survey.
abstract: BACKGROUND
  Exclusive breastfeeding for infants up to 6 months is widely recommended, yet breastfeeding rates are relatively low in the US. The most common reason women stop breastfeeding early is a perceived insufficiency of milk. Galactagogues are herbal and pharmaceutical products that can help increase milk supply; however, data on their efficacy and safety is limited. Lactation consultants, obstetricians, and other health providers are an important point of contact for breastfeeding women experiencing challenges with lactation. This study explored providers' perceptions, experiences, and practices in relation to galactagogue recommendation.
  
  
  METHODS
  A cross-sectional survey was conducted among a convenience sample of English-speaking health providers in the US who counsel breastfeeding women and their infants.
  
  
  RESULTS
  More than 70% of respondents reported to recommend galactagogues. The most frequently recommended galactagogue was fenugreek with respondents indicating that they recommend it either 'always' (8.5%) or 'most of the time' (14.9%) and 'sometimes' (46.8%). More than 80% of the respondents indicated that galactagogues were useful for their clients and only one-third reported side effects. Reasons for refraining from recommending galactagogues were insufficient evidence of its efficacy and safety. Respondents reported a wide variety of sources of information used for their own education about galactagogues.
  
  
  CONCLUSIONS
  Despite little evidence regarding safety and efficacy, some galactagogues are widely recommended and often perceived to be useful. However, concerns about their efficacy and safety remain. In order to assure both providers and users about safety and efficacy, more robust studies as well as better pharmacovigilance systems are needed.
authors.affiliation: Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine.
authors.forename: Alessandra N
authors.initials: AN
authors.lastname: Bazzano
authors.affiliation: Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine.
authors.forename: Lisa
authors.initials: L
authors.lastname: Littrell
authors.affiliation: Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine.
authors.forename: Amelia
authors.initials: A
authors.lastname: Brandt
authors.affiliation: Ochsner Health System, New Orleans, LA, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Thibeau
authors.affiliation: MLT EpiConsult, Jingili, NT, Australia.
authors.forename: Kamala
authors.initials: K
authors.lastname: Thriemer
authors.affiliation: Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Theall
keywords: clinical decision making; human milk; lactation; lactogenesis; nutrition